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Goueslard K, Jollant F, Cottenet J, Bechraoui-Quantin S, Rozenberg P, Simon E, Quantin C. Author reply. BJOG 2024; 131:118-120. [PMID: 37712741 DOI: 10.1111/1471-0528.17660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Université Bourgogne Franche-Comté, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry, Paris-Saclay University and Academic Hospital (CHU) Bicêtre, Le Kremlin-Bicêtre, France
- Department of Psychiatry, Nîmes Academic Hospital (CHU), Nîmes, France
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- MOODS Research Team, CESP, Inserm, Le Kremlin-Bicêtre, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Université Bourgogne Franche-Comté, Dijon, France
| | - Sonia Bechraoui-Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Université Bourgogne Franche-Comté, Dijon, France
- Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Poissy, Université Versailles Saint-Quentin, Poissy, France
| | - Emmanuel Simon
- Gynecology, Obstetrics and Fetal Medicine, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Université Bourgogne Franche-Comté, Dijon, France
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
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Loiseau M, Cottenet J, François-Purssell I, Bechraoui-Quantin S, Jud A, Gilard-Pioc S, Quantin C. Hospitalization for physical child abuse: Associated medical factors and medical history since birth. CHILD ABUSE & NEGLECT 2023; 146:106482. [PMID: 37776729 DOI: 10.1016/j.chiabu.2023.106482] [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: 04/04/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population. OBJECTIVE To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France. PARTICIPANTS AND SETTING We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS). METHODS To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability). RESULTS Over the 2009-2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8-2.7]), male sex (aHR = 1.3[1.2-1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4-2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5-4.7]) with being hospitalized for physical abuse. CONCLUSION These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason.
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Affiliation(s)
- Mélanie Loiseau
- Forensic Medicine Unit, University Hospital, Dijon, France; Inserm, UMR 1231, Lipides Nutrition Cancer, CHU Dijon Bourgogne, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
| | | | - Sonia Bechraoui-Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Gynecology, Obstetrics, and Fetal Medicine, University Hospital, Dijon, France
| | - Andreas Jud
- Child and Adolescent Psychiatry/Psychotherapy, University Hospital, Ulm, Germany, School of Social Work, Lucerne University of Applied Sciences and Arts, Switzerland; Zurich University of Applied Sciences, School of Social Work, Zurich, Switzerland
| | - Séverine Gilard-Pioc
- Forensic Medicine Unit, University Hospital, Dijon, France; Cabinet d'Expertises Médicales, Belgium
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Inserm, CIC 1432, Dijon, France; Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics 22 for Drug Safety and Genomics, CESP, Villejuif, France; Dijon University Hospital, Clinical Investigation Center, 20 Clinical Epidemiology/Clinical Trials Unit, Dijon, France.
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Martin T, McIntyre S, Waight E, Baynam G, Watson L, Langdon K, Woolfenden S, Smithers‐Sheedy H, Sherwood J. Prevalence and trends for Aboriginal and Torres Strait Islander children living with cerebral palsy: A birds-eye view. Dev Med Child Neurol 2023; 65:1475-1485. [PMID: 37147854 PMCID: PMC10952932 DOI: 10.1111/dmcn.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/07/2023]
Abstract
AIM To provide a birds-eye view of the trends of cerebral palsy (CP) for Australian Aboriginal and Torres Strait Islander children and young adults. METHOD Data were obtained for this population-based observational study from the Australian Cerebral Palsy Register (ACPR), birth years 1995 to 2014. The Indigenous status of children was classified by maternal Aboriginal and Torres Strait Islander or non-Indigenous status. Descriptive statistics were calculated for socio-demographic and clinical characteristics. Prenatal/perinatal and post-neonatal birth prevalence was calculated per 1000 live births and per 10 000 live births respectively, and Poisson regression used to assess trends. RESULTS Data from the ACPR were available for 514 Aboriginal and Torres Strait Islander individuals with CP. Most children could walk independently (56%) and lived in urban or regional areas (72%). One in five children lived in socioeconomically disadvantaged remote/very remote areas. The birth prevalence of prenatal/perinatal CP declined after the mid-2000s from a high of 4.8 (95% confidence interval 3.2-7.0) to 1.9 per 1000 live births (95% confidence interval 1.1-3.2) (2013-2014), with marked declines observed for term births and teenage mothers. INTERPRETATION The birth prevalence of CP in Aboriginal and Torres Strait Islander children in Australia declined between the mid-2000s and 2013 to 2014. This birds-eye view provides key stakeholders with new knowledge to advocate for sustainable funding for accessible, culturally safe, antenatal and CP services. WHAT THIS PAPER ADDS Birth prevalence of cerebral palsy (CP) is beginning to decline for Aboriginal and Torres Strait Islanders. Recent CP birth prevalence for Aboriginal and Torres Strait Islanders is 1.9 per 1000 live births. Most children with CP live in more populated areas rather than remote or very remote areas. One in five Aboriginal and Torres Strait Islander children with CP live in socioeconomically disadvantaged remote areas.
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Affiliation(s)
- Tanya Martin
- School of Nursing and MidwiferyThe University of SydneyCamperdownNew South WalesAustralia
| | - Sarah McIntyre
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Emma Waight
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Gareth Baynam
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | - Linda Watson
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Susan Woolfenden
- Discipline of Paediatrics, School of Clinical MedicineUNSW SydneySydneyNew South WalesAustralia
- Sydney Institute of Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Hayley Smithers‐Sheedy
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Juanita Sherwood
- Jumbunna Institute for Indigenous Education and ResearchUniversity of Technology SydneySydneyNew South WalesAustralia
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Saito Y, Asakura T, Takashi K, Umazume T, Watari H, Tamakoshi A. Relationship between out-of-facility deliveries and distance and travel time to delivery facilities in Hokkaido, Japan: An ecological study. J Obstet Gynaecol Res 2023; 49:930-937. [PMID: 36604952 DOI: 10.1111/jog.15543] [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: 09/19/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023]
Abstract
AIM This study aimed to investigate the relationship between the distance and travel time from each municipality to the nearest delivery facilities in the other municipalities and the frequency of out-of-facility deliveries in Hokkaido. METHODS Vital statistics from 2016 to 2020 were used. For municipalities without delivery facilities, the distance and travel time from the town office of each municipality to the nearest delivery facility was measured using Google maps. Negative binomial regression with an offset term was used to calculate the relative risks (RRs) and 95% confidence intervals (CIs) of out-of-facility delivery for distance (<30, 30-59, ≥60 km), and travel time by car (<30, 30-59, and ≥60 min) from the town office to the nearest delivery facility compared with the presence of delivery facilities. RESULTS The overall rate of out-of-facility deliveries in Hokkaido was 2.1‰; in municipalities with delivery facilities, 1.8‰, and in municipalities without delivery facilities, 3.1‰. The adjusted RRs (95% CIs) for out-of-facility deliveries were significantly higher in municipalities with less than 30 km and travel time of less than 30 min to delivery facilities, 2.63 (1.34-5.17) and 2.76 (1.36-5.58), respectively, compared to municipalities with delivery facilities. However, the adjusted RR of out-of-facility delivery for municipalities ≥30 km was higher, although the difference was not significant. CONCLUSIONS Even in municipalities with a distance to delivery facilities of less than 30 km or travel time of less than 30 min, we should keep in mind the occurrence of out-of-facility deliveries.
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Affiliation(s)
- Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshiaki Asakura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kimura Takashi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Jakobsen MH, Udjus E, Røseth I, Dahl B. Midwives' experiences with accompaniment service work in Norway: A qualitative study. Eur J Midwifery 2023; 7:5. [PMID: 36844193 PMCID: PMC9951232 DOI: 10.18332/ejm/160074] [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: 10/20/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/28/2023] Open
Abstract
INTRODUCTION The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. METHODS This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. RESULTS The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. CONCLUSIONS The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.
