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Yeşil Y, Gündüz Ü, Dönmez A, Paşa S. Evaluation of Prenatal Comfort, Sleep, and Quality of Life in Pregnant Women with Cholestasis: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1399. [PMID: 39057542 PMCID: PMC11276272 DOI: 10.3390/healthcare12141399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Associated with adverse pregnancy outcomes, intrahepatic cholestasis of pregnancy is the most prevalent liver disease that women typically experience during pregnancy. This study aimed to evaluate prenatal comfort, sleep, and quality of life in pregnant women with cholestasis. METHODS This cross-sectional study was implemented between November 2022 and June 2023 at Mardin Training and Research Hospital with 150 pregnant women who received a diagnosis of pregnancy-induced intrahepatic cholestasis and agreed to participate. The following tools were utilized to collect data: A personal information form exploring socio-demographic and obstetric characteristics of participants, the Prenatal Comfort Scale (PCS), the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF). RESULTS The mean age of participants was 27.79 ± 6.33 years. The mean PCS and PSQI scores were 61.20 ± 5.84 and 9.52 ± 3.02, respectively. The mean scores of "physical health, psychological health, social relationships, and environmental health" sub-dimensions in WHOQOL-BREF were 10.63 ± 2.18, 10.48 ± 2.10, 11.31 ± 3.28, and 11.27 ± 2.10, respectively. A significant difference was found for PSQI regarding hospitalization status and change in sleep quality variables (p = 0.025 and p = 0.035, respectively). CONCLUSIONS Cholestasis of pregnancy creates problems such as pruritus, body image changes, hospitalization, and poor sleep quality in women. This study showed that pregnant women with cholestasis had low levels of sleep quality and quality of life, implying that cholestasis affects their sleep quality, prenatal comfort levels, and quality of life in general. In addition, it is seen that women with this problem do not want to fall pregnant again.
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Affiliation(s)
- Yeşim Yeşil
- Department of Midwifery, Faculty of Health Sciences, Mardin Artuklu University, 47100 Mardin, Turkey;
| | - Ülkin Gündüz
- Department of Midwifery, Faculty of Health Sciences, Mardin Artuklu University, 47100 Mardin, Turkey;
| | - Ayşegül Dönmez
- Department of Midwifery, Faculty of Health Sciences, İzmir Tınaztepe University, 35400 İzmir, Turkey;
| | - Semir Paşa
- Medikal Park Çanakkale Hospital, 17020 Çanakkale, Turkey;
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Boutib A, Chergaoui S, Azizi A, Achak D, Saad EM, Hilali A, Nejjari C, Youlyouz-Marfak I, Marfak A. Health-related quality of life among Moroccan women after vaginal birth and cesarean section: Cross-sectional study. Heliyon 2024; 10:e32276. [PMID: 38873689 PMCID: PMC11170132 DOI: 10.1016/j.heliyon.2024.e32276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
Background During the postpartum period, understanding women's well-being, specifically their Health-related Quality of Life (HRQoL), is vital for comprehensive healthcare. Objectives Our study aims to explore the HRQoL and its associated factors in Moroccan women after vaginal birth (VB) and cesarean section (CS). Study design In this cross-sectional study we assessed the HRQoL and its associated factors among Moroccan women who gave birth at the provincial hospital center of Settat. We gathered data from 566 women, using the EQ-5D-5L instrument alongside questionnaires about socioeconomic and obstetrical aspects. The assessment was conducted utilizing the improved Relative to an Identified Distribution (RIDIT) approach, and we employed a multiple linear regression model to pinpoint the associated factors. Results A total of 566 women were included in our study. Our results revealed that the HRQoL in women who underwent CS was significantly lower than in VB women (EQ-5D index score = 0.30 ± 0.28 vs 0.61 ± 0.31; p < 0.0001). Similarly, the CS reduced the EQ-VAS score (mean difference = -10.73 ± 3.78; p < 0.0001). The CS was associated negatively with problems in mobility (ARI = 55 % [42-67], p < 0.0001), autonomy (ARI = 67 % [57-80], p < 0.0001), and usual activities (ARI = 56 % [42-69], p < 0.0001). Also, CS was associated with pain/discomfort (ARI = 47 % [34-60], p < 0.0001) and anxiety/depression (ARI = 3 % [-5.8-12.6], p = 0.31). The women who had birth complications had the worst HRQoL (EQ-5D index score = 0.32) compared to those who had no complications (EQ-5D index score = 0.56). Likewise, women who had postpartum complications had the worst HRQoL (EQ-5D index score = 0.39 vs EQ-5D index score = 0.54). Conclusion The results highlighted that mode of birth, childbirth complications, and postpartum complications are strongly associated with women's HRQoL. The EQ-5D-5L dimensions were affected after delivery. Hence, there is a requirement to create specialized initiatives for overseeing postpartum HRQoL, aiming to enhance the quality of maternal healthcare.
