Women choosing repeat cesarean deliveries and having them at term but before completing 39 weeks gestation are up to two times more likely to have a baby with serious complications including respiratory distress resulting in mechanical ventilation and NICU admission.
UAB researchers, led by Alan T.N. Tita, M.D., Ph.D., assistant professor in the UAB Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, and colleagues reported in a study published January 8 in the New England Journal of Medicine that women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child.
"The cesarean rate in the United States has risen dramatically, from 20.7 percent in 1996 to 31.1 percent in 2006. A major reason is the decline in attempted vaginal births after cesarean. Because elective cesareans can be scheduled to accommodate patient and physician convenience, there is a risk that they may be performed earlier than is appropriate." Tita said. "We knew from previous small studies that infants born before 39 weeks' gestation are at increased risk for respiratory distress.
Because nearly 40 percent of the cesareans performed in the United States each year are repeat procedures, we undertook this large study to describe the timing of elective repeat cesareans and assess its relationship with the risk of various adverse neonatal outcomes."
Tita and colleagues studied 13,258 women who had elective repeat cesarean sections at the 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network from 1999 through 2002. They were selected from the Cesarean Section Registry of the network. The registry contains detailed, prospectively collected information on nearly 50,000 women with a prior cesarean who underwent either repeat cesarean delivery or a trial of labor at the 19 centers over the 4-year period. The 13,258 women studied were those who underwent an elective cesarean of a viable infant at 37 weeks gestation or later in the absence of labor or other obstetric or medical indications for early cesarean delivery (prior to 39 weeks).
The researchers looked at whether an infant who was delivered at 37 weeks later died or was diagnosed with a number of conditions, including respiratory distress syndrome and/or transient tachypnea of the newborn, newborn sepsis, seizures, necrotizing entercolitis, hypoxic ischemic encephalopathy, required ventilator support within 24 hours of birth, had umbilical cord arterial pH (a measure of oxygenation) below 7.0, an Apgar score at five minutes of three or below, was admitted to a neonatal intensive care unit or required prolonged hospitalization.
Of the 13,258 women who had elective repeat cesarean sections, as many as 35.8 percent were delivered before 39 weeks. Babies born at 37 weeks, were two times more likely to suffer with conditions common to babies born too soon, and at 38 weeks, they were one and a half times more likely.
Tita said these findings, along with other studies, underscore the importance of not delivering a baby before 39 weeks for the sake of convenience.
"Unfortunately, these early deliveries are associated with a preventable increase in neonatal morbidity and NICU admissions, which carry a high personal and economic cost. These findings support recommendations to delay elective delivery until 39 weeks gestation and should be helpful in counseling women on the necessity of waiting to deliver."
Friday, March 6, 2009
Repeat C-Section Before 39 Weeks Raises Risk of Neonatal Illness
Monday, February 23, 2009
Six Things Women Should Know About the Pap Test
January is Cervical Cancer Awareness Month and The University of Texas M. D. Anderson Cancer Center shares important information about the cervical cancer screening exam, the Pap test.
For many women, their annual Pap test is not something to look forward to; however, this test has the potential to make a huge difference in the lives of women everywhere. The Pap test detects cell changes, which may cause cervical cancer. If these cell changes are found and treated early, cervical cancer may be prevented.
Andrea Milbourne, M.D., associate professor in M. D. Anderson's Department of Gynecologic Oncology, explores six facts women should know about this important test.
1. Increased sexual activity equals increased need for a Pap test.
Increased sexual activity raises a woman¹s risk for acquiring the human papilloma virus (HPV). While HPV can be harmless, it also can cause cervical cancer by changing normal cells in the cervix.
"Because condoms do not provide 100 percent protection against HPV, women who are sexually active and not in a monogamous relationship need to be even more vigilant about following cervical cancer screening guidelines," Milbourne said.
2. The HPV vaccine is a supplement, not a replacement for the Pap test.
Getting the HPV vaccine, or encouraging young female family members to consider it, is a great first step toward cervical cancer prevention. That being said, the vaccine is in no way a substitute for the Pap test.
"The vaccine may give women a false sense of security," Milbourne said. "And because getting a Pap test is not what most women consider a favorite activity, getting the vaccine might cause them to procrastinate even more to make an appointment for their next Pap test."
Because the HPV vaccine does not protect against all types of HPV, or other sexually transmitted diseases, it cannot be the only method of cervical cancer prevention. Women also should remember that cervical cancer doesn¹t have many visible symptoms, which makes the Pap test significantly important in preventing cervical cancer.
3. Women should prepare for an upcoming Pap test.
Milbourne recommends a few tips to help women prepare for an upcoming test: * Avoid douching or using vaginal medicines, spermicidal foams, creams or jellies 48 hours before the test. * Do not have sexual intercourse 48 hours before the test. * Reschedule a Pap test appointment if an unexpected heavy menstrual flow occurs on the day of the exam.
"Lubricants, spermicides, douching and sexual activity can interfere with the interpretation of Pap test results, potentially leading to incorrectly interpreted results or the need for repeat tests," Milbourne said.
4. A woman is never too old to get her Pap test.
Of all the benefits that might come with growing older, skipping a regular Pap test for a sexually active woman over age 65 is not one of them.
As female life expectancy gets longer, many women continue to enjoy sexually active lives throughout their sixties and into their seventies.
"For women over age 65, cervical cancer is rare, but it does happen," Milbourne said. "If you are over age 65, sexually active and not in a monogamous relationship, you should continue your annual Pap test, as you are still susceptible to HPV, which can cause cervical cancer."
5. Women can afford a Pap test.
"Without health insurance or access to affordable health care, a Pap test can be costly," Milbourne said. "For women who can not afford a Pap test, there may be places in your community where you can get one for free."
For information on where to get a free or low-cost Pap test, call the National Cancer Institute¹s Cancer Information Service at 1-800-4-CANCER. Pap tests also are sometimes covered by Medicaid and are covered every two years by Medicare or every year for certain women at higher risk. For more information, call 1-800-MEDICARE.
6. Before the Pap test, cervical cancer was a leading cause of death in American women.
The American Cancer Society estimates that about 3,870 women died from cervical cancer in the United States during 2008. This number is low compared to annual statistics for other more common cancer types, such as breast or lung cancer, but what most people do not know is that cervical cancer was once one of the most common causes of cancer death in American women.
As the Pap test became a standard test for American women, doctors were able to find abnormal changes in the cervix before cancer developed. Between 1955 and 1992, the cervical cancer death rate declined by 74 percent.
"While the cervical cancer death rate continues to decline in the United States, women in countries where Pap tests are not as readily available or affordable still face the challenges, shared by American women more than 50 years ago," Milbourne said.
Cervical cancer is the second largest cause of female cancer deaths worldwide, according to the World Health Organization, with 288,000 deaths each year. About 510,000 cases of cervical cancer are reported each year nearly 80 percent are in developing countries.
For additional information, visit www.mdanderson.org/focused.