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Affiliation(s)
- Marita H. Jakobsen
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Elise Udjus
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Idun Røseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway,Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
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Debost-Legrand A, Legrand G, Duclos-Médard J, Thomazet J, Pranal M, Langlois E, Mourgues C, Vendittelli F. Opti'care protocol: a randomised control trial to evaluate the impact of a mobile antenatal care clinic in isolated rural areas on prenatal follow-up. BMJ Open 2023; 13:e060337. [PMID: 36797021 PMCID: PMC9936278 DOI: 10.1136/bmjopen-2021-060337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Rural residence appears to be a factor of vulnerability among pregnant women with poor clinical antenatal care. Our principal objective is to assess the impact of an infrastructure for a mobile antenatal care clinic on the completion of antenatal care for women identified as geographically vulnerable in a perinatal network. METHODS AND ANALYSIS Controlled cluster-randomised study in two parallel arms comparing an intervention group with an open-label control group. This study will concern the population of pregnant women who must live in one of the municipalities covered by the perinatal network and considered to be an area of geographic vulnerability. The cluster randomisation will take place according to the municipality of residence. The intervention will be the implementation of pregnancy monitoring by a mobile antenatal care clinic. The completion of antenatal care between the intervention and control groups will be a binary criterion: 1 will be attributed to each antenatal care that includes all visits and supplementary examinations. Sample size has been estimated to be 330 at least with an 80% participation rate.The univariate analyses will compare the follow-up rates (with Fisher's exact test), and all individual characteristics collected (Fisher's exact test, Student's t-test) between the two groups. The multivariate analysis will use a mixed linear model analysis and consider the cluster effect as random; the initial model will include known confounders from the literature, confounders identified in univariate analyses, and the clinically relevant prognostic factors. All of these factors will be taken into account in the model as a fixed effect. ETHICS AND DISSEMINATION The Patient Protection Committee North-West II approved this study on 4 February 2021 (IRB 2020-A02247-32). The results will be the subject of scientific communications and publications. TRIAL REGISTRATION NUMBER NCT04823104.
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Affiliation(s)
- Anne Debost-Legrand
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Legrand
- Centre Hospitalier Sainte Marie de Clermont-Ferrand, Association Hospitalière Sainte-Marie, Chamalieres, France
| | - Julie Duclos-Médard
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Juliette Thomazet
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marine Pranal
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Eric Langlois
- UMR Territoires, AgroparisTech, INRA, Irstea, VetAgro Sup, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - Charline Mourgues
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Françoise Vendittelli
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Association of Driving Distance to Maternity Hospitals and Maternal and Perinatal Outcomes. Obstet Gynecol 2022; 140:812-819. [DOI: 10.1097/aog.0000000000004960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
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Simon E, Gouyon JB, Cottenet J, Bechraoui-Quantin S, Rozenberg P, Mariet AS, Quantin C. Impact of SARS-CoV-2 infection on risk of prematurity, birthweight and obstetric complications: A multivariate analysis from a nationwide, population-based retrospective cohort study. BJOG 2022; 129:1084-1094. [PMID: 35253329 PMCID: PMC9111136 DOI: 10.1111/1471-0528.17135] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/11/2022]
Abstract
Objective To determine the impact of maternal coronavirus disease 2019 (COVID‐19) on prematurity, birthweight and obstetric complications. Design Nationwide, population‐based retrospective cohort study. Setting National Programme de Médicalisation des Systèmes d'Information database in France. Population All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID‐19 in the mother and/or the newborn. Methods The group with COVID‐19 was compared with the group without COVID‐19 using the chi‐square test or Fisher's exact test, and the Student's t test or Mann–Whitney U test. Logistic regressions were used to study the effect of COVID‐19 on the risk of prematurity or macrosomia (birthweight ≥4500 g). Main outcome measures Prematurity less than 37, less than 28, 28–31, or 32–36 weeks of gestation; birthweight; obstetric complications. Results In singleton pregnancies, COVID‐19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p < 0.01), pre‐eclampsia (3.6% versus 2.0%, p < 0.01), diabetes (18.8% versus 14.4%, p < 0.01) and caesarean delivery (26.8% versus 19.7%, p < 0.01). Among pregnant women with COVID‐19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p < 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p < 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small‐for‐gestational‐age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55–2.01) for COVID‐19. For macrosomia, COVID‐19 resulted in non‐significant aOR of 1.38 (95% CI 0.95–2.00). Conclusions COVID‐19 is a risk factor for prematurity, even after adjustment for other risk factors. Tweetable Abstract The risk of prematurity is twice as high in women with COVID‐19 after adjustment for factors usually associated with prematurity. The risk of prematurity is twice as high in women with COVID‐19 after adjustment for factors usually associated with prematurity.
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Affiliation(s)
- Emmanuel Simon
- Gynaecology, Obstetrics, and Fetal Medicine, University Hospital, Dijon, France
| | - Jean-Bernard Gouyon
- Centre d'Etudes Périnatales Océan Indien (EA 7388), Centre Hospitalier Universitaire Sud Réunion, La Réunion, Saint Pierre, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
| | | | - Patrick Rozenberg
- Department of Obstetrics and Gynaecology, Hôpital Intercommunal de Poissy, Université Versailles Saint-Quentin, Poissy, France
| | - Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France.,High-Dimensional Biostatistics for Drug Safety and Genomics, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, CESP, Villejuif, France
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Javaudin F, Zayat N, Bagou G, Mitha A, Chapoutot AG. Prise en charge périnatale du nouveau-né lors d’une naissance en milieu extrahospitalier. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les accouchements inopinés extrahospitaliers représentent environ 0,3 % des accouchements en France. La prise en charge du nouveau-né en préhospitalier par une équipe Smur fait partie de l’activité courante. L’évaluation initiale du nouveau-né comprend systématiquement la mesure de sa fréquence cardiaque (FC) et respiratoire (FR), l’appréciation de son tonus ainsi que la mesure de sa température axillaire. En cas de doute ou de transition incomplète un monitoring cardiorespiratoire sera immédiatement mis en place (FC, FR, SpO2). Nous faisons ici une mise au point sur les données connues et avons adapté les pratiques, si besoin, au contexte extrahospitalier, car la majeure partie des données rapportées dans la littérature concernent les prises en charge en maternité ou en milieu hospitalier. Nous abordons les points essentiels de la prise en charge des nouveau-nés, à savoir la réanimation cardiopulmonaire, le clampage tardif du cordon ombilical, la lutte contre l’hypothermie et l’hypoglycémie; ainsi que des situations particulières comme la prématurité, la conduite à tenir en cas de liquide méconial ou de certaines malformations congénitales. Nous proposons aussi quels peuvent être : le matériel nécessaire à la prise en charge des nouveau-nés en extrahospitalier, les critères d’engagement d’un renfort pédiatrique à la régulation ainsi que les méthodes de ventilation et d’abord vasculaire que l’urgentiste doit maîtriser. L’objectif de cette mise au point est de proposer des prises en charge les plus adaptées au contexte préhospitalier.
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Daniali ZM, Sepehri MM, Sobhani FM, Heidarzadeh M. A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran. J Prev Med Public Health 2022; 55:49-59. [PMID: 35135048 PMCID: PMC8841192 DOI: 10.3961/jpmph.21.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/31/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. Methods First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. Results It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. Conclusions This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.
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Affiliation(s)
- Zahra Mohammadi Daniali
- Department of Industrial Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Mehdi Sepehri
- Department of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
- Corresponding author: Mohammad Mehdi Sepehri Department of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Jalal Al-e-Ahmad Highway, Tehran 1411713116, Iran E-mail:
| | - Farzad Movahedi Sobhani
- Department of Industrial Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Quantin C, Yamdjieu Ngadeu C, Cottenet J, Escolano S, Bechraoui‐Quantin S, Rozenberg P, Tubert‐Bitter P, Gouyon J. Early exposure of pregnant women to non-steroidal anti-inflammatory drugs delivered outside hospitals and preterm birth risk: nationwide cohort study. BJOG 2021; 128:1575-1584. [PMID: 33590634 PMCID: PMC8451913 DOI: 10.1111/1471-0528.16670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the risk of preterm birth associated with nonsteroidal anti-inflammatory drugs (NSAIDs), focusing on early exposure in the period from conception to 22 weeks of gestation (WG). DESIGN National population-based retrospective cohort study. SETTING The French National Health Insurance Database that includes hospital discharge data and health claims data. POPULATION Singleton pregnancies (2012-2014) with a live birth occurring after 22WG from women between 15 and 45 years old and insured the year before the first day of gestation and during pregnancy were included. We excluded pregnancies for which anti-inflammatory medications were dispensed after 22WG. METHODS The association between exposure and risk of preterm birth was evaluated with GEE models, adjusting on a large number of covariables, socio-demographic variables, maternal comorbidities, prescription drugs and pregnancy complications. MAIN OUTCOME MEASURES Prematurity, defined as a birth that occurred before 37WG. RESULTS Among our 1 598 330 singleton pregnancies, early exposure to non-selective NSAIDs was associated with a significantly increased risk of preterm birth, regardless of the severity of prematurity: adjusted odds ratio (aOR) = 1.76 (95% CI 1.54-2.00) for extreme prematurity (95% CI 22-27WG), 1.28 (95% CI 1.17-1.40) for moderate prematurity (28-31WG) and 1.08 (95% CI 1.05-1.11) for late prematurity (32-36WG), with non-overlapping confidence intervals. We identified five NSAIDs for which the risk of premature birth was significantly increased: ketoprofen, flurbiprofen, nabumetone, etodolac and indomethacin: for the latter, aOR = 1.92 (95% CI 1.37-2.70) with aOR = 9.33 (95% CI 3.75-23.22) for extreme prematurity. CONCLUSION Overall, non-selective NSAID use (delivered outside hospitals) during the first 22WG was found to be associated with an increased risk of prematurity. However, the association differs among NSAIDs. TWEETABLE ABSTRACT French study for which early exposure to non-selective NSAIDs was associated with increased risk of prematurity.
