1
|
Zotareli V, Bento S, Souza R, Cecatti JG. Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo75. [PMID: 39380587 PMCID: PMC11460412 DOI: 10.61622/rbgo/2024rbgo75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 06/07/2024] [Indexed: 10/10/2024] Open
Abstract
Objective To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries. Methods A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled. Results In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue. Conclusion Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
Collapse
Affiliation(s)
- Vilma Zotareli
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - Silvana Bento
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - Renato Souza
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - José Guilherme Cecatti
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| |
Collapse
|
2
|
Deneux-Tharaux C, Donati S. Maternal mortality surveillance must go beyond death certificates. Am J Obstet Gynecol 2024; 231:e94. [PMID: 38759710 DOI: 10.1016/j.ajog.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Catherine Deneux-Tharaux
- Université Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, CRESS U1153, INSERM, INRAE, Paris, France.
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| |
Collapse
|
3
|
Baguiya A, Bonet M, Brizuela V, Cuesta C, Knight M, Lumbiganon P, Abalos E, Kouanda S. Infection-related severe maternal outcomes and case fatality rates in 43 low and middle-income countries across the WHO regions: Results from the Global Maternal Sepsis Study (GLOSS). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003109. [PMID: 38662723 PMCID: PMC11045079 DOI: 10.1371/journal.pgph.0003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
The highest toll of maternal mortality due to infections is reported in low and middle-income countries (LMICs). However, more evidence is needed to understand the differences in infection-related severe maternal outcomes (SMO) and fatality rates across the WHO regions. This study aimed to compare the burden of infection-related SMO and case fatality rates across the WHO regions using the Global Maternal Sepsis Study (GLOSS) data. GLOSS was a hospital-based one-week inception prospective cohort study of pregnant or recently pregnant women admitted with suspected or confirmed infection in 2017. Four hundred and eight (408) hospitals from 43 LMICs in the six WHO regions were considered in this analysis. We used a logistic regression model to compare the odds of infection-related SMOs by region. We then calculated the fatality rate as the proportion of deaths over the total number of SMOs, defined as maternal deaths and near-misses. The proportion of SMO was 19.6% (n = 141) in Africa, compared to 18%(n = 22), 15.9%(n = 50), 14.7%(n = 48), 12.1%(n = 95), and 10.8%(n = 21) in the Western Pacific, European, Eastern Meditteranean, Americas, and South-Eastern Asian regions, respectively. Women in Africa were more likely to experience SMO than those in the Americas (aOR = 2.41, 95%CI: [1.78 to 2.83]), in South-East Asia (aOR = 2.60, 95%CI: [1.57 to 4.32]), and the Eastern Mediterranean region (aOR = 1.58, 95%CI: [1.08 to 2.32]). The case fatality rate was 14.3%[3.05% to 36.34%] (n/N = 3/21) and 11.4%[6.63% to 17.77%] (n/N = 16/141) in the South-East Asia and Africa, respectively. Infection-related SMOs and case fatality rates were highest in Africa and Southeast Asia. Specific attention and actions are needed to prevent infection-related maternal deaths and severe morbidity in these two regions.
Collapse
Affiliation(s)
- Adama Baguiya
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Cristina Cuesta
- Faculty of Economics and Statistics, National University of Rosario, Rosario, Argentina
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Pisake Lumbiganon
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Séni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Doctoral School, Saint Thomas d’Aquin University, Ouagadougou, Burkina Faso
| | | |
Collapse
|
4
|
Alexe A, Eisele O, Fernandes MFS, Garg A, Kovacs B, Wurst K, Balramsingh-Harry L, Abramova N, Zheteyeva Y, Lewis D. Call to action: Harmonization of pharmacovigilance regulations for post-marketing pregnancy and breastfeeding safety studies. Br J Clin Pharmacol 2024; 90:715-721. [PMID: 37793773 DOI: 10.1111/bcp.15920] [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: 12/08/2022] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
Globally, more than 200 million women become pregnant each year, most of whom receive medications despite limited information on their safe use during pregnancy. The paucity of drug safety data on pregnant and breastfeeding women stems from the routine exclusion of this population from clinical trials due to scientific, ethical, regulatory and legal concerns. Consequently, at the time of initial drug approval, there may be scant safety data to inform the drug benefit-risk balance to the mother, foetus or infant. Although momentum is growing to include this underrepresented population in clinical trials, most information on drug exposure outcomes comes from data collected in the postmarketing setting. Regulatory guidance and legislation on medication use in pregnancy and breastfeeding were reviewed globally by the TransCelerate IGR PV Pregnancy and Breastfeeding Team. The International Conference of Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) standards and Council for International Organizations of Medical Sciences guidelines served as benchmarks for national safety regulations and guidance. The landscape assessment identified a lack of harmonization of global regulations on research in pregnant and breastfeeding women and a lack of specific regulations on this topic in the majority of the territories included in the assessment. This article focuses on the ambiguities and lack of harmonization in global regulations on postmarketing pregnancy and breastfeeding safety studies. There is currently no ICH standard to guide these types of safety studies and, in most regions reviewed, there are no clear regulations or guidance on when and how to conduct them. While a challenging undertaking, greater clarity and harmonization would facilitate more timely completion of postmarketing pregnancy safety studies that would ultimately generate the critical data needed to optimize benefit-risk decisions for women who may conceive, as well as pregnant and breastfeeding women.
Collapse
Affiliation(s)
- Amalia Alexe
- Novartis, Lichtstrasse 35, Basel, 4056, Switzerland
| | | | | | - Anju Garg
- Sanofi, Bridgewater, Massachusetts, USA
| | - Birgit Kovacs
- Boehringer Ingelheim Pharmaceuticals, Danbury, Connecticut, USA
| | - Keele Wurst
- GlaxoSmithKline, Raleigh, North Carolina, USA
| | | | | | | | - David Lewis
- Novartis, Lichtstrasse 35, Basel, 4056, Switzerland
| |
Collapse
|
5
|
Young BK, Florine Magdelijns P, Chervenak JL, Chan M. Amniotic fluid embolism: a reappraisal. J Perinat Med 2024; 52:126-135. [PMID: 38082418 DOI: 10.1515/jpm-2023-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/20/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Using cases from our own experience and from the published literature on amniotic fluid embolism (AFE), we seek to improve on existing criteria for diagnosis and discern associated risk factors. Additionally, we propose a novel theory of pathophysiology. METHODS This retrospective case review includes eight cases of AFE from two hospital systems and 21 from the published literature. All cases were evaluated using the modified criteria for research reporting of AFE by Clark et al. in Am J Obstet Gynecol, 2016;215:408-12 as well as our proposed criteria for diagnosis. Additional clinical and demographic characteristics potentially correlated with a risk of AFE were included and analyzed using descriptive analysis. RESULTS The incidence of AFE was 2.9 per 100,000 births, with five maternal deaths in 29 cases (17.2 %) in our series. None of the cases met Clark's criteria while all met our criteria. 62.1 % of patients were over the age of 32 years and two out of 29 women (6.9 %) conceived through in-vitro fertilization. 6.5 % of cases were complicated by fetal death. Placenta previa occurred in 13.8 %. 86.2 % of women had cesarean sections of which 52.0 % had no acute maternal indication. CONCLUSIONS Our criteria identify more patients with AFE than others with a low likelihood of false positives. Clinical and demographic associations in our review are consistent with those previously reported. A possible relationship between cesarean birth and risk of AFE was identified using our criteria. Additionally, we propose a new hypothesis of pathophysiology.
