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Aviram A, Barrett J, Mei-Dan E, Yoon EW, Melamed N. A prediction tool for mode of delivery in twin pregnancies-a secondary analysis of the Twin Birth Study. Am J Obstet Gynecol 2024; 231:124.e1-124.e11. [PMID: 37979823 DOI: 10.1016/j.ajog.2023.11.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND One of the controversies regarding the management of twin gestations relates to the mode of delivery. Currently, counseling regarding the mode of delivery and the chance of successful vaginal twin delivery is based on the average risk for intrapartum cesarean delivery in the general population of twin pregnancies. Decision support tools that provide an individualized risk for intrapartum cesarean delivery based on the unique characteristics of each patient can improve counseling and decision-making regarding the choice of mode of delivery in twin pregnancies. OBJECTIVE This study aimed to develop and validate a prediction model to determine the risk for intrapartum cesarean delivery in twin pregnancies. STUDY DESIGN In this secondary analysis of the Twin Birth Study, a multicenter randomized controlled trial, we considered the subgroup of individuals who underwent a trial of vaginal delivery. Candidate predictors included maternal age, parity, previous cesarean delivery, conception method, chorionicity, diabetes and hypertension in pregnancy, gestational age at birth, the onset of labor, presentation of the second twin, sonographic fetal weight estimation, and fetal sex. The co-primary outcomes were overall intrapartum cesarean delivery and cesarean delivery of the second twin. Multivariable logistic regression models were used to estimate the probability of the study outcomes. Model performance was evaluated using measures of discrimination (the area under the receiver operating characteristic curve), calibration, and predictive accuracy. Internal validation was performed using the bootstrap resampling technique. RESULTS A total of 1221 individuals met the study criteria. The rate of overall intrapartum cesarean delivery and cesarean delivery for the second twin was 25.4% and 5.7%, respectively. The most contributory predictor variables were nulliparity, term birth (≥37 weeks), a noncephalic presentation of the second twin, previous cesarean delivery, and labor induction. The models for overall intrapartum cesarean delivery and cesarean delivery of the second twin had good overall discriminatory accuracy (area under the receiver operating characteristic curve, 0.720; 95% confidence interval, 0.688-0.752 and 0.736; 95% confidence interval, 0.669-0.803, respectively) and calibration (as illustrated by the calibration plot and Brier scores of 0.168; 95% confidence interval, 0.156-0.180 and 0.051; 95% confidence interval, 0.040-0.061, respectively). The models achieved good specificity (66.7% and 81.6%, respectively), high negative predictive value (86.0% and 96.9%, respectively), and moderate sensitivity (68.1% and 57.1%, respectively). CONCLUSION The prediction models developed in this study may assist care providers in counseling individuals regarding the optimal timing and mode of delivery in twin pregnancies by providing individualized estimates of the risk for intrapartum cesarean delivery.
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Affiliation(s)
- Amir Aviram
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Eugene W Yoon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Pasokpuckdee K, Boriboonhirunsarn D. Incidence of Preeclampsia and Cesarean Section Rate According to the Robson Classification. Cureus 2023; 15:e49845. [PMID: 38169664 PMCID: PMC10758345 DOI: 10.7759/cureus.49845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives The objective of this study was to determine the incidence of preeclampsia and associated cesarean section (CS) rate according to the Robson classification. Methods A retrospective cross-sectional study was conducted on a total of 670 women who delivered at a tertiary care hospital in Thailand during January to March 2023. All women were classified into 10 groups according to the Robson classification, and preeclampsia was identified. Overall and group-specific incidence of preeclampsia and CS rate were estimated. Comparison of CS rate was made between those with and without preeclampsia using the Chi-squared test. Relative risks (RR) and corresponding 95% confidence intervals were estimated. Results The majority of women were in group 1 (34%) and group 3 (30.7%). Overall CS rate was 40.6% with highest contribution from group 1, 5, and 10. Incidence of preeclampsia was 9.1%, and the majority were in groups 10 (29.5%) and 1 (23%). Preeclampsia significantly increased the rate of overall CS (RR 1.8, p<0.001). The risk of CS significantly increased in group 1 (RR 1.8, p=0.043), group 3 (RR 3.5, p=0.025), and group 10 (RR 1.9, p=0.006). Preeclampsia accounted for 15.4% of all CS, with the highest contribution in group 2 (37.5%), group 10 (31.1%), group 3 (16.7%), and group 1 (10.8%). Without preeclampsia, the overall CS rate was relatively reduced by 6.9%, with the largest relative reduction in group 10 (14.3%), group 3 (11.5%), group 2 (6.3%), and group 1 (5.2%). Conclusion The incidence of preeclampsia was 9.1%, and preeclampsia significantly increased the rate of overall CS. Without preeclampsia, overall CS rate relatively reduced by 6.9% but did not significantly change the relative contribution of CS according to the Robson classification.
