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Unger V, Gasparics Á, Nagy Z, Hernádfői M, Nagy R, Walter A, Farkas N, Szabó M, Hegyi P, Garami M, Varga P. Cesarean delivery is associated with lower neonatal mortality among breech pregnancies: a systematic review and meta-analysis of preterm deliveries ≤32 weeks of gestation. Am J Obstet Gynecol 2024:S0002-9378(24)00683-5. [PMID: 38908650 DOI: 10.1016/j.ajog.2024.06.015] [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: 02/21/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To investigate the association between actual and planned modes of delivery, neonatal mortality, and short-term outcomes among preterm pregnancies ≤32 weeks of gestation. DATA SOURCES A systematic literature search was conducted in 3 main databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to November 16, 2022. The protocol was registered in advance in the International Prospective Register of Systematic Reviews (CRD42022377870). STUDY ELIGIBILITY CRITERIA Eligible studies examined pregnancies ≤32nd gestational week. All infants received active care, and the outcomes were reported separately by different modes of delivery. Singleton and twin pregnancies at vertex and breech presentations were included. Studies that included pregnancies complicated with preeclampsia and abruptio placentae were excluded. Primary outcomes were neonatal mortality and intraventricular hemorrhage. STUDY APPRAISAL AND SYNTHESIS METHODS Articles were selected by title, abstract, and full text, and disagreements were resolved by consensus. Random effects model-based odds ratios with corresponding 95% confidence intervals were calculated for dichotomous outcomes. Risk Of Bias In Non-randomized Studies - of Interventions-I was used to assess the risk of bias. RESULTS A total of 19 observational studies were included involving a total of 16,042 preterm infants in this systematic review and meta-analysis. Actual cesarean delivery improves survival (odds ratio, 0.62; 95% confidence interval, 0.42-0.9) and decreases the incidence of intraventricular hemorrhage (odds ratio, 0.70; confidence interval, 0.57-0.85) compared to vaginal delivery. Planned cesarean delivery does not improve the survival of very and extremely preterm infants compared to vaginal delivery (odds ratio, 0.87; 95% confidence interval, 0.53-1.44). Subset analysis found significantly lower odds of death for singleton breech preterm deliveries born by both planned (odds ratio, 0.56; 95% confidence interval, 0.32-0.98) and actual (odds ratio, 0.34; 95% confidence interval, 0.13-0.88) cesarean delivery. CONCLUSION Cesarean delivery should be the mode of delivery for preterm ≤32 weeks of gestation breech births due to the higher mortality in preterm infants born via vaginal delivery.
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Affiliation(s)
- Vivien Unger
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Pediatric Center, Csolnoky Ferenc Hospital, Veszprém, Hungary
| | - Ákos Gasparics
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Márk Hernádfői
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Bethesda Children's Hospital, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Anna Walter
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Miklós Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Péter Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary.
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Chen X, Shi Y. Determinants of microbial colonization in the premature gut. Mol Med 2023; 29:90. [PMID: 37407941 DOI: 10.1186/s10020-023-00689-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Abnormal microbial colonization in the gut at an early stage of life affects growth, development, and health, resulting in short- and long-term adverse effects. Microbial colonization patterns of preterm infants differ from those of full-term infants in that preterm babies and their mothers have more complicated prenatal and postnatal medical conditions. Maternal complications, antibiotic exposure, delivery mode, feeding type, and the use of probiotics may significantly shape the gut microbiota of preterm infants at an early stage of life; however, these influences subside with age. Although some factors and processes are difficult to intervene in or avoid, understanding the potential factors and determinants will help in developing timely strategies for a healthy gut microbiota in preterm infants. This review discusses potential determinants of gut microbial colonization in preterm infants and their underlying mechanisms.
