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Gordon C S Smith - One of the best experts on this subject based on the ideXlab platform.
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Perinatal mortality associated with induction of labour versus expectant management in nulliparous women aged 35 years or over: An English national cohort study
2017Co-Authors: Hannah E. Knight, David A. Cromwell, Ipek Gurol-urganci, Katie Harron, Jan H. Van Der Meulen, Gordon C S SmithAbstract:BackgroundA recent randomised controlled trial (RCT) demonstrated that induction of labour at 39 weeks of gestational age has no short-term adverse effect on the mother or infant among nulliparous women aged ≥35 years. However, the trial was underpowered to address the effect of routine induction of labour on the risk of Perinatal Death. We aimed to determine the association between induction of labour at ≥39 weeks and the risk of Perinatal mortality among nulliparous women aged ≥35 years.Methods and findingsWe used English Hospital Episode Statistics (HES) data collected between April 2009 and March 2014 to compare Perinatal mortality between induction of labour at 39, 40, and 41 weeks of gestation and expectant management (continuation of pregnancy to either spontaneous labour, induction of labour, or caesarean section at a later gestation). Analysis was by multivariable Poisson regression with adjustment for maternal characteristics and pregnancy-related conditions. Among the cohort of 77,327 nulliparous women aged 35 to 50 years delivering a singleton infant, 33.1% had labour induced: these women tended to be older and more likely to have medical complications of pregnancy, and the infants were more likely to be small for gestational age.Induction of labour at 40 weeks (compared with expectant management) was associated with a lower risk of in-hospital Perinatal Death (0.08% versus 0.26%; adjusted risk ratio [adjRR] 0.33; 95% CI 0.13–0.80, P = 0.015) and meconium aspiration syndrome (0.44% versus 0.86%; adjRR 0.52; 95% CI 0.35–0.78, P = 0.002). Induction at 40 weeks was also associated with a slightly increased risk of instrumental vaginal delivery (adjRR 1.06; 95% CI 1.01–1.11, P = 0.020) and emergency caesarean section (adjRR 1.05; 95% CI 1.01–1.09, P = 0.019). The number needed to treat (NNT) analysis indicated that 562 (95% CI 366–1,210) inductions of labour at 40 weeks would be required to prevent 1 Perinatal Death. Limitations of the study include the reliance on observational data in which gestational age is recorded in weeks rather than days. There is also the potential for unmeasured confounders and under-recording of induction of labour or Perinatal Death in the dataset.ConclusionsBringing forward the routine offer of induction of labour from the current recommendation of 41–42 weeks to 40 weeks of gestation in nulliparous women aged ≥35 years may reduce overall rates of Perinatal Death.
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birth weight percentile and the risk of term Perinatal Death
Obstetrics & Gynecology, 2014Co-Authors: Alexandros A Moraitis, Michael Fleming, Angela M Wood, Gordon C S SmithAbstract:OBJECTIVE:To estimate the association between birth weight percentile and the risk of Perinatal Death at term in relation to the cause of Death.METHODS:We performed a retrospective cohort study of all term singleton births in delivery units in Scotland between 1992 and 2008 (n=784,576), excluding pe
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advanced maternal age and the risk of Perinatal Death due to intrapartum anoxia at term
Journal of Epidemiology and Community Health, 2011Co-Authors: Dharmintra Pasupathy, Jill P Pell, Angela M Wood, Michael Fleming, Gordon C S SmithAbstract:Background Advanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of Perinatal Death due to these complications is unclear. The aim of the present study was to determine the association between maternal age and delivery-related Perinatal Death at term. Methods In this retrospective cohort study, birth records of 1 043 002 singleton term infants with cephalic presentation were analysed excluding anomalous and antepartum losses in Scotland between 1985 and 2004. Linked Scottish national registries of pregnancy outcome data and Perinatal Death data were used. The event was delivery-related Perinatal Death (ie, intrauterine fetal Death during labour or Death of the infant in the first 4 weeks of life), plus a subgroup ascribed to intrapartum anoxia. Results There were 803 delivery-related Perinatal Deaths, with 490 due to intrapartum anoxia (4.7 per 10 000 births) and 313 (3.0 per 10 000 births) due to non-anoxic causes. Compared to women aged 25–34, women aged 40 and above had a twofold risk of delivery-related Perinatal Death at term (adjusted OR 2.20, 95% CI 1.42 to 3.40). The excess was explained by increased risk of Death due to intrapartum anoxia. Among women in labour at term, age greater than 40 was independently associated with risk of anoxic Death among primiparous (adjusted OR 5.34, 95% CI 2.34 to 12.20) and multiparous women (adjusted OR 2.14, 95% CI 0.99 to 4.60). Conclusions Advanced maternal age is associated with an increased risk of Death due to intrapartum anoxia at term.
