Adult ; Cesarean Section/statistics & numerical data* ; China/epidemiology* ; Female ; Humans ; Pregnancy ; Pregnancy Outcome/epidemiology* ; Risk Factors ; Trial of Labor ; Young Adult

INTRODUCTION: This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes. METHODS: A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes. RESULTS: Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar. CONCLUSION More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Adult ; Cesarean Section ; methods ; statistics & numerical data ; Databases, Factual ; Delivery, Obstetric ; Emergency Medical Services ; Extraction, Obstetrical ; methods ; statistics & numerical data ; Female ; Humans ; Labor Stage, First ; Labor Stage, Second ; Obstetrical Forceps ; Pregnancy ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult

Objective: To investigate the risks of pre-pregnancy overweight, excessive gestational weight gain on macrosomia. Methods: We conducted one hospital-based cohort study, focusing on pregnant women from January 2015. All pregnant women attending to this hospital for maternal check-ups, were included in our cohort and followed to the time of delivery. Data related to general demographic characteristics, pregnancy and health status of those pregnant women, was collected and maternal pre-pregnant BMI and maternal weight gain were calculated. Logistic regression was used to explore the risk difference of pre-pregnancy BMI, excessive gestational weight gain on macrosomia. Results: The overall incidence of macrosomia in our cohort appeared as 6.6% (149/2 243). After adjusting the confounding factors including age and histories on pregnancy, pre-pregnancy overweight/obesity was associated with higher risks of macrosomia (OR=3.12, 95%CI: 1.35-7.22, P=0.008; OR=2.99, 95%CI: 1.17-7.63, P=0.022) when comparing to those with normal pre-pregnancy weight. Cesarean delivery and sex of the offspring were associated with higher risk of macrosomia, while excessive gestational weight gain showed no significant difference (OR=1.41, 95%CI: 0.96-2.09, P=0.084). Our data showed that Macrosomia was statistically associated with gestational weight gain (P=0.002). After controlling parameters as age, history of pregnancy and related complications of the pregnant women, results from the logistic regression showed that women with gestational inadequate weight gain having reduced risks to deliver macrosomia, when compared to those pregnant women with adequate weight gain (OR=0.52, 95%CI: 0.30-0.90, P=0.019). Conclusion: Pre-pregnancy overweight and obesity were on higher risks to macrosomia.
Body Mass Index ; Cesarean Section/statistics & numerical data* ; China/epidemiology* ; Female ; Fetal Macrosomia/epidemiology* ; Humans ; Incidence ; Logistic Models ; Obesity/epidemiology* ; Overweight/epidemiology* ; Pregnancy ; Pregnancy Complications/epidemiology* ; Prospective Studies ; Weight Gain

Objective: To analyze the correlation between age and pregnancy-induced hypertension (PIH) in pregnant women from Hebei province in 2016. Methods: A retrospective analysis was conducted by using the clinical data of 64 909 pregnant women, delivering in 22 hospitals in Hebei in 2016. Descriptive statistics was used to describe the general data and pregnancy outcomes of pregnant women, and χ(2) test was used to compare the incidence of PIH in different age groups, and logistic regression analysis was used to analyze the risk factors for PIH. Results: The incidence of PIH was lowest in 20-29 year old women, and increased obviously in those aged<20 and>35 years (P<0.05), and the incidence was positively correlated with age. Logistic regression analysis showed that age, times of pregnancy, number of previous cesarean section and fetus number of current pregnancy were the risk factors for PIH (OR=1.293, 1.153, 1.307, 3.607), while times of deliver and times of prenatal examination were the protective factors (OR=0.655, 0.951). Conclusion: Advanced age pregnancy and young age pregnancy would significantly increase the incidence of PIH. Prenatal care should be strengthened for pregnant women at risk for PIH.
Adult ; Cesarean Section/statistics & numerical data* ; China/epidemiology* ; Female ; Humans ; Hypertension/complications* ; Hypertension, Pregnancy-Induced/ethnology* ; Incidence ; Maternal Age ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Young Adult

BACKGROUNDThe association between the previous history of endometriosis and obstetric outcomes is still ambiguous. This study aimed to evaluate the effects of previous history of operatively diagnosed endometriosis on pregnancy outcomes.