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Affiliation(s)
- C Quantin
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
- InsermCIC 1432DijonFrance
- Clinical Investigation CentreClinical Epidemiology/Clinical Trials UnitDijon University HospitalDijonFrance
| | - C Yamdjieu Ngadeu
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - J Cottenet
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - S Escolano
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - S Bechraoui‐Quantin
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - P Rozenberg
- Department of Obstetrics and GynaecologyPoissy‐Saint Germain HospitalPoissyFrance
- Paris Saclay University, UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESPMontigny‐le‐BretonneuxFrance
| | - P Tubert‐Bitter
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - J‐B Gouyon
- Centre d’Etudes Périnatales Océan Indien (EA 7388)Centre Hospitalier Universitaire Sud RéunionLa RéunionSaint PierreFrance
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12
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Örtqvist AK, Haas J, Ahlberg M, Norman M, Stephansson O. Association between travel time to delivery unit and unplanned out-of-hospital birth, infant morbidity and mortality: A population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:1478-1489. [PMID: 33779982 DOI: 10.1111/aogs.14156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Over the last decade, a number of delivery units have been closed in Sweden, justified by both economic incentives and patient safety issues. However, concentrating births to larger delivery units naturally increases travel time for some parturient women, which may lead to unintended negative consequences. We aimed to investigate the association between travel time to delivery unit and unplanned out-of-hospital birth, and subsequent infant morbidity and mortality. MATERIAL AND METHODS We performed a population-based cohort study including 365 604 women in the Swedish Pregnancy Register, giving birth between 2014 and 2017. Modified Poisson regression was used to investigate the association between travel time from home address to actual delivery unit, based on geographic information system analysis, and risk of an unplanned out-of-hospital birth. Analyses were stratified by parity and urban/rural residence. Lastly, the associations between an unplanned out-of-hospital birth and severe infant morbidity, stillbirth, peripartum, perinatal and neonatal mortality were investigated. RESULTS Of those with an unplanned out-of-hospital birth (n = 2159), 65% had a travel time up to 30 minutes. A travel time between 31 and 60 minutes was associated with a doubled risk of unplanned out-of-hospital birth (adjusted risk ratio [RR] 1.96, 95% confidence interval [CI] 1.74-2.22) and women with a travel time of more than 1 hour had an adjusted RR of 3.19 (95% CI 2.64-3.86), compared with those with a travel time of <30 minutes. No difference in results was seen when stratified for parity and urban/rural residence. No association was found between unplanned out-of-hospital birth and severe infant morbidity. Significant associations were found in crude analyses for stillbirth (RR 1.85, 95% CI 1.09-3.13), peripartum (RR 1.93, 95% CI 1.18-3.16), perinatal (RR 2.03, 95% CI 1.28-3.23) and neonatal mortality (RR 3.08, 95% CI 1.27-7.46), although neonatal mortality was very rare (2.3/1000 out-of-hospital births). Similar effect estimates were found in the adjusted analyses, though no longer significant. CONCLUSIONS Although the majority of unplanned out-of-hospital births occurred in the group of women with a travel time of 0-30 minutes, increasing travel time to a delivery unit is associated with unplanned out-of-hospital birth, which may increase the risk of mortality.
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Affiliation(s)
- Anne K Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
| | - Jan Haas
- Department of Environmental and Life Sciences, Faculty of Health, Science and Technology, Geomatics, Karlstad University, Karlstad, Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
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13
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Ovaskainen K, Ojala R, Gissler M, Luukkaala T, Tammela O. Is birth out-of-hospital associated with mortality and morbidity by seven years of age? PLoS One 2021; 16:e0250163. [PMID: 33882082 PMCID: PMC8059817 DOI: 10.1371/journal.pone.0250163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background and aims Compared to in-hospital births, the long-term outcome of children born out-of-hospital, planned or unplanned, is poorly studied. This study aimed to examine mortality and morbidity by seven years of age in children born out-of-hospital compared to those born in-hospital. Methods This study was registered retrospectively and included 790 136 children born in Finland between 1996 and 2013. The study population was divided into three groups according to birth site: in-hospital (n = 788 622), planned out-of-hospital (n = 176), and unplanned out-of-hospital (n = 1338). Data regarding deaths, hospital visits, reimbursement of medical expenses, and disability allowances was collected up to seven years of age or by the year-end of 2018. The association between birth site and childhood morbidity was determined using multivariable-adjusted Cox hazard regression analysis. Results No deaths were reported during the first seven years after birth in the children born out-of-hospital. The percentage of children with hospital visits due to infection by seven years of age was lower in those born planned out-of-hospital and in the combined planned out-of-hospital and unplanned out-of-hospital group compared to those born in-hospital. Furthermore, the percentage of children with hospital visits and who received disability allowances due to neurological or mental disorders was higher among those born unplanned out-of-hospital and out-of-hospital in total when compared to those born in-hospital. In the multivariable-adjusted Cox proportional hazard regression analysis, the hazard ratio for hospital visits due to asthma and/or allergic diseases (HR 0.84; 95% CI 0.72–0.98) was lower in children born out-of-hospital when compared to those born in-hospital. A similar decreased risk was found due to infections (HR 0.76; 95% CI 0.68–0.84). However, the risk for neurological or mental health disorders was similar between the children born in-hospital and out-of-hospital. Conclusions Morbidity related to asthma or allergic diseases and infections by seven years of age appeared to be lower in children born out-of-hospital. Birth out-of-hospital seemed to not be associated with increased risk for neurological morbidity nor early childhood mortality. Our study groups were small and heterogeneous and because of this the results need to be interpreted with caution.
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Affiliation(s)
- Katja Ovaskainen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- School of Medicine Doctoral Programme, University of Tampere, Tampere, Finland
- * E-mail:
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet, Stockholm, Sweden
| | - Tiina Luukkaala
- Tampere University Hospital, Research, Development and Innovation Center, Tampere, Finland
- Tampere University, Faculty of Social Sciences, Health Sciences, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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14
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Girault A, Blondel B, Goffinet F, Le Ray C. Contemporary duration of spontaneous labor and association with maternal characteristics: A French national population-based study. Birth 2021; 48:86-95. [PMID: 33274503 DOI: 10.1111/birt.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective of this study was to describe labor duration of women managed with current obstetric practices in a French national population-based cohort and to assess the association of age and BMI on this duration. METHODS All women in the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. Duration of labor was defined as time between admission to the labor ward and birth. Duration of total labor and first and second stage of labor were described. Then, duration of labor was estimated according to maternal age and BMI, using Kaplan-Meier's method and compared with the log-rank test after stratification on parity. Intrapartum cesarean birth was considered as a censoring event. Multivariable modeling was performed using Cox's proportional hazard's method. RESULTS Data of 3120 nulliparous and 4385 multiparous women were analyzed. Median labor duration was 6.1 hours ([5th; 95th percentile]) [1.4; 12.6] and 3.1 hours [0.3; 8.5] in nulliparous and multiparous women. Multivariable Cox analysis showed no independent association of maternal age and duration of labor. Nulliparous obese women had significantly lower odds of having a shorter labor than women with a BMI < 25 kg/m2 , HR: 0.75; 95% CI [0.64-0.88], but BMI was not associated with labor duration in multiparous women. CONCLUSIONS Our study provides important information for both women and care practitioners on what to expect when entering the labor ward. There appears to be little association between maternal characteristics and labor duration, with the exception of BMI in nulliparous women.