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Affiliation(s)
- Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Asmaa Azizi
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Doha Achak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - El Madani Saad
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Chakib Nejjari
- Euro-Mediterranean University of Fez (UEMF), Fez, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, 26000, Settat, Morocco
| | - Abdelghafour Marfak
- Euro-Mediterranean University of Fez (UEMF), Fez, Morocco
- National School of Public Health, Ministry of Health and Social Protection, Rabat, Morocco
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Amana IG, Tefera EG, Chaka EE, Bulto GA. Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study. BMC Womens Health 2024; 24:79. [PMID: 38297361 PMCID: PMC10829299 DOI: 10.1186/s12905-024-02918-2] [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: 07/25/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Promoting a favorable experience of postpartum care has become increasingly emphasized over recent years. Despite the fact that maternal health care services have improved over the years, postnatal care service utilization is generally low and the health-related quality of life of postpartum women remains overlooked. Furthermore, the health-related quality of life of postpartum women is not well studied. Therefore, this study aimed to assess the health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia, Region, Ethiopia. METHODS A community-based cross-sectional study was conducted among 429 participants. A multistage stratified sampling procedure was used to select the sampling unit and simple random sampling technique was employed to select the study participants from 23 August 2022 to 16 November 2022. A pre-tested standard structured questionnaire was used to collect the data. Data were entered using Epi-Data 3.1 and then exported to Statistical package for social science version 26. Binary logistic regression analysis was computed at p-value < 0.25 were considered candidates for multivariable logistic regression. Adjusted Odds Ratios (AOR) with 95% confidence interval and statistical significance was declared at a p-value < 0.05. RESULTS The study revealed that 73.7% (95% CI: 69.4-77.7) had a low level of health-related quality-of-life with a mean of 44.02 (SD ± 10.4). Urban residing [AOR = 0.27, 95% CI: (0.10-0.74)], no education [AOR = 3.44, 95% CI (1.35-8.74)], received at least four antenatal contact [AOR = 0.56, 95% CI (0.33-0.95)], received at least one postnatal care [AOR = 0.30, 95% CI (0.14-0.62)], poor social support [AOR = 2.23, 95% CI: (1.025-4.893)], having postpartum depression [AOR = 2.99, 95% CI: (1.52-5.56)], cesarean delivery [AOR = 3.18, 95% CI: (1.09-9.26)], and lowest household assets [AOR = 5.68, 95% CI: (2.74-11.76)] were significant associations with low health-related quality of life of postpartum women. CONCLUSIONS The health-related quality of life among postpartum women was very low. Postpartum women with low socio-economic status and inadequate maternal health service utilization had a low health-related quality of life. Promoting women's education and postnatal care services is needed to improve the health-related quality of life of postpartum women.