METHODSA total of 98 primiparous women who had been diagnosed with endometriosis by previous laparoscopic surgery were included in this retrospective cohort study. Pregnancy outcomes were compared between these women (study group) who had a live birth and 300 women without endometriosis (control group) who had a live birth. In the study group, the pregnancy outcomes of 74 women who conceived naturally (no assisted reproductive technology [ART] subgroup) were simultaneously compared with 24 women who conceived by ART (ART subgroup).

RESULTSMiscarriage was observed in 23 of 98 women with endometriosis (23.5%). There were 75 women who had a live birth after laparoscopic diagnosis of endometriosis in the study group eventually. On multivariate analysis, the postpartum hemorrhage rate increased significantly in the study group when compared with the control group (adjusted odds ratio: 2.265, 95% confidence interval: 1.062, 4.872; P = 0.034). There was an upward tendency of developing other pregnancy-related complications, such as preterm birth, placental abruption, placenta previa, cesarean section, fetal distress/anemia, and others in the study group than in the control group. However, the differences showed no statistical significance. Within the study group, the occurrence rate of postpartum hemorrhage and preterm birth was both higher in the ART subgroup than in the no ART subgroup. The differences both had statistical significance (44.4% vs. 17.5%, P = 0.024 and 27.8% vs. 1.8%, P = 0.010, respectively). At the same time, median (interquartile range) for gestational age at delivery in the ART subgroup was significantly shorter than that in the no ART subgroup (38 weeks [36-39 weeks] vs. 39 weeks [38-40 weeks]; P = 0.005).

CONCLUSIONSEndometriosis may affect obstetric outcomes. Women with endometriosis have a higher risk of postpartum hemorrhage. Women with endometriosis who conceived by ART may have a higher risk of postpartum hemorrhage and preterm birth than those conceived naturally.

Abortion, Spontaneous ; epidemiology ; etiology ; Adult ; Cesarean Section ; statistics & numerical data ; Endometriosis ; complications ; epidemiology ; Female ; Gestational Age ; Humans ; Live Birth ; epidemiology ; Placenta Previa ; epidemiology ; etiology ; Postpartum Hemorrhage ; epidemiology ; etiology ; Pregnancy ; Pregnancy Complications ; epidemiology ; etiology ; physiopathology ; Pregnancy Outcome ; Premature Birth ; epidemiology ; etiology ; Reproductive Techniques, Assisted ; adverse effects ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the short-term clinical outcomes of neonates of secundiparous mothers, and to provide a reference for the clinical practice after the change in birth policy.

METHODSA cohort study was performed for the parturients and their neonates born in Yongkang Maternal and Child Health Care Hospital in Zhejiang, China between June 2015 and April 2016. According to the parity of the mother, the neonates were divided into primiparous group and secundiparous group. The short-term clinical outcomes of neonates were compared between the two groups.

RESULTSA total of 4 091 neonates who met the inclusion criteria were enrolled, and there were 2 023 neonates in the primiparous group and 2 068 in the secundiparous group. In the secundiparous group, most mothers (57.16%) were aged 26-34 years, and 16.49% were aged above 35 years. Compared with the primiparous group, the secundiparous group had a significantly higher rate of births by cesarean section (42.55% vs 25.06%; P<0.05). The percentages of neonatal respiratory distress syndrome (NRDS; 8.6% vs 3.4%) and transient tachypnea of the newborn (TTN; 7.2% vs 2.6%; P<0.05) in hospitalized neonates from the secundiparous group were significantly higher than in those from the primiparous group.

CONCLUSIONSElderly parturient women are not the major population of secundiparous parturients. The neonates of secundiparous mothers have a higher rate of births by cesarean section, which might be associated with increased percentages of NRDS and TTN in hospitalized neonates from the secundiparous mothers.

Adult ; Cesarean Section ; statistics & numerical data ; Cohort Studies ; Female ; Humans ; Infant, Newborn ; Parity ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Tachypnea ; epidemiology

BACKGROUNDThe effect of endometriosis on obstetric outcomes is still ambiguous. The aim of our study was to determine the association between endometriosis and adverse obstetric outcomes in a cohort of Chinese women.

METHODSA retrospective cohort study was undertaken to compare obstetric outcomes between 249 women with endometriosis and 249 women without endometriosis. All women were nulliparous and achieved singleton pregnancies naturally. Women with endometriosis were diagnosed during surgery and confirmed histologically. Odds ratios (ORs) and 95% confidence intervals (CIs) of measures of obstetric outcomes were calculated.