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rates of and factors associated with delivery related Perinatal Death among term infants in scotland
JAMA, 2009Co-Authors: Dharmintra Pasupathy, Jill P Pell, Angela M Wood, Michael Fleming, Gordon C S SmithAbstract:Context Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of Perinatal and neonatal Death associated with complications of labor at term. Objectives To determine whether rates of Perinatal Death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in Deaths ascribed to intrapartum anoxia. Design, Setting, and Participants A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of Perinatal Deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1 012 266), excluding those with Perinatal Death due to congenital anomaly or antepartum stillbirth. Main Outcome Measure Delivery-related Perinatal Death, defined as intrapartum stillbirth or neonatal Death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of Death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. Results During the study period, the risk of delivery-related Perinatal Death decreased from 8.8 to 5.5 per 10 000 births (unadjusted change, −38%; 95% confidence interval [CI], −51% to −21%). When analyzed by the cause of Death, there was a significant decrease in the risk of Death ascribed to intrapartum anoxia (5.7 to 3.0 per 10 000 births; unadjusted change, −48%; 95% CI, −62% to −29%), but no significant change in the risk of Death ascribed to other causes. When Deaths ascribed to intrapartum anoxia were analyzed by the time of Death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10 000 births; unadjusted change, −60%; 95% CI, −75% to −34%) and neonatal Deaths (3.1 to 1.9 per 10 000 births; unadjusted change, −38%; 95% CI, −59% to −7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. Conclusion Rates of intrapartum stillbirth and neonatal Death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for Deaths ascribed to intrapartum anoxia.
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birth order of twins and risk of Perinatal Death related to delivery in england northern ireland and wales 1994 2003 retrospective cohort study
BMJ, 2007Co-Authors: Gordon C S Smith, Kate M Fleming, Ian R WhiteAbstract:Objective To determine the effect of birth order on the risk of Perinatal Death in twin pregnancies. Design Retrospective cohort study. Setting England, Northern Ireland, and Wales, 1994-2003. Participants 1377 twin pregnancies with one intrapartum stillbirth or neonatal Death from causes other than congenital abnormality and one surviving infant. Main outcome measures The risk of Perinatal Death in the first and second twin estimated with conditional logistic regression. Results There was no association between birth order and the risk of Death overall (odds ratio 1.0, 95% confidence interval 0.9 to 1.1). However, there was a highly significant interaction with gestational age (P<0.001). There was no association between birth order and the risk of Death among infants born before 36 weeks' gestation but there was an increased risk of Death among second twins born at term (2.3, 1.7 to 3.2, P<0.001), which was stronger for Deaths caused by intrapartum anoxia or trauma (3.4, 2.2 to 5.3). Among term births, there was a trend (P=0.1) towards a greater risk of the second twin dying from anoxia among those delivered vaginally (4.1, 1.8 to 9.5) compared with those delivered by caesarean section (1.8, 0.9 to 3.6). Conclusions In this cohort, compared with first twins, second twins born at term were at increased risk of Perinatal Death related to delivery. Vaginally delivered second twins had a fourfold risk of Death caused by intrapartum anoxia.
