ABSTRACT
OBJECTIVE: To assess maternal postpartum and neonatal outcomes associated with previous method of delivery. STUDY DESIGN: We analyzed prospectively collected maternal and neonatal data from July 2002 to December 2003. Data were collected from dedicated perinatal database and neonatal database from discharge and procedure codes. Groups were: (i) multiparous, prior vaginal delivery (VD), and (ii) multiparous, prior cesarean (CS). This group was subdivided by subsequent pregnancy trial or no trial of labor (No TOL). Results were compared with chi (2)-analysis; significance P<0.05. RESULTS: There were 17 406 births. Prior CS patients without trial of labor (TOL) required more blood transfusions, intensive care unit admissions and hospital readmissions than women with a prior VD. Prior CS patients with TOL required more aminoglycosides for postpartum infection. Term neonates of (CS) mothers without a TOL were more likely to have prolonged hospitalization and require ventilatory support. CONCLUSIONS: In their subsequent delivery, women with a prior CS delivery are at significant risks for postpartum maternal and neonatal morbidities compared with parous patients who experienced a prior VD.
Subject(s)
Cesarean Section/statistics & numerical data , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/etiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Pregnancy Outcome , Puerperal Disorders/epidemiology , Puerperal Disorders/etiology , Trial of Labor , Vaginal Birth after Cesarean/statistics & numerical data , Blood Transfusion/statistics & numerical data , California , Cesarean Section, Repeat/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Parity , Patient Admission/statistics & numerical data , Patient Readmission/statistics & numerical data , Pregnancy , Prospective Studies , Puerperal Infection/epidemiology , Puerperal Infection/etiology , Retrospective Studies , Risk Assessment/statistics & numerical data , Thromboembolism/epidemiology , Thromboembolism/etiologyABSTRACT
OBJECTIVE: To determine whether inflammatory bowel disease (IBD) is associated with increased risk for adverse perinatal outcome. METHODS: A case-control study of 116 singleton pregnancies with IBD compared to 56,398 singleton controls delivered between 1986 and 2001. RESULTS: Patients with IBD were slightly older (32.8 vs. 30.6 years, p < 0.001), more likely to be Caucasian or Asian than Black or Latino (92% vs. 57%, p < 0.001) and have private health insurance (33% vs. 3%, p < 0.001). IBD was associated with an increased risk for labor induction (32% vs. 24%, p = 0.002), chorioamnionitis (7% vs. 3%, p = 0.04) and Cesarean section (32% vs. 22%, p = 0.007), but there were no differences in neonatal outcomes. Subgroup analysis demonstrated an increased risk for low birth weight (LBW) in the ulcerative colitis group vs. the Crohn's disease group (19% vs. 0%, p = 0.002). Patients with prior surgery for IBD had a lower incidence of LBW (0% vs. 12%, p = 0.03). Flares during pregnancy were associated with an increased risk for preterm delivery (27% vs. 8%, p = 0.02) and LBW (32% vs. 3%, p = 0.003). CONCLUSION: IBD was an independent risk factor for Cesarean section but there was no increase in adverse perinatal outcome. Crohn's disease, prior IBD surgery and quiescent disease were associated with a lower risk for LBW.
