Reducing primary cesarean delivery: can we prevent current and future morbidity and mortality?

Caughey, AB

doi:10.1038/jp.2009.132

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…(37, 38) In that context, we note that cesarean delivery for most twin gestations, especially those in vertex-vertex presentation, has no proven clinical benefit for either mother or child. The dramatic rise in cesarean delivery rates for twins undoubtedly has adverse implications for maternal morbidity and health care costs.…”

Section: Discussionmentioning

confidence: 99%

Trends in Cesarean Delivery for Twin Births in the United States

Lee

Gould

Boscardin

et al. 2011

Obstetrics &Amp; Gynecology

123

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Objective To estimate trends and risk factors for cesarean delivery for twins in the United States. Methods This was a cross-sectional study in which we calculated cesarean rates for twins from 1995 to 2008 using National Center for Health Statistics data. We compared cesarean rates by year and for vertex vs. breech presentation. The order of presentation for a given twin pair could not be determined from the available records and therefore analysis was based on individual discrete twin data. Multivariable logistic regression was used to estimate independent risk factors, including year of birth and maternal factors, for cesarean delivery. Results Cesarean rates for twin births increased steadily from 53.4% to 75.0% in 2008. Rates rose for the breech twin category (81.5% to 92.1%) and the vertex twin category (45.1% to 68.2%). The relative increase in cesarean rate for preterm and term infants was similar. After risk adjustment, there was an average increase noted in cesarean delivery of 5% each year during the study period (risk ratio 1.05, 95% confidence interval 1.04, 1.05). Conclusions Cesarean delivery rates for twin births increased dramatically from 1995 to 2008. This increase is significantly higher than that which could be explained by an increase in cesarean delivery for breech presentation of either the presenting or second twin.

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Section: Discussionmentioning

confidence: 99%

Trends in Cesarean Delivery for Twin Births in the United States

Lee

Gould

Boscardin

et al. 2011

Obstetrics &Amp; Gynecology

123

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show abstract

mentioning

confidence: 99%

“…7 These reports suggest that nonmedical factors, such as race and ethnicity, might play a role in who attempts TOL, similar to the role such nonmedical factors have been known to play in other areas of obstetric care. 8,10,11 In this study we aimed to better understand the factors associated with women undergoing TOL who were eligible for vaginal twin delivery. Improving our understanding of disparities in twin TOL may support later identification of interventions that may reduce twin CD rates.…”

mentioning

confidence: 99%

Disparities in Trial of Labor among Women with Twin Gestations in the United States

Cheng

Caughey

et al. 2021

Am J Perinatol

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Objective The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery. Study Design This was a population-based cohort study of women giving birth to twin gestations in the United States (2012–2014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed. Results Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age >35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater. Conclusion In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL. Key Points

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“…The caesarean delivery rate reached an all-time high of 31.8% in 2007. Although the caesarean rate rose 50% since 1995, there has been no concomitant reduction in neonatal mortality [2] . Studies carried out in various medical colleges and teaching hospitals in India the overall rate of caesarean deliveries is reported to be 24.4% [3] .…”

Section: Introductionmentioning

confidence: 99%

A study of maternal morbidity and mortality in elective and emergency lower segment caesarean section

Hemalatha¹

2021

Int. J. Clin. Obstet. Gynaecol.

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Background: Caesarean delivery being one of the most commonly performed surgical procedures in the world has enormous potential for preservation of life and health. It also poses a greater risk of maternal morbidity and mortality compared to vaginal delivery. Indications for performing caesarean delivery have shown a marked change in recent years and there is a growing concern regarding the rising rate of caesarean deliveries. Although the morbidity has come down over the years, it is important to assess and study the maternal as well as neonatal morbidity and mortality associated with it. Aims and Objectives: The present study was aimed to study and compare maternal morbidity like intraoperative and post-operative complications in emergency and elective caesarean delivery groups, and to study maternal mortality if any, between the two groups and also study neonatal outcome in both the study groups.Material and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, TRR Institute of Medical Sciences, Inole (v), Patancheru (M), Sangareddy (Dist.), Telangana, India. The study subjects selected were pregnant women participants attending the antenatal outpatient department attached to our Medical College consisting of n = 250 subjects who underwent elective and emergency Lower Segment Caesarean Section. The patients were divided into two study groups: those undergoing emergency caesarean section and those undergoing elective caesarean section. For every fourth case of emergency lower segment caesarean section (LSCS), one elective case was studied, since the ratio of emergency to elective lower segment caesarean section was 4:1 in our institution. Results: Maternal morbidity and mortality studied in n = 250 subjects who underwent caesarean delivery, morbidity was found to be more in emergency caesarean delivery group than in elective section. Majority caesarean sections were at term, whereas most of the preterm sections were of emergency group. Haemorrhage was most frequent intra-operative complication in both study groups. Additional procedures like B-lynch, uterine artery ligation, internal iliac artery ligation were seen in both groups. Morbidity associated with second stage sections like uterine incision extension, haemorrhage and difficult extraction was documented. Post-operative complications like anaemia, wound infection, sepsis, prolonged hospital stay, pulmonary oedema, DIC, SICU admission were significantly associated with emergency caesarean sections. Conclusion: Caesarean delivery should be done only when indicated and justified. Only then can we bring down caesarean section rates and the maternal and perinatal complications related to it.

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Reducing primary cesarean delivery: can we prevent current and future morbidity and mortality?

Cited by 5 publications

References 16 publications

Trends in Cesarean Delivery for Twin Births in the United States

Trends in Cesarean Delivery for Twin Births in the United States

Disparities in Trial of Labor among Women with Twin Gestations in the United States

A study of maternal morbidity and mortality in elective and emergency lower segment caesarean section

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