Luigi Matturri - One of the best experts on this subject based on the ideXlab platform.
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pesticide exposure during pregnancy like nicotine affects the brainstem α7 nicotinic acetylcholine receptor expression increasing the risk of sudden unexplained Perinatal Death
Journal of the Neurological Sciences, 2015Co-Authors: Anna Maria Lavezzi, Melissa F Corna, Achille Cappiello, Teresa Pusiol, Veronica Termopoli, Luigi MatturriAbstract:article This study indicates the impact of nicotine and pesticides (organochlorine and organophosphate insecticides used in agriculture) on neuronal α7-nicotinic acetylcholine receptor expression in brainstem regions receiving cholinergic projections in human Perinatal life. An in-depth anatomopathological examination of the autonomic nervous system and immunohistochemistry to analyze the α7-nicotinic acetylcholine receptor expression in the brainstem from 44 fetuses and newborns were performed. In addition, the presence of selected agricultural pesticides in cerebral cortex samples of the victims was determined by specific analytical procedures. Hypodevelopment of brainstem structures checking the vital functions, frequently associated with α7-nicotinic acetylcholine receptor immunopositivity and smoke absorption in pregnancy, was observed in high percentages of victims of sudden unexpected Perinatal Death. In nearly 30% of cases however the mothers never smoked, but lived in rural areas. The search for pesticides highlighted in many of these cases traces of both organochlorine and organophosphate pesticides. We detain that exposition to pesticides in pregnancy produces homologous actions to those of nicotine on neuronal α7-nicotinic acetylcholine receptor, allowing to developmental alterations of brainstem vital centers in victims of sudden unexplained Death.
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neuronal nuclear antigen neun a useful marker of neuronal immaturity in sudden unexplained Perinatal Death
Journal of the Neurological Sciences, 2013Co-Authors: Anna Maria Lavezzi, Melissa F Corna, Luigi MatturriAbstract:Abstract Introduction In the developing brain neuronal differentiation is associated with permanent exit from the mitotic cycle. Neuronal nuclear antigen (NeuN) is a nuclear protein widely expressed in the mature postmitotic neurons. Methods We applied NeuN immunocytochemistry in 65 cases of Perinatal Death (16 victims of sudden intrauterine unexplained Death syndrome/SIUDS, 19 of sudden infant Death syndrome/SIDS and 30 controls) to test the physiological status of the brain neurons. In addition we applied both TUNEL and Caspase 3 immunohistochemical methods in order to highlight a possible relation between decreased NeuN expression and apoptotic outcome. We also attempted to see whether or not NeuN pathological changes can be related to cigarette smoke absorption in pregnancy. Results NeuN staining was considerably reduced or lost in SIUDS/SIDS compared to controls. However neurons with decreased NeuN-labeling showed no sign of apoptosis. A significant association was found between NeuN depletion and maternal smoking. Conclusion Altered NeuN expression can be a marker of immature and/or suffering neurons. The exclusive presence of this pattern of expression in SIUDS/SIDS victims, leads us to recommend the NeuN immunohistochemistry as a routine method in neuropathological protocols to convalidate a diagnosis of sudden Perinatal Death.
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unexplained stillbirth versus sids common congenital diseases of the autonomic nervous system pathology and nosology
Early Human Development, 2011Co-Authors: Luigi Matturri, Anna Maria LavezziAbstract:Abstract Objective To contribute to a more balanced assessment of the morphological substrates underlying unexplained Perinatal Death and SIDS. Methods In-depth histological, immunohistochemical and genetic examinations were performed on the autonomic nervous and cardiac conduction systems in 95 unexpected Perinatal Deaths, 140 SIDS and 78 controls (44 infants and 34 Perinatal Death victims). Results The study revealed the localization and the nature of a variety of specific congenital abnormalities of the autonomic nervous system, central and peripheral, and of the cardiac conduction system that represent the morphological substrates of the pathophysiological mechanism of sudden fetal Death and SIDS. Conclusions The observation of similar anomalies of the autonomic nervous and the cardiac conduction systems in both unexplained Perinatal Deaths and SIDS indicates their common congenital nature. Therefore, the definitions of these Deaths, currently nosographically distinct, should be unified.
