Mode of delivery and risk of respiratory diseases in newborns

doi:10.1016/S0029-7844(00)01150-9

Obstetrics & Gynecology

Volume 97, Issue 3, March 2001, Pages 439-442

https://doi.org/10.1016/S0029-7844(00)01150-9 Get rights and content

Abstract

Objective: To determine whether there is an increased incidence of persistent pulmonary hypertension in neonates delivered by cesarean, with or without labor, compared with those delivered vaginally.

Methods: We did a computerized retrospective review of 29,669 consecutive deliveries over 7 years (1992–1999). The incidences of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and respiratory distress syndrome (RDS) were tabulated for each delivery mode. Cases of persistent pulmonary hypertension were reviewed individually to determine delivery method and whether labor had occurred. The three groups defined were all cesarean deliveries, all elective cesareans, and all vaginal deliveries.

Results: Among 4301 cesareans done, 17 neonates had persistent pulmonary hypertension (four per 1000 live births). Among 1889 elective cesarean deliveries, seven neonates had persistent pulmonary hypertension (3.7 per 1000 live births). Among 21,017 vaginal deliveries, 17 neonates had persistent pulmonary hypertension (0.8 per 1000 live births). χ² analysis showed an odds ratio 4.6 and P < .001 for comparison of elective cesarean and vaginal delivery for that outcome.

Conclusion: The incidence of persistent pulmonary hypertension of the newborn was approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally. The findings have implications for informed consent before cesarean and increased surveillance of neonates after cesarean.

Section snippets

Materials and methods

We did a computerized retrospective review of 29,669 consecutive women who delivered at Illinois Masonic Medical Center between January 1, 1992 and December 31, 1999. Deliveries were grouped by delivery route and whether labor had occurred (all cesareans, elective cesareans, and all vaginal deliveries). Our perinatal database consists of information entered in a custom computer program each day by a chart abstractor, based on what providers write on the Hollister Labor and Delivery Summary Form

Results

Among 29,669 deliveries at our institution from 1992–1999, 25,318 met the inclusion criteria. Table 1 is a compilation of data and statistical analyses from that cohort. There were 4301 cesareans (17%), and of those 1889 were elective. Seven hundred thirty-five scheduled cesareans were for breech presentation, placenta previa, genital herpes, macrosomia, or multiple gestation; the rest of the elective cesareans (1154) were done because of prior cesareans. During that period, 34 neonates (1.3

Discussion

The incidence of persistent pulmonary hypertension of the newborn was one in 270 among newborns delivered by elective cesarean, a rate almost fivefold higher than that for neonates delivered vaginally. It is apparent that risk of transient tachypnea or RDS is greater than that of persistent pulmonary hypertension, but the risk of persistent pulmonary hypertension has a remarkably greater mortality rate.6, 7 The risk of persistent pulmonary hypertension (about one in 1000 deliveries)6 was less

