This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of wom...This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of women with low transverse cesarean delivery in their first viable pregnancy who underwent a VBAC in their second v iable pregnancy at our urban tertiary care institution were reviewed.Maternal body mass index(BMI )was classified as underweight (<19.8kg /m 2 ),normal(19.8-24.9kg /m 2 ),over-weight (25-29.9kg /m 2 ),or obese(≥30kg /m 2 ).Clinical characteristics and labor outcomes were assessed.Factors potentially affecting VBAC success were analyzed by univariate analysis.Logistic re gressions were performed to determine the impact of maternal p regravid BMI on VBAC success after controlling for c onfounding factors.Of 510women attempting a trial of labor,337(66%)were successful and 173(34%)failed VBAC.Decreased VBAC success was seen in obese(54.6%)but not over-weight (65.5%)women compared with women of normal BMI (70.5%),P =.003and.36,respectively.Un-derweight women had more VBAC success than women of normalBMI (84.7%vs 70.5%,P =.04).Controlling for other factors,the association b etween increasing pre-gravid BMI and BMI ≥30kg /m 2 with decreased VBAC success persisted,P =.03and.006,r espectively.Nor-mal BMI women who became overweight before the second pregnancy had decreased VBAC success compared with those whose BMI remained normal(56.6%vs 74.2%,P =.006).However,overweight women who decreased their BMI to normal before the second pregnancy did not significantly improve VBAC success(64.0%vs 58.4%,P =.67).Increasing pregravid BMI and weigh t gain be-tween pregnancies reduce VBAC succe ss after a single low transverse cesarean delivery.展开更多
This study was undertaken to determine rates of recurrent preterm birth according to number of prior preterm births, 1 versus 2 or more and cervical length by endovaginal ultrasound at 220 to 246 weeks, less than 25 m...This study was undertaken to determine rates of recurrent preterm birth according to number of prior preterm births, 1 versus 2 or more and cervical length by endovaginal ultrasound at 220 to 246 weeks, less than 25 mm versus more than 25 mm. Study design: We retrospectively analyzed data from charts of women with prior spontaneous preterm birth seen in a Prematurity Prevention Clinic from 1998 through 2004. Women with a history of 1 or more spontaneous preterm births (180- 366 weeks) were included. Women with multiple gestations, uterine anomalies, and prior cervical surgery were excluded. Transvaginal sonography was used to evaluate each woman’ s cervical length at 220 to 246 weeks. Cerclage, bed rest, tocolysis, and steroids were used when clinically appropriate. Primary outcome was gestational age at delivery less than 32 and less than 35 weeks. Data were analyzed according to number of prior preterm births (1 vs ≥ 2) and sonographic cervical length at 220 to 246 weeks (< 25mm vs ≥ 25 mm). Results: A total of 188 eligible women were evaluated. Median gestational age of earliest preterm birth was 26.3 weeks. Of the total 188, 118 (62.8% ) women had 1 prior and 70 (37.2% ) had 2 or more preterm births. Thirty-eight (20.2% ) of the women had a cervical length less than 25 mm and 150 (79.8% ) had a cervical length 25 mm or greater. A higher percentage of women with a cervical length less than 25 mm and 2 or more preterm births delivered less than 32 weeks compared with women with 1 prior preterm birth, although this did not reach statistical significance (21.5% vs 12.5% , P = .47). Rates of delivery less than 35 weeks in women with a cervical length less than 25 mm were similar in those with a history of 1 and 2 or more preterm births. Women who had 2 or more prior preterm births were analyzed separately to identify if a cervical length greater than 30 mm or greater than 35 mm could be reassuring for decreasing the risk of recurrent preterm birth. Conclusion: Rates of preterm birth less than 32 and less than 35 weeks were similar in women whose cervical length was less than 25 mm at 220 to 246 weeks, regardless of number of prior preterm births. Women with 2 prior preterm births and a cervix greater than 35 mm were at low risk for subsequent preterm birth less than 35 weeks.展开更多