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Affiliation(s)
| | | | - Eshetu Ejeta Chaka
- Department of Public Health, Ambo University, Ambo, Oromia Region, Ethiopia
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Bakhbakhi D, Siassakos D, Davies A, Merriel A, Barnard K, Stead E, Shakespeare C, Duffy JMN, Hinton L, McDowell K, Lyons A, Fraser A, Burden C. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set. BJOG 2023; 130:560-576. [PMID: 36655361 DOI: 10.1111/1471-0528.17390] [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: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. OBJECTIVES To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. SEARCH STRATEGY Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. SELECTION CRITERIA Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. DATA COLLECTION AND ANALYSIS Interventions, outcomes reported, definitions and outcome measurement tools were extracted. MAIN RESULTS Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome. CONCLUSIONS Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
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Affiliation(s)
| | | | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | | | - Emma Stead
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Anna Lyons
- Northern General Hospital, Sheffield, UK
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Ilska M, Kołodziej-Zaleska A, Banaś-Fiebrich E, Brandt-Salmeri A, Janowska-Tyc E, Łyszczarz A, Rzewiczok J, Piela B, Cnota W. Health-Related Quality-of-Life among Pregnant Women after First, Second, and Multiple Cesarean Sections in the Perinatal Period: A Short-Term Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16747. [PMID: 36554628 PMCID: PMC9779739 DOI: 10.3390/ijerph192416747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The primary objective of this study was to compare assessments of health-related quality-of-life (HRQoL) in women who had a medical qualification for cesarean section (CS), depending on the number of CSs in their medical history. A short longitudinal study was conducted among 115 women on the day before a planned cesarean section (CS)-T1, and on the third day after CS-T2. They were divided into three groups. G1: no CS (n = 17); G2: one CS (n = 34); G3: two or more CSs (n = 64). Participants completed a set of questionnaires concerning sociodemographic aspects and psychological outcomes: the HRQoL questionnaire (EQ-5D-3L). A chi-square test, McNemar's test, and repeated measures ANOVA were used to compare the three groups in T1 and T2. Regardless of the number of CSs, before a CS, women mainly experience health problems with pain and anxiety/depression, and after a CS, mostly problems with pain, usual activity, and mobility. All participants experienced an increase in the amount of health problems with mobility and pain after a CS. Women who have had two or more CSs also had problems with self-care and usual activities. Women who have had one or two CSs experienced a decrease in the general assessment of the HRQoL, which is not observed in the group of women with multiple CSs. However, the HRQoL of women in the group with multiple CSs was lower before the CS than in the other groups. The results indicated the significance of the number of CSs, not only in postoperative, but also in preoperative HRQoL.
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Affiliation(s)
- Michalina Ilska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Anna Kołodziej-Zaleska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Ewa Banaś-Fiebrich
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Anna Brandt-Salmeri
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland
| | - Ewa Janowska-Tyc
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Anna Łyszczarz
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Justina Rzewiczok
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Bogusława Piela
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
| | - Wojciech Cnota
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Ślaska, Medical University of Silesia, W. Lipa Street 2, 41-703 Ruda Śląska, Poland
- Faculty of Health Sciences in Katowice, Medical University of Silesia, 41-703 Ruda Śląska, Poland
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Davis DL, Wu C, Brown WJ, Nohr EA. Parity and mode of birth and their relationships with quality of life: A longitudinal study. PLoS One 2022; 17:e0273366. [PMID: 36084030 PMCID: PMC9462673 DOI: 10.1371/journal.pone.0273366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.
Design
Prospective cohort study
Setting
Australia
r sample
A total of 7770 women participating in the 1973–1978 cohort of the Longitudinal Study of Women’s Health.
Methods
Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.
Main outcome measure
Quality of Life as measured by the SF36
Results
Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).
Conclusions
Parity and mode of birth may have long-term implications for women’s physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.
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Affiliation(s)
- Deborah L. Davis
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- ACT Government Health Directorate, Canberra, ACT, Australia
- * E-mail:
| | - Chunsen Wu
- Department of Clinical Research, Research Unit for Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Ellen A. Nohr
- Department of Clinical Research, Research Unit for Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
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Minuye Birhane B, Alebachew Bayih W, Chanie M, Awoke G, Simegn A, Asnakew S, Mamuye M, Yeshambel A, Muche T, Demis A, Munye T, Endalamaw A, Eshetie Y, Kefale D, Chanie ES, Mengesha Yalew Z, Mesfin Belay D. Home based postpartum care and determinants in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0272489. [PMID: 36007086 PMCID: PMC9409559 DOI: 10.1371/journal.pone.0272489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia. Methods A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care. Conclusion Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother’s knowledge about neonatal danger sign.
