Revital Faro

Mode of Delivery in Stillbirth, 1995-2004

Objective: There are no national reports on the mode of delivery in pregnancies that end in stillbirth. We aimed at analyzing the cesarean delivery rates in pregnancies resulting in stillbirth over a 10-year period in the United States. Materials and Methods: This was a retrospective analysis evaluating data from the 1995 to 2004 US linked live birth–infant death files reported by the National Center for Health Statistics to examine the cesarean delivery rates in singleton pregnancies with and without stillbirth. Results: There were 39 797 616 singleton births registered in the database after the 20th week of gestation. During the study period, there were 243 979 stillbirths (0.61 per 100). Significant differences in stillbirths were noted in the African American population, nonmarried patients, in mothers who smoked, and at the extremes of the patients reproductive age (P < .01). The overall cesarean delivery rate in liveborn was 23.54% (9 309 961 cases) and 10.5% in stillbirth (25 558 cases; P < .01). The rate of cesarean delivery increased in liveborn (from 20.8% in 1995 to 28.9% in 2004; 28% overall increase) and in stillbirth (9.5% in 1995 to 11.23% in 2004; 15% overall increase). The rates of primary and repeat cesarean operations increased with gestational age in the stillbirth group. This pattern was not observed in the liveborn group. Conclusion: This analysis indicates that the cesarean delivery rates increased both in liveborn and in stillbirth from 1995 to 2004. This epidemiological observation deserves new clinical investigations to understand the clinical reasons, driving this obstetrical practice and the financial and societal impact that it portends.

Paternal age and risk for cesarean delivery

Objective: To determine whether advanced paternal age is associated with increased risk for cesarean delivery. Study design: We used the 1990–2002 US linked live birth and infant death data files restricted to primiparous Caucasian and African-American women that delivered a singleton birth at ≥20 week’s gestation (12.5 million). We examined temporal trends and risk ratios of cesarean birth in relation to paternal age before and after adjustments for known confounders. Results: Among Caucasians, the cesarean delivery rates were 21.1%, 26.7% and 31.8% in fathers aged 20–29, 30–39 and ≥40 years, respectively. Among African-Americans, the corresponding rates were 24.1%, 33.2%, and 38.1%, respectively. These increased cesarean delivery rates persisted in analyses stratified by maternal age before and after adjustment for a variety of confounders. Conclusions: These findings suggest that increasing paternal age may be associated with an increased risk for cesarean delivery in primiparous women.

OP26.06: Rates of Cesarean deliveries performed for Down syndrome fetuses with and without major congenital abnormalities in the United States of America

Methods: This was a prospective, cross sectional study. The study enrolled pregnant women, in the 2nd and 3rd trimester, undergoing a routine fetal ultrasound. The parenchymal measurements were done in transverse and sagital cross sections, using predefined criteria. Results: The final analysis included 128 women. The various measurements preformed (anterior and posterior parenchyma), in each of the cross sections (Sagital and transverse) did not show and difference between male and female fetuses. In the sagital section, there were no differences between the right and left kidney. The nomogram established demonstrates that there is a linear constant growth of the fetal parenchyma during pregnancy. Conclusions: This is a novel study, describing the normal growth of the renal parenchyma in healthy, non anomalous fetuses. This is the basis for future studies that will determine the correlation between parenchymal thickness and post natal kidney function, in fetuses with urinary tract anomalies.