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Multiple repeat caesarean section
- The aim of this study was to estimate the incidence of multiple repeat caesarean section (MRCS) (five or more) in the UK, and to describe the outcomes for women and their babies relative to women having fewer repeat caesarean sections.
- Ninety-four women undergoing MRCS were identified over 1 year, giving an estimated UK incidence of 1.2 per 10 000 maternities (95% confidence interval [CI], 0.97–1.47).
- Women with MRCS had significantly more major obstetric haemorrhages (>1500 ml) (adjusted odds ratio [aOR], 18.6; 95% CI, 3.89–88.8), visceral damage (aOR, 17.6; 95% CI, 1.85–167.1) and critical care admissions (aOR, 15.5; 95% CI, 3.16–76.0), than women with lower order repeat caesarean sections.
- Women with MRCS who also had placenta praevia or accreta were at highest risk of complications.
- Neonates of mothers having MRCS were more likely to be born preterm (OR, 6.15; 95% CI, 2.56–15.78).
- This study shows that MRCS is associated with greater maternal and neonatal morbidity than fewer caesarean sections. Importantly, the associated maternal morbidity is largely secondary to placenta praevia and accreta; in women undergoing MRCS who do not have these conditions, risks are lower.
Antenatal management and outcomes of gastroschisis
- The aim of this study was to describe the antenatal management and outcomes of pregnancies affected by gastroschisis.
- Estimates based on these data suggest that four per 100 fetuses surviving to the third trimester are stillborn (95% CI 2–6), four per 100 affected infants born alive die in the neonatal period (95% CI 1–10) and fewer than 1% of surviving infants die in the postnatal period (0.7 per 100 infants, 95% CI 0–2).
- Infants were variably monitored with growth scans (90%), umbilical artery Doppler ultrasound (85%), cardiotocography (65%) and biophysical profile (27%). Bowel measurements were undertaken for only 113 infants (52%).
- There were no statistically significant differences in growth measurements or gestation at delivery between babies who were stillborn or liveborn or those who died and those who survived, but note that this analysis has limited power to detect any differences as statistically significant due to a low number of deaths.
- The variability in management and paucity of evidence on antenatal monitoring approaches suggests that there may be a place for randomised trials of fetal surveillance strategies in order to develop the evidence to improve outcomes for the at-risk fetus with gastroschisis.
Thank you to all members who contributed information to these studies.
Details of these and other UKOSS study results can be obtained from the UKOSS website http://www.npeu.ox.ac.uk/ukoss/completed-surveillance. If you would like a reprint of any UKOSS publications please contact firstname.lastname@example.org.