Cesarean: changing the trends

Article Abstract:

The rate of cesarean sections performed in the US has continued to escalate in spite of national guidelines which promote alternatives to the procedure such as aggressive labor management, vaginal birth for particular breech positions, and vaginal birth after cesarean (VBAC). In many hospitals, the fact that a woman has had a previous cesarean section is the leading reason for performing another such procedure. This article reports the effects on the rate of cesarean sections of a concerted effort by one obstetrical hospital to promote VBAC for patients with previous sections. During the years studied (1982-1988), the total rate of cesarean sections (both first-time and repeat) increased significantly and then stabilized; the increase was mostly the result of an increase in the first-time cesarean rate. The rate of repeat cesareans rose from 5 percent in 1982 to 6.9 percent in 1985, then dropped to 5.3 percent by 1988. This decline was due to an increase in attempted VBACs: approximately 30 percent of the patients with histories of previous cesareans attempted labor in 1982, compared with 62 percent in 1988. The success rate of VBACs remained constant during the study years (about 62 percent). The health status of infants born by VBAC, or vaginally to mothers without histories of previous cesarean sections, was comparable. The rate of primary cesareans continued to increase, for which the most frequent reasons were cephalopelvic disproportion (fetus too large for the maternal pelvis) and failure to progress in labor. The primary cesarean rate increased during the study period for patients cared for by private physicians (usually low-risk patients) and by hospital residents (usually high-risk, indigent patients), while rates for patients treated by faculty physicians (both low-and high-risk private patients) held steady. Some possible causes are discussed for the increase in the rate of primary cesarean sections at this institution. The authors comment that both individual and institutional commitments are needed to lower the rate of cesarean section. If rates continue to increase, third-party payers (such as insurance companies) may attempt to define criteria for this procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Statistics, Social policy, Cesarean section, Vaginal birth after cesarean, Obstetrics

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Cord blood gas patterns identifying newborns at increased risk of group B streptococcal sepsis

Article Abstract:

Group B Streptococcus is a common bacterial cause of pneumonia, sepsis (disease caused by pus-forming bacteria in the blood) and meningitis (inflammation of the brain and spinal cord membranes) in newborn infants. It is estimated that 20 percent of all pregnant women are carriers of group B Streptococcus and that half of these women transmit the bacteria to their infants. While only one to four infants out of every 1,000 born actually develop disease caused by group B Streptococcus, almost half of them die from the infection. This type of infection can produce a variety of different symptoms and can be difficult to diagnose. Early diagnosis of group B streptococcal infection is crucial to the survival of the infant. One study reported the development of group B streptococcal sepsis in an infant who had acidosis (low blood Ph or abnormally acidic blood). Based on this observation it was suggested that acidosis may increase the risk of developing group B streptococcal sepsis. To test this theory, umbilical cord blood was analyzed and the incidence of group B streptococcal sepsis was determined in 4,301 newborn infants. Eleven of these infants developed streptococcal sepsis. Four of the 11 infants (36 percent) with streptococcal sepsis had mild acidosis (blood pH less than 7.18) and low levels of carbon dioxide and bicarbonate in their blood. However, only 1 percent of the infants who did not have streptococcal sepsis had mild acidosis and low levels of carbon dioxide and bicarbonate in their blood. These findings suggest that infants with acidosis may have an increased risk of developing group B streptococcal sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Streptococcal infections, Causes of, Complications and side effects, Risk factors, Diseases, Neonatal diseases, Streptococcus agalactiae, Septicemia

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Umbilical cord blood gases and mortality and morbidity in the very low birth weight infant

Article Abstract:

Very low birth weight (VLBW) is a major cause of infant mortality. Over the last several decades, significant advances in medical care have improved the survival of VLBW infants. However, this has increased morbidity (sickness) among VLBW infants because more infants are surviving longer that tend to be less healthy. The Ph (relative acidity) and the amounts of oxygen, carbon dioxide and bicarbonate in the blood of the umbilical cord can be measured and used to evaluate the health status of the newborn infant. Several studies have tried to use these sorts of measurements to predict morbidity and mortality in VLBW infants, but have produced conflicting results. To investigate this issue further, 191 VLBW infants (weighing between 1.1 and 3.3 pounds at birth) were studied. The Ph and blood gases in umbilical cord blood were determined immediately after birth. The health status of each infant was determined, and infant morbidity and mortality were recorded. When attempts were made to correlate the results of the blood tests with infant morbidity, there was no detectable relationship between blood gas measurements and morbidity. However, the blood gas measurements were related to mortality. The rate of infant survival decreased as the amount of acid in the blood increased (indicated as a decrease in the pH). These findings indicate that blood gas measurements can be used to predict mortality, but not morbidity, in VLBW infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Birth weight, Low, Low birth weight, Newborn infants, Infant mortality, Perinatal death

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