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“Maternal risk factor for postterm pregnancy and cesarean delivery following labor induction.” Acta Obstet Gynecol Scand 89(8): 1003-1010.

Maternal smoking and reduced duration of breastfeeding…

Maternal Smoking During Pregnancy and Severe …

PageA quantitative study on the effects of maternal smoking on placental ..
Continuous variables were compared with the use of the Wilcoxon rank-sum test, and categorical variables with the use of the chi-square test or Fisher's exact test. Multivariate logistic-regression analysis was performed to adjust for potential confounding factors for the composite end point of the rate of maternal adverse events (endometritis, transfusion, uterine rupture, hysterectomy, death, dehiscence, and thromboembolic disease, as well as hematoma of the broad ligament, cystotomy, bowel injury, and ureteral injury) and of neonatal adverse events at term (intrapartum stillbirth, hypoxic–ischemic encephalopathy, and neonatal death). These possible confounding factors included maternal age at delivery, race or ethnic background, marital status, smoking status during pregnancy, type of insurance at the time of delivery, number of previous cesarean deliveries, birth weight of the infant in the current delivery, prior vaginal delivery, and underlying medical disease. Nominal two-sided P values are reported. SAS software, version 8 (SAS Institute), and Stat-Xact, version 5 (Cytel Software), were used for the analyses.

The Effect of Maternal Smoking during Pregnancy on …


Maternal and perinatal outcomes were compared between women who had a trial of labor and those who underwent elective repeated cesarean delivery without labor or other indications for cesarean delivery, such as a prior classical (up-and-down) or “inverted T” incision, breech or transverse presentation, placenta previa, prior myomectomy, nonreassuring patterns in the antepartum fetal heart rate, genital herpes, or a medical condition precluding a trial of labor. Women presenting in labor with cervical dilatation of at least 4 cm, as well as those receiving oxytocin, were classified as undergoing a trial of labor. Women presenting in early labor who subsequently underwent cesarean delivery were excluded from the analysis owing to the difficulty in distinguishing between a failed trial of labor and a planned elective repeated cesarean delivery. The study was approved by the human subjects committee at each participating center; written consent was not required, since patient identifiers were not included in the data-collection process.

 

Parental Smoking During Pregnancy and ADHD in …


After adjustment for demographic factors and the presence of maternal diseases, the odds ratio for maternal adverse events (one or more of the complications listed in ) associated with a trial of labor was 1.96 (95 percent confidence interval, 1.73 to 2.22). Maternal adverse events were more frequent among women who had an unsuccessful trial of labor than among women who had a successful vaginal delivery ().


Our data indicate that a trial of labor by women with a history of cesarean delivery is associated with an increased risk of adverse perinatal outcomes and a higher rate of maternal adverse events, as compared with elective repeated cesarean delivery. The magnitude of these risks is small; however, this information is important for women and health care providers who are making choices about the type of delivery. The strengths of this study are its large size, its multicenter design, and its prospective process of data collection by trained obstetrical research nursing staff with the use of standardized definitions.


carinum AG | Article review: maternal smoking

The labor and delivery logbook or database at each participating center was screened daily to identify all cases. Medical records for each woman and infant were reviewed by trained study nurses who were not blinded to the mode of delivery. Demographic data, details of the obstetrical history, and information about intrapartum and postpartum events were recorded. The prospective nature of the study allowed treating physicians to be contacted to resolve questions about complications of delivery. Neonatal data were collected up to 120 days after delivery or at the time of hospital discharge. Additional detailed data were collected regarding the clinical course of all infants admitted to a neonatal intensive care unit. A separate data-collection form was completed for all infants who had a clinical diagnosis of hypoxic–ischemic encephalopathy, for all women with uterine rupture, and for infants who had any of the following: seizures or cardiopulmonary resuscitation during the first 24 hours of life, umbilical-artery blood pH values below 7.0, head imaging at term, or a five-minute Apgar score of less than 4. All instances of uterine rupture, maternal death, stillbirth, and hypoxic–ischemic encephalopathy of the newborn underwent secondary review by local study investigators and a final central review by two of the authors to ensure accurate diagnoses.

Prevalence of maternal smoking and ..

It has generally been accepted that vaginal delivery is associated with lower maternal morbidity and mortality rates than is cesarean section. In contrast to an earlier meta-analysis, we found an increased risk of both endometritis and transfusion in women who underwent a trial of labor. The exclusion from the study of women who presented in early labor and subsequently underwent repeated cesarean delivery probably lowered the risk of these complications in the group of women undergoing elective repeated cesarean delivery. We confirmed that many of the excess adverse events accompanying a trial of labor are attributable to the failure of labor and the requirement for a repeated cesarean operation.

Meta‐analysis of the association of maternal smoking …

We performed a prospective cohort study from 1999 through 2002 at 19 academic medical centers belonging to the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Eight centers participated throughout the study, five participated only during the first two years, and six participated for part of the last two years. The cesarean registry was planned as a three-year study in order to collect sufficient data about uncommon and rare maternal complications such as uterine rupture. However, because the rate of trial of labor declined during the study period, data were collected for an additional year. This study includes all women who had a prior cesarean delivery and who had a singleton pregnancy at 20 weeks or more of gestation or whose infant had a birth weight of at least 500 g.