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Pritchett RV, Rudge G, Taylor B, Cummins C, Kenyon S, Jones E, Morad S, MacArthur C, Jolly K. Emergency Maternal Hospital Readmissions in the Postnatal Period: A Population-Based Cohort Study. BJOG 2024. [PMID: 39291340 DOI: 10.1111/1471-0528.17955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/25/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To determine the change in English emergency postnatal maternal readmissions 2007-2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS). DESIGN National cohort study. SETTING All English National Health Service hospitals. POPULATION A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017. METHODS Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database. MAIN OUTCOME MEASURES Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS. RESULTS A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28-1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31-1.39); age < 20 years (aOR 1.09, 95% CI 1.05-1.12); 40+ years (aOR 1.07, 95% CI 1.03-1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91-0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82-1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53-1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06-2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83-2.21). CONCLUSIONS The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those <20 and ≥40 years old; primiparous women; and those with specified obstetric risk factors.
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Affiliation(s)
- Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Beck Taylor
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ellie Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Leonard SA, Girsen AI, Trepman P, Carmichael SL, Darmawan K, Butwick AJ, Gibbs RS. Early Postpartum Hospital Encounters among Patients with Genitourinary and Wound Infections during Hospitalization for Birth. Am J Perinatol 2024; 41:e2017-e2025. [PMID: 37216972 DOI: 10.1055/a-2097-1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study aimed to assess the associations between genitourinary and wound infections during the birth hospitalization and early postpartum hospital encounters, and to evaluate clinical risk factors for early postpartum hospital encounters among patients with genitourinary and wound infections during the birth hospitalization. STUDY DESIGN We conducted a population-based cohort study of births in California during 2016 to 2018 and postpartum hospital encounters. We identified genitourinary and wound infections using diagnosis codes. Our main outcome was early postpartum hospital encounter, defined as a readmission or emergency department (ED) visit within 3 days after discharge from the birth hospitalization. We evaluated the association of genitourinary and wound infections (overall and subtypes) with early postpartum hospital encounter using logistic regression, adjusting for sociodemographic factors and comorbidities and stratified by mode of birth. We then evaluated factors associated with early postpartum hospital encounter among patients with genitourinary and wound infections. RESULTS Among 1,217,803 birth hospitalizations, 5.5% were complicated by genitourinary and wound infections. Genitourinary or wound infection was associated with an early postpartum hospital encounter among patients with both vaginal births (2.2%; adjusted risk ratio [aRR[: 1.26; 95% confidence interval [CI]: 1.17-1.36) and cesarean births (3.2%; aRR: 1.23; 95% CI: 1.15-1.32). Patients with a cesarean birth and a major puerperal infection or wound infection had the highest risk of an early postpartum hospital encounter (6.4 and 4.3%, respectively). Among patients with genitourinary and wound infections during the birth hospitalization, factors associated with an early postpartum hospital encounter included severe maternal morbidity, major mental health condition, prolonged postpartum hospital stay, and, among cesarean births, postpartum hemorrhage (p-value < 0.05). CONCLUSION Genitourinary and wound infections during hospitalization for birth may increase risk of a readmission or ED visit within the first few days after discharge, particularly among patients who have a cesarean birth and a major puerperal infection or wound infection. KEY POINTS · In all, 5.5% of patients giving birth had a genitourinary or wound infection (GWI).. · A total of 2.7% of GWI patients had a hospital encounter within 3 days of discharge after birth.. · Major puerperal infection and wound infection had the highest risk of an early hospital encounter.. · Among GWI patients, several birth complications were associated with an early hospital encounter..
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Paula Trepman
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Suzan L Carmichael
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
- Department of Pediatrics, Stanford University, Stanford, California
| | - Kelly Darmawan
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Schaafsma IJ, Hoogenboom FJ, Dijkstra G, Prins JR, Visschedijk MC. Vaginal delivery in women with perianal Crohn's disease: why not? AJOG GLOBAL REPORTS 2024; 4:100333. [PMID: 38655569 PMCID: PMC11035108 DOI: 10.1016/j.xagr.2024.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Pregnant women with active perianal Crohn's disease indicate a cesarean delivery according to the current European Crohn's and Colitis Organisation guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and worsening of fecal continence. However, there is no strong evidence to support this. OBJECTIVE This study aims to examine the effects of the delivery method on perianal disease progression and fecal incontinence in women with perianal Crohn's disease. STUDY DESIGN In this retrospective cohort study, 102 women were selected from the 1000 inflammatory bowel disease cohort of a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal Crohn's disease, and have given birth. In addition, all women completed a questionnaire. Fecal continence was scored using the Vaizey score. Using SPSS, descriptive analysis and linear regression analysis were performed, and P values <.05 were considered statistically significant. RESULTS The cesarean delivery rate within our cohort was 19.5%. Within the group of women who delivered at least one child vaginally (n=84), 25.5% reported alteration of fecal continence, compared with 13.1% in women who only had cesarean delivery (n=18). After a mean follow-up of 15 years, the median Vaizey score within the cesarean delivery group was 5, compared with 7 in the vaginal delivery group. Within the vaginal delivery group, 18.8% reported perianal disease progression, compared with 22.2% in the cesarean delivery group. No significant relation between mode of delivery and fecal continence or perianal disease progression was found (B, 0,97 [-1,19 to 3,14], P=.38). CONCLUSION Fecal incontinence and perianal disease progression after vaginal delivery in Crohn's disease women with active perianal fistula is not significantly increased in this retrospective cohort. This study opens the discussion for more tailored obstetric advice in women with perianal Crohn's disease.
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Affiliation(s)
- Irene J. Schaafsma
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Drs Schaafsma, Dijkstra and Visschedijk)
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Drs Schaafsma and Hoogenboom)
| | - Froukje J. Hoogenboom
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Drs Schaafsma and Hoogenboom)
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Drs Schaafsma, Dijkstra and Visschedijk)
| | - Jelmer R. Prins
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Dr Prins)
| | - Marijn C. Visschedijk
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (Drs Schaafsma, Dijkstra and Visschedijk)
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Saad J, Painter C. Management of postpartum perineal wound complications. Curr Opin Obstet Gynecol 2023; 35:505-509. [PMID: 37560791 DOI: 10.1097/gco.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Perineal wound complications occur in up to 25% of postpartum patients. Wound complications are most common after obstetric anal sphincter injuries (OASIS) but can occur after any laceration. It is imperative that any provider caring for postpartum patients understand the best evidence-based practices to recognize and manage these complications. We present a review of the available literature on the management of postpartum perineal wound complications. RECENT FINDINGS There is a paucity of new publications on the management of postpartum perineal wound complications, despite an increased emphasis on postpartum recovery in women's health. The role of topical estrogen in healing of perineal wounds was investigated in a pilot study, demonstrating that granulation tissue does express estrogen receptors, and the use of estrogen increases cell proliferation. Progression of perineal wound healing by secondary intention was evaluated in an observational study. Wound healing was delayed in 30% of women, with the initial wound area, perimeter, bacterial colonization, and OASIS being associated with delayed healing. SUMMARY Evidence based practices on timing of follow-up, addressing wound care and analgesia, administrating antibiotics, timing secondary repair, and surgical technique all play a role in optimizing recovery and reducing morbidity in patients with postpartum perineal wound complications.
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Affiliation(s)
- Jaber Saad
- Kaiser Permanente East Bay and University of California San Francisco
| | - Caitlyn Painter
- University of California San Francisco, Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Science, San Francisco, California, USA
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Leybovitz-Haleluya N, Sheiner E, Wainstock T. Obstetric and perinatal outcome in short-stature patients. Int J Gynaecol Obstet 2023; 163:978-982. [PMID: 37269046 DOI: 10.1002/ijgo.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Scarce data exist regarding obstetric complications of short-stature patients. This study aimed to investigate obstetric and perinatal outcomes in women with short stature; specifically, to investigate whether short-stature patients are at an increased risk for cesarean delivery. METHODS A population-based cohort study was conducted, including all singletons born between the years 1991 and 2021 at a tertiary medical center. Obstetric and perinatal outcomes of short-stature patients were compared with those of non-short patients. A generalized estimation equation binary logistic model was constructed to adjust for confounders and maternal recurrence in the cohort. RESULTS The study population included 356 356 parturient; among them, 14 035 (3.9%) were short-stature patients. Short-stature patients had significantly higher rates of cesarean delivery (20.7% vs 13.7%, odds ratio = 1.64, 95% confidence interval 1.57-1.71, P < 0.001), induction of labor, pathologic presentations, prolonged second stage of labor, non-reassuring fetal monitoring, and meconium-stained amniotic fluid. Newborns of short-stature patients had a significantly higher risk of being small for gestational age as compared with those of non-short patients. In the generalized estimation equation models, the association between short stature and risk of cesarean delivery remained significant (adjusted odds ratio = 1.32, 95% confidence interval 1.27-1.38, P < 0.001), as well as the risk of small for gestational age newborns (adjusted odds ratio = 1.51, 95% confidence interval 1.40-1.63, P < 0.001), but not for the other adverse outcomes. CONCLUSIONS Maternal short stature is an independent risk factor for cesarean delivery and is associated with small for gestational age newborns.
