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Bertini A, Varela MJ, Holz A, Gonzalez P, Bastias D, Giovanetti M, Salas R, Pardo F. Impact of pregestational obesity on perinatal complications: update in a Latin American cohort. Public Health 2024; 233:170-176. [PMID: 38905746 DOI: 10.1016/j.puhe.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/22/2024] [Accepted: 05/16/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES While the association between pregestational obesity and perinatal complications has been established, it is necessary to update the current understanding of its impact on maternal and foetal health due to its growing prevalence. Thus, this study aimed to investigate the association between pregestational obesity with the leading perinatal complications during the last 6 years. STUDY DESIGN A cross-sectional study was performed in San Felipe, Chile. Anonymised data of 11,197 deliveries that occurred between 2015 and 2021 were included. METHODS Pregestational body mass index was defined according to the World Health Organisation during the first trimester of pregnancy. The association between pregestational obesity and perinatal complications was analysed by calculating the odds ratio (OR), which was adjusted for confounding variables. Statistical differences were considered with a P-value of <0.05. RESULTS The prevalence of pregestational obesity was 30.1%. Pregestational obesity was related to a high incidence of perinatal complications (≥3 complications; P < 0.0001). The main perinatal complications were caesarean section, large for gestational age (LGA), gestational diabetes (GD), macrosomia, hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), intrauterine growth restriction, and failed induction. Pregestational obesity was shown to be a risk factor for macrosomia (OR: 2.3 [95% confidence interval {95% CI}: 2.0-2.8]), GD (OR: 1.9 [95% CI: 1.6-2.1]), HDP (OR: 1.8 [95% CI: 1.5-2.1]), LGA (OR: 1.6 [95% CI: 1.5-1.8]), failed induction (OR: 1.4 [95% CI: 1.0-1.8]), PROM (OR: 1.3 [95% CI: 1.1-1.6]), and caesarean section (OR: 1.3 [95% CI: 1.2-1.4]). CONCLUSIONS Pregestational obesity has been shown to be a critical risk factor for the main perinatal complications in the study population. Pregestational advice is imperative not only in preventing pregestational obesity but also in the mitigation of critical perinatal complications once they arise.
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Affiliation(s)
- A Bertini
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile; Programa de Doctorado en Ciencias e Ingeniería para la Salud, Universidad de Valparaíso, Chile; Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Chile; Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
| | - M J Varela
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile; School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile
| | - A Holz
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile; School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile
| | - P Gonzalez
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile; School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile
| | - D Bastias
- School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile
| | - M Giovanetti
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile
| | - R Salas
- Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Chile; Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
| | - F Pardo
- Metabolic Diseases Research Laboratory (MDRL), Center of Interdisciplinary Biomedical and Engineering Research for Health, School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile; School of Medicine, Faculty of Medicine, Campus San Felipe, Universidad de Valparaíso, Chile.
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2
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Kaombe TM, Hamuza GA. Impact of ignoring sampling design in the prediction of binary health outcomes through logistic regression: evidence from Malawi demographic and health survey under-five mortality data; 2000-2016. BMC Public Health 2023; 23:1674. [PMID: 37653375 PMCID: PMC10469829 DOI: 10.1186/s12889-023-16544-4] [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: 02/07/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
The birth and death rates of a population are among the crucial vital statistics for socio-economic policy planning in any country. Since the under-five mortality rate is one of the indicators for monitoring the health of a population, it requires regular and accurate estimation. The national demographic and health survey data, that are readily available to the puplic, have become a means for answering most health-related questions among African populations, using relevant statistical methods. However, many of such applications tend to ignore survey design effect in the estimations, despite the availability of statistical tools that support the analyses. Little is known about the amount of inaccurate information that is generated when predicting under-five mortality rates. This study estimates and compares the bias encountered when applying unweighted and weighted logistic regression methods to predict under-five mortality rate in Malawi using nationwide survey data. The Malawi demographic and health survey data of 2004, 2010, and 2015-16 were used to determine the bias. The analyses were carried out in R software version 3.6.3 and Stata version 12.0. A logistic regression model that included various bio- and socio-demographic factors concerning the child, mother and households was used to estimate the under-five mortality rate. The results showed that accuracy of predicting the national under-five mortality rate hinges on cluster-weighting of the overall predicted probability of child-deaths, regardless of whether the model was weighted or not. Weighting the model caused small positive and negative changes in various fixed-effect estimates, which diffused the result of weighting in the fitted probabilities of deaths. In turn, there was no difference between the overall predicted mortality rate obtained using the weighted model and that obtained in the unweighted model. We recommend considering survey cluster-weights during the computation of overall predicted probability of events for a binary health outcome. This can be done without worrying about the weights during model fitting, whose aim is prediction of the population parameter.
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Affiliation(s)
- Tsirizani M Kaombe
- Department of Mathematical Sciences, School of Natural and Applied Sciences, University of Malawi, Zomba, Malawi.
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Grant D. The "Quiet Revolution" and the cesarean section in the United States. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101192. [PMID: 36351359 DOI: 10.1016/j.ehb.2022.101192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
This paper estimates how changes in family structure and women's labor market attachment during the last fifty years have affected the incidence of cesarean delivery in the United States. Both sets of factors are strongly related to cesarean utilization, and have generally changed so as to increase the rate of cesarean delivery over time. Altogether, changes in these factors, complemented by demographic changes, raised the U.S. cesarean section rate by eleven percentage points since the late 1970s, nearly two-thirds of the increase over that period. Today's elevated cesarean section rate is in part a social phenomenon.
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Affiliation(s)
- Darren Grant
- Department of Economics and International Business, Sam Houston State University, Box 2118, Huntsville, TX 77341-2118, USA.
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4
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Islam MN, Mustafina SN, Mahmud T, Khan NI. Machine learning to predict pregnancy outcomes: a systematic review, synthesizing framework and future research agenda. BMC Pregnancy Childbirth 2022; 22:348. [PMID: 35546393 PMCID: PMC9097057 DOI: 10.1186/s12884-022-04594-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Machine Learning (ML) has been widely used in predicting the mode of childbirth and assessing the potential maternal risks during pregnancy. The primary aim of this review study is to explore current research and development perspectives that utilizes the ML techniques to predict the optimal mode of childbirth and to detect various complications during childbirth. A total of 26 articles (published between 2000 and 2020) from an initial set of 241 articles were selected and reviewed following a Systematic Literature Review (SLR) approach. As outcomes, this review study highlighted the objectives or focuses of the recent studies conducted on pregnancy outcomes using ML; explored the adopted ML algorithms along with their performances; and provided a synthesized view of features used, types of features, data sources and its characteristics. Besides, the review investigated and depicted how the objectives of the prior studies have changed with time being; and the association among the objectives of the studies, uses of algorithms, and the features. The study also delineated future research opportunities to facilitate the existing initiatives for reducing maternal complacent and mortality rates, such as: utilizing unsupervised and deep learning algorithms for prediction, revealing the unknown reasons of maternal complications, developing usable and useful ML-based clinical decision support systems to be used by the expecting mothers and health professionals, enhancing dataset and its accessibility, and exploring the potentiality of surgical robotic tools. Finally, the findings of this review study contributed to the development of a conceptual framework for advancing the ML-based maternal healthcare system. All together, this review will provide a state-of-the-art paradigm of ML-based maternal healthcare that will aid in clinical decision-making, anticipating pregnancy problems and delivery mode, and medical diagnosis and treatment.
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Affiliation(s)
- Muhammad Nazrul Islam
- Department of Computer Science and Engineering, Military Institute of Science and Technology, Dhaka, 1216, Bangladesh.
| | - Sumaiya Nuha Mustafina
- Department of Computer Science and Engineering, Military Institute of Science and Technology, Dhaka, 1216, Bangladesh
| | - Tahasin Mahmud
- Department of Computer Science and Engineering, Military Institute of Science and Technology, Dhaka, 1216, Bangladesh
| | - Nafiz Imtiaz Khan
- Department of Computer Science and Engineering, Military Institute of Science and Technology, Dhaka, 1216, Bangladesh
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5
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Roa L, Caddell L, Choksi N, Devi S, Pyda J, Boatin AA, Shrime M. Optimizing availability of obstetric surgical care in India: A cost-effectiveness analysis examining rates and access to Cesarean sections. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001369. [PMID: 36962905 PMCID: PMC10021835 DOI: 10.1371/journal.pgph.0001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
The objective of this study is to assess the cost-effectiveness of three different strategies with different availabilities of cesarean sections (CS). The setting was rural and urban areas of India with varying rates of CS and access to comprehensive emergency obstetric care (CEmOC) for women of reproductive age in India. Three strategies with different access to CEmOC and CS rates were evaluated: (A) India's national average (50.2% access, 17.2% CS rate), (B) rural areas (47.2% access, 12.8% CS rate) and(C) urban areas (55.7% access, 28.2% CS rate). We performed a first-order Monte Carlo simulation using a 1-year cycle time and 34-year time horizon. All inputs were derived from literature. A societal perspective was utilized with a willingness-to-pay threshold of $1,940. The outcome measures were costs and quality-adjusted life years were used to calculate the incremental cost-effectiveness ratio (ICER). Maternal and neonatal outcomes were calculated. Strategy C with the highest access to CEmOC despite the highest CS rate was cost-effective, with an ICER of 354.90. Two-way sensitivity analysis demonstrated this was driven by increased access to CEmOC. The highest CS rate strategy had the highest number of previa, accreta and ICU admissions. The strategy with the lowest access to CEmOC had the highest number of fistulae, uterine rupture, and stillbirths. In conclusion, morbidity and mortality result from lack of access to CEmOC and overuse of CS. While interventions are needed to address both, increasing access to surgical obstetric care drives cost-effectiveness and is paramount to optimize outcomes.
