Increased rate of cesarean section in primiparous women aged 40 years or more: a single-center study in Japan

Takahashi, Hironori; Watanabe, Noriyoshi; Sugibayashi, Rika; Aoki, Hiroaki; Egawa, Makiko; Sasaki, Akira; Tsukahara, Yuki; Kubo, Takahiko; Sago, Haruhiko

doi:10.1007/s00404-011-2099-z

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…These trends seem to be the same as those previously reported in the USA [1–3, 5, 6] and Japan [7–9]. For example, in a recent observation at other perinatal centers in Japan, Cesarean delivery rate was about 50% in primiparous women aged ≥40 years [8]. …”

Section: Discussionsupporting

confidence: 85%

Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

Suzuki

Nakata

2013

ISRN Obstetrics and Gynecology

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Objective. We examined which specific factors contributed to the increase in Cesarean delivery rate at our hospital over a 10-year period. Methods. From January 2002 to December 2012, data on the Japanese singleton deliveries at ≥22-week gestation managed at Japanese Red Cross Katsushika Maternity Hospital were collected. Potential factors associated with the increasing Cesarean delivery rate were selected according to previous studies. In this study, the incidences of intrauterine fetal demise, umbilical artery pH <7.1, and severe perineal laceration were calculated for each year. Results. The Cesarean delivery rate at our institution increased significantly during the study period (17.3% in 2002 versus 23.4% in 2012, P < 0.01). During the study period, the Cesarean delivery rates in the cases of nulliparity, preterm delivery, low birth weight (<2,500 g), previous Cesarean deliveries and breech presentation were increased significantly. The incidence of intrauterine fetal demise and low umbilical artery pH was significantly decreased, and a negative correlation was found between the Cesarean delivery rate and the incidence of low umbilical artery pH for each year (r = −0.92, P < 0.01). Conclusion. At our institute, the neonatal outcomes seemed to be improved associated with the increased Cesarean delivery rate between 2002 and 2012.

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Section: Discussionsupporting

confidence: 85%

Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

Suzuki

Nakata

2013

ISRN Obstetrics and Gynecology

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“…The optimal mode of delivery for VLBW infants remains a controversial one, with several observational studies producing conflicting results. (18,(23)(24)(25)(26) The main finding in our study is that delivery mode did not affect neonatal mortality within the first seven days of life and did not influence preterm morbidity in infants surviving > 7 days of life. This finding is supported by other population studies in Australia ( 27) and the USA.…”

Section: Discussionsupporting

confidence: 43%

Outcomes of very low birth weight infants born by vaginal delivery versus cesarean section

Kardum

Grčić²,

Müller³

et al. 2018

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The optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Despite lacking evidence of benefits regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, particularly in early gestational ages. In our retrospective, multicentr study data were collected for very low birth weight infants born in two Croatian perinatal regions in a 3 -year period (2014. -2016.). The final cohort consisted of 255 very low birth weight infants. The rate of delivery via cesarean section was 74.1% (189/255) and is one of the highest reported in the literature so far. Infants born vaginally were born at an lower gestational age, had lower 1-and 5-minute Apgar scores, lower birth weights, and prognosis as expressed by higher Clinical risk index for babies (CRIB) scores and were more often born following chorioamnionitis and had higher mortality rate until 7 days of hospitalization. Univariate logistic regression analysis showed that cesarean section reduced the risk of death before 7 days of life (OR 0.34 95% CI 0.182-0.667). This significance was lost after multivariate analysis. In infants surviving after 7 days of hospitalization, rates of short-term neonatal morbidity (severe intracranial hemorrhage, cystic periventricular leukomalacia (cPVL), late-onset sepsis, necrotizing enterocolitis, kidney injury and retinopathy of prematurity requiring interventions) were not significant when comparing infants born vaginally and those born following cesarean section.

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“…The risks of ectopic pregnancy and stillbirth also increase with advancing maternal age (Nybo Andersen et al, 2000) and, overall, fetal loss is high in women in their late thirties or older, irrespective of their reproductive history. However, maternal age seems to have little impact on the rate of late antenatal complications in primiparous women in their forties with a singleton pregnancy and with no medical history (Fox et al, 2009;Franz and Husslein, 2010;Montan, 2007;Usta and Nassar, 2008), but more than half of them can expect to deliver via Caesarean section (Gilbert et al, 1999;Kort et al, 2012;Takahashi et al, 2012). By contrast, post-menopausal women aged 50 years or more, without a pre-existing medical condition, are at increased risk of pre-eclampsia and gestational diabetes and almost all of them will need a Caesarean section (Chibber, 2005;Kort et al, 2012;Paulson et al, 2002).…”

Section: Maternal Antenatal Care In Assistedreproduction Twin Pregnanciesmentioning

confidence: 99%

Do assisted-reproduction twin pregnancies require additional antenatal care?

Jauniaux

Ben‐Ami

Maymon

2013

Reproductive BioMedicine Online

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Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women <45 years of age are not associated with a notable increase in antenatal complication rates and thus do not require additional antenatal care compared with spontaneous twins. The risks of maternal and fetal morbidity and mortality associated with assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are obviously at higher risk of perinatal complications than singletons due to a natural increase in the incidence of fetal anomalies, antenatal disorders and obstetric and neonatal complications associated with the development of two fetuses instead of one. Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, a...

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Increased rate of cesarean section in primiparous women aged 40 years or more: a single-center study in Japan

Abstract: CS rate was 50.0% in primiparous women aged ≥40 years. In addition, CS caused by dystocia was almost twice as frequent in primiparous women aged ≥40 years as in women aged 35-39 years. Among late pregnancies, primiparous women aged 40 years and older had higher risk of CS.

Cited by 14 publications

References 18 publications

Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

Outcomes of very low birth weight infants born by vaginal delivery versus cesarean section

Do assisted-reproduction twin pregnancies require additional antenatal care?

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