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Affiliation(s)
- Noa Leybovitz-Haleluya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Hamilton S, Olson S, Voegtline K, Lawson SM. Postpartum readmission in Maryland by race and ethnicity, 2016-2019. AJOG GLOBAL REPORTS 2023; 3:100278. [PMID: 38046531 PMCID: PMC10692712 DOI: 10.1016/j.xagr.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The majority of maternal deaths occur in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand whether there are disparities in maternal health in the postpartum period as indicated by readmission to the hospital. OBJECTIVE This study aimed to use state-wide Maryland data to identify postpartum readmission rates by race and ethnicity, as well as the major risk factors, indications, and timing of readmission. STUDY DESIGN In this retrospective study (2016-2019), childbirth hospitalizations for patients of childbearing age were identified from the Maryland State Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Indication for readmission was described. Multivariable logistic regression models were employed to determine racial and ethnic differences in postpartum readmissions, adjusting for maternal and obstetrical characteristics. RESULTS Among total deliveries (n=260,778), 3914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% (1306/111,325) for White patients, 2.3% (1786/79,412) for Black patients, 1.2% (485/40,862) for Hispanic patients and 1.2% (337/29,179) for patients of Other race or ethnicity (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders as compared with all other races (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio, 1.64; confidence interval, 1.52-1.77). The majority of all readmissions occurred in the first week after delivery with Black patients having higher rates of readmission in the second week relative to all other groups (P<.0001). CONCLUSION Hypertension is a leading cause of postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race or ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.
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Affiliation(s)
- Sonia Hamilton
- Johns Hopkins University School of Medicine, Baltimore, MD (Ms Hamilton)
| | - Sarah Olson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (Ms Olson and Dr Voegtline)
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (Ms Olson and Dr Voegtline)
| | - Shari M. Lawson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Lawson)
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Ghebremeskel GG, Kahsay MT, Gulbet ME, Mehretab AG. Determinants of maternal length of stay following childbirth in a rural health facility in Eritrea. BMC Pregnancy Childbirth 2023; 23:613. [PMID: 37626294 PMCID: PMC10464326 DOI: 10.1186/s12884-023-05931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The days following childbirth are a critical phase in the lives of mothers and newborns. Postpartum length of stay is a critical indicator of the efficiency of health care delivery. This study aims to explore maternal length of hospital stay (LOS) following childbirth and associated factors in a rural health facility in Eritrea. METHODOLOGY A retrospective study of all mothers who delivered at Nakfa Hospital between 2020 and 2022 was conducted. Sociodemographic, past obstetric, and neonatal factors associated with postpartum LOS were evaluated for both vaginal delivery (VD) and cesarean delivery (CD). The determinants of LOS following VD were explored using negative binomial regression. RESULTS A total of 2025 mothers [1975 (97.5%) VD and 50 (2.5%) CD] were included in the study. The median LOS following childbirth was 1 (IQR: 0-1) day for VD and 6 (IQR: 4-8) days for CD. A substantial proportion of mothers were found to have inadequate stays following VD [29% (95% CI: 27-31)], whereas 68% (95% CI: 54-81%) stayed for > 4 days following CD. In this study, VD that were attended by physicians had no inadequate stay, whereas 27.4% of deliveries attended by midwives and 31.3% by associate nurses resulted in inadequate stay (P-value < 0.001). Determinants of LOS following VD were: the presence of maternal complications (IRR = 2.8, 95% CI: 1.6-5, p-value < 0.001), delivery years 2020 and 2021 (IRR = 1.5, 95% CI: 1.2-1.8, p-value < 0.001 and IRR = 1.4, 95% CI: 1.2-1.7, p-value < 0.001, respectively), and delivery hour interval 23:00-7:00 (IRR = 0.8, 95% CI: 0.7-0.9, p-value = 0.03). CONCLUSION A substantial proportion of mothers stay too short post-VD to allow adequate postnatal care, which can have untoward consequences for maternal and child health. Going forward, improved coverage of antenatal care for early diagnosis of maternal complications in pregnancy as well as assessing the level of knowledge and provisions of training and refresher courses for birth attendants should be worked upon. In addition, efforts to conduct studies that explore maternal and health care provider perspectives on LOS should be emphasized.
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Affiliation(s)
| | - Meron Tesfay Kahsay
- B. Sc. Clinical laboratory science, Nakfa Hospital,, Northern Red Sea branch of the Ministry of Health, Nakfa, Eritrea
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Teslim SA, Adeola ASR, Adesina O. Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100197. [PMID: 37273910 PMCID: PMC10238573 DOI: 10.1016/j.eurox.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/19/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Background The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38 % of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24 h, at day 3, days 10-14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. Methods This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p < 0.05. Results Of the respondents, 71.9 % had poor or incorrect knowledge. About 87.4 % perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9 %) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3 %), days 10-14 (86.2 %) and six weeks postpartum (91.6 %). Also, 69.5 % were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Conclusion Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality.
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Affiliation(s)
- Sanusi Akinsola Teslim
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Abdus-salam Rukiyat Adeola
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine University of Ibadan/ University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oladokun Adesina
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine University of Ibadan/ University College Hospital, Ibadan, Oyo State, Nigeria
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Bouchghoul H, Deneux-Tharaux C, Georget A, Madar H, Bénard A, Sentilhes L. Association Between Surgeon Gender and Maternal Morbidity After Cesarean Delivery. JAMA Surg 2023; 158:273-281. [PMID: 36696127 PMCID: PMC9878430 DOI: 10.1001/jamasurg.2022.7063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/16/2022] [Indexed: 01/26/2023]
Abstract
Importance The stereotype that men perform surgery better than women is ancient. Surgeons have long been mainly men, but in recent decades an inversion has begun; the number of women surgeons is increasing, especially in obstetrics and gynecology. Studies outside obstetrics suggest that postoperative morbidity and mortality may be lower after surgery by women. Objective To evaluate the association between surgeons' gender and the risks of maternal morbidity and postpartum hemorrhage (PPH) after cesarean deliveries. Design, Setting, and Participants This prospective cohort study was based on data from the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, a multicenter, randomized, placebo-controlled trial that took place from March 2018 through January 2020 (23 months). It aimed to investigate whether the administration of tranexamic acid plus a prophylactic uterotonic agent decreased PPH incidence after cesarean delivery compared with a uterotonic agent alone. Women having a cesarean delivery before or during labor at or after 34 weeks' gestation were recruited from 27 French maternity hospitals. Exposures Self-reported gender (man or woman), assessed by a questionnaire immediately after delivery. Main Outcomes and Measures The primary end point was the incidence of a composite maternal morbidity variable, and the secondary end point was the incidence of PPH (the primary outcome of the TRAAP2 trial), defined by a calculated estimated blood loss exceeding 1000 mL or transfusion by day 2. Results Among 4244 women included, men surgeons performed 943 cesarean deliveries (22.2%) and women surgeons performed 3301 (77.8%). The rate of attending obstetricians was higher among men (441 of 929 [47.5%]) than women (687 of 3239 [21.2%]). The risk of maternal morbidity did not differ for men and women surgeons: 119 of 837 (14.2%) vs 476 of 2928 (16.3%) (adjusted risk ratio, 0.92 [95% CI, 0.77-1.13]). Interaction between surgeon gender and level of experience on the risk of maternal morbidity was not statistically significant. Similarly, the groups did not differ for PPH risk (adjusted risk ratio, 0.98 [95% CI, 0.85-1.13]). Conclusions and Relevance Risks of postoperative maternal morbidity and of PPH exceeding 1000 mL or requiring transfusion by day 2 did not differ by the surgeon's gender.
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Affiliation(s)
- Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in Pregnancy, Paris, France
| | - Aurore Georget
- Public Health Department, Clinical Epidemiology Unit (USMR), Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
- Université Paris Cité, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in Pregnancy, Paris, France
| | - Antoine Bénard
- Public Health Department, Clinical Epidemiology Unit (USMR), Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Sundaram KM, Morgan MA, Depetris J, Arif-Tiwari H. Imaging of benign gallbladder and biliary pathologies in pregnancy. Abdom Radiol (NY) 2023; 48:1921-1932. [PMID: 36790454 DOI: 10.1007/s00261-023-03832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
The rising incidence combined with pregnancy-related physiological changes make gallbladder and biliary pathology high on the differential for pregnant patients presenting with right upper abdominal pain. Imaging plays a crucial role in determining surgical versus non-surgical management in pregnant patients with biliary or gallbladder pathology. Ultrasound (first-line) and magnetic resonance with magnetic resonance cholangiopancreatography (second-line) are the imaging techniques of choice in pregnant patients with suspected biliary pathology due to their lack of ionizing radiation. MRI/MRCP offers an excellent non-invasive imaging option, providing detailed anatomical detail without known harmful fetal side effects. This article reviews physiological changes in pregnancy that lead to gallstone and biliary pathology, key imaging findings on US and MRI/MRCP, and management pathways.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Jena Depetris
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, 1501 N. Campbell Avenue, Tuscon, AZ, USA
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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12
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Puro N, Kelly RJ, Bodas M, Feyereisen S. Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach. PLoS One 2022; 17:e0266666. [PMID: 35390095 PMCID: PMC8989242 DOI: 10.1371/journal.pone.0266666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates. METHODS We used Florida's inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors. RESULTS Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors. CONCLUSIONS The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.
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Affiliation(s)
- Neeraj Puro
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Reena J. Kelly
- Department of Health Administration and Policy, School of Health Sciences, University of New Haven, West Haven, CT, United States of America
| | - Mandar Bodas
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Scott Feyereisen
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
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13
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Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol 2022; 139:381-390. [PMID: 35115443 DOI: 10.1097/aog.0000000000004687] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017-February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-February 2021). METHODS We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20-44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery. RESULTS Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7-44.5%), vaginal births (25.4-39.5%), and cesarean births (35.3-55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32-2.39; vaginal births: aOR 2.14, 99% credible interval 2.11-2.18; cesarean births aOR 2.90, 99% credible interval 2.83-2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97-1.08) analyses for all births or when stratified by mode of delivery. CONCLUSION Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional-identified as appropriate for discharge.
