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Walker C, Begum T, Boyle JA, Ward J, Barzi F. Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:345. [PMID: 38541344 PMCID: PMC10969840 DOI: 10.3390/ijerph21030345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States. METHODS This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis. RESULTS We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%). CONCLUSIONS While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.
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Affiliation(s)
- Clara Walker
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Tahmina Begum
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Jacqueline A Boyle
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Federica Barzi
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
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Shah N, Mehta V. Obese Parturient: A Modern-Day Obstetric Challenge. Cureus 2023; 15:e39958. [PMID: 37416027 PMCID: PMC10320224 DOI: 10.7759/cureus.39958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Obesity has become a growing pandemic with a significant increase in incidence in recent years. The complications associated with pregnancy in obese patients can lead to increased morbidity and mortality in pregnant women. A 41-year-old morbidly obese female with primary hypertension and 32.4 weeks pregnant, presented with severe oligohydramnios, breech presentation, and a history of previous lower segment cesarean section (LSCS). The patient experienced abdominal pain, lower backache, and leaking per vaginal, and a decision was made to perform LSCS. Challenges were encountered during the procedure related to anesthesia management and the need for specialized equipment and additional assistants. A multidisciplinary approach was chosen for managing this patient with the special role of anesthetists. Intra-operative and post-operative management was crucial for a successful recovery. Obesity during pregnancy presents unique challenges for healthcare providers, and it is necessary to increase resources and prepare skilfully to manage these patients effectively.
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Affiliation(s)
- Nehal Shah
- Obstetrics and Gynecology, Lokmanya Tilak Municipal General Hospital, Mumbai, IND
| | - Varshil Mehta
- Genitourinary Medicine, Northwick Park Hospital, London, GBR
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Jorgensen K, Nitecki R, Nichols HB, Fu S, Wu CF, Melamed A, Brady P, Chavez Mac Gregor M, Clapp MA, Giordano S, Rauh-Hain JA. Obstetric and Neonatal Outcomes 1 or More Years After a Diagnosis of Breast Cancer. Obstet Gynecol 2022; 140:939-949. [PMID: 36357983 PMCID: PMC9712170 DOI: 10.1097/aog.0000000000004936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate obstetric and neonatal outcomes of the first live birth conceived 1 or more years after breast cancer diagnosis. METHODS We performed a population-based study to compare live births between women with a history of breast cancer (case group) and matched women with no cancer history (control group). Individuals in the case and control groups were identified using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development data sets. Individuals in the case group were diagnosed with stage I-III breast cancer at age 18-45 years between January 1, 2000, and December 31, 2012, and conceived 12 or more months after breast cancer diagnosis. Individuals in the control group were covariate-matched women without a history of breast cancer who delivered during 2000-2012. The primary outcome was preterm birth at less than 37 weeks of gestation. Secondary outcomes were preterm birth at less than 32 weeks of gestation, small for gestational age (SGA), cesarean delivery, severe maternal morbidity, and neonatal morbidity. Subgroup analyses were used to assess the effect of time from initial treatment to fertilization and receipt of additional adjuvant therapy before pregnancy on outcomes of interest. RESULTS Of 30,021 women aged 18-45 years diagnosed with stage I-III breast cancer during 2000-2012, 553 met the study inclusion criteria. Those with a history of breast cancer and matched women in the control group had similar odds of preterm birth at less than 37 weeks of gestation (odds ratio [OR], 1.29; 95% CI 0.95-1.74), preterm birth at less than 32 weeks of gestation (OR 0.77; 95% CI 0.34-1.79), delivering an SGA neonate (less than the 5th percentile: OR 0.60; 95% CI 0.35-1.03; less than the 10th percentile: OR 0.94; 95% CI 0.68-1.30), and experiencing severe maternal morbidity (OR 1.61; 95% CI 0.74-3.50). Patients with a history of breast cancer had higher odds of undergoing cesarean delivery (OR 1.25; 95% CI 1.03-1.53); however, their offspring did not have increased odds of neonatal morbidity compared with women in the control group (OR 1.15; 95% CI 0.81-1.62). CONCLUSION Breast cancer 1 or more years before fertilization was not strongly associated with obstetric and neonatal complications.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, the Department of Breast Oncology, the Department of Health Services Research, and the Division of Cancer Prevention and Population Sciences, the University of Texas MD Anderson Cancer Center, and the University of Texas Health Science Center at Houston, Houston, Texas; the UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NewYork-Presbyterian/Columbia University Medical Center, and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; and the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Program, Massachusetts General Hospital, Boston, Massachusetts
