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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]

Objectives To compare the composite neonatal and maternal adverse outcomes among women with diabetes who labor and deliver at 37–41 weeks at distinct time shifts. Methods This population-based retrospective cohort study using the US Vital Statistics dataset on Period Linked Birth-Infant Death Data from 2013–2017. The study population was restricted to non-anomalous singleton live births from women with pregestational or gestational diabetes, who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. The time of delivery was categorized as the first shift (7:00–15:00), the second shift (15:00–23:00), and the third shift (23:00–7:00). The primary outcome was a composite neonatal adverse outcome; the secondary outcome was a composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI). Results Of 19.8 million live births during the study period, 3.3% (643,610) met the study inclusion criteria. The overall rate of composite neonatal and maternal adverse outcomes were 9.62 and 3.63 per 1000 live births, respectively. Multivariable adjusted regression analysis showed that, compared to newborns delivered at the first shift, the risk of composite neonatal adverse outcome was modestly but significantly higher (aRR 1.19, 95% CI 1.12–1.27) in the third shift (23:00–7:00). There was no significant difference in the risk of composite maternal adverse outcomes between time shifts. In the sensitivity analysis stratified by the day of the week (weekday vs weekend), the results were consistent with the primary analyses. Conclusion Among term pregnancies complicated by diabetes, compared with delivery at 7:00–15:00, the risk of a composite neonatal adverse outcome is marginally but significantly higher if delivery occurs at the third shift (23:00–7:00). [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of neonatal hypoglycemia among newborns delivered by individuals with Type 2 diabetes mellitus (T2DM) in two clinical scenarios: who attempted vaginal delivery vs. had a planned cesarean delivery (CD); who had intrapartum insulin infusion vs. who did not. Methods: This was a retrospective cohort study of individuals with insulin-treated T2DM who had non-anomalous singleton pregnancy and delivered at a single tertiary center (March 2012 and May 2018). Individuals with chronic renal failure, proliferative retinopathy, or major congenital anomalies were excluded. The primary outcome was neonatal hypoglycemia (blood glucose < 40 mg/dl <24 h of age or < 50 mg/dl >24 h of age). Secondary outcomes included neonatal outcomes. Multivariable Poisson regression models with robust error variance were used to examine the association between groups and the primary outcome. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. Results: Of 233 individuals with T2DM, 215 (92.2%) met the inclusion criteria, of whom 95 (44%) attempted vaginal delivery and 120 (56%) had a planned CD. Individuals who labored had a higher gestational age at delivery (36.6 vs. 35.8 weeks, p = .005), and higher blood glucose levels upon admission (125 vs 103, p < .001) compared to those with a planned CD. After adjustment for potential confounders, there was no difference in risk of neonatal hypoglycemia between the groups (41.2 vs 44.1%, aRR 1.05, 95% CI = 0.75-1.45). Among those who attempted vaginal delivery, 34 (35.8%) required insulin infusion. There was no difference in the risk of neonatal hypoglycemia (aRR = 0.79, 95% CI = 0.45-1.37) between newborns delivered by individuals who required insulin infusion and those who did not. Conclusion: Over 40% of newborns delivered by individuals with insulin-dependent T2DM had hypoglycemia; however, there was no significant difference in the risk of hypoglycemia, irrespective of the route of delivery and the use of insulin infusion. [ABSTRACT FROM AUTHOR]

Objective  Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. Study Design  Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal morbidity which defined as any of the following: transfusion of ≥4 RBC units or ureter/bowel injury. Neonatal outcome was a composite neonatal morbidity defined as any of the following: Apgar score's < 5 at 5 minutes, mechanical ventilation, or respiratory distress syndrome. Maternal demographic, clinical, and sonographic characteristics were compared between the two groups (planned vs. unplanned). Descriptive statistics were used as appropriate, and a statistical significance was established if p -value was < 0.05. Results  Of 109 women who underwent cesarean hysterectomy for PAS, 41 (37.6%) had an unplanned delivery. There was no significant difference in the number of previous cesarean deliveries or ultrasound findings between the two groups. Women with an unplanned delivery were more likely to bleed during pregnancy than those that had a planned delivery (p  = 0.04). Women with unplanned delivery had lower gestational age at delivery (30.3 vs. 33.8 weeks, p  = 0.001) had a 75% higher rate of the primary outcome (63 vs. 36%, p  = 0.007) and had a higher rate of intensive care unit admissions (39 vs. 17.7%, p  = 0.01) compared with women with a planned delivery. The neonatal morbidity did not differ between the two groups. Conclusion  Since unplanned cesarean hysterectomy among women with PAS occurs in 40% and is associated with significantly higher morbidity, interventions are needed to mitigate the rate of adverse outcomes. Key Points Only 60% of women with PAS reached planned delivery at 34 weeks. PAS unplanned delivery is associated with high morbidity. Some women with PAS may need a scheduled earlier delivery. [ABSTRACT FROM AUTHOR]