RESULTSWomen with endometriosis showed significantly increased risks of preterm labor (adjusted OR, 2.42; 95% CI, 1.05-5.57), placenta previa (adjusted OR, 4.51; 95% CI, 1.23-16.50), and cesarean section (adjusted OR, 1.93; 95% CI, 1.31-2.84). No significant differences were observed in the incidence of pregnancy-induced hypertension, fetal growth restriction, small for gestational age, placental abruption, or luteal support in the first trimester between the two groups.

CONCLUSIONSWomen with endometriosis are at a higher risk of preterm labor, placenta previa, and cesarean section during pregnancy and need additional care.

Adult ; Cesarean Section ; statistics & numerical data ; Endometriosis ; epidemiology ; physiopathology ; Female ; Humans ; Obstetric Labor, Premature ; epidemiology ; Placenta Previa ; epidemiology ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

The aim of this study was to investigate the whole picture regarding pregnancy, prenatal care, obstetrical complications, and delivery among disabled pregnant women in Korea. Using the data of National Health Insurance Corporation, we extracted the data of women who terminated pregnancy including delivery and abortion from January 1, 2010 to December 31, 2010. Pearson's chi-square test and Student-t test were conducted to examine the difference between disabled women and non-disabled women. Also, to define the factors affecting inadequate prenatal care, logistic regression was performed. The total number of pregnancy were 463,847; disabled women was 2,968 (0.6%) and 460,879 (99.4%) were by non-disabled women. Abortion rates (27.6%), Cesarean section rate (54.5%), and the rate of receiving inadequate prenatal care (17.0%), and the rate of being experienced at least one obstetrical complication (11.3%) among disabled women were higher than those among non-disabled women (P < 0.001). Beneficiaries of Medical Aid (OR, 2.21) (P < 0.001) and severe disabled women (OR, 1.46) (P = 0.002) were more likely to receive inadequate prenatal care. In conclusion, disabled women are more vulnerable in pregnancy, prenatal care and delivery. Therefore, the government and society should pay more attention to disabled pregnant women to ensure they have a safe pregnancy period up until the delivery.
Abortion, Induced/*statistics & numerical data ; Adult ; Cesarean Section/*statistics & numerical data ; Delivery, Obstetric/*statistics & numerical data ; Disabled Persons/*statistics & numerical data ; Female ; Humans ; Mothers/statistics & numerical data ; Pregnancy ; Pregnancy Complications ; Prenatal Care/*statistics & numerical data ; Republic of Korea ; Young Adult

The aim of this study was to investigate the whole picture regarding pregnancy, prenatal care, obstetrical complications, and delivery among disabled pregnant women in Korea. Using the data of National Health Insurance Corporation, we extracted the data of women who terminated pregnancy including delivery and abortion from January 1, 2010 to December 31, 2010. Pearson's chi-square test and Student-t test were conducted to examine the difference between disabled women and non-disabled women. Also, to define the factors affecting inadequate prenatal care, logistic regression was performed. The total number of pregnancy were 463,847; disabled women was 2,968 (0.6%) and 460,879 (99.4%) were by non-disabled women. Abortion rates (27.6%), Cesarean section rate (54.5%), and the rate of receiving inadequate prenatal care (17.0%), and the rate of being experienced at least one obstetrical complication (11.3%) among disabled women were higher than those among non-disabled women (P < 0.001). Beneficiaries of Medical Aid (OR, 2.21) (P < 0.001) and severe disabled women (OR, 1.46) (P = 0.002) were more likely to receive inadequate prenatal care. In conclusion, disabled women are more vulnerable in pregnancy, prenatal care and delivery. Therefore, the government and society should pay more attention to disabled pregnant women to ensure they have a safe pregnancy period up until the delivery.
Abortion, Induced/*statistics & numerical data ; Adult ; Cesarean Section/*statistics & numerical data ; Delivery, Obstetric/*statistics & numerical data ; Disabled Persons/*statistics & numerical data ; Female ; Humans ; Mothers/statistics & numerical data ; Pregnancy ; Pregnancy Complications ; Prenatal Care/*statistics & numerical data ; Republic of Korea ; Young Adult

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.
Cesarean Section/*statistics & numerical data/trends ; Data Collection ; Female ; Humans ; *Insurance, Health ; Insurance, Liability ; Maternal Age ; Obesity/epidemiology ; Pregnancy ; Pregnancy, Multiple/statistics & numerical data ; Republic of Korea ; Social Class ; Vaginal Birth after Cesarean/*statistics & numerical data/trends