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A rare case of post cesarean duodenal perforation diagnosed by laparoscopy. Eur J Obstet Gynecol Reprod Biol 2018; 222:193-194. [PMID: 29402493 DOI: 10.1016/j.ejogrb.2018.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/20/2022]
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52
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Estimating Educational Differences in Low-Risk Cesarean Section Delivery: A Multilevel Modeling Approach. POPULATION RESEARCH AND POLICY REVIEW 2017. [DOI: 10.1007/s11113-017-9452-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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53
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Freitas PF, Fernandes TMB. Association between institutional factors, birth care profile, and cesarean section rates in Santa Catarina. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:525-538. [PMID: 27849268 DOI: 10.1590/1980-5497201600030005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/24/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives: To investigate how institutional factors, represented by the social profile of childbirth care, can relate to cesarean section rates. Methods: A cross-sectional study based on data from Sistema de Informações sobre Nascidos Vivos (SINASC) for the state of Santa Catarina collected information for each of the six municipalities with the largest number of births from the six macroregional areas. For those municipalities, all of the establishments that had obstetric facilities were considered. A total of 61.278 births took place over 61 selected maternity services. Cesarean prevalence ratios (PR), both crude and adjusted for confounders, were estimated for each one of the individual variables using robust Cox regression. Results: Cesarean births were almost as twice as high in private maternity facilities (89%) when compared to the public ones (45.1%). Giving birth in private hospitals increased by at least 50% the prevalence of caesarean section among primiparae (PR = 1.64), Caucasian (PR = 1.57), women with greater attendance to prenatal care (PR = 1.54), and women having daylight birth (PR = 1.5), when compared with those delivering inside the public sector. Conclusion: Differences in cesarean rates in favor of the private system, among women with better social conditions, amongst which it would be expected a lower obstetric risk, have pointed toward differences in obstetric/medical culture permeability and flexibility on medical judgment concerning clinical criteria for cesarean sections.
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Affiliation(s)
- Paulo Fontoura Freitas
- Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.,Universidade do Sul de Santa Catarina, Unidade Pedra Branca - Florianópolis (SC), Brasil
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Rosińska M, Parda N, Kołakowska A, Godzik P, Zakrzewska K, Madaliński K, Zieliński A, Boguradzka A, Gierczyński R, Stępień M. Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016. PLoS One 2017; 12:e0185055. [PMID: 28931062 PMCID: PMC5607182 DOI: 10.1371/journal.pone.0185055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022] Open
Abstract
Background & aims There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland. Methods A cross-sectional study was conducted in 2012–2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: ‘significant fibrosis’ (APRI≥0.7 or FIB4≥1.45) and ‘no significant fibrosis’ (APRI<0.7 and FIB4<1.45). Results Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures. Conclusions As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.
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Affiliation(s)
- Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
- * E-mail:
| | - Natalia Parda
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Agnieszka Kołakowska
- Department of Virology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Paulina Godzik
- Department of Virology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Karolina Zakrzewska
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
- Department of Virology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Kazimierz Madaliński
- Department of Virology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Andrzej Zieliński
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Anna Boguradzka
- Department of Family Practice, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Rafał Gierczyński
- Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Małgorzata Stępień
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
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55
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Kling D, Haile ZT, Francescon J, Chertok I. Association Between Method of Delivery and Exclusive Breastfeeding at Hospital Discharge. J Osteopath Med 2017; 116:430-9. [PMID: 27367948 DOI: 10.7556/jaoa.2016.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Studies have shown that exclusive breastfeeding at hospital discharge is associated with longer duration of breastfeeding. Method of delivery (MOD) is a barrier that may hinder breastfeeding practices. However, research examining the association between MOD and exclusive breastfeeding at hospital discharge is lacking. OBJECTIVE To examine the association between MOD and exclusive breastfeeding at hospital discharge. METHODS We used a cross-sectional study design to conduct a secondary data analysis of 1494 women who participated in the Infant Feeding Practices Study II between 2005 and 2007. Multiple logistic regression was conducted to estimate the OR and 95% CI for the association between MOD and exclusive breastfeeding at hospital discharge, after adjusting for potential confounding variables. RESULTS The crude prevalence rates of vaginal delivery and cesarean delivery were 74.8% and 25.2%, respectively. The prevalence of exclusive breastfeeding at hospital discharge was 70.6% among respondents who gave birth by cesarean delivery compared with 79.9% of women who gave birth vaginally (P=.001). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding at hospital discharge were lower among women who gave birth by cesarean delivery compared with women who gave birth vaginally (OR, 0.41; 95% CI, 0.24-0.71). CONCLUSION Women who give birth by cesarean delivery may require additional attention, assistance, and encouragement during their hospital stay to improve rates of exclusive breastfeeding at discharge. Health care professionals should address the issue of MOD when promoting exclusive breastfeeding to maximize the potential for longer-term breastfeeding success.
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56
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Grytten J, Skau I, Sørensen R. The impact of the mass media on obstetricians’ behavior in Norway. Health Policy 2017; 121:986-993. [DOI: 10.1016/j.healthpol.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
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57
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Pergialiotis V, Prodromidou A, Perrea DN, Doumouchtsis SK. The impact of subcutaneous tissue suturing at caesarean section on wound complications: a meta-analysis. BJOG 2017; 124:1018-1025. [PMID: 28176441 DOI: 10.1111/1471-0528.14593] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caesarean wound complications are frequently observed in everyday practice. OBJECTIVES To study whether subcutaneous tissue closure following caesarean section results in decreased wound complications. SEARCH STRATEGY We systematically searched Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) databases together with reference lists from included studies. SELECTION CRITERIA Randomised and quasi-randomised trials that investigated the impact of subcutaneous tissue suturing on wound complications following caesarean section were held eligible for inclusion. Retrospective studies and prospective nonrandomised studies were excluded from the present meta-analysis. DATA COLLECTION AND ANALYSIS The methodological quality of studies was assessed with the Jadad scale. Statistical meta-analysis was performed with the RevMan 5.3 software. MAIN RESULTS Ten studies were finally included in our meta-analysis, which involved 3696 women delivered by caesarean section. Re-approximation of the subcutaneous tissue significantly reduced the odds of developing any type of wound complication [3811 women, random effects model (REM), odds ratio (OR) 0.66, 95% CI 0.47-0.93]. The incidence of seroma was also decreased (1979 women, REM, OR 0.53, 95% CI 0.33-0.84). On the other hand, the incidence of haematoma remained unaffected by subcutaneous closure (1663 women, REM, OR 0.74, 95% CI 0.22-2.42) as well as the likelihood of developing a wound infection (1971 women, REM, OR 0.99, 95% CI 0.70-1.41). CONCLUSIONS The results of our meta-analysis suggest that subcutaneous tissue closure may benefit women undergoing caesarean section. Current data in women with high body mass index remain very limited; hence, definitive conclusions are precluded for this specific group. TWEETABLE ABSTRACT Subcutaneous tissue closure may benefit women undergoing caesarean section.