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techniques and criteria in pathologic and forensic medical diagnostics in sudden unexpected infant and Perinatal Death
American Journal of Clinical Pathology, 2005Co-Authors: Luigi Matturri, Giulia Ottaviani, Anna Maria LavezziAbstract:For each case of sudden infant and Perinatal Death, a full review of clinical and epidemiologic data and a complete necropsy study were performed according to the necropsy protocol devised by the Institute of Pathology, University of Milan, Milan, Italy (available at: ). Histopathologic examination of unexpected late fetal and neonatal Death and SIDS cases allowed us to identify frequent alterations, mainly congenital, of the autonomic nervous system, modulating respiratory, cardiovascular, arousal, and upper digestive activities. The data and arguments presented herein provide a brief survey tending to open, rather than conclude, a far-reaching subject and to motivate medicolegal specialists and pathologists to perform more in-depth study.
Jill P Pell - One of the best experts on this subject based on the ideXlab platform.
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advanced maternal age and the risk of Perinatal Death due to intrapartum anoxia at term
Journal of Epidemiology and Community Health, 2011Co-Authors: Dharmintra Pasupathy, Jill P Pell, Angela M Wood, Michael Fleming, Gordon C S SmithAbstract:Background Advanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of Perinatal Death due to these complications is unclear. The aim of the present study was to determine the association between maternal age and delivery-related Perinatal Death at term. Methods In this retrospective cohort study, birth records of 1 043 002 singleton term infants with cephalic presentation were analysed excluding anomalous and antepartum losses in Scotland between 1985 and 2004. Linked Scottish national registries of pregnancy outcome data and Perinatal Death data were used. The event was delivery-related Perinatal Death (ie, intrauterine fetal Death during labour or Death of the infant in the first 4 weeks of life), plus a subgroup ascribed to intrapartum anoxia. Results There were 803 delivery-related Perinatal Deaths, with 490 due to intrapartum anoxia (4.7 per 10 000 births) and 313 (3.0 per 10 000 births) due to non-anoxic causes. Compared to women aged 25–34, women aged 40 and above had a twofold risk of delivery-related Perinatal Death at term (adjusted OR 2.20, 95% CI 1.42 to 3.40). The excess was explained by increased risk of Death due to intrapartum anoxia. Among women in labour at term, age greater than 40 was independently associated with risk of anoxic Death among primiparous (adjusted OR 5.34, 95% CI 2.34 to 12.20) and multiparous women (adjusted OR 2.14, 95% CI 0.99 to 4.60). Conclusions Advanced maternal age is associated with an increased risk of Death due to intrapartum anoxia at term.
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rates of and factors associated with delivery related Perinatal Death among term infants in scotland
JAMA, 2009Co-Authors: Dharmintra Pasupathy, Jill P Pell, Angela M Wood, Michael Fleming, Gordon C S SmithAbstract:Context Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of Perinatal and neonatal Death associated with complications of labor at term. Objectives To determine whether rates of Perinatal Death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in Deaths ascribed to intrapartum anoxia. Design, Setting, and Participants A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of Perinatal Deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1 012 266), excluding those with Perinatal Death due to congenital anomaly or antepartum stillbirth. Main Outcome Measure Delivery-related Perinatal Death, defined as intrapartum stillbirth or neonatal Death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of Death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. Results During the study period, the risk of delivery-related Perinatal Death decreased from 8.8 to 5.5 per 10 000 births (unadjusted change, −38%; 95% confidence interval [CI], −51% to −21%). When analyzed by the cause of Death, there was a significant decrease in the risk of Death ascribed to intrapartum anoxia (5.7 to 3.0 per 10 000 births; unadjusted change, −48%; 95% CI, −62% to −29%), but no significant change in the risk of Death ascribed to other causes. When Deaths ascribed to intrapartum anoxia were analyzed by the time of Death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10 000 births; unadjusted change, −60%; 95% CI, −75% to −34%) and neonatal Deaths (3.1 to 1.9 per 10 000 births; unadjusted change, −38%; 95% CI, −59% to −7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. Conclusion Rates of intrapartum stillbirth and neonatal Death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for Deaths ascribed to intrapartum anoxia.