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Perinatal data was obtained from 2004 to 2008 in the TMCHD and linked the NHIRD to obtain relevant medical information regarding maternal and neonatal risk factors of three asthma phenotypes which were identified as transient early asthma, persistent asthma, and late-onset asthma. A multivariate logistic regression analysis was conducted to adjust for covariates.
The percentage of non-asthmatic patients was 77.02% and asthmatic (transient early asthma, late onset asthma, and persistent asthma) patients were 8.96%, 11.64%, and 2.42%, respectively. Maternal risk factors—including Cesarean section, maternal asthma, maternal allergic rhinitis (AR), and premature rupture of membranes—and neonatal risk factors, such as male gender, gestational age 29–37 weeks, ventilator use, antibiotics use, AR, and atopic dermatitis, were associated with the development of these three asthma phenotypes. Twins and a gestational age of 28 weeks or less premature were associated with the development of transient early asthma and persistent asthma, but not late onset asthma. Triplets and above were associated with the development of transient early asthma, but not late onset or persistent asthma.
Various asthma phenotypes have different risk factors; therefore, their distinct risk factors should be identified in order to early diagnosis and treatment.
Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery
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This study aimed to estimate the impact of third-trimester ultrasound with measurement of the lower uterine segment thickness (LUST) and estimation of fetal weight (EFW) on maternal and perinatal morbidity among women with a prior cesarean delivery.
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Third-trimester ultrasound with EFW and LUST measurement is associated with a significant reduction in major perinatal morbidity in women with a prior cesarean delivery.
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Nous avons effectué une analyse secondaire de l'essai QUARISMA, en incluant les femmes qui ont accouché à terme après 1 césarienne dans des centres de soins tertiaires. À l'aide d’équations d'estimation généralisées et de rapports de cotes ajustés (RCa), nous avons comparé le taux de morbidités maternelles et périnatales majeures et mineures entre les centres qui avaient intégré la mesure de l’épaisseur du SUI et l'EPF dans la pratique courante et ceux qui n'avaient pas intégré ces mesures. Dans une analyse secondaire, nous avons comparé les femmes qui se sont soumises à une épreuve de travail avec et sans ces mesures.
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L’échographie du troisième trimestre avec EPF et mesure de l’épaisseur du SUI est associée à une réduction significative du taux de morbidités périnatales majeures chez les femmes avec antécédent de césarienne.
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Citation Excerpt :
Some of these methods are time consuming to perform and there can be considerable variability in measurements between different ultrasonographers. One previously described method of measuring the chest circumference to abdominal circumference ratio cannot be used in fetuses with large abdominal circumferences, therefore fetuses with polycystic kidneys, obstructive uropathy or omphaloceles would be excluded [5]. Recent studies have shown that the fetal pulmonary vasculature reacts to MH [6–8].
Persistent pulmonary hypertension of the newborn (PPHN) is a condition that occurs in 0.5–7 per 1000 live births and can result in significant cardiovascular instability in the newborn. It occurs when there is a failure of the normal circulatory transition in the early newborn period. Recent studies have shown that fetal pulmonary vasculature reacts to maternal hyperoxygenation (MH). The aim of the study is to assess if the in-utero response to MH can predict pulmonary hypertension in the early newborn period.
We will perform a prospective cohort study. It will evaluate the use of fetal echocardiographic Doppler assessment of the pulmonary vasculature prior to and following MH to predict fetuses that may develop pulmonary hypertension in the neonatal period. The study will be undertaken in the Rotunda Hospital, Dublin, Ireland. A fetal ultrasound and echocardiography will be performed on fetuses in the third trimester. Blood flow velocity waveforms will be recorded during periods of fetal quiescence. Pulsatility index (PI), Resistance index (RI), Peak systolic (PSV) and end diastolic velocity (EDV), time-averaged velocity (TAV), acceleration time (AT), and ejection time (ET) will be measured within the fetal distal pulmonary artery (PA). The acceleration-to-ejection time ratio (AT: ET) will be used to assess pulmonary vascular resistance (PVR). Doppler measurements will be taken at baseline and repeated immediately following MH for 10 min (O2 100% v/v inhalational gas) at a rate of 12L/min via a partial non-rebreather mask. Doppler waveform measurements from the umbilical artery (UAD), middle cerebral artery (MCA) ductus arteriosus (DA), aortic isthmus (AoI) and ductus venosus (DV) will also be obtained. After birth, a comprehensive neonatal functional echocardiogram will be performed within the first 24 hours of life.
This study proposes to validate methods described to date in investigating the fetal pulmonary vascular response to MH, with expansion of the study subjects to include fetuses at risk of PPHN. Evaluation of the different at-risk subgroups will be informative in relation to the fetal circulatory adaptation close to term. Prediction of neonatal pulmonary hypertension may help guide the pharmacological and neonatal ICU strategies that optimise postnatal survival.
Descriptive and Functional Genomics in Neonatal Respiratory Distress Syndrome: From Lung Development to Targeted Therapies
2024, International Journal of Molecular Sciences

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Mode of delivery and risk of respiratory diseases in newborns

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Obstet Gynecol

Clin Perinatol

Obstet Gynecol

Obstet Gynecol

Obstet Gynecol Clin North Am

Elective delivery of the term fetus

JAMA

Neonatal morbidity after elective repeat cesarean section and trial of labor

Pediatrics

Severe respiratory failure after elective repeat cesarean deliveryA potentially preventable condition leading to extracorporeal membrane oxygenation

Pediatrics