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14
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Shoemaker ES, Saiyin T, Smith S, Loutfy M, Darling L, Walker M, Hawken S, Begum J, Bibeau C, Bertozzi B, Fraleigh A, Kwaramba G, Johnson K, Cousineau A, Kendall CE. Patterns of cesarean birth among women living with HIV in Ontario: A cross-sectional, population-level study. Birth 2021; 48:357-365. [PMID: 33733473 DOI: 10.1111/birt.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/10/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12-year period. METHODS Our research is co-led and codesigned with WLWH. We conducted a retrospective population-level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006/07 and 2017/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables. RESULTS Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, P < 0.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%-19.3%), whereas the proportion of repeat CB increased (13.1%-20.5%, P = 0.013). CONCLUSIONS Because of decreasing HIV-related indications for CB, more practitioners may be following the guidelines for first-time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.
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Affiliation(s)
- Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Tana Saiyin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Mona Loutfy
- ICES, Ottawa, ON, Canada.,Infectious Disease Clinician Scientist, Departments of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Liz Darling
- ICES, Ottawa, ON, Canada.,Department of Midwifery, McMaster University, Hamilton, ON, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven Hawken
- ICES, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Breklyn Bertozzi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Annette Fraleigh
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Gladys Kwaramba
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Kerrigan Johnson
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ashlee Cousineau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
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Kadour-Peero E, Sagi S, Awad J, Bleicher I, Gonen R, Vitner D. Are we preventing the primary cesarean delivery at the second stage of labor following ACOG-SMFM new guidelines? Retrospective cohort study. J Matern Fetal Neonatal Med 2021; 35:6708-6713. [PMID: 33980117 DOI: 10.1080/14767058.2021.1920913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) published an Obstetric Care Consensus for safe prevention of primary cesarean delivery. We aimed to assess whether these guidelines decreased the primary CD rate during the second stage of labor, in our department. DESIGN, SETTING, AND POPULATION A retrospective cohort study of all women reaching the second stage of labor, at term, in a single university-affiliated medical center between2010 and 2017. METHODS We compared maternal and neonatal outcomes over three year's periods:-pre-guidelines (2010-2013) vs. 2nd period - post-guidelines (2014-2017). THE MAIN OUTCOME MEASURES CD rate at 2ndstage of labor. RESULTS The study included 11,464 women. The CD rate in the 2nd stage of labor has increased significantly from 4% to 5.9% in the post-guidelines period (OR 1.48, 95% CI 1.16-1.89, p = .001). After a sub-analysis of specific subgroups, and adjustment for confounders, the increase was solely observed in nulliparous women (aOR 1.418, 95% CI 1.067-1.885, p = .016). Furthermore, increased odds for vaginal operative delivery were observed in the multiparous women in the post-guidelines period (2.7% vs. 4.1%, p = .046). CONCLUSIONS The implementation of the new ACOG and SMFM guidelines was not associated with a change in the CD rate performed at the 2nd stage of labor in the whole study population. However, there was a rise in the CD rate performed at the 2nd stage in nulliparous women. Furthermore, there was an increase in operative deliveries in the whole study population, especially in multiparous women, without an apparent increase in other immediate adverse neonatal or maternal outcomes.
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Affiliation(s)
- Einav Kadour-Peero
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shlomi Sagi
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Janan Awad
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Inna Bleicher
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ron Gonen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion - Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Faculty of Medicine, Department of Obstetrics and Gynecology, Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel
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16
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Sakai-Bizmark R, Ross MG, Estevez D, Bedel LEM, Marr EH, Tsugawa Y. Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States. JAMA Netw Open 2021; 4:e212235. [PMID: 33739430 PMCID: PMC7980096 DOI: 10.1001/jamanetworkopen.2021.2235] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE A high cesarean delivery rate in US hospitals indicates the potential overuse of this procedure; however, underlying causes of the excessive use of cesarean procedures in the US have not been fully understood. OBJECTIVE To investigate the association between the probability of cesarean delivery at the patient-level and profit per procedure from cesarean deliveries. DESIGN, SETTING, AND PARTICIPANTS This observational, cross-sectional study used a nationally representative sample of hospital discharge data from women at low risk for cesarean birth who delivered newborns between 2010 and 2014 in the US. Data were gathered from the Nationwide Readmissions Database from the Healthcare Cost and Utilization Project, compiled by the Agency for Healthcare Research and Quality. Data cleaning and analyses were conducted between August 2019 and May 2020. EXPOSURES Hospital-level median value of profits from cesarean deliveries, defined as the difference between the charge and the cost for cesarean delivery calculated for each hospital. MAIN OUTCOMES AND MEASURES Our primary outcome was the individual-level probability of undergoing a cesarean delivery. We examined the association with the hospital-level median value of profits per procedure for cesarean delivery (defined as the difference between the charge and the cost for cesarean delivery) using hierarchical regression models adjusted for patient and hospital characteristics and year-fixed effects. RESULTS A total of 13 215 853 deliveries were included in our analyses (mean [SE] age, 27.4 [0] years), of which 2 202 632 (16.7%) were cesarean deliveries. After adjusting for potential confounders, pregnant women were more likely to have a cesarean birth when they delivered at hospitals with higher profits per procedure from cesarean deliveries. Women cared for at hospitals with the highest (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .005) and second-highest profit quartiles (adjusted odds ratio, 1.07; 95% CI, 1.02-1.13; P = .007) had higher probabilities of a cesarean delivery compared with those cared for at hospitals in the lowest profit quartile. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US nationally representative hospital discharge data, hospitals with higher profits per cesarean procedure were associated with an increased probability of delivering newborns through cesarean birth. These findings highlight the potential influence financial incentives play in determining a high cesarean delivery rate in the US.
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Affiliation(s)
- Rie Sakai-Bizmark
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance
| | - Michael G. Ross
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance
| | - Dennys Estevez
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Lauren E. M. Bedel
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Emily H. Marr
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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17
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Xu C, Zhong W, Fu Q, Yi L, Deng Y, Cheng Z, Lin X, Cai M, Zhong S, Wang M, Tao H, Xiong H, Jiang X, Chen Y. Differential effects of different delivery methods on progression to severe postpartum hemorrhage between Chinese nulliparous and multiparous women: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:660. [PMID: 33129300 PMCID: PMC7603680 DOI: 10.1186/s12884-020-03351-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivery methods are associated with postpartum hemorrhage (PPH) both in nulliparous and multiparous women. However, few studies have examined the difference in this association between nulliparous and multiparous women. This study aimed to explore the difference of maternal and neonatal characteristics and delivery methods between Chinese nulliparous and multiparous women, and then examine the differential effects of different delivery methods on PPH between these two-type women. METHODS Totally 151,333 medical records of women who gave birth between April 2013 to May 2016 were obtained from the electronic health records (EHR) in a northern province, China. The severity of PPH was estimated and classified into blood loss at the level of < 900 ml, 900-1500 ml, 1500-2100 ml, and > 2100 ml. Neonatal and maternal characteristics related to PPH were derived from the same database. Multiple ordinal logistic regression was used to estimate associations. RESULTS Medical comorbidities, placenta previa and accreta were higher in the nulliparous group and the episiotomy rate was higher in the multiparous group. Compared with spontaneous vaginal delivery (SVD), the adjusted odds (aOR) for progression to severe PPH due to the forceps-assisted delivery was much higher in multiparous women (aOR: 9.32; 95% CI: 3.66-23.71) than in nulliparous women (aOR: 1.70; 95% CI: 0.91-3.18). The (aOR) for progression to severe PPH due to cesarean section (CS) compared to SVD was twice as high in the multiparous women (aOR: 4.32; 95% CI: 3.03-6.14) as in the nulliparous women (aOR: 2.04; 95% CI: 1.40-2.97). However, the (aOR) for progression to severe PPH due to episiotomy compared to SVD between multiparous (aOR: 1.24; 95% CI: 0.96-1.62) and nulliparous women (aOR: 1.55; 95% CI: 0.92-2.60) was not significantly different. The (aOR) for progression to severe PPH due to vacuum-assisted delivery compared to SVD in multiparous women (aOR: 2.41; 95% CI: 0.36-16.29) was not significantly different from the nulliparous women (aOR: 1.05; 95% CI: 0.40-2.73). CONCLUSIONS Forceps-assisted delivery and CS methods were found to increase the risk of severity of the PPH. The adverse effects were even greater for multiparous women. Episiotomy and the vacuum-assisted delivery, and SVD were similar to the risk of progression to severe PPH in either nulliparous or multiparous women. Our findings have implications for the obstetric decision on the choice of delivery methods, maternal and neonatal health care, and obstetric quality control.