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Affiliation(s)
- Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Luke Caddell
- Department of General Surgery, Stanford University, Stanford, CA, United States of America
| | - Namit Choksi
- Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
- School of Healthcare, Rishihood University, Sonepat, Haryana, India
| | - Shylaja Devi
- Gudalur Adivasi Hospital, Gudalur, Nilgiris, Tamil Nadu, India
| | - Jordan Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Adeline A Boatin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mark Shrime
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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6
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Barili E, Bertoli P, Grembi V. Fee equalization and appropriate health care. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100981. [PMID: 33607465 DOI: 10.1016/j.ehb.2021.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/19/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Fee equalization in health care brings under a unique tariff several medical treatments, coded under different Diagnosis Related Groups (DRGs). The aim is to improve healthcare quality and efficiency by discouraging unnecessary, but better-paid, treatments. We evaluate its effectiveness on childbirth procedures to reduce overuse of c-sections by equalizing the DRGs for vaginal and cesarean deliveries. Using data from Italy and a difference-in-differences approach, we show that setting an equal fee decreased c-sections by 2.6%. This improved the appropriateness of medical decisions, with more low-risk mothers delivering naturally and no significant changes in the incidence of complications for vaginal deliveries. Our analysis supports the effectiveness of fee equalization in avoiding c-sections, but highlights the marginal role of financial incentives in driving c-section overuse. The observed drop was only temporary and in about a year the use of c-sections went back to the initial level. We found a greater reduction in lower quality, more capacity-constrained hospitals. Moreover, the effect is driven by districts where the availability of Ob-Gyn specialists is higher and where women are predominant in the gender composition of Ob-Gyn specialists.
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Affiliation(s)
| | - Paola Bertoli
- University of Verona, Italy; Prague University of Economic and Business, Czechia.
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7
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Ayalew M, Mengistie B, Dheressa M, Demis A. Magnitude of Cesarean Section Delivery and Its Associated Factors Among Mothers Who Gave Birth at Public Hospitals in Northern Ethiopia: Institution-Based Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1563-1571. [PMID: 33235456 PMCID: PMC7678705 DOI: 10.2147/jmdh.s277747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background Cesarean section is one of the most common surgeries around the world performed whenever abnormal conditions complicate labour and vaginal delivery, threatening the life or health of the mother or the baby. Although the cesarean section is a safe operation, when it is performed without medical need, it puts mothers and their babies at risk of short- and long-term health problems. However, the factors are not persistent and there is limited information concerning the levels of cesarean section delivery and its associated factors in public hospitals of North Wollo Zone. Therefore, this study aimed to assess the magnitude of cesarean section and associated factors in hospitals of North Wollo Zone, Northern Ethiopia. Methods and Materials An institution-based cross-sectional study design was employed among 433 mothers who gave birth in public hospitals of North Wollo Zone, Northern Ethiopia, from March 01 to 30, 2019. A systematic random sampling method was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable analyses were carried out to identify independent predictors of cesarean section. Results The magnitude of cesarean section delivery was 30.9% (95% CI, 26.8–35.3). Being urban resident (AOR=4.04, 95% CI: 2.19–7.45), malpresentation (AOR=2.56, 95% CI: 1.29–5.05), having a previous cesarean section (AOR=9.11, 95% CI: 3.77–22.01) and antepartum haemorrhage (AOR=8.65, 95% CI: 3.82–19.56) were statistically and positively associated with cesarean section delivery. Conclusion The magnitude of cesarean section delivery among mothers who gave birth at North Wollo Zone public hospitals was high. Residence, antepartum haemorrhage, having a previous cesarean section, and malpresentation were factors associated with cesarean section. Therefore, health education and giving a clear picture regarding the risks and benefits of cesarean section as well as avoiding unjustified cesarean section delivery should be encouraged.
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Affiliation(s)
- Melese Ayalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheressa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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8
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Du SG, Tang F, Zhao Y, Sun GQ, Lin Y, Tan ZH, Wu XF. Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China. Curr Med Sci 2020; 40:348-353. [PMID: 32337696 DOI: 10.1007/s11596-020-2190-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 02/04/2020] [Indexed: 10/24/2022]
Abstract
China's universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China's two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.
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Affiliation(s)
- Shu-Guo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Fei Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Guo-Qiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Ying Lin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Zhi-Hua Tan
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Xu-Feng Wu
- Department of Gynecology and Oncology, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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9
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Zhou H, Ding Y, Yang Y, Zou S, Qu X, Wang A, Wang X, Huang Y, Li X, Huang X, Wang Y. Effects on developmental outcomes after cesarean birth versus vaginal birth in Chinese children aged 1-59 months: a cross-sectional community-based survey. PeerJ 2019; 7:e7902. [PMID: 31660274 PMCID: PMC6815197 DOI: 10.7717/peerj.7902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/16/2019] [Indexed: 01/27/2023] Open
Abstract
Objective It is controversial whether the mode of delivery is associated with developmental outcome, and little was known about growth and development of cesarean children in poor rural areas in China. We aim to measure the development of both cesarean and vaginal-delivered children by Ages and Stages Questionnaires (ASQ) and explore the association between mode of delivery and developmental outcome in poor rural areas in China. Methods Data were collected from a cross-sectional community-based survey, which recruited 1,755 vaginal delivered and cesarean children ages 1 to 59 months in eight counties of China. Caregivers of those children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination andquestionnaires on socio-demographic and neonatal characteristics were conducted. Multivariate logistic regressions were used to measure the association between developmental delay and mode of delivery as well as each socio-demographic factor, respectively, after adjusting other socio-demographic characteristics. Results The prevalence of suspected overall developmental delay was 23.4% in the cesarean group, compared with 21.3% in the vaginal delivered group, yet without statistical difference (p < 0.05). Developmental delay was also not significantly different between cesarean and vaginal delivered group in five ASQ domains of communication (7.7% vs. 7.8%, p = 0.949), fine motor (7.0% vs. 6.1%, p = 0.538), gross motor (8.5% vs. 6.4%, p = 0.154), problem solving (7.2% vs. 6.7%, p = 0.722) and personal social (8.0% vs. 7.9%, p = 0.960). Conclusions Our findings suggest that cesarean delivery does not increase or decrease the risk of suspected developmental in children delay as compared with vaginal delivery.
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Affiliation(s)
- Hong Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China
| | - Yuan Ding
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | | | - Siyu Zou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xueqi Qu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Anqi Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Xi Wang
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Yue Huang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xintong Li
- Beijing Camford Royal School, Beijing, China
| | | | - Yan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Environmental and Spatial Epidemiology Research Center, National Human Genetic Resources Center, Beijing, China
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10
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Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2019; 29:200-209. [PMID: 31532326 DOI: 10.1089/jwh.2019.7750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
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Affiliation(s)
- Yanfang Chen
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lixing Guo
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
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11
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Kahankova R, Martinek R, Jaros R, Behbehani K, Matonia A, Jezewski M, Behar JA. A Review of Signal Processing Techniques for Non-Invasive Fetal Electrocardiography. IEEE Rev Biomed Eng 2019; 13:51-73. [PMID: 31478873 DOI: 10.1109/rbme.2019.2938061] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fetal electrocardiography (fECG) is a promising alternative to cardiotocography continuous fetal monitoring. Robust extraction of the fetal signal from the abdominal mixture of maternal and fetal electrocardiograms presents the greatest challenge to effective fECG monitoring. This is mainly due to the low amplitude of the fetal versus maternal electrocardiogram and to the non-stationarity of the recorded signals. In this review, we highlight key developments in advanced signal processing algorithms for non-invasive fECG extraction and the available open access resources (databases and source code). In particular, we highlight the advantages and limitations of these algorithms as well as key parameters that must be set to ensure their optimal performance. Improving or combining the current or developing new advanced signal processing methods may enable morphological analysis of the fetal electrocardiogram, which today is only possible using the invasive scalp electrocardiography method.
