JAMA · 2002 · 346 citations · 21 references
MedicineMaternal HealthObstetricsMaternal-fetal MedicineObstetric ComplicationsPreterm BirthCesarean DeliveryCesarean SectionIntrapartum ComplicationsMaternal ComplicationsPostpartum ComplicationsPregnancyBreastfeeding After Cesarean SectionCesarean Delivery PlanningComplete Breech Presentation
The Term Breech Trial showed that planned cesarean delivery reduces adverse perinatal outcomes without increasing immediate maternal morbidity compared with planned vaginal birth. This study aimed to assess whether planned cesarean delivery versus planned vaginal birth affects maternal outcomes three months after delivery. Using data from the Term Breech Trial, 1,596 of 1,940 women from 110 centers worldwide completed a 3‑month postpartum questionnaire that evaluated breastfeeding, infant health, caregiving ease, sexual relations, pain, urinary, flatal, fecal incontinence, depression, and perceptions of childbirth and participation. At three months postpartum, women who had a planned cesarean were less likely to report urinary incontinence (4.5% vs 7.3%, RR 0.62) and experienced no higher rates of other outcomes, suggesting planned cesarean may reduce incontinence risk without increasing other problems, though long‑term effects remain uncertain.
<h3>Context</h3>The Term Breech Trial found a significant reduction in adverse perinatal outcomes without an increased risk of immediate maternal morbidity with planned cesarean delivery compared with planned vaginal birth. No randomized controlled trial of planned cesarean delivery has measured benefits and risks of postpartum outcomes months after the birth.<h3>Objective</h3>To compare maternal outcomes of planned cesarean delivery and planned vaginal birth at 3 months post partum.<h3>Design</h3>Follow-up study to the Term Breech Trial, a randomized controlled trial conducted between January 9, 1997, and April 21, 2000.<h3>Setting and Participants</h3>a total of 1596 of 1940 women from 110 centers worldwide who had a singleton fetus in breech presentation at term responded to a follow-up questionnaire at 3 months post partum.<h3>Main Outcome Measures</h3>Breastfeeding; infant health; ease of caring for infant and adjusting to being a new mother; sexual relations and relationship with husband/partner; pain; urinary, flatal, and fecal incontinence; depression; and views regarding childbirth experience and study participation. <h3>Results</h3>Baseline information was similar for both the cesarean and vaginal delivery groups. Women in the planned cesarean delivery group were less likely to report urinary incontinence than those in the planned vaginal birth group (36/798 [4.5%] vs 58/797 [7.3%]; relative risk, 0.62; 95% confidence interval, 0.41-0.93). Incontinence of flatus was not different between groups but was less of a problem in the planned cesarean delivery group when it occurred (p = .006). There were no differences between groups in other outcomes.<h3>Conclusions</h3>Planned cesarean delivery for pregnancies with breech presentation at term may result in a lower risk of incontinence and is not associated with an increased risk of other problems for women at 3 months post partum, although the effect on longer-term outcomes is uncertain.
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Detection of Postnatal Depression
J. L. Cox, Joan Holden, R. Sagovsky · The British Journal of Psychiatry · 1987 · 13.9K citations
Nursing, Maternal Health, Psychiatry +17