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Racial and Ethnic Inequities in Cesarean Birth and Maternal Morbidity in a Low-Risk, Nulliparous Cohort. Obstet Gynecol 2022; 139:73-82. [PMID: 34856577 PMCID: PMC8678297 DOI: 10.1097/aog.0000000000004620] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term. METHODS We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth. Secondary outcome was maternal morbidity, defined as: transfusion of 4 or more units of red blood cells, any transfusion of other products, postpartum infection, intensive care unit admission, hysterectomy, venous thromboembolism, or maternal death. Multivariable modified Poisson regression was used to evaluate associations between race and ethnicity, cesarean birth, and maternal morbidity. Indication for cesarean birth was assessed using multivariable multinomial logistic regression. A mediation model was used to estimate the portion of maternal morbidity attributable to cesarean birth by race and ethnicity. RESULTS Of 5,759 included participants, 1,158 (20.1%) underwent cesarean birth; 1,404 (24.3%) identified as non-Hispanic Black, 1,670 (29.0%) as Hispanic, and 2,685 (46.6%) as non-Hispanic White. Adjusted models showed increased relative risk of cesarean birth among non-Hispanic Black (adjusted relative risk [aRR] 1.21, 95% CI 1.03-1.42) and Hispanic (aRR 1.26, 95% CI 1.08-1.46) people compared with non-Hispanic White people. Maternal morbidity affected 132 (2.3%) individuals, and was increased among non-Hispanic Black (aRR 2.05, 95% CI 1.21-3.47) and Hispanic (aRR 1.92, 95% CI 1.17-3.14) people compared with non-Hispanic White people. Cesarean birth accounted for an estimated 15.8% (95% CI 2.1-48.7%) and 16.5% (95% CI 4.0-44.0%) of excess maternal morbidity among non-Hispanic Black and Hispanic people, respectively. CONCLUSION Non-Hispanic Black and Hispanic nulliparous people who are low-risk at term undergo cesarean birth more frequently than low-risk non-Hispanic White nulliparous people. This difference accounts for a modest portion of excess maternal morbidity.
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Alemu AA, Zeleke LB. <p>Magnitude and Determinants of Primary Cesarean Section Among Women Who Gave Birth in Shire, Northern Ethiopia</p>. OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s254758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Caesarean sections are associated with sonographic determined fetal size from the second trimester onwards. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Human birth represents a critical and life-threatening event in the life of mother and child and is therefore of special importance for anthropological as well as public health research.
Study aims: to analyze the association patterns between fetal biometry and delivery modes from the first trimester onwards.
In this electronic medical record-based study, a dataset of 3408 singleton term birth taking place at the Viennese Danube hospital in Austria. was analyzed. Fetal biometry was reconstructed by the results of three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33thweek of gestation. In detail, crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal trans-verse diameter, abdominal sagittal diameter, abdominal circumference, and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. Four delivery modes were compared: spontaneous vaginal birth, instrumental vaginal birth, planned cesarean section and emergency cesarean section.
The total cesarean section rate was 10.2%. Fetal biometry and newborn size differed significantly between the four delivery modes. From the second trimester onward, head circumferences were significantly larger (p=0.005) among fetuses delivered by instrumental delivery or emergency cesarean section than among fetuses delivered by spontaneous vaginal birth. The fetal abdominal dimensions during the third trimester were significantly largest (p=0.001) among fetuses delivered by emergency cesarean section. In comparison to spontaneous vaginal delivery the risk to require instrumental delivery increased significantly with increasing fetal head dimensions at the second (p=0.019) and third trimester(p=0.032) independent of maternal somatic factors. The risk of emergency CS increased significantly with increasing head dimensions (p=0.030) as well as abdominal dimensions (p=0.001) at the third trimester and newborn size (p=0.002), also independently of maternal somatic factors.
In general, larger fetuses are on an increased risk of experiencing instrumental delivery or emergency caesarean section. This association between fetal size and delivery mode is detectable from the second trimester onwards.