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Affiliation(s)
- Chang Xu
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Wanting Zhong
- Department of medical administration, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, 519000, China
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63013, USA
| | - Li Yi
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yuqing Deng
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Zhaohui Cheng
- Department of Health Statistics and Research Development, Chongqing Health Information Center, Chongqing, 401120, China
| | - Xiaojun Lin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Miao Cai
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63013, USA
| | - Shilin Zhong
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Manli Wang
- China Center for Special Economic Zone Research, Shenzhen University, Shenzhen, 518060, Guangdong, China.
| | - Hongbing Tao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Haoling Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Xin Jiang
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yun Chen
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
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18
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Shrestha P, Mahato V, Karmacharya SS. Postpartum Maternal Morbidity Requiring Hospital Admission in A Teaching Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:686-689. [PMID: 33068092 PMCID: PMC7580332 DOI: 10.31729/jnma.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Major concern shifts from mother to newborn in postnatal period. Postpartum complications contribute to a lot of maternal morbidity and mortality. This study aims to determine the prevalence of morbidities in women following delivery at Manipal Teaching Hospital so as to identify and improve maternal quality care. METHODS This is a descriptive cross-sectional study conducted at department of Obstetrics and Gynaecology, Manipal Teaching Hospital from September 2018 to March 2020 after ethical approval from the institutional review committee with reference number 1296. All the women presenting to the department during the study period were included in the study. Women who were admitted to accompany and nurse their babies for neonatal problems were excluded.Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were entered in Excel and analysed in SPSS. RESULTS Among 3510 cases, 104 women were admitted with various postpartum morbidities. The prevalence of postpartum morbidity was found to be 104 (2.96%) at 95% Confidence Interval (2.67-3.25). Puerperal sepsis was diagnosed in 23 (22.11%), preeclampsia in 20(19.23%) eclampsia in 14 (13.46%) and haemorrhage in 14 (13.46%) respectively. Majority of patients, 83.65% belonged to age group of 20-34 years. Nine patients (8.65%) were teenage mothers. CONCLUSIONS Puerperal sepsis, preeclampsia, eclampsia and haemorrhage were the major postpartum complications requiring admissions in hospital.
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Affiliation(s)
- Pravin Shrestha
- Department of Obstetrics and Gynecology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Vibha Mahato
- Department of Obstetrics and Gynecology, Manipal College of Medical Sciences, Pokhara, Nepal
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Szafrańska M, Begley C, Carroll M, Daly D. Factors associated with maternal readmission to hospital, attendance at emergency rooms or visits to general practitioners within three months postpartum. Eur J Obstet Gynecol Reprod Biol 2020; 254:251-258. [PMID: 33032101 DOI: 10.1016/j.ejogrb.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
While most women remain healthy after giving birth to their baby, others experience complications that require medical attention or readmission to hospital. However, data on maternal attendance for medical care postpartum or readmission to hospital are not collected or reported routinely in many countries so the extent of health problems experienced remain unknown. Collecting data on the proportion of women who seek medical care in the early postpartum period may deepen understanding of risk factors, the consequences for women, their families and the maternity care system and, ultimately, help identify preventative strategies and processes. OBJECTIVE To identify the factors associated with maternal rehospitalisation, attendance at emergency rooms or visits to general practitioners, the three main sources of medical services postpartum in Ireland, within the first three months postpartum. STUDY DESIGN A prospective cohort study, embedded in a larger maternal health and morbidity study, with 1668 nulliparous women recruited from two maternity hospitals in Ireland. Univariate and multivariable logistic regression analyses were used to explore associations with postpartum rehospitalisation, emergency room attendance and general practitioner visits within the first three months postpartum, for maternal health-related reasons. RESULTS Four percent (n = 66) of women were rehospitalised, 10% (n = 166) attended an emergency room, and 13.6% (n = 223) attended their general practitioner three or more times, regarding their own health. Women aged 24 years or less were more likely to attend their doctor (p = 0.02, AOR 2.13, 95% CI 1.08-4.21) compared to women aged 25-29 years, the reference category. Women who were obese or very obese were also more likely to attend their doctor three or more times (p = 0.01, AOR 1.79, 95% CI 1.15-2.79) and also more likely to attend an emergency room (p = 0.04, AOR 1.69, 95% CI 1.02-2.80) within three months postpartum, for their own health reasons. CONCLUSION Findings indicate that considerable proportions of women seek medical care from various healthcare sources postpartum. These medical visits are not routinely reported and point to the need for interventions regarding the care, management and services available to first-time mothers birthing in Ireland, with specific attention on preventative postpartum health.
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Affiliation(s)
- Marcelina Szafrańska
- School of Nursing, Midwifery and Health Systems, University College Dublin, UCD Health Sciences Centre, 4, Stillorgan Rd, Belfield, Dublin, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
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20
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Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc 2020; 35:4673-4680. [PMID: 32875420 DOI: 10.1007/s00464-020-07910-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Current guidelines support laparoscopic cholecystectomy as the treatment of choice for pregnant women with symptomatic gallbladder disease, regardless of the trimester. Early intervention has remained the standard of care, but recent evidence has challenged this practice in pregnant women. We sought to compare surgical and maternal-fetal outcomes of antepartum versus postpartum cholecystectomy in New York State. METHODS Between 2005 and 2014, the New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for patients who underwent cholecystectomy within 3 months before (antepartum cholecystectomy, APCCY: n = 82) and after (postpartum cholecystectomy, PPCCY: n = 5040) childbirth to approximate third-trimester operations. All patients who underwent cholecystectomy during pregnancy (n = 971) were extracted to evaluate inter-trimester differences. Subgroup analysis compared APCCY patients who were not hospitalized within 1 year before APCCY (n = 80) and PPCCY patients who were hospitalized within 1 year before childbirth (n = 29) for symptomatic biliary disease. Multivariable generalized linear regression models were used to characterize the association between timing of cholecystectomy and several primary outcomes: length of stay (LOS), 30-day non-pregnancy, non-delivery readmission (NPND), bile duct injury (BDI), composite maternal outcome (antepartum hemorrhage, preterm delivery, cesarean section), any complications, and fetal demise. RESULTS Third-trimester APCCY women had longer LOS (Ratio: 1.44, 95% CI [1.26-1.66], p < 0.0001) and greater incidence of preterm delivery (OR 2.54, 95% CI [1.37-4.43], p = 0.0019). Cholecystectomy timing was not independently associated with differences in composite maternal outcome (p = 0.1480), BDI (p = 0.2578), 30-day NPND readmission (p = 0.7579), any complications (p = 0.2506), and fetal demise (2.44% versus 0.44%, p = 0.0545). Subgroup analysis revealed no differences in any of the seven outcomes. CONCLUSIONS New York Statewide data suggest that although laparoscopic cholecystectomy is safe in pregnancy, delay of cholecystectomy should be discussed in the third trimester due to an increased risk for preterm delivery.
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Johar N, Mohamad N, Saddki N, Tengku Ismail TA, Sulaiman Z. Factors Associated with Early Breastfeeding Initiation among Women Who Underwent Cesarean Delivery at Tertiary Hospitals in Kelantan, Malaysia. Korean J Fam Med 2020; 42:140-149. [PMID: 32423181 PMCID: PMC8010441 DOI: 10.4082/kjfm.19.0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cesarean delivery is linked with lower rates of early breastfeeding initiation. This study aimed to determine the prevalence and associated factors of early initiation of breastfeeding among women admitted for elective cesarean delivery in Kelantan, Malaysia. Methods A total of 171 women admitted for elective cesarean delivery at two tertiary hospitals in Kelantan, Malaysia, participated in this study. On day two after cesarean delivery, face-to-face interviews were conducted with the mothers to get information on feeding practice. Descriptive statistics, including simple and multiple logistic regressions, were used for data analysis. Results Seventy-three percent of mothers initiated breastfeeding within 1 hour of birth. Approximately 15.8% and 10.5% of mothers initiated breastfeeding within 24 hours and ≥24 hours, respectively. Skin-to-skin contact between mothers and their infants occurred in 77.8% of cases after cesarean delivery. Breastfeeding initiation was significantly associated with skin-to-skin contact (odds ratio [OR], 14.42; 95% confidence interval [CI], 3.58–58.06), mothers who exclusively breastfed during hospitalization (OR, 36.37; 95% CI, 5.60–236.24), and infants who were not sleepy during attempts at breastfeeding (OR, 5.17; 95% CI, 1.32–20.21). Conclusion Based on our results, it is possible to increase the proportion of mothers initiating breastfeeding within 1 hour among women who undergo elective cesarean delivery. Therefore, it is important that health practitioners educate women beginning in the antenatal period who plan to undergo cesarean delivery by emphasizing the importance of early initiation of breastfeeding.
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Affiliation(s)
- Nazirah Johar
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noraini Mohamad
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Norkhafizah Saddki
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
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Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis. Obstet Gynecol Int 2020; 2020:1582653. [PMID: 32934656 PMCID: PMC7479451 DOI: 10.1155/2020/1582653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue. Methods A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019. Results The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear. Conclusion Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.
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Weissmann-Brenner A, Heusler I, Manteka R, Dulitzky M, Baum M. Postpartum visits in the gynecological emergency room: How can we improve? BMC Pregnancy Childbirth 2020; 20:278. [PMID: 32381028 PMCID: PMC7204226 DOI: 10.1186/s12884-020-02927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background The attendance to the gynecological-emergency-room (GER) of women only a few weeks following previous discharge after birth comprises a medical as well as social problem. The objective of the study was to characterize the postpartum women that attended the GER, and depict the leading etiologies and risk-factors that lead them to attend the GER, and to examine correlations between their medical findings at discharge and the reasons for their attendance to the hospital. Methods All women that attended the GER between 01/01/2016 and 30/09/2016 during 6 weeks after birth were included. The variables assessed were: medical history, mode of birth, maternal complications of birth, diagnosis at the GER, treatment received and readmission. Results There were 446 visits of 413 women (5.6% of all deliveries). Most were generally healthy after their first normal vaginal birth with no complications during or following birth. 38.7% had a cesarean birth (p < 0.001). The most common causes of the visits were fever (30.3%), problems in episiotomy or surgical scar (26.6%) and abdominal pain (25.7%). Women with hypertensive disorders during birth had significantly more hypertensive problems in the GER. Diabetic women suffered statistically more from hypertensive disorder in the GER. 33.2% were examined and found healthy. Seventy-two women (1% of all deliveries) were hospitalized, most of them due to infection. Only 7.5% were referred to the GER due to bleeding. Conclusions Postpartum women are at risk of morbidities, especially following cesarean sections and in women with hypertensive disorders of during pregnancy. Scheduled visits to high-risk women to attend outpatient clinic sooner are recommended.
