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2.
Medicine (Baltimore) ; 99(3): e18792, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011478

RESUMEN

BACKGROUND: Tranexamic acid (TA) has been demonstrated to reduce blood loss and the incidences of postpartum hemorrhage (PPH) during caesarean sections. We compared the clinical efficacy of TA administration on vaginal deliveries with recently published papers. METHODS: Electronic databases of PubMed, Cochrane Library, Embase and Chinese CNKI (Chinese database) and Wanfang were searched through November 2019.The randomized controlled trials were selected between TA and control groups. The relevant studies included four trials with a total of 4579 patients. RESULTS: Patients treated with TA had a reduction in total blood loss (P = .009), lower postoperative blood loss (P < .00001), a reduced number of PPH (P = .02). However, the occurrence of nausea or/and vomiting is higher in the TA group (the incidence of nausea or vomiting [P < .00001], nausea [P < .00001] and vomiting [P < .00001]). CONCLUSION: TA resulted in fewer occurrence rates of PPH, and no significant increase in occurrences of dizziness or photopsia, but higher incidence of vomiting and nausea.


Asunto(s)
Antifibrinolíticos/uso terapéutico , Hemorragia Posparto/prevención & control , Ácido Tranexámico/uso terapéutico , Antifibrinolíticos/efectos adversos , Parto Obstétrico , Femenino , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Ácido Tranexámico/efectos adversos
3.
Invest. educ. enferm ; 38(1): [E04], febrero 15 2020. Tab 1, Tab 2
Artículo en Inglés | LILACS, COLNAL | ID: biblio-1051969

RESUMEN

Objective. To evaluate the effect of interactive training conducted during pregnancy on choosing delivery method among primiparous women. Methods. Quasi-experimental study carried out in 2017 in two hospitals in the city of Bushehr (Iran), with the participation of 108 primiparous pregnant women in an educational program consisting of eight 2-hour sessions every two weeks in which interactive training activities were performed (group discussions, classroom sessions, and delivery of printed educational material) on themes related with physiological delivery, painless vaginal delivery methods, and complications of cesarean delivery without indication, among others. Before and after the intervention, the Knowledge and Preferred Method of Delivery Questionnaire by Moradabadi et al., was used to obtain information. Results. The results indicated that the level of knowledge in the group of mothers increased significantly between the pre-intervention and post-intervention assessment (13.2 versus 19.4, of 20 possible maximum points; p <0.001). Additionally, significant difference was observed in the selection of the vaginal delivery method before and after the intervention (74.1% versus 98.1%; p<0.001). Conclusion. Implementation of interactive training increased knowledge of pregnant women on the delivery and induced a positive effect to encourage the primiparous mothers to have a vaginal delivery.


Objetivo. Evaluar el efecto de un entrenamiento interactivo realizado durante el embarazo sobre la elección del método de parto en mujeres primíparas. Métodos. Estudio cuasiexperimental realizado en 2017 en dos hospitales de la ciudad de Bushehr (Irán). 108 mujeres embarazadas primíparas participaron en un programa educativo consistente en ocho sesiones de dos horas de duración cada dos semanas, en las que se realizaron actividades de capacitación interactiva (discusiones grupales, clases magistrales y entrega de material educativo impreso) sobre temas relacionados con el parto fisiológico, los métodos de parto vaginal sin dolor, las complicaciones del parto por cesárea sin indicación, entre otros. Antes y después de la intervención se utilizó, para la toma de información, el Knowledge and Preferred Method of Delivery Questionnaire de Moradabadi et al. Resultados. Los resultados indicaron que el nivel de conocimiento en el grupo de madres aumentó significativamente entre la evaluación preintervención a la posintervención (13.2 versus 19.4, de 20 puntos máximos posibles; p<0.001). Además, se observó una diferencia significativa en la selección del método de parto vaginal antes y después de la intervención (74.1% versus 98.1%; p<0.001). Conclusión. La implementación de la capacitación interactiva aumentó el conocimiento de las embarazadas sobre el parto e indujo un efecto positivo para alentar a las madres primíparas a tener un parto vaginal.