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Affiliation(s)
- Xiaoyu Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Yongyan Shi
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
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Muhammad A, Forcados GE, Yusuf AP, Abubakar MB, Sadiq IZ, Elhussin I, Siddique MAT, Aminu S, Suleiman RB, Abubakar YS, Katsayal BS, Yates CC, Mahavadi S. Comparative G-Protein-Coupled Estrogen Receptor (GPER) Systems in Diabetic and Cancer Conditions: A Review. Molecules 2022; 27:molecules27248943. [PMID: 36558071 PMCID: PMC9786783 DOI: 10.3390/molecules27248943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
For many patients, diabetes Mellitus and Malignancy are frequently encountered comorbidities. Diabetes affects approximately 10.5% of the global population, while malignancy accounts for 29.4 million cases each year. These troubling statistics indicate that current treatment approaches for these diseases are insufficient. Alternative therapeutic strategies that consider unique signaling pathways in diabetic and malignancy patients could provide improved therapeutic outcomes. The G-protein-coupled estrogen receptor (GPER) is receiving attention for its role in disease pathogenesis and treatment outcomes. This review aims to critically examine GPER' s comparative role in diabetes mellitus and malignancy, identify research gaps that need to be filled, and highlight GPER's potential as a therapeutic target for diabetes and malignancy management. There is a scarcity of data on GPER expression patterns in diabetic models; however, for diabetes mellitus, altered expression of transport and signaling proteins has been linked to GPER signaling. In contrast, GPER expression in various malignancy types appears to be complex and debatable at the moment. Current data show inconclusive patterns of GPER expression in various malignancies, with some indicating upregulation and others demonstrating downregulation. Further research should be conducted to investigate GPER expression patterns and their relationship with signaling pathways in diabetes mellitus and various malignancies. We conclude that GPER has therapeutic potential for chronic diseases such as diabetes mellitus and malignancy.
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Affiliation(s)
- Aliyu Muhammad
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | | | - Abdurrahman Pharmacy Yusuf
- Department of Biochemistry, School of Life Sciences, Federal University of Technology, Minna P.M.B. 65, Nigeria
| | - Murtala Bello Abubakar
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto P.M.B. 2254, Nigeria
- Centre for Advanced Medical Research & Training (CAMRET), Usmanu Danfodiyo University, Sokoto P.M.B. 2254, Nigeria
| | - Idris Zubairu Sadiq
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Isra Elhussin
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Md Abu Talha Siddique
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Suleiman Aminu
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Rabiatu Bako Suleiman
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Yakubu Saddeeq Abubakar
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Babangida Sanusi Katsayal
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Clayton C Yates
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Sunila Mahavadi
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
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Moresi EHC, Moreira PP, Ferrer IL, Baptistella MKCS, Bolognani CV. Robson Classification for cesarean section in a Public Hospital in Distrito Federal. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract Objectives: to evaluate cesarean taxes by looking at Robson classification on 10 groups (G) and the principal indications at the prevalent groups and at G10. Methods: cross-sectional, observational, retrospective study, including all deliveries performed in a public hospital in Distrito Federal in 2019. Data were collected from medical records and pregnant women were classified in 10 groups. Pearson’s chi-squared test was used to calculate the p-value. The risk estimate for cesarean was defined by common odds ratio of Mantel-Haenszel, with calculation of odds ratio (OR) and 95% confidence interval (CI95%). Results: there were 2,205 deliveries, 1,084 (49.1%) of which were cesarean and 1,121 (50.9%) vaginal deliveries. The principal factors for cesarean were G5 (39.3%), G2 (21.2%) and G1 (13.6%). At G10, cesarean had 51.5% of births, not differing statistically from the other groups (p>0.05). Considering all preterm births, G6 to G10 and the other groups, there is a bigger chance of cesarean happening in relation to normal labor (OR=1.4; CI95%= 1.011-2.094; p=0.042). Dystocia remained at G1 and G2, previous cesarean at G5 and hypertensive syndrome at G10. Conclusion: cesarean was most prevalent delivery route, showing elevated rates even in primiparous and preterm births. Preponderance of dystocia and acute fetal distress suggests better evaluation of the diagnostic criteria, mainly in G1, G2 and G10.