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Affiliation(s)
- Aude Girault
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
| | - Béatrice Blondel
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
| | - Camille Le Ray
- INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, FHU PREMA, Université de Paris, Paris, France.,Department of Obstetrics, Cochin Port Royal Hospital, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Port Royal, Port Royal Maternity, Université de Paris, Paris, France
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15
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Girault A, Blondel B, Goffinet F, Le Ray C. Frequency and determinants of misuse of augmentation of labor in France: A population-based study. PLoS One 2021; 16:e0246729. [PMID: 33561131 PMCID: PMC7872232 DOI: 10.1371/journal.pone.0246729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction While use of augmentation of labor (AL) is appropriate for labor dystocia, it is frequently used inadequately and unnecessarily. The objective was to assess at a national level, the frequency and determinants of misuse of augmentation of labor (AL). Material and methods Women of the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. “Misuse of AL” was defined by artificial rupture of the membranes (ROM) and/or oxytocin within one hour of admission and/or duration between ROM and oxytocin of less than one hour. Women, labor and maternity unit’s characteristics were compared between the “misuse of AL” and “no misuse of AL” groups by bivariate analysis. To identify the determinants of misuse of AL, a multivariable multilevel logistic regression was performed taking into account the data’s hierarchical structure (first level: women, second level: maternity units). Results Among the 7196 women included, 1524 (21.2%) had a misuse of AL. The determinants of misuse of AL were middle school educational level (reference high school), aOR = 1.21; 95%CI[1.01–1.45], gestational age at delivery ≥41weeks (reference 39–40 weeks), aOR = 1.19; 95%CI[1.00–1.42], cervical dilation ≥6cm at admission (reference <3cm), aOR = 1.39; 95%CI[1.10–1.76], epidural analgesia aOR = 1.63; 95%CI[1.35–1.96], delivery in a private hospital (reference public teaching hospital), aOR = 2.25; 95%CI[1.57–3.23]; and maternity units with <1000 deliveries/year and 1000–1999 deliveries/year (reference ≥3000 deliveries/year), respectively aOR = 1.52; 95%CI[1.11–2.08] and aOR = 1.42; 95%CI[1.05–1.92]. Less than 3% of the variance was explained by women characteristics, and 24.17% by the maternity units’ characteristics. Conclusions In France, one spontaneous laboring woman among five is subject to misuse of AL. The misuse is mostly explained by maternity unit’s characteristics. The determinants identified in this study can be used to implement targeted actions in small and private maternity units.
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Affiliation(s)
- Aude Girault
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- * E-mail:
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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16
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Malouf RS, Tomlinson C, Henderson J, Opondo C, Brocklehurst P, Alderdice F, Phalguni A, Dretzke J. Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review. BMJ Open 2020; 10:e036852. [PMID: 33318106 PMCID: PMC7735086 DOI: 10.1136/bmjopen-2020-036852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To systematically review (1) The effect of obstetric unit (OU) closures on maternal and neonatal outcomes and (2) The association between travel distance/time to an OU and maternal and neonatal outcomes. DESIGN Systematic review of any quantitative studies with a comparison group. DATA SOURCES Embase, MEDLINE, PsycINFO, Applied Social Science Index and Abstracts, Cumulative Index to Nursing and Allied Health and grey literature were searched. METHODS Eligible studies explored the impact of closure of an OU or the effect of travel distance/time on prespecified maternal or neonatal outcomes. Only studies of women giving birth in high-income countries with universal health coverage of maternity services comparable to the UK were included. Identification of studies, extraction of data and risk of bias assessment were undertaken by at least two reviewers independently. The risk of bias checklist was based on the Cochrane Effective Practice and Organisation of Care criteria and the Newcastle-Ottawa scale. Heterogeneity across studies precluded meta-analysis and synthesis was narrative, with key findings tabulated. RESULTS 31 studies met the inclusion criteria. There was some evidence to suggest an increase in babies born before arrival following OU closures and/or associated with longer travel distances or time. This may be associated with an increased risk of perinatal or neonatal mortality, but this finding was not consistent across studies. Evidence on other maternal and neonatal outcomes was limited but did not suggest worse outcomes after closures or with longer travel times/distances. Interpretation of findings for some studies was hampered by concerns around how accurately exposures were measured, and/or a lack of adjustment for confounders or temporal changes. CONCLUSION It is not possible to conclude from this review whether OU closure, increased travel distances or times are associated with worse outcomes for the mother or the baby. PROSPERO REGISTRATION NUMBER CRD42017078503.
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Affiliation(s)
- Reem Saleem Malouf
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Claire Tomlinson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Henderson
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Charles Opondo
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Angaja Phalguni
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Janine Dretzke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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17
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Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffler M, Sagot P, Quantin C. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep 2020; 10:20208. [PMID: 33214621 PMCID: PMC7677317 DOI: 10.1038/s41598-020-70881-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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Affiliation(s)
- Christophe Clesse
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, Old Anatomy Building Charterhouse Square, London, EC1M 6BQ, UK.,Interpsy Laboratory (EA 4432), Universite de Lorraine - Campus Lettres Et Sciences Humaines, Nancy, France.,Majorelle Polyclinic, Nancy, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | | | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | - Michele Scheffler
- Obstetricial Gynecologist, Endocrinologist, Gynecologist, The FNCGM (National Federation of Gynecology Medical Colleges), Cabinet de Gynécologie Médicale Et Obstétrique, 21 avenue Foch, 54000, Nancy, France
| | - Paul Sagot
- Department of Obstetrics and Gynecology, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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18
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Ovaskainen K, Ojala R, Tihtonen K, Gissler M, Luukkaala T, Tammela O. Unplanned out-of-hospital deliveries in Finland: A national register study on incidence, characteristics and maternal and infant outcomes. Acta Obstet Gynecol Scand 2020; 99:1691-1699. [PMID: 32609879 DOI: 10.1111/aogs.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland. MATERIAL AND METHODS We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected. RESULTS The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500 g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality. CONCLUSIONS The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.
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Affiliation(s)
- Katja Ovaskainen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,School of Medicine Doctoral Program, University of Tampere, Tampere, Finland
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institutet, Stockholm, Sweden
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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19
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Allen M, Villeneuve E, Pitt M, Thornton S. How can consultant-led childbirth care at time of delivery be maximised? A modelling study. BMJ Open 2020; 10:e034830. [PMID: 32641323 PMCID: PMC7348651 DOI: 10.1136/bmjopen-2019-034830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Royal College of Obstetricians and Gynaecologists has advised that consolidation of birth centres, where reasonable, into birth centres of at least 6000 admissions per year should allow constant consultant presence. Currently, only 17% of mothers attend such birth centres. The objective of this work was to examine the feasibility of consolidation of birth centres, from the perspectives of birth centre size and travel times for mothers. DESIGN Computer-based optimisation. SETTING Hospital-based births. POPULATION OR SAMPLE 1.91 million admissions in 2014-2016. METHODS A multiple-objective genetic algorithm. MAIN OUTCOME MEASURES Travel time for mothers and size of birth centres. RESULTS Currently, with 161 birth centres, 17% of women attend a birth centre with at least 6000 admissions per year. We estimate that 95% of women have a travel time of 30 min or less. An example scenario, with 100 birth centres, could provide 75% of care in birth centres with at least 6000 admissions per year, with 95% of women travelling 35 min or less to their closest birth centre. Planning at local level leads to reduced ability to meet admission and travel time targets. CONCLUSIONS While it seems unrealistic to have all births in birth centres with at least 6000 admissions per year, it appears realistic to increase the percentage of mothers attending this type of birth centre from 17% to about 75% while maintaining reasonable travel times. Planning at a local level leads to suboptimal solutions.
