Cesarean section was not associated with mortality or morbidities advantage in very low birth weight infants: a nationwide cohort study.

This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23-34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23-24, 25-26, 27-28 and 29-34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23-24 GW and the highest at 84% in VLBWIs delivered at 29-34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25-26 GW (26%) and sepsis in the 27-28 GW (25%) and 29-34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89-1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98-1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59-2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08-1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.

A mixed methods study to explore women and clinicians' response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE].

BACKGROUND: perineal suturing is a common event which affects women across a variety of international settings. Women have expressed pain related to perineal trauma in the postnatal period but little is known about pain during suturing. In addition, there is a lack of evidence to identify how professional decisions are made about pain management during the suturing process. OBJECTIVE: to explore women and clinicians' response to pain during the suturing of second degree tears and episiotomies. DESIGN: mixed method feasibility study which included observation, questionnaires and interviews. SETTING: a Hospital Trust in Northwest England. PARTICIPANTS: 40 women and 21 clinicians participated. MEASUREMENTS AND FINDINGS: mild, moderate and severe pain was measured via the McGill Pain Questionnaire-Short Form (MCPQ-SF). Psychological distress was identified via the Hospital Anxiety and Depression Scale (HADS). Semi-structured face to face interviews identified three themes, Psychological distress and future functioning; Variation in practice and Style of communication. KEY CONCLUSIONS: women who experienced psychological distress during previous or current childbirth scored higher on HADS and MCPQ-SF, and appeared to express more concerns about future functioning and healing. Variation in practice exists and style of communication had the potential to make the difference for women. IMPLICATIONS FOR PRACTICE AND RESEARCH: the process of suturing is complex and is not a standalone event for a woman. It is crucial that health professionals consider previous and subsequent experience of perineal suturing. Future research aims to develop a decision tree to support pain management during suturing.

Demographic, institutional and obstetrical risk factors for postpartum haemorrhage mortality.

This study, initially presented at the SMFM Annual Conference in San Diego on 29 January 2009, sought to explore the risk factors for mortality from postpartum haemorrhage (PPH). A total of 138,316 cases of PPH from 1991 to 2000 were identified using the California Health Discharge Database. Data analysed included demographic information and clinical risk factors. PPH increased from 1.9% to 2.8%, while mortality rate decreased during the study period (1991-2000). Logistic regression showed that hysterectomy, hypertensive disorders, abruption, transverse caesarean delivery, and classical caesarean delivery, increased risk for PPH mortality, while manual placental extraction, episiotomy, and laceration repairs decreased risk. Two geographical regions, Inland Empire and Orange County, were associated with increased PPH mortality, despite having lower incidence of PPH. Teaching status and investor ownership of hospitals increased the risk of PPH mortality. There was no associated change in mortality based on hospital quality rating.

[Prophylactic episiotomy--a historical heritage with no medical foundation?].

The purpose of this study was to determine the historical roots of so called routine or prophylactic episiotomy and its real value in now-a-day obstetric practice. We made a retrospective study on clinical trails and medical anthropology data.