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Affiliation(s)
- V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
| | - A Prodromidou
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
| | - D N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece
| | - S K Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.,Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.,St George's University of London, London, UK
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58
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Hesselman S, Jonsson M, Råssjö EB, Windling M, Högberg U. Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section. J Perinat Med 2017; 45:121-127. [PMID: 27768584 DOI: 10.1515/jpm-2016-0198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the maternal complications associated with cesarean section (CS) in the extremely preterm period according to the gestational week (GW) and to indication of delivery. STUDY DESIGN This is a retrospective case-referent study with a review of medical records of women who delivered at 22-27 weeks of gestation (n=647) at two level III units in Sweden. For abdominal delivery, gestational length was stratified into 22-24 (n=105) and 25-27 (n=301) weeks. For comparison, data on women who underwent a CS at term were identified in a register-based database. RESULTS The rate of CS in extremely preterm births was 62.8%. There was no difference in the complication rates, but types of incisions other than the low transverse incision were required more often at 22-24 (18.1%) weeks than at 25-27 GWs (9.6%) (P=0.02). Major maternal complications occurred in 6.6% compared with 2.1% in the extremely preterm and term CS, respectively (P<0.01). A maternal indication of extremely preterm CS increased the risk of complications. CONCLUSIONS Almost two-thirds of the births at 22-27 GWs had an abdominal delivery. No increase in short-term morbidity was observed at 22-24 weeks compared to 25-27 weeks. CS performed extremely preterm had more major complications recorded than cesarean at term. The complications are driven by the underlying maternal condition.
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59
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Vejux N, Ledu R, D’ercole C, Piechon L, Loundou A, Bretelle F. Guideline choice for CTG analysis influences first caesarean decision. J Matern Fetal Neonatal Med 2016; 30:1816-1819. [DOI: 10.1080/14767058.2016.1228050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Nadege Vejux
- Department of Gynaecology and Obstetrics, GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France,
| | - Renaud Ledu
- Department of Gynaecology and Obstetrics, GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France,
| | - Claude D’ercole
- Department of Gynaecology and Obstetrics, GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France,
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France, and
| | - Laurence Piechon
- Department of Gynaecology and Obstetrics, GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France,
| | - Anderson Loundou
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France, and
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU, Marseille, France,
- Faculté de Médecine de Marseille, UMR CNRS-IRD 6236, Université de la Méditerranée, Marseille, France
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60
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Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis. Chest 2016; 150:572-96. [DOI: 10.1016/j.chest.2016.05.021] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022] Open
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61
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Rosman A, Vlemmix F, Ensing S, Opmeer B, te Hoven S, Velzel J, de Hundt M, van den Berg S, Rota H, van der Post J, Mol B, Kok M. Mode of childbirth and neonatal outcome after external cephalic version: A prospective cohort study. Midwifery 2016; 39:44-8. [DOI: 10.1016/j.midw.2016.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 02/10/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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62
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Tan JKH, Tan EL, Kanagalingam D, Yu SL, Tan LK. Multiple pregnancy is the leading contributor to cesarean sections in in vitro fertilization pregnancies: An analysis using the Robson 10-group classification system. J Obstet Gynaecol Res 2016; 42:1141-5. [PMID: 27251069 DOI: 10.1111/jog.13032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
AIM In vitro fertilization (IVF) pregnancy is an important contributor to rising cesarean section (CS) rates. The profile of CS in this group is not well documented. This study sought to identify leading patient categories of the Robson 10-Group Classification System (TGCS) contributing to the high IVF CS rate. METHODS We carried out a prospective study of IVF patients who delivered in the Singapore General Hospital from January 2010 to July 2012. Parity, singleton/multiple pregnancy, previous CS, mode of labor onset and gestational age at delivery were collected based on the TGCS. All other deliveries during the study period served as control. RESULTS There were a total of 215 IVF deliveries, of which 114 (54.4%) were CS. Group 8 (all multiple pregnancies) was the greatest contributor to the overall CS rate (43.0%). Group 2 (term nulliparous singleton cephalic pregnancies with induction of labor or planned CS) was the second largest contributor to overall CS rate (12.3%). The third and fourth leading contributors were Group 10 (preterm singleton pregnancies) and Group 5 (pregnancies with previous CS), respectively. In contrast, these two groups were top contributors to the overall CS rate for the control group. CONCLUSION Multiple pregnancy is the principal contributor to CS in our IVF population, and reducing its incidence may reduce its CS rate. Among singleton pregnancies, planned CS and failed induction for cephalic term pregnancies and preterm singleton pregnancies were the next largest contributors, suggesting a higher prevalence of maternal request and high-risk obstetric indications requiring interventions at preterm gestations.