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Affiliation(s)
- Alina Weissmann-Brenner
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ishai Heusler
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renana Manteka
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Dulitzky
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Baum
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nam JY, Park EC. The relationship between severe maternal morbidity and a risk of postpartum readmission among Korean women: a nationwide population-based cohort study. BMC Pregnancy Childbirth 2020; 20:148. [PMID: 32143586 PMCID: PMC7060630 DOI: 10.1186/s12884-020-2820-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/18/2020] [Indexed: 11/26/2022] Open
Abstract
Background As the rate of cesarean section delivery has increased, the incidence of severe maternal morbidity continues to increase. Severe maternal morbidity is associated with high medical costs, extended length of hospital stay, and long-term rehabilitation. However, there is no evidence whether severe maternal morbidity affects postpartum readmission. Therefore, this study aimed to determine the relationship between severe maternal morbidity and postpartum readmission. Methods This nationwide population-based cohort study used the Korean National Health Insurance Service-National Sample cohort of 90,035 delivery cases between January 2003 and November 2013. The outcome variable was postpartum readmission until 6 weeks after the first date of delivery in the hospital. Another variable of interest was the occurrence of severe maternal morbidity, which was determined using the Center for Disease Control and Prevention’s algorithm. The Cox proportional hazard model was used to assess the association between postpartum readmission and severe maternal morbidity after all covariates were adjusted. Results The overall incidence of postpartum readmission was 2041 cases (0.95%) of delivery. Women with severe maternal morbidity had an approximately 2.4 times higher risk of postpartum readmission than those without severe maternal morbidity (hazard ratio 2.36, 95% confidence interval 1.75–3.19). In addition, compared with reference group, women who were aged 20–30 years, nulliparous, and delivered in a tertiary hospital were at high risk of postpartum readmission. Conclusions Severe maternal morbidity was related to the risk of postpartum readmission. Policy makers should provide a quality indicator of postpartum maternal health care and improve the quality of intrapartum care.
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Affiliation(s)
- Jin Young Nam
- Research Institute of Asian Women, Sookmyung Women's University, 47 Na-gil 36 Cheongpa-ro, Yongsan-gu, Seoul, 04309, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Institute of Health Services Research, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Wingert A, Hartling L, Sebastianski M, Johnson C, Featherstone R, Vandermeer B, Wilson RD. Clinical interventions that influence vaginal birth after cesarean delivery rates: Systematic Review & Meta-Analysis. BMC Pregnancy Childbirth 2019; 19:529. [PMID: 31888540 PMCID: PMC6937863 DOI: 10.1186/s12884-019-2689-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/19/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. METHODS We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting VBAC, uterine rupture and uterine dehiscence rates. One reviewer extracted data and a second reviewer verified for accuracy. Meta-analysis was conducted using Mantel-Haenszel (random effects model) relative risks (VBAC rate) and risk differences (uterine rupture and dehiscence). Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). RESULTS Twenty-nine studies (six trials and 23 cohorts) examined different clinical interventions affecting rates of vaginal deliveries among women with a prior cesarean delivery (CD). Methodological quality was good overall for the trials; however, concerns among the cohort studies regarding selection bias, comparability of groups and outcome measurement resulted in higher risk of bias. Interventions for labor induction, with or without cervical ripening, included pharmacologic (oxytocin, prostaglandins, misoprostol, mifepristone, epidural analgesia), non-pharmacologic (membrane sweep, amniotomy, balloon devices), and combined (pharmacologic and non-pharmacologic). Single studies with small sample sizes and event rates contributed to most comparisons, with no clear differences between groups on rates of VBAC, uterine rupture and uterine dehiscence. CONCLUSIONS This systematic review evaluated clinical interventions directed at increasing the rate of vaginal delivery among women with a prior CD and found low to very low certainty in the body of evidence for cervical ripening and/or labor induction techniques. There is insufficient high-quality evidence to inform optimal clinical interventions among women attempting a trial of labor after a prior CD.
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Affiliation(s)
- Aireen Wingert
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta Canada
| | - Lisa Hartling
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Alberta Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Alberta Canada
| | - Cydney Johnson
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta Canada
| | - Robin Featherstone
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta Canada
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Alberta Canada
| | - Ben Vandermeer
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta Canada
| | - R. Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 1403 – 29 Street NW, Calgary, AB T2N 2T9 Canada
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Abstract
Diseases of the gallbladder and biliary tract are extremely common in developed nations. Because of the physiology of pregnancy, their incidence increases during gestation. This article represents a review of the existing literature on the entire spectrum of biliary disease. The physiology, clinical presentation, and diagnostic evaluation of a variety of conditions are reviewed. Historical and contemporary data regarding pregnancy implications and treatment options are discussed.
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Does pregnancy increase the risk of cholecystectomy following bariatric surgery? A cross-sectional cohort study. Surg Obes Relat Dis 2019; 15:1822-1828. [PMID: 31466873 DOI: 10.1016/j.soard.2019.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/04/2019] [Accepted: 06/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported. OBJECTIVES To explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve gastrectomy (LSG). SETTING A university hospital. METHODS A cross-sectional cohort study of reproductive aged women (18-45 yr) who underwent LSG. The association between pregnancy and cholecystectomy was evaluated with Cox regression analysis. RESULTS Of 1056 women of childbearing age who underwent LSG during 2006-2017, 128 (12.1%) subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9 years for women who did and did not conceive, respectively (P < .001). The median time from procedure to conception was 509 (374-1031) days. Overall, 117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy among those who conceived was higher than among those who did not (18.8% versus 10.0%, P = .005). In an unadjusted analysis, pregnancy was associated with an increased risk of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P < .0001). The association between pregnancy and cholecystectomy persisted after controlling for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92], P < .0001). Among those who experienced pregnancy, lower gestational weight gain was the only factor found to be associated with cholecystectomy after surgery (P = .05). CONCLUSIONS Pregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG. Thus, the desire for future pregnancy should be considered before LSG.
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Power C, Williams C, Brown A. Does childbirth experience affect infant behaviour? Exploring the perceptions of maternity care providers. Midwifery 2019; 78:131-139. [PMID: 31437757 DOI: 10.1016/j.midw.2019.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE High levels of childbirth interventions are known to increase risk of health complications for mother and infant, alongside having a negative impact upon maternal wellbeing. However less is understood about how childbirth experience may affect infant behaviour (e.g. how calm or unsettled an infant is). This study explores maternity care provider perceptions of how and why childbirth experience may affect infant behaviour. DESIGN A qualitative semi-structured interview study. SETTING Bristol, Swansea and West Wales, UK. PARTICIPANTS 18 maternity care providers. MEASUREMENTS AND FINDINGS A semi-structured interview schedule was developed to explore maternity care providers' perceptions of how maternal experience of childbirth could influence infant behaviour. Findings highlighted how maternity care providers perceived childbirth experience to sometimes impact positively or negatively on infant behaviour. A calmer birth and postnatal experience was believed to lead to a calmer infant, whilst physical and emotional stress was associated with more challenging infant behaviours such as crying and being unsettled. Pathways were perceived to be direct (pain and stress during birth might physiologically affect the infant) and indirect (birth was perceived to affect maternal wellbeing and subsequently her interactions with her baby). However, postnatal factors such as skin to skin, postnatal environment and emotional support were believed to mediate these impacts. KEY CONCLUSIONS Birth experience was considered to affect infant behaviour. Promoting as positive a birth experience as possible, including postnatal care, was viewed as significant in supporting positive infant behaviours. Maternity care providers believed this could help facilitate bonding, attachment, and mother-infant wellbeing in the postnatal period. IMPLICATIONS FOR PRACTICE The findings highlight maternity care providers' views concerning supporting normal birth and protecting emotional wellbeing during birth and postnatally. Where interventions are necessary, ensuring a calm environment, and enabling normal postnatal behaviours such as skin to skin and breastfeeding were perceived as important. Midwives, it was claimed, need time to nurture mothers alongside providing physical care. LIMITATIONS Participants were self-selecting and might therefore have been biased.
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Affiliation(s)
- C Power
- Department of Public Health, Policy and Social Sciences, Swansea University, Wales, UK
| | - C Williams
- Department of Psychology, Swansea University, Wales, UK
| | - A Brown
- Department of Public Health, Policy and Social Sciences, Swansea University, Wales, UK; Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Wales, UK.
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Bigelow B, Desalegn DN, Salomon JA, Verguet S. Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia. BMJ Glob Health 2019; 4:e001281. [PMID: 31179031 PMCID: PMC6528765 DOI: 10.1136/bmjgh-2018-001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/21/2019] [Accepted: 03/30/2019] [Indexed: 11/17/2022] Open
Abstract
In the Ethiopian health system, operations management techniques have been underutilised. Although previous research has outlined limitations of paper-based patient records, few studies have examined their potential utility for improving management of hospital operations. In this paper, we used data collected from paper registries in an Ethiopian obstetrics ward at Addis Ababa’s Tikur Anbessa Specialized Hospital, Ethiopia’s largest university hospital, to model the ward’s operations. First, we attempted to identify predictors of lengthy stays and readmissions among women giving birth: few predictors were deemed significant. Second, time series methods for demand forecasting were applied to the data and evaluated with several error metrics, and these forecasts were improvements over baseline methods. We conclude with recommendations on how the obstetrics ward could incorporate our modelling approaches into their daily operations.