Objetivo. Avaliar o efeito de um treinamento interativo realizado durante a gravidez na escolha do método de parto em mulheres primíparas. Métodos Estudo quase experimental realizado em 2017 em dois hospitais na cidade de Bushehr (Irã). 108 gestantes primíparas participaram de um programa educacional composto por oito sessões de duas horas a cada duas semanas, nas quais foram realizadas atividades de treinamento interativas (discussões em grupo, master classes e entrega de material educacional impresso) sobre questões relacionadas ao parto métodos fisiológicos, parto vaginal sem dor, complicações do parto cesáreo sem indicação, entre outros. Antes e após a intervenção, o Questionário de Conhecimento e Método Preferido de Entrega de Moradabadi et al. Resultados Os resultados indicaram que o nível de conhecimento no grupo de mães aumentou significativamente entre a avaliação pré-intervenção e a pós-intervenção (13.2 versus 19.4, de 20 possíveis pontos máximos; p<0.001). Além disso, foi observada diferença significativa na seleção do método de parto vaginal antes e após a intervenção (74.1% versus 98.1%; p<0.001). Conclusão A implementação do treinamento interativo aumentou o conhecimento das gestantes sobre o parto e induziu um efeito positivo para incentivar as primíparas a terem um parto vaginal.


Asunto(s)
Humanos , Paridad , Embarazo , Cesárea , Procedimientos Innecesarios , Parto Obstétrico
4.
Niger Postgrad Med J ; 27(1): 42-48, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32003361

RESUMEN

Background: The delivery locations of pregnant women contribute greatly to their birth outcome. The objectives of this study were to determine the choices and determinants of delivery locations among mothers attending a primary health centre (PHC) in southern Nigeria. Research Methodology: This was a descriptive cross-sectional study among mothers attending PHC, West Itam, Itu, Nigeria. Data were collected using interviewer-administered questionnaire and analysed with STATA version 12.0. Level of significance was set at 0.05. Results: A total of 185 mothers participated in the study. The mean age of respondents was 27.6 ± 5.2 years. The delivery locations of last pregnancy were health facility (64.9%), traditional birth attendant's place (23.3%), respondent's residence (6.3%) and church (5.4%). The top five reasons that influenced the choice of delivery locations were distance (45.4%), cost (34.6%), skills of healthcare workers (30.3%), drug availability (27.6%) and attitude of healthcare workers (26.5%). Utilisation of healthcare facilities for delivery increased significantly with level of education and income of respondents and spouses (P < 0.05). Conclusion: Different non-institutionalised delivery locations were utilised by some of the respondents. Factors influencing women's choices of delivery locations included distance, cost and attitude of health workers. It is recommended that pregnant women be offered free or highly subsidised healthcare services to encourage their delivery at health facilities. Healthcare providers should endeavour to develop better relationship with clients who patronise their services. Female education should also be encouraged as this would empower them to make better choices about their health services options.


Asunto(s)
Parto Obstétrico , Accesibilidad a los Servicios de Salud , Madres , Población Rural , Adulto , Estudios Transversales , Femenino , Instituciones de Salud , Humanos , Nigeria , Embarazo , Adulto Joven
5.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895764

RESUMEN

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Asunto(s)
Parto Obstétrico/efectos adversos , Vagina/cirugía , Adulto , Femenino , Humanos , Laceraciones/etiología , Laceraciones/cirugía , Diafragma Pélvico/fisiopatología , Diafragma Pélvico/cirugía , Perineo/lesiones , Perineo/cirugía , Embarazo , Calidad de Vida , Vagina/fisiopatología , Vulva/cirugía
6.
Br J Anaesth ; 124(3): e117-e130, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31955857