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12
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Ali Y, Khan MW, Mumtaz U, Salman A, Muhammad N, Sabir M. Identification of factors influencing the rise of cesarean sections rates in Pakistan, using MCDM. Int J Health Care Qual Assur 2019; 31:1058-1069. [PMID: 30415618 DOI: 10.1108/ijhcqa-04-2018-0087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The rate of cesarean sections has been rapidly increased in the last few decades in all the developing as well as developed countries. The rate of cesarean sections determined by the World Health Organization has been crossed by many countries, like Brazil, India, China, USA, Australia, etc. Similarly, this rate has also increased in Pakistan. The purpose of this paper is to explore and identify the factors that are responsible for the rising rate of cesarean sections in Pakistan. DESIGN/METHODOLOGY/APPROACH These factors are categorized under medical and non-medical factors. The medical factors include the obesity of mother, age of mother, weight of the baby, umbilical cord prolapse, fetal distress, abnormal presentation, dystocia and failure to progress. The non-medical factors include financial incentives of doctors, time convenience for doctors, high tolerance to surgery, patient's preference toward cesarean section, private hospitals, public hospitals, income status of patients, rural areas, urban areas and the education of patients. To identify the critical factors, data have been collected and a multi-criteria decision-making technique, called Decision Making Trial and Evaluation Laboratory, is used. FINDINGS The result shows that the medical factors that are responsible for the rise in the rate of cesarean sections are umbilical cord prolapse, age of mother and obesity of mother. On the other hand, the non-medical factors that are the reasons for the increase in cesarean sections are the large number of private hospitals and the unethical acts of the doctors in these hospitals, preference of patients, and either the unavailability of doctors or poor conditions of hospitals in rural areas. ORIGINALITY/VALUE Cesarean section is an important surgical intervention and is considered to be very essential in the cases of existing as well as potential medical problems to the mother or the baby. Cesarean section is also performed for non-medical reasons. In Pakistan, the number of private hospitals has increased and these hospitals provide good health care. However, these hospitals do not work under the rules and regulations set by the government. The doctors in private hospitals perform unnecessary cesarean sections in order to fulfill the demands of private hospital's owners. In addition to this, it is also found that, nowadays, most women prefer to give birth through cesarean section in order to eliminate the pain of normal vaginal delivery.
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Affiliation(s)
- Yousaf Ali
- Department of Management Science and Humanities, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Pakistan
| | - Muhammad Waseem Khan
- Department of Management Science and Humanities, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Pakistan
| | - UbaidUllah Mumtaz
- Department of Management Science and Humanities, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Pakistan
| | - Aneel Salman
- Department of Management Science COMSATS, Institute of Information Technology, Islamabad, Pakistan
| | - Noor Muhammad
- Department of Management Science, GIK Institute of Engineering Sciences and Technology, Topi, Pakistan
| | - Muhammad Sabir
- Department of Management Science and Humanities, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Pakistan
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13
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Cookson G, Laliotis I. Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme. HEALTH ECONOMICS 2018; 27:675-689. [PMID: 29114977 DOI: 10.1002/hec.3624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
This paper evaluates the impact of the 2008 Rapid Improvement Programme that aimed at promoting normal birth and reducing caesarean section rates in the English National Health Service. Using Hospital Episode Statistics maternity records for the period 2001-2013, a panel data analysis was performed to determine whether the implementation of the programme reduced caesarean sections rates in participating hospitals. The results obtained using either the unadjusted sample of hospitals or a trimmed sample determined by a propensity score matching approach indicate that the impact of the programme was small. More specifically there were 2.3 to 3.4 fewer caesarean deliveries in participating hospitals, on average, during the postprogramme period offering a limited scope for cost reduction. This result mainly comes from the reduction in the number of emergency caesareans as no significant effect was uncovered for planned caesarean deliveries.
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14
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Idoko P, Anyanwu M. Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia. Afr Health Sci 2018; 18:157-165. [PMID: 29977269 PMCID: PMC6016991 DOI: 10.4314/ahs.v18i1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Caesarean section is a very important procedure to decrease maternal and perinatal morbidity and mortality. Anecdotal evidence suggests that more than half of all caesarean sections done in The Gambia are done at the Edward Francis Small Teaching Hospital. OBJECTIVE The aim of the study was to determine the caesarean section rate at the Edward Francis Small teaching Hospital. The study also aimed to determine the socio-demographic factors associated with caesarean section and maternal and fetal outcomes of caesarean section at the hospital. METHOD A retrospective review of all caesarean sections carried out at the Edward Francis Small Teaching Hospital from 1st January 2014 to 31st December 2014 was done. Data was extracted from patients' record. Descriptive statistics was done using Epi Info 7 statistical software. RESULTS The Caesarean section rate in the hospital is 24.0%. The commonest indications for caesarean section were previous caesarean section (20.6%) and cephalopelvic disproportion (20.2%). There were 21 maternal deaths (1.8%) and 71 fresh stillbirths (6.0%) in the study population. CONCLUSION About a quarter of all deliveries in the hospital were caesarean sections most of which were done as emergencies. The commonest indications for caesarean section were cephalopelvic disproportion and previous caesarean section.
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Affiliation(s)
- Patrick Idoko
- Edward Francis Small Teaching Hospital, Banjul The Gambia
- School of Medical and Allied Health Sciences, University of The Gambia
| | - Matthew Anyanwu
- Edward Francis Small Teaching Hospital, Banjul The Gambia
- School of Medical and Allied Health Sciences, University of The Gambia
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15
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Estimating Educational Differences in Low-Risk Cesarean Section Delivery: A Multilevel Modeling Approach. POPULATION RESEARCH AND POLICY REVIEW 2017. [DOI: 10.1007/s11113-017-9452-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Marino R, Capriglione S, Morosetti G, Di Angelo Antonio S, Miranda A, Pazzola M, Lopez S, Patrizi L, Angioli R, Stella P. May intraperitoneal irrigation with Betadine improve cesarean delivery outcomes? Results of a 6 years’ single centre experience. J Matern Fetal Neonatal Med 2017; 31:670-676. [DOI: 10.1080/14767058.2017.1293036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Riccardo Marino
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, San Camillo-Forlanini Hospital, Rome, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynaecology Campus Bio-Medico, University of Rome, Rome, Italy
| | - Giulia Morosetti
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Di Angelo Antonio
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Miranda
- Department of Obstetrics and Gynaecology Campus Bio-Medico, University of Rome, Rome, Italy
| | - Marta Pazzola
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Lopez
- Department of Obstetrics and Gynaecology Campus Bio-Medico, University of Rome, Rome, Italy
| | - Lodovico Patrizi
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology Campus Bio-Medico, University of Rome, Rome, Italy
| | - Paolo Stella
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, San Camillo-Forlanini Hospital, Rome, Italy
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17
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Cheng ER, Declercq ER, Belanoff C, Iverson RE, McCloskey L. Racial and Ethnic Differences in the Likelihood of Vaginal Birth After Cesarean Delivery. Birth 2015; 42:249-53. [PMID: 26088760 PMCID: PMC4618667 DOI: 10.1111/birt.12174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND A major contributor to the increase in cesarean deliveries over recent decades is the decline in vaginal births after cesarean (VBAC). Racial and ethnic disparities in other perinatal outcomes are widely recognized, but few studies have been directed toward racial/ethnic differences in VBAC rates. METHODS We used the population-based Massachusetts Pregnancy to Early Life (PELL) database to investigate racial/ethnic differences in rates of VBAC for Massachusetts residents with one prior cesarean from 1998 to 2008. RESULTS The overall VBAC rate was 17.3 percent. After adjusting for demographic, behavioral, and medical risk factors, non-Hispanic Asian mothers had a greater likelihood of VBAC than non-Hispanic white mothers (adjusted risk ratio 1.31 [95% CI 1.23-1.39]). No other racial/ethnic group was significantly different from non-Hispanic whites in adjusted analyses. The likelihood of VBAC also decreased with increasing maternal age. DISCUSSION Non-Hispanic Asian women are significantly more likely to have VBAC than non-Hispanic white women. Efforts to reduce cesarean delivery rates in the United States should address these disparities. Future research should investigate factors underlying these differences to ensure that all women have access to appropriate maternity care services.