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Affiliation(s)
- Jarrod Kah Hwee Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Eng Loy Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | | | - Su Ling Yu
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Lay Kok Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
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63
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Smarandache A, Kim THM, Bohr Y, Tamim H. Predictors of a negative labour and birth experience based on a national survey of Canadian women. BMC Pregnancy Childbirth 2016; 16:114. [PMID: 27193995 PMCID: PMC4870779 DOI: 10.1186/s12884-016-0903-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A negative birth experience has been shown to have a significant impact on the well-being and future choices of mothers. The objective of this study was to assess the prevalence of, and identify the risk factors associated with a negative birth experience for women in Canada. METHODS The study was based on secondary data analysis of the Maternity Experiences Survey (MES), a Canadian population database administered to 6,421 Canadian women in 2006. The examined outcome - negative birth experience - was derived from mothers' self-report of overall labour and birth experience. Independent variables were maternal demographics, health characteristics, pregnancy-related characteristics, and birth characteristics. Multivariable logistic regression analysis was performed to determine the significant predictors of negative birth experience. Adjusted Odds Ratios (AOR) and 95 % Confidence Intervals (CI) are reported. RESULTS Negative birth experience was reported among 9.3 % of women. The main significant predictors of a negative birth experience included older age (AOR 2.29, 95 % CI, 1.03-5.07), violence experienced in the past two years (AOR, 1.62, 95 % CI, 1.21-2.18), poor self-perceived health (adjusted OR, 1.95, 95 % CI, 1.36-2.80), prenatal classes attended (adjusted OR, 1.36, 95 % CI, 1.06-1.76), unintended pregnancy (adjusted OR, 1.30, 95 % CI, 1.03-1.63), caesarean birth (AOR, 1.65, 95 % CI, 1.32-2.06), and neonate admission to intensive care (AOR, 1.40, 95 % CI, 1.08-1.82). CONCLUSION Significant predictors of a negative labour and birth experience were identified through this study, a first in the Canadian context. These findings suggest future research directions and provide a basis for the design and evaluation of maternal health policy and prevention programs.
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Affiliation(s)
- Andrei Smarandache
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Theresa H M Kim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Yvonne Bohr
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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64
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Seal SL, Dey A, Barman SC, Kamilya G, Mukherji J, Onwude JL. Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation. Int J Gynaecol Obstet 2016; 133:178-82. [PMID: 26868074 DOI: 10.1016/j.ijgo.2015.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/16/2015] [Accepted: 01/08/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate whether use of the Fetal Pillow (Safe Obstetric Systems, Shenfield, UK) affects maternal and fetal morbidity in cesarean delivery at full cervical dilatation. METHODS A randomized controlled trial was conducted at two teaching hospitals in West Bengal, India, between April 1, 2013, and March 31, 2014. Women undergoing cesarean delivery at full dilatation were enrolled and randomly assigned with computer-generated random numbers (block size 10) to undergo delivery with or without the Fetal Pillow. Group assignment was not masked. The primary outcome was the incidence of major uterine wound extensions (grade 2-3). RESULTS Overall, 120 women were assigned to each group. Major uterine wound extensions occurred in 6 (5.0%) women in the Fetal Pillow group and 39 (32.5%) in the control group (relative risk 0.23, 95% confidence interval 0.11-0.48). CONCLUSION Use of the Fetal Pillow in second-stage cesarean delivery significantly reduces the risk of a major extension of the uterine incision. CTRI registration number: CTRI/2015/03/005651.
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Affiliation(s)
- Subrata L Seal
- Department of Obstetrics and Gynaecology, R. G. Kar Medical College, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Alok Dey
- Department of Obstetrics and Gynaecology, R. G. Kar Medical College, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | | | | | - Joydev Mukherji
- Department of Obstetrics and Gynaecology, R. G. Kar Medical College, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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65
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Fredheim OMS, Hansen TWR, Haugen G, Magelssen M. [Should we offer caesarean sections in trisomy 13 and 18?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:630-2. [PMID: 27094666 DOI: 10.4045/tidsskr.15.0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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66
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Ononge S, Mirembe F, Wandabwa J, Campbell OMR. Incidence and risk factors for postpartum hemorrhage in Uganda. Reprod Health 2016; 13:38. [PMID: 27080710 PMCID: PMC4832492 DOI: 10.1186/s12978-016-0154-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Globally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different risk factors for PPH. We assessed the incidence of, and risk factors for postpartum hemorrhage among rural women in Uganda. Methods Between March 2013 and March 2014, a prospective cohort study was conducted at six health facilities in Uganda. Women were administered a questionnaire to ascertain risk factors for postpartum hemorrhage, defined as a blood loss of 500 mls or more, and assessed using a calibrated under-buttocks drape at childbirth. We constructed two separate multivariable logistic regression models for the variables associated with PPH. Model 1 included all deliveries (vaginal and cesarean sections). Model 2 analysis was restricted to vaginal deliveries. In both models, we adjusted for clustering at facility level. Results Among the 1188 women, the overall incidence of postpartum hemorrhage was 9.0 %, (95 % confidence interval [CI]: 7.5–10.6 %) and of severe postpartum hemorrhage (1000 mls or more) was 1.2 %, (95 % CI 0.6–2.0 %). Most (1157 [97.4 %]) women received a uterotonic after childbirth for postpartum hemorrhage prophylaxis. Risk factors for postpartum hemorrhage among all deliveries (model 1) were: cesarean section delivery (adjusted odds ratio [aOR] 7.54; 95 % CI 4.11–13.81); multiple pregnancy (aOR 2.26; 95 % CI 0.58–8.79); foetal macrosomia ≥4000 g (aOR 2.18; 95 % CI 1.11–4.29); and HIV positive sero-status (aOR 1.93; 95 % CI 1.06–3.50). Risk factors among vaginal deliveries only, were similar in direction and magnitude as in model 1, namely: multiple pregnancy, (aOR 7.66; 95 % CI 1.81–32.34); macrosomia, (aOR 2.14; 95 % CI1.02–4.47); and HIV positive sero-status (aOR 2.26; 95 % CI 1.20–4.25). Conclusion The incidence of postpartum hemorrhage was high in our setting despite use of uterotonics. The risk factors identified could be addressed by extra vigilance during labour and preparedness for PPH management in all women giving birth.
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Affiliation(s)
- Sam Ononge
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Florence Mirembe
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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67
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Boz İ, Teskereci G, Akman G. How did you choose a mode of birth? Experiences of nulliparous women from Turkey. Women Birth 2016; 29:359-67. [PMID: 26846560 DOI: 10.1016/j.wombi.2016.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND One of the most important decisions that women have to make after becoming pregnant concerns their mode of birth, and these decisions are influenced by complex physiological, psychological and socio-cultural factors. AIM To obtain in-depth descriptions of nulliparous women's experiences during the decision-making process for their mode of birth and to reveal their beliefs, attitudes and values. METHODS This is a qualitative, phenomenological study that included 29 nulliparous women. Data were collected using semi-structured, face-to-face interviews and analysed using the constant comparison method and guidelines developed by Collaizi. FINDINGS The women's experiences during their decision-making process for their mode of birth were placed into one of four categories, "getting confused", "no matter what happens", "others influencing women's decisions" and "make a decision one way or the other". Vaginal births were considered under the theme "natural but hard way" and caesarean sections under the theme "easy choice". The women indicated that they wanted to have vaginal births, but that they were not offered knowledge and support about modes of birth from health care professionals and, as a result, they asked their relatives for support. CONCLUSION It is important to obtain pregnant women's preferences for modes of birth so that knowledge, support and care can be provided and so that they can be involved in the decision-making process. Therefore, health care professionals should understand pregnant women's experiences during the decision-making process for their mode of birth.