Collapse
Affiliation(s)
- Bruce K Young
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, USA
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
| | | | - Judith L Chervenak
- Department of Obstetrics and Gynecology, Bellevue Medical Center, New York City, USA
| | - Michael Chan
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
| |
Collapse
|
6
|
Tura AK, Knight M, Girma S, Ahmed R, Yuya M, Bekele D, Hassen TA, Stekelenburg J, van den Akker T. Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study. Int J Gynaecol Obstet 2024; 164:714-720. [PMID: 37961999 PMCID: PMC10952177 DOI: 10.1002/ijgo.15240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. METHODS Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. RESULTS Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). CONCLUSION Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.
Collapse
Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Department of Obstetrics and GynecologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Marian Knight
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
| | - Sagni Girma
- School of Nursing and Midwifery, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
| | - Redwan Ahmed
- Department of Obstetrics and GynecologyHiwot Fana Specialized University HospitalHararEthiopia
| | - Mohammed Yuya
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
- School of Public Health, College of Health and Medical Sciences, Haramaya UniversityHararEthiopia
| | - Delayehu Bekele
- Department of Obstetrics and GynecologySt. Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | - Tahir Ahmed Hassen
- Center for Women's Health ResearchUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global HealthUniversity Medical Center Groningen, University of GroningenThe Netherlands
- Department of Obstetrics and GynecologyLeeuwarden Medical CenterLeeuwardenThe Netherlands
| | - Thomas van den Akker
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
- Department of Obstetrics and GynecologyLeiden University Medical CenterLeidenThe Netherlands
- Athena Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
7
|
Schreurs AMF, Overtoom EM, de Boer MA, van der Houwen LEE, Lier MCI, van den Akker T, Cornette J, Vogelvang TE, Beenakkers ICM, Rosman AN, Maas JWM, Heineman DJ, Finken MJJ, de Vries JJJ, Burger NB, Schaap TP, Bloemenkamp KWM, Mijatovic V. Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system. BJOG 2023; 130:1620-1628. [PMID: 37280664 DOI: 10.1111/1471-0528.17556] [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: 11/19/2022] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. DESIGN A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). SETTING Nationwide, the Netherlands. POPULATION All pregnant women between April 2016 and April 2018. METHODS This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. MAIN OUTCOME MEASURES Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. RESULTS In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. CONCLUSIONS SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.
Collapse
Affiliation(s)
- Anneke M F Schreurs
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Evelien M Overtoom
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisette E E van der Houwen
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marit C I Lier
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Jerome Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Jacques W M Maas
- Department of Obstetrics and Gynaecology and GROW - School for Oncology and Reproduction, Maastricht UMC+, Maastricht, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| |
Collapse
|
8
|
de Bruin O, Engjom H, Vousden N, Ramakrishnan R, Aabakke AJM, Äyräs O, Donati S, Jónasdóttir E, Knight M, Overtoom EM, Salvatore MA, Sturkenboom MCJM, Svanvik T, Varpula R, Vercoutere A, Bloemenkamp KWM. Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic: Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS). Acta Obstet Gynecol Scand 2023; 102:1521-1530. [PMID: 37594175 PMCID: PMC10577630 DOI: 10.1111/aogs.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The majority of data on COVID-19 in pregnancy are not from sound population-based active surveillance systems. MATERIAL AND METHODS We conducted a multi-national study of population-based national or regional prospective cohorts using standardized definitions within the International Network of Obstetric Survey systems (INOSS). From a source population of women giving birth between March 1 and August 31, 2020, we included pregnant women admitted to hospital with a positive SARS-CoV-2 PCR test ≤7 days prior to or during admission and up to 2 days after birth. The admissions were further categorized as COVID-19-related or non-COVID-19-related. The primary outcome of interest was incidence of COVID-19-related hospital admission. Secondary outcomes included severe maternal disease (ICU admission and mechanical ventilation) and COVID-19-directed medical treatment. RESULTS In a source population of 816 628 maternities, a total of 2338 pregnant women were admitted with SARS-CoV-2; among them 940 (40%) were COVID-19-related admissions. The pooled incidence estimate for COVID-19-related admission was 0.59 (95% confidence interval 0.27-1.02) per 1000 maternities, with notable heterogeneity across countries (I2 = 97.3%, P = 0.00). In the COVID-19 admission group, between 8% and 17% of the women were admitted to intensive care, and 5%-13% needed mechanical ventilation. Thromboprophylaxis was the most frequent treatment given during COVID-19-related admission (range 14%-55%). Among 908 infants born to women in the COVID-19-related admission group, 5 (0.6%) stillbirths were reported. CONCLUSIONS During the initial months of the pandemic, we found substantial variations in incidence of COVID-19-related admissions in nine European countries. Few pregnant women received COVID-19-directed medical treatment. Several barriers to rapid surveillance were identified. Investment in robust surveillance should be prioritized to prepare for future pandemics.
Collapse
Affiliation(s)
- Odette de Bruin
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Hilde Engjom
- Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Anna J. M. Aabakke
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐HolbækHolbækDenmark
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐Nordsjælland‐HillerødHillerødDenmark
| | - Outi Äyräs
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità – Italian National Institute of HealthRomeItaly
| | - Eva Jónasdóttir
- Department of Obstetrics and GynecologyLandspitali University HospitalReykjavikIceland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Evelien M. Overtoom
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Michele A. Salvatore
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità – Italian National Institute of HealthRomeItaly
| | - Miriam C. J. M. Sturkenboom
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Teresia Svanvik
- Region Västra Götaland, Sahlgrenska University HospitalDepartment of Obstetrics and GynecologyGothenburgSweden
| | - Reetta Varpula
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - An Vercoutere
- Department of Obstetrics and Gynecology, CUB Hôpital ErasmeHôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB)BrusselsBelgium
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina Children's Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | |
Collapse
|
9
|
Vandenberghe G, Vierin A, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Donati S, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Maier B, van Roosmalen J, Zwart J, Roelens K. Incidence and outcomes of uterine rupture in women with unscarred, preterm or prelabour uteri: data from the international network of obstetric survey systems. BJOG 2023; 130:1493-1501. [PMID: 37113103 DOI: 10.1111/1471-0528.17517] [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: 11/23/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Analysis of atypical cases of uterine rupture, namely, uterine rupture occurring in unscarred, preterm or prelabour uteri. DESIGN Descriptive multi-country population-based study. SETTING Ten high-income countries within the International Network of Obstetric Survey Systems. POPULATION Women with unscarred, preterm or prelabour ruptured uteri. METHODS We merged prospectively collected individual patient data in ten population-based studies of women with complete uterine rupture. In this analysis, we focused on women with uterine rupture of unscarred, preterm or prelabour ruptured uteri. MAIN OUTCOME MEASURES Incidence, women's characteristics, presentation and maternal and perinatal outcome. RESULTS We identified 357 atypical uterine ruptures in 3 064 923 women giving birth. Estimated incidence was 0.2 per 10 000 women (95% CI 0.2-0.3) in the unscarred uteri, 0.5 (95% CI 0.5-0.6) in the preterm uteri, 0.7 (95% CI 0.6-0.8) in the prelabour uteri, and 0.5 (95% CI 0.4-0.5) in the group with no previous caesarean. Atypical uterine rupture resulted in peripartum hysterectomy in 66 women (18.5%, 95% CI 14.3-23.5%), three maternal deaths (0.84%, 95% CI 0.17-2.5%) and perinatal death in 62 infants (19.7%, 95% CI 15.1-25.3%). CONCLUSIONS Uterine rupture in preterm, prelabour or unscarred uteri are extremely uncommon but were associated with severe maternal and perinatal outcome. We found a mix of risk factors in unscarred uteri, most preterm uterine ruptures occurred in caesarean-scarred uteri and most prelabour uterine ruptures in 'otherwise' scarred uteri. This study may increase awareness among clinicians and raise suspicion of the possibility of uterine rupture under these less expected conditions.