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Affiliation(s)
| | | | - Muluken Chanie
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Getaneh Awoke
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Amare Simegn
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis
- College of Health Sciences, Woldia University, Ethiopia
| | - Tigabu Munye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- School of Health Sciences, College Medicine and Health Sciences, Bahirdar University, Bahirdar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yeshambew Eshetie
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Zemen Mengesha Yalew
- Department Comprehensive Nursing, College of Health Sciences, Wollo University, Ethiopia
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Evans K, Fraser H, Uthman O, Osokogu O, Johnson S, Al-Khudairy L. The effect of mode of delivery on health-related quality-of-life in mothers: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:149. [PMID: 35193505 PMCID: PMC8864819 DOI: 10.1186/s12884-022-04473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research is inconclusive on the effects of mode of delivery on maternal health-related quality-of-life (HRQoL). We conducted a systematic review and meta-analysis to assess the current evidence for associations between mode of delivery and postpartum health-related quality-of-life. METHODS Electronic databases MEDLINE ALL (OVID), Web of Science, The Cochrane Library, CINAHL and EMBASE (OVID) were searched for English written articles investigating the relationship between mode of delivery and quality-of-life published form inception to 15th October 2020. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data. Meta-analysis was conducted where possible. RESULTS Twenty-one studies, including 19,879 women, met the inclusion criteria. A meta-analysis of 18 studies found HRQoL scores were significantly higher for women after vaginal delivery in comparison to caesarean (emergency and elective combined) (Effect Size (ES) 0.17, 95% CI 0.01-0.25, n = 7665) with highest scores after assisted vaginal delivery (ES 0.21, 95% CI 0.13-0.30, n = 2547). Physical functioning (ES 11.18, 95% CI = 2.29-20.06, n = 1746), physical role (ES 13.10, 95% CI = 1.16-25.05, n = 1471), vitality (ES 6.31, 95% CI = 1.14-10.29, n = 1746) and social functioning (ES 5.69, 95% CI = 1.26-10.11, n = 1746) were significantly higher after vaginal delivery compared to caesarean. CONCLUSIONS Health-related quality-of-life scores were higher for women after vaginal delivery in comparison to caesarean section. Consequently, women should be encouraged to deliver vaginally where possible. The findings of this research should be available to the relevant population to help support informed choice.
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Affiliation(s)
- Kate Evans
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England.
| | - Hannah Fraser
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Olalekan Uthman
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Osemeke Osokogu
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Samantha Johnson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Lena Al-Khudairy
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
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9
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Chilkoti G, Gaur D, Saxena A, Gupta A, Agarwal R, Jain S. Ultrasound-guided transversalis fascia plane block versus wound infiltration for both acute and chronic post-caesarean pain management – A randomised controlled trial. Indian J Anaesth 2022; 66:517-522. [PMID: 36111099 PMCID: PMC9468997 DOI: 10.4103/ija.ija_173_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Ultrasound-guided transversalis fascia plane block (USG-guided TFPB) has recently been evaluated for post-caesarean acute pain management. We compared it with standard wound infiltration for both acute and chronic post-caesarean pain management. Methods: All patients undergoing caesarean section (CS) under subarachnoid block were included and randomised. Patients in group C received standard wound infiltration (20 ml of 0.375% ropivacaine) and group-T received bilateral USG-guided TFPB (20 ml of 0.375% ropivacaine) at the end of the surgery. Acute pain assessed using numeric rating scale (NRS), time to first request of analgesia and total rescue analgesic consumption in 24 hours. The incidence of chronic persistent post-surgical pain (CPSP), neuropathic pain component and quality of life (QoL) were assessed. Fisher’s exact test, Chi-square test, unpaired Student’s t-test and Mann-Whitney U test were used. Results: Sixty patients were included with 30 in each group. NRS score on rest at 6th and 24th hour and on active movement at 1st hour was significantly decreased in group T. The “time to first request of analgesia” was statistically higher in group T, that is, 10.77 ± 1.39 h versus 6.30 ± 1.60 h. Five (16.6%) and two (6.6%) patients in groups C and T, respectively, required rescue analgesia in first 24 hours. 30% (n = 6) and 10% (n = 2) patients in groups C and T, respectively, developed CPSP. The neuropathic pain component was significantly reduced and QoL was significantly improved in group T. Conclusion: TFPB is efficacious for management of both acute and chronic post-caesarean pain management.
