CYBERMED LIFE - ORGANIC  & NATURAL LIVING

Cybermedlife - Therapeutic Actions Natural Birth

Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. 📎

Abstract Title: Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. Abstract Source: BMJ. 2007 Nov 17;335(7628):1025. Epub 2007 Oct 30. PMID: 17977819 Abstract Author(s): José Villar, Guillermo Carroli, Nelly Zavaleta, Allan Donner, Daniel Wojdyla, Anibal Faundes, Alejandro Velazco, Vicente Bataglia, Ana Langer, Alberto Narváez, Eliette Valladares, Archana Shah, Liana Campodónico, Mariana Romero, Sofia Reynoso, Karla Simônia de Pádua, Daniel Giordano, Marius Kublickas, Arnaldo Acosta, Article Affiliation: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford OX3 9DU. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery. DESIGN: Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health. SETTING: 410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided data PARTICIPANTS: 106,546 deliveries reported during the three month study period, with data available for 97,095 (91% coverage). MAIN OUTCOME MEASURES: Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics. RESULTS: Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective. CONCLUSIONS: Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations. Article Published Date : Nov 17, 2007

Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy.

Abstract Title: Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. Abstract Source: J Allergy Clin Immunol. 2011 Nov ;128(5):948-55.e1-3. Epub 2011 Aug 27. PMID: 21872915 Abstract Author(s): Frederika A van Nimwegen, John Penders, Ellen E Stobberingh, Dirkje S Postma, Gerard H Koppelman, Marjan Kerkhof, Naomi E Reijmerink, Edward Dompeling, Piet A van den Brandt, Isabel Ferreira, Monique Mommers, Carel Thijs Article Affiliation: Frederika A van Nimwegen Abstract: BACKGROUND: Both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. However, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet. OBJECTIVES: We sought to investigate the relationship between microbiota composition, mode and place of delivery, and atopic manifestations. METHODS: The Child, Parent and Health: Lifestyle and Genetic Constitution Birth Cohort Study included data on birth characteristics, lifestyle factors, and atopic manifestations collected through repeated questionnaires from birth until age 7 years. Fecal samples were collected at age 1 month (n = 1176) to determine microbiota composition, and blood samples were collected at ages 1 (n = 921), 2 (n = 822), and 6 to 7 (n = 384) years to determine specific IgE levels. RESULTS: Colonization by Clostridium difficile at age 1 month was associated with wheeze and eczema throughout the first 6 to 7 years of life and with asthma at age 6 to 7 years. Vaginal home delivery compared with vaginal hospital delivery was associated with a decreased risk of eczema, sensitization to food allergens, and asthma. After stratification for parental history of atopy, the decreased risk of sensitization to food allergens (adjusted odds ratio, 0.52; 95% CI, 0.35-0.77) and asthma (adjusted odds ratio, 0.47; 95% CI, 0.29-0.77) among vaginally home-born infants was only found for children with atopic parents. Mediation analysis showed that the effects of mode and place of delivery on atopic outcomes were mediated by C difficile colonization. CONCLUSION: Mode and place of delivery affect the gastrointestinal microbiota composition, which subsequently influences the risk of atopic manifestations. Article Published Date : Oct 31, 2011

Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study.

Abstract Title: Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Abstract Source: Midwifery. 2011 Jan 12. Epub 2011 Jan 12. PMID: 21236528 Abstract Author(s): Ngai Fen Cheung, Rosemary Mander, Xiaoli Wang, Wei Fu, Hong Zhou, Liping Zhang Article Affiliation: Nursing College, Hangzhou Normal University, 16 Xuelin Road, Xiasha, Hangzhou 310036, China. Abstract: AIMS: to report the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in China in 2008, aiming to facilitate normal birth and enhance midwifery practice. SETTING: an urban hospital with 2000-3000 deliveries per year. METHOD: this study was part of a major action research project that led to implementation of the MNBU. A retrospective cohort and a questionnaire survey were used. The data were analysed thematically. PARTICIPANTS: the outcomes of the first 226 women accessing the MNBU were compared with a matched retrospective cohort of 226 women accessing standard care. In total, 128 participants completed a satisfaction questionnaire before discharge. MAIN OUTCOME MEASURE: mode of birth and model of care. FINDINGS: the vaginal birth rate was 87.6% in the MNBU compared with 58.8% in the standard care unit. All women who accessed the MNBU were supported by both a midwife and a birth companion, referred to as 'two-to-one' care. None of the women labouring in the standard care unit were identified as having a birth companion. DISCUSSION: the concept of 'two-to-one' care emerged as fundamental to women's experiences and utilisation of midwives' skills to promote normal birth and decrease the likelihood of a caesarean section. CONCLUSION: the MNBU provides an environment where midwives can practice to the full extent of their role. The high vaginal birth rate in the MNBU indicates the potential of this model of care to reduce obstetric intervention and increase women's satisfaction with care within a context of extraordinary high caesarean section rates. IMPLICATIONS FOR PRACTICE: midwife-led care implies a separation of obstetric care from maternity care, which has been advocated in many European countries. Article Published Date : Jan 12, 2011

