The prediction of morbidity related to vaginal delivery in nulliparous women - a secondary analysis from the Genesis multicenter trial

Published on Sep 1, 2021in European Journal of Obstetrics & Gynecology and Reproductive Biology1.868
· DOI :10.1016/J.EJOGRB.2021.07.026
Khadijah I. Ismail2
Estimated H-index: 2
(UL: University of Limerick),
Naomi Burke5
Estimated H-index: 5
(RCSI: Royal College of Surgeons in Ireland)
+ 15 AuthorsAmanda Cotter17
Estimated H-index: 17
(UL: University of Limerick)
Source
Abstract
Abstract null null Objective null In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery. null null null Study Design: null The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39+0- and 40+6-weeks’ gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated. null null null Results null A total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p null null null Conclusion null In women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.
References23
Newest
#1Chadakarn Phaloprakarn (Navamindradhiraj University)H-Index: 5
#2Siriwan Tangjitgamol (Navamindradhiraj University)H-Index: 13
Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM. A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 indiv...
1 CitationsSource
#1Niamh C. Murphy (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
#2Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
Last. Fionnuala Breathnach (RCSI: Royal College of Surgeons in Ireland)H-Index: 13
view all 11 authors...
Abstract Objective The ability to predict the need for emergency Cesarean delivery holds the potential to facilitate birth choices. The objective of the RECIPE study (Reducing Emergency Cesarean delivery and Improving the Primiparous Experience) was to externally validate a Cesarean delivery risk prediction model. This model, developed by the Genesis study, identified five key predictive factors for emergency Cesarean delivery: maternal age, maternal height, BMI, fetal head circumference (HC) an...
1 CitationsSource
#1Niamh C. Murphy (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
#2Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
Last. Fergal D. Malone (RCSI: Royal College of Surgeons in Ireland)H-Index: 62
view all 18 authors...
OBJECTIVE: Contemporary approaches to monitoring quality of care in obstetrics often focus on comparing Cesarean Delivery rates. Varied rates can complicate interpretation of quality of care. We previously developed a risk prediction tool for nulliparous women who may require intrapartum Cesarean delivery which identified five key predictors. Our objective with this study was to ascertain if patient heterogeneity can account for much of the observed variation in Cesarean delivery rates, thereby ...
1 CitationsSource
#1Ping GuanH-Index: 2
#2Fei TangH-Index: 2
Last. Wei RenH-Index: 2
view all 4 authors...
Objective To analyze the maternal and fetal factors affecting emergency cesarean section (EmCS) and establish a risk scoring system to quantitatively predict the risk of EmCS. Design A total of 10,295 pregnant women were enrolled in this study. The influence of maternal and fetal factors on the risk of EmCS was analyzed. Results 991 (9.63%) cases of failed vaginal delivery received EmCS. The two main causes of EmCS were fetal distress (67.21%) and abnormal fetal position (14.93%). There were sig...
8 CitationsSource
#1Catherine Finnegan (RCSI: Royal College of Surgeons in Ireland)H-Index: 1
#2Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
Last. Fergal D. Malone (RCSI: Royal College of Surgeons in Ireland)H-Index: 62
view all 18 authors...
Abstract Background Increased duration of second stage of labor provides clinical challenges in decision- making regarding the optimal mode of delivery that minimises maternal and neonatal morbidity. Objective In a large cohort of uncomplicated nulliparous singleton cephalic labors, we sought to examine the effect of increasing duration of second stage on delivery and perinatal outcome. Design The Genesis Study recruited 2,336 nulliparous patients with vertex presentation in a prospective double...
1 CitationsSource
4 CitationsSource
#1Audrey A. Merriam (Columbia University)H-Index: 6
#2Cande V. Ananth (Columbia University)H-Index: 92
Last. Alexander M. Friedman (Columbia University)H-Index: 27
view all 6 authors...
Objective The objectives of this study were to determine temporal trends in forceps and vacuum delivery and factors associated with operative vaginal delivery. Design Retrospective cohort. Setting Population-based study of US birth records. Population US births from 2005 to 2013. Methods This study evaluated forceps and vacuum extraction during vaginal delivery in live-born, non-anomalous singleton gestations from ≥ 36 to < 42 weeks of gestation. The primary outcomes were vacuum, forceps and ove...
42 CitationsSource
#1Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
#2Gerard Burke (UL: University of Limerick)H-Index: 17
Last. Fergal D. Malone (RCSI: Royal College of Surgeons in Ireland)H-Index: 62
view all 16 authors...
Background In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable method to predict the requirement for such potentially hazardous obstetric procedures during labor and delivery. This issue is important, as there are greater rates of morbidity and mor...
38 CitationsSource
#1Ángel Paternina-Caicedo (University of Cartagena)H-Index: 12
#2Jezid Miranda (University of Cartagena)H-Index: 20
Last. José Rojas-Suarez (University of Cartagena)H-Index: 8
view all 7 authors...
Background Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a cli...
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The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is dedicated to the establishment of high standards of practice in obstetrics and gynaecology and women’s health.
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