Collapse
Affiliation(s)
- Griet Vandenberghe
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Anne Vierin
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Kitty Bloemenkamp
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children's Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sylvia Berlage
- Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany
| | - Lotte Colmorn
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Obstetrics, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics, Paris, France
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pelle G Lindqvist
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Stockholm, Sweden
| | - Barbara Maier
- Department of Gynaecology and Obstetrics, Clinic Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Jos van Roosmalen
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Kristien Roelens
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
10
|
de Vries PLM, van den Akker T, Bloemenkamp KWM, Grossetti E, Rigouzzo A, Saucedo M, Verspyck E, Zwart J, Deneux-Tharaux C. Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care. Int J Gynaecol Obstet 2023; 162:1077-1085. [PMID: 37177815 DOI: 10.1002/ijgo.14829] [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: 10/19/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. METHODS In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. RESULTS For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. CONCLUSION A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.
Collapse
Affiliation(s)
- P L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Grossetti
- Department of Obstetrics, Hospital group du Havre, Le Havre, France
| | - A Rigouzzo
- Department of Anesthesiology, Armand Trousseau Children's Hospital, Paris, France
| | - M Saucedo
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - E Verspyck
- Department of Obstetrics and Gynaecology, University Hospital of Rouen, Rouen, France
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - C Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| |
Collapse
|
11
|
Tura AK, Girma S, Dessie Y, Bekele D, Stekelenburg J, van den Akker T, Knight M. Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00281. [PMID: 37116928 PMCID: PMC10141431 DOI: 10.9745/ghsp-d-22-00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/21/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. METHODS We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. RESULTS Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. CONCLUSIONS In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.
Collapse
Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Sagni Girma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynaecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
12
|
Thakkar A, Hameed AB, Makshood M, Gudenkauf B, Creanga AA, Malhamé I, Grandi SM, Thorne SA, D'Souza R, Sharma G. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity. JACC. ADVANCES 2023; 2:100275. [PMID: 37560021 PMCID: PMC10410605 DOI: 10.1016/j.jacadv.2023.100275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 08/11/2023]
Abstract
Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes.
Collapse
Affiliation(s)
- Aarti Thakkar
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afshan B. Hameed
- Department of Obstetrics & Gynecology, Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - Minhal Makshood
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent Gudenkauf
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia M. Grandi
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Departments of Obstetrics & Gynaecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Gernand AD, Gallagher K, Bhandari N, Kolsteren P, Lee AC, Shafiq Y, Taneja S, Tielsch JM, Abate FW, Baye E, Berhane Y, Chowdhury R, Dailey-Chwalibóg T, de Kok B, Dhabhai N, Jehan F, Kang Y, Katz J, Khatry S, Lachat C, Mazumder S, Muhammad A, Nisar MI, Sharma S, Martin LA, Upadhyay RP, Christian P. Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection. BMC Pregnancy Childbirth 2023; 23:107. [PMID: 36774497 PMCID: PMC9919738 DOI: 10.1186/s12884-023-05366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.
Collapse
Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
| | - Kelly Gallagher
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - James M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, D.C, USA
| | - Firehiwot Workneh Abate
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sitanshi Sharma
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Leigh A Martin
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
14
|
Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study. Microorganisms 2022; 11:microorganisms11010105. [PMID: 36677397 PMCID: PMC9865500 DOI: 10.3390/microorganisms11010105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks' gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80-6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.
Collapse
|
15
|
Maraschini A, Salvi S, Colciago E, Corsi E, Cetin I, Lovotti M, Donati S. Eclampsia in Italy: A prospective population-based study (2017–2020). Pregnancy Hypertens 2022; 30:204-209. [DOI: 10.1016/j.preghy.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
|
16
|
Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, Donati S, Gissler M, Johansen M, Knight M, Korbel M, Kristufkova A, Nyflot LT, Deneux-Tharaux C. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ 2022; 379:e070621. [PMID: 36384872 PMCID: PMC9667469 DOI: 10.1136/bmj-2022-070621] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare maternal mortality in eight countries with enhanced surveillance systems. DESIGN Descriptive multicountry population based study. SETTING Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. POPULATION 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). OUTCOME MEASURES Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country's office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women's origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. RESULTS Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. CONCLUSIONS Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
Collapse
Affiliation(s)
- Caroline Diguisto
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, 37 044 Tours, France; Université de Tours, 37032 Tours, France
| | - Monica Saucedo
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Athanasios Kallianidis
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Miroslav Korbel
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Lill T Nyflot
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| |
Collapse
|
17
|
Every maternal near-miss counts: Need for a national audit in South Africa? A mixed-methods study. S Afr Med J 2022; 112:769-777. [DOI: 10.7196/samj.2022.v112.i9.16248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
Background. To improve maternal health, studies of maternal morbidity are increasingly being used to evaluate the quality of maternity care, in addition to studies of mortality. While South Africa (SA) has a well-established confidential enquiry into maternal deaths, there is currently no structure in place to systematically collect and analyse maternal near-misses (MNMs) at national level.Objectives. To synthesise MNM indicators and causes in SA by performing a systematic literature search, and to investigate perceived needs for data collection related to MNMs and determine whether the MNM tool from the World Health Organization (WHO-MNM) would require adaptations in order to be implemented.Methods. The study used a mixed-methods approach. A systematic literature search was conducted to find all published data on MNM audits in SA. Semi-structured interviews were conducted virtually with maternal health experts throughout the country who had been involved in studies of MNMs, and main themes arising in the interviews were synthesised. A method for MNM data collection for SA use was discussed with these experts.Results. The literature search yielded 797 articles, 15 of which met the WHO-MNM or Mantel et al. severe acute maternal morbidity criteria. The median (interquartile range) MNM incidence ratio in SA was 8.4/1 000 (5.6 - 8.7) live births, the median maternal mortality ratio was 130/100 000 (71.4 - 226) live births, and the median mortality index was 16.6% (11.7 - 18.8). The main causes of MNMs were hypertensive disorders of pregnancy and obstetric haemorrhage. Eight maternal health experts were interviewed from May 2020 to February 2021. All participants focused on the challenges of implementing a national MNM audit, yet noted the urgent need for one. Recognition of MNMs as an indicator of quality of maternity care was considered to lead to improved management earlier in the chain of events, thereby possibly preventing mortality. Obtaining qualitative information from women with MNMs was perceived as an important opportunity to improve the maternity care system. Participants suggested that the WHO-MNM tool would have to be adapted into a simplified tool with more clearly defined criteria and a number of specific diagnoses relevant to the SA setting. This ‘Maternal near-miss: Inclusion criteria and data collection form’ is provided as a supplementary file.Conclusion. Adding MNMs to the existing confidential maternal death enquiry could potentially contribute to a more robust audit with data that may inform health systems planning. This was perceived by SA experts to be valuable, but would require context-specific adaptations to the WHO-MNM tool. The available body of evidence is sufficient to justify moving to implementation.