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Hospital variation in extremely preterm birth. J Perinatol 2022; 42:1686-1694. [PMID: 36104499 DOI: 10.1038/s41372-022-01505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Given that regionalization of extremely preterm births (EPTBs) is associated with improved infant outcomes, we assessed between-hospital variation in EPTB stratified by hospital level of neonatal care, and determined the proportion of variance explained by differences in maternal and hospital factors. STUDY DESIGN We assessed 7,046,253 births in California from 1997 to 2011, using hospital discharge, birth, and death certificate data. We estimated the association between maternal and hospital factors and EPTB using multivariable regression, calculated hospital-specific EPTB frequencies, and estimated between-hospital variances and median odds ratios, stratified by hospital level of care. RESULT Hospital frequencies of EPTB ranged from 0% to 2.5%. Between-hospital EPTB frequencies varied substantially, despite stratifying by hospital level of care and accounting for confounding factors. CONCLUSION Our results demonstrate differences in EPTBs among hospitals with level 1 and 2 neonatal care, an area to target for future research and quality improvement.
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Korst LM, Gregory KD, Nicholas LA, Saeb S, Reynen DJ, Troyan JL, Greene N, Fridman M. A scoping review of severe maternal morbidity: describing risk factors and methodological approaches to inform population-based surveillance. Matern Health Neonatol Perinatol 2021; 7:3. [PMID: 33407937 PMCID: PMC7789633 DOI: 10.1186/s40748-020-00123-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Current interest in using severe maternal morbidity (SMM) as a quality indicator for maternal healthcare will require the development of a standardized method for estimating hospital or regional SMM rates that includes adjustment and/or stratification for risk factors. Objective To perform a scoping review to identify methodological considerations and potential covariates for risk adjustment for delivery-associated SMM. Search methods Following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews, systematic searches were conducted with the entire PubMed and EMBASE electronic databases to identify publications using the key term “severe maternal morbidity.” Selection criteria Included studies required population-based cohort data and testing or adjustment of risk factors for SMM occurring during the delivery admission. Descriptive studies and those using surveillance-based data collection methods were excluded. Data collection and analysis Information was extracted into a pre-defined database. Study design and eligibility, overall quality and results, SMM definitions, and patient-, hospital-, and community-level risk factors and their definitions were assessed. Main results Eligibility criteria were met by 81 studies. Methodological approaches were heterogeneous and study results could not be combined quantitatively because of wide variability in data sources, study designs, eligibility criteria, definitions of SMM, and risk-factor selection and definitions. Of the 180 potential risk factors identified, 41 were categorized as pre-existing conditions (e.g., chronic hypertension), 22 as obstetrical conditions (e.g., multiple gestation), 22 as intrapartum conditions (e.g., delivery route), 15 as non-clinical variables (e.g., insurance type), 58 as hospital-level variables (e.g., delivery volume), and 22 as community-level variables (e.g., neighborhood poverty). Conclusions The development of a risk adjustment strategy that will allow for SMM comparisons across hospitals or regions will require harmonization regarding: a) the standardization of the SMM definition; b) the data sources and population used; and c) the selection and definition of risk factors of interest. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-020-00123-1.
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Affiliation(s)
- Lisa M Korst
- Childbirth Research Associates, LLC, North Hollywood, CA, USA.
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA, USA
| | - Lisa A Nicholas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samia Saeb
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA
| | - David J Reynen
- Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA
| | - Jennifer L Troyan
- Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA
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Jiang HL, Lu C, Wang XX, Wang X, Zhang WY. Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes. Chin Med J (Engl) 2020; 133:25-32. [PMID: 31923101 PMCID: PMC7028204 DOI: 10.1097/cm9.0000000000000582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is associated with high neonatal morbidity and mortality. However, the influences of cesarean section (CS) on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated. The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM. METHODS A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st, 2011 to December 31st, 2011. A total of 2756 singleton pregnancies complicated with PPROM were included. Adverse neonatal outcomes including early neonatal death, birth asphyxia, respiratory distress syndrome (RDS), pneumonia, infection, birth trauma, and 5-min/10-min Apgar scores were obtained from the hospital records. Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression. Numerical variables were compared by multiple linear regressions. RESULTS In total, 2756 newborns were involved in the analysis. Among them, 1166 newborns (42.31%) were delivered by CS and 1590 newborns belonged to vaginal delivery (VD) group. The CS proportion of PPROM obviously increased with the increase of gestational age (χ = 5.014, P = 0.025). Compared with CS group, VD was associated with a higher risk of total newborns mortality (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.102-5.118; P = 0.027), and a lower level of pneumonia (OR, 0.32; 95% CI, 0.126-0.811; P = 0.016). However, after multivariable adjustment and stratification for gestational age, only pneumonia was significantly related with CS in 28 to 34 weeks group (OR, 0.34; 95% CI, 0.120-0.940; P = 0.038). There were no differences regarding to other adverse outcomes in the two groups, including neonatal mortality, birth asphyxia, Apgar scores, RDS, pneumonia, and sepsis. CONCLUSIONS The proportion of CS of pregnant women with PPROM was very high in China. The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.