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Affiliation(s)
- Kritpol Pasokpuckdee
- Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
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Kähkönen K, Väänänen A. Labour analgesia by single shot spinal for any parturient?-A retrospective one-year single centre audit. Acta Anaesthesiol Scand 2023; 67:1079-1084. [PMID: 37217441 DOI: 10.1111/aas.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Single shot spinal (SSS) provides effective analgesia for multiparous parturients during advanced labour. Its utility in early labour or primiparous parturients may be limited by the insufficient duration of action. Regardless, SSS may offer a reasonable labour analgesia option in certain clinical scenarios. In this retrospective study, we analyse the failure rate of SSS analgesia by assessing pain after the SSS and by determining the need for additional analgesic interventions in primiparous or early-stage multiparous parturients compared to multiparous parturients in advanced labour (cervix ≥6 cm). METHODS Following institutional ethical board approval, the patient files of all parturients receiving SSS analgesia during a 12-month period in a single centre were analysed for any recorded notes regarding recurrent pain or subsequent analgesia interventions (a new SSS, epidural, pudendal or paracervical bloc) as a marker for insufficient analgesia. RESULTS A total of 88 primiparous and 447 multiparous parturients (cervix <6 cm: N = 131; cervix ≥6 cm: N = 316) received SSS analgesia. The odds ratio for the insufficient duration of analgesia was 1.94 (1.08-3.48) in primiparous and 2.08 (1.25-3.46) in early-stage multiparous parturients compared to advanced multiparous labour (p < .01). Primiparous and early-stage multiparous parturients were also 2.20 (1.15-4.20) and 2.61 (1.50-4.55) times more likely, respectively, to receive new peripheral and/or neuraxial analgesic interventions during delivery (p < .01). CONCLUSIONS SSS appears to provide adequate labour analgesia for the majority of parturients in whom it is used, including nulliparous and early-stage multiparous parturients. It remains a reasonable option in certain clinical scenarios, including resource-limited settings where epidural analgesia is unavailable.
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Affiliation(s)
- Kati Kähkönen
- Department of anaesthesiology, Central hospital of Seinäjoki, Seinäjoki, Finland
| | - Antti Väänänen
- Department of anaesthesiology, Helsinki University Central Hospital, Women's hospital, Helsinki, Finland
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Huang C, Luo B, Wang G, Chen P, Ren J. Development and validation of a prediction model for intrapartum cesarean delivery based on the artificial neural networks approach: a protocol for a prospective nested case-control study. BMJ Open 2023; 13:e066753. [PMID: 36828664 PMCID: PMC9972428 DOI: 10.1136/bmjopen-2022-066753] [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] [Received: 07/20/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Although intrapartum caesarean delivery can resolve dystocia, it would still lead to several adverse outcomes for mothers and children. The obstetric care professionals need effective tools that can help them to identify the possibility and risk factors of intrapartum caesarean delivery, and further implement interventions to avoid unnecessary caesarean birth. This study aims to develop a prediction model for intrapartum caesarean delivery with real-life data based on the artificial neural networks approach. METHODS AND ANALYSIS This study is a prospective nested case-control design. Pregnant women who plan to deliver vaginally will be recruited in a tertiary hospital in Southwest China from March 2022 to March 2024. The clinical data of prelabour, intrapartum period and psychosocial information will be collected. The case group will be the women who finally have a baby with intrapartum caesarean deliveries, and the control group will be those who deliver a baby vaginally. An artificial neural networks approach with the backpropagation algorithm multilayer perceptron topology will be performed to construct the prediction model. ETHICS AND DISSEMINATION Ethical approval for data collection was granted by the Ethics Committee of West China Second University Hospital, Sichuan University, and the ethical number is 2021 (204). Written informed consent will be obtained from all participants and they can withdraw from the study at any time. The results of this study will be published in peer-review journal.