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Affiliation(s)
- İlkay Boz
- Akdeniz University, Nursing Faculty, Antalya, Turkey.
| | | | - Gülay Akman
- Samsun School of Health, Ondokuz Mayıs University, Samsun 55100, Turkey.
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Abstract
BACKGROUND Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis. METHODS Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications. RESULTS Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05). CONCLUSIONS In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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Merry L, Vangen S, Small R. Caesarean births among migrant women in high-income countries. Best Pract Res Clin Obstet Gynaecol 2015; 32:88-99. [PMID: 26458998 DOI: 10.1016/j.bpobgyn.2015.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/13/2015] [Accepted: 09/06/2015] [Indexed: 01/05/2023]
Abstract
High caesarean birth rates among migrant women living in high-income countries are of concern. Women from sub-Saharan Africa and South Asia consistently show overall higher rates compared with non-migrant women, whereas women from Latin America and North Africa/Middle East consistently show higher rates of emergency caesarean. Higher rates are more common with emergency caesareans than with planned caesareans. Evidence regarding risk factors among migrant women for undergoing a caesarean birth is lacking. Research suggests that pathways leading to caesarean births in migrants are complex, and they are likely to involve a combination of factors related to migrant women's physical and psychological health, their social and cultural context and the quality of their maternity care. Migration factors, including length of time in receiving country and migration classification, have an influence on delivery outcome; however, their effects appear to differ by women's country/region of origin.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Department for Women and Children's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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Ngowa JDK, Ngassam A, Fouogue JT, Metogo J, Medou A, Kasia JM. [Early maternal complications of cesarean section: about 460 cases in two university hospitals in Yaounde, Cameroon]. Pan Afr Med J 2015; 21:265. [PMID: 26600898 PMCID: PMC4646440 DOI: 10.11604/pamj.2015.21.265.6967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/19/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction La césarienne est l'une des interventions chirurgicales courantes en obstétrique. L'objectif de cette étude était de déterminer l'incidence des complications maternelles précoces de la césarienne dans deux hôpitaux universitaires de Yaoundé. Méthodes Il s'agissait d'une analyse descriptive d'une cohorte de 460 cas de césariennes à l'Hôpital Central de Yaoundé (HCY) et à l'Hôpital Général de Yaoundé (HGY) pendant la période du 1er avril au 30 septembre 2012. Résultats Le taux de césarienne était de 19,7% dans l'ensemble de la population de l’étude, 18,64% à l'HCY et de 23,73% à l'HGY. Les indications de la césarienne étaient prophylactiques dans 191 cas (41,52%), urgentes en dehors du travail dans 67cas (14,56%) et urgentes au cours du travail dans 202 cas (43,91%). L'incidence des complications maternelles précoces était de 20,11% à l'HCY (69/343 cas), de 7,69% à l'HGY (9/117 cas) et de 16,95% dans l'ensemble (78/460 cas). Les complications hémorragiques étaient les plus fréquentes, 39(8,48%) cas dans l'ensemble, 35(10,2%) cas à l'HCY et 4(3,42%) cas à l'HGY. Tandis que les complications infectieuses étaient retrouvées dans 33(7,17%) cas dans l'ensemble, 31(9,04%) cas à l'HCY et 2(1,7%) cas à l'HGY. La différence des incidences de complications entre l'HCY et l'HGY était significative tant dans l'ensemble des morbidités (20,11% vs 7,69%; P=0,002) que pour les complications hémorragiques (10,2% vs 3,42%; P=0,02) et infectieuses (9,04% vs 1,71%; P=0,008). Conclusion Les complications maternelles précoces de la césarienne dans notre milieu restent considérables. Les complications hémorragiques et infectieuses sont les plus fréquentes.
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Affiliation(s)
- Jean Dupont Kemfang Ngowa
- Departement de Gynécologie-Obstétrique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Service d'Anesthésie-Réanimation, Hôpital Général de Yaoundé, Yaoundé, Cameroun
| | - Anny Ngassam
- Departement de Gynécologie-Obstétrique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
| | - Jovanny Tsuala Fouogue
- Departement de Gynécologie-Obstétrique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
| | - Junie Metogo
- Departement de Gynécologie-Obstétrique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
| | - Alexis Medou
- Service d'Anesthésie-Réanimation, Hôpital Général de Yaoundé, Yaoundé, Cameroun
| | - Jean Marie Kasia
- Departement de Gynécologie-Obstétrique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun ; Service d'Anesthésie-Réanimation, Hôpital Général de Yaoundé, Yaoundé, Cameroun
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Sense of coherence and childbearing choices: A cross sectional survey. Midwifery 2015; 31:1081-6. [PMID: 26299371 DOI: 10.1016/j.midw.2015.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 06/24/2015] [Accepted: 07/20/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman's SOC and the childbirth choices she makes in pregnancy. METHODS the study aims to investigate the relationship between SOC and women's pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. FINDINGS 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women's pregnancy choices. CONCLUSION this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women's birthing outcomes.
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Ekin A, Gezer C, Solmaz U, Taner CE, Dogan A, Ozeren M. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet 2015; 292:1247-54. [PMID: 26041324 DOI: 10.1007/s00404-015-3771-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/27/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH. METHODS Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses. RESULTS PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006). CONCLUSION Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.