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Adverse Maternal Metabolic Intrauterine Environment and Placental Epigenetics: Implications for Fetal Metabolic Programming. Curr Environ Health Rep 2019; 5:531-543. [PMID: 30267228 DOI: 10.1007/s40572-018-0217-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Herein, we summarize existent epidemiological studies relating adverse maternal metabolic environments of maternal obesity and gestational diabetes and placental DNA methylation. RECENT FINDINGS Multiple studies have evaluated associations between intrauterine exposure to gestational diabetes and/or maternal glucose levels and DNA methylation at candidate metabolic genes as well as in epigenome-wide studies. Some of the genomic regions more consistently associated include lipid-related genes (LPL and PPARGC1A), the major histocompatibility complex (MHC), and imprinted genes. Studies solely focused on maternal obesity influences on the placental epigenome are scarce. Understanding the placental mechanisms involved in fetal metabolic programming could lead to discovery of placental biomarkers at birth that predict later-life metabolic risk. Moving forward is important to standardize methods utilized in epigenetics research; consistent methodology can help interpret disparate findings. Larger studies with longitudinal follow-up are needed to address future challenges in fetal programming research.
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Starnes SE, Nardi F, Fitchev P, Plunkett BA, Thorpe C, Wang CH, Vogler C, Crawford SE. Influence of maternal obesity and metabolic and vascular mediators in twin-twin transfusion syndrome. Reprod Biol 2019; 19:165-172. [PMID: 31147266 DOI: 10.1016/j.repbio.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Obesity is a risk factor for complications in singleton and twin pregnancies; however, there are limited data regarding maternal body mass index (BMI) in the setting of twin-twin transfusion syndrome (TTTS). We hypothesized that increased BMI in TTTS is associated with adverse perinatal outcomes and vascular pathology. A retrospective study of twin reversed arterial perfusion (n = 4), selective intrauterine growth restriction (n = 10) and TTTS (n = 33) was conducted. Treatment included fetoscopic laser photocoagulation (FLP) (n = 35) or Solomon technique (n = 12). Ex vivo placental intravascular injections, immunohistochemistry, and perinatal outcomes were compared by maternal BMI. In pregnancy complicated by TTTS, 16/33 women were obese (BMI > 30 kg/m2) and 11/33 were overweight (BMI 25-29.9 kg/m2). Women who were overweight or obese had an increased rate of premature rupture of membranes (PPROM), cesarean delivery, and/or concomitant co-morbidities when compared to the normal weight group. Duration of neonatal intensive care unit (NICU) admission was longer in neonates of overweight/obese women versus normal weight. Placental examination of FLP sites in the obese group showed larger infarcts, increased adipose triglyceride lipase, and a proangiogenic phenotype. Increased BMI is common in our TTTS cohort and it is associated with higher rate of co-morbidity, PPROM, prolonged NICU stay, and an imbalance of placental metabolic and vascular mediators.
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Affiliation(s)
- Sarah E Starnes
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, 63103, United States
| | - Francesca Nardi
- Department of Surgery, NorthShore University Research Institute, Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, 60201, United States
| | - Philip Fitchev
- Department of Surgery, NorthShore University Research Institute, Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, 60201, United States
| | - Beth A Plunkett
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, NorthShore University, Evanston, IL, 60201, United States
| | - Constance Thorpe
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, 63103, United States
| | - Chi-Hsung Wang
- Center for Bioinformatics and Computational Biology, NorthShore University Research Institute, Evanston, IL, 60201, United States
| | - Carole Vogler
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, 63103, United States
| | - Susan E Crawford
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, 63103, United States; Department of Surgery, NorthShore University Research Institute, Affiliate of University of Chicago Pritzker School of Medicine, Evanston, IL, 60201, United States.