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Affiliation(s)
- Hai-Li Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2019; 301:447-458. [DOI: 10.1007/s00404-019-05417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022]
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Aubry EM, Oelhafen S, Fankhauser N, Raio L, Cignacco EL. Adverse perinatal outcomes for obese women are influenced by the presence of comorbid diabetes and hypertensive disorders. Sci Rep 2019; 9:9793. [PMID: 31278325 PMCID: PMC6611811 DOI: 10.1038/s41598-019-46179-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/20/2019] [Indexed: 01/20/2023] Open
Abstract
Maternal obesity often occurs together with comorbid diabetes and hypertensive disorders. All three conditions are independently associated with negative perinatal outcomes. Our objective was to determine the risk and burden of adverse perinatal outcome that could be attributed to maternal obesity in combination with a comorbid status. We analyzed data from 324'664 singleton deliveries in Switzerland between 2005 and 2016. For the association of maternal obesity in the presence or absence of comorbidities with various perinatal outcomes, we estimated adjusted relative risk (RR) using multivariable regression modeling and determined the multivariable-adjusted attributable fraction of the population (AFp). Obesity was a main predictor for macrosomia, fracture of the clavicle, failure to progress in labor and prolonged labor. By stratifying women based on comorbidities, we identified significantly increased risk for preterm birth and early neonatal death only for women diagnosed with a comorbidity. However, various other outcomes were independently associated with either obesity or comorbidities. The AFp showed greatest reduction in comorbidities (15.4/15.0/13.2%), in macrosomia (6.3%) and in shoulder dystocia (4.8%) if all women were to become non-obese. We suggest that comorbidities such as diabetes and hypertensive disorders should be considered when relating maternal obesity to adverse perinatal outcomes.
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Affiliation(s)
- Evelyne M Aubry
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Stephan Oelhafen
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology. Inselspital, University of Bern, Bern, Switzerland
| | - Eva L Cignacco
- Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
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Abstract
OBJECTIVE To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo. DESIGN Cross-sectional survey. SETTING Five largest public hospitals in Kosovo. PARTICIPANTS 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. OUTCOME MEASURES The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital. RESULTS Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90). CONCLUSIONS We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
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Affiliation(s)
- Ilir Hoxha
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
- Action for Mother and Children, Prishtina, Kosovo
| | | | - Mrika Aliu
- Action for Mother and Children, Prishtina, Kosovo
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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Nguyen DB, Pare-Miron V, Czuzoj-Shulman N, Abenhaim HA. Effect of Hospital Choice on the Risk of Caesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1302-1310. [PMID: 30879777 DOI: 10.1016/j.jogc.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate the variation in Caesarean delivery rate (CDR) among hospitals across the United States, its effect on maternal and neonatal outcomes, and whether differences in pregnancy and hospital characteristics can explain the higher CDRs seen in certain hospitals. METHODS This retrospective population-based cohort study was conducted using the 2014 Healthcare and Utilization Project Nationwide Inpatient Sample. The investigators identified all hospitals with birth admissions and compared hospitals with high CDRs with hospitals with low/mid CDRs, in terms of hospital characteristics, maternal characteristics, and maternal and neonatal outcomes. Regression analyses within multiple hospital and patient characteristic strata were used to evaluate the adjusted independent effect of the hospital on the risk of Caesarean delivery (Canadian Task Force Classification II-2). RESULTS In this study population, 96% of U.S. hospitals had a CDR above 20%, and 5% had a CDR >40%. High-CDR hospitals (>40%) were more often privately owned, non-teaching hospitals with an older patient population. When adjusting for baseline obstetrical and hospital characteristics, high-CDR hospitals remained independently associated with an elevated risk of Caesarean delivery. These findings persisted in stratified analyses of each hospital and patient-level characteristic. Obstetrical and neonatal outcomes were comparable in all hospitals irrespective of CDR. CONCLUSION Hospital characteristics and case mix do not account for the significant variation in CDRs across U.S. hospitals. Individual hospitals are in themselves independent risk factors for Caesarean delivery. Choosing to give birth in a certain hospital may put women at an increased risk of having a Caesarean delivery, without maternal or neonatal benefit.
