Trusted Information for Healthy Pregnancies
c-section
Vaginal birth can be OK after multiple C-sections
Feb 18th
Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.
Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.
In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.
In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.
Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.
These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.
For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.
There were no cases of uterine rupture in either group, the researchers found.
The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery -- the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section -- though that difference, the researchers say, is not significant in statistical terms.
When it came to successful delivery -- meaning the doctor did not have to switch to a C-section during labor -- the chances were similar regardless of the number of prior C-sections.
Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.
Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision -- a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.
Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.
Source
Sterilization surgery not linked to sexual problems
Feb 18th
Women who have their "tubes tied" to prevent future pregnancies do not seem to have an increased risk of sexual dysfunction afterward, according to a new study.
In fact, researchers found, women in their study who'd had the procedure showed lower risks of certain sexual problems and tended to be happier with their sex lives than other women.
The surgery, known as tubal ligation, involves blocking the fallopian tubes that connect the ovaries with the uterus. It is done either right after childbirth -- through the vagina or during a cesarean section -- or via laparoscopic surgery, where one or two small incisions are made in the abdomen.
There are no physiological reasons to believe tubal ligation would cause sexual problems, but there has been little research on the subject, said Dr. Anthony Smith of La Trobe University in Melbourne, Australia, the lead researcher on the current study.
What studies there are have generally only asked women about their general sexual satisfaction, Smith told Reuters Health in an email.
For their study, Smith and his colleagues surveyed 2,721 Australian women about various sexual dysfunction symptoms and their overall satisfaction with their sex lives. Of those women, 447 -- or about 16 percent -- had had a tubal ligation, most of whom were between the ages of 40 and 64.
Overall, women who had had the procedure were less likely to report sexual problems and more likely to say they were happy with their sex lives, according to findings published in BJOG, a British medical journal.
Just over 42 percent said they lacked interest in sex, for example, compared with 51 percent of women who had not had a tubal ligation. And while 17 percent of the latter group said they "did not find sex pleasurable," only 14 percent of women in the tubal-ligation group said the same.
When the researchers accounted for other factors -- like age, education and marital status -- women who'd had a tubal ligation were roughly one-third less likely to lack interest in sex, take "too long" to reach orgasm, have vaginal dryness during sex or find sex unpleasant.
In addition, the study found, women in the tubal-ligation group generally gave higher marks to their sex lives. Thirty-six percent reported "extremely high sexual satisfaction," compared with 30 percent of women who had not had the procedure; when the researchers considered the other factors, women in the tubal-ligation group were two-thirds more likely to give such high ratings to their sex lives.
It's possible, Smith's team notes, that the women and their partners were enjoying sex more because they were free of anxiety over a potential unplanned pregnancy.
Of course, tubal ligation is only one method of birth control. In general, experts recommend it only for women who are sure they do not want to become pregnant in the future. And like any surgery, it carries some risks -- including bleeding or infection during the procedure, and incomplete closing of the tubes; about one in 200 women who have a tubal ligation later become pregnant.
Studies have also found that anywhere from 6 percent to 20 percent of women who have the procedure later regret their decision -- with younger women being more likely to express regrets.
Source
Excess weight raises pregnancy risks: study
Feb 12th
Being overweight or obese increases a woman's chances of having an extra-big baby, even after the effects of pregnancy-related, or "gestational," diabetes are taken into account, new research shows.
Excess weight in and of itself also sharply increased a woman's risk of pre-eclampsia, a potentially deadly pregnancy complication, Dr. Boyd E. Metzger of Northwestern University Feinberg School of Medicine in Chicago and his colleagues found.
Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother's weight from those of gestational diabetes, Metzger and his colleagues note in the British Journal of Obstetrics and Gynecology.
This led them to investigate whether body mass index (BMI) -- a standard measure of weight in relation to height used to gauge how fat or thin a person is -- might influence pregnancy risks and fetal and newborn health, independently of a woman's blood sugar levels.
The study involved 23,316 women from 15 different medical centers in nine different countries. All had undergone an oral glucose tolerance test, which is used to identify women with, or at risk for, pregnancy-related diabetes; at that time, their height and weight were measured, too.
The researchers then used statistical techniques to control for women's oral glucose tolerance test results. Even after this adjustment, they found that the women with BMIs of 42 or greater, denoting severe obesity (for example, a 5-foot-5-inch tall woman weighing at least 250 pounds), were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study, who had BMIs of 22.6 or less (a 5'5" woman weighing less than 138 pounds).
The heaviest women's risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women. However, the heaviest women's risk for delivering a preterm baby was actually cut in half.
These findings help sort out the role BMI and gestational diabetes each play in the risk of complications of pregnancy and delivery, Metzger told Reuters Health in an interview.
He noted that recent studies have shown that dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.
"We're pretty confident that treating gestational diabetes going forward is going to continue to be beneficial," the researcher said. "We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome."
What is becoming clear, he added, is that it's probably a woman's weight before she gets pregnant, rather than how much she gains during pregnancy, that's important in determining risk.
