Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study.

OBJECTIVE: Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis. METHODS: We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes. RESULTS: A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed. CONCLUSIONS: History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.

Risk factors and consequences of undiagnosed cesarean scar pregnancy: a cohort study in China.

BACKGROUND: The historically high cesarean section rate and the recent change in second-child policy could increase the risk of cesarean scar pregnancy (CSP) in China. This study aims to assess risk factors and consequences of undiagnosed CSP in China. METHODS: We conducted a retrospective cohort study between January 2013 and December 2017 in Qingyuan, Guangdong, China. Independent risk factors for undiagnosed CSP at the first contact with healthcare providers were assessed by log binomial regression analysis. Occurrence of serious complications was compared between undiagnosed and diagnosed CSP cases. RESULTS: A total of 195 women with CSP were included in the analysis. Of them, 81 (41.5%) women were undiagnosed at the first contact with healthcare providers. Women initially cared in primary or secondary hospitals were at increased risk for undiagnosed CSP: adjusted relative risks (95% confidence intervals) were 3.28 (2.06, 5.22) and 1.91 (1.16, 3.13), respectively, compared with women initially cared in the tertiary hospital. Undiagnosed CSP cases had higher incidences in serious complications (11 versus 0) and post-surgery anemia (23 (28.4%) versus 8 (7.0%)), stayed longer in hospital, and cost higher than diagnosed CSP cases. CONCLUSIONS: Initial care provided at primary or secondary maternity care facilities is an important risk factor for undiagnosed CSP, with serious consequences to the affected women.

Menopausal symptoms in mid-life women in southern China.

OBJECTIVES: To explore the prevalence of menopausal symptoms in Chinese women aged 40-65 years living in Guangdong province in southern China, and to investigate their care-seeking behavior. DESIGN: A cross-sectional population-based study performed in Guangdong province, PR China. METHODS: A total of 9939 women were selected by multistage cluster sampling. From November 2003 to July 2004, women were interviewed in person with a prepared questionnaire about symptoms experienced in the 2 months preceding the survey. The main outcome measurements were self-reported menopausal symptoms and related factors. RESULTS: The mean age of natural menopause was 48.9 years. The prevalence and severity of menopausal symptoms were low. The three most prevalent symptoms were insomnia, joint and muscle pain, and dizziness (in 37.2%, 35.7%, and 31.5% of the sample, respectively). Hot flushes were experienced by 17.5% of women. The factors associated with the frequency of menopausal symptoms included profession, education, type of menopause and the presence of physical or emotional problems. Ever and current hormone replacement therapy usage was reported in 0.8% and 1.3% of women, respectively. Of the total study population, 28.9% had sought health care because of menopausal symptoms. CONCLUSIONS: The prevalence of menopausal symptoms in southern Chinese women is low, and this is accompanied by low usage of hormone replacement therapy.

Determinants of intrapartum fetal death in a remote and indigent population in China.

OBJECTIVE: To explore the reasons for the high rate of intrapartum fetal death observed in a remote and indigent population in China. STUDY DESIGN: We conducted an epidemiologic analysis of determinants of intrapartum fetal death in a sample of 20,891 births in 18 hospitals participating in the Qingyuan Perinatal Surveillance System from January 1, 1997 to June 30, 1998. The main determinant examined was cesarean delivery; other determinants included mother's insurance status, residence, maternal age, infant's gender, parity, gestational age, birth weight, and obstetric complications. Rates of intrapartum fetal death within categories of various maternal and infant factors were first calculated and compared; adjusted odds ratios for intrapartum fetal death were then estimated by multiple logistic regression analysis. RESULTS: The intrapartum fetal death rate in this population was 5 per 1000 total births, which accounted for about one-third of all fetal deaths. Compared with vaginal delivery, elective cesarean delivery was associated with a 100% (i.e., no intrapartum fetal death among 1572 elective cesarean deliveries) and emergency cesarean delivery with a 88% reduction, in intrapartum fetal death. Other significant determinants were related to access to obstetric care (i.e., insurance status and residence). CONCLUSION: Lack of access to quality obstetric care is the major determinant of intrapartum fetal death in this population.

Determinants of caesarean delivery among women hospitalized for childbirth in a remote population in China.

OBJECTIVE: To assess determinants of a high Caesarean delivery rate in a remote population in China. METHODS: A prospective cohort study including 20,891 women who gave birth between January 1, 1997, and June 30, 1998, in one of the 18 hospitals participating in a hospital-based regional perinatal surveillance system in Qingyuan, a remote rural region in Guangdong province, China. RESULTS: Of the 20,891 pregnant women registered by the Qingyuan Perinatal Surveillance System, 7.5% were delivered by elective Caesarean section, and 18.4% were delivered by non-elective Caesarean section. The most common indications for elective Caesarean delivery were socio-cultural, non-medical reasons, such as the woman's fear of pain, her wish to give birth on a date or at a time believed to be particularly auspicious, or her belief that delivery by Caesarean section would protect the baby's brain. Factors strongly related to elective Caesarean delivery included insurance status, maternal age, plurality, preeclampsia and eclampsia, gestational age, and birth weight. The most common indication for non-elective Caesarean delivery was cephalopelvic disproportion. Factors strongly related to non-elective Caesarean delivery included maternal age, preeclampsia and eclampsia, placenta previa, gestational age, and birth weight. CONCLUSION: Non-medical causes, including a woman's insurance status and her personal and social demands, accounted for a large proportion of elective Caesarean deliveries in this remote population in China.