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Affiliation(s)
- Dong Bach Nguyen
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Valerie Pare-Miron
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC.
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Hoxha I, Braha M, Syrogiannouli L, Goodman DC, Jüni P. Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open 2019; 9:e025356. [PMID: 30833323 PMCID: PMC6443081 DOI: 10.1136/bmjopen-2018-025356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. RESULTS 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72). CONCLUSIONS CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
| | - Medina Braha
- International Business College Mitrovica, Mitrovica, Kosovo
| | | | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Hoxha I, Syrogiannouli L, Braha M, Goodman DC, da Costa BR, Jüni P. Caesarean sections and private insurance: systematic review and meta-analysis. BMJ Open 2017; 7:e016600. [PMID: 28827257 PMCID: PMC5629699 DOI: 10.1136/bmjopen-2017-016600] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Financial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and The Cochrane Library from the first year of records through August 2016. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. RESULTS Eighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ2=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ2=0.011). CONCLUSIONS Caesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | | | - Medina Braha
- Department of Management and Marketing, International Business College Mitrovica, Mitrovica, Kosovo
| | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Bruno R da Costa
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Shany E, Berger I, Goldberg O, Karplus M, Gilat S, Benzaquen O, Yogev H, Shalev R. Do Prenatal Corticosteroids Affect Brain Maturation of the Premature Infant? An Electroencephalography Study. Clin EEG Neurosci 2017; 48:79-87. [PMID: 27090506 DOI: 10.1177/1550059416643202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether prenatal treatment with betamethasone has a significant influence on cerebral maturation indices as measured by electroencephalographic (EEG) indices. STUDY DESIGN Infants born less than 35 weeks postmenstrual age (PMA) were prospectively enrolled if their mother received a full course of bethametasone prior to delivery (study group) or not (control group); infants with major intracranial abnormalities were excluded as well as those who were sedated or needed assisted ventilation. EEG was recorded during the first 10 days of life. Interburst intervals and maximal amplitudes of theta and delta bandwidths were calculated by a signal processing software. A multivariate general linear model was used to analyze the relationship between the 2 groups and the different electrophysiologic parameters, adjusting for PMA and mode of delivery. RESULTS Thirty-eight infants were included in the study group and 36 in the control group. Univariate analysis demonstrated a negative correlation between PMA at test and EEG indices (interburst interval and delta and theta frequencies). Multivariate analysis demonstrated a less robust correlation of PMA and EEG indices and a positive correlation of prenatal betamethasone treatment with Theta frequencies. Repeating the data analysis separately for each study group, the above results remained significant mainly in the study group. CONCLUSIONS Our findings suggest a possible stabilization effect of corticosteroids on the central nervous system and a possible delay of the maturation of cerebral activity related to prenatal corticosteroids use. These findings may relate to a better neurodevelopmental outcome of infants treated prenatally with corticosteroids.
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Affiliation(s)
- Eilon Shany
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Neonatal Department, Soroka Medical Center, Beer Sheva, Israel
| | - Itai Berger
- 3 Neuro-Cognitive Center, Pediatric Wing, Hadassah-Hebrew University Medical Center (Mt. Scopus Campus), Jerusalem, Israel
| | - Ori Goldberg
- 4 Pediatric Department, Shneider Children Hospital, Petah Tikwa, Israel
| | - Michael Karplus
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shlomo Gilat
- 5 S. Gilat Medical Research & Equipment Ltd, Karkur, Israel
| | - Oshra Benzaquen
- 6 Radiology Department, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Hagai Yogev
- 7 Tel Aviv-Yaffo Academic College, Tel Aviv-Yaffo, Israel
| | - Ruth Shalev
- 8 Neuropaediatric Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
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