Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births

Declercq, Eugene; Barger, Mary K.; Cabral, Howard; Evans, Stephen; Kotelchuck, Milton; Simon, Carol; Weiß, J.; Heffner, Linda J.

doi:10.1097/01.aog.0000255668.20639.40

Cited by 313 publications

(179 citation statements)

References 17 publications

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“…4 In addition, identification of subjects via unvalidated methods, for instance requiring only a single International Classification of Diseases (ICD) billing code, and requiring it to be present around the time of the birth hospitalization may result in a bias toward patients with more active or severe MS in some studies. Consistent with this was the observation of an increased risk of cesarean deliveries, a known cause of longer birth hospitalizations, 19,20 in women with MS when MS was identified by ICD billing codes alone 4 -something not found in other studies with a more comprehensive case ascertainment. 7 One study examining hospital stays in newborns of mothers with MS 11 reported longer stays (relative risk 5 1.5; 95% CI: 0.99-2.3) compared with newborns of mothers without MS 11 ; however, the authors speculated this was attributable to the common practice of discharging mother and newborn home together, as no other adverse birth outcomes were observed.…”

supporting

confidence: 53%

“…In building the generalized estimating equations, a logarithmic transformation was applied to the length of birth hospitalization to account for the right-skewed data distribution. A priori potential confounders considered in the maternal hospitalization analysis included cesarean delivery, 19,20 maternal age, 19 maternal comorbidity 19 (hypertension or diabetes), number of antenatal visits, 19 obesity as measured by BMI, 21 parity, 19 and prolonged labor. 19 For newborns, the following a priori confounders were considered: 5-minute Apgar score, 19 birth weight, 19 congenital anomaly, 19 maternal age, 19 comorbidity 19 (hypertension or diabetes), and substance use exposure 19 (i.e., alcohol, cigarettes, or drugs of abuse).…”

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confidence: 99%

“…Few newborns were admitted to the NICU (with a similar proportion being admitted in the MS and general population cohorts), such that we are unable to draw firm conclusions based on these data. Finally, factors such as (20) 66 ( parental ethnicity, parental perceptions of their childcare abilities, socioeconomic background, and the availability of support resources after discharge from hospital were not available, but could influence the length of birth hospitalization. 19 Overall, our findings are reassuring for women with MS planning a pregnancy or already expecting a child; the presence of MS in the mother does not seem to alter the length of birth hospitalization for the mother or baby.…”

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confidence: 99%

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Birth hospitalization in mothers with multiple sclerosis and their newborns

Zhao

Zhu

et al. 2013

Neurology

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Objective: To compare the duration of birth hospitalization in mothers with multiple sclerosis (MS) and their newborns relative to the general population and to investigate the impact of MS-related clinical factors on the length of birth hospitalization stays.Methods: Data from the British Columbia Perinatal Database Registry and the British Columbia MS database were linked in this retrospective cohort study. The duration of birth hospitalization in mothers with MS and their newborns (n 5 432) were compared with a frequency-matched sample of the general population (n 5 2,975) from 1998 to 2009. Clinical factors investigated included disease duration and disability, as measured by the Expanded Disability Status Scale. A multivariable model (generalized estimating equations) was used to analyze the association between MS and duration of birth hospitalization, adjusting for factors such as maternal age, diabetes, hypertension, and consecutive births to the same mother. Additional analyses included propensity score matching to further balance cohort characteristics.Results: Compared with the general population, the duration of birth hospitalization was not statistically or clinically different for mothers with MS or their newborns (median differences 5 11.5 and 12.1 hours, respectively; adjusted p . 0.4). Lengths of birth hospitalization were not significantly associated with disease duration (adjusted p . 0.7) or level of disability (adjusted p . 0.5). Findings remained virtually unchanged after propensity score matching.Conclusions: Birth hospitalization has been understudied in women with MS. Contrary to existing studies, we found that MS was not associated with a longer birth hospitalization. This study provides assurance to expectant mothers with MS, their families, and health care providers. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS, often manifesting in women of childbearing age. 1 Fatigue and pelvic organ dysfunction are common, 2 which may cause difficult labor and prolonged birth hospitalization. MS has been associated with a greater risk of difficult labor, 3 assisted vaginal delivery, 3 cesarean delivery, 4 as well as impaired fetal growth and prematurity. [3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. 7-10 However, the durations of birth hospitalization were not examined in these studies. To our knowledge, only 2 studies have examined birth hospitalization in MS 4,11 ; both were from the United States and reported longer hospital stays for mothers with MS 4,11 and their newborns 11 compared with the general population. Prolonged stays can have negative consequences, including an increased risk of hospital-acquired infection as well as creating a strain on scarce health care resources. 12 By linking 2 comprehensive population databases, the British Columbia Multiple Sclerosis (BCMS) database and the British Columbia Perinatal Database Registry (BCPDR), we