文摘This study was undertaken to determi ne the impact of ma-ternal obesity on success of a trial of labor(vaginal birth after cesarean sectionVBAC)after a single low transverse ce-sarean delivery.Individual charts of women with low transverse cesarean delivery in their first viable pregnancy who underwent a VBAC in their second v iable pregnancy at our urban tertiary care institution were reviewed.Maternal body mass index(BMI )was classified as underweight (<19.8kg /m 2 ),normal(19.8-24.9kg /m 2 ),over-weight (25-29.9kg /m 2 ),or obese(≥30kg /m 2 ).Clinical characteristics and labor outcomes were assessed.Factors potentially affecting VBAC success were analyzed by univariate analysis.Logistic re gressions were performed to determine the impact of maternal p regravid BMI on VBAC success after controlling for c onfounding factors.Of 510women attempting a trial of labor,337(66%)were successful and 173(34%)failed VBAC.Decreased VBAC success was seen in obese(54.6%)but not over-weight (65.5%)women compared with women of normal BMI (70.5%),P =.003and.36,respectively.Un-derweight women had more VBAC success than women of normalBMI (84.7%vs 70.5%,P =.04).Controlling for other factors,the association b etween increasing pre-gravid BMI and BMI ≥30kg /m 2 with decreased VBAC success persisted,P =.03and.006,r espectively.Nor-mal BMI women who became overweight before the second pregnancy had decreased VBAC success compared with those whose BMI remained normal(56.6%vs 74.2%,P =.006).However,overweight women who decreased their BMI to normal before the second pregnancy did not significantly improve VBAC success(64.0%vs 58.4%,P =.67).Increasing pregravid BMI and weigh t gain be-tween pregnancies reduce VBAC succe ss after a single low transverse cesarean delivery.
文摘This study was undertaken to determine rates of recurrent preterm birth according to number of prior preterm births, 1 versus 2 or more and cervical length by endovaginal ultrasound at 220 to 246 weeks, less than 25 mm versus more than 25 mm. Study design: We retrospectively analyzed data from charts of women with prior spontaneous preterm birth seen in a Prematurity Prevention Clinic from 1998 through 2004. Women with a history of 1 or more spontaneous preterm births (180- 366 weeks) were included. Women with multiple gestations, uterine anomalies, and prior cervical surgery were excluded. Transvaginal sonography was used to evaluate each woman’ s cervical length at 220 to 246 weeks. Cerclage, bed rest, tocolysis, and steroids were used when clinically appropriate. Primary outcome was gestational age at delivery less than 32 and less than 35 weeks. Data were analyzed according to number of prior preterm births (1 vs ≥ 2) and sonographic cervical length at 220 to 246 weeks (< 25mm vs ≥ 25 mm). Results: A total of 188 eligible women were evaluated. Median gestational age of earliest preterm birth was 26.3 weeks. Of the total 188, 118 (62.8% ) women had 1 prior and 70 (37.2% ) had 2 or more preterm births. Thirty-eight (20.2% ) of the women had a cervical length less than 25 mm and 150 (79.8% ) had a cervical length 25 mm or greater. A higher percentage of women with a cervical length less than 25 mm and 2 or more preterm births delivered less than 32 weeks compared with women with 1 prior preterm birth, although this did not reach statistical significance (21.5% vs 12.5% , P = .47). Rates of delivery less than 35 weeks in women with a cervical length less than 25 mm were similar in those with a history of 1 and 2 or more preterm births. Women who had 2 or more prior preterm births were analyzed separately to identify if a cervical length greater than 30 mm or greater than 35 mm could be reassuring for decreasing the risk of recurrent preterm birth. Conclusion: Rates of preterm birth less than 32 and less than 35 weeks were similar in women whose cervical length was less than 25 mm at 220 to 246 weeks, regardless of number of prior preterm births. Women with 2 prior preterm births and a cervix greater than 35 mm were at low risk for subsequent preterm birth less than 35 weeks.