Collapse
|
18
|
Engjom H, van den Akker T, Aabakke A, Ayras O, Bloemenkamp K, Donati S, Cereda D, Overtoom E, Knight M. Severe COVID-19 in pregnancy is almost exclusively limited to unvaccinated women - time for policies to change. THE LANCET REGIONAL HEALTH. EUROPE 2022; 13:100313. [PMID: 35098198 PMCID: PMC8791061 DOI: 10.1016/j.lanepe.2022.100313] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Hilde Engjom
- Dept of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Thomas van den Akker
- Department of obstetrics and gynaecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Anna Aabakke
- Dept of Obstetrics and Gynecology, Hillerød Hospital, Nordsjaellands Hospital, Denmark
- Dept obstetrics and Gynecology, Copenhagen University Hospital, Holbæk, Denmark
| | - Outi Ayras
- Dept of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Kitty Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome Italy
| | | | - Evelien Overtoom
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Donati S, Corsi E, Maraschini A, Salvatore MA. SARS-CoV-2 infection among hospitalised pregnant women and impact of different viral strains on COVID-19 severity in Italy: a national prospective population-based cohort study. BJOG 2021; 129:221-231. [PMID: 34687585 PMCID: PMC8652503 DOI: 10.1111/1471-0528.16980] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN National population-based prospective cohort study. SETTING A total of 315 Italian maternity hospitals. SAMPLE A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.
Collapse
Affiliation(s)
- S Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - E Corsi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - A Maraschini
- Servizio tecnico scientifico di statistica, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - M A Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | | |
Collapse
|
20
|
Donati S, Fano V, Maraschini A. Uterine rupture: Results from a prospective population-based study in Italy. Eur J Obstet Gynecol Reprod Biol 2021; 264:70-75. [PMID: 34274701 DOI: 10.1016/j.ejogrb.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the incidence of uterine rupture (UR), and evaluate risk factors, management, and associated maternal and perinatal outcomes. STUDY DESIGN This multicentre prospective population-based study involved six regions in Italy accounting for 49% of national births. The study population comprised all women aged 11-59 years delivering at ≥22 gestational weeks with a diagnosis of UR from September 2014 to August 2016. Maternal and pregnancy characteristics and information on potential risk factors were collected. Unadjusted relative risks (RR) and 95% confidence intervals (CI) were computed with respect to the background population. RESULTS In total, 74 cases of UR occurred among the study population (rate 0.16/1000 pregnancies; mean age 34 years; 14 perinatal deaths, one maternal death). A significantly higher risk of UR was observed for maternal age ≥ 35 years (RR = 1.58, 95% CI 1.00-2.51), multiparity (RR = 5.71, 95% CI 3.14-10.04), previous caesarean section (RR = 20.5, 95% CI 11.11-37.74) and uterine scarring (RR = 6.44, 95% CI 2.94-14.12). A significant association was observed between UR and caesarean section as the mode of delivery (RR = 27.9, 95% CI 10.2-76.5) and gestational age < 37 weeks (RR = 11.82, 95% CI 7.46-18.71). CONCLUSIONS This study found a low rate of UR compared with other European countries, probably due to the high rate of primary caesarean sections and to resistance towards trial of labour and vaginal delivery after caesarean section among obstetricians in Italy. The unforeseen increase in caesarean sections -and, as a result, an increase in placenta accreta spectrum disorders, peripartum hysterectomy and related maternal and perinatal morbidity and mortality as a consequence of previous uterine scarring - failed to ensure better maternal and perinatal outcomes.
Collapse
Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | | | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | |
Collapse
|
21
|
Engjom H, Aabakke AJM, Klungsøyr K, Svanvik T, Äyräs O, Jonasdottir E, Thurn L, Jones E, Pettersson K, Nyfløt LT, Al-Zirqi I, Vangen S, Júlíusson PB, Källén K, Gissler M, Krebs L. COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries. Acta Obstet Gynecol Scand 2021; 100:1611-1619. [PMID: 33885150 PMCID: PMC8250817 DOI: 10.1111/aogs.14160] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
Introduction Population‐based studies about the consequences of SARS‐CoV‐2 infection (COVID‐19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems. Material and methods This study examines pregnant women with COVID‐19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS‐CoV‐2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID‐19‐related. Results In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID‐19. The risk of admission due to COVID‐19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID‐19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID‐19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID‐19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusions The risk of admission due to COVID‐19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID‐19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.
Collapse
Affiliation(s)
- Hilde Engjom
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Holbaek, Holbaek, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Norway
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Eva Jonasdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | - Lars Thurn
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden
| | - Elin Jones
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Lill T Nyfløt
- Norwegian Research Center for Womens' Health, Oslo University Hospital, Oslo, Norway
| | - Iqbal Al-Zirqi
- Norwegian Research Center for Womens' Health, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Center for Womens' Health, Oslo University Hospital, Oslo, Norway
| | - Pétur B Júlíusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Karin Källén
- Institution of Clinical Sciences, Department of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Mika Gissler
- The Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Lone Krebs
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| |
Collapse
|
22
|
Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One 2021; 16:e0250373. [PMID: 33891629 PMCID: PMC8064507 DOI: 10.1371/journal.pone.0250373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
Collapse
Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- * E-mail:
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - for the ItOSS working group
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| |
Collapse
|
23
|
Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, van den Akker T. Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries. Acta Obstet Gynecol Scand 2021; 100:1345-1354. [PMID: 33719032 PMCID: PMC8360099 DOI: 10.1111/aogs.14113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/20/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
Introduction Peripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy. Material and methods We merged data from nine nationwide or multi‐regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48 h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated. Results A total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48/73, 66%) and highest in Denmark (25/27, 93%), intrauterine balloon use was lowest in Slovakia (1/72, 1%) and highest in Denmark (11/27, 41%), and interventional radiology varied between 0/27 in Denmark and Slovakia to 11/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5/16, 31%) and highest in the UK (84/103, 82%), intrauterine balloon use varied between 0/14 in Belgium and Slovakia to 29/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0/16) and highest in Finland (9/15, 60%). Maternal mortality occurred in 14/1226 (1%), the most common complications were hematologic (95/1202, 8%) and respiratory (81/1101, 7%). Adverse neonatal events were observed in 79/1259 (6%) births. Conclusions Management of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life‐saving procedure is associated with substantial adverse maternal and neonatal outcome.