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Affiliation(s)
- Erika R. Cheng
- Post-doctoral Fellow, Harvard Medical School, Massachusetts General Hospital for Children, Division of General Academic Pediatrics, 100 Cambridge Street, 1570-B5, Boston, MA 02114, Tel: (617) 643-0473
| | - Eugene R. Declercq
- Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT430, Boston, MA 02118
| | - Candice Belanoff
- Clinical Assistant Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT429, Boston, MA 02118
| | - Ronald E. Iverson
- Director of Obstetrics and Assistant Professor of Obstetrics and Gynecology, Boston University School of Medicine, 10 Grove Street, East Boston, MA 02128
| | - Lois McCloskey
- Associate Professor, Community Health Sciences, Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT436, Boston, MA 02118
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18
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Souza JP, Betran AP, Dumont A, de Mucio B, Gibbs Pickens CM, Deneux-Tharaux C, Ortiz-Panozo E, Sullivan E, Ota E, Togoobaatar G, Carroli G, Knight H, Zhang J, Cecatti JG, Vogel JP, Jayaratne K, Leal MC, Gissler M, Morisaki N, Lack N, Oladapo OT, Tunçalp Ö, Lumbiganon P, Mori R, Quintana S, Costa Passos AD, Marcolin AC, Zongo A, Blondel B, Hernández B, Hogue CJ, Prunet C, Landman C, Ochir C, Cuesta C, Pileggi-Castro C, Walker D, Alves D, Abalos E, Moises E, Vieira EM, Duarte G, Perdona G, Gurol-Urganci I, Takahiko K, Moscovici L, Campodonico L, Oliveira-Ciabati L, Laopaiboon M, Danansuriya M, Nakamura-Pereira M, Costa ML, Torloni MR, Kramer MR, Borges P, Olkhanud PB, Pérez-Cuevas R, Agampodi SB, Mittal S, Serruya S, Bataglia V, Li Z, Temmerman M, Gülmezoglu AM. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG 2015; 123:427-36. [PMID: 26259689 PMCID: PMC4873961 DOI: 10.1111/1471-0528.13509] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/01/2022]
Abstract
Objective To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross‐sectional study. Setting Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods We hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models. Main outcome measures Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstract The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems. The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.
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Affiliation(s)
- J P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A P Betran
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - A Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France
| | - B de Mucio
- Latin American Center for Perinatology, Women and Reproductive Health, (CLAP/WR), WHO Regional Office for the Americas, Montevideo, Uruguay
| | - C M Gibbs Pickens
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - C Deneux-Tharaux
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris Descartes University, Paris, France
| | - E Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - E Sullivan
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - E Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - G Togoobaatar
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - G Carroli
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - H Knight
- Royal College of Obstetricians and Gynaecologists, Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J G Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - J P Vogel
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - K Jayaratne
- Family Health Bureau, Ministry of Health, Colombo, Sri Lanka
| | - M C Leal
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - M Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - N Morisaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.,Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - N Lack
- Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der Stationären Versorgung (BAQ), Bayerische Krankenhausgesellschaft, Munich, Germany
| | - O T Oladapo
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - Ö Tunçalp
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - P Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - R Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S Quintana
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A D Costa Passos
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A C Marcolin
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A Zongo
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France.,Direction de la santé de la famille, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - B Blondel
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris Descartes University, Paris, France
| | - B Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - C J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - C Prunet
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris Descartes University, Paris, France
| | - C Landman
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - C Ochir
- School of Public Health, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia
| | - C Cuesta
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - C Pileggi-Castro
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil.,Department of Paediatrics, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - D Walker
- Departments of Obstetrics & Gynaecology and Global Health Sciences, University of California, San Francisco, CA, USA
| | - D Alves
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - E Abalos
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - Ecd Moises
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - E M Vieira
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - G Duarte
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - G Perdona
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - I Gurol-Urganci
- Royal College of Obstetricians and Gynaecologists, Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - K Takahiko
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - L Moscovici
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil
| | - L Campodonico
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - L Oliveira-Ciabati
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil
| | - M Laopaiboon
- Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - M Danansuriya
- Family Health Bureau, Ministry of Health, Colombo, Sri Lanka
| | - M Nakamura-Pereira
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - M L Costa
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - M R Torloni
- Department of Obstetrics, School of Medicine of São Paulo, São Paulo Federal University, São Paulo, Brazil
| | - M R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - P Borges
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - P B Olkhanud
- School of Public Health, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia
| | - R Pérez-Cuevas
- Social Protection and Health Division, Inter-American Development Bank, Mexico City, Mexico
| | - S B Agampodi
- Family Health Bureau, Ministry of Health, Colombo, Sri Lanka
| | - S Mittal
- Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - S Serruya
- Latin American Center for Perinatology, Women and Reproductive Health, (CLAP/WR), WHO Regional Office for the Americas, Montevideo, Uruguay
| | - V Bataglia
- Hospital Nacional de Itauguá, Itauguá, Paraguay
| | - Z Li
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - M Temmerman
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - A M Gülmezoglu
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
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Rahman M, Shariff AA, Shafie A, Saaid R, Tahir RM. Caesarean delivery and its correlates in Northern Region of Bangladesh: application of logistic regression and cox proportional hazard model. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:8. [PMID: 26825988 PMCID: PMC5025997 DOI: 10.1186/s41043-015-0020-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/26/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Caesarean delivery (C-section) rates have been increasing dramatically in the past decades around the world. This increase has been attributed to multiple factors such as maternal, socio-demographic and institutional factors and is a burning issue of global aspect like in many developed and developing countries. Therefore, this study examines the relationship between mode of delivery and time to event with provider characteristics (i.e., covariates) respectively. METHODS The study is based on a total of 1142 delivery cases from four private and four public hospitals maternity wards. Logistic regression and Cox proportional hazard models were the statistical tools of the present study. RESULTS The logistic regression of multivariate analysis indicated that the risk of having a previous C-section, prolonged labour, higher educational level, mother age 25 years and above, lower order of birth, length of baby more than 45 cm and irregular intake of balanced diet were significantly predict for C-section. With regard to survival time, using the Cox model, fetal distress, previous C-section, mother's age, age at marriage and order of birth were also the most independent risk factors for C-section. By the forward stepwise selection, the study reveals that the most common factors were previous C-section, mother's age and order of birth in both analysis. As shown in the above results, the study suggests that these factors may influence the health-seeking behaviour of women. CONCLUSIONS Findings suggest that program and policies need to address the increase rate of caesarean delivery in Northern region of Bangladesh. Also, for determinant of risk factors, the result of Akaike Information Criterion (AIC) indicated that logistic model is an efficient model.
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Affiliation(s)
| | - Asma Ahmad Shariff
- Centre for Foundation Studies in Science, University of Malaya, Kuala Lumpur, Malaysia.
| | - Aziz Shafie
- Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia.
| | - Rahmah Saaid
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rohayatimah Md Tahir
- Centre for Foundation Studies in Science, University of Malaya, Kuala Lumpur, Malaysia
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20
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Campo-Engelstein L, Howland LE, Parker WM, Burcher P. Scheduling the Stork: Media Portrayals of Women's and Physicians' Reasons for Elective Cesarean Delivery. Birth 2015; 42:181-8. [PMID: 25881794 DOI: 10.1111/birt.12161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Media interest in cesarean delivery has grown in recent years driven both by rising cesarean delivery rates and the decision by the American College of Obstetrics and Gynecology (ACOG) to permit elective cesarean (EC) delivery. METHODS A content analysis of United States newspaper and magazine articles from 2000 to 2013 (n = 131 articles) was completed to understand how the news media portrays ECs. RESULTS The majority of articles (71.8%) emphasized reasons to support women having an EC, while 38.2 percent of the articles exhibited themes of physician support for ECs. Relatively few articles mentioned reasons against ECs either from the women's perspective (11.5%) or the practitioners' (3.8%). The most common themes given for women choosing ECs were convenience/scheduling (48.9%), avoidance of pain or fear of labor (29.8%), and physical harm to women from vaginal birth (17.6%). Doctors' perspectives were less prevalent in the media than women's perspectives, but when mentioned they were almost exclusively in support of ECs for reasons including avoiding malpractice (28.2%), avoiding physical harm to the woman or baby (16.8%), and timing/scheduling (14.5%). DISCUSSION Media coverage suggests ECs are widely accepted by both women and doctors, with women choosing an EC mainly for convenience/scheduling and fear. However, 43 percent of doctors surveyed by ACOG said they were not willing to perform the procedure, and surveys report that mothers rarely request an EC.
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Affiliation(s)
- Lisa Campo-Engelstein
- Alden March Bioethics Institute & OBGYN Department, Albany Medical College, Albany, NY, USA
| | - Lauren E Howland
- Department of Epidemiology & Biostatistics, University at Albany, Albany, NY, USA
| | - Wendy M Parker
- School of Arts and Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - Paul Burcher
- Alden March Bioethics Institute & OBGYN Department, Albany Medical College, Albany, NY, USA
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Jensen VM, Wüst M. Can Caesarean section improve child and maternal health? The case of breech babies. JOURNAL OF HEALTH ECONOMICS 2015; 39:289-302. [PMID: 25179865 DOI: 10.1016/j.jhealeco.2014.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/27/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
This paper examines the health effects of Caesarean section (CS) for children and their mothers. We use exogenous variation in the probability of CS in a fuzzy regression discontinuity design. Using administrative Danish data, we exploit an information shock for obstetricians that sharply altered CS rates for breech babies. We find that CS decreases the child's probability of having a low APGAR score and the number of family doctor visits in the first year of life. We find no significant effects for severe neonatal morbidity or hospitalizations. While mothers are hospitalized longer after birth, we find no effects of CS for maternal post-birth complications or infections. Although the change in mode of delivery for the marginal breech babies increases direct costs, the health benefits show that CS is the safest option for these children.
