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Mitchell KA, Haddock AJ, Husainy H, Walter LA, Rajapreyar I, Wingate M, Smith CH, Tita A, Sinkey R. Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality. Am J Perinatol 2023; 40:489-507. [PMID: 34327686 PMCID: PMC10961102 DOI: 10.1055/s-0041-1732455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. STUDY DESIGN We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. RESULTS A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. CONCLUSION As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126). KEY POINTS · Up to 12% of postpartum women seek care in the ED.. · One-third of maternal deaths occur postpartum.. · Maternal mortality reduction efforts should include ED stakeholders..
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Affiliation(s)
- Kellie A. Mitchell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Alison J. Haddock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Lauren A. Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha Wingate
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H. Smith
- Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Rachel Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
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Dayan N, Velez MP, Vigod S, Pudwell J, Djerboua M, Fell DB, Basso O, Nguyen TV, Joseph KS, Ray JG. Infertility treatment and postpartum mental illness: a population-based cohort study. CMAJ Open 2022; 10:E430-E438. [PMID: 35580889 PMCID: PMC9196066 DOI: 10.9778/cmajo.20210269] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Subfertility and infertility treatment can be stressful experiences, but it is unknown whether each predisposes to postpartum mental illness. We sought to evaluate associations between subfertility or infertility treatment and postpartum mental illness. METHODS We conducted a population-based cohort study of individuals without pre-existing mental illness who gave birth in Ontario, Canada, from 2006 to 2014, stratified by fertility exposure: subfertility without infertility treatment; noninvasive infertility treatment (intrauterine insemination); invasive infertility treatment (in vitro fertilization); and no reproductive assistance. The primary outcome was mental illness occurring 365 days or sooner after birth (defined as ≥ 2 outpatient visits, an emergency department visit or a hospital admission with a mood, anxiety, psychotic, or substance use disorder, self-harm event or other mental illness). We used multivariable Poisson regression with robust error variance to assess associations between fertility exposure and postpartum mental illness. RESULTS The study cohort comprised 786 064 births (mean age 30.42 yr, standard deviation 5.30 yr), including 78 283 with subfertility without treatment, 9178 with noninvasive infertility treatment, 9633 with invasive infertility treatment and 688 970 without reproductive assistance. Postpartum mental illness occurred in 60.8 per 1000 births among individuals without reproductive assistance. Relative to individuals without reproductive assistance, those with subfertility had a higher adjusted relative risk of postpartum mental illness (1.14, 95% confidence interval 1.10-1.17), which was similar in noninvasive and invasive infertility treatment groups. INTERPRETATION Subfertility or infertility treatment conferred a slightly higher risk of postpartum mental illness compared with no reproductive assistance. Further research should elucidate whether the stress of infertility, its treatment or physician selection contributes to this association.
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Affiliation(s)
- Natalie Dayan
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont.
| | - Maria P Velez
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Simone Vigod
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Jessica Pudwell
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Maya Djerboua
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Deshayne B Fell
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Olga Basso
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Tuong Vi Nguyen
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - K S Joseph
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
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Shoemaker ES, Saiyin T, Smith S, Loutfy M, Darling L, Walker M, Hawken S, Begum J, Bibeau C, Bertozzi B, Fraleigh A, Kwaramba G, Johnson K, Cousineau A, Kendall CE. Patterns of cesarean birth among women living with HIV in Ontario: A cross-sectional, population-level study. Birth 2021; 48:357-365. [PMID: 33733473 DOI: 10.1111/birt.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/10/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12-year period. METHODS Our research is co-led and codesigned with WLWH. We conducted a retrospective population-level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006/07 and 2017/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables. RESULTS Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, P < 0.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%-19.3%), whereas the proportion of repeat CB increased (13.1%-20.5%, P = 0.013). CONCLUSIONS Because of decreasing HIV-related indications for CB, more practitioners may be following the guidelines for first-time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.
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Affiliation(s)
- Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Tana Saiyin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Mona Loutfy
- ICES, Ottawa, ON, Canada.,Infectious Disease Clinician Scientist, Departments of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Liz Darling
- ICES, Ottawa, ON, Canada.,Department of Midwifery, McMaster University, Hamilton, ON, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven Hawken
- ICES, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Breklyn Bertozzi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Annette Fraleigh
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Gladys Kwaramba
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Kerrigan Johnson
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ashlee Cousineau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
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