Is induced labour in the nullipara associated with more maternal and perinatal morbidity?

Abstract Title: Is induced labour in the nullipara associated with more maternal and perinatal morbidity? Abstract Source: Arch Gynecol Obstet. 2010 Sep 14. Epub 2010 Sep 14. PMID: 20838800 Abstract Author(s): Dan Selo-Ojeme, Cathy Rogers, Ashok Mohanty, Naseem Zaidi, Rose Villar, Panicos Shangaris Article Affiliation: Department of Obstetrics and Gynaecology, Women and Children's Directorate, Barnet and Chase Farm Hospitals NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, UK, This email address is being protected from spambots. You need JavaScript enabled to view it.. Abstract: PURPOSE: To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term. METHODS: A retrospective matched cohort study consisting of 403 nulliparous women induced at≥292 days and 806 nulliparous women with spontaneous labour at 285-291 days. RESULTS: Compared to those in spontaneous labour, women who had induction of labour were three times more likely to have a caesarean delivery (OR 3.1, 95% CI 2.4-4.1; P < 0.001). Women who had induction of labour were 2.2 times more likely to have oxytocin augmentation (OR 2.2, 95% CI 1.7-2.8; P < 0.001), 3.6 times more likely to have epidural anaesthesia (OR 3.6, 95% CI 2.8-4.6; P < 0.001), 1.7 times more likely to have uterine hyperstimulation (OR 1.7, 95% CI 1.1-2.6), 2 times more likely to have a suspicious foetal heart rate trace (OR 2.0, 95% CI 1.5-2.6), 4.1 times more likely to have blood loss over 500 ml (OR 4.1, 95% CI 2.9-5.5; P < 0.001), and 2.9 times more likely to stay in hospital beyond 5 days (OR 2.9, 95% CI 1.5-5.6; P < 0.001). Babies born to mothers who had induction of labour were significantly more likely to have an Apgar score of<5 at 5 min and an arterial cord pH of<7.0. CONCLUSION: Compared to those with spontaneous labour, nulliparous women with induced labours are more likely to have uterine hyperstimulation, caesarean delivery, and babies with low Apgar scores. Nulliparous women should be made aware of this, as well as potential risks of expectant management during counseling. Article Published Date : Sep 14, 2010

Vaginal parturition decreases recurrence of endometriosis.

Abstract Title: Vaginal parturition decreases recurrence of endometriosis. Abstract Source: Fertil Steril. 2010 Aug;94(3):850-5. Epub 2009 Jun 13. PMID: 19524893 Abstract Author(s): Carlo Bulletti, Anna Montini, Paolo Levi Setti, Antonio Palagiano, Filippo Ubaldi, Andrea Borini Article Affiliation: Unit of Physiopathology of Reproduction, Cattolica General Hospital and University of Bologna, Bologna, Italy. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To evaluate the role of parturition in the recurrence of endometriosis. DESIGN: Retrospectively analyzed, prospectively obtained data. SETTING: Unit of Physiopathology of Reproduction, Health Care Unit of Rimini, and University of Bologna Cervesi General Hospital, Cattolica, Italy. PATIENT(S): Three hundred forty-five patients with stage II-IV endometriosis, dysmenorrhea, and infertility were treated for endometriosis and divided into four groups according to parity and mode of parturition. INTERVENTION(S): The patients were laparoscopically treated for endometriosis upon the occurrence and recurrence of the disease. Ultrasound measurements of the uterine internal ostium (IOS) were performed at each study interval. MAIN OUTCOME MEASURE(S): Degree of dysmenorrhea, occurrence and recurrence of endometriosis, and uterine IOS measurements were established and related to parity and mode of parturition. RESULT(S): After parturition, dysmenorrhea recurrence was significantly higher in nulliparous women than in women with vaginal parturition. The endometriosis recurrence rate was higher in women who did not have vaginal parturition. The IOS significantly enlarged after vaginal delivery but not after cesarean delivery. There were significant negative correlations between IOS and the recurrence of endometriosis and dysmenorrhea. Odds ratios indicated that as the IOS enlarged, the risk of recurrence decreased. CONCLUSION(S): Vaginal parturition plays a protective role in the recurrence of endometriosis. Article Published Date : Aug 01, 2010

Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population.

Abstract Title: Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population. Abstract Source: Arch Gynecol Obstet. 2010 May 27. Epub 2010 May 27. PMID: 20505947 Abstract Author(s): Klaus Bodner, Franz Wierrani, Werner Grünberger, Barbara Bodner-Adler Article Affiliation: Department of Gynecology and Obstetrics, Hospital Rudolfstiftung, Vienna, Austria, This email address is being protected from spambots. You need JavaScript enabled to view it.. Abstract: OBJECTIVE: The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery. METHODS: A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (>500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections. RESULTS: A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss>500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p>0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p>0.05). CONCLUSION: The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications. Article Published Date : May 27, 2010

Maternal mortality and cesarean delivery: an analytical observational study.

Abstract Title: Maternal mortality and cesarean delivery: an analytical observational study. Abstract Source: J Obstet Gynaecol Res. 2010 Apr;36(2):248-53. PMID: 20492373 Abstract Author(s): Gourisankar Kamilya, Subrata Lall Seal, Joydev Mukherji, Subir Kumar Bhattacharyya, Avijit Hazra Article Affiliation: Department of Obstetrics and Gynaecology, R. G. Kar Medical College, Kolkata, India. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: AIM: Pregnant women and their doctors need to know the maternal risks associated with different methods of delivery. There are few publications with ideal study design and adequate power to establish the relationship between maternal mortality and mode of delivery. The present retrospective cohort study was undertaken to evaluate the intrinsic risk of maternal death, directly attributed to cesarean delivery (CD) compared to vaginal delivery (VD), and to evaluate further the differential risk associated with antepartum and intrapartum CD. METHODS: After exclusion of medical or obstetric comorbidities, all deliveries, either vaginal or cesarean, were critically analyzed. The surviving mothers who had either method of delivery represented the two comparative groups. In the same period, relevant clinical information of every maternal death was noted. RESULTS: Twenty seven mothers died among the 13 627 CD mothers and 19 died among 30 215 VD mothers. CD was associated with a 3.01-fold increase in the risk of maternal mortality, compared with VD. The risk of antepartum CD differed from intrapartum CD (OR 1.73 vs OR 4.86). There was a significantly increased risk of maternal death from complications of anesthesia, puerperal infection and venous thromboembolism. The risk of death from postpartum hemorrhage did not differ significantly (95% CI 0.7-3.95). CONCLUSION: CD is increasingly perceived as a low-risk procedure. However, the present study clearly demonstrates that the risk of maternal death due to CD is significantly high, particularly when performed in labor. Therefore, CD should only be practiced when conditions clearly demand it. Article Published Date : Apr 01, 2010

Term labor induction compared with expectant management.