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Affiliation(s)
- Atalay Ekin
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Cenk Gezer
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ulas Solmaz
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cuneyt Eftal Taner
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Askin Dogan
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozeren
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Nash Z, Nathan B, Mascarenhas L. Kielland's forceps. From controversy to consensus? Acta Obstet Gynecol Scand 2014; 94:8-12. [DOI: 10.1111/aogs.12511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Zachary Nash
- Department of Obstetrics and Gynaecology; St Thomas' Hospital; London UK
- King's College; London UK
| | - Bassem Nathan
- Department of Surgery; Riverside Hospital; London UK
| | - Lawrence Mascarenhas
- Department of Obstetrics and Gynaecology; St Thomas' Hospital; London UK
- King's College; London UK
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Sørbye IK, Daltveit AK, Sundby J, Stoltenberg C, Vangen S. Caesarean section by immigrants' length of residence in Norway: a population-based study. Eur J Public Health 2014; 25:78-84. [PMID: 25192708 DOI: 10.1093/eurpub/cku135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrants to Europe account for a significant proportion of births in a context of rising caesarean rates. We examined the risk of planned and emergency caesarean section (CS) by immigrants' length of residence in Norway, and compared the results with those of non-immigrants. METHODS We linked population-based birth registry data to immigration data for first deliveries among 23 147 immigrants from 10 countries and 385 306 non-immigrants between 1990-2009. Countries were grouped as having low CS levels (<16%; Iraq, Pakistan, Poland, Turkey, Yugoslavia, Vietnam) or high CS levels (>22%; the Philippines, Somalia, Sri Lanka, Thailand). Associations between length of residence and planned/emergency CS were estimated as relative risks (RR) with 95% confidence intervals (CI) in multivariable models. RESULTS In the immigrant group with low CS levels, planned, but not emergency, CS was independently associated with longer length of residence. Compared with recent immigrants (<1 year), the risk of planned CS was 70% greater among immigrants with residency of 2-5 years (RR 1.70, CI: 1.19-2.42), and twice as high in those with residency of ≥ 6 years. (RR 2.01, CI: 1.28-3.17). Compared with non-immigrants, immigrants in the low group with residency <2 years had lower risk of planned CS, while those with residency >2 years had greater risk of emergency CS. In the high group, the risk of planned CS was similar to non-immigrants, while emergency CS was 51-75% higher irrespective of length of residency. CONCLUSION Efforts to improve immigrants' labour outcomes should target subgroups with sustained high emergency caesarean risk.
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Affiliation(s)
- Ingvil K Sørbye
- 1 Norwegian Resource Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Anne K Daltveit
- 2 Norwegian Institute of Public Health, Oslo, Norway 3 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Johanne Sundby
- 4 Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Camilla Stoltenberg
- 2 Norwegian Institute of Public Health, Oslo, Norway 3 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Vangen
- 1 Norwegian Resource Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway 2 Norwegian Institute of Public Health, Oslo, Norway
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Ezegwui HU, Ogbuefi FC. Routine cervical dilatation during elective caesarean section. Should we continue? J OBSTET GYNAECOL 2014; 35:150-2. [DOI: 10.3109/01443615.2014.937333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stach SL, Liao AW, Brizot MDL, Francisco RPV, Zugaib M. Maternal postpartum complications according to delivery mode in twin pregnancies. Clinics (Sao Paulo) 2014; 69:447-51. [PMID: 25029574 PMCID: PMC4081886 DOI: 10.6061/clinics/2014(07)01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors. METHODS This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated. RESULTS A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR=2.34). CONCLUSIONS Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.
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Affiliation(s)
- Sonia Leme Stach
- Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Adolfo Wenjaw Liao
- Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maria de Lourdes Brizot
- Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Reinhard J, Hanker L, Sänger N, Yuan J, Louwen F. Neonatal Transfer Rate and Mode of Delivery from 37th Week of Gestation in a German Perinatal Center Level 1. Geburtshilfe Frauenheilkd 2014; 73:324-329. [PMID: 24771918 DOI: 10.1055/s-0032-1328435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 02/05/2013] [Accepted: 03/06/2013] [Indexed: 10/26/2022] Open
Abstract
Introduction: Rates for caesarean section are on the rise and the reasons for this are being discussed worldwide. As the data is unclear, the identification of additional predictive factors for caesarean section is important as caesarean sections are closely linked to maternal and neonatal morbidity. The aim of the study was to identify predictive factors for the transfer of the neonate to a neonatal intensive care unit (NICU) depending on the mode of delivery. The study investigated the neonatal transfer rates for singleton and twin pregnancies delivered at ≥ 36 + 0 weeks of gestation. Material and Methods: The data of all singleton (n = 4181) and twin pregnancies (n = 305 neonates), delivered between 1 January 2009 and 31 March 2012 in the OB/Gyn Department of the University Hospital Frankfurt/M, Germany, (perinatal center level 1) were evaluated. The indications for transfer to the NICU and possible predictive factors were evaluated. Results: Our study found a two times lower neonatal transfer rate for vaginal deliveries of pregnant women without risk factors compared to women with risk factors. The following neonatal transfer rates to the NICU were noted for singleton pregnancies: 4.7 % without risk factors, 8.3 % high-risk pregnancy, 6.2 % vaginal breech delivery, 9.3 % forceps delivery, 10 % elective primary caesarean section and 14 % secondary caesarean section. There was a statistically signific.
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Affiliation(s)
- J Reinhard
- St. Marienkrankenhaus Frankfurt, Frankfurt am Main
| | - L Hanker
- Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main
| | - N Sänger
- Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main
| | - J Yuan
- Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main
| | - F Louwen
- Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main
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Seal SL, Dey A, Barman SC, Kamilya G, Mukherji J. Does elevating the fetal head prior to delivery using a fetal pillow reduce maternal and fetal complications in a full dilatation caesarean section? A prospective study with historical controls. J OBSTET GYNAECOL 2014; 34:241-4. [PMID: 24483234 DOI: 10.3109/01443615.2013.844108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A caesarean section at full dilatation (CSFD) can be technically demanding and has consistent association with increased intraoperative trauma. There is evidence that the incidence of caesarean sections at full dilation is on the rise. We report on a prospective study of 50 women undergoing CSFD using a fetal pillow (FP) to elevate the fetal head. Data were compared with historical controls of 124 women without FP use on uterine extensions, uterine incision delivery interval, blood loss, need for transfusion, operating time, length of stay, intensive care unit admission. The FP elevated the fetal head in all 50 women (p < 0.001). We found that patients in the FP group had a lower incidence of extensions (p = 0.03), shorter operating time (p < 0.001), uterine incision to delivery interval (p < 0.001) and shorter length of hospital stay (p < 0.001). Blood loss > 1,000 ml and admission to ICU was also lower but were not statistically significant. There were no significant differences in the fetal complications studied, APGAR scores, admission to neonatal intensive care unit, seizures, neonatal injury or death.
