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Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network.

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.

journal_name

Acta Obstet Gynecol Scand

journal_title

Acta obstetricia et gynecologica Scandinavica

authors

Duffy CR,Moore JL,Saleem S,Tshefu A,Bose CL,Chomba E,Carlo WA,Garces AL,Krebs NF,Hambidge KM,Goudar SS,Derman RJ,Patel A,Hibberd PL,Esamai F,Liechty EA,Wallace DD,McClure EM,Goldenberg RL,NICHD Global Network for Wo

doi

10.1111/aogs.13502

subject

Has Abstract

pub_date

2019-03-01 00:00:00

pages

300-308

issue

eissn

0001-6349

issn

1600-0412

journal_volume

pub_type

杂志文章

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Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network.