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mode of delivery and the risk of delivery related Perinatal Death among twins at term a retrospective cohort study of 8073 births
British Journal of Obstetrics and Gynaecology, 2005Co-Authors: Gordon C S Smith, Jill P Pell, Ian R White, Imran Shah, Richard DobbieAbstract:Objective To determine the risk of Perinatal Death among twins born at term in relation to mode of delivery. Design Retrospective cohort study. Setting Scotland 1985–2001. Population All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and Perinatal Deaths due to congenital abnormality (n= 8073). Methods The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression. Main outcome measures Intrapartum stillbirth or neonatal Death of either twin. Results Overall, there were six Deaths of first twins and 30 Deaths of second twins (OR for second twin 5.00, 95% CI 2.00–14.70). The odds ratio for Death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4–868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of Death among 1472 deliveries by planned caesarean section. There was Death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03–1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158–808) would be required to prevent each Death. Conclusion Planned caesarean section may reduce the risk of Perinatal Death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of Death of the second twin due to intrapartum anoxia.
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factors predisposing to Perinatal Death related to uterine rupture during attempted vaginal birth after caesarean section retrospective cohort study
BMJ, 2004Co-Authors: Gordon C S Smith, Jill P Pell, Dharmintra Pasupathy, Richard DobbieAbstract:Objective To determine the factors associated with an increased risk of Perinatal Death related to uterine rupture during attempted vaginal birth after caesarean section. Design Population based retrospective cohort study. Setting Data from the linked Scottish Morbidity Record and Stillbirth and Infant Death Survey of births in Scotland, 1985-98. Participants All women with one previous caesarean delivery who gave birth to a singleton infant at term by a means other than planned repeat caesarean section (n = 35 854). Main outcome measures All intrapartum uterine rupture and uterine rupture resulting in Perinatal Death (that is, Death of the fetus or neonate). Results The overall proportion of vaginal births was 74.2% and of uterine rupture was 0.35%. The risk of intrapartum uterine rupture was higher among women who had not previously given birth vaginally (adjusted odds ratio 2.5, 95% confidence interval 1.6 to 3.9, P < 0.001) and those whose labour was induced with prostaglandin (2.9, 2.0 to 4.3, P < 0.001). Both factors were also associated with an increased risk of Perinatal Death due to uterine rupture. Delivery in a hospital with < 3000 births a year did not increase the overall risk of uterine rupture (1.1, 0.8 to 1.5, P = 0.67). However, the risk of Perinatal Death due to uterine rupture was significantly higher in hospitals with < 3000 births a year (one per 1300 births) than in hospitals with ≥ 3000 births a year (one per 4700; 3.4, 1.0 to 14.3, P = 0.04). Conclusion Women who have not previously given birth vaginally and those whose labour is induced with prostaglandin are at increased risk of uterine rupture when attempting vaginal birth after caesarean section. The risk of consequent Death of the infant is higher in units with lower annual numbers of births.