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Affiliation(s)
- Chuanya Huang
- Department of Nursing, West China Second University, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Biru Luo
- Department of Nursing, West China Second University, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Guoyu Wang
- Department of Nursing, West China Second University, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Peng Chen
- School of Computer and Software Engineering, Xihua University, Chengdu, Sichuan, China
| | - Jianhua Ren
- Department of Nursing, West China Second University, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
- West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
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Luoma J, Adubra L, Ashorn P, Ashorn U, Bendabenda J, Dewey KG, Hallamaa L, Coghlan R, Horton WA, Hyöty H, Kortekangas E, Lehto KM, Maleta K, Matchado A, Nkhoma M, Oikarinen S, Parkkila S, Purmonen S, Fan YM. Association between asymptomatic infections and linear growth in 18-24-month-old Malawian children. MATERNAL & CHILD NUTRITION 2023; 19:e13417. [PMID: 36111423 DOI: 10.1111/mcn.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
Inadequate diet and frequent symptomatic infections are considered major causes of growth stunting in low-income countries, but interventions targeting these risk factors have achieved limited success. Asymptomatic infections can restrict growth, but little is known about their role in global stunting prevalence. We investigated factors related to length-for-age Z-score (LAZ) at 24 months by constructing an interconnected network of various infections, biomarkers of inflammation (as assessed by alpha-1-acid glycoprotein [AGP]), and growth (insulin-like growth factor 1 [IGF-1] and collagen X biomarker [CXM]) at 18 months, as well as other children, maternal, and household level factors. Among 604 children, there was a continuous decline in mean LAZ and increased mean length deficit from birth to 24 months. At 18 months of age, the percentage of asymptomatic children who carried each pathogen was: 84.5% enterovirus, 15.5% parechovirus, 7.7% norovirus, 4.6% rhinovirus, 0.6% rotavirus, 69.6% Campylobacter, 53.8% Giardia lamblia, 11.9% malaria parasites, 10.2% Shigella, and 2.7% Cryptosporidium. The mean plasma IGF-1 concentration was 12.5 ng/ml and 68% of the children had systemic inflammation (plasma AGP concentration >1 g/L). Shigella infection was associated with lower LAZ at 24 months through both direct and indirect pathways, whereas enterovirus, norovirus, Campylobacter, Cryptosporidium, and malaria infections were associated with lower LAZ at 24 months indirectly, predominantly through increased systemic inflammation and reduced plasma IGF-1 and CXM concentration at 18 months.
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Affiliation(s)
- Juho Luoma
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Laura Adubra
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jaden Bendabenda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ryan Coghlan
- Research Center, Shriners Hospitals for Children, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - William A Horton
- Research Center, Shriners Hospitals for Children, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Heikki Hyöty
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Fimlab Ltd., Tampere University Hospital, Tampere, Finland
| | - Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kirsi-Maarit Lehto
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Minyanga Nkhoma
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sami Oikarinen
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Seppo Parkkila
- Fimlab Ltd., Tampere University Hospital, Tampere, Finland.,Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sami Purmonen
- Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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