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Obstetric Interventions (obstetric + intervention)

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Medical Sciences100%

Selected Abstracts

Secular trends in socio-economic status and the implications for preterm birth

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2006
John M. D. Thompson
Summary The rate of preterm birth in the developed world has been shown to be increasing, in part attributable to obstetric intervention. It has been suggested that this may be a differential increase between socio-economic groups. We aimed to assess whether the preterm rate in Norway is different in socio-economic groups defined by maternal education, and to determine the extent to which a difference is attributable to a socio-economic differential in obstetrical intervention, in terms of caesarean section or induction of labour. We used data from the Medical Birth Registry of Norway from 1980 to 1998 with preterm rate as the outcome and maternal educational level, marital status and obstetric intervention as exposure variables. In multivariable analyses, adjustment was made for maternal age, year of birth and birth order, and secular trends were assessed according to year of birth. The preterm birth rate was highest in the lowest socio-economic group. An increase of 25.2% in the preterm rate was seen over the observation period. No apparent differential was seen in the increase of the crude preterm rates between socio-economic groups, although in multivariable analyses there was a significant interaction between socio-economic group and time, implying a stronger effect of low education towards the end of the observation period attributable to demographic change. In conclusion, the preterm birth rate increased over time, but was mainly due to an increase in obstetric interventions. No closing of the gap between socio-economic groups was observed. [source]

Original Article: Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010
Christopher R.H. WHITE
Background:, Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there's debate whether umbilical cord blood gas analysis (UC-BGA) should be conducted on some or all deliveries. Aim:, The aim of this study was to evaluate the impact of introducing universal UC-BGA at delivery on perinatal outcome. Methods:, An observational study of all deliveries ,20 weeks' gestation at a tertiary obstetric unit between January 2003 and December 2006. Paired UC-BGA was performed on 97% of deliveries (n = 19,646). Univariate and adjusted analysis assessed inter-year UC-BGA differences and the likelihood of metabolic acidosis and nursery admission. Results:, There was a progressive improvement in umbilical artery pH, pO2, pCO2, base excess and lactate values in univariate and adjusted analyses (P < 0.001). There was a significant reduction in the newborns with an arterial pH <7.10 (OR = 0.71; 95%CI 0.53,0.95) and lactate >6.1 mmol/L (OR = 0.37; 95%CI 0.30,0.46). Utilising population specific 5th and 95th percentiles, there was a reduction in newborns with arterial pH less than 5th percentile (pH 7.12; OR = 0.75; 95%CI 0.59,0.96) and lactate levels greater than 95th percentile (6.7 mmol/L; OR = 0.37; 95%CI 0.29,0.49). There was a reduction in term (OR = 0.65; 95%CI 0.54,0.78), and overall (OR = 0.75; 95%CI 0.64,0.87) nursery admissions. These improved perinatal outcomes were independent of intervention rates. Conclusions:, These data suggest that introduction of universal UC-BGA may result in improved perinatal outcomes, which were observed to be independent of obstetric intervention. We suggest that these improvements might be attributed to provision of biochemical data relating to fetal acid-base status at delivery influencing intrapartum care in subsequent cases. [source]

Update on intrapartum fetal pulse oximetry

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2002
Christine E East
ABSTRACT This article examines the current status of fetal pulse oximetry (FPO) as a means of intrapartum assessment of fetal wellbeing. FPO has been developed to a stage where it is a safe and accurate indicator of intrapartum fetal oxygenation. In general, sliding the FPO sensor along the examiner's fingers and through the cervix, to lie alongside the fetal cheek or temple is easy. The recent publication of a randomized controlled trial (RCT) of FPO versus conventional intrapartum monitoring has validated its use to reduce caesarean section rates for nonreassuring fetal status. An Australian multicentre RCT is currently underway. Maternal satisfaction rates with FPO are high. FPO may be used during labour when the electronic fetal heart rate trace is nonreassuring or when conventional monitoring is unreliable, such as with fetal arrhythmias. If the fetal oxygen saturation (FSpO2) values are < 30%, prompt obstetric intervention is indicated, such as fetal scalp blood sampling or delivery. FSpO2 monitoring should not form the sole basis of intrapartum fetal welfare assessment. Rather, the whole clinical picture should be considered. [source]

Secular trends in socio-economic status and the implications for preterm birth

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2006
John M. D. Thompson
Summary The rate of preterm birth in the developed world has been shown to be increasing, in part attributable to obstetric intervention. It has been suggested that this may be a differential increase between socio-economic groups. We aimed to assess whether the preterm rate in Norway is different in socio-economic groups defined by maternal education, and to determine the extent to which a difference is attributable to a socio-economic differential in obstetrical intervention, in terms of caesarean section or induction of labour. We used data from the Medical Birth Registry of Norway from 1980 to 1998 with preterm rate as the outcome and maternal educational level, marital status and obstetric intervention as exposure variables. In multivariable analyses, adjustment was made for maternal age, year of birth and birth order, and secular trends were assessed according to year of birth. The preterm birth rate was highest in the lowest socio-economic group. An increase of 25.2% in the preterm rate was seen over the observation period. No apparent differential was seen in the increase of the crude preterm rates between socio-economic groups, although in multivariable analyses there was a significant interaction between socio-economic group and time, implying a stronger effect of low education towards the end of the observation period attributable to demographic change. In conclusion, the preterm birth rate increased over time, but was mainly due to an increase in obstetric interventions. No closing of the gap between socio-economic groups was observed. [source]

High incidence of obstetric interventions after successful external cephalic version

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002
Louis Yik-Si Chan
Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source]