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Affiliation(s)
- Benjamin Bigelow
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Dawit N Desalegn
- Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Center for Medical Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Joshua A Salomon
- Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Stéphane Verguet
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Risk factors, early and late postpartum complications of retained placenta: A case control study. Eur J Obstet Gynecol Reprod Biol 2019; 236:160-165. [PMID: 30933886 DOI: 10.1016/j.ejogrb.2019.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To identify risk factors and complications associated with 3rd stage of labor removal of placental fragments (3rd SRPF) by manual uterine revision under a strict protocol. STUDY DESIGN Ten years retrospective register-based cohort study of vaginal deliveries. Women with 3rd SRPF n = 3297 (exposed) and those without n = 97,888 (non exposed) were compared. MAIN OUTCOMES MEASURES (1) risk factors for 3rd SRPF aOR (95%CI) (2) early (2a) and late (2b) maternal complications. RESULTS (1) Risk factors for 3rd SRPF procedure were assisted reproductive technologies 2.20 (1.73-2.34), preterm delivery 2.53 (2.21-2.88), preeclampsia 1.66 (1.25-2.21) Multiple previous early pregnancy loss (>3) 1.40(1.19-1.66), VBAC 1.26(1.13-1.47) and epidural analgesia 1.56 (1.46-1.69). (2a) Early complications: puerperal fever 1.1% vs 0.3%, blood transfusion 9.0% vs. 0.5%, prolonged maternal hospitalization 21.0% vs. 11.4%, all P < 0.0001. Puerperal readmission was 0.819% in the 3rd SRPF vs. 0.315% the control group, P < 0.0001. (2b) Late complications: retained placenta and hysteroscopy / D&C rates were significantly higher among the 3rd SRPF vs. controls: 40.7% vs. 7.1%, 14.8% vs. 3.6% and 48.1% vs. 18.2%, respectively, all P < 0.0001. CONCLUSION Uterine revision for 3rd SPRF is associated with significant early and late maternal morbidity; should be considered discriminative of a population at risk and postpartum health care planning, beyond being a therapeutic intervention.
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Socioeconomic, Racial, and Ethnic Disparities in Postpartum Readmissions in Patients with Preeclampsia: a Multi-state Analysis, 2007–2014. J Racial Ethn Health Disparities 2019; 6:806-820. [DOI: 10.1007/s40615-019-00580-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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Male infants and birth complications are associated with increased incidence of postnatal depression. Soc Sci Med 2019; 220:56-64. [DOI: 10.1016/j.socscimed.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/18/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022]
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Kirchengast S, Hartmann B. Recent Lifestyle Parameters Are Associated with Increasing Caesarean Section Rates among Singleton Term Births in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:E14. [PMID: 30577604 PMCID: PMC6338883 DOI: 10.3390/ijerph16010014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
Caesarean section (CS) rates are increasing in many parts of the world, recently reaching about 20% worldwide. The postmodern lifestyle characteristics, obesity and delayed childbirth, have been put forward as the main reasons for high CS rates. The present study tests the association patterns between lifestyle parameters and delivery mode on a data set of 3786 births in Vienna between 2005 and 2013. The focus is exclusively on singleton term births. As well as maternal age, prepregnancy weight status, maternal body height and gestational weight gain, newborn size (birth weight, birth length, and head circumference), Apgar scores and child presentation were recorded. Planned as well as emergency CS rates increased significantly (p < 0.0001) with increasing maternal age and decreasing maternal body height. Emergency CS rates, however, increased significantly with increasing maternal prepregnancy weight status and gestational weight gain. An especially high risk of emergency CS occurred among four groups of mothers: those older than 40 years (OR = 2.68; 95% CI 1.87⁻3.86), those who were obese (OR = 1.44; 95% 1.15⁻1.81), those experiencing a gestational weight gain above 15 kg (OR = 1.32; 95% CI 1.13⁻1.54), and those shorter than 160 cm (OR = 1.216; 95% CI 1.02⁻1.45). Emergency CS rates were significantly higher among low-weight newborns (<2500 g) and macrosome newborns (>4000 g) than among normal-weight newborns. Furthermore, breech presentation was associated with an increased risk of caesarean delivery (OR 6.97; 95% CI 6.09⁻7.96). Logistic regression analyses reveal that maternal age, maternal body height, prepregnancy weight status, gestational weight gain, birth weight, newborn head circumference and child presentation show an independent, highly significant association with caesarean delivery. We conclude that maternal and newborn characteristics typical of recent lifestyle patterns, such as advanced maternal age, obesity, increased gestational weight gain and increased newborn size, are highly significantly associated with increased emergency CS rates. Moreover, maternal shortness and breech presentation are risk factors for emergency CS.
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Affiliation(s)
- Sylvia Kirchengast
- Department of Anthropology, University of Vienna, A-1090 Vienna, Austria.
| | - Beda Hartmann
- Clinic for Gynaecology and Obstetrics, Danube Hospital, A-1220 Vienna, Austria.
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Davenport MH, Ruchat SM, Sobierajski F, Poitras VJ, Gray CE, Yoo C, Skow RJ, Jaramillo Garcia A, Barrowman N, Meah VL, Nagpal TS, Riske L, James M, Nuspl M, Weeks A, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Mottola MF. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med 2018; 53:99-107. [PMID: 30337349 DOI: 10.1136/bjsports-2018-099821] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To perform a systematic review of the relationships between prenatal exercise and maternal harms including labour/delivery outcomes. DESIGN Systematic review with random effects meta-analysis and meta-regression. DATASOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; "exercise + co-intervention"]) and outcome (preterm/prelabour rupture of membranes, caesarean section, instrumental delivery, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms (author defined) and diastasis recti). RESULTS 113 studies (n=52 858 women) were included. 'Moderate' quality evidence from exercise-only randomised controlled trials (RCTs) indicated a 24% reduction in the odds of instrumental delivery in women who exercised compared with women who did not (20 RCTs, n=3819; OR 0.76, 95% CI 0.63 to 0.92, I 2= 0 %). The remaining outcomes were not associated with exercise. Results from meta-regression did not identify a dose-response relationship between frequency, intensity, duration or volume of exercise and labour and delivery outcomes. SUMMARY/CONCLUSIONS Prenatal exercise reduced the odds of instrumental delivery in the general obstetrical population. There was no relationship between prenatal exercise and preterm/prelabour rupture of membranes, caesarean section, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms and diastasis recti.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Frances Sobierajski
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Courtney Yoo
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Victoria L Meah
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Taniya S Nagpal
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute , The University of Western Ontario, London, Ontario, Canada
| | - Laurel Riske
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marina James
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley Weeks
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andree-Anne Marchand
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute , The University of Western Ontario, London, Ontario, Canada
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Marvin-Dowle K, Kilner K, Burley VJ, Soltani H. Impact of adolescent age on maternal and neonatal outcomes in the Born in Bradford cohort. BMJ Open 2018; 8:e016258. [PMID: 29549196 PMCID: PMC5857698 DOI: 10.1136/bmjopen-2017-016258] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Explore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women. DESIGN Population-based cohort study. SETTING Maternity department of a large hospital in Northern England. PARTICIPANTS Primiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20-34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20-34 years were used as the reference group. PRIMARY OUTCOME MEASURES Maternal and neonatal outcomes. RESULTS The odds of extremely low birth weight (<1000 g) were significantly higher in the adolescent group (≤19 years) compared with the reference group (adjusted OR (aOR) 4.13, 95% CI 1.41 to 12.11). The odds of very (<32 weeks) and extremely (<28 weeks) preterm delivery were also higher in the adolescent group (aOR 2.12, 95% CI 1.06 to 4.25 and aOR 5.06, 95% CI 1.23 to 20.78, respectively).Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67). CONCLUSIONS This study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist.
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Affiliation(s)
- Katie Marvin-Dowle
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Karen Kilner
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | | | - Hora Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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Kim SJ, Kim SJ, Han KT, Park EC. Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea. PLoS One 2017; 12:e0188612. [PMID: 29190768 PMCID: PMC5708707 DOI: 10.1371/journal.pone.0188612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS) procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN) care. Methods We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery. Results We found that 150,256 (35.9%) total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93–0.96compared to other hospitals Medical costs (0.74%) and length of stay (1%) in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57%) in specialty hospitals compared with other hospitals. Conclusions We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.
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Affiliation(s)
- Seung Ju Kim
- Department of Nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration, Soonchunhyang University, Chungnam, Republic of Korea
| | - Kyu-Tae Han
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Harvey EM, Ahmed S, Manning SE, Diop H, Argani C, Strobino DM. Severe Maternal Morbidity at Delivery and Risk of Hospital Encounters Within 6 Weeks and 1 Year Postpartum. J Womens Health (Larchmt) 2017; 27:140-147. [PMID: 28953424 DOI: 10.1089/jwh.2017.6437] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the impact of severe maternal morbidity (SMM) after delivery. We examined the risk of rehospitalization in the first year postpartum among deliveries to women with and without SMM. MATERIALS AND METHODS We used the Pregnancy to Early Life Longitudinal data system, in which vital birth/fetal death records were linked with hospital delivery discharge data and subsequent nondelivery hospitalization data, including observational stays (OSs) and in-patient stays (hospital discharge [HD]) for Massachusetts residents during 2002-2011. We excluded deliveries to women with preexisting chronic conditions: hypertension, diabetes, asthma, and autoimmune conditions for a final sample of 685,228 deliveries. Multivariable log binomial regression with generalized estimating equations modeled the relative risk (RR) of hospital encounters 6 weeks and 1 year postpartum. RESULTS The rate of SMM was 99 per 10,000 deliveries. In the first year postpartum, 2.8% of deliveries to women without chronic medical conditions experienced at least one HD encounter and 1.0% at least one OS encounter. The adjusted relative risk (aRR) of any HD encounter for deliveries with SMM was 2.48 (95% confidence interval [CI]: 2.20-2.80) within 6 weeks postpartum and 2.04 (95% CI: 1.87-2.23) within 1 year. For OS encounters, aRRs among deliveries with SMM at delivery were 2.47 (95% CI: 1.94-3.14) in the first 6 weeks and 1.69 (95% CI: 1.43-2.01) in 1 year. CONCLUSIONS In Massachusetts, SMM increased the risk of rehospitalization in the first year postpartum among deliveries to women without chronic medical conditions.
