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- Abdul Rouf Pallivalappil [2]
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- Chief Executive Officer, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar [2]
- Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: [email protected] [2]
- Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar [2]
- Department of Research, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar [2]
- Department of Obstetrics and Gynecology, Sidra Medicine, Doha Qatar [1]
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Maternal and neonatal outcomes associated with multiple repeat cesarean deliveries: A registry-based study from Qatar
Background: Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs.Methods: This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications blood loss and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth neonatal ICU (NICU) admission respiratory distress syndrome (RDS) and perinatal death.Results: Of the 6316 women in the study 2608 (41.3%) had a primary CD. 30.3% 17.5% and 7.3% of the cohort had their second third and fourth CDs respectively. Women undergoing the 5th CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1% p = 0.015) and postpartum hemorrhage (7.5% p = 0.010). 24% of babies in Group 5 were born preterm (p < 0.001). They also had a 3.5 times higher risk of having a surgical complication (RR = 3.5 95% CI 1.6-7.6 p = 0.002) a 1.8 times higher risk of developing postpartum hemorrhage (RR = 1.8 95% CI 1.1-2.9 p = 0.014) a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR = 1.7 95% CI 1.3-2.2 p < 0.001) a higher risk of the baby getting admitted to NICU (RR = 1.3 95% CI 1.0-1.6 p = 0.038) and developing RDS (RR = 1.5 95% CI 1.2-2.0 p = 0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9 95% CI 2.1-4.0) and RDS (RR 3.5 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p < 0.001 for both).Conclusion: Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups—consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.
Impact of bariatric surgery on maternal gestational weight gain and pregnancy outcomes in women with obesity: A population-based cohort study from Qatar
Background: Bariatric surgery is performed in obese women of reproductive age to help achieve a healthy prepregnancy weight to reduce the complications associated with obesity in pregnancy. However these procedures can impact maternal nutrition and gestational weight gain (GWG). This study evaluates the maternal and neonatal outcomes in women with prepregnancy bariatric surgery and determines the impact on GWG. Methods: This study included 24 weeks gestation or more pregnancies with a maternal BMI at delivery of 30 kg/m2 or more. It was categorized into two groups based on whether they had prepregnancy bariatric surgery (exposed) or not (unexposed). The outcomes included gestational diabetes (GDM) gestational hypertension (GHT) mode of delivery preterm birth (PTB) GWG birthweight (BW) and customized BW centiles low birthweight (LBW) congenital anomalies and admission to the neonatal intensive unit (NICU). Categorization was also done based on the adequacy of GWG (low adequate and excess). Results: A total of 8323 women were included in the study 194 of whom had prepregnancy bariatric surgery. After adjusting for confounders the exposed group had a mean GWG 1.33 kg higher than the unexposed group (95% CI 0.55-2.13 p = 0.001). The exposed group had higher odds of PTB (aOR 1.78 95% CI 1.16-2.74 p = 0.008) CD (aOR 6.52 95% CI 4.28-9.93 p < 0.001) LBW in term babies (aOR 2.60 95% CI 1.34-5.03 p = 0.005) congenital anomalies (aOR 2.64 95% CI 1.21-5.77 p = 0.015) low APGAR score (aOR 3.75 95% CI 1.12-12.5 p = 0.032) and 80.4g lesser birthweight (95% CI -153.0 -5.8; p = 0.034). More women in the low GWG category had LBW babies (28.6% versus 6.7% in the high GWG group p = 0.033) lowest mean BW and median BW centiles (2775 grams versus 3289 grams in the high GWG group p = 0.004 and 57.5% versus 74.5% in the high GWG group p = 0.040 respectively). Conclusion: The findings of this study highlight differences in perinatal outcomes such as preterm birth low birth weight congenital anomalies cesarean deliveries and gestational weight gain between post-bariatric women and controls. These insights can help inform the planning and provision of appropriate maternity care to enhance patient safety and outcomes. The results of this study can also guide the counseling of reproductive age-group women who are planning to undergo bariatric surgery.