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Affiliation(s)
- Michael Allen
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Emma Villeneuve
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Martin Pitt
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Women's experiences of unplanned pre-hospital births: A pilot study. Int Emerg Nurs 2020; 51:100868. [PMID: 32444164 DOI: 10.1016/j.ienj.2020.100868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Prehospital births are fairly rare in Sweden but occasionally occur in the ambulance care system. The ambulance nurse's experience of prehospital births has previously been studied, but there is a lack of research that depicts the woman's perspective of a prehospital birth. AIM To describe women's experiences of unplanned prehospital births. METHOD A qualitative questionnaire consisting of six open-ended questions that encouraged participants to describe their prehospital-birth experience. Eight women answered the survey and nine birth stories were included. A qualitative content analysis with an inductive approach was used as an analysis method. RESULTS The analysis of the texts resulted in four main categories. The main categories were an unpredictable event, the woman's suffering, her perceived gratitude and the importance of the ambulance nurse now and in the future. The main category of women's suffering resulted in two subcategories: physical stresses and psychological and emotional suffering. CONCLUSION The women are not prepared to give birth to a child outside the hospital, and the course of events happen quickly. A prehospital birth is described as a tumultuous event for women. The ambulance nurse has a central role in the care outside the hospital. The advice women suggest to ambulance nurses are remaining calm and safe no matter what the situation looks like, listening to the mother and meeting the woman's wishes. Proposals for further research are to investigate the importance of further education in childbirth care for ambulance nurses and how that affects the care of women and their family.
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Combier E, Roussot A, Chabernaud JL, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS One 2020; 15:e0228785. [PMID: 32092074 PMCID: PMC7039464 DOI: 10.1371/journal.pone.0228785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions. Results The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]). Discussion In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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Affiliation(s)
- Evelyne Combier
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Jean-Louis Chabernaud
- Neonatal and Pediatric Emergency Transport Team and NICU, Antoine-Beclere Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Patrick Rozenberg
- Versailles Saint-Quentin University, Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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Association of Oxytocin Use and Artificial Rupture of Membranes With Cesarean Delivery in France. Obstet Gynecol 2020; 135:436-443. [DOI: 10.1097/aog.0000000000003618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mújica-Mota RE, Landa P, Pitt M, Allen M, Spencer A. The heterogeneous causal effects of neonatal care: a model of endogenous demand for multiple treatment options based on geographical access to care. HEALTH ECONOMICS 2020; 29:46-60. [PMID: 31746059 DOI: 10.1002/hec.3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
Neonatal units in the UK are organised into three levels, from highest Neonatal Intensive Care Unit (NICU), to Local Neonatal Unit (LNU) to lowest Special Care Unit (SCU). We model the endogenous treatment selection of neonatal care unit of birth to estimate the average and marginal treatment effects of different neonatal designations on infant mortality, length of stay and hospital costs. We use prognostic factors, survival and hospital care use data on all preterm births in England for 2014-2015, supplemented by national reimbursement tariffs and instrumental variables of travel time from a geographic information system. The data were consistent with a model of demand for preterm birth care driven by physical access. In-hospital mortality of infants born before 32 weeks was 8.5% overall, and 1.2 (95% CI: -0.7, 3.2) percentage points lower for live births in hospitals with NICU or SCU compared to those with an LNU according to instrumental variable estimates. We find imprecise differences in average total hospital costs by unit designation, with positive unobserved selection of those with higher unexplained absolute and incremental costs into NICU. Our results suggest a limited scope for improvement in infant mortality by increasing in-utero transfers based on unit designation alone.
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Affiliation(s)
- Rubén E Mújica-Mota
- University of Leeds Medical School, Leeds Institute of Health Sciences, Leeds, UK
| | - Paolo Landa
- Department of Economics, University of Genoa, Genoa, Italy
| | - Martin Pitt
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
| | - Mike Allen
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
| | - Anne Spencer
- University of Exeter Medical School, Institute of Health Research, Exeter, UK
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Blotière PO, Raguideau F, Weill A, Elefant E, Perthus I, Goulet V, Rouget F, Zureik M, Coste J, Dray-Spira R. Risks of 23 specific malformations associated with prenatal exposure to 10 antiepileptic drugs. Neurology 2019; 93:e167-e180. [PMID: 31189695 DOI: 10.1212/wnl.0000000000007696] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the association between exposure to monotherapy with 10 different antiepileptic drugs (AEDs) during the first 2 months of pregnancy and the risk of 23 major congenital malformations (MCMs). METHODS This nationwide cohort study, based on the French health care databases, included all pregnancies ≥20 weeks and ending between January 2011 and March 2015. Women were considered to be exposed when an AED had been dispensed between 1 month before and 2 months after the beginning of pregnancy. The reference group included pregnant women with no reimbursement for AEDs. MCMs were detected up to 12 months after birth (24 months for microcephaly, hypospadias, and epispadias). Odds ratios (ORs) were adjusted for potential confounders for MCMs with at least 5 cases. Otherwise, we calculated crude ORs with exact confidence intervals (CIs). RESULTS The cohort included 1,886,825 pregnancies, 2,997 of which were exposed to lamotrigine, 1,671 to pregabalin, 980 to clonazepam, 913 to valproic acid, 579 to levetiracetam, 517 to topiramate, 512 to carbamazepine, 365 to gabapentin, 139 to oxcarbazepine, and 80 to phenobarbital. Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6-43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4-20.0). We identified 3 other signals. We found no significant association for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin. CONCLUSIONS These results confirm the teratogenicity of valproic acid and topiramate. Because of the small numbers of cases and possible confounding, the other 3 signals should be interpreted with appropriate caution.
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Affiliation(s)
- Pierre-Olivier Blotière
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France.
| | - Fanny Raguideau
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Alain Weill
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Elisabeth Elefant
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Isabelle Perthus
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Véronique Goulet
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Florence Rouget
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Mahmoud Zureik
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Joël Coste
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Rosemary Dray-Spira
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
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Pilkington H, Prunet C, Blondel B, Charreire H, Combier E, Le Vaillant M, Amat-Roze JM, Zeitlin J. Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France. Matern Child Health J 2018; 22:101-110. [PMID: 28780684 DOI: 10.1007/s10995-017-2359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.
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Affiliation(s)
- Hugo Pilkington
- Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, 93526, Saint-Denis, France.
| | - Caroline Prunet
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Béatrice Blondel
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Hélène Charreire
- Université Paris-Est, LabUrba, Ecole d'urbanisme de Paris, Créteil, France
| | - Evelyne Combier
- Centre d'épidémiologie des populations (CEP), University of Burgundy, EA4184 CHU, Hôpital du Bocage, Dijon, France
| | - Marc Le Vaillant
- Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211, Villejuif Cedex, France
| | | | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Persson AC, Engström Å, Burström O, Juuso P. Specialist ambulance nurses' experiences of births before arrival. Int Emerg Nurs 2018; 43:45-49. [PMID: 30190223 DOI: 10.1016/j.ienj.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/11/2018] [Accepted: 08/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. AIM This study describes the experiences of specialist ambulance nurses with BBA. METHOD A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis. FINDINGS The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education. CONCLUSION Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.
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Affiliation(s)
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Oskar Burström
- Resource Unit in Ambulance Care, Jämtland/Härjedalen, Sweden
| | - Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Abstract
OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P<.01). Among women who delivered vaginally, the use of arterial embolization was also significantly lower in the pilot than the control network (0.2/1,000 vs 3.7/1,000, P<.01) as it was for those who delivered by cesarean (1.3/1,000 vs 5.7/1,000, P<.01). After controlling for potential confounding factors, the risk of an invasive procedure among women who delivered vaginally remained significantly lower in the pilot network (adjusted odds ratio [OR] 0.14, 95% CI 0.08-0.27), but not for women who delivered by cesarean (adjusted OR 1.19, 95% CI 0.87-1.61). CONCLUSION The use of intrauterine balloon tamponade in routine clinical practice was associated with a significantly lower use of invasive procedures for hemorrhage control among women undergoing vaginal delivery.
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Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study. Am J Obstet Gynecol 2017; 217:210.e1-210.e12. [PMID: 28390672 DOI: 10.1016/j.ajog.2017.03.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/18/2017] [Accepted: 03/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. OBJECTIVE The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. STUDY DESIGN This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. RESULTS A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time <1 hour, 1-2 hours, and >2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. CONCLUSION Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have an important impact on perinatal health in high-income countries and also for low-risk births. The results show the importance of skilled birth attendance and warrant attention from clinicians and policy makers to negative consequences of reduced access to institutions.