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birth order gestational age and risk of delivery related Perinatal Death in twins retrospective cohort study
BMJ, 2002Co-Authors: Gordon C S Smith, Jill P Pell, Richard DobbieAbstract:Abstract Objective: To determine whether twins born second are at increased risk of Perinatal Death because of complications during labour and delivery. Design: Retrospective cohort study. Setting: Scotland, 1992 and 1997. Participants: All twin births at or after 24 weeks9 gestation, excluding twin pairs in which either twin died before labour or delivery or died during or after labour and delivery because of congenital abnormality, non-immune hydrops, or twin to twin transfusion syndrome. Main outcome measure: Delivery related Perinatal Deaths (Deaths during labour or the neonatal period). Results: Overall, delivery related Perinatal Deaths were recorded for 23 first twins only and 23 second twins only of 1438 twin pairs born before 36 weeks (preterm) by means other than planned caesarean section (P>0.99). No Deaths of first twins and nine Deaths of second twins (P=0.004) were recorded among the 2436 twin pairs born at or after 36 weeks (term). Discordance between first and second twins differed significantly in preterm and term births (P=0.007). Seven of nine Deaths of second twins at term were due to anoxia during the birth (2.9 (95% confidence interval 1.2 to 5.9) per 1000); five of these Deaths were associated with mechanical problems with the second delivery following vaginal delivery of the first twin. No Deaths were recorded among 454 second twins delivered at term by planned caesarean section. Conclusions: Second twins born at term are at higher risk than first twins of Death due to complications of delivery. Previous studies may not have shown an increased risk because of inadequate categorisation of Deaths, lack of statistical power, inappropriate analyses, and pooling of dataabout preterm births and term births. What is already known on this topic It is difficult to assess the wellbeing of second twins during labour Deliveries of second twins are at increased risk of mechanical problems, such as cord prolapse and malpresentation, after vaginal delivery of first twins Increased risks of Perinatal Death in second twins have not been shown, but the methods of these studies were flawed What this study adds Second twins delivered at term are at increased risk of delivery relatedPerinatal Deaths Intrapartum anoxia caused 75% of these Deaths in second twins, and most of these resulted from mechanical problems after vaginal delivery of first twins Planned caesarean section of twins at term may prevent Perinatal Deaths
Richard Dobbie - One of the best experts on this subject based on the ideXlab platform.
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mode of delivery and the risk of delivery related Perinatal Death among twins at term a retrospective cohort study of 8073 births
British Journal of Obstetrics and Gynaecology, 2005Co-Authors: Gordon C S Smith, Jill P Pell, Ian R White, Imran Shah, Richard DobbieAbstract:Objective To determine the risk of Perinatal Death among twins born at term in relation to mode of delivery. Design Retrospective cohort study. Setting Scotland 1985–2001. Population All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and Perinatal Deaths due to congenital abnormality (n= 8073). Methods The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression. Main outcome measures Intrapartum stillbirth or neonatal Death of either twin. Results Overall, there were six Deaths of first twins and 30 Deaths of second twins (OR for second twin 5.00, 95% CI 2.00–14.70). The odds ratio for Death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4–868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of Death among 1472 deliveries by planned caesarean section. There was Death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03–1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158–808) would be required to prevent each Death. Conclusion Planned caesarean section may reduce the risk of Perinatal Death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of Death of the second twin due to intrapartum anoxia.
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factors predisposing to Perinatal Death related to uterine rupture during attempted vaginal birth after caesarean section retrospective cohort study
BMJ, 2004Co-Authors: Gordon C S Smith, Jill P Pell, Dharmintra Pasupathy, Richard DobbieAbstract:Objective To determine the factors associated with an increased risk of Perinatal Death related to uterine rupture during attempted vaginal birth after caesarean section. Design Population based retrospective cohort study. Setting Data from the linked Scottish Morbidity Record and Stillbirth and Infant Death Survey of births in Scotland, 1985-98. Participants All women with one previous caesarean delivery who gave birth to a singleton infant at term by a means other than planned repeat caesarean section (n = 35 854). Main outcome measures All intrapartum uterine rupture and uterine rupture resulting in Perinatal Death (that is, Death of the fetus or neonate). Results The overall proportion of vaginal births was 74.2% and of uterine rupture was 0.35%. The risk of intrapartum uterine rupture was higher among women who had not previously given birth vaginally (adjusted odds ratio 2.5, 95% confidence interval 1.6 to 3.9, P < 0.001) and those whose labour was induced with prostaglandin (2.9, 2.0 to 4.3, P < 0.001). Both factors were also associated with an increased risk of Perinatal Death due to uterine rupture. Delivery in a hospital with < 3000 births a year did not increase the overall risk of uterine rupture (1.1, 0.8 to 1.5, P = 0.67). However, the risk of Perinatal Death due to uterine rupture was significantly higher in hospitals with < 3000 births a year (one per 1300 births) than in hospitals with ≥ 3000 births a year (one per 4700; 3.4, 1.0 to 14.3, P = 0.04). Conclusion Women who have not previously given birth vaginally and those whose labour is induced with prostaglandin are at increased risk of uterine rupture when attempting vaginal birth after caesarean section. The risk of consequent Death of the infant is higher in units with lower annual numbers of births.