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Affiliation(s)
- Elizabeth M Harvey
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Saifuddin Ahmed
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Susan E Manning
- 2 Bureau of Family Health and Nutrition , Massachusetts Department of Public Health, Boston, Massachusetts.,3 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Hafsatou Diop
- 2 Bureau of Family Health and Nutrition , Massachusetts Department of Public Health, Boston, Massachusetts
| | - Cynthia Argani
- 4 Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Donna M Strobino
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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Njim T, Choukem SP, Mbu R. Cesarean sections in a secondary level care hospital of Cameroon: an analysis of their six-year trends and adverse neonatal outcomes. BMC Res Notes 2017; 10:430. [PMID: 28851419 PMCID: PMC5576232 DOI: 10.1186/s13104-017-2750-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this study were to determine the trends of CS in a regional hospital in Cameroon and to explore its association with adverse neonatal outcomes. METHODS The study was conducted in the Buea Regional Hospital (BRH), Cameroon. A 6-year retrospective records analysis was used to determine the trends in rates of CS and neonatal adverse outcomes. In a 3-month prospective phase, indications of CS were identified. RESULTS Of a total of 4941 records reviewed from the year 2007 to 2012, the overall CS rate was 20.4%. The rates increased from 17.1% in 2007 to 20.9% in 2012, with a peak of 22.7% in 2011, but this time-trend was not significant (p-trend =0.06). Three of the 25 cases of CS (12%) in the prospective phase were done at the request of mothers. The odds of having a low first minute APGAR (APGAR <7) in neonates born from CS were higher than in neonates born from a normal delivery (OR = 6.6 and 95% CI 5.7-7.7; p < 0.01). CONCLUSION One out of every five women give birth through a CS in the BRH. This rate of CS is relatively high for a suburban population in a developing country. Strategies to reduce these rates should be investigated and instituted in the BRH to reduce health expenditures.
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Affiliation(s)
- Tsi Njim
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxfordshire, UK
| | - Simeon-Pierre Choukem
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. .,Health and Human Development (2HD) Research Network, Douala, Cameroon. .,Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon.
| | - Robinson Mbu
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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Bostanci Ergen E, Ozkaya E, Eser A, Abide Yayla C, Kilicci C, Yenidede I, Eser SK, Karateke A. Comparison of readmission rates between groups with early versus late discharge after vaginal or cesarean delivery: a retrospective analyzes of 14,460 cases. J Matern Fetal Neonatal Med 2017; 31:1318-1322. [PMID: 28372515 DOI: 10.1080/14767058.2017.1315661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this retrospective analysis was to show the readmission rate of cases with and without early discharge following vaginal or cesarean delivery. METHODS After exclusion of cases with pregnancy, delivery and neonatal complications, a total of 14,460 cases who delivered at Zeynep Kamil Women and Children's Health Training and Research Hospital were retrospectively screened from hospital database. Subjects were divided into two groups as Group 1: early discharge (n = 6802) and Group 2: late discharge (n = 7658). Groups were compared in terms of readmission rates and indications for readmission. RESULTS There were 6802 cases with early discharge whereas the remaining women were discharged after 24 h for vaginal delivery and 48 h following cesarean delivery on regular bases. Among cases with early discharge, 205 (3%) cases readmitted to emergency service with variable indications, while there were 216 (2.8%) readmitted women who were discharged on regular bases. Most common indication for readmission was wound infection in both groups. Neonatal sex distributions were similar between groups (p > .05), where as there was a higher rate of cesarean deliveries in Group 2 (p < .05). Furthermore, cesarean rate was significantly higher in readmitted women with early discharge (p < .05). CONCLUSION Similar readmission rates were observed in groups with early and late discharges following vaginal or cesarean delivery without any mortality or permanent morbidity and cost analyses revealed 68 Turkish liras lower cost with early discharge.
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Affiliation(s)
- Evrim Bostanci Ergen
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Enis Ozkaya
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Ahmet Eser
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Cigdem Abide Yayla
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Cetin Kilicci
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Ilter Yenidede
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Semra Kayatas Eser
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
| | - Ates Karateke
- a Department of Reproductive Medicine and Infertility , Zeynep Kamil Maternity/Children Education and Training Hospital , Istanbul , Turkey
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Mesterton J, Ladfors L, Ekenberg Abreu A, Lindgren P, Saltvedt S, Weichselbraun M, Amer-Wåhlin I. Case mix adjusted variation in cesarean section rate in Sweden. Acta Obstet Gynecol Scand 2017; 96:597-606. [DOI: 10.1111/aogs.13117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Johan Mesterton
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Ivbar Institute; Stockholm Sweden
| | - Lars Ladfors
- Institute of Clinical Sciences; Department of Obstetrics and Gynecology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Anna Ekenberg Abreu
- Department of Obstetrics and Gynecology; Akademiska Hospital; Uppsala Sweden
| | - Peter Lindgren
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Sissel Saltvedt
- Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
| | - Marianne Weichselbraun
- Institute of Clinical Sciences; Department of Obstetrics and Gynecology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Isis Amer-Wåhlin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Peyvandi S, Nguyen TATT, Almeida-Jones M, Boe N, Rhee L, Anton T, Sklansky M, Tarsa M, Satou G, Moon-Grady AJ. Timing and Mode of Delivery in Prenatally Diagnosed Congenital Heart Disease- an Analysis of Practices within the University of California Fetal Consortium (UCfC). Pediatr Cardiol 2017; 38:588-595. [PMID: 28078382 PMCID: PMC5969910 DOI: 10.1007/s00246-016-1552-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
Prenatal diagnosis of critical congenital heart disease (CHD) is associated with decreased morbidity. It is also associated with lower birth weights and earlier gestational age at delivery. The University of California Fetal Consortium (UCfC) comprises five tertiary medical centers, and was created to define treatment practices. We utilized this consortium to assess delivery patterns and outcomes in subjects with prenatal and postnatal diagnosis of CHD. A retrospective cohort study was conducted on maternal-neonatal pairs diagnosed with complex CHD prenatally (n = 186) and postnatally (n = 110) from 2011 to 2013. Outcomes were assessed between groups after adjusting for disease severity. Prenatally diagnosed subjects were born earlier (38.1 ± 0.11 vs. 39 ± 0.14 weeks, p = < 0.001), and had lower birth weights (2853 ± 49 vs. 3074 ± 58 g, p = 0.005) as compared to postnatal diagnosis. For every week increase in gestational age and 100 g increase in birth weight, length of stay decreased by 12.3 ± 2.7% (p < 0.001) and 3.9 ± 0.9% (p < 0.001). Subjects with prenatal diagnosis were more often born via cesarean both planned (35.6 vs. 26.2%, p = 0.004) and after a trial of labor (13 vs. 7.8%, p = 0.017). Neonates with cesarean delivery trended toward a longer length of stay (2.6 days longer), and were born earlier as compared to other modalities (37.7 ± 0.22 weeks, p = 0.001). Management after prenatal diagnosis of CHD appears to have modifiable disadvantages for maternal and neonatal outcomes. The UCfC provides a platform to study best practices and standardization of care for future studies.
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Affiliation(s)
- Shabnam Peyvandi
- Division of Pediatric Cardiology and the Fetal Treatment Center, University of California San Francisco Benioff Children's Hospital, 550 16th street, 5th floor, San Francisco, CA, 94158, USA.
| | - Tina Ahn Thu Thi Nguyen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Myriam Almeida-Jones
- Division of Cardiology, University of California Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Nina Boe
- Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, University of California, Davis, CA, USA
| | - Laila Rhee
- Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, University of California, Davis, CA, USA
| | - Tracy Anton
- Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - Mark Sklansky
- Division of Cardiology, Mattel Children's Hospital and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Maryam Tarsa
- Division of Maternal Fetal Medicine, Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - Gary Satou
- Division of Cardiology, Mattel Children's Hospital and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology and the Fetal Treatment Center, University of California San Francisco Benioff Children's Hospital, 550 16th street, 5th floor, San Francisco, CA, 94158, USA
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Liu Y, Wang X, Zou L, Ruan Y, Zhang W. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study. Medicine (Baltimore) 2017; 96:e5509. [PMID: 28207498 PMCID: PMC5319487 DOI: 10.1097/md.0000000000005509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022] Open
Abstract
In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014. Caesarean delivery on maternal request (CDMR) cannot improve the maternal-fetal prognosis compared with the spontaneous vaginal delivery. With the releasing of China's 2 children policy, more CS will be implemented due to previous CS. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians.
