Impact of cesarean delivery due to maternal choice on perinatal outcome in term nulliparous patients with a singleton fetus in a vertex presentation.

OBJECTIVE: The objectives of our study were to: (1) evaluate the prevalence of cesarean delivery due to maternal request among nulliparous, term, singleton, vertex (NTSV) patients; (2) identify the clinical profile, if any, of these patients; and (3) compare the perinatal outcomes between NTSV patients who requested a cesarean delivery versus patients who did not request cesarean delivery. STUDY DESIGN: This was a retrospective case control study performed at a single institution between November 2018 and July 2019. All NTSV patients who had a cesarean delivery due to maternal choice were identified and compared to the next two NTSV patients in labor who delivered vaginally or by medically indicated cesarean delivery following a cesarean delivery by maternal choice. The primary outcome was composite neonatal morbidity. Secondary outcomes were individual components of composite neonatal and maternal morbidity. RESULTS: Of 1138 NTSV patients, 61 (5.4%) patients opted for cesarean delivery by maternal choice. There were significant differences in the demographic/clinical profile between cases and controls including BMI (35.3 kg/m2 vs. 32.7 kg/m2, p < .01), birthweight (3552 gr vs. 3333 gr, p < .001) and documented mental illness (41.0% vs. 22.1% respectively, p < .01). There was no significant difference in composite neonatal morbidity between cases and controls (6.6% vs. 5.7%, adjusted odds ratio [aOR] 0.96, 95% CI 0.25-3.61). The risk for postpartum hemorrhage requiring blood transfusion was higher (but not statistically significant) in the study group (5.0% vs. 0.0%, aOR 6.43, 95% CI: 0.65-63.24). Patients who chose cesarean delivery during the intrapartum period had a higher (but not statistically significant) composite neonatal morbidity (14.3% vs. 5.7%, aOR 2.24, 95% CI 0.52-9.78) and composite maternal morbidity (28.6% vs.11.8%, aOR 2.90, 95% CI 0.92-9.16) and significantly higher transfusion rate (aOR 16.93, 95% CI 1.53-187.74). CONCLUSION: Cesarean delivery by maternal choice in NTSV patients is not associated with improved neonatal outcomes; in contrast, it is associated with increased composite maternal morbidity and increased transfusion rate.

Adverse Pregnancy Outcomes Among Individuals With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Systematic Review and Meta-analysis.

OBJECTIVE: To compare the risk of intrauterine fetal death (20 weeks of gestation or later) and neonatal death among individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with those who tested negative for SARS-CoV-2 on admission for delivery. DATA SOURCES: MEDLINE, Ovid, EMBASE, Cumulative Index to Nursing and Allied Health, and Cochrane Library were searched from their inception until July 17, 2020. Hand search for additional articles continued through September 24, 2020. ClinicalTrials.gov was searched on October 21, 2020. METHODS OF STUDY SELECTION: The inclusion criteria were publications that compared at least 20 cases of both pregnant patients who tested positive for SARS-CoV-2 on admission to labor and delivery and those who tested negative. Exclusion criteria were publications with fewer than 20 individuals in either category or those lacking data on primary outcomes. A systematic search of the selected databases was performed, with co-primary outcomes being rates of intrauterine fetal death and neonatal death. Secondary outcomes included rates of maternal and neonatal adverse outcomes. TABULATION, INTEGRATION, AND RESULTS: Of the 941 articles and completed trials identified, six studies met criteria. Our analysis included 728 deliveries to patients who tested positive for SARS-CoV-2 and 3,836 contemporaneous deliveries to patients who tested negative. Intrauterine fetal death occurred in 8 of 728 (1.1%) patients who tested positive and 44 of 3,836 (1.1%) who tested negative (P=.60). Neonatal death occurred in 0 of 432 (0.0%) patients who tested positive and 5 of 2,400 (0.2%) who tested negative (P=.90). Preterm birth occurred in 95 of 714 (13.3%) patients who tested positive and 446 of 3,759 (11.9%) who tested negative (P=.31). Maternal death occurred in 3 of 559 (0.5%) patients who tested positive and 8 of 3,155 (0.3%) who tested negative (P=.23). CONCLUSION: The incidences of intrauterine fetal death and neonatal death were similar among individuals who tested positive compared with negative for SARS-CoV-2 when admitted to labor and delivery. Other immediate outcomes of the newborns were also similar among those born to individuals who tested positive compared with negative for SARS-CoV-2. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020203475.

External funding of obstetrical publications: citation significance and trends over 2 decades.

OBJECTIVE: The objective of the study was to identify the external funding status of the most frequently cited obstetrical publications (citation classics) and to assess trends in funded vs nonfunded manuscripts as well as each publication's type of external funding. STUDY DESIGN: For the first objective, the citation classics, which were reported in a previous publication, were reviewed to identify their funding status. For the second objective, all pregnancy-related and obstetrical publications from the 2 US-based leading journals, the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology, were reviewed to identify the funding status and trends between 1989 and 2012. RESULTS: Twenty-seven of 44 of the citation classics (61%) had external funding, whereas only 43% of the reviewed regular (non-citation classic) obstetrical publications had external funding. There was a decreasing trend in the number of obstetrical manuscripts associated with a decreasing trend in the number and proportion of nonfunded manuscripts and an increasing trend in the number and proportion of National Institutes of Health (NIH)-funded manuscripts. Relative to 1989, in 2012 there was a 34.8% decrease in the number of published obstetrical manuscripts, a 59.6% decrease in the number of nonfunded manuscripts, and a 6.8% increase in the number of funded manuscripts accompanied by an 8.2% increase in the number of NIH-funded publications. In the last 9 years (2004-2012), there was a 35.1% increase in the proportion of NIH-funded manuscripts accompanied by an 18.8% decrease in the proportion of non-NIH-funded manuscripts. CONCLUSION: Our findings provide useful data regarding the importance of securing NIH-based funding for physicians contemplating academic careers in obstetrics.