This is a systematic review of Type 1 VWD in pregnancy. The primary outcome was rate of PPH, defined as a cumulative blood loss greater than or equal to 1000 ml, or blood loss accompanied by signs and symptoms of hypovolemia within 24 hours postpartum or requiring blood products. Secondary PPH was defined as significant bleeding 24 hours to 12 weeks postpartum. Electronic databases were searched for eligible articles. The reference lists of all identified articles were examined to identify additional studies. RESULTS: Seven articles (n¼144 pregnancies) met inclusion criteria. The rate of primary PPH was 4/144 (2.8%). The secondary PPH rate was reported in four studies and occurred in 7/48 pregnancies (14.6%), ranging from 2 to 19 days postpartum. Five studies reported on delivery route, with frequencies of spontaneous vaginal, operative vaginal and cesarean delivery being 54/62 (87%), 3/62 (5%) and 5/62 (8%), respectively. Desmopressin was used in 17/123 reported cases (13.8%). Tranexamic acid was only used in one of 43 deliveries (2.3%). Data regarding blood product transfusion was available for 31 pregnancies. Blood products were given in 5 pregnancies (3 received cryoprecipitate and 2 received red blood cells). CONCLUSION: According to this systematic review, the frequency of primary PPH in pregnancies affected by Type 1 VWD is 2.8%. This is similar to the overall PPH rates of 3% reported in the literature. Although the sample size was small, secondary PPH occurred in almost 15% of pregnancies, while in the overall obstetrical population this occurs in approximately 1% of pregnancies. Women with type 1 VWD may not be at increased risk of primary PPH; however, with the return of clotting factors to baseline in the postpartum period, these women appear to be at increased risk of secondary PPH.
INTRODUCTION:
Prior work has demonstrated differences in cesarean-associated maternal morbidity based on time of delivery, but it remains unclear whether delivery mode or neonatal outcomes are associated with diurnal patterns. The objective was to determine if there is an association between delivery time and perinatal outcomes.
METHODS:
This is a retrospective cohort study of all nulliparous women delivering singleton, vertex, live births at ≥37 weeks gestation at a single center from 2014-15. Delivery time was dichotomized with nighttime deliveries designated as those occurring between 6pm and 6am. The primary outcome was delivery mode. Secondary outcomes included epidural use, labor augmentation, episiotomy and perineal lacerations, 5 minute Apgar < 7, cord umbilical artery pH < 7.0, and NICU admission. Bivariable and multivariable analyses were utilized for analyses.
RESULTS:
Of 7,691 women eligible for inclusion, 3,707 (48.2%) delivered during the night. Women undergoing night deliveries were marginally more likely to be undergoing induction of labor (20.1% vs 18.4%, p=0.06). Women delivering during the night were less likely to experience augmentation of labor (79.8% vs 81.6%, p=0.05) and had a higher frequency of cesarean delivery (20.6% vs 17.0%, p < 0.001). They were also more likely to have neonates with a 5-minute Apgar score < 7 (aOR 1.57, 95% CI 1.07-2.30) and umbilical artery pH < 7.0 (aOR 1.75, 95% CI 1.17-2.61).
CONCLUSION:
Among nulliparous women, delivery at night is associated with greater odds of cesarean delivery, low 5-minute Apgar score, and low umbilical artery pH.
OBJECTIVE: To identify how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding.
METHODS: This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017-2018. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first two to three days of life.
RESULTS: A total of 2,966 women met inclusion criteria during the study period, 1936 (65.3%) of whom underwent spontaneous vaginal delivery (SVD), 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor.
Women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (aOR 1.71, 95% CI 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR 1.71, 95% CI 1.04-1.31). The infants of these women also had an increased number of breastfeeding sessions on average (β 0.06, p=0.002), required fewer number of daily formula feedings (β 0.14, p<0.001), and experienced a smaller percentage in neonatal weight loss over the first 2-3 days of life (β 0.18, p<0.001).
CONCLUSIONS: Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation.
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