Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes

Levine, Lisa D.; Elovitz, Michal A.; Limaye, Meghana; Sammel, Mary D.; Srinivas, Sindhu K.

doi:10.1038/jp.2016.84

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…There were 347 women identified as having preeclampsia with severe features in the electronic medical record during the study period; 193 women were included in the parent study 12 and in our current analyses.…”

Section: Resultsmentioning

confidence: 99%

“…The parent study included all women with PEC-S who were carrying a singleton gestation, were diagnosed with PEC-S prior to active labor, were ≥ 34 weeks gestation and who delivered between July 2011 and February 2013 at the Hospital of the University of Pennsylvania. 12 Approval was obtained from the Institutional Review Board prior to the study.…”

Section: Methodsmentioning

confidence: 99%

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Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia

et al. 2016

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Objective To determine factors associated with lower 6-week postpartum follow-up rates and persistent hypertension among women with preeclampsia with severe features (PEC-S). Study Design Planned secondary analysis of a retrospective cohort study of women with PEC-S. Outcomes were (1) attendance at the 6-week postpartum visit and (2) persistent hypertension. Results One hundred ninety-three women were in the final cohort. The 6-week follow-up rate was 52.3%. Factors associated with lower follow-up were African-American race (OR 0.37 (0.18–0.77)) and < 5 prenatal visits (OR 0.44 (0.20–0.97)). Women with diabetes and women with a cesarean had higher follow-up (OR 4.00 (1.09–14.66) and 2.61 (1.40–4.88), respectively). Among those with 6-week follow-up, 21% had persistent hypertension. Obese women, women diagnosed with PEC-S by severe range blood pressure (BP) and women discharged home on BP medication were more likely to have persistent hypertension (OR 3.50 7 (1.06–11.58), 3.58 (1.11-11.54) and 3.04 (1.12–8.23), respectively). Conclusion We identified a subgroup of women at higher risk for poor postpartum follow-up and those at risk for persistent hypertension.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia

et al. 2016

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“…The in uence of transfer-cesarean section to mother and neonates Termination of pregnancy is the only cure for preeclampsia.Caesarean sections were associated with increased maternal morbidity, raising the risk of haemorrhagic and infectious complications and the rate of postpartum hypertensive crises,and prolonged hospitalization [7][8][9] .Thus,To pregnant with severe preeclampsia,guidelines and medical literature support vaginal delivery if there is no other indication of caesarean sections [10][11][12] .However,the decision regarding mode of delivery is not easy, obstetricians and pregnants often worry about that the maternal and fetal'clinical conditions will worsen during vaginal delivery.Thus,many patients and doctors choose cesarean section directly in clinical.In the present study, a high direct caesarean section rate of almost 66% was found in patients with severe preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Maternal-Fetal Outcomes of Pregnant with Preeclampsia Who Converted to Cesarean Section After A Trial Vaginal Birth

Yan²,

Chen³

2020

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Background: At present, most pregnant with preeclampsia choose direct cesarean section. Whether cesarean section after vaginal trial affects the outcome of mother and child and its related risk factorsIt are still unclear. The purpose of this study is to investigate the risk factors and maternal-neonatal outcomes in severe preeclampsia patients who undergo transfer-cesarean section during vaginal labor. Methods: For this retrospective study, patient with severe preeclampsia data from 2015 to 2019 was collected. Study participants were women with severe preeclampsia having a cesarean section during week 34 and 41 of gestation.The population was classified into three groups: patients with severe preeclampsia had cesarean section directly, patients with severe preeclampsia had vaginal deliveries and patients with severe preeclampsia who sufferred from transfer-cesarean section in the vaginal labor. The demographic variables and maternal-fetal outcomes were collected and analyzed. Results: (1) 34%(553/1626) severe preeclampsia had labor induction or natural labor and the ratio of transfer-cesarean section after trial of labor was 39% (216/553) . (2)There was a greater incidence of postpartum haemorrhage (7.7% versus 4.5%),the need for blood transfusion (2.4% versus 0.6%) and more than 7 days of hospitalization (10.4% versus 0.6%) in patients submitted to direct caesarean section compared with vaginal delivery.Apgar score at 5 min <7score and admission of NICU (7.5% versus 2.7%;26.0% versus 18.4%) in the neonates were significantly higher in the direct cesarean section group compared with vaginal delivery,but no difference between direct cesarean section group and transfer cesarean section.(3)When multiple logistic regression analysis was performed,the variables that remained significantly associated with transfer cesarean section were cephalopelvic disproportion (OR ¼ 2.13; 95% CI: 1.43–8.13) and fetal distress (OR ¼ 2.42; 95% CI: 1.76–6.65). Conclusion: Vaginal delivery can be recommended to pregnants with severe preeclampsia as long as there are no contraindications for vaginal delivery. Attempting but failing vaginal delivery would not increase the complications of mother and neonates,but fetal monitoring and labor evaluation should be strengthen during the process of labor.

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“…Amorim et al investigated the effect of delivery modes among women with HDP in Brazil [14] and they found an increased risk of adverse outcomes for HDP patients with CD. Levine LD et al found that CD in labors were associated with the overall composite of adverse outcomes seen in women with HDP [15] .…”

Section: Discussionmentioning

confidence: 99%

Mode of Delivery in Stable Patients with Hypertensive Disorders of Pregnancy Based on the Classification Tree

Hong¹,

Zhang²,

Yan³

et al. 2019

Preprint

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Purpose It is very critical to consider features of Hypertensive Disorders of Pregnancy (HDP) when choosing mode of delivery, which are rarely reported in present studies. This study is to construct a user-friendly combination of HDP patients’ features to choose optimal mode of delivery for stable patients without other indications for cesarean section. Methods A retrospective analysis was performed in 307 stable HDP patients with clinical cure. 116 patients underwent vaginal delivery (VD) and 191 patients underwent cesarean delivery (CD). Univariate analysis was done between VD group and CD group on demographic, anthropometric and laboratory variables. Then, with classification tree, separate set of HDP features were enabled to be linked into mode of delivery. Results The levels of edema, proteinuria, systolic blood pressure (SBP), hematocrit (HCT), β-2 microglobulin and aspartate aminotransferase (AST) were higher in CD group than those in VD group (P<0.001). The classification tree was consisted of 3 layers: the first layer was edema, the second layer were β-2microglobulin and proteinuria, and the third layer was HCT. Node 3 (no edema; β-2microglobulin ≤1.71ug/ml) reached VD rate of 86.4%, which was the highest VD rate among all terminal nodes. Node 6 (edema is limited to the ankle or above,proteinuria>1+) had the lowest VD rates of 11.3%. Conclusions The classification tree explores the collection of HDP features suitable for different modes of delivery, which offers the ability of assisting obstetricians to select proper mode of delivery for HDP patients without other certain indications for cesarean section.

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Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes

Cited by 16 publications

References 13 publications

Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia

Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia

Risk Factors and Maternal-Fetal Outcomes of Pregnant with Preeclampsia Who Converted to Cesarean Section After A Trial Vaginal Birth

Mode of Delivery in Stable Patients with Hypertensive Disorders of Pregnancy Based on the Classification Tree

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