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Affiliation(s)
- Vibeke Myrup Jensen
- The Danish National Centre for Social Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark.
| | - Miriam Wüst
- The Danish National Centre for Social Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; Aarhus University RECEIV (Research Center for Early Interventions), Fuglesangs Allé, 8210 Aarhus, Denmark.
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Schulkind L, Shapiro TM. What a difference a day makes: quantifying the effects of birth timing manipulation on infant health. JOURNAL OF HEALTH ECONOMICS 2014; 33:139-158. [PMID: 24334004 DOI: 10.1016/j.jhealeco.2013.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 06/03/2023]
Abstract
Scheduling births for non-medical reasons has become an increasingly common practice in the United States and around the world. We exploit a natural experiment created by child tax benefits, which rewards births that occur just before the new year, to better understand the full costs of elective c-sections and inductions. Using data on all births in the U.S. from 1990 to 2000, we first confirm that expectant parents respond to the financial incentives by electing to give birth in December rather than January. We find that most of the manipulation comes from changes in the timing of c-sections. Small birth timing changes, even at full-term, lead to lower birthweight, a lower Apgar score, and an increase in the likelihood of being low birthweight.
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Affiliation(s)
- Lisa Schulkind
- Trinity College, Department of Economics, 300 Summit Street, Hartford 06106, USA
| | - Teny Maghakian Shapiro
- Santa Clara University, Leavey School of Business, Lucas Hall, 500 El Camino Real, Santa Clara, CA 95053, USA.
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Silveira LCD, Segre CADM. Physical exercise during pregnancy and its influence in the type of birth. EINSTEIN-SAO PAULO 2013; 10:409-14. [PMID: 23386078 DOI: 10.1590/s1679-45082012000400003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 06/15/2012] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To verify if medium intensity exercise performed during pregnancy can influence in the type of delivery, and to observe compliance to an exercise program among primiparous women with different levels of schooling. METHODS A study carried out at the Centro de Incentivo ao Aleitamento Materno, in São Sebastiao (SP), between April 7, 2008, and April 14, 2009. A prospective study involving 66 primiparous women who were divided into two groups: an Exercise Group, engaged in regular physical activity during pregnancy, and the Control Group, that did not participate in regular physical activity during the same period. Significance level in this project was 5% (p = 0.05). RESULTS The group that did engage in regular exercise had a higher rate of vaginal deliveries, with a statistically significance difference evaluated by the χ² test (p = 0.031). The pregnant women with the highest level of schooling showed greater compliance with the exercise program, with a statistically significant difference (p = 0.01736). CONCLUSION Physical exercise in primiparous women increased the chances of vaginal deliveries, and there was greater compliance with the exercise program among those with a higher level of schooling when compared to those with a basic education.
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O'Neill SM, Khashan AS, Kenny LC, Greene RA, Henriksen TB, Lutomski JE, Kearney PM. Caesarean section and subsequent ectopic pregnancy: a systematic review and meta-analysis. BJOG 2013; 120:671-80. [PMID: 23398899 DOI: 10.1111/1471-0528.12165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Caesarean section rates are increasing worldwide, and the long-term effects are unknown. OBJECTIVE To evaluate the risk of subsequent ectopic pregnancy in women with a previous caesarean section, compared with vaginal delivery. SEARCH STRATEGY Systematic review of the literature using CINAHL, the Cochrane Library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge, published from 1945 until 17 July 2011. SELECTION CRITERIA Cohort and case-control designs reporting on the mode of delivery and subsequent ectopic pregnancy. Two reviewers independently assessed the titles, abstracts, and full articles to identify eligible studies, using a standardised data collection form, and also assessed the study quality. Reference lists of the studies included were also cross-checked. DATA COLLECTION AND ANALYSIS Odds ratios (ORs) were combined using a random-effect model to estimate the overall association between caesarean section delivery and the risk of subsequent ectopic pregnancy. MAIN RESULTS Thirteen studies were included, which recruited a total of 61,978 women. Five studies reported adjustment for confounding factors, and the pooled OR of subsequent ectopic pregnancy following a caesarean section was 1.05 (95% CI 0.51-2.15). The removal of one study that reported outlier results yielded a pooled OR of 0.82 (95% CI 0.42-1.61). The pooled crude OR for all 13 studies was 1.36 (95% CI 0.99-1.88). AUTHOR'S CONCLUSIONS This review found no evidence of an association between prior caesarean section delivery and the occurrence of a subsequent ectopic pregnancy, but the studies included were of poor or variable quality, and only a small number adjusted for potential confounding factors. Further research of a higher methodological quality is required to assess any potential association between mode of delivery and subsequent ectopic pregnancy.
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Affiliation(s)
- S M O'Neill
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, and Department of Epidemiology and Public Health, University College Cork, Wilton, Cork, Ireland.
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Kaitelidou DC, Tsirona CS, Galanis PA, Siskou OC, Mladovsky P, Kouli EG, Prezerakos PE, Theodorou M, Sourtzi PA, Liaropoulos LL. Informal payments for maternity health services in public hospitals in Greece. Health Policy 2012; 109:23-30. [PMID: 23153567 DOI: 10.1016/j.healthpol.2012.10.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/10/2012] [Accepted: 10/21/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Private health expenditure for consuming maternity health services has been identified as an issue within public hospitals. AIM To estimate level of private health expenditure, in the form of informal payments, for maternal services in public hospitals in Greece. METHODS The study population consisted of 160 women who had recently given birth in three provincial general hospitals and one general hospital in Athens. A three-part questionnaire was developed in order to collect financial information regarding the use of public obstetrics services in Greece. RESULTS The mean age of respondents was 29.5 (±5.6) years. There was a high rate of informal payments with 74.4% of women involved in informal transactions. Mean total private payments were €1549 (±992), representing 7.9% of the mean annual per capita income in Greece. Mean informal payment was €848 (±714). For 56.3% of the respondents, it was at the obstetrician's request, on top of formal payment of €701 (±1351). Total informal payments were higher for women who gave birth in Athens (p<0.001), for Greek women compared to non Greek (p<0.001) and for deliveries that were conducted by women's personal obstetrician (p=0.001). CONCLUSION There is a large black economy in the field of obstetric services, as 74.4% of women who used public maternity services had to pay under-the-table payments corresponding approximately to the net salary of an intern physician. There is a need for the state to adopt innovative strategies and mechanisms in order to reduce informal payments for obstetric services in the public sector.
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Affiliation(s)
- Daphne Ch Kaitelidou
- Center for Health Services Management and Evaluation, University of Athens, Greece.
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Colais P, Fantini MP, Fusco D, Carretta E, Stivanello E, Lenzi J, Pieri G, Perucci CA. Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables. BMC Pregnancy Childbirth 2012; 12:54. [PMID: 22720844 PMCID: PMC3570355 DOI: 10.1186/1471-2393-12-54] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/23/2012] [Indexed: 11/17/2022] Open
Abstract
Background Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson’s Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. Methods The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V–X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. Results The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson’s classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). Conclusions The TGCS classification is useful for inter-hospital comparison of CS section rates, but residual confounding is present in the TGCS strata.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Regional Health Service, Lazio Region, Italy.
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Patah LEM, Malik AM. Modelos de assistência ao parto e taxa de cesárea em diferentes países. Rev Saude Publica 2011; 45:185-94. [DOI: 10.1590/s0034-89102011000100021] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 08/23/2010] [Indexed: 11/21/2022] Open
Abstract
Revisão bibliográfica que descreve as taxas de cesárea em diferentes países e os modelos de atenção ao parto de acordo com o uso de tecnologias assistenciais. Foram analisados 60 estudos publicados entre 1999 e 2010, obtidos nas bases de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e ProQuest. O modelo de assistência obstétrica praticado no país baseia-se na relação médico-paciente, ao grau de utilização de tecnologias e à realização do parto cesáreo.
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Kealy MA, Small RE, Liamputtong P. Recovery after caesarean birth: a qualitative study of women's accounts in Victoria, Australia. BMC Pregnancy Childbirth 2010; 10:47. [PMID: 20718966 PMCID: PMC2939528 DOI: 10.1186/1471-2393-10-47] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 08/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The caesarean section rate is increasing globally, especially in high income countries. The reasons for this continue to create wide debate. There is good epidemiological evidence on the maternal morbidity associated with caesarean section. Few studies have used women's personal accounts of their experiences of recovery after caesarean. The aim of this paper is to describe women's accounts of recovery after caesarean birth, from shortly after hospital discharge to between five months and seven years after surgery. METHOD Women who had at least one caesarean birth in a tertiary hospital in Victoria, Australia, participated in an interview study. Women were selected to ensure diversity in experiences (type of caesarean, recency), caesarean and vaginal birth, and maternal request caesarean section. Interviews were audiotaped and transcribed verbatim. A theoretical framework was developed (three Zones of clinical practice) and thematic analysis informed the findings. RESULTS Thirty-two women were interviewed who between them had 68 births; seven women had experienced both caesarean and vaginal births. Three zones of clinical practice were identified in women's descriptions of the reasons for their first caesareans. Twelve women described how, at the time of their first caesarean section, the operation was performed for potentially life-saving reasons (Central Zone), 11 described situations of clinical uncertainty (Grey Zone), and nine stated they actively sought surgical intervention (Peripheral Zone).Thirty of the 32 women described difficulties following the postoperative advice they received prior to hospital discharge and their physical recovery after caesarean was hindered by a range of health issues, including pain and reduced mobility, abdominal wound problems, infection, vaginal bleeding and urinary incontinence. These problems were experienced across the three zones of clinical practice, regardless of the reasons women gave for their caesarean. CONCLUSION The women in this study reported a range of unanticipated and unwanted negative physical health outcomes following caesarean birth. This qualitative study adds to the existing epidemiological evidence of significant maternal morbidity after caesarean section and underlines the need for caesarean section to be reserved for circumstances where the benefit is known to outweigh the harms.
