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Am J Perinatol 2016; 33(07): 646-657
DOI: 10.1055/s-0035-1571200
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

“The More the Better” Paradox of Antenatal Ultrasound Examinations in Low-Risk Pregnancy

Giuseppe Chiossi
1   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Boulevard, Galveston, Texas
,
Stefano Palomba
2   Department of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy
,
Sara Balduzzi
3   Statistics Unit, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
,
Maged M. Costantine
1   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Boulevard, Galveston, Texas
,
Angela I. Falbo
1   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Boulevard, Galveston, Texas
,
Giovanni B. La Sala
1   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Boulevard, Galveston, Texas
4   University of Modena and Reggio Emilia, Modena, Italy
› Author Affiliations
Further Information

Publication History

17 August 2015

28 November 2015

Publication Date:
10 February 2016 (online)

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Abstract

Objective To investigate whether different antenatal care models could account for differences in operative delivery rates and adverse neonatal outcomes among low-risk pregnant women, and to identify independent variables associated with delivery modes and adverse neonatal outcomes.

Study design Retrospective cohort from a single center of singleton, term, live births between January 2012 and June 2014. Rates of cesarean deliveries, operative vaginal deliveries, and neonatal morbidities were analyzed among women followed by private obstetrician-gynecologists versus national health system providers (certified nurse midwifes supervised by obstetrician-gynecologists), and adjusted for potential confounders.

Results Among the 2,831 women in our cohort, obstetric and neonatal outcomes were independent of obstetric providers. After we controlled for confounders, private patients having more than four antenatal ultrasound examinations were more likely to undergo cesarean delivery than public patients with four or fewer sonographic assessments (five to eight prenatal scans: relative risk ratio, 3.3; 95% confidence interval [CI] 1.4–8; nine or more prenatal scans: relative risk ratio, 4.1; 95% CI 1.2–14).

Conclusions Multiple prenatal ultrasound examinations in low-risk obstetric populations appear to be an independent and potentially modifiable risk factor for cesarean deliveries.

Keywords

cesarean delivery - operative delivery - prenatal ultrasound scanning - private patients
 