Abstract Title: Term labor induction compared with expectant management. Abstract Source: Obstet Gynecol. 2010 Jan;115(1):70-6. PMID: 20027037 Abstract Author(s): J Christopher Glantz Article Affiliation: University of Rochester School of Medicine, Rochester, New York 14642, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To determine whether changing the definition of the group to which induction is being compared (ie, noninduced delivering during the same week as those induced compared with two definitions of expectant management) changes the association of labor induction and increased cesarean risk. METHODS: A New York State birth-certificate database was used to estimate odds ratios for cesarean delivery associated with labor induction at term. The analyses used three definitions of controls: cesarean delivery after induction compared with after spontaneous labor by week (week-to-week), induction at a given gestation age compared with expectant management of all other women after gestational age (all above), or induction at a given gestational age compared with expectant management of all other women at or after that gestational age (at or above). Chi-square logistic regression was used for comparisons and adjustment for possible confounders. RESULTS: All variations of comparison groups were associated with increased unadjusted cesarean risk after induction, although not after 39 weeks in the all-above group. After adjustment, increased risk persisted from 37 to 41 weeks using the week-to-week group and from 38 to 41 weeks in the at-or-above group (odds ratios 1.24 to 1.45) but was no longer significant in the all-above group. The excess cesarean delivery risk associated with labor induction is between 1 and 2 per 25 inductions. CONCLUSION: Labor induction is associated with increased cesarean risk whether using a week-to-week comparison group or an expectant group that includes women the same week or beyond that of the index induction, even after adjustment for parity, high-risk factors, and demographic variables. Although the magnitude of increased risk for a given woman undergoing induction is not large, women nonetheless should be informed of this increased risk. LEVEL OF EVIDENCE: II. Article Published Date : Jan 01, 2010

Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period.

Abstract Title: Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. Abstract Source: Am J Obstet Gynecol. 2010 Jan;202(1):35.e1-7. Epub 2009 Nov 4. PMID: 19889389 Abstract Author(s): Michael A Belfort, Steven L Clark, George R Saade, Kacie Kleja, Gary A Dildy, Teelkien R Van Veen, Efe Akhigbe, Donna R Frye, Janet A Meyers, Shalece Kofford Article Affiliation: Hospital Corporation of America, Nashville, TN, USA. Abstract: OBJECTIVE: The purpose of this study was to analyze reasons for postpartum readmission. STUDY DESIGN: We conducted a database analysis of readmissions within 6 weeks after delivery during 2007, with extended (180 day) analysis for pneumonia, appendicitis, and cholecystitis. Linear regression analysis, survival curve fitting, and Gehan-Breslow statistic with Holm-Sidak all-pairwise analysis for multiple comparisons were used. Probability values of<.05 were considered significant. RESULTS: Of 222,751 women delivered, 2655 women (1.2%) were readmitted within 6 weeks (0.83% vaginal delivery and 1.8% cesarean section delivery; P<.001). A high percentage of these readmittances occurred within the first 6 weeks: pneumonia (84%), appendicitis (43%), or cholecystitis (46%). Cumulative readmission rates were higher in the first 6 weeks after delivery than in the next 20 weeks (pneumonia curve gradient, 3.7 vs 0.11; appendicitis curve gradient, 1.1 vs 0.36; cholecystitis curve gradient, 6.6 vs 1.7). CONCLUSION: The cause of postpartum readmission is primarily infectious in origin. A recent pregnancy appears to increase the risk of pneumonia, appendicitis, and cholecystitis. Article Published Date : Jan 01, 2010

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. 📎

Abstract Title: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Abstract Source: CMAJ. 2009 Sep 15;181(6-7):377-83. Epub 2009 Aug 31. PMID: 19720688 Abstract Author(s): Patricia A Janssen, Lee Saxell, Lesley A Page, Michael C Klein, Robert M Liston, Shoo K Lee Article Affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. METHODS: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. RESULTS: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21-0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09-1.85). INTERPRETATION: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician. Article Published Date : Sep 15, 2009

Effects of onset of labor and mode of delivery on severe postpartum hemorrhage.

Abstract Title: Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Abstract Source: Am J Obstet Gynecol. 2009 Sep;201(3):273.e1-9. PMID: 19733277 Abstract Author(s): Iqbal Al-Zirqi, Siri Vangen, Lisa Forsén, Babill Stray-Pedersen Article Affiliation: Division of Obstetrics and Gynecology, Faculty of Medicine, University of Oslo, Rikshospitalet, Oslo, Norway. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: Our purpose was to study the impact of labor onset and delivery mode on the risk of severe postpartum hemorrhage. STUDY DESIGN: This was a population-based study of 307,415 mothers who were registered in the Medical Birth Registry of Norway from 1999-2004. RESULTS: Severe postpartum hemorrhage occurred in 1.1% of all mothers and in 2.1% of those mothers with previous cesarean section delivery (CS). Compared with spontaneous labor, hemorrhage risk was higher for induction (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.56-1.88) and prelabor CS (OR, 2.05; 95% CI, 1.84-2.29). The risk was 55% higher for emergency CS and half that for vaginal deliveries (OR, 0.48; 95% CI, 0.43-0.53), compared with prelabor CS. The highest risk was for emergency CS after induction in mothers with previous CS (OR, 6.57; 95% CI, 4.25-10.13), compared with spontaneous vaginal delivery in mothers with no previous CS. CONCLUSION: Induction and prelabor CS should be practiced with caution because of the increased risk of severe postpartum hemorrhage. Article Published Date : Sep 01, 2009

Maternal morbidity associated with vaginal versus cesarean delivery.

