The association between SGA and perinatal outcomes compared with AGA by HDI country groups.

<p>The reference category is infants with a birthweight that is appropriate for gestational age in each subgroup analysis.</p><p>SGA = small-for-gestational age; AGA = appropriate-for-gestational age; HDI = Human Development Index, AOR = adjusted odds ratio.</p><p>Two-level structure random effects regression models were used to obtain ORs: individual (level 1) and facility (level 2). Adjusted for maternal age, marital status, education, parity, medical conditions during pregnancy such as chronic hypertension, preeclampsia/eclampsia, severe anaemia, malaria/dengue, HIV/AIDs at the individual level, and capacity of health facilities at the facility level.</p><p>Three-level structure random effects regression models were used to obtain ORs: individual (level 1), facility (level 2) and country (level 3). Same adjustment at individual and facility level and additional adjustment for country HDI at the country level.</p><p>***p<0.001 **p<0.01 *p<0.05.</p

Maternal and neonatal characteristics.

<p>Other medical conditions were included, such as chronic or acute injury or disorders affecting the heart, lungs, liver and kidneys (including pyelonephritis).</p><p>Chi-square <i>p</i>-values adjusted for survey design.</p

Factors associated with adverse perinatal outcomes in twin pregnancies in 23 low- and middle-income countries.

a<p>Perinatal mortality defined as stillbirth or early neonatal death.</p>b<p>smaller twin in a birth weight discordant (>15%) twin pair (Weight of larger twin – weight of smaller twin)/weight of larger twin ] * 100.</p>*<p>unable to calculate OR as zero cases in perinatal mortality group.</p

Crude and adjusted odds ratios for adverse maternal and perinatal outcomes in twins versus singleton pregnancies.

1<p>Severe adverse maternal outcome index: maternal death, admission to ICU, blood transfusion or hysterectomy.</p>*<p>Odds ratio adjusted for maternal age, maternal education, marital status, parity, antenatal visits, malaria, prelabour premature rupture of membranes, chronic hypertension, pregnancy-induced hypertension, pre-eclampsia, eclampsia, vaginal bleeding in 2^nd half of pregnancy, mode of delivery and facility (as random effect).</p>†<p>odds ratio adjusted for maternal age, maternal education, marital status, parity, antenatal visits, mode of delivery, chronic hypertension, malaria, prelabour premature rupture of membranes, pregnancy-induced hypertension, pre-eclampsia, eclampsia, vaginal bleeding in 2^nd half of pregnancy, severe anaemia, infant sex, birth order, fetal presentation, facility (as a random effect) and clustering effect of twin neonates.</p

Birthweight and proportion of SGA by country.

<p>Numbers shown are for singleton births with gestational age 28 to 41 completed weeks.</p><p>OPT = Occupied Palestinian Territory; DRC = Democratic Republic of Congo.</p

Maternal outcomes in twin and singleton deliveries.

*<p>Defined as maternal death, blood transfusion, admission to ICU or hysterectomy.</p>a<p>Denominator is vaginal deliveries only: 1,849 for twins and 205,508 for singletons.</p>b<p>Denominator is caesarean deliveries only : 1,389 for twins and 70,399 for singletons.</p

Risk factors for SGA.

<p>Other medical conditions were included, such as chronic or acute injury or disorders affecting the heart, lungs, liver and kidneys (including pyelonephritis).</p><p>SGA = small-for-gestational age; HDI = Human Development Index; OR = odds ratio; AOR = adjusted odds ratio. Three-level structure random effects regression models were used to obtain ORs: individual (level 1), facility (level 2) and country (level 3).</p><p>***p<0.001 **p<0.01 *p<0.05.</p

Prevalence of fresh stillbirths and early neonatal mortality by HDI country groups.

<p>SGA = small-for-gestational age; HDI = Human Development Index Chi-square <i>p</i>-values adjusted for survey design.</p

Characteristics of twin and singleton pregnancies in 23 low- and middle-income countries.

*<p>Severe anaemia: Haemoglobin <7 g/L at any time during pregnancy.</p>**<p>Emergency or intrapartum caesarean section.</p

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health

<div><p>Objective</p><p>To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries.</p><p>Design</p><p>Secondary analysis of a cross-sectional study.</p><p>Setting</p><p>Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health.</p><p>Population</p><p>29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37–41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour.</p><p>Methods</p><p>We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age.</p><p>Main Outcome Measures</p><p>Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality.</p><p>Results</p><p>Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39–0.60) and 0.31 (95% CI 0.16–0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age.</p><p>Conclusions</p><p>Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.</p></div