Judith Weiss

Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births.

OBJECTIVE: To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal). METHODS: Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries—3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal—240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay. RESULTS: Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74–2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000) (P<.001) and infection (3.3 in 1,000). The average initial hospital cost of a planned primary cesarean of

Hospital use and associated costs of children aged zero‐to‐two years with craniofacial malformations in Massachusetts

4,372 (95% C.I.

Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor

4,293–4,451) was 76% higher than the average for planned vaginal births of

Contemporary Childbirth in the United States: Interventions and Disparities

2,487 (95% C.I.

Early Discharge Among Late Preterm and Term Newborns and Risk of Neonatal Morbidity

2,481–2,493), and length of stay was 77% longer (4.3 days to 2.4 days). CONCLUSION: Clinicians should be aware of the increased risk for maternal rehospitalization after cesarean deliveries to low-risk mothers when counseling women about their choices. LEVEL OF EVIDENCE: II

Risk Factors for Neonatal Morbidity and Mortality Among “Healthy,” Late Preterm Newborns

BACKGROUND Craniofacial malformations (CFMs) are among the most common and correctable birth defects in the United States, often requiring multiple medical and surgical treatments. However, population-based data on hospital utilization and costs are sparse. METHODS This retrospective cohort study used linked data from the Massachusetts Pregnancy to Early Life Longitudinal Data System. Cases were children born during 1998-2002 in Massachusetts hospitals to Massachusetts residents, alive at age two years, and ascertained by the Massachusetts Birth Defects Monitoring Program as having a CFM (orofacial cleft, craniosynostosis, microtia/anotia). Mean and median number of inpatient days and hospital facility costs (excluding professional fees) during birth and postbirth hospitalizations to age two years are presented by defect type and pattern for cases and compared to Massachusetts children without CFMs. RESULTS Children with CFMs (N = 649) mostly had orofacial clefts (73%), and 73% had no other major birth defect. Both mean (12.0) and median (6) number of inpatient days from birth to age two years among children with CFMs were three times higher than among all other children. Mean incremental hospital cost of children who survived to age two years with CFMs compared to those with no CFM was

Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999.

4,901 more during the birth hospitalization and

Risk factors for uterine rupture among women who attempt a vaginal birth after a previous cesarean: a case-control study.

12,858 more for postbirth hospitalizations, or

Uterine rupture among women with a prior cesarean delivery [1] (multiple letters)

17,760 overall. CONCLUSION In the first two years of life, children with CFMs incur increased hospital costs compared to other children without such conditions, with substantial heterogeneity by defect and pattern type.

Uterine rupture among women with a prior cesarean delivery.

Objective:To describe maternal and perinatal morbidity and mortality associated with uterine rupture (UR) among women with prior cesarean/s, singleton term pregnancies and a trial of labor after cesarean (TOLAC).Study Design:Linked hospital discharge files and birth/fetal death certificates identified potential cases of UR in Massachusetts from 1990 to 1998 with definitive identification by medical record abstraction.Result:Among the 347 identified URs, severe outcomes occurred in 86 cases (25%), in 49 (14%) of mothers and 49 (14%) of infants. Of the infants, 25 were discharged with a good prognosis. Maternal age and interdelivery interval <18 months (relative risk (RR)=1.55; 95% confidence interval (CI): 1.05, 2.31) were associated with a severe outcome. The type of hospital and labor were not associated with the increased risk of a severe outcome.Conclusion:Assuming a 0.7% UR rate among women at term with a TOLAC, the increased rate of severe outcomes related to UR above the baseline risk of elective cesarean is estimated to be 1.3 per 1000 TOLACs.