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Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise-Does advanced maternal age explain the increase? A population register-based study. PLoS One 2019; 14:e0210655. [PMID: 30677047 PMCID: PMC6345458 DOI: 10.1371/journal.pone.0210655] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
Abstract
Background In Denmark, the cesarean section rate has increased by 49% between 1998 and 2015 and accounts for 21% of all births. Cesarean sections may cause short- as well as long-term consequences for both the mother and the child and impose further risks in future pregnancies. Delaying pregnancy until advanced maternal age at childbirth has been suggested as contributing to the increase. The proportion of women giving birth at 35 years or above increased from 15% (1998) to 21% (2015). Advanced maternal age at childbirth has been found to be related to increased pre-pregnancy morbidity and associated risk factors that may contribute to an increased risk of cesarean section. The aim of this study was to examine the association between advanced maternal age and cesarean section in a Danish population and the influence of demographic, anthropometric, health, and obstetric factors on this association. Methods This study draws on a national population-based cohort study of all Danish births between 1998 and 2015 (N = 1,122,964). Maternal age less than 30 years serves as reference with the following age categories: (30–34 years); (35–39 years), and (40 years and above). The primary outcome was a cesarean section. Multivariate regression models with adjustment for demographic, health, pregnancy, fetal, and obstetric characteristics were performed with the results further stratified by parity. Results In general, a positive association between advanced maternal age and cesarean section was found. Only minor changes in the risk estimate occurred after adjustment for relevant confounders. In comparison with the reference category, nulliparous women aged 35-39- years had twice the risk for cesarean section (adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) [2.11–2.26]) whereas for women of 40 years or above, the risk was more than tripled (AOR 3.64, 95% CI [3.41–3.90]). For multiparous women aged 35-39-years the risk was more moderate, but still with an AOR of 1.56, 95% CI [1.53–1.60], and for those 40 years and above, the AOR was 2.02, 95% CI [1.92–2.09]. Conclusions Overall, cesarean section increased with increasing maternal age. Adjustment for maternal and obstetric risk factors had only a minor influence on the association. The association was stronger in nulliparous women compared to multiparous women. Given the lack of impact of demographic and health risks on the relationship between maternal age and cesarean section, the authors suggest obstetric culture could be added to the list of risk factors for a cesarean. Future research on obstetric culture is recommended as are studies on a possible age-related decrease in the ability to maintain the progression of labor. Trial registration The study uses depersonalized register data and has been approved by the Danish Data Protection Agency (2015-41-4168).
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Affiliation(s)
- Eva Rydahl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Mette Juhl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Ancel J, Rault E, Fernandez MP, Huissoud C, Savidan A, Gaire C, Dupont C, Rudigoz RC. When can obstetric risk be predicted? J Gynecol Obstet Hum Reprod 2018; 48:179-186. [PMID: 30580069 DOI: 10.1016/j.jogoh.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the study was to assess the chronology of the appearance of perpartum obstetric risk factors (POR) in order to define the best moment to evaluate the type of management to which women will be oriented. We have secondarily studied the extent to which inappropriate medical interventions play a role in the genesis of some complications in the deliveries of women who are in principle at low risk. MATERIALS AND METHODS We conducted a prospective cohort study from January 1 to June 30, 2015 at the Croix-Rousse Hospital of Lyon, a level III maternity, and the Valence Hospital Center, a level II maternity, including all women giving birth at 24 to 42 weeks of gestation at hospital. The women were divided into two groups : one with no known perpartum obstetric risk (POR-) and the other with at least one obstetrical perpartum risk factor (POR+), defined at three different stages (at the last pregnancy monitoring consultation, at the onset of labor at the admission in the delivery room, and at the end of labor just before expulsive efforts). We observed medical interventions and foeto-maternal complications in each group. A non-simple delivery was a delivery involving a medical intervention, or a maternal or neonatal complication, or any combination of these. A secondary retrospective analysis of the practices and management was made for women initially considered POR- at the onset of labor but who had a non-simple delivery to assess adherence to current guidelines according to an audit schedule. RESULTS Among 1975 women, we identified 32% women as POR- at end of pregnancy, 21% at start of labor and 20% at end of labor. Among the POR- women at start of labor, 16% had a non-simple delivery. 35% of these non-simple deliveries might perhaps have been avoided by closer adherence to current recommendations. Nonetheless 54% of these women still had an unpredictable and inevitable non-simple delivery that in some cases required an extremely rapid intervention. CONCLUSION Determining and predicting pregnant women who will need additional resources in addition to the usual obstetric and neonatal care is difficult. This identification should be made at the admission for delivery and this risk should be reassessed during labor. There are no women at zero risk of intervention. Therefore, delivery in demedicalized units should not take place in isolated or distant free-standing facilities.
