Cassandra R Duffy1, Janet L Moore2, Sarah Saleem3, Antoinette Tshefu4, Carl L Bose5, Elwyn Chomba6, Waldemar A Carlo7, Ana L Garces8, Nancy F Krebs9, K Michael Hambidge9, Shivaprasad S Goudar10, Richard J Derman11, Archana Patel12, Patricia L Hibberd13, Fabian Esamai14, Edward A Liechty15, Dennis D Wallace2, Elizabeth M McClure2, Robert L Goldenberg1. 1. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 2. Social, Statistical and Environmental Health Sciences, Durham, NC, USA. 3. Aga Khan University, Karachi, Pakistan. 4. Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. 5. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 6. University Teaching Hospital, Lusaka, Zambia. 7. University of Alabama at Birmingham, Birmingham, AL, USA. 8. Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala. 9. University of Colorado Denver, Denver, CO, USA. 10. KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India. 11. Thomas Jefferson University, Philadelphia, PA, USA. 12. Lata Medical Research Foundation, Nagpur, India. 13. Boston University, Boston, MA, USA. 14. Moi University, Eldoret, Kenya. 15. Indiana University, Indianapolis, IN, USA.
Abstract
INTRODUCTION: Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS: Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS: Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS: In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
INTRODUCTION: Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS: Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS: Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS: In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
Authors: José Villar; Guillermo Carroli; Nelly Zavaleta; Allan Donner; Daniel Wojdyla; Anibal Faundes; Alejandro Velazco; Vicente Bataglia; Ana Langer; Alberto Narváez; Eliette Valladares; Archana Shah; Liana Campodónico; Mariana Romero; Sofia Reynoso; Karla Simônia de Pádua; Daniel Giordano; Marius Kublickas; Arnaldo Acosta Journal: BMJ Date: 2007-10-30
Authors: Ryan G Gomes; Bellington Vwalika; Chace Lee; Angelica Willis; Marcin Sieniek; Joan T Price; Christina Chen; Margaret P Kasaro; James A Taylor; Elizabeth M Stringer; Scott Mayer McKinney; Ntazana Sindano; George E Dahl; William Goodnight; Justin Gilmer; Benjamin H Chi; Charles Lau; Terry Spitz; T Saensuksopa; Kris Liu; Tiya Tiyasirichokchai; Jonny Wong; Rory Pilgrim; Akib Uddin; Greg Corrado; Lily Peng; Katherine Chou; Daniel Tse; Jeffrey S A Stringer; Shravya Shetty Journal: Commun Med (Lond) Date: 2022-10-11