Objective: To examine risk factors and adverse outcomes for neonatal-maternal dyads among low-risk pregnancies at term with subsequent neonatal seizures.Methods: United States vital statistics data sets were used for this retrospective study. Inclusion criteria were low-risk women (without hypertensive disease or diabetes) with nonanomalous singleton pregnancies, who delivered after labor at 37-41 weeks of gestation. The primary composite neonatal adverse outcome included 5-minute Apgar score less than 5, assisted ventilation longer than 6 hours, and neonatal death. A secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used, with adjusted relative risk (aRR) and 95% CI reported.Results: Of 19.76 million live births during the study interval, 11.7 million (59.4%) met inclusion criteria. The rate of neonatal seizures after low-risk pregnancies delivered at term was 0.2 per 1,000 live births. The maternal risks factors associated with neonatal seizures included no prenatal care, smoking during pregnancy, being overweight or obese, and gestational age of 41 weeks. The strongest risk factors for neonatal seizures were chorioamnionitis (relative risk [RR] 5.04, 95% CI 4.40-5.77; aRR 3.27, 95% CI 2.84-3.76) and route of delivery, with operative vaginal (RR 3.62, 95% CI 3.20-4.09; aRR 3.02, 95% CI 2.66-3.43) and cesarean (RR 4.13, 95% CI 3.81-4.48; aRR 3.14, 95% CI 2.86-3.45) higher than spontaneous vaginal. Compared with neonates without seizures, those with seizures had higher risk of composite neonatal adverse outcome (RR 64.55, 95% CI 61.83-67.39; aRR 37.09, 95% CI 35.20-39.08). Compared with women who delivered neonates without seizures, those who delivered neonates with seizures had higher risk of composite maternal adverse outcome (RR 16.27, 95% CI 13.66-19.37; aRR 9.70, 95% CI 8.15-11.53).Conclusion: We identified modifiable maternal risk factors associated with neonatal seizures among low-risk pregnancies at term. Though infrequent, neonatal seizures are associated with higher risk of adverse outcomes in neonatal-maternal dyads. [ABSTRACT FROM AUTHOR]

Objective: To compare the composite neonatal and maternal adverse outcomes among low-risk pregnant women who labor and subsequently deliver at different time shifts.Methods: This was a population-based retrospective cohort study using the U.S. vital statistics data set on Period Linked Birth-Infant Death Data from 2012 to 2016. The study population was restricted to live births from low-risk women with nonanomalous singletons who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. Time of delivery was categorized as the first shift (7:00-15:00), the second shift (15:00-23:00), and the third shift (23:00-7:00). The primary outcome was composite neonatal adverse outcome, and the secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI).Results: Of 19.9 million live births during the study period, 58.8% (more than 11.6 million) met the inclusion criteria. The overall composite neonatal adverse outcome was 6.6 per 1,000 live births. The multivariable adjusted analysis demonstrated that, compared with neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the second shift (relative risk [RR] 1.15, aRR 1.07, 95% CI 1.05-1.09), and the third shift (RR 1.28, aRR 1.24, 95% CI 1.22-1.27). The overall composite maternal adverse outcome was 2.45 per 1,000 live births. After adjustment, there was no significant difference in the risk of composite maternal adverse outcome based on the time of delivery.Conclusion: Among low-risk singleton pregnancies, compared with delivery at 7:00-15:00, the composite neonatal adverse outcome is marginally but significantly higher if the delivery occurs at the second (15:00-23:00) and the third (23:00-7:00) shifts. The composite maternal adverse outcome is similar among the three different time shifts. [ABSTRACT FROM AUTHOR]

Introduction: A potential manner to lower the morbidity with the hypertensive disoreders of pregancy is to explore the time of day of delivery.Objective: To compare composite neonatal adverse outcomes among term women with hypertensive disorders.Methods: This population-based cohort study used the U.S. vital statistics dataset from 2013 to 2017. Time of delivery was categorized into three shifts. The primary outcome was composite neonatal adverse outcome..Results: Compared to neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the third shift (aRR = 1.19, 95% CI = 1.13-1.25).Conclusion: the risk of composite neonatal adverse outcome is higher if the delivery occurs at the third (23:00-7:00) shift. [ABSTRACT FROM AUTHOR]

Objective: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women.Methods: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, composite neonatal morbidity, included any of the following: Apgar score below 5 at 5 minutes, assisted ventilation longer than 6 hours, seizure, or mortality. The secondary outcome, composite maternal morbidity, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson regression was used to estimate the association between gestational age and morbidity (using adjusted relative risk [aRR] and 95% CI).Results: Of 19.8 million live births during the study interval, 3.3 million met inclusion criteria: 43.5% were delivered at 39 weeks of gestation, 41.4% at 40 weeks, and 15.1% at 41 weeks. The overall rates of composite neonatal and maternal morbidity were 8.8 and 2.8 per 1,000 live births, respectively. Composite neonatal morbidity was higher for those delivered at 40 (aRR 1.22; 95% CI 1.19-1.25) and 41 (aRR 1.53; 95% CI 1.49-1.58) weeks of gestation when compared with 39 weeks. Composite maternal morbidity was also significantly higher with delivery at 40 (aRR 1.19; 95% CI 1.14-1.25) and 41 weeks of gestation (aRR 1.56; 95% CI 1.47-1.65).Conclusion: Among low-risk nulliparous women, the rate of composite neonatal and maternal morbidity increases, albeit modestly, from 39 through 41 weeks of gestation. [ABSTRACT FROM AUTHOR]

Objective This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM). Methods Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death.CNMincluded 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death.Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMMwas higher amongmacrosomic deliveries (aRR = 4.08, 95% CI = 2.45-6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39-2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia. Conclusion Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM. [ABSTRACT FROM AUTHOR]