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Affiliation(s)
- Julie Ancel
- Service de gynécologie obstétrique CH de la Croix Rousse, France.
| | - Emmanuel Rault
- Service de gynécologie obstétrique CH de Valence, France
| | | | - Cyril Huissoud
- Service de gynécologie obstétrique CH de la Croix Rousse, France
| | - Anne Savidan
- Service de gynécologie obstétrique CH de Valence, France
| | - Coralie Gaire
- Service de gynécologie obstétrique CH de Valence, France
| | | | - R C Rudigoz
- Service de gynécologie obstétrique CH de la Croix Rousse, France
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Morris T, McNamara K, Morton CH. Hospital-ownership status and cesareans in the United States: The effect of for-profit hospitals. Birth 2017; 44:325-330. [PMID: 28737270 DOI: 10.1111/birt.12299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the increasing proportion of United States hospitals that are for-profit, we examined whether women who give birth in for-profit hospitals are more likely to have cesareans than women who give birth in not-for-profit hospitals. We hypothesized that cesareans are more likely to occur in for-profit hospitals because of the organizational emphasis on short-term financial indicators, including payment of shareholder dividends. METHODS We used logistic regression and difference of means tests to analyze data from the Listening to Mothers III survey of women who gave birth in the United States in 2011 and 2012. RESULTS Controlling for patient-level characteristics, we found that the odds of a woman's having a cesarean were two times higher in for-profit hospitals than in not-for-profit hospitals. We also found for-profit hospitals were significantly more likely to be members of multihospital systems and to have fewer full-time registered nurses and staff members per hospital bed. CONCLUSION This research suggests that women who give birth in for-profit hospitals are more likely to have cesareans than women who give birth in not-for-profit hospitals. This information is important to women when deciding where to give birth. Knowing which hospital characteristics are associated with a greater likelihood of cesarean is helpful since hospital cesarean rates may be difficult to find. These findings are also informative for obstetric professionals, who can implement improvement initiatives to decrease cesarean rates and improve the overall quality of care for childbearing women in the United States.
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Affiliation(s)
- Theresa Morris
- Department of Sociology, Texas A&M University, College Station, TX, USA
| | - Kelly McNamara
- Department of Sociology, Texas A&M University, College Station, TX, USA
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Foo XY, Greer RM, Kumar S. Impact of Maternal Body Mass Index on Intrapartum and Neonatal Outcomes in Brisbane, Australia, 2007 to 2013. Birth 2016; 43:358-365. [PMID: 27500501 DOI: 10.1111/birt.12246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of maternal body mass index on intrapartum and neonatal outcomes at one of the largest maternity hospitals in Australia. METHODS A retrospective cross-sectional study of 55,352 term singleton deliveries at the Mater Mothers' Hospital in Brisbane, Australia, was conducted. The study cohort was stratified into six groups based on the World Health Organization's body mass index classification. The normal body mass index category was the reference group for all comparisons. Multivariate logistic regression was used to examine the effect of maternal body mass index, adjusted for maternal age, ethnicity, parity, and preexisting conditions (e.g., diabetes mellitus and hypertension), on selected intrapartum and neonatal outcomes. RESULTS Women in the overweight and Obese I, II, and III categories were more likely to have chronic or gestational hypertension/preeclampsia, and preexisting or gestational diabetes mellitus. They also had an increased risk for induction of labor, elective and emergency cesarean, and postpartum hemorrhage. Underweight women were less likely to require induction of labor and emergency cesarean. Infants born to women with increased body mass index were more likely to require neonatal resuscitation, neonatal intensive care unit admission, and have lower Apgar scores at 5 minutes. CONCLUSION There is an increased risk of adverse intrapartum and neonatal outcomes for women who are overweight and obese, with the risks increasing with rising body mass index. Appropriately targeted weight management strategies and health education may yield improved maternal and perinatal outcomes if effectively implemented before pregnancy. These may particularly be of benefit in the teenage cohort that has yet to embark on pregnancy.
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Affiliation(s)
- Xin Y Foo
- Mater Mothers' Hospital, South Brisbane, Qld., Australia
| | - Ristan M Greer
- Mater Research Institute - University of Queensland, South Brisbane, Qld., 4101, Australia
| | - Sailesh Kumar
- Mater Mothers' Hospital, South Brisbane, Qld., Australia.,Mater Research Institute - University of Queensland, South Brisbane, Qld., 4101, Australia.,School of Medicine, Herston, Brisbane, Qld., Australia
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