Collapse
Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Inserm U1153, Paris Descartes University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää Hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Karolinska Institute, Department of Obstetrics and Gynecology, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Athena Institute, VU, Amsterdam, the Netherlands
| | | |
Collapse
|
24
|
Giannakou K. Perinatal epidemiology: Issues, challenges, and potential solutions. Obstet Med 2020; 14:77-82. [PMID: 34394715 DOI: 10.1177/1753495x20948984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
Perinatal epidemiology research is concerned with identifying the effects of events during pregnancy on pregnancy outcomes that include maternal, fetal, and neonatal health outcomes. Randomized trials in perinatal research face many challenges, including randomization difficulties, ethical considerations, and inadequate statistical power due to the small number of subjects eligible for participation. For these reasons, most epidemiological studies conducted in this research field are observational and include different types of bias. This review describes the key methodological difficulties in the design and analysis of randomized and observational studies in perinatal epidemiology, and provides potential corrective approaches.
Collapse
|
25
|
Knight M, Morris RK, Furniss J, Chappell LC. Include pregnant women in research-particularly covid-19 research. BMJ 2020; 370:m3305. [PMID: 32843352 DOI: 10.1136/bmj.m3305] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Katie Morris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Furniss
- UK Obstetric Surveillance System Steering Committee, National Perinatal Epidemiology Unit, Oxford, UK
| | - Lucy C Chappell
- School of Life Course Sciences, King's College London, London, London, UK
| |
Collapse
|
26
|
Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
Collapse
Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| |
Collapse
|
27
|
Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.1] [Citation(s) in RCA: 4] [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] [Accepted: 01/19/2021] [Indexed: 11/15/2023] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
Collapse
Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S. Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D. Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M. Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| |
Collapse
|
28
|
Heemelaar S, Josef M, Diener Z, Chipeio M, Stekelenburg J, van den Akker T, Mackenzie S. Maternal near-miss surveillance, Namibia. Bull World Health Organ 2020; 98:548-557. [PMID: 32773900 PMCID: PMC7411319 DOI: 10.2471/blt.20.251371] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods From the results of an initial feasibility study, we adapted the World Health Organization’s criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings During the 6-month period, we recorded 37 106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100 000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting.
Collapse
Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Mirjam Josef
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Zoe Diener
- Department of Obstetrics & Gynaecology, University of North Carolina, North Carolina, United States of America
| | - Melody Chipeio
- Department of Obstetrics & Gynaecology, Katutura State Hospital, PO Box 86237, Eros, Windhoek, Namibia
| | - Jelle Stekelenburg
- Department of Health Science, Global Health, University Medical Center Groningen, Groningen, Netherlands
| | | | - Shonag Mackenzie
- Department of Obstetrics & Gynaecology, University of Namibia, Windhoek, Namibia
| |
Collapse
|
29
|
Chantry AA, Berrut S, Donati S, Gissler M, Goldacre R, Knight M, Maraschini A, Monteath K, Morris A, Teixeira C, Wood R, Zeitlin J, Deneux-Tharaux C. Monitoring severe acute maternal morbidity across Europe: A feasibility study. Paediatr Perinat Epidemiol 2020; 34:416-426. [PMID: 31502306 DOI: 10.1111/ppe.12557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated. OBJECTIVE To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe. METHODS We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity. RESULTS Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity. CONCLUSIONS In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe.
Collapse
Affiliation(s)
- Anne A Chantry
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Midwifery School of Baudelocque, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris-Descartes University, Paris, France
| | | | - Serena Donati
- Maternal and Child Health Unit, National Centre for Disease Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alice Maraschini
- Maternal and Child Health Unit, National Centre for Disease Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Kirsten Monteath
- Information Services Division, NHS National Services Scotland, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Anna Morris
- Information Services Department, NHS Wales Informatics Service, Cardiff, UK
| | - Cristina Teixeira
- EPI Unit Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| |
Collapse
|
30
|
Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369:m2107. [PMID: 32513659 PMCID: PMC7277610 DOI: 10.1136/bmj.m2107] [Citation(s) in RCA: 644] [Impact Index Per Article: 161.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants. DESIGN Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS). SETTING All 194 obstetric units in the UK. PARTICIPANTS 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020. MAIN OUTCOME MEASURES Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission. RESULTS The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth. CONCLUSIONS Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation. STUDY REGISTRATION ISRCTN 40092247.
Collapse
Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Nicola Vousden
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| |
Collapse
|
31
|
McCall SJ, Bonnet MP, Äyräs O, Vandenberghe G, Gissler M, Zhang WH, Van Leeuw V, Deneux-Tharaux C, Kurinczuk JJ, Knight M. Anaphylaxis in pregnancy: a population-based multinational European study. Anaesthesia 2020; 75:1469-1475. [PMID: 32463487 DOI: 10.1111/anae.15069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1-1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4-11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8-30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.
Collapse
Affiliation(s)
- S J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK.,Center for Research on Population and Health, American University of Beirut, Lebanon
| | - M-P Bonnet
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France.,Department of Anesthesiology and Critical Care, Hôpital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, France.,Société Française d'Anesthésie et de Réanimation Research Network, Paris, France
| | - O Äyräs
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - G Vandenberghe
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - M Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - W-H Zhang
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Laboratory for Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - V Van Leeuw
- Perinatal Epidemiology Center (CEpiP), Brussels, Belgium
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOPé, INSERM U1153, Paris, France
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | | |
Collapse
|
32
|
Rapport F, Hughes SE, Boisvert I, McMahon CM, Braithwaite J, Faris M, Bierbaum M. Adults' cochlear implant journeys through care: a qualitative study. BMC Health Serv Res 2020; 20:457. [PMID: 32448127 PMCID: PMC7247254 DOI: 10.1186/s12913-020-05334-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. Method Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. Results One hundred forty-three data-capture events disclosed 2 themes: 1) “The burden of hearing loss and the impact of Cochlear Implants”, and 2) “Professional Support and Practice, and HCPs Roles and Responsibilities”. Conclusions Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.
Collapse
Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia.
| | - Sarah E Hughes
- Swansea University Medical School, Swansea University, Swansea, Wales, United Kingdom.,South Wales Cochlear Implant Programme, Princess of Wales Hospital, Bridgend, Mid Glamorgan, Wales, United Kingdom
| | - Isabelle Boisvert
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Catherine M McMahon
- H:EAR [Hearing: Education, Application, Research], Australian Hearing Hub, Macquarie University, Macquarie Park, NSW, Australia.,The HEARing Cooperative Research Centre, Melbourne, VIC, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mona Faris
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| |
Collapse
|
33
|
Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, Van Den Akker T. Epidemiological analysis of peripartum hysterectomy across nine European countries. Acta Obstet Gynecol Scand 2020; 99:1364-1373. [PMID: 32358968 PMCID: PMC7540498 DOI: 10.1111/aogs.13892] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. MATERIAL AND METHODS We performed a descriptive, multinational, population-based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. RESULTS A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0-10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4-12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05). CONCLUSIONS Prevalence of peripartum hysterectomy may vary considerably between high-income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine-fold increased risk of peripartum hysterectomy.
Collapse
Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Paris University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Department of Obstetrics and Gynecology, Karolinska Institute, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Van Den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Athena Institute, VU University Amsterdam, The Netherlands
| | | |
Collapse
|
34
|
Abstract
In a Perspective, Sarka Lisonkova and Michael Kramer discuss the accompanying study by Kathryn Fitzpatrick and co-authors on management of amniotic fluid embolism.