Source
With C-Section, Stitches May Be Best
Feb 4th
Women who've had a cesarean delivery are less likely to suffer complications if their wound is closed using sutures rather than staples, says a U.S. study.
It included more than 400 women who underwent cesarean delivery in labor or scheduled cesarean delivery and were interviewed two to four weeks after the procedure.
The researchers at the Lehigh Valley Health Network in Allentown, Pa., found that: wound separation rates were 16.8 percent for staples and 4.6 percent for sutures; composite wound complication rates were 21.8 percent for staples and 9.1 percent for sutures; and that 36 percent of women who received staples required post-surgery physicians visits, compared with 10.6 percent of women who received sutures.
Median surgery time for women who received staples was 49 minutes, compared with 57 minutes for those who received sutures.
The researchers concluded that the use of staples for cesarean delivery wound closure is associated with increased risk of wound complications and post-operative physician visits. They said their findings suggest that sutures may be the preferred method.
The study was to be presented Thursday at the annual meeting of the Society for Maternal-Fetal Medicine in Chicago.
Source
Readmissions After Cesarean Higher Than Vaginal Delivery
Jan 8th
Hospital readmissions for women in the postpartum period are often due to infections, and women have a higher risk of readmission after cesarean than vaginal deliveries, according to research published in the January issue of the American Journal of Obstetrics & Gynecology.
Michael A. Belfort, M.D., of the Hospital Corporation of America (HCA) in Nashville, Tenn., and colleagues analyzed 222,751 deliveries in 2007 in 114 HCA hospitals to evaluate reasons for readmission after delivery.
Of this group, the researchers found that 2,655 women (1.2 percent) were readmitted within six weeks. Readmission was more common after cesarean than vaginal delivery (1.8 versus 0.83 percent). Hypertension and uterine and wound infections were the most common reasons for readmission, though readmissions for cholecystitis, appendicitis, and pneumonia were also notable.
"Our data confirm that, although readmissions in the first six weeks after delivery are uncommon, cesarean delivery carries with it roughly twice the risk for readmission as does vaginal birth," the authors write. "Perhaps of most interest was our observation of a significantly higher rate of hospital readmission for cholecystitis, appendicitis, and pneumonia in the first few postpartum weeks than would be expected by chance. None of these conditions has ever before been linked causally to pregnancy or delivery."
Source
Inducing labor may lead to more C-sections
Jan 7th
Dr. J. Christopher Glantz at the University of Rochester School of Medicine found that inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.
While this risk to individual women is not particularly large, Glantz told Reuters Health that 1 to 2 cesareans per 25 inductions can quickly add up to tens of thousands of unnecessary cesareans over the course of millions of inductions.
While the procedures have become more common, C-sections are major surgeries, and carry risk of infection, bleeding, blood clots, and injury to other organs, Glantz emphasizes in a report in the journal Obstetrics and Gynecology.
The researcher analyzed birth certificate data for some 38,000 women from 13 hospitals in the Finger Lakes region of New York State from January 2004 to March 2008. He excluded women with scheduled or previous cesarean deliveries, or who had come to the hospital with ruptured membranes.
While previous studies have already shown that induced labor increases the risk for cesarean, Glantz examined how that risk might shift given a redefined comparison group.
He examined C-section rates after induction using three comparison groups: a week-by-week comparison of women induced to labor compared with those delivering spontaneously; women induced at a chosen week compared with women who delivered spontaneously after that week; and women induced at a chosen week compared with women who delivered spontaneously on or after that week.
In a nutshell, the study found that all labor induced groups faced increased risk for C-section, except for those women delivering after 39 weeks.
Glantz advises that pregnant women and their doctors may be better off waiting for spontaneous labor. "Try to reserve interventions for situations where risk outweighs benefit," said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date.
Source
Prompt treatment beneficial for pregnant and postpartum women with H1N1
Dec 31st
Delayed treatment of suspected influenza A (H1N1) illness among pregnant women may result in a four-fold risk of intensive care admission or death, according to results of a recent study.
Regardless of rapid antigen test results, prompt evaluation and antiviral treatment should be considered for pregnant or postpartum women displaying influenza A (H1N1)-like symptoms, according to researchers from the California Department of Public Health.
The study was a review of records for women of reproductive age who had been hospitalized or died from influenza A (H1N1) between April 23 and August 11, 2009.
The study involved 94 pregnant women, 137 non-pregnant women and 8 postpartum women who had delivered <2 weeks prior. False negative results for rapid antigen tests were observed in 38% of patients.
Among 94 pregnant women, 95% were in the second or third trimester. Risk factors for complications from influenza other than pregnancy were observed in 32 of 93 (34%) of those pregnant women.
Early antiviral treatment was defined as treatment <2 days after the onset of symptoms. Pregnant women treated later than this had an RR of 4.3 for admission to an ICU or death.
Intensive care was required for 18 pregnant women and four postpartum women (total, 22 of 102 [22%]). There were eight deaths (8%).