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confidence: 53%

mentioning

confidence: 99%

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confidence: 99%

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Birth hospitalization in mothers with multiple sclerosis and their newborns

Zhao

Zhu

et al. 2013

Neurology

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“…Several experts have noted a shift in norms towards higher use of technology at birth (McCourt et al, 2007;MacDonald, 2011). Cesarean section is generally safe, although not as safe as vaginal delivery unless indicated by complications (Declercq et al, 2007). A scheduled Cesarean section can be convenient for obstetricians, other hospital personnel, and the family, yet the cost is about 50 percent higher for Medicaid than for a vaginal birth (see Exhibit 3).…”

Section: Reducing Cesarean Section Ratesmentioning

confidence: 99%

Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center

Howell¹,

Palmer²,

Benatar³

et al. 2014

MMRR

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Objectives:Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women. Methods:The study uses results from a study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from other national sources of the cost of obstetrical care. Results:We estimate that birth center care could save an average of $1,163 per birth (2008 constant dollars), or $11.6 million per 10,000 births per year. Conclusions:Medicaid is the leading payer for maternity services. As Medicaid faces continuing cost increases and budget constraints, policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk Medicaid pregnant women.

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“…Probability weights are calculated, adjusted for incomplete and missing data, and used to establish correct matches. The validity of the probabilistic record linkage is extremely high with less than 1% of records having an incorrect match [13][14][15][16] . The NSW Centre for Health Record Linkage conducted the record linkage and identifying information was removed prior to the release of data for analysis.…”

Section: Data Sourcesmentioning

confidence: 99%

Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies

Schneuer

Nassar

Guilbert

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Short title: sTie-2 on pregnancy outcomesKey words: sTie-2 receptor, first trimester, adverse pregnancy outcomes, serum levels, predictive accuracy 2 ABSTRACT Aims: To assess soluble endothelial cell-specific tyrosine kinase receptor (sTie-2) levels in the first trimester of pregnancy and its association with adverse pregnancy outcomes; and examine the predictive accuracy.Study Design: In this nested case-control study, serum sTie-2 levels were measured in 2,616 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum sTie-2 with subsequent adverse pregnancy outcomes.Results: Median (interquartile range) sTie-2 for the total population was 19.6 ng/ml (13.6-26.4). Maternal age, weight, and smoking status significantly affected sTie-2 levels. There was no difference in serum sTie-2 between unaffected and women with adverse pregnancy outcomes. After adjusting maternal and clinical risk factors, low sTie-2 (<25 th centile) was associated with preeclampsia (Adjusted odds ratio: 1.61; 95%CI: 1.01-2.57), however, the accuracy of sTie-2 in predicting preeclampsia was not different from chance (AUC=0.54; P=0.08) and does not add valuable predictive information to maternal and clinical risk factors. Conclusions:Our findings suggest that low sTie-2 levels are associated with preeclampsia, however, it does not add valuable information to clinical and maternal risk factor information in predicting preeclampsia or any other adverse pregnancy outcomes.3

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Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births

Abstract: II.

Cited by 313 publications

References 17 publications

Birth hospitalization in mothers with multiple sclerosis and their newborns

Birth hospitalization in mothers with multiple sclerosis and their newborns

Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center

Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies

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