Collapse
Affiliation(s)
- Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S. Kramer
- Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
35
|
Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, Schaap TP, Sullivan EA, Tuffnell D, Knight M. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med 2019; 16:e1002962. [PMID: 31714909 PMCID: PMC6850527 DOI: 10.1371/journal.pmed.1002962] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. METHODS AND FINDINGS A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93-28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21-0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10-0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16-0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication. CONCLUSIONS The findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to improve maternal outcome. Future research should focus on early detection of the coagulation deficiencies seen in AFE alongside the role of tranexamic acid and other coagulopathy management strategies.
Collapse
Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kitty W. M. Bloemenkamp
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Alexandra Kristufkova
- First Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Timme P. Schaap
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Derek Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
36
|
Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Dell'Oro S, Donati S. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. Acta Obstet Gynecol Scand 2019; 99:274-282. [PMID: 31520414 DOI: 10.1111/aogs.13727] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage. MATERIAL AND METHODS A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. RESULTS The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13-5.96), assisted reproductive technology (RR 5.99, 95% CI 4.42-8.11) multiple pregnancy (RR 5.03, 95% CI 3.57-7.09) and maternal age ≥35 years (RR 2.69, 95% CI 2.25-3.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died. CONCLUSIONS The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.
Collapse
Affiliation(s)
- Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Stefania Dell'Oro
- Department of Obstetrics and Gynecology, Foundation MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | | |
Collapse
|
37
|
Hoegh S, Thellesen L, Christensen KB, Bergholt T, Hedegaard M, Sorensen JL. Incidences of obstetric outcomes and sample size calculations: A Danish national registry study based on all deliveries from 2008 to 2015. Acta Obstet Gynecol Scand 2019; 99:34-41. [PMID: 31370099 PMCID: PMC6972555 DOI: 10.1111/aogs.13700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/13/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Abstract
Introduction In high‐income countries the majority of pregnancies have a good outcome, and many adverse obstetric outcomes rarely occur. This makes demonstrating clinically relevant and statistically significant effects of new interventions a challenge. The objective of the study was to report incidences of important obstetric outcomes and to calculate sample sizes for tentative studies. Material and methods The study was a registry‐based study. Data were retrieved from the Danish Medical Birth Registry and included all deliveries in Denmark from 2008 to 2015. The total population included 465 919 deliveries. The study population comprised intended vaginal deliveries with a single fetus in cephalic presentation at term (n = 381 567). Incidences were reported for 20 outcomes considering the relevance for the patients and the severity of the outcomes. We calculated the sample sizes required in tentative obstetric studies to detect risk reductions of 25 and 50%, for tests at the 5% level, using a power of 80 and 90%. For the randomized controlled trials we calculated the sample size required for comparing two proportions with equal‐sized groups. For the cohort study we calculated the sample size also required for two proportions but with unequal sized groups. Outcome measures for sample size calculation were neonatal mortality, Apgar score <7 at 5 minutes and emergency cesarean section. Results The incidence of neonatal mortality, Apgar score <7 at 5 minutes and emergency cesarean section was 0.05, 0.58 and 10.5%, respectively. Using neonatal mortality as the outcome in a tentative randomized controlled trial with an expected risk reduction of 50% and power of 80%, our calculation showed a sample size of 195 036 deliveries. Using Apgar score <7 at 5 minutes or emergency cesarean section as the outcome, 16 254 and 818 deliveries, respectively, were required. In tentative cohort studies, the required sample sizes were larger due to the unequal proportion of exposed/non‐exposed women. Conclusions Most adverse obstetric outcomes occur rarely; thus, very large sample sizes are required to achieve adequate statistical power in randomized controlled trials. Multicenter studies, international collaborations or alternative study designs to randomized controlled trials could be considered.
Collapse
Affiliation(s)
- Stinne Hoegh
- Department of Obstetrics, Juliane Marie Center for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line Thellesen
- Department of Obstetrics, Juliane Marie Center for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics, Juliane Marie Center for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jette Led Sorensen
- Department of Obstetrics, Juliane Marie Center for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
Jónasdóttir E, Aabakke AJM, Colmorn LB, Jakobsson M, Äyräs O, Baghestan E, Svanvik T, van den Akker T, Bloemenkamp K, van Roosmalen J, Krebs L, Knight M, Langhoff-Roos J. Lessons learnt from anonymized review of cases of peripartum hysterectomy by international experts: A qualitative pilot study. Acta Obstet Gynecol Scand 2019; 98:955-957. [PMID: 30825327 DOI: 10.1111/aogs.13601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Abstract
Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be an essential part of the process of continuing improvement in maternity care.
Collapse
Affiliation(s)
- Eva Jónasdóttir
- Department of Obstetrics and Gynecology, Landspítali University Hospital, Reykjavík, Iceland
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Lotte B Colmorn
- The Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Elham Baghestan
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, Birth Center Wilhelmina Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lone Krebs
- Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
39
|
Ramler PI, van den Akker T, Henriquez DDCA, Zwart JJ, van Roosmalen J, van Lith JMM, van der Bom JG. Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies. Acta Obstet Gynecol Scand 2019; 98:795-804. [PMID: 30667050 PMCID: PMC6593418 DOI: 10.1111/aogs.13542] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/29/2022]
Abstract
Introduction Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high‐income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years. Material and methods Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands. Results Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56‐75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81‐101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250‐6000) to 6000 mL (interquartile range 4500‐8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006. Conclusions The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care.
Collapse
Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Dacia D C A Henriquez
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost J Zwart
- Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jos van Roosmalen
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan M M van Lith
- Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | |
Collapse
|
40
|
Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K. The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG 2018; 126:370-381. [PMID: 29727918 DOI: 10.1111/1471-0528.15271] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE International comparison of complete uterine rupture. DESIGN Descriptive multi-country population-based study. SETTING International. POPULATION International Network of Obstetric Survey Systems (INOSS). METHODS We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes. MAIN OUTCOME MEASURES Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality. RESULTS We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived. CONCLUSIONS Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.