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birth order gestational age and risk of delivery related Perinatal Death in twins retrospective cohort study
BMJ, 2002Co-Authors: Gordon C S Smith, Jill P Pell, Richard DobbieAbstract:Abstract Objective: To determine whether twins born second are at increased risk of Perinatal Death because of complications during labour and delivery. Design: Retrospective cohort study. Setting: Scotland, 1992 and 1997. Participants: All twin births at or after 24 weeks9 gestation, excluding twin pairs in which either twin died before labour or delivery or died during or after labour and delivery because of congenital abnormality, non-immune hydrops, or twin to twin transfusion syndrome. Main outcome measure: Delivery related Perinatal Deaths (Deaths during labour or the neonatal period). Results: Overall, delivery related Perinatal Deaths were recorded for 23 first twins only and 23 second twins only of 1438 twin pairs born before 36 weeks (preterm) by means other than planned caesarean section (P>0.99). No Deaths of first twins and nine Deaths of second twins (P=0.004) were recorded among the 2436 twin pairs born at or after 36 weeks (term). Discordance between first and second twins differed significantly in preterm and term births (P=0.007). Seven of nine Deaths of second twins at term were due to anoxia during the birth (2.9 (95% confidence interval 1.2 to 5.9) per 1000); five of these Deaths were associated with mechanical problems with the second delivery following vaginal delivery of the first twin. No Deaths were recorded among 454 second twins delivered at term by planned caesarean section. Conclusions: Second twins born at term are at higher risk than first twins of Death due to complications of delivery. Previous studies may not have shown an increased risk because of inadequate categorisation of Deaths, lack of statistical power, inappropriate analyses, and pooling of dataabout preterm births and term births. What is already known on this topic It is difficult to assess the wellbeing of second twins during labour Deliveries of second twins are at increased risk of mechanical problems, such as cord prolapse and malpresentation, after vaginal delivery of first twins Increased risks of Perinatal Death in second twins have not been shown, but the methods of these studies were flawed What this study adds Second twins delivered at term are at increased risk of delivery relatedPerinatal Deaths Intrapartum anoxia caused 75% of these Deaths in second twins, and most of these resulted from mechanical problems after vaginal delivery of first twins Planned caesarean section of twins at term may prevent Perinatal Deaths
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risk of Perinatal Death associated with labor after previous cesarean delivery in uncomplicated term pregnancies
Obstetrical & Gynecological Survey, 2002Co-Authors: Gordon C S Smith, Jill P Pell, A D Cameron, Richard DobbieAbstract:Although a trial of labor after a past cesarean delivery is known to carry an increased risk of uterine rupture, there is no reliable information on whether it also increases the risk of Perinatal Death in otherwise uncomplicated term pregnancies. This question was addressed in a retrospective, population-based cohort study comprising 313,238 singleton births at 37 to 43 weeks' gestation where the fetus was in a cephalic presentation. At 12.9 per 10,000 women, the rate of Perinatal Death was highest for women having a trial of labor. The odds ratio (OR), compared with women having a planned repeat cesarean delivery, was 11.6. The risk of Death from a trial of labor was similar when compared with that for nulliparous women in labor, but it was more than twice that of other multiparous women in labor (OR, 2.2). More than 90% of all delivery-related Perinatal Deaths among women with a previous cesarean delivery were attributable to the increased risk associated with a trial of labor. Adjusting for maternal age, smoking status, height, gestational age at birth, and birth weight strengthened the association between a trial of labor and Perinatal Death compared with elective repeat cesarean delivery. Similar results were obtained when only births at or after 40 weeks' gestation were analyzed. Compared with other multiparas, those having a trial of labor were more than 8-fold likelier to have a Perinatal Death due to a mechanical cause and nearly 3-fold likelier to have a Perinatal Death due to intrapartum anoxia. Although the absolute risk of Perinatal Death in women with a past cesarean delivery who undergo a trial of labor is low, the risk in the present study was higher than that of planned repeat cesarean delivery.