  • References

  • 1 Boutsikou T, Malamitsi-Puchner A. Caesarean section: impact on mother and child. Acta Paediatr 2011; 100 (12) 1518-1522
    CrossrefPubMedGoogle Scholar
  • 2 Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstet Gynecol 2007; 109 (2, Pt 1): 270-276
    CrossrefPubMedGoogle Scholar
  • 3 Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits?. Am J Perinatol 2012; 29 (1) 7-18
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 2008; 38 (4) 634-642
    CrossrefPubMedGoogle Scholar
  • 5 Cardwell CR, Stene LC, Joner G , et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008; 51 (5) 726-735
    CrossrefPubMedGoogle Scholar
  • 6 National Collaborating Centre for Women's and Children's Health. Caesarean Section Clinical Guideline. Glasgow: RCOG Press; 2004
    Google Scholar
  • 7 Boyle A, Reddy UM. Epidemiology of cesarean delivery: the scope of the problem. Semin Perinatol 2012; 36 (5) 308-314
    CrossrefPubMedGoogle Scholar
  • 8 MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008; 35 (2) 293-307 , v
    CrossrefPubMedGoogle Scholar
  • 9 Little SE, Edlow AG, Thomas AM, Smith NA. Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery?. Am J Obstet Gynecol 2012; 207 (4) 309.e1-309.e6
    CrossrefPubMedGoogle Scholar
  • 10 Huang K, Tao F, Raven J, Liu L, Wu X, Tang S. Utilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China. BMC Health Serv Res 2012; 12: 93-97
    CrossrefPubMedGoogle Scholar
  • 11 Petrou S, Kupek E, Vause S, Maresh M. Antenatal visits and adverse perinatal outcomes: results from a British population-based study. Eur J Obstet Gynecol Reprod Biol 2003; 106 (1) 40-49
    CrossrefPubMedGoogle Scholar
  • 12 Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2013; 8: CD004667
    PubMedGoogle Scholar
  • 13 McLachlan HL, Forster DA, Davey MA , et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG 2012; 119 (12) 1483-1492
    CrossrefPubMedGoogle Scholar
  • 14 Huesch MD. Association between type of health insurance and elective cesarean deliveries: New Jersey, 2004-2007. Am J Public Health 2011; 101 (11) e1-e7
    PubMedGoogle Scholar
  • 15 Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C. Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open 2012; 2 (5) 1-8
    PubMedGoogle Scholar
  • 16 Gould JB, Davey B, Stafford RS. Socioeconomic differences in rates of cesarean section. N Engl J Med 1989; 321 (4) 233-239
    CrossrefPubMedGoogle Scholar
  • 17 Lipkind HS, Duzyj C, Rosenberg TJ, Funai EF, Chavkin W, Chiasson MA. Disparities in cesarean delivery rates and associated adverse neonatal outcomes in New York City hospitals. Obstet Gynecol 2009; 113 (6) 1239-1247
    CrossrefPubMedGoogle Scholar
  • 18 Dowswell T, Carroli G, Duley L , et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev 2010; (10) CD000934
    PubMedGoogle Scholar
  • 19 Guidelines on Personal Data Management in Clinical Studies . Available at: http://www.garanteprivacy.it/web/guest/home/docweb/-/docweb-display/docweb/2818670
    PubMed
  • 20 Personal Data Protection Act . Available at: http://www.medicoeleggi.com/argomenti000/italia2008/400194-a.htm
    PubMed
  • 21 O'Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Serv Res 2005; 40 (5, Pt 2): 1620-1639
    CrossrefPubMedGoogle Scholar
  • 22 Certificate of care to delivering mothers . Available at: http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=751&area=Salute%20donna&menu=nascita
    PubMed
  • 23 Low risk pregnancy Italian guidelines . Available at: http://www.snlg-iss.it/cms/files/LG_Gravidanza.pdf
    PubMed
  • 24 Hildingsson I, Waldenström U, Rådestad I. Women's expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content. Acta Obstet Gynecol Scand 2002; 81 (2) 118-125
    CrossrefPubMedGoogle Scholar
  • 25 Italian law on diagnostic examinations in pregnancy . Available at: https://www.salute.gov.it/imgs/C_17_normativa_1653_allegato.pdf
    PubMed
  • 26 Fagerland MW, Hosmer DW, Bofin AM. Multinomial goodness-of-fit tests for logistic regression models. Stat Med 2008; 27 (21) 4238-4253
    CrossrefPubMedGoogle Scholar
  • 27 Nijagal MA, Kuppermann M, Nakagawa S, Cheng Y. Two practice models in one labor and delivery unit: association with cesarean delivery rates. Am J Obstet Gynecol 2015; 212 (4) 491.e1-491.e8
    CrossrefPubMedGoogle Scholar
  • 28 Huynh HP, Legg AM, Ghane A, Tabuenca A, Sweeny K. Who is satisfied with general surgery clinic visits?. J Surg Res 2014; 192 (2) 339-347
    CrossrefPubMedGoogle Scholar
  • 29 Bamberg C, Hinkson L, Henrich W. Prenatal detection and consequences of fetal macrosomia. Fetal Diagn Ther 2013; 33 (3) 143-148
    CrossrefPubMedGoogle Scholar
  • 30 Mayer C, Joseph KS. Fetal growth: a review of terms, concepts and issues relevant to obstetrics. Ultrasound Obstet Gynecol 2013; 41 (2) 136-145
    CrossrefPubMedGoogle Scholar
  • 31 Chauhan SP, Sanderson M, Hendrix NW, Magann EF, Devoe LD. Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis. Am J Obstet Gynecol 1999; 181 (6) 1473-1478
    CrossrefPubMedGoogle Scholar
  • 32 Blackwell SC, Refuerzo J, Chadha R, Carreno CA. Overestimation of fetal weight by ultrasound: does it influence the likelihood of cesarean delivery for labor arrest?. Am J Obstet Gynecol 2009; 200 (3) 340.e1-340.e3
    CrossrefPubMedGoogle Scholar
  • 33 Melamed N, Yogev Y, Meizner I, Mashiach R, Ben-Haroush A. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med 2010; 29 (2) 225-230
    CrossrefPubMedGoogle Scholar
  • 34 Skråstad RB, Eik-Nes SH, Sviggum O , et al. A randomized controlled trial of third-trimester routine ultrasound in a non-selected population. Acta Obstet Gynecol Scand 2013; 92 (12) 1353-1360
    CrossrefPubMedGoogle Scholar
  • 35 Zhang J, Troendle J, Reddy UM , et al; Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (4) 326.e1-326.e10
    CrossrefPubMedGoogle Scholar
  • 36 American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (3) 179-193
    CrossrefPubMedGoogle Scholar
  • 37 American College of Obstetricians and Gynecologists. Practice bulletin no. 146: Management of late-term and postterm pregnancies. Obstet Gynecol 2014; 124 (2, Pt 1): 390-396
    CrossrefPubMedGoogle Scholar
  • 38 Schuit E, Kwee A, Westerhuis ME , et al. A clinical prediction model to assess the risk of operative delivery. BJOG 2012; 119 (8) 915-923
    CrossrefPubMedGoogle Scholar
  • 39 Hoffman MK, Vahratian A, Sciscione AC, Troendle JF, Zhang J. Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol 2006; 107 (5) 1029-1034
    CrossrefPubMedGoogle Scholar
  • 40 Tita AT, Landon MB, Spong CY , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360 (2) 111-120
    CrossrefPubMedGoogle Scholar
  • 41 Hemminki E, Heikkilä K, Sevón T, Koponen P. Special features of health services and register based trials - experiences from a randomized trial of childbirth classes. BMC Health Serv Res 2008; 8: 126
    CrossrefPubMedGoogle Scholar