Abstract Title: Maternal morbidity associated with vaginal versus cesarean delivery. Abstract Source: Life Sci. 2007 Jul 19;81(6):509-18. Epub 2007 Jun 28. PMID: 15121564 Abstract Author(s): Lara J Burrows, Leslie A Meyn, Anne M Weber Article Affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania 15213, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies. METHODS: The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery without trial of labor, and repeat cesarean delivery with trial of labor. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) for morbidity by delivery mode adjusted for demographic characteristics and comorbidities. Spontaneous vaginal delivery was used as the referent group (odds ratio = 1). RESULTS: Of 32,834 subjects, 27,178 had vaginal delivery (operative = 4,908; spontaneous = 22,270) and 5,656 had cesarean delivery. Third- or fourth-degree lacerations occurred in 1,733 (7.8%) women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95% CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95% CI 5.9, 17.9) than after spontaneous vaginal delivery. The risk of transfusion was highest in women delivered by primary cesarean after labor, 4.2 times higher (95% CI 1.8, 10.1) than spontaneous vaginal delivery. The risk of pneumonia was 9.3 times higher (95% CI 3.4, 25.6) after repeat cesarean delivery with labor. Deep venous thromboses occurred in 15 (0.1%) after spontaneous vaginal delivery, 2 (0.04%) after operative vaginal delivery, and 12 (0.2%) after cesarean delivery. CONCLUSION: Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased risks of endometritis, the need for transfusion, and pneumonia; however, these rates are lower than reported previously. Article Published Date : Jul 19, 2007

Maternal morbidity and mortality associated with elective Caesarean delivery at a university hospital in Nigeria.

Abstract Title: Maternal morbidity and mortality associated with elective Caesarean delivery at a university hospital in Nigeria. Abstract Source: Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):110-4. PMID: 17355299 Abstract Author(s): Olufemi T Oladapo, Mustafa A Lamina, Adewale O Sule-Odu Article Affiliation: Department of Obstetrics and Gynaecology, Obafemi Awolowo College of Health Sciences/Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Data about maternal outcomes of elective Caesarean section in low-income countries are limited. AIMS: To estimate the maternal morbidity and mortality associated with elective Caesarean delivery at a Nigerian University hospital. METHODS: Retrospective analysis of all elective Caesarean deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (1990-2005). For each case of elective Caesarean delivery, four parturients who achieved non-operative vaginal delivery following spontaneous onset of labour were selected to serve as a referent group. Morbidity outcomes and mortality among women who had elective Caesarean delivery were compared with those of the referent group to estimate their comparative risks. Level of significance was put at P<0.05. RESULTS: A total of 164 elective Caesarean sections were performed out of 6882 deliveries (2.4%). All morbidities were more frequent among women who had elective Caesarean section compared to those who had vaginal delivery but only peripartum blood transfusion (11.6 vs 5.6%), puerperal febrile morbidity (11.0 vs 4.7%), unplanned readmission (4.3 vs 1.4%), mean fall in haemoglobin concentration (1.5 +/- 0.6 vs 0.5 +/- 0.7 g/dL) and mean hospital stay (13.3 +/- 8.8 vs 6.2 +/- 5.4 days) showed statistically significant differences. There was one maternal death among the elective Caesarean section group, giving a maternal mortality ratio of 6.1:1000 deliveries, which was not significantly different from 3.0:1000 deliveries in the referent group. CONCLUSION: Elective Caesarean delivery in this hospital is certainly accompanied by considerable maternal risks and should be offered to pregnant women with extreme caution. Efforts should be made to improve its safety by investigating and rectifying the factors responsible for the associated severe maternal complications. Article Published Date : Apr 01, 2007

Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. 📎

Abstract Title: Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Abstract Source: CMAJ. 2007 Feb 13;176(4):455-60. PMID: 17296957 Abstract Author(s): Shiliang Liu, Robert M Liston, K S Joseph, Maureen Heaman, Reg Sauve, Michael S Kramer, Article Affiliation: Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ont. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women. METHODS: Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally. RESULTS: The planned cesarean group comprised 46,766 women v. 2,292,420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1-6.3), wound hematoma (OR 5.1, 95% CI 4.6-5.5), hysterectomy (OR 3.2, 95% CI 2.2-4.8), major puerperal infection (OR 3.0, 95% CI 2.7-3.4), anesthetic complications (OR 2.3, 95% CI 2.0-2.6), venous thromboembolism (OR 2.2, 95% CI 1.5-3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2-3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46-1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2-0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2-2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87). INTERPRETATION: Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians. Article Published Date : Feb 13, 2007

Infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts.

Abstract Title: Infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts. Abstract Source: Birth. 2006 Sep;33(3):175-82. PMID: 16948717 Abstract Author(s): Marian F MacDorman, Eugene Declercq, Fay Menacker, Michael H Malloy Article Affiliation: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. Abstract: BACKGROUND: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37-41 weeks' gestation) women with no indicated medical risks or complications. METHODS: National linked birth and infant death data for the 1998-2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. RESULTS: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. CONCLUSIONS: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. Article Published Date : Sep 01, 2006
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Early-Life Assets in Oldest-Old Age: Evidence From Primary Care Reform in Early Twentieth Century Sweden.

Related Articles Early-Life Assets in Oldest-Old Age: Evidence From Primary Care Reform in Early Twentieth Century Sweden. Demography. 2019 Jan 16;: Authors: Lazuka V Abstract Do early-life effects of investments in public health persist to the oldest-old ages? This article answers this question by using the primary care reform in rural Sweden that between 1890 and 1917 led to the establishment of local health districts, together with openings of hospitals and recruitments of medical personnel, as a natural experiment in early-life environmental conditions. The initiatives undertaken within these districts targeted control of infectious diseases, including various isolation and disinfection measures. This study applies a difference-in-differences method combined with propensity score matching to register-based individual-level data for Sweden from 1968 to 2012 and to multisource, purposely collected data on the reform implementation. Providing pioneering evidence for such a distal relationship (ages 78-95), this study finds that treatment through primary care in the year of birth leads to a significant reduction in all-cause mortality (4 % to 6%) and mortality from cardiovascular diseases (5 % to 6 %) and to an increase in average incomes (2 % to 3 %). The effects are universal and somewhat stronger among individuals from poor socioeconomic backgrounds and at higher baseline levels of disease burden. PMID: 30652299 [PubMed - as supplied by publisher]

A sibling study of whether maternal exposure to different types of natural space is related to birthweight.

Related Articles A sibling study of whether maternal exposure to different types of natural space is related to birthweight. Int J Epidemiol. 2018 02 01;47(1):146-155 Authors: Richardson EA, Shortt NK, Mitchell R, Pearce J Abstract Background: Birthweight is an important determinant of health across the life course. Maternal exposure to natural space has been linked to higher birthweight, but stronger evidence of a causal link is needed. We use a quasi-experimental sibling study design to investigate if change in the mother's exposure to natural space between births was related to birthweight, in urban Scotland. Methods: Amount (% area) of total natural space, total accessible (public) natural space, parks, woodlands and open water within 100 m of the mother's postcode was calculated for eligible births (n = 40 194; 1991-2010) in the Scottish Longitudinal Study (a semi-random 5.3% sample of the Scottish population). Associations between natural space and birthweight were estimated, using ordinary least squares and fixed effects models. Results: Birthweight was associated with the total amount of natural space around the mother's home (+8.2 g for interquartile range increase), but was unrelated to specific types of natural space. This whole-sample relationship disappeared in the sibling analysis, indicating residual confounding. The sibling models showed effects for total natural space with births to women who already had children (+20.1 g), and to those with an intermediate level of education (+14.1 g). Conclusions: The importance of total natural space for birthweight suggests that benefits can be experienced near to as well as within natural space. Ensuring expectant mothers have good access to high quality neighbourhood natural space has the potential to improve the infant's start in life, and consequently their health trajectory over the life course. PMID: 29253203 [PubMed - indexed for MEDLINE]
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