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Affiliation(s)
- Michelle A Kealy
- Mother and Child Health Research, La Trobe University, Bundoora, Australia
| | - Rhonda E Small
- Mother and Child Health Research, La Trobe University, Bundoora, Australia
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Cardoso PO, Alberti LR, Petroianu A. Morbidade neonatal e maternas relacionada ao tipo de parto. CIENCIA & SAUDE COLETIVA 2010; 15:427-35. [DOI: 10.1590/s1413-81232010000200019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 07/04/2008] [Indexed: 11/22/2022] Open
Abstract
Foi realizada uma análise da morbidade neonatal e materna e a mortalidade neonatal de acordo com o tipo de parto, cesariana ou vaginal. Foram estudadas prospectivamente 170 parturientes sem complicações gestacionais e com nascimento a termo: Grupo 1 (n = 95), puérpera com parto por via vaginal, Grupo 2 (n = 75), puérpera submetida à cesariana. Parâmetros maternos e fetais foram avaliados. Foi observada maior incidência de partos por via vaginal nas pacientes que estudaram até o ensino fundamental incompleto (p = 0,0045). Houve prevalência maior de partos prévios por via vaginal no Grupo 1 e de cesáreas no Grupo 2 (p < 0,001). Observou preferência de 78 (82,1%) das mulheres do Grupo 1 pelo parto vaginal contra apenas 28 (37,3%) das mulheres do Grupo 2, pela cesárea (p = 0,0002). Houve dor intensa no pós-operatório nas pacientes submetidas a parto cesáreo (oito casos) (p = 0,018). Traumas obstétricos foram verificados em catorze recém-nascidos do Grupo 1 e em sete do Grupo 2 (p = 0,28). Concluímos que existe maior morbidade neonatal em recém-natos de parto por via vaginal quando comparada com neonatos de cesárea e maior morbidade materna em puérperas com parto cesariana.
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Abstract
BACKGROUND The current rate of cesarean delivery in the United States is 31 percent. Previous studies have suggested that exercise during pregnancy may be associated with a lower risk of cesarean delivery, but sample sizes were small and methods often inadequate. This study examined whether or not an association exists between prenatal exercise and delivery mode using data from the 2004 and 2005 North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) survey. METHODS PRAMS postpartum questionnaire responses about frequency of exercise during the last 3 months of pregnancy for 1,955 women without a prior cesarean delivery were linked to birth certificates. RESULTS Among 1,342 women delivering at term, exercise was not associated with delivery mode in this data set: compared with women exercising less than once a week, neither women exercising one to four times per week nor those exercising five times or more per week had an altered risk of cesarean (risk ratio [RR] [95% confidence limit] [CL] 0.89 [0.69-1.15], 1.04 [0.66-1.64], respectively, adjusted for parity, gestational age, hypertension). Among 613 women delivering preterm, the results were also not statistically significant, but a compelling trend toward a protective effect could be seen (RR [95% CL] 0.65 [0.38-1.13], 0.62 [0.29-1.33]). CONCLUSIONS Maternal self-reported frequency of exercise during pregnancy was not associated with a reduced risk of cesarean delivery. Larger studies with better exposure ascertainment may provide a more definitive answer.
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Affiliation(s)
- Marit L. Bovbjerg
- Pre-doctoral Fellow in the Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Anna Maria Siega-Riz
- Associate Professor and Associate Chair, Department of Epidemiology and Associate Professor, Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Chou YA, Chou YJ, Lee CH, Huang N. Pregnancy outcomes among native and foreign-born women in Taiwan: maternal health utilization. J Womens Health (Larchmt) 2009; 17:1505-12. [PMID: 18954239 DOI: 10.1089/jwh.2007.0714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As immigrant populations increase rapidly around the world and with most immigrant women being of childbearing age, their use of pregnancy-related healthcare has become an important health issue. However, there has been only limited research available on maternal health use by foreign immigrants in Asia. This study aims to compare inpatient use for pregnancy complications and type of delivery among foreign and native-born women of different socioeconomic status in Taiwan. METHODS Using the 2001 National Health Insurance (NHI) database, 232,828 deliveries were identified, of which 222,852 were to native-born mothers and 9,976 were to foreign-born mothers. Univariate and multivariate logistic regression models were used to determine the likelihood of using inpatient services for any pregnancy complication and for cesarean section. RESULTS Our results indicate that after adjusting for other factors, foreign-born women were less likely than native-born women to use inpatient services for complicated pregnancies across all socioeconomic status (SES) levels. On the other hand, a pattern emerged among the higher SES groups showing a similar likelihood of cesarean section when foreign-born and native-born mothers were compared. This was not the case for the lower SES groups, however, where native-born mothers were significantly more likely to undergo a cesarean section than foreign-born mothers. CONCLUSIONS Foreign-born mothers tended to use fewer inpatient services for complicated pregnancies than native-born mothers and were less likely to undergo cesarean section. As immigrants increase across the world as a result of globalization and with half of them being female, pregnancy-related health service use among this group needs our attention.
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Affiliation(s)
- Yun-An Chou
- Institute of Public Health, School of Medicine, School of Medicine, National Yang Ming University, Taiwan, ROC
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Chen CS, Lin HC, Liu TC, Lin SY, Pfeiffer S. Urbanization and the likelihood of a cesarean section. Eur J Obstet Gynecol Reprod Biol 2008; 141:104-10. [PMID: 18722701 DOI: 10.1016/j.ejogrb.2008.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/30/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. STUDY DESIGN The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. RESULTS There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI=0.85-0.98, p=0.014), 0.84 (95% CI=0.78-0.91, p<0.001), 0.83 (95% CI=0.68-0.88, p<0.001), 0.79 (95% CI=0.72-0.86, p<0.001), and 0.70 (95% CI=0.62-0.80, p<0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. CONCLUSIONS We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.
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Lin HC, Xirasagar S, Liu TC. Doctors' obstetric experience and Caesarean section (CS): does increasing delivery volume result in lower CS likelihood? J Eval Clin Pract 2007; 13:954-7. [PMID: 18070269 DOI: 10.1111/j.1365-2753.2006.00763.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
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Abstract
The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.
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Hollard AL, Wing DA, Chung JH, Rumney PJ, Saul L, Nageotte MP, Lagrew D. Ethnic disparity in the success of vaginal birth after cesarean delivery. J Matern Fetal Neonatal Med 2007; 19:483-7. [PMID: 16966113 DOI: 10.1080/14767050600847809] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). STUDY DESIGN A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g. RESULTS Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27-0.50) for African American women and 0.63 (95% CI 0.51-0.79) for Hispanic women. CONCLUSION African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.
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Affiliation(s)
- Amie L Hollard
- Division of Maternal-Fetal Medicine, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA, USA
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Yam EA, Grossman AA, Goldman LA, García SG. Introducing birth plans in Mexico: an exploratory study in a hospital serving low-income Mexicans. Birth 2007; 34:42-8. [PMID: 17324177 DOI: 10.1111/j.1523-536x.2006.00124.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased medicalization of childbirth in Mexico has not always translated into more satisfactory childbirth experiences for women. In developed countries, pregnant women often prepare written birth plans, outlining how they would like their childbirth experiences to proceed. The notion of expressing childbirth desires with a birth plan is novel in the developing world. We conducted an exploratory study to assess the feasibility and acceptability of introducing birth plans in a hospital serving low-socioeconomic status Mexicans and to document women's and health practitioners' perspectives on the advantages and barriers in implementing a birth plan program. METHODS We invited 9 pregnant women to prepare birth plans during their antenatal care visits. The women also participated in interviews before and after childbirth. We also conducted in-depth interviews with 4 women who had given birth in the past year, and with 2 nurses, 2 social workers, and 1 physician to learn about their perspectives on the benefits and challenges of implementing a birth plan program. RESULTS All 9 women who completed a birth plan found the experience highly satisfying, despite the fact that in some cases, their childbirths did not proceed as they had specified in their plans. Interviewed practitioners believed that birth plans could improve the childbirth experience for women and health care practitioners, but facilities often lacked space and financial incentives for birth plan programs. CONCLUSIONS Our findings suggest that birth plans are acceptable and feasible in this study population. Facility administrators would need to commit to provide the physical space and financial incentives necessary to ensure successful implementation.