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Affiliation(s)
- S L Seal
- Department of Obstetrics and Gynaecology, R.G. Kar Medical College, Institute of Postgraduate Medical Education and Research , Kolkata, West Bengal , India
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Abstract
BACKGROUND Approximately 15% of the 4 million annual US births occur in rural hospitals. OBJECTIVE To (1) measure differences in obstetric care in rural and urban hospitals, and to (2) examine whether trends over time differ by rural-urban hospital location. RESEARCH DESIGN AND SUBJECTS This was a retrospective analysis of hospital discharge records for all births in the 2002-2010 Nationwide Inpatient Sample, which constitutes 20% sample of US hospitals (N = 7,188,972 births: 6,316,743 in urban hospitals, 837,772 in rural hospitals). MEASURES Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), nonindicated cesarean, and nonindicated labor induction were estimated. RESULTS In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. VBAC rates were 5.0% in rural and 10.0% in urban hospitals in 2010. Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and VBAC rates decreased in both rural and urban hospitals. Nonindicated labor induction was less frequent in rural versus urban hospitals in 2002 [adjusted odds ratio = 0.79 (0.78-0.81)], but increased more rapidly in rural hospitals from 2002 to 2010 [adjusted odds ratio = 1.05 (1.05-1.06)]. In 2010, 16.5% of rural births were induced without indication (12.0% of urban births). CONCLUSIONS From 2002 to 2010, cesarean rates rose and VBAC rates fell in both rural and urban hospitals. Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals.
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von Schmidt auf Altenstadt JF, Hukkelhoven CWPM, van Roosmalen J, Bloemenkamp KWM. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands. PLoS One 2013; 8:e81959. [PMID: 24367496 PMCID: PMC3867333 DOI: 10.1371/journal.pone.0081959] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands. Methods A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n = 1 457 576). Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ≥1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses. Results Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4%) developed postpartum haemorrhage, compared to 60 517 (4.2%) from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89). Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60). Conclusion Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by 2015.
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Affiliation(s)
| | | | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
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A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery. Int J Gynaecol Obstet 2013; 124:99-105. [DOI: 10.1016/j.ijgo.2013.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/17/2013] [Accepted: 10/25/2013] [Indexed: 11/18/2022]
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82
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Flo K, Widnes C, Vårtun Å, Acharya G. Blood flow to the scarred gravid uterus at 22-24 weeks of gestation. BJOG 2013; 121:210-5. [DOI: 10.1111/1471-0528.12441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K Flo
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - C Widnes
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - Å Vårtun
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
| | - G Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Obstetrics and Gynaecology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
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83
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Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/283025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background. Lower segment caesarean section (LSCS) is a common mode of delivery now and surgical site infection is the second most common infectious complication in these patients. This study was planned with this background to have a comprehensive approach to SSI following LSCS. Methods. 500 consecutive patients undergoing LSCS, irrespective of indication, were studied. A questionnaire was developed to assess the risk factors associated with development of SSI. All patients were followed up from day one of surgery till discharge and then up till the postoperative day 30 after discharge. Results. SSI was identified in 121 (24.2%) out of 500 patients. In all age groups, Gram-negative bacilli were the commonest finding. The commonest isolate was Acinetobacter species (32.03%) followed by Staphylococcus aureus and coagulase negative Staphylococcus (21.09%). 23.8% of Staphylococcus aureus strains were MRSA. By multivariate logistic regression premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be significant. Conclusions. A proper assessment of risk factors that predispose to SSI and their modification may help in reduction of SSI rates. Also, frequent antimicrobial audit and qualitative research could give an insight into the current antibiotic prescription practices and the factors affecting these practices.
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84
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Homer CSE, Besley K, Bell J, Davis D, Adams J, Porteous A, Foureur M. Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial. BMC Pregnancy Childbirth 2013; 13:140. [PMID: 23819882 PMCID: PMC3717054 DOI: 10.1186/1471-2393-13-140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC. Methods/Design A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups. Discussion This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Level 7, 235-253 Jones St, Broadway, Sydney, NSW, Australia.
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85
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Conde-Agudelo A, Nieto A, Rosas-Bermudez A, Romero R. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 2013; 209:40.e1-40.e17. [PMID: 23507545 DOI: 10.1016/j.ajog.2013.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/26/2013] [Accepted: 03/13/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and metaanalysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol vs oxytocin and 8 evaluated misoprostol plus oxytocin vs oxytocin alone. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, -2.1%; 95% confidence interval, -3.4 to -0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% confidence interval, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during cesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.
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Affiliation(s)
- Agustín Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
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86
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Wu CH, Chen CF, Chien CC. Prediction of dystocia-related cesarean section risk in uncomplicated Taiwanese nulliparas at term. Arch Gynecol Obstet 2013; 288:1027-33. [PMID: 23636412 DOI: 10.1007/s00404-013-2864-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/18/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to assess risk factors for dystocia-related cesarean section (CS) in uncomplicated Taiwanese nulliparas at term METHODS We reviewed 1,272 deliveries by 1 obstetrician in a Taiwanese hospital between February 2004 and December 2011. These parturients were nulliparas with singleton pregnancies ≥ 37 weeks gestation who had liveborn cephalic deliveries. The CS group consisted of parturients with dystocia-related CS for the following indications: prolonged latent phase, failure to progress, or arrest of descent. Eight confounding variables [maternal age, height, weight, body mass index (BMI) in labor, gestational age, infant birth weight, gender, and cervical dilatation] were obtained from the medical records. Multivariate logistic regression analysis was used to determine the association between each variable and route of delivery. A predictive formula for CS probability was generated using a logistic regression model. RESULTS Overall 15.0 % of nulliparas in our population underwent CS. Logistic regression analysis revealed a significant association between maternal BMI and CS (adjusted OR 1.112; 95 % CI 1.065-1.161; P < 0.001). The association between maternal age and CS was also statistically significant (adjusted OR 1.074, 95 % CI 1.033-1.116, P = 0.001). Maternal height, weight in labor, gestational age, infant birth weight, gender, and cervical dilatation were not significantly associated with the route of delivery. A predictive formula for CS probability was developed based on a combination of maternal BMI and age. CONCLUSIONS Our results show that maternal age and BMI in labor are significantly associated with dystocia-related CS in uncomplicated Taiwanese nulliparas at term. We develop a practical formula to predict the probability for CS. Using this formula, obstetricians can estimate the risk of CS according to maternal age and BMI in labor.