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Walker JJ. Planned home birth. Best Pract Res Clin Obstet Gynaecol 2017; 43:76-86. [DOI: 10.1016/j.bpobgyn.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
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Gunnarsson B, Fasting S, Skogvoll E, Smárason AK, Salvesen KÅ. Why babies die in unplanned out-of-institution births: an enquiry into perinatal deaths in Norway 1999-2013. Acta Obstet Gynecol Scand 2017; 96:326-333. [PMID: 27886371 PMCID: PMC5347971 DOI: 10.1111/aogs.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/19/2016] [Indexed: 12/01/2022]
Abstract
Introduction The aims were to describe causes of death associated with unplanned out‐of‐institution births, and to study whether they could be prevented. Material and methods Retrospective population‐based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out‐of‐institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions. Results 63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub‐optimal care, involving 25 cases (40%), most commonly due to sub‐optimal maternal use of available care (n = 14, 22%). Conclusions Infections, neonatal, and placental causes accounted for almost two‐thirds of perinatal mortality associated with unplanned out‐of‐institution births in Norway. Sub‐optimal maternal use of available care was found in more than one‐fifth of cases.
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Affiliation(s)
- Björn Gunnarsson
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Fasting
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Alexander K Smárason
- Institute of Health Science Research, University of Akureyri, Akureyri, Iceland.,Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland
| | - Kjell Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
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Vik ES, Haukeland GT, Dahl B. Women's experiences with giving birth before arrival. Midwifery 2016; 42:10-15. [PMID: 27697614 DOI: 10.1016/j.midw.2016.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/08/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore women's experiences with giving birth before arrival. DESIGN A qualitative interview study. SETTING Individual semi structured interviews with women from Western Norway conducted in their homes in 2015. PARTICIPANTS 10 women who experienced BBA-births in 2014, or the beginning of 2015. Two primiparous and eight multiparous women participated in the study. KEY FINDINGS Three themes were generated from the analysis. In the encounter with the healthcare services, the women described midwives as gatekeepers defining active labour. Giving birth before arrival was dramatic, but at some point fear of giving birth alone was replaced by feelings of coping, and in hindsight they felt empowered. The women described giving birth before arrival to be a special experience, but this was not always acknowledged by the midwives. CONCLUSION AND IMPLICATIONS FOR PRACTICE The findings in this study question the cost-benefit of today's maternity care system pointing towards a more differentiated and decentralised care. To enhance patient safety adequate capacity of midwives in the maternity care is essential. Furthermore, good communication skills are key to improving practice and enhancing safety. Further research must be conducted.
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Affiliation(s)
- Eline Skirnisdottir Vik
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University College of Southeast Norway. Postboks 235, 3603 Kongsberg, Norway.
| | - Gunn Terese Haukeland
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University College of Southeast Norway. Postboks 235, 3603 Kongsberg, Norway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University College of Southeast Norway. Postboks 235, 3603 Kongsberg, Norway
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Padilla CM, Kihal-Talantikit W, Perez S, Deguen S. Use of geographic indicators of healthcare, environment and socioeconomic factors to characterize environmental health disparities. Environ Health 2016; 15:79. [PMID: 27449640 PMCID: PMC4957910 DOI: 10.1186/s12940-016-0163-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/30/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality. METHODS Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion. RESULTS Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality. CONCLUSION Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered in other cities or related to other birth outcomes.
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Affiliation(s)
- Cindy M. Padilla
- />Department of Quantitative Methods in Public Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
| | - Wahida Kihal-Talantikit
- />Department of Environmental and Occupational Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
- />INSERM U1085-IRSET – Research institute of environmental and occupational health, Rennes, France
| | - Sandra Perez
- />UMR ESPACE 7300, University of Nice Sophia, Nice, France
| | - Severine Deguen
- />Department of Environmental and Occupational Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
- />INSERM U1085-IRSET – Research institute of environmental and occupational health, Rennes, France
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Kragelj K, Prosen M. Izkušnje žensk ob nenačrtovanem porodu zunaj porodnišnice. OBZORNIK ZDRAVSTVENE NEGE 2016. [DOI: 10.14528/snr.2016.50.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Porodi zunaj porodnišnice so v Sloveniji redkost. Nekaj teh porodov se zgodi tudi v Zgornjem Posočju, ki je posebno zaradi svojega geografskega položaja in časovne oddaljenosti do najbližje porodnišnice. Cilj raziskave je bil pridobiti poglobljen vpogled v doživljajski svet porodnic, ki so nenačrtovan porod zunaj porodnišnice izkusile, in zaznati oceno kakovosti ponujene obporodne skrbi skozi občuteno zadovoljstvo.
Metode: Raziskava je temeljila na kvalitativni metodologiji. V namenski vzorec je bilo vključenih 10 porodnic, ki so rodile med letoma 2004 in 2014. Podatki so bili pridobljeni s pomočjo delno strukturiranih intervjujev v juniju 2014 in analizirani z metodo analize besedila.
Rezultati: Z metodo analize besedila je bilo identificiranih pet tem, in sicer (1) proces rojevanja – rituali, prakse in doživljanja, (2) podoživljanje poroda, (3) v žensko osredotočena skrb, (4) zaznana stopnja zadovoljstva z institucionalno obravnavo in (5) zaznavanje poroda med nosečnostjo – želje in pričakovanja.
Diskusija in zaključek: Ugotovitve nakazujejo, da so med porodom v ospredju ljudje, ki so ob porodnici, in njihov odnos do nje. Čeprav se porodnice takrat morda res ne zavedajo vseh morebitnih tveganj, se tega zavedajo zdravstveni delavci ob njej. Vključene v raziskavo so svojo porodno izkušnjo izkusile kot pozitivno in obenem izrazile zadovoljstvo do obporodne zdravstvene oskrbe. Nadaljnje raziskovanje bi moralo vključevati vidik zdravstvenih delavcev.
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Primary Maternity Units in rural and remote Australia: Results of a national survey. Midwifery 2016; 40:1-9. [PMID: 27428092 DOI: 10.1016/j.midw.2016.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary Maternity Units (PMUs) offer less expensive and potentially more sustainable maternity care, with comparable or better perinatal outcomes for normal pregnancy and birth than higherlevel units. However, little is known about how these maternity services operate in rural and remote Australia, in regards to location, models of care, service structure, support mechanisms or sustainability. This study aimed to confirm and describe how they operate. DESIGN a descriptive, cross-sectional study was undertaken, utilising a 35-item survey to explore current provision of maternity care in rural and remote PMUs across Australia. Data were subjected to simple descriptive statistics and thematic analysis for free text answers. SETTING AND PARTICIPANTS Only 17 PMUs were identified in rural and remote areas of Australia. All 17 completed the survey. RESULTS the PMUs were, on average, 56km or 49minutes from their referral service and provided care to an average of 59 birthing women per year. Periodic closures or downgrading of services was common. Low-risk eligibility criteria were universally used, but with some variability. Medically-led care was the most widely available model of care. In most PMUs midwives worked shift work involving both nursing and midwifery duties, with minimal uptake of recent midwifery workforce innovations. Perceived enablers of, and threats to, sustainability were reported. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE a small number of PMUs operate in rural Australia, and none in remote areas. Continuing overreliance on local medical support, and under-utilisation of the midwifery workforce constrain the restoration of maternity services to rural and remote Australia.
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Moudi Z, Tabatabaei SM. Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran. Public Health 2016; 135:114-21. [PMID: 27003671 DOI: 10.1016/j.puhe.2016.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 02/02/2016] [Accepted: 02/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran. STUDY DESIGN A quasi-experimental design was applied in this study. METHODS In this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011-2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited. RESULTS Based on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs. CONCLUSION In the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings.
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Affiliation(s)
- Z Moudi
- Pregnancy Health Research Center, Zahedan University of Medical Science, Zahedan, Iran; Midwifery Department, Nursing and Midwifery School, Mashahir Square, Zahedan, Iran.
| | - S M Tabatabaei
- Department of Statistic and Epidemiology, Zahedan University of Medical Science, Iran.
