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Journal ArticleDOI

Indications contributing to the increasing cesarean delivery rate.

01 Jul 2011-Obstetrics & Gynecology (NIH Public Access)-Vol. 118, Iss: 1, pp 29-38
TL;DR: Among primary cesarean deliveries, more subjective indications (nonreassuring fetal status and arrest of dilation) contributed larger proportions than more objective indications (malpresentation, maternal-fetal, and obstetric conditions).
About: This article is published in Obstetrics & Gynecology.The article was published on 2011-07-01 and is currently open access. It has received 564 citations till now. The article focuses on the topics: Placenta previa.
Citations
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Journal ArticleDOI
TL;DR: Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of the most common indications, including labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

1,033 citations


Cites background from "Indications contributing to the inc..."

  • ...In a 2011 population-based study, the most common indications for primary cesarean delivery included, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia (Figure 3).(16) Arrest of labor and abnormal or indeterminate fetal heart rate tracing accounted for more than half of all primary cesarean deliveries in the study population....

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  • ...nate fetal heart rate”) and the rarity of category III patterns, it can be deduced that category II tracings likely account for most cesarean deliveries performed for nonreassuring fetal status.(16) Thus, one important consideration for health care providers who are making the diagnosis of nonreassuring fetal status with the intent to proceed with cesarean delivery is to ensure that clinically indicated measures have been undertaken to resolve the concerning elements of the category II tracing or provide reassurance of fetal well-being....

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Journal ArticleDOI
TL;DR: It is demonstrated that vaginal microbes can be partially restored at birth in C-section–delivered babies.
Abstract: Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section were exposed to maternal vaginal fluids at birth. Similarly to vaginally delivered babies, the gut, oral and skin bacterial communities of these newborns during the first 30 d of life was enriched in vaginal bacteria--which were underrepresented in unexposed C-section-delivered infants--and the microbiome similarity to those of vaginally delivered infants was greater in oral and skin samples than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section-delivered infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section-delivered babies.

710 citations

Journal ArticleDOI
TL;DR: It is concluded that within the first 6 weeks of life, the infant microbiota undergoes substantial reorganization, which is primarily driven by body site and not by mode of delivery.
Abstract: Whole-genome shotgun sequencing and sequencing of the gene encoding the 16S rRNA in samples from a variety of body sites in a large cohort of mothers and their infants reveals that, during the 6 weeks after birth, changes in the composition and function of the microbiome are driven by body site but not by the mode of delivery. Human microbial communities are characterized by their taxonomic, metagenomic and metabolic diversity, which varies by distinct body sites and influences human physiology. However, when and how microbial communities within each body niche acquire unique taxonomical and functional signatures in early life remains underexplored. We thus sought to determine the taxonomic composition and potential metabolic function of the neonatal and early infant microbiota across multiple body sites and assess the effect of the mode of delivery and its potential confounders or modifiers. A cohort of pregnant women in their early third trimester (n = 81) were prospectively enrolled for longitudinal sampling through 6 weeks after delivery, and a second matched cross-sectional cohort (n = 81) was additionally recruited for sampling once at the time of delivery. Samples across multiple body sites, including stool, oral gingiva, nares, skin and vagina were collected for each maternal–infant dyad. Whole-genome shotgun sequencing and sequencing analysis of the gene encoding the 16S rRNA were performed to interrogate the composition and function of the neonatal and maternal microbiota. We found that the neonatal microbiota and its associated functional pathways were relatively homogeneous across all body sites at delivery, with the notable exception of the neonatal meconium. However, by 6 weeks after delivery, the infant microbiota structure and function had substantially expanded and diversified, with the body site serving as the primary determinant of the composition of the bacterial community and its functional capacity. Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with the cesarean mode of delivery in some body sites (oral gingiva, nares and skin; R2 = 0.038), this was not true for neonatal stool (meconium; Mann–Whitney P > 0.05), and there was no observable difference in community function regardless of delivery mode. For infants at 6 weeks of age, the microbiota structure and function had expanded and diversified with demonstrable body site specificity (P < 0.001, R2 = 0.189) but without discernable differences in community structure or function between infants delivered vaginally or by cesarean surgery (P = 0.057, R2 = 0.007). We conclude that within the first 6 weeks of life, the infant microbiota undergoes substantial reorganization, which is primarily driven by body site and not by mode of delivery.

683 citations

Journal ArticleDOI
TL;DR: Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of the most common indications, including labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

626 citations

Journal ArticleDOI
TL;DR: Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient.

569 citations


Cites background from "Indications contributing to the inc..."

  • ...In many centers, the number of cesarean deliveries performed for “nonreassuring fetal status” has increased more than any other indication despite the fact that the number of women classified as high risk has not increased concomitantly.(35,36) All of these factors are compounded by the belief among many patients that cesarean delivery is safer for the fetus....

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References
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Journal ArticleDOI
TL;DR: A population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period assessed the risk of uterine rupture.
Abstract: Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 ...

821 citations

Journal ArticleDOI
TL;DR: The number of delivery hospitalizations in the United States with hypertensive disorders in pregnancy is increasing, and these hospitalizations are associated with a substantial burden of severe obstetric morbidity.

519 citations

Journal ArticleDOI
TL;DR: Increases in primary cesareans in cases of "no indicated risk" have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request."

445 citations

Journal Article
TL;DR: From 1996 to 2007, the cesarean rate increased for mothers in all age and racial and Hispanic origin groups, and the pace of the increase accelerated from 2000 to 2007.
Abstract: KEY FINDINGS Data from the Natality Data File, National Vital Statistics System. The cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States. From 1996 to 2007, the cesarean rate increased for mothers in all age and racial and Hispanic origin groups. The pace of the increase accelerated from 2000 to 2007. Cesarean rates also increased for infants at all gestational ages; from 1996 to 2006 preterm infants had the highest rates. Cesarean rates increased for births to mothers in all U.S. states, and by more than 70% in six states from 1996 to 2007.

383 citations