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Affiliation(s)
- Eileen A Yam
- Population Council's Mexico Country Office, Mexico City, Mexico
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Fantini MP, Stivanello E, Frammartino B, Barone AP, Fusco D, Dallolio L, Cacciari P, Perucci CA. Risk adjustment for inter-hospital comparison of primary cesarean section rates: need, validity and parsimony. BMC Health Serv Res 2006; 6:100. [PMID: 16911770 PMCID: PMC1590020 DOI: 10.1186/1472-6963-6-100] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 08/15/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cesarean section rates is often used as an indicator of quality of care in maternity hospitals. The assumption is that lower rates reflect in developed countries more appropriate clinical practice and general better performances. Hospitals are thus often ranked on the basis of caesarean section rates. The aim of this study is to assess whether the adjustment for clinical and sociodemographic variables of the mother and the fetus is necessary for inter-hospital comparisons of cesarean section (c-section) rates and to assess whether a risk adjustment model based on a limited number of variables could be identified and used. METHODS Discharge abstracts of labouring women without prior cesarean were linked with abstracts of newborns discharged from 29 hospitals of the Emilia-Romagna Region (Italy) from 2003 to 2004. Adjusted ORs of cesarean by hospital were estimated by using two logistic regression models: 1) a full model including the potential confounders selected by a backward procedure; 2) a parsimonious model including only actual confounders identified by the "change-in-estimate" procedure. Hospital rankings, based on ORs were examined. RESULTS 24 risk factors for c-section were included in the full model and 7 (marital status, maternal age, infant weight, fetopelvic disproportion, eclampsia or pre-eclampsia, placenta previa/abruptio placentae, malposition/malpresentation) in the parsimonious model. Hospital ranking using the adjusted ORs from both models was different from that obtained using the crude ORs. The correlation between the rankings of the two models was 0.92. The crude ORs were smaller than ORs adjusted by both models, with the parsimonious ones producing more precise estimates. CONCLUSION Risk adjustment is necessary to compare hospital c-section rates, it shows differences in rankings and highlights inappropriateness of some hospitals. By adjusting for only actual confounders valid and more precise estimates could be obtained.
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Affiliation(s)
- Maria P Fantini
- Department of Medicine and Public Health, University of Bologna, Bologna, Italy
| | - Elisa Stivanello
- Department of Medicine and Public Health, University of Bologna, Bologna, Italy
| | | | - Anna P Barone
- Department of Epidemiology, Local Health Authority RM E, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Local Health Authority RM E, Rome, Italy
| | - Laura Dallolio
- Department of Medicine and Public Health, University of Bologna, Bologna, Italy
| | - Paolo Cacciari
- Azienda Ospedaliera S. Orsola – Malpighi, University Hospital, Bologna, Italy
| | - Carlo A Perucci
- Department of Epidemiology, Local Health Authority RM E, Rome, Italy
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Lin HC, Xirasagar S, Tung YC. Impact of a cultural belief about ghost month on delivery mode in Taiwan. J Epidemiol Community Health 2006; 60:522-6. [PMID: 16698984 PMCID: PMC2563930 DOI: 10.1136/jech.2005.041475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many Chinese believe the lunar month of July, "ghost month" is inauspicious for major surgical procedures. This study hypothesised that caesaren delivery (CS) rates will be significantly lower during lunar July, and higher than normal during June, representing preemptive caesaren delivery to avoid delivering in July. METHODS Population based data from Taiwan on all singleton deliveries during 1997-2003 (1 750 862 cases) were subjected to multivariate autoregressive integrated moving average (ARIMA) modelling, adjusting for major obstetric complications (previous CS, breech presentation, dystocia, and fetal distress). RESULTS ARIMA intervention models showed significantly lower CS rates in lunar July, and among younger age groups (p<0.001), but not among 35 plus aged mothers. Incidence of previous CS, is significantly higher among June deliveries, while the incidence of the remaining major complications is similar in July, June, and other months. Patients with clinically less salient obstetric complications show significantly lower CS rates in July. CONCLUSIONS Adjusted CS rates during the ghost month are significantly lower than other months. Lunar June shows an increase in deliveries of previous CS mothers (almost all by CS), suggesting elective CS to preempt CS in July. A major policy implication is that health education must be launched to dissipate the cultural belief about the ghost month. Evidence also implies some proportion of clinically un-indicated CS in other months, showing the need for professional and policy initiatives to reduce unnecessary CS. Policy makers and researchers in other countries should be alert to cultural beliefs associated with delivery to enable informed delivery choices by mothers.
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Affiliation(s)
- Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
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Queiroz MVO, Jacobina e Silva NS, Jorge MSB, Moreira TMM. [Incidence and features of cesarean section and natural childbirth: study in a city from Ceara's countryside]. Rev Bras Enferm 2006; 58:687-91. [PMID: 16689502 DOI: 10.1590/s0034-71672005000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The research aimed to describe the features of a given population studied, as civil state, occupation and number of pre-natal appointments; to verify the incidence of cesarean section and normal labor in clients attended in an institution; to compare these occurrence in the period of research, discussing the indications of cesarean sections more frequently referred. It is a descriptive-retrospective study based upon patient records from a philanthropic institution of the National Health System. It highlighted a rising percentage of cesarean sections with high incidence in teenagers. It evidenced that the main indications of cesarean section were due to former cesarean section and pregnancy specific hypertensive disease. It was recorded predominance of pregnants with 4 to 7 pre-natal appointments. Changes in pre-natal care can impact in cesarean section rate, preparing the mother to natural labor, something that can be closely related to midwives obstetrical nurses and physicians capacitation, as well as the placement of group care instead individual care.
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Chung JH, Garite TJ, Kirk AM, Hollard AL, Wing DA, Lagrew DC. Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery. Am J Obstet Gynecol 2006; 194:1323-8. [PMID: 16647917 DOI: 10.1016/j.ajog.2005.11.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 11/03/2005] [Accepted: 11/28/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver. STUDY DESIGN A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor. The contribution of hospital and physician level cluster correlation was evaluated using fixed and random effects regression models. RESULTS Compared with white patients, black and Hispanic patients were 75% and 22% more likely to undergo primary cesarean delivery. Further adjustment for hospital and physician level cluster correlation resulted in persistently increased risks of primary cesarean delivery in black (54%) and Hispanic patients (12%). CONCLUSION Hospital site of delivery and individual physician practices do not fully explain racial differences in the risk of primary cesarean delivery.
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Affiliation(s)
- Judith H Chung
- Department of Obstetrics and Gynecology, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA.
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Freitas PF, Drachler MDL, Leite JCDC, Grassi PR. Desigualdade social nas taxas de cesariana em primíparas no Rio Grande do Sul. Rev Saude Publica 2005; 39:761-7. [PMID: 16254652 DOI: 10.1590/s0034-89102005000500010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Investigar o efeito das desigualdades sociais nas taxas de cesariana em primíparas, com gravidez única e parto hospitalar. MÉTODOS: Estudo realizado no Estado do Rio Grande do Sul em 1996, 1998 e 2000. Foram utilizados dados do Sistema de Informação de Nascidos Vivos no cálculo das taxas anuais e das razões de chance de cesariana (RC) brutas e ajustadas para condições sociais (escolaridade e idade maternas, etnia/cor da pele e macro-regional de saúde), duração da gestação e número de consultas pré-natal. RESULTADOS: A taxa de cesarianas foi de 45%, e acima de 37% para todas as macro-regionais. As taxas aumentaram entre: mulheres de etnia indígena e negra, mulheres com mais de 30 anos, residentes nas macro-regiões Metropolitana, Vales e Serra, e com mais de seis consultas no pré-natal. Razões brutas e ajustadas indicaram taxas negativamente associadas para todas as categorias de etnia/cor, quando comparadas à cor branca da pele do recém-nascido, em especial para etnia indígena (RCaj=0,43; IC 95%: 0,31-0,59), positivamente associadas à escolaridade (RCaj=3,52; IC 95%: 3,11-3,99) e idade maternas mais elevadas (RCaj=6,87; IC 95%: 5,90-8,00), e maior número de consultas pré-natal (RCaj=2,16; IC 95%: 1,99-2,35). Os efeitos de idade e escolaridade mostraram estar parcialmente mediados pelo maior número de consultas pré-natal nas mulheres com idade e escolaridade mais elevadas. As taxas variaram entre as macro-regionais, sendo maiores na região da Serra, economicamente mais rica. CONCLUSÕES: Altas taxas de cesariana no sul do Brasil constituem problema de saúde pública e estão associadas a fatores sociais, econômicos e culturais, os quais podem levar ao mau-uso da tecnologia médica na atenção ao parto.