Of six deliveries which took place in the ICU, four were emergency cesarean deliveries.
The specific mortality ratio associated with influenza A (H1N1), which the researchers defined as the number of maternal deaths per 100,000, was 4.3.
Source
Tips for Avoiding an Unwanted C-Section
Dec 17th
Not every mother wants to avoid a C-section -- in fact, some request them -- but if you do, here are some tips for what to ask your doctor (or midwife) in the delivery room if the suggestion is made that it's time to give up on a vaginal birth and head to the operating room.
"Doctor, is this an emergency, or do we have time to talk?"
Sometimes you need a C-section to save your life, your baby's life, or both. In those cases, there's no room for discussion.
Delivery room emergencies include excessive bleeding, a breech position where the baby is headed out foot-first, or when the baby has certain heart rate problems.
"Doctor, what would happen if we waited an hour or two?"
The vast majority of the time, when your doctor or midwife tells you it's time for a C-section, it's not an emergency.
In many cases, women just need more time to labor. In fact, the No. 1 reason for a C-section is "failure to progress" during labor. If that's what we're talking about, then it's not an emergency.
"Doctor, are you sure the baby is too big for me to deliver?"
Sometimes parents are told a baby is too big to deliver vaginally. Dr. Ware Branch, medical director of women and newborns clinical program at Intermountain Healthcare in Utah, says parents should ask whether a C-section is absolutely necessary, especially if labor hasn't advanced very far.
"If it was my wife in labor and she's three or four centimeters dilated and the obstetrician says the baby's head is too big and she can't deliver him, I'd say, 'Nonsense, she hasn't really had a trial of labor, doctor.' "
"Doctor, is there something else I can try before having a C-section?"
Antunes, a spokeswoman for DONA International, which certifies doulas, says there may be options such as maneuvers like the one she used on Ste. Marie to get a slow labor moving.
"Doctor, can we talk more about the baby's heart rate?"
If you're told you need a C-section because of the baby's heart rate, try to get your doctor or midwife to be as specific as possible.
Some heart-rate problems mean a C-section is necessary immediately, but other types of heart-rate issues are not nearly as serious, and you may be able to labor longer.
"This is a very gray area," says Debbie Levy, a certified nurse midwife in Marietta, Georgia. "It takes years to learn how to read fetal heart tones, and it's not an exact science."
Levy says it can be difficult to ask these questions when the person delivering your baby says it's time for a C-section, especially since mom and dad are often exhausted.
"This is a very tough discussion to have in the delivery room," she says. "You're vulnerable, because you're talking about your baby's well-being."
But she says as long as it's not an emergency, you should have these delivery room conversations with your doctor or midwife.
"You shouldn't be afraid to speak up and say you'd like to try to labor longer," she says.
Good News for Pregnant Women With Multiple Sclerosis
Nov 18th
- Good news for women with multiple sclerosis (MS) who are pregnant or thinking about becoming pregnant.
- A study published Wednesday shows that although women with MS have a mildly increased risk of certain pregnancy complications, by and large, their pregnancies are as healthy as other women's.
- Using a national database on nearly 19 million deliveries in the U.S., researchers found that women with MS had marginally higher risks of cesarean delivery and intrauterine growth restriction -- where a newborn's weight is below the 10th percentile for his or her gestational age.
- Among more than 10,000 women with MS who gave birth between 2003 and 2006, 42 percent had a C-section, compared with roughly 33 percent of women overall. Meanwhile, intrauterine growth restriction was seen in almost 3 percent, versus 2 percent of other women. Still, the overall findings, published in the medical journal Neurology, are being seen as good news for women with MS -- a disorder that is more prevalent among women of childbearing age than any other group.
- MS is believed to arise from an abnormal immune system attack on the body's own myelin, a protective sheath surrounding nerve fibers in the brain and spine. This leads to symptoms such as muscle weakness, numbness, vision problems and difficulty with coordination and balance.
- Years ago, women with MS were advised to avoid pregnancy, out of concern that it could exacerbate the disease. But studies in recent decades have shown that the opposite is true; many women see a remission in their symptoms during pregnancy -- possibly because immune system activity naturally declines and levels of anti-inflammatory corticosteroids naturally rise during pregnancy.
- The current study included information on 10,055 pregnant women with MS, as well as 4,730 with epilepsy and 187,239 with diabetes -- two disorders already associated with higher risks of certain pregnancy complications.
- Overall, women with either MS or epilepsy had elevated risks of C-section delivery and intrauterine growth restriction compared with U.S. women overall. They did, however, generally fare better than women with diabetes, who had higher rates of additional complications, like high blood pressure and premature rupture of the sac surrounding the fetus.
- Women who are planning on becoming pregnant also need to talk with their doctors about whether they should stop taking any of their MS medications. It is not known whether the so-called disease-modifying drugs often used for MS are safe during pregnancy, and research suggests that at least one -- beta-interferon -- may be associated with miscarriage.
- Chakravarty noted that the drug methotrexate, sometimes used for MS, is known to cause birth defects.