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Affiliation(s)
- Chiung-Hui Wu
- Department of Obstetrics and Gynecology, Ton-Yen General Hospital, No.69, Sianjheng 2nd Rd, Jhubei City, 302, Hsinchu County, Taiwan, ROC,
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87
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Gómez-Durán EL, Mulà-Rosías JA, Lailla-Vicens JM, Benet-Travé J, Arimany-Manso J. Analysis of obstetrics and gynecology professional liability claims in Catalonia, Spain (1986-2010). J Forensic Leg Med 2013; 20:442-6. [PMID: 23756513 DOI: 10.1016/j.jflm.2012.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks. STUDY DESIGN Analysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period. RESULTS Most claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment. CONCLUSION OG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.
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Affiliation(s)
- Esperanza L Gómez-Durán
- Professional Liability Department, Barcelona's Official College of Physicians, Passeig Bonanova, 47, 08017 Barcelona, Spain.
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88
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Sun J, Ding M, Liu J, Li Y, Sun X, Liu T, Chen Y, Liu J. Prophylactic Administration of Cefazolin Prior to Skin Incision versus Antibiotics at Cord Clamping in Preventing Postcesarean Infectious Morbidity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gynecol Obstet Invest 2013; 75:175-8. [DOI: 10.1159/000346458] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 12/13/2012] [Indexed: 11/19/2022]
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89
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Circumferential Avulsion of the Uterine Body from the Lower Segment During Cesarean Section: Complication of a Wedged Fetal Head. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2012.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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90
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Xu S, Wu H, Zhao Q, Shen X, Guo X, Wang F. The median effective volume of crystalloid in preventing hypotension in patients undergoing cesarean delivery with spinal anesthesia. Rev Bras Anestesiol 2012; 62:312-24. [PMID: 22656677 DOI: 10.1016/s0034-7094(12)70132-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal anesthesia-associated maternal hypotension in Cesarean delivery is the most frequent and troublesome complication, posing serious risks to mothers and compromising neonatal well-being. The effective volume of intravenous crystalloid as the preventive strategy in this context has not been estimated. METHODS Eighty-five parturients with ASA physical status I/II undergoing elective Cesarean delivery were screened and 67 eligible women were assigned to receive pre-spinal crystalloid loading. Hyperbaric 0.5% bupivacaine 2mL (10mg) plus morphine 50μg was given to all patients. The volume of crystalloid was determined by an up-and-down sequential method. The crystalloid was infused at a rate of 100-150mL.min(-1) prior to the spinal anesthetic injection. The initial volume of crystalloid was 5mL.kg(-1). Volume-effect data were fitted to a sigmoidal maximum efficacy model and the median effective volume (EV(50)) and corresponding 95% confidence interval (95% CI) were estimated using maximum likelihood estimation and logistic regression with Firth's correction. RESULTS A total of 67 subjects completed the study and were analyzed. Twenty-eight (41.8%) patients developed hypotension with their systolic blood pressure (SBP) decreasing > 20% of baseline. The EV(50) of crystalloid were 12.6mL.kg(-1) (95% CI, 11.6 to 14.8mL.kg(-1)). With Firth's correction, the pooled probability of an effective preventive volume of crystalloid at 13mL.kg(-1) was 50.2% (95% CI, 30% to 83.1%). CONCLUSIONS The estimated EV(50) of the preloaded crystalloid required to prevent spinal anesthesia-induced hypotension in a Cesarean section is, approximately, 13mL.kg(-1). However, prophylactic or therapeutic vasoconstrictors should also be prepared and administered at an appropriate time.
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Affiliation(s)
- ShiQin Xu
- Nanjing Medical University, Nanjing, China
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91
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Saha S, Saha S, Das R, Chakraborty M, Bala HS, Naskar P. A Paradigm Shift to Check the Increasing Trend of Cesarean Delivery is the Need of Hour: But How? J Obstet Gynaecol India 2012; 62:391-7. [PMID: 23904696 DOI: 10.1007/s13224-012-0288-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 06/18/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To check the progressive increasing trend of caesarean delivery in a tertiary facility care centre. AIMS The purpose of this study is to implement a paradigm shift in caesarean delivery by introducing a new classification system and a check list based management protocol. METHODS The study was conducted from 1st January, 2007 to 31st December, 2008 at CNMC G&O Department. All deliveries in the year 2007 were compared retrospectively and all deliveries in the year 2008 under prospective study with implementation of a new strategic protocol. Comparative audit and analysis of deliveries in retrospective and prospective year reveals significant changes in the caesarean delivery rate. RESULTS In retrospective group all women in labour were allowed for spontaneous delivery and in prospective group all women were subjected to intervention protocol and caesarean delivery done in both the groups in need for risk of fetal and maternal salvage. Incidence of caesarean delivery (CD) in retrospective group was 29 % while in the prospective group it was 18.4 %. Marked decrease in CD was observed for augmentation, induction and trial of labour (TOL) for delivery in prospective group. The result was compared with Robson's studies following similar type of classification system. CONCLUSION Marked improvement was noticed in this new paradigm and more multicentric trial is needed to check the increasing trend of CD.