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Affiliation(s)
- Paulo Fontoura Freitas
- Programa de Pós Graduação em Saúde Pública, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
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Abstract
BACKGROUND Maternal posture is commonly recommended to promote cephalic version of breech presentation during pregnancy, but the few studies conducted to examine the efficacy of this obstetric practice are inconclusive. The purpose of this systematic review was to evaluate the research evidence base for postural management of breech presentation. METHODS This review critically examined the research on maternal posture for breech presentation using guidelines from the third United States Preventive Services Task Force. Database searches were conducted of Ovid Medline, Cumulative Index of Nursing and Allied Health Literature, PubMed, and Cochrane Database of Systematic Reviews, using the keywords "pregnancy," "maternal posture," "maternal position," "postural management," "breech," "presentation." Hand searches were conducted on reference citations from databases, and all research articles, commentaries, and reports of clinical cases were included. RESULTS Conceptual and methodological issues in the individual studies posed threats to internal validity in each study. Interpretation of the nonsignificant results in the research reports is debatable because the randomized controlled trials were underpowered, and flaws in each study challenged validity of the results. Meta-analysis of previous findings may be inappropriate. CONCLUSIONS Further research based on explicit theory and improved methods, including sufficient sample size, is needed to determine whether maternal posture promotes cephalic version for pregnant women with breech presentation.
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Affiliation(s)
- Sandra A Founds
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Mossialos E, Allin S, Karras K, Davaki K. An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience. Eur J Public Health 2005; 15:288-95. [PMID: 15923214 DOI: 10.1093/eurpub/cki002] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates have been increasing dramatically in the past decades around the world. The objective of our study was to investigate the factors increasing the likelihood of undergoing CS in two public hospitals and one private hospital in Athens, Greece. Specifically, the purpose was primarily to assess the impact of non-medical factors such as private health insurance, potential for making informal payments, physician convenience and socio-economic status on the rate of CS deliveries. METHODS All available demographic, socio-economic and medical information from the medical records of all deliveries in the three hospitals in January 2002 were analysed. The relative importance of the variables in predicting delivery with CS rather than normal vaginal delivery was calculated in multiple logistic regression models to generate odds ratios (OR). RESULTS The CS rate in the public hospitals was 41.6% (52.5% for Greeks and 26% for immigrants), while the CS rate in the private hospital was 53% (65.2% for women with private insurance and 23.9% for women who paid directly). In the public hospitals, after controlling for demographic and medical factors, Greek ethnic background, delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, and on Monday, Wednesday and Friday were found to increase the likelihood of CS delivery. In the private hospital, having private health insurance is the strongest predictor of CS delivery, followed by delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, delivery on a Saturday and being a housewife. CONCLUSION The results of this study lend support to the hypothesis that physicians are motivated to perform CS for financial and convenience incentives. The recent commercialization of gynaecology services in Greece is discussed, along with its implications on physicians' decisions to perform CS.
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Affiliation(s)
- E Mossialos
- LSE Health and Social Care, Cowdray House, London School of Economics and Political Science, London, UK.
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Cnattingius R, Höglund B, Kieler H. Emergency cesarean delivery in induction of labor: an evaluation of risk factors. Acta Obstet Gynecol Scand 2005; 84:456-62. [PMID: 15842210 DOI: 10.1111/j.0001-6349.2005.00620.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Induction of labor has been associated with an increased risk of emergency cesarean delivery. Knowledge of factors that influence the risk of cesarean delivery in women with induced labor is limited. METHODS We performed a case-control study, nested within a population-based cohort of women with induced labor at term during 1991-1996 in Uppsala County, Sweden. Cases were women delivered with emergency cesarean delivery, and controls were women vaginally delivered (n = 193, respectively). Using logistic regression, analyses were performed. Odds ratio (OR) with 95% confidence intervals (CI) was used as a measure of relative risk. RESULTS Women with a previous cesarean delivery had high risks of cesarean delivery (adjusted OR = 10.10, 95% CI = 3.30-30.92). The risk of cesarean delivery was also increased among nulliparous (adjusted OR = 4.92, 95% CI = 2.81-8.61), short (adjusted OR = 2.20, 95% CI = 1.06-4.59), and obese women (adjusted OR = 2.03, 95% CI = 1.07-3.84). A cervix dilatation less than 1.5 cm doubled the risk of cesarean delivery (adjusted OR = 2.26, 95% CI = 1.09-4.66). Mother's age, epidural analgesia, oxytocin augmentation, gestational age, and birthweight were not significantly associated with risks of cesarean delivery. CONCLUSIONS Women with a previous cesarean delivery, nulliparous, short, and obese women with induced labor are at high risk of a cesarean delivery. When there is a need to deliver a woman with a previous cesarean section or a nulliparous woman with other risk factors for cesarean delivery, it may be prudent to consider an elective cesarean section.
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Affiliation(s)
- Ragnhild Cnattingius
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
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Lin HC, Xirasagar S. Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study. Am J Obstet Gynecol 2005; 192:848-55. [PMID: 15746681 DOI: 10.1016/j.ajog.2004.09.133] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine associations between maternal age and maternal request cesarean deliveries. STUDY DESIGN Five-year population-based data from Taiwan (1997-2001) that covered 904,657 singleton deliveries without a clinical indication for cesarean delivery that were judged by the attending physician were subjected to multiple logistic regression, year-wise, to examine the association of maternal age with request cesarean delivery, adjusted for health care institutional characteristics. RESULTS Request cesarean delivery rates steadily increased over the study period within each age group, disproportionately so among the 34+ age group. Women aged < 25 years were less likely than women aged 25 to 34 years (reference group) to request a cesarean delivery (odds ratio range, 0.67-0.88) and women aged 34+ were more likely than the reference group to have a request cesarean delivery (odds ratio range, 1.96-2.01), adjusted for health care institutional characteristics. CONCLUSION Population-based data confirms the expectancy that request cesarean delivery propensity increases with maternal age.
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Affiliation(s)
- Herng-Ching Lin
- Taipei Medical University, School of Health Care Administration, Taipei, Taiwan.
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Grant D. Explaining Source of Payment Differences in U.S. Cesarean Rates: Why do Privately Insured Mothers Receive More Cesareans than Mothers Who are not Privately Insured? Health Care Manag Sci 2005; 8:5-17. [PMID: 15782508 DOI: 10.1007/s10729-005-5212-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The difference in the risk-adjusted cesarean rates of mothers who are and who are not privately insured is divided into components attributable to the following four factors: the practice style of the physician attending the birth, the closeness of the physician-mother relationship, individual nonclinical factors, and the direct influence of private insurance on the physician's treatment decision. Estimates from two expansive, complementary data sets indicate that the most of the differential is attributable to the first two factors, particularly the pairing of privately insured mothers with physicians who are inclined to perform cesareans. There is some evidence that these pairings are not incidental but the result of firm (and possibly consumer) choices.
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Affiliation(s)
- Darren Grant
- Department of Economics, University of Texas, Arlington, Box 19479, Arlington, TX 76019, USA.
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Grisaru S, Samueloff A. Primary nonmedically indicated cesarean section ("section on request"): evidence based or modern vogue? Clin Perinatol 2004; 31:409-30, vii. [PMID: 15325529 DOI: 10.1016/j.clp.2004.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cesarean section, initially described as an emergency operative procedure for delivering moribund parturients, is now advocated by many as a routine technique with major advantages over vagi-nal delivery. In fact, it has been suggested that labor and vaginal delivery are no longer the desired consequence of pregnancy, a conclusion that reflects perceived medical advantages and patient and physician convenience. This article systematically reviews the various medical implications to the mother and infant of this procedure in the hope of facilitating a more rational approach to this spreading and controversial phenomenon.
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Affiliation(s)
- Sorina Grisaru
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, PO Box 76100, Jerusalem 91031, Israel.
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Khawaja M, Kabakian-Khasholian T, Jurdi R. Determinants of caesarean section in Egypt: evidence from the demographic and health survey. Health Policy 2004; 69:273-81. [PMID: 15276307 DOI: 10.1016/j.healthpol.2004.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Indexed: 11/26/2022]
Abstract
This paper examines the impact of near birth complications and socio-demographic, healthcare and spatial characteristics of caesarean section in Egypt, using data on 4032 births from the 2000 Egypt Demographic and Health Survey. The hospital caesarean section rate was 22% in Egypt. Fever/vaginal discharge around delivery, birth weight, mother's age and education, birth order, residence and antenatal visits were important determinants of caesarean section. Variations by place of delivery were evident, although complications were more significant determinants of caesarean section in public settings and demographic characteristics were more important in private facilities. Unexpectedly, long labour and bleeding around delivery were not associated with caesarean section, particularly, in private hospitals. In view of the high and rising caesarean section rate in Egypt, monitoring the quality of maternity services in Egypt is imperative. An investigation of the forces sustaining the differential in determinants by place of delivery is needed.
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Affiliation(s)
- Marwan Khawaja
- Department of Health Behavior and Education, American University of Beirut, Beirut, Lebanon.
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