RESUMEN

A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted. Factors strongly and specifically associated with persistent incisional scar pain after Caesarean delivery include a coexisting persistent pain problem in another part of the body and severe acute postoperative pain. For persistent vaginal and perineal pain, operative vaginal delivery and the magnitude of perineal trauma have been consistently linked. History of pregnancy-related and pre-pregnancy back pain and heavier body weight are robust risk factors for persistent back pain after pregnancy. Unfortunately, limitations, particularly small samples and lack of a priori sample size calculation designed to detect specific effect sizes for risk of persistent pain outcomes, preclude definitive conclusions about many other predictors and the strength of outcome associations. In future studies, assessments of specific phenotypes using a rigorous analysis with appropriate predetermined sample sizes and validated instruments are needed to allow elucidation of stronger and reliable associations. Interventional studies targeting the most robustly associated, modifiable risk factors, such as acute post-partum pain, may lead to solutions for the prevention and treatment of these common problems that impact a large population.


Asunto(s)
Cesárea/efectos adversos , Dolor Crónico/etiología , Parto Obstétrico/efectos adversos , Analgésicos Opioides/uso terapéutico , Catecol O-Metiltransferasa/genética , Dolor Crónico/prevención & control , Cicatriz/complicaciones , Femenino , Humanos , Perineo , Embarazo , Receptores Opioides mu/genética , Factores de Riesgo
8.
Lancet ; 395(10220): 285-293, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31982074

RESUMEN

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks' gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. FINDINGS: From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks' gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (<34 weeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. INTERPRETATION: In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development.


Asunto(s)
Aspirina/administración & dosificación , Preeclampsia/epidemiología , Nacimiento Prematuro/epidemiología , Adolescente , Adulto , Aspirina/efectos adversos , Presión Sanguínea , Parto Obstétrico/estadística & datos numéricos , Países en Desarrollo , Método Doble Ciego , Femenino , Humanos , Preeclampsia/prevención & control , Embarazo , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/prevención & control , Adulto Joven
15.
BJOG ; 127(3): 405-413, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31762140

RESUMEN

OBJECTIVE: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. DESIGN: Prospective observational study. SETTING: University hospital. SAMPLE: CBG from 97 VDs and 124 CDs without fetal distress. METHODS: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. MAIN OUTCOME MEASURES: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage. RESULTS: Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 -  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 -  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. CONCLUSIONS: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. TWEETABLE ABSTRACT: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.


Asunto(s)
Acidosis , Cesárea , Parto Obstétrico , Sangre Fetal/metabolismo , Complicaciones del Trabajo de Parto , Cordón Umbilical/cirugía , Acidosis/sangre , Acidosis/diagnóstico , Acidosis/etiología , Análisis de los Gases de la Sangre/métodos , Cesárea/efectos adversos , Cesárea/métodos , Cesárea/estadística & datos numéricos , Constricción , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Italia/epidemiología , Masculino , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/etiología , Embarazo , Resultado del Embarazo/epidemiología , Tiempo de Tratamiento
17.
BJOG ; 127(3): 397-403, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31749273

RESUMEN

OBJECTIVE: To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications. DESIGN: A multicentre randomised controlled trial. SETTING: Two tertiary and two general hospitals in Thailand. POPULATION: 3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery. METHODS: This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between-group differences. MAIN OUTCOME MEASURES: Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes. RESULTS: 3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46-1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10-4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62-2.37) and multiparous women (RR 2.21, 95% CI 1.77-2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit. CONCLUSIONS: Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy. TWEETABLE ABSTRACT: Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.


Asunto(s)
Parto Obstétrico , Episiotomía , Complicaciones Intraoperatorias , Laceraciones , Perineo/lesiones , Adulto , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Episiotomía/efectos adversos , Episiotomía/métodos , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/prevención & control , Presentación en Trabajo de Parto , Laceraciones/diagnóstico , Laceraciones/etiología , Laceraciones/prevención & control , Paridad , Embarazo , Resultado del Embarazo/epidemiología , Ajuste de Riesgo/métodos , Nacimiento a Término , Tailandia
18.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 14-17, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31072967

RESUMEN

OBJECTIVE: To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion. DESIGN: Randomised controlled trial. METHODS: Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother's abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights. RESULTS: 144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns' haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size. CONCLUSIONS: When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth. TRIAL REGISTRATION NUMBER: NCT02618499.