Collapse
Affiliation(s)
- G Vandenberghe
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - K Bloemenkamp
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children Hospital, Devision Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S Berlage
- Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany
| | - L Colmorn
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Inserm U1153, Paris Descartes University, Paris, France
| | - M Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - P G Lindqvist
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - W Oberaigner
- Department of Clinical Epidemiology, Tirol Kliniken Ltd., Innsbruck, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - J Van Roosmalen
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - K Roelens
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
41
|
Lazzerini M, Richardson S, Ciardelli V, Erenbourg A. Effectiveness of the facility-based maternal near-miss case reviews in improving maternal and newborn quality of care in low-income and middle-income countries: a systematic review. BMJ Open 2018; 8:e019787. [PMID: 29674368 PMCID: PMC5914892 DOI: 10.1136/bmjopen-2017-019787] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/01/2018] [Accepted: 02/20/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The maternal near-miss case review (NMCR) has been promoted by WHO as an approach to improve quality of care (QoC) at facility level. This systematic review synthesises evidence on the effectiveness of the NMCR on QoC and maternal and perinatal health outcomes in low-income and middle-income countries (LMICs). METHODS Studies were searched for in six electronic databases (MEDLINE, Index Medicus, Web of Science, the Cochrane library, Embase, LILACS), with no language restrictions. Two authors independently screened papers and selected them for inclusion and independently extracted data. Maternal mortality was the primary outcome. Secondary outcomes included any outcome informing on any of the six dimensions of QoC: efficacy, safety, efficiency, equity, accessibility and timely care, acceptability and patient-centred care. RESULTS Out of 24 822 papers retrieved, 17 studies from 11 countries were included. Maternal mortality measured before and after the implementation of the NMCR cycle significantly decreased (OR 0.77, 95% CI 0.61 to 0.98, eight studies, 55 573 043 women; I2=39%). A statistically significant reduction in the incidence of uterine rupture, postpartum haemorrhage and maternal sepsis was observed in three out of six studies. Ten studies reporting on maternal care process all showed some significant improvement when measured against predefined standards. All studies reported that the NMCR resulted in some amelioration of the facility structure (physical structure, staffing, equipment, training, organisation of care). Newborn outcomes were overall poorly reported; four studies showed no significant difference in perinatal mortality. Patient satisfaction and equity were also poorly reported. CONCLUSIONS Policy makers may consider implementing the maternal NMCR cycle approach among strategies aiming at improving QoC and reducing maternal mortality and morbidity in LMIC. Future studies should better document the effectiveness of the NMCR cycle particularly on outcomes reflecting patient-centred care and cost-effectiveness.
Collapse
Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Sonia Richardson
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Valentina Ciardelli
- Department of Obstetrics and Gynaecology, Bentivoglio Hospital, Bentivoglio, Italy
| | - Anna Erenbourg
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
42
|
Bacci A, Hodorogea S, Khachatryan H, Babojonova S, Irsa S, Jansone M, Dondiuc I, Matarazde G, Lazdane G, Lazzerini M. What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan. BMJ Open 2018; 8:e017696. [PMID: 29654004 PMCID: PMC5898291 DOI: 10.1136/bmjopen-2017-017696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. DESIGN Cross-sectional study. SETTINGS Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. ASSESSMENT TOOLS A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). RESULTS Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the 'inclusion of users' views' (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. CONCLUSIONS Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff's commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation.
Collapse
Affiliation(s)
- Alberta Bacci
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Stelian Hodorogea
- State Medical and Pharmaceutical University "N. Testemitanu", Chisinau, Moldova
| | | | | | - Signe Irsa
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | | | | | - Gunta Lazdane
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
43
|
Grüßner S, Lack N, Franz HBG, Berlage S. GerOSS (German Obstetric Surveillance System). Methods Inf Med 2018; 54:406-11. [DOI: 10.3414/me14-01-0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/13/2015] [Indexed: 01/07/2023]
Abstract
SummaryBackground: Severe and very rare obstetric complications (e.g. eclampsia, postpartum haemorrhage or uterine rupture), typically culminate in a chaotic, uncontrollable sequence of events. Outcome for mother and child depends on whether doctors and midwives are able to quickly take correct decisions and initiate optimal treatment.Objectives: GerOSS (German Obstetric Surveillance System) aims at generating deeper insight into relevant risk factors to improve diagnosis and treatment of severe complications during pregnancy and delivery. As such it is primarily conceived as a system for quality improvement and less as a register. Another focus is the provision of an information and communication platform for dissemination of these insights. Finally, incidences of selected rare obstetric events may be derived.Methods: These rare events are monitored for two to five years in Lower Saxony, Bavaria and Berlin. Quantitative analyses of aggregate data are complemented with in depth case based anonymised evaluations by experts. The temporal sequence of measures taken as well as the management of care is inspected. Participants receive a feedback of comments on the synopsis of individual cases. Aggregate data results are published and made available through the GerOSS platform. A scientific advisory committee ensures the link with the professional scientific bodies. A comparison within INOSS (International Network of Obstetric Survey Systems) allows additional insights into the treatment of obstetric rare diseases and complications. More reliable estimates of the incidence of such events can be computed and compared within a larger database.Results: Following the implementation in three federal states in Germany in 2010, participation in GerOSS-Project has increased to 100% of all hospitals with a delivery unit in Lower Saxony, 30% in Bavaria and 80% in Berlin. Feasibility of the project is shown by successful implementation of GerOSS. Quantitative analyses enable construction of risk profiles (e.g. for the prevalence of hysterectomies and uterine ruptures) such that tailored treatment algorithms may be derived. Age, body mass index and previous caesarean section are common risk factors when complications occur. Respective recommendations have not always been adhered to in the diagnosis and therapy of such cases. The presentation of initial GerOSS results has paved the path for first changes in obstetric care.Conclusions: The envisaged expansion of GerOSS to an interactive platform will allow dissemination of insights such that optimal obstetric care and transferal among all involved medical facilities may see future enhancements via the internet or even through smartphone applications.
Collapse
|
44
|
|
45
|
Cecatti JG, Silveira C, Souza RT, Fernandes KG, Surita FG. EXPERIENCE WITH THE BRAZILIAN NETWORK FOR STUDIES IN REPRODUCTIVE AND PERINATAL HEALTH: THE POWER OF COLLABORATION IN POSTGRADUATE PROGRAMS. Rev Col Bras Cir 2017; 42 Suppl 1:89-93. [PMID: 27437983 DOI: 10.1590/0100-69912015s01027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/12/2015] [Indexed: 12/11/2022] Open
Abstract
The scientific collaboration in networks may be developed among countries, academic institutions and among peer researchers. Once established, they contribute for knowledge dissemination and a strong structure for research in health. Several advantages are attributed to working in networks: the inclusion of a higher number of subjects in the studies; generation of stronger evidence with a higher representativeness of the population (secondary generalization and external validity); higher likelihood of articles derived from these studies to be accepted in high impact journals with a wide coverage; a higher likelihood of obtaining budgets for sponsorship; easier data collection on rare conditions; inclusions of subjects from different ethnic groups and cultures, among others. In Brazil, the Brazilian Network for Studies on Reproductive and Perinatal Health was created in 2008 with the initial purpose of developing a national network of scientific cooperation for the surveillance of severe maternal morbidity. Since the establishment of this Network, five studies were developed, some of them already finished and others almost being completed, and two new ones being implemented. Results of the activities in this Network have been very productive and with a positive impact on not only the Postgraduate Program of Obstetrics and Gynecology from the University of Campinas, its coordinating center, but also on other participating centers. A considerable number of scientific articles was published, master´s dissertations and PhD theses were presented, and post-doctorate programs were performed, including students from several areas of health, from distinct regions and from several institutions of the whole country. This represents a high social impact taking into account the relevance of the studied topics for the country. As colaborações científicas em rede podem ocorrer entre países, instituições acadêmicas e entre pares de pesquisadores e, uma vez estabelecidas, contribuem para a disseminação do conhecimento e estruturação da pesquisa em saúde. Diversas vantagens são atribuídas ao trabalho em rede como: a inclusão de maior número de participantes nos estudos; gerar evidências mais fortes e com maior representatividade da população (generalização secundária e validade externa); maior facilidade das publicações oriundas dos estudos serem aceitas em periódicos de impacto e abrangência; maior probabilidade de obtenção de verbas para financiamento; maior facilidade na coleta de dados sobre condições raras; inclusão de participantes de diferentes grupos étnicos e culturas, entre outras. No Brasil a Rede Brasileira de Estudos em Saúde Reprodutiva e Perinatal foi criada em 2008 com o objetivo inicial de desenvolver rede nacional de cooperação científica para vigilância da morbidade materna grave. Desde sua formação, cinco estudos foram desenvolvidos, alguns já encerrados e outros em fase de finalização, com outros dois em fase final de implantação. Os resultados das atividades desta Rede têm sido bastante produtivos e impactaram positivamente não apenas no Programa de Pós-Graduação em Tocoginecologia da Universidade Estadual de Campinas, seu centro coordenador, mas também o de outros centros participantes, uma vez que expressivo número de artigos científicos foi publicado, mestrados e doutorados foram defendidos e pós-doutorados finalizados, de alunos de diversas áreas da saúde, de diferentes regiões e de várias instituições de todo o país, com alto impacto social dada a relevância dos temas estudados para o país.
