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Introduction To determine the impact of route of delivery on maternal outcomes among individuals who deliver preterm (before 37 weeks). Materials and methods This was a population-based retrospective cohort study using the U.S. vital statistics datasets on Period Linked Birth-Infant Death Data from 2014 to 2018. The study population was restricted to live births from women with non-anomalous singletons who delivered at 24–36 weeks of gestation. The main explanatory variable for this study was route of delivery, which was categorized as: (i) vaginal delivery, (ii) cesarean delivery with labor, and (iii) cesarean delivery without labor. The primary outcome was composite maternal adverse outcome, which encompassed any of the following: admission to the intensive care unit, maternal blood transfusion, uterine rupture, or unplanned hysterectomy. The results were presented as adjusted relative risk (aRR) with 95% confidence interval (CI). Results Over the study period 1,440,510 live births met the inclusion criteria, and the overall composite maternal adverse outcome was 14.38 per 1,000 live births. After multivariable adjustment, compared to women who underwent a vaginal delivery, the risk of composite maternal adverse outcome was higher in women who had a cesarean delivery with labor (aRR 3.70; 95% CI 3.52–3.90) and those who had a cesarean delivery without labor (aRR 4.79; 95% CI 4.59–4.98). Conclusion With preterm birth, cesarean delivery without labor has higher rate of composite maternal morbidity than cesarean during labor or vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: Among low-risk pregnancies, we aimed to ascertain the association between 5-minute Apgar score and adverse outcomes of newborn-maternal dyad.Study Design: We conducted a retrospective cohort study using the U.S. vital statistics datasets (2012-2016), including live births from low-risk women with non-anomalous singleton gestations who delivered at 37-41 weeks. Apgar score was categorized as low (0-3), moderate (4-6), and normal (7-10). The primary outcome was composite neonatal adverse outcome (any of the following: assisted ventilation > 6 h, neonatal seizure, or neonatal death). The secondary outcomes were infant mortality and composite maternal adverse outcome (any of the following: admission to the intensive care unit, blood transfusion, uterine rupture, or unplanned hysterectomy). Multivariable Poisson regression analyses were used to estimate the association between 5-minute Apgar score and adverse outcomes (using adjusted relative risk [aRR] and 95% confidence intervals [CI]).Results: Of 19.9 million live births delivered between 2012 and 2016, 11.7 million (58.7%) met inclusion criteria; 98.9% had a normal 5-minute Apgar score, 0.9% had a moderate score, and 0.2% had a low score. The overall composite neonatal adverse outcome was 3.2 per 1,000 live births and the rates were significantly higher among those with a moderate (aRR 20.8; 95% CI 20.2-21.4) or low score (aRR 43.1; 95% CI 41.6-44.5) than normal score. The overall composite maternal adverse outcome was 2.45 per 1,000 live births and it was significantly higher in deliveries with a moderate (aRR 3.1; 95% CI 2.9-3.3) and low (aRR 4.6; 95% CI 4.2-5.0) 5-minute Apgar score than those with a normal score. Infant mortality also showed a similar pattern.Conclusion: Though approximate 1% of live births had a 5-minute Apgar score below 7 among low-risk pregnancies, a decreased score was associated with a significantly higher risk of neonatal and maternal adverse outcomes, as well as infant mortality. [ABSTRACT FROM AUTHOR]