Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to...Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.展开更多
and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The mate...and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.展开更多
目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料...目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料,并根据阴道分娩结局分为成功组(n=101)和失败组(n=60),采用logistic回归法分析各种因素在两组之间的差异。结果161例孕妇中,TOLAC成功101例,失败60例,成功率为62.7%,无子宫破裂和孕妇死亡,新生儿结局均良好。两组孕妇的孕周、体质指数(body mass index,BMI)、妊娠前BMI、瘢痕厚度、初次剖宫产试产比较,差异均无统计学意义(P>0.05)。logistic单因素回归分析显示,年龄<35岁、与前次分娩间隔时间<8年、新生儿体质量<3500 g及初次分娩宫口扩张≥3 cm为TOLAC成功的有利因素,差异有统计学意义(P<0.05);logistic多因素回归分析上述因素,差异均无统计学意义(P>0.05);两组是否自然临产比较,差异有统计学意义(P<0.05),成功组自然临产率明显高于失败组(P<0.05)。结论剖宫产术后再次妊娠孕妇在严密监测下行TOLAC是安全可行的,自然临产TOLAC成功率高。展开更多
文摘Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.
文摘and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.
文摘目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料,并根据阴道分娩结局分为成功组(n=101)和失败组(n=60),采用logistic回归法分析各种因素在两组之间的差异。结果161例孕妇中,TOLAC成功101例,失败60例,成功率为62.7%,无子宫破裂和孕妇死亡,新生儿结局均良好。两组孕妇的孕周、体质指数(body mass index,BMI)、妊娠前BMI、瘢痕厚度、初次剖宫产试产比较,差异均无统计学意义(P>0.05)。logistic单因素回归分析显示,年龄<35岁、与前次分娩间隔时间<8年、新生儿体质量<3500 g及初次分娩宫口扩张≥3 cm为TOLAC成功的有利因素,差异有统计学意义(P<0.05);logistic多因素回归分析上述因素,差异均无统计学意义(P>0.05);两组是否自然临产比较,差异有统计学意义(P<0.05),成功组自然临产率明显高于失败组(P<0.05)。结论剖宫产术后再次妊娠孕妇在严密监测下行TOLAC是安全可行的,自然临产TOLAC成功率高。