Collapse
Affiliation(s)
- José G Cecatti
- Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil
| | - Carla Silveira
- Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil
| | - Renato T Souza
- Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil
| | - Karayna G Fernandes
- Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil
| | - Fernanda G Surita
- Postgraduate Program in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medical Sciences, Campinas State University, Campinas, SP, Brazil
| |
Collapse
|
46
|
Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, van den Akker T. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG 2017; 126:394-401. [PMID: 28755459 DOI: 10.1111/1471-0528.14833] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN Electronic Delphi study. SETTING International. POPULATION Eight expert panels. METHODS All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES Definitions with a rate of agreement of more than 70%. RESULTS The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
Collapse
Affiliation(s)
- T Schaap
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Sullivan
- Australian Centre for Public and Population Health Research Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - T van den Akker
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | | |
Collapse
|
47
|
Ramler PI, van den Akker T, Henriquez DDCA, Zwart JJ, van Roosmalen J. Incidence, management and outcome of women requiring massive transfusion after childbirth in the Netherlands: secondary analysis of a nationwide cohort study between 2004 and 2006. BMC Pregnancy Childbirth 2017. [PMID: 28629440 PMCID: PMC5477228 DOI: 10.1186/s12884-017-1384-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Few population-based studies have examined the epidemiology of massive transfusion for postpartum hemorrhage. The aim of this study was to determine the incidence, management, and outcomes of women with postpartum hemorrhage who required massive transfusion in the Netherlands between 2004 and 2006. Methods Data for all women from a gestational age of 20 weeks onwards who had postpartum hemorrhage requiring eight or more red blood cell concentrates were obtained from a nationwide population-based cohort study including all 98 hospitals with a maternity unit in the Netherlands. Results Three hundred twenty-seven women who had postpartum hemorrhage requiring massive transfusion were identified (massive transfusion rate 91 per 100,000 deliveries (95% confidence interval: 81–101)). The median blood loss was 4500 mL (interquartile range 3250–6000 mL) and the median number of red blood cell concentrates transfused was 11 units (interquartile range 9–16 units). Among women receiving massive transfusion, the most common cause of hemorrhage was uterine atony. Eighty-three women (25%) underwent hysterectomy, 227 (69%) were admitted to an intensive care unit, and three women died (case fatality rate 0,9%). Conclusion The number of women in the Netherlands who had postpartum hemorrhage treated with massive transfusion was relatively high compared to other comparable settings. Evidence-based uniform management guidelines are necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1384-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Paul I Ramler
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands. .,Department of Obstetrics and Gynecology, Haaglanden Medical Center, The Hague, the Netherlands.
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Obstetrics and Gynecology, Haga Hospital, The Hague, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
| |
Collapse
|
48
|
Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2017; 128:1281-1294. [PMID: 27824773 DOI: 10.1097/aog.0000000000001736] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy across income settings. DATA SOURCES PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases up to March 30, 2015. METHODS OF STUDY SELECTION Studies including emergency peripartum hysterectomies performed within 6 weeks postpartum. Not eligible were comments, case reports, elective hysterectomies for associated gynecologic conditions, studies with fewer than 10 inclusions, and those reporting only percentages published in languages other than English or before 1980. Interstudy heterogeneity was assessed by χ test for heterogeneity; a random-effects model was applied whenever I exceeded 25%. TABULATION, INTEGRATION, AND RESULTS One hundred twenty-eight studies were selected, including 7,858 women who underwent emergency peripartum hysterectomy, of whom 87% were multiparous. Hysterectomy complicated almost 1 per 1,000 deliveries (range 0.2-10.1). Prevalence differed between poorer (low and lower middle income) and richer (upper middle and high income) settings: 2.8 compared with 0.7 per 1,000 deliveries, respectively (relative risk 4.2, 95% confidence interval [CI] 4.0-4.5). Most common indications were placental pathology (38%), uterine atony (27%), and uterine rupture (26%). Risk indicators included cesarean delivery in the current pregnancy (odds ratio [OR] 11.38, 95% CI 9.28-13.97), previous cesarean delivery (OR 7.5, 95% CI 5.1-11.0), older age (mean difference 6.6 years between women in the case group and those in the control group, 95% CI 4.4-8.9), and higher parity (mean difference 1.4, 95% CI 0.7-2.2). Having attended antenatal care was protective (OR 0.12, 95% CI 0.06-0.25). Only 3% had accessed arterial embolization to prevent hysterectomy. Average blood loss was 3.7 L. Mortality was 5.2 per 100 hysterectomies (reported range 0-59.1) and higher in poorer settings: 11.9 compared with 2.5 per 100 hysterectomies (relative risk 4.8, 95% CI 3.9-5.9). CONCLUSION Emergency peripartum hysterectomy is associated with considerable morbidity and mortality and is more frequent in lower-income countries, where it contains a higher risk of mortality. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.
Collapse
|
49
|
MacDonald EJ, Geller SE, Lawton B. Establishment of a national severe maternal morbidity preventability review in New Zealand. Int J Gynaecol Obstet 2016; 135:120-3. [DOI: 10.1016/j.ijgo.2016.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/16/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022]
|
50
|
Sentilhes L, Goffinet F, Vayssière C, Deneux-Tharaux C. Comparison of postpartum haemorrhage guidelines: discrepancies underline our lack of knowledge. BJOG 2016; 124:718-722. [DOI: 10.1111/1471-0528.14305] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L Sentilhes
- Department of Obstetrics and Gynaecology; Bordeaux University Hospital; Bordeaux France
| | - F Goffinet
- INSERM U1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks and Pregnancy; Paris Descartes University; Paris France
- Port-Royal Maternity Unit; Cochin Broca Hôtel-Dieu University Hospital; APHP; Paris Descartes University; Paris France
| | - C Vayssière
- Department of Obstetrics and Gynaecology; Paule de Viguier University Hospital; Toulouse France
- UMR 1027 Inserm Toulouse III University ‘Epidémiologie Périnatale et handicap de l'enfant, Santé des adolescents’; Toulouse France
| | - C Deneux-Tharaux
- INSERM U1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks and Pregnancy; Paris Descartes University; Paris France
| |
Collapse
|