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Ovaskainen K, Ojala R, Gissler M, Luukkaala T, Tammela O. Out-of-hospital deliveries have risen involving greater neonatal morbidity: Risk factors in out-of-hospital deliveries in one University Hospital region in Finland. Acta Paediatr 2015; 104:1248-52. [PMID: 26174411 DOI: 10.1111/apa.13117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/07/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
AIM Most Finnish births take place in hospital, but out-of-hospital deliveries (OHDs) have increased. This study evaluated trends and reasons for OHDs in the Tampere University Hospital catchment area. METHODS The study cohort included all planned and unplanned OHDs in the Hospital area from 1996 to 2011; the control group comprised two hospital births for each OHD. Trends in incidence and risk factors for OHDs, including neonatal morbidities, were established and compared to the controls. RESULTS OHDs accounted for 67 (0.10%) of the 76 773 births in the area, the proportion remaining unchanged between 1996 and 2005, but then increasing. Risk factors associated with OHDs were smoking during pregnancy, short labour, higher number of previous births, single status, residence more than 35 kilometres from the delivery unit and fewer prenatal visits. OHD cases were more likely to be admitted to the neonatal care unit than controls and to be treated for suspected infections and hypothermia. CONCLUSION Smoking, short duration of labour, a higher number of previous births, single status and longer distances from the delivery unit were associated with OHDs. Eight (12%) mothers had OHDs without antenatal care, and their infants had more neonatal morbidities.
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Affiliation(s)
- Katja Ovaskainen
- School of Medicine Doctoral Programme; University of Tampere; Tampere Finland
- Department of Pediatrics; Kanta-Häme Central Hospital; Hämeenlinna Finland
| | - Riitta Ojala
- Department of Neonatology; Tampere University Hospital; Tampere Finland
| | - Mika Gissler
- National Institute for Health and Welfare; Helsinki Finland
- Nordic School of Public Health; Gothenburg Sweden
| | - Tiina Luukkaala
- Science Center; Pirkanmaa Hospital District; Tampere Finland
- School of Health Sciences; University of Tampere; Tampere Finland
| | - Outi Tammela
- Department of Neonatology; Tampere University Hospital; Tampere Finland
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Alabi AA, O'Mahony D, Wright G, Ntsaba MJ. Why are babies born before arrival at health facilities in King Sabata Dalindyebo Local Municipality, Eastern Cape, South Africa? A qualitative study. Afr J Prim Health Care Fam Med 2015; 7:881. [PMID: 26842514 PMCID: PMC4685658 DOI: 10.4102/phcfm.v7i1.881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 10/08/2015] [Accepted: 08/20/2015] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Babies born before arrival at a health facility have a higher risk of neonatal death and their mothers a higher risk of maternal death compared with those born in-facility. The study explored the reasons for mothers giving birth before arrival (BBA) at health facilities and their experiences of BBA. METHODS A qualitative research design was used. Individual and focus group interviews of BBA mothers and of nurses were undertaken at a community health centre and a district hospital in King Sabata Dalindyebo Local Municipality. RESULTS Reasons for BBA included a lack of transport, a lack of security at night that deterred mothers from travelling, precipitate labour, failure to identify true labour, and a lack of waiting areas at health facilities. Traditional and cultural beliefs favouring childbirth at homeand nurses' negative attitudes during antenatal care and labour influenced mothers to go to health facilities when in advanced labour. Mothers were aware of possible complications associated with BBA. CONCLUSION Socio-economic, individual, cultural and health system factors influence the occurrence of BBA. Relevant parties need to address these factors to ensure that all babies in the King Sabata Dalindyebo Local Municipality are delivered within designated health facilities.
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Affiliation(s)
| | - Don O'Mahony
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University.
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Kildea S, McGhie AC, Gao Y, Rumbold A, Rolfe M. Babies born before arrival to hospital and maternity unit closures in Queensland and Australia. Women Birth 2015; 28:236-45. [DOI: 10.1016/j.wombi.2015.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/12/2015] [Accepted: 03/14/2015] [Indexed: 11/17/2022]
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Pierron A, Revert M, Goueslard K, Vuagnat A, Cottenet J, Benzenine E, Fresson J, Quantin C. [Evaluation of the metrological quality of the medico-administrative data for perinatal indicators: A pilot study in 3 university hospitals]. Rev Epidemiol Sante Publique 2015; 63:237-46. [PMID: 26143088 DOI: 10.1016/j.respe.2015.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/10/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In order to assess public health policies for the perinatal period, routinely produced indicators are needed for the whole population. In France, these indicators are used to compare the national public health policy with those of other European countries. French administrative and medical data (PMSI) are straightforward and reliable and may be a valuable source of information for research. This study aimed to measure the quality of PMSI data from three university health centers for core indicators in perinatal health. METHOD PMSI data were compared with medical files in 2012 from 300 live births after 22 weeks of amenorrhea, drawn at random from University Hospitals in Dijon, Paris and Nancy. The variables were chosen based on the Europeristat Project's core and recommended indicators, as well as those of the French National Perinatal survey conducted in 2010. The information gathered blindly from the medical files was compared with the PMSI data positive predictive value (PPV) and the sensitivity was used to assess data quality. RESULTS Data on maternal age, parity and mode of delivery as well as the rates of premature births were superimposable for the two sources. The PPV for epidural injection was 96.2% and 94.3% for perineal tears. Overall, maternal morbidity was underdocumented in the PMSI, so the PPV was 100.0% for pre-existing diabetes, 88.9% for gestational diabetes and 100.0% for high blood pressure with a rate of 9.0% in PMSI and 6.3% in the medical files. The PPV for bleeding during labor was 89.5%. CONCLUSION To conclude, PMSI data are apparently becoming more and more reliable for two reasons: on one hand, the importance of these data for budgetary promotion in hospitals; on the other, the increasing use of this information for statistical and epidemiological purposes.
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Affiliation(s)
- A Pierron
- Service de biostatistique et d'informatique médicale (DIM), CHRU de Dijon, 21000 Dijon, France
| | - M Revert
- École de sages-femmes Saint-Antoine, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Unité de recherche EA7285, risques cliniques et sécurité en santé des femmes et en santé périnatale, université Versailles St-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
| | - K Goueslard
- École de sages-femmes, service de biostatistique et d'informatique médicale (DIM), CHRU de Dijon, 21000 Dijon, France
| | - A Vuagnat
- Ministère des Affaires sociales et de la Santé, direction de la recherche, des études, de l'évaluation et des statistiques, 14, avenue Duquesne, 75350 Paris, France
| | - J Cottenet
- Service de biostatistique et d'informatique médicale (DIM), CHRU de Dijon, 21000 Dijon, France
| | - E Benzenine
- Service de biostatistique et d'informatique médicale (DIM), CHRU de Dijon, 21000 Dijon, France
| | - J Fresson
- Département d'information médicale, maternité régionale, CHU de Nancy, 54000 Nancy, France
| | - C Quantin
- Service de biostatistique et d'informatique médicale (DIM), CHRU de Dijon, 21000 Dijon, France; Inserm, U866, université de Bourgogne, 21000 Dijon, France.
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Billon M, Bagou G, Gaucher L, Comte G, Balsan M, Rudigoz RC, Dupont C. [Unexpected out-of-hospital deliveries: Management and risk factors]. ACTA ACUST UNITED AC 2015; 45:285-90. [PMID: 25934383 DOI: 10.1016/j.jgyn.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/25/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate the frequency of accidental out-of-hospital deliveries (OHDs), to describe the home care and the complications occurred, and to identify risk factors. MATERIALS AND METHODS A retrospective case-control study from 1st January 2012 to 31 December 2012 in Lyon urban area. Cases were identified from the Emergency Medical Aid Service 69 (SAMU 69) registry and control from the birth registry of the maternity corresponding to the case, recruiting two controls per case. RESULTS The frequency of the OHDs was 0.3% [0.2-0.4]. At home, the prophylactic administration of oxytocin was performed in 18.3% [9.31-27.3] of cases and prevention of neonatal hypothermia was performed in 45.7% [34.1%-57.3%] of cases. Multiparity [OR: 3.43 (1.65-7.23)], a precarious situation [OR: 37.63 (5.02-7.81)], and lack of antenatal care [OR: 3.36 (2.72-4.15)] were OHDs' risk factors. CONCLUSION The practical prevention of postpartum hemorrhage, and that of the home neonatal hypothermia could be improved. Points of vigilance for the medical teams to look for during the pregnancy monitoring are precariousness and less than 3 consultations scheduled.