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risk of Perinatal Death associated with labor after previous cesarean delivery in uncomplicated term pregnancies
JAMA, 2002Co-Authors: Gordon C S Smith, Jill P Pell, A D Cameron, Richard DobbieAbstract:ContextTrial of labor after previous cesarean delivery is associated with increased risk of uterine rupture. However, no reliable data exist on the effect of a trial of labor on the risk of Perinatal Death in otherwise uncomplicated term pregnancies.ObjectiveTo determine the risk of intrapartum stillbirth or neonatal Death not related to congenital abnormality among women with uncomplicated term pregnancies who had a trial of labor after previous cesarean delivery, compared with women having a planned repeat cesarean delivery, and multiparous and nulliparous women at term not delivered by planned cesarean method.Design and SettingPopulation-based, retrospective cohort study of data from the linked Scottish Morbidity Record and Stillbirth and Neonatal Death Enquiry encompassing births in Scotland between January 1, 1992, and December 31, 1997.PopulationA total of 313 238 singleton births between 37 and 43 weeks' gestational age in which the fetus was in a cephalic presentation.Main Outcome MeasureDelivery-related Perinatal Death, defined as intrapartum stillbirth or neonatal Death unrelated to congenital anomaly, compared among the 4 groups.ResultsAmong women who had a trial of labor following previous cesarean delivery (n = 15 515), the overall rate of delivery-related Perinatal Death was 12.9 (95% confidence interval [CI], 7.9-19.9) per 10 000 women. This was approximately 11 times greater (odds ratio [OR], 11.6; 95% CI, 1.6-86.7) than the risk associated with planned repeat cesarean delivery (n = 9014), more than twice (OR, 2.2; 95% CI, 1.3-3.5) the risk associated with other multiparous women in labor (n = 151 549), and similar to the risk among nulliparous women in labor (n = 137 160; OR, 1.3; 95% CI, 0.8-2.1). The associations were not explained by differences in maternal height, smoking status, socioeconomic status, age, fetal growth, or week of gestation at delivery. Among women having a trial of labor, the rate of Death due to mechanical causes, including uterine rupture, was 4.5 (95% CI, 1.8-9.3) per 10 000 women. This was more than 8 times greater than other multiparous women (OR, 8.5; 95% CI, 3.2-22.3) and nulliparous women (OR, 8.8; 95% CI, 3.2-24.2).ConclusionsThe absolute risk of Perinatal Death associated with trial of labor following previous cesarean delivery is low. However, in our study, the risk was significantly higher than that associated with planned repeat cesarean delivery, and there was a marked excess of Deaths due to uterine rupture compared with other women in labor.
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causes of Perinatal Death at a tertiary care hospital in northern tanzania 2000 2010 a registry based study
BMC Pregnancy and Childbirth, 2012Co-Authors: Blandina T Mmbaga, Rolv T Lie, Raimos Olomi, Michael J Mahande, Oneko Olola, Anne Kjersti DaltveitAbstract:Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of Perinatal Death in order to identify categories of potentially preventable Deaths. We studied a total of 1958 stillbirths and early neonatal Deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The Deaths were classified according to the Neonatal and Intrauterine Deaths Classification according to Etiology (NICE). Overall Perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal Deaths. Major causes of Perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all Deaths), Perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer Deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000). The distribution of causes of Death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of Deaths.