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Affiliation(s)
- Yajun Liu
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Liying Zou
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Hussein J, Fortney JA. Puerperal sepsis and maternal mortality: what role can new technologies play? Int J Gynaecol Obstet 2017; 85 Suppl 1:S52-61. [PMID: 15147854 DOI: 10.1016/j.ijgo.2004.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify new and underutilized technologies to reduce maternal mortality related to puerperal sepsis in developing countries. METHOD Review of current medical literature. RESULT The literature indicates that infection-control protocols and evidence-based procedures--including prophylactic antibiotics for cesarean section or preterm rupture of membranes, and updated antibiotic regimens--should be widely adopted. Devices such as hand rubs, needle-disposal systems, and rapid microbiological diagnostic tests can improve compliance and efficiency. Operational research on promising developments like vaginal cleansing with antiseptics, vitamin A supplementation, and prophylactic antibiotics in high-risk women is needed. CONCLUSION Sepsis management continues to depend on good implementation of established technologies. Program-based approaches are required to improve uptake.
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Affiliation(s)
- J Hussein
- Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Scotland, UK.
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Kaboré C, Ridde V, Kouanda S, Queuille L, Somé PA, Agier I, Dumont A. DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso. BMC Pregnancy Childbirth 2016; 16:322. [PMID: 27769190 PMCID: PMC5073955 DOI: 10.1186/s12884-016-1112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 10/13/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Since 2006, Burkina Faso has subsidized the cost of caesarean sections to increase their accessibility. Caesareans are performed by obstetricians, general practitioners, and nurses trained in emergency surgery. While the national caesarean rate is still too low (only 2 % in 2010), 12 to 24 % of caesareans performed in hospital are, in fact, not medically indicated. The objective of this study is to evaluate the effectiveness and analyze the implementation of a multi-faceted intervention to lower the rate of non-medically indicated caesareans in Burkina Faso. METHODS This study combines a multicentre cluster randomized controlled trial with an implementation analysis in a mixed-methods approach. The evidence-based intervention will consist of three strategies to improve the competencies of maternity teams: 1) clinical audits based on objective criteria; 2) training of personnel; and 3) decision-support reminders of indications for caesareans via text messages. The unit of randomization and of intervention is the public hospital equipped with a functional operating room. Using stratified randomization on hospital type and staff qualifications, 11 hospitals have been assigned to the intervention group and 11 to the control group. The intervention will cover 1 year. Every patient who delivered by caesarean during a 6-month period in the year preceding the intervention and the 6 months following its end will be included in the trial. The change in the rate of non-medically indicated caesareans is the main criterion by which the intervention's impact will be assessed. To analyze the intervention process, a longitudinal qualitative study consisting of deliberative workshops and individual in-depth interviews will be conducted. The target outcome is a 50 % reduction in the rate of non-medically indicated caesareans. DISCUSSION This study will provide evidence regarding the effectiveness of a multi-faceted intervention for reducing non-medically indicated caesareans in a low-income country. By combining qualitative and quantitative methods, the study's findings will allow understanding the factors that could influence the intervention process and ultimately the intended outcomes. TRIAL REGISTRATION The DECIDE trial is registered on the Current Controlled Trials website under the number ISRCTN48510263 on January 28, 2014.
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Affiliation(s)
- Charles Kaboré
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Séni Kouanda
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Ludovic Queuille
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | | | - Isabelle Agier
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Alexandre Dumont
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
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Koroukian SM. Relative Risk of Postpartum Complications in the Ohio Medicaid Population: Vaginal Versus Cesarean Delivery. Med Care Res Rev 2016; 61:203-24. [PMID: 15155052 DOI: 10.1177/1077558703260123] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to estimate the relative risk of postpartum complication by type of delivery among Ohio Medicaid beneficiaries. The study uses the linked Medicaid and Ohio birth certificate data for births occurring from July 1991 through April 1996 (N = 168,736). The results indicate that the incidence of major puerperal infection, thromboembolic events, anesthetic complications, and obstetrical surgical wound infection was higher among women undergoing a C-section as compared to those with vaginal delivery, even after limiting the analysis to elective cesarean deliveries and uncomplicated vaginal deliveries. On the other hand, women with C-sections were less likely to experience obstetrical trauma, and results on postpartum hemorrhage were inconclusive. Aside from obstetrical trauma, the relative risk of postpartum complications remains significantly higher among women undergoing C-section. These findings are of particular relevance in light of the substantial proportion of repeat C-sections performed on an elective basis.
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Maternal Postpartum Hospitalization Following Assisted Reproductive Technology Births. Epidemiology 2016; 26:e64-5. [PMID: 26317669 DOI: 10.1097/ede.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215:113.e1-113.e10. [PMID: 27829570 DOI: 10.1016/j.ajog.2016.01.174] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/18/2016] [Accepted: 01/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Readmission rates are used as a quality metric in medical and surgical specialties; however, little is known about obstetrics readmissions. OBJECTIVE Our goals for this study were to describe the trends in postpartum readmissions over time; to characterize the common indications and associated diagnoses for readmissions; and to determine maternal, delivery, and hospital characteristics that may be associated with readmission. STUDY DESIGN Postpartum readmissions occurring within the first 6 weeks after delivery in California, Florida, and New York were identified between 2004 and 2011 in State Inpatient Databases. Of the 5,949,739 eligible deliveries identified, 114,748 women were readmitted over the 8-year period. We calculated the rates of readmissions and their indications by state and over time. The characteristics of the readmission stay, including day readmitted, length of readmission, and charge for readmission, were compared among the diagnoses. Odds ratios were calculated using a multivariate logistic regression to determine the predictors of readmission. RESULTS The readmission rate increased from 1.72% in 2004 to 2.16% in 2011. Readmitted patients were more likely to be publicly insured (54.3% vs 42.0%, P < .001), to be black (18.7% vs 13.5%, P < .001), to have comorbidities such as hypertension (15.3% vs 2.4%, P < 0.001) and diabetes (13.1% vs 6.8%, P < .001), and to have had a cesarean delivery (37.2% vs 32.9%, P < .001). The most common indications for readmission were infection (15.5%), hypertension (9.3%), and psychiatric illness (7.7%). Patients were readmitted, on average, 7 days after discharge, but readmission day varied by diagnosis: day 3 for hypertension, day 5 for infection, and day 9 for psychiatric disease. Maternal comorbidities were the strongest predictors of postpartum readmissions: psychiatric disease, substance use, seizure disorder, hypertension, and tobacco use. CONCLUSION Postpartum readmission rates have risen over the last 8 years. Understanding the risk factors, etiologies, and cause-specific timing for postpartum readmissions may aid in the development of new quality metrics in obstetrics and targeted strategies to curb the rising rate of postpartum readmissions in the United States.
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Affiliation(s)
- Mark A Clapp
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
| | - Sarah E Little
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Jie Zheng
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
| | - Julian N Robinson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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Adverse Pregnancy Outcomes Among Women with Inflammatory Bowel Disease: A Population-Based Study from England. Inflamm Bowel Dis 2016; 22:1621-30. [PMID: 27306070 DOI: 10.1097/mib.0000000000000802] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is limited contemporary population-based evidence on adverse birth outcomes and pregnancy-related complications for women with inflammatory bowel disease (IBD). This study provides such estimates of these risks and assesses variation by IBD type and surgical interventions. METHODS We calculated the proportion of pregnancies in women with and without IBD between 1997 and 2012 throughout England using linked primary (Clinical Practice Research Datalink) and secondary care (Hospital Episode Statistics) data. Risk of pregnancy-related complications and adverse birth outcomes in women with Crohn's disease and ulcerative colitis were compared with risks in women without IBD using odds ratios (ORs). RESULTS Of 364,363 singleton pregnancies resulting in live or stillbirths, 1969 (0.5%) were in women with IBD. Women with Crohn's disease were more likely to have preterm births (OR = 1.42; 95% confidence interval, 1.12-1.79), babies with low birth weights (OR = 1.39; 95% confidence interval, 1.05-1.83), and postpartum hemorrhage (OR = 1.27; 95% confidence interval, 1.04-1.55), whereas women with ulcerative colitis were only at increased risk of preterm births with an absolute risk difference of <2.7%. These risks remained independent of caesarean section. Prior surgery for IBD did not increase the risk of adverse birth outcomes or pregnancy-related complications compared with cases without surgery, however, women with IBD were more likely to have an elective caesarean section. CONCLUSIONS Women with Crohn's disease have increased risks of some specific pregnancy-related complications and adverse birth outcomes which are independent of caesarean section, however, the absolute risk differences are small, indicating that most women with IBD will have an uncomplicated pregnancy.
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Panda S, Begley C, Daly D. Readmission following caesarean section: Outcomes for women in an Irish maternity hospital. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjom.2016.24.5.322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sunita Panda
- Clinical midwife manager, Coombe Women and Infants University Hospital; PhD student, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Cecily Begley
- Chair of Nursing and Midwifery, School of Nursing and Midwifery, Trinity College Dublin; visiting professor, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Deirdre Daly
- Assistant professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Mesterton J, Lindgren P, Ekenberg Abreu A, Ladfors L, Lilja M, Saltvedt S, Amer-Wåhlin I. Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study. BMC Pregnancy Childbirth 2016; 16:125. [PMID: 27245845 PMCID: PMC4888656 DOI: 10.1186/s12884-016-0921-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/24/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. METHODS In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. RESULTS Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for risk of haemorrhage > 1000 ml and post-partum infections. CONCLUSIONS Maternal characteristics have a large impact on care process, resource use and outcomes in childbirth care. For meaningful comparisons between hospitals and benchmarking, a broad spectrum of sociodemographic and clinical maternal characteristics should be accounted for.
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Affiliation(s)
- Johan Mesterton
- Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Ivbar Institute, Stockholm, Sweden.
| | - Peter Lindgren
- Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Anna Ekenberg Abreu
- Departement of Obstetrics and Gynecology, Akademiska Hospital, Uppsala, Sweden
| | - Lars Ladfors
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monica Lilja
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden
| | - Sissel Saltvedt
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Stockholm, Sweden
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