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Affiliation(s)
- M Billon
- Hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - G Bagou
- SAMU 69, 69437 Lyon cedex 03, France
| | - L Gaucher
- Hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - G Comte
- SAMU 69, 69437 Lyon cedex 03, France
| | - M Balsan
- Faculté de médecine et de maïeutique, Lyon Sud-Charles-Mérieux, 69921 Oullins, France
| | - R-C Rudigoz
- Réseau périnatal Aurore, laboratoire « santé, individu, société », faculté de médecine Laennec, université Lyon-Est, EA 4129, 69372 Lyon cedex 08, France
| | - C Dupont
- Réseau périnatal Aurore, laboratoire « santé, individu, société », faculté de médecine Laennec, université Lyon-Est, EA 4129, 69372 Lyon cedex 08, France.
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Quantin C, Cottenet J, Vuagnat A, Prunet C, Mouquet MC, Fresson J, Blondel B. Qualité des données périnatales issues du PMSI : comparaison avec l’état civil et l’enquête nationale périnatale 2010. ACTA ACUST UNITED AC 2014; 43:680-90. [DOI: 10.1016/j.jgyn.2013.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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Gunnarsson B, Smárason AK, Skogvoll E, Fasting S. Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study. Acta Obstet Gynecol Scand 2014; 93:1003-10. [PMID: 25182192 DOI: 10.1111/aogs.12450] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 06/25/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. DESIGN Register-based cross-sectional study. POPULATION All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. METHODS Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). RESULTS The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. CONCLUSIONS Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.
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Affiliation(s)
- Björn Gunnarsson
- Norwegian Air Ambulance Foundation, Drøbak, Norway; Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Concentration of gynaecology and obstetrics in Germany: is comprehensive access at stake? Health Policy 2014; 118:396-406. [PMID: 25201487 DOI: 10.1016/j.healthpol.2014.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 07/07/2014] [Accepted: 07/25/2014] [Indexed: 11/24/2022]
Abstract
Financial soundness will become more and more difficult in the future for all types of hospitals. This is particularly relevant for gynaecology and obstetrics departments: while some disciplines can expect higher demand due to demographic changes and progress in medicine and medical technology, the inpatient sector for gynaecology and obstetrics is likely to lose patients in line with these trends. In this paper we estimate future demand for gynaecology and obstetrics in Germany and develop a cost model to calculate the average profitability in this discipline. The number of inpatient cases in gynaecology and obstetrics can be expected to decrease by 3.62% between 2007 and 2020 due to the demographic change and a potential shift from inpatient to outpatient services. Small departments within the fields of gynaecology and obstetrics are already incurring heavy losses, and the anticipated decline in cases should increase this financial distress even more. As such, the further centralisation of services is indicated. We calculate travel times for gynaecology and obstetrics patients and estimate the anticipated changes in travel times by simulating different scenarios for this centralisation process. Our results show that the centralisation of hospital services in gynaecology and obstetrics may be possible without compromising comprehensive access as measured by travel times.
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Silva ZPD, Almeida MFD, Alencar GP. Parto acidental não-hospitalar como indicador de risco para a mortalidade infantil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivos: analisar diferenças na mortalidade infantil, segundo local do parto, no Estado de São Paulo (2009). Métodos: coorte de 252.201 nascidos vivos (NV) por parto vaginal, vinculados a 3289 óbitos infantis, por técnica determinística, divididos em: nascidos em hospitais (250.850) e em domicílio/outro local (1351). Foram calculadas probabilidades de morte e os riscos relativos (RR) e para avaliar o efeito de covariáveis sobre o óbito, utilizou-se modelo de regressão logística multinomial. Resultados: 0,5% NV ocorreram em domicílio/outro local e apresentaram maior probabilidade de morte (45,2 por mil NV) do que os nascidos em hospitais (12,9). A mortalidade foi maior para os nascimentos fora do hospital em todos os componentes da mortalidade infantil: neonatal precoce (RR=3,9), neonatal tardio (RR=2,6) e pós-neonatal (RR=3,4). A probabilidade de morte diminuiu conforme aumentou o peso ao nascer, porém o risco de morte dos NV ≥2500 g em domicílio/outro local foi duas vezes maior que nos partos hospitalares. Após ajuste, nascer fora do hospital permaneceu como risco apenas para a mortalidade pós-neonatal. Conclusões: embora reduzidos, os partos fora do hospital apresentam maior risco de morte, inclusive no período pós-neonatal, sugerindo que há barreiras de acesso não só durante o pré-natal e parto, mas que estas persistem na atenção à criança no primeiro ano de vida.
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Butori JB, Guiot O, Luperon JL, Janky E, Kadhel P. Évaluation de l’imminence de l’accouchement inopiné extra-hospitalier en Guadeloupe : expérience du service médical d’urgence et de réanimation de Pointe-à-Pitre. ACTA ACUST UNITED AC 2014; 43:254-62. [DOI: 10.1016/j.jgyn.2013.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/10/2013] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
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Pilkington H, Blondel B, Drewniak N, Zeitlin J. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France. Eur J Public Health 2014; 24:905-10. [PMID: 24390464 PMCID: PMC4245008 DOI: 10.1093/eurpub/ckt207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome.
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Affiliation(s)
- Hugo Pilkington
- 1 Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, F-93526 Saint-Denis, France
| | - Béatrice Blondel
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Nicolas Drewniak
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Jennifer Zeitlin
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
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Combier E, Charreire H, Le Vaillant M, Michaut F, Ferdynus C, Amat-Roze JM, Gouyon JB, Quantin C, Zeitlin J. Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy. Health Place 2013; 24:225-33. [PMID: 24177417 DOI: 10.1016/j.healthplace.2013.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/01/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022]
Abstract
Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.
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Affiliation(s)
- Evelyne Combier
- Centre d'épidémiologie et de santé publique Bourgogne (EA4184). Faculté de Médecine, Dijon, France.
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Faut-il craindre les fermetures et fusions de maternités en France ? ACTA ACUST UNITED AC 2013; 42:407-9. [DOI: 10.1016/j.jgyn.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
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Moudi Z, Ghazi Tabatabaie M, Mahdi Tabatabaei S, Vedadhir A. Safe Delivery Posts: an intervention to provide equitable childbirth care services to vulnerable groups in Zahedan, Iran. Midwifery 2013; 30:1073-81. [PMID: 23866686 DOI: 10.1016/j.midw.2013.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/15/2013] [Accepted: 06/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, there has been a shift towards alternative childbirth services to increase access to skilled care during childbirth. OBJECTIVE This study aims to assess the past 10 years of experience of the first Safe Delivery Posts (SDPs) established in Zahedan, Iran to determine the number of deliveries and the intrapartum transfer rates, and to examine the reasons why women choose to give birth at a Safe Delivery Post and not in one of the four large hospitals in Zahedan. DESIGN A mixed-methods research strategy was used for this study. In the quantitative phase, an analysis was performed on the existing data that are routinely collected in the health-care sector. In the qualitative phase, a grounded theory approach was used to collect and analyse narrative data from in-depth interviews with women who had given birth to their children at the Safe Delivery Posts. SETTING Women were selected from two Safe Delivery Posts in Zahedan city in southeast Iran. PARTICIPANTS Nineteen mothers who had given birth in the Safe Delivery Posts were interviewed. FINDINGS During the 10-year period, 22,753 low-risk women gave birth in the Safe Delivery Posts, according to the records. Of all the women who were admitted to the Safe Delivery Posts, on average 2.1% were transferred to the hospital during labour or the postpartum period. Three key categories emerged from the analysis: barriers to hospital use, opposition to home birth and finally, reasons for choosing the childbirth care provided by the SDPs. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE Implementing a model of midwifery care that offers the benefits of modern medical care and meets the needs of the local population is feasible and sustainable. This model of care reduces the cost of giving birth and ensures equitable access to care among vulnerable groups in Zahedan.
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Affiliation(s)
- Zahra Moudi
- Pregnancy Health Research Center, Zahedan University of Medical Science, Midwifery Department, Nursing and Midwifery School, Mashahir Square, Zahedan, Iran.
| | - Mahmood Ghazi Tabatabaie
- Department of Demography & Population Studies, Faculty of Social Science, University of Tehran, Tehran 14395-773, Iran
| | | | - AbouAli Vedadhir
- Department of Anthropology, Faculty of Social Science, University of Tehran, Tehran, Iran
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