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Affiliation(s)
- Sudarsan Saha
- Department Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, 700 014 India
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92
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Fiocchi F, Nocetti L, Siopis E, Currà S, Costi T, Ligabue G, Torricelli P. In vivo 3 T MR diffusion tensor imaging for detection of the fibre architecture of the human uterus: a feasibility and quantitative study. Br J Radiol 2012; 85:e1009-17. [PMID: 22744322 DOI: 10.1259/bjr/76693739] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility of depicting fibre architecture of human uteri in vivo using 3 T MR diffusion tensor imaging (MR-DTI) with a three-dimensional (3D) tractography approach. Quantitative results were provided. METHODS In vivo 3 T MR-DTI was performed on 30 volunteers (9 Caesarean delivery). Main diffusion directions reflecting the fibre orientation were determined using sensitivity-encoding single-shot echo planar imaging with diffusion-sensitised gradients (b=600 mm(2) s(-1)) along 32 directions. A deterministic fibre-tracking algorithm was used to show in vivo fibre architecture, compared with ex vivo histological slides of cadaveric uteri. The number of fibres, the fibre density, the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) were measured in 13 volunteers. RESULTS Anisotropy was found in most regions of normal uteri and the preferential order of uterine fibres depicted, consisting of two representative fibre directions: circular and longitudinal, as in ex vivo studies. Two-thirds of uteri with a Caesarean scar did not have the same orientation of fibres in the anterior isthmus when compared with non-scarred myometrium. Quantitative data were obtained from 13 volunteers: Caesarean-scarred uteri (n=5) showed lower fibre number and density in the scarred anterior isthmus than the nulliparous uteri (n=8). No significant differences were found in FA (0.42 ± 0.02, 0.41 ± 0.02; p=0.25) and ADC (1.82 ± 0.18 × 10(-3) mm(2) s(-1), 1.93 ± 0.25 × 10(-3) mm(2) s(-1); p=0.20). CONCLUSION Fibre architecture of the human uterus can be depicted in vivo using 3 T MR-DTI. Advances in knowledge 3 T MR-DTI can help to provide an in vivo insight of uterine anatomy non-invasively, especially in females with previous Caesarean surgery, in order to provide better management of subsequent deliveries.
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Affiliation(s)
- F Fiocchi
- Department of Diagnostic Radiology, Policlinico Hospital, University of Modena and Reggio-Emilia, Modena, Italy.
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93
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Karabulut A, Derbent AU, Yildirim M, Simavli S, Turhan NÖ. Evaluation of risk factors and effect of physical activity in caesarean section in nulliparous women. J Matern Fetal Neonatal Med 2012; 25:1456-9. [DOI: 10.3109/14767058.2011.640370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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94
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Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res 2012; 38:509-15. [PMID: 22353388 DOI: 10.1111/j.1447-0756.2011.01746.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To estimate the incidence of and identify the risk factors for a surgical site infection after a cesarean section. METHOD A survey of women who underwent a cesarean section was conducted in eight hospitals in Guangdong Province, China. The rate of surgical site infection was estimated and a nested case control study was then carried out to identify the risk factors. RESULTS Among 13 798 women surveyed, 96 (0.7%) developed a surgical site infection after a cesarean section. Multivariate logistic regression analysis identified six factors independently associated with an increased risk of surgical site infection, which included obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations performed during hospitalization. CONCLUSION Surgical site infection occurs in approximately 0.7% of cesarean section cases in the general obstetric population in China. Obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations during hospitalization are considered to be independent risk factors.
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Affiliation(s)
- Shi-Peng Gong
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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95
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Appropriate Use of Caesarean Section. INTERNATIONAL JOURNAL OF CHILDBIRTH 2012. [DOI: 10.1891/2156-5287.2.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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96
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Wang Z, Sun W, Zhou H. Midwife-led care model for reducing caesarean rate: A novel concept for worldwide birth units where standard obstetric care still dominates. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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97
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Bernis C, Varea C. Hour of birth and birth assistance: From a primate to a medicalized pattern? Am J Hum Biol 2011; 24:14-21. [DOI: 10.1002/ajhb.21228] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/08/2011] [Accepted: 09/14/2011] [Indexed: 11/10/2022] Open
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98
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Abstract
A 32-week-gestation female was delivered emergently via caesarian section to a mother in premature labor due to placental abruption. On delivery, the neonate was noted to have sustained right upper and lower eyelid full-thickness lacerations extending from the medial canthal area with associated right upper and lower full-thickness canalicular lacerations. The neonate underwent same-day surgical repair of her eyelid lacerations with stenting of her canalicular system with a Crawford tube. At 2 months postoperatively, the child is opening her right upper eyelid without any signs of deprivation ambylopia. This case demonstrates the need to inform expectant mothers of the intrinsic risks of periorbital trauma during the birthing process that may result in visual loss through either ambylopia and/or globe injury.
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99
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Grytten J, Monkerud L, Hagen TP, Sørensen R, Eskild A, Skau I. The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005. BMC Health Serv Res 2011; 11:267. [PMID: 21992174 PMCID: PMC3210106 DOI: 10.1186/1472-6963-11-267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There has been a marked increase in the number of Caesarean sections in many countries during the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased by about 260% (adjusted for inflation). METHODS The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included. RESULTS The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p < 0.05). This represents an increase in the Caesarean section rate from the basis year 1976 to the final year 2005 of about 35 per cent. Most of the variables measuring characteristics of the health status of the mother and child had the expected effects. CONCLUSION The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
| | - Lars Monkerud
- Department of Economics, BI Norwegian Business School, Oslo, Norway
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
| | - Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Rune Sørensen
- Department of Economics, BI Norwegian Business School, Oslo, Norway
| | - Anne Eskild
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Oslo, Norway
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100
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Freitas PF, Savi EP. Desigualdades sociais nas complicações da cesariana: uma análise hierarquizada. CAD SAUDE PUBLICA 2011; 27:2009-20. [DOI: 10.1590/s0102-311x2011001000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
Com objetivo de investigar associações entre fatores socioeconômicos e complicações da cesariana, uma amostra de 604 puérperas cujos partos ocorreram em duas maternidades no Sul do Brasil foi entrevistada 24 horas pós-parto e na segunda semana do puerpério, por meio de entrevistas hospitalares e domicilio. Regressão de Cox foi aplicada ao modelo hierárquico dos fatores associados ao tipo de parto e às complicações no pós-parto. Complicações foram duas vezes mais frequentes após cesariana, independentemente das condições socioeconômicas. Contudo, a maneira como o parto cesáreo se associou ao risco de complicações mostrou-se mediada pelas circunstâncias socioeconômicas representadas pela categoria do pré-natal e parto, ter ou não o mesmo profissional no pré-natal e parto e ter sua cesariana decidida intraparto. Resultados do estudo evidenciam que complicações pós-cirúrgicas da cesariana têm impacto adverso, principalmente, entre aquelas mulheres vivendo em condições sociais e de saúde menos privilegiadas, as quais, após o parto, retornam para um ambiente de menor suporte, com uma cicatriz abdominal.
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Affiliation(s)
- Paulo Fontoura Freitas
- Universidade Federal de Santa Catarina, Brasil; Universidade do Sul de Santa Catarina, Brasil
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