Asunto(s)
Constricción , Oxitócicos/administración & dosificación , Oxitocina/administración & dosificación , Circulación Placentaria , Periodo Posparto , Cordón Umbilical , Adulto , Bilirrubina/sangre , Peso al Nacer , Parto Obstétrico , Femenino , Hematócrito , Maternidades , Humanos , Recién Nacido , Inyecciones Intravenosas , Masculino , Hemorragia Posparto/prevención & control , Embarazo , Factores de Tiempo , Aumento de Peso
19.
Yonsei Med J ; 61(1): 79-84, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31887803

RESUMEN

PURPOSE: Hyaluronidase (HAase) has many uses in medicine, and reports suggest that it affects perineal tissue during fetal passage through the vaginal canal. However, its potential use for preventing perineal trauma has yet to be determined. This study sought to evaluate the efficacy and safety of perineal HAase injections in reducing perineal trauma during vaginal delivery. MATERIALS AND METHODS: A multi-center, double-blind, placebo-controlled, randomized study was conducted from January 2016 to March 2017. Nulliparous women who planned to undergo vaginal delivery were recruited, and the enrolled women were randomly assigned to the HAase injection group (HAase injection, 5000 IU, n=75) or the control group (normal saline injection, n=73). The degree of perineal laceration, rate of episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal delivery were compared between the two groups. RESULTS: A total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed between the HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24 hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). The overall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar between the two groups. CONCLUSION: HAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events.


Asunto(s)
Hialuronoglucosaminidasa/uso terapéutico , Perineo/patología , Heridas y Traumatismos/tratamiento farmacológico , Adulto , Estudios de Casos y Controles , Parto Obstétrico , Método Doble Ciego , Edema/patología , Episiotomía , Femenino , Humanos , Hialuronoglucosaminidasa/administración & dosificación , Incidencia , Recién Nacido , Laceraciones/etiología , Placebos , Embarazo , Resultado del Tratamiento , Adulto Joven
20.
BJOG ; 127(5): 610-617, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31883402

RESUMEN

OBJECTIVE: To determine the risk of overall preterm birth (PTB) and spontaneous PTB in a pregnancy after a caesarean section (CS) at term. DESIGN: Longitudinal linked national cohort study. SETTING: The Dutch Perinatal Registry (1999-2009). POPULATION: 268 495 women with two subsequent singleton pregnancies were identified. METHODS: A cohort study based on linked registered data from two subsequent pregnancies in the Netherlands. MAIN OUTCOME MEASURES: The incidence of overall PTB and spontaneous PTB with subgroup analysis on gestational age at first delivery and type of CS (planned or unplanned). RESULTS: Of 268 495 women with a singleton first pregnancy who delivered at term, 15.76% (n = 42 328) had a CS. The incidence of PTB in the second pregnancy was 2.79% (n = 1182) in women with a previous CS versus 2.46% (n = 5570) in women with a previous vaginal delivery (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.07-1.21). This increased risk is mainly driven by an increased risk of spontaneous PTB after previous CS at term (aOR 1.50, 95% CI 1.38-1.70). Analysis for type of CS compared with vaginal delivery showed an aOR on spontaneous PTB of 1.86 (95% CI 1.58-2.18) for planned CS and an aOR of 1.40 (95% CI 1.24-1.58) for unplanned CS. CONCLUSIONS: CS at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. TWEETABLE ABSTRACT: Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.


Asunto(s)
Cesárea , Nacimiento Prematuro/epidemiología , Nacimiento a Término , Adulto , Estudios de Cohortes , Parto Obstétrico , Femenino , Edad Gestacional , Humanos , Incidencia , Estudios Longitudinales , Países Bajos/epidemiología , Embarazo , Sistema de Registros , Riesgo
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