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10
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Khanum S, Jabeen S, Souza MDLD, Naz N, Andrade ZBD, Nóbrega JFD, Lynn FA, Giacon-Arruda BCC. MENTAL HEALTH OF MOTHERS AFTER NATURAL CHILDBIRTH AND CESAREAN SECTION: A COMPARATIVE STUDY IN KOHAT, KHYBER PAKHTUNKHWA, PAKISTAN. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0140en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
ABSTRACT Objective: to compare the quality of life of women after natural childbirth and cesarean section from a mental health perspective. Method: this is a causal-comparative study that included 104 women, 52 of whom underwent natural childbirth: and 52 cesarean sections. It was conducted in the gynecology ward of Liaqat Memorial Hospital in Kohat Khyber Pakhtunkhwa, Pakistan using the Quality-of-Life Questionnaire. Pakistani Nurses made direct translation of it in to Urdu language, interview by interview (read in English and told in Urdu). The results related to Emotional Health Problems, Energy, Emotions and Social Activities were analyzed. Results: women after cesarean section reported more problems regarding emotional health variables than women after natural childbirth. The mean quality of life score among the natural childbirth group was 89.94 and 66.02 among the cesarean section group (p<0.001). Conclusion: women who undergo natural childbirth have better quality of life than women who undergo cesarean section (average versus poor quality of life). Mental health is also affected, especially for those who undergo cesarean section. Thus, natural childbirth demonstrates benefits in the puerperium in terms of emotional indicators.
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Mokhtaryan-Gilani T, Ozgoli G, Kariman N, Sharif Nia H, Ahmadi Doulabi M, Nasiri M. Psychometric properties of the Persian translation of maternal postpartum quality of life questionnaire (MAPP-QOL). Health Qual Life Outcomes 2021; 19:141. [PMID: 33964935 PMCID: PMC8106222 DOI: 10.1186/s12955-021-01781-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background and objective Many studies have been conducted in Iran on the postpartum quality of life, and the majority have used the general quality of life questionnaire. With a specific tool in this context, the dimensions of maternal postpartum quality of life can be more accurately determined. The present study was conducted to determine psychometric properties and validate the Persian version of the Maternal Postpartum Quality of Life Questionnaire (MAPP-QOL). Materials and methods The present methodological study was conducted in 2018. The original version of MAPP-QOL was translated into Persian by both forward and backward translation. In a cross-sectional study, the Persian version was completed by 407 eligible postpartum women aged 18 to 47 and living in Tehran. Reliability of the questionnaire was assessed using Cronbach's alpha coefficient and test–retest. For construct validity, exploratory and confirmatory factor analyses were used. Results The MAPP-QOL showed good content validity; content validity ratio (CVR) ranged from 0.6 to 1.00, and content validity index (CVI) ranged from 0.7 to 1.00. Using exploratory factor analysis, five factors, including Socioeconomic; Relational/Family-Friends; Psychological/Baby; Health & functioning; and Relational/Spouse-Partner, were extracted, which together explained 78.84% of the total variance. After modifications of CFA, the confirmatory factor analysis showed an acceptable goodness-of-fit. AVE value Above 0.5 exhibited appropriate convergent validity, and AVE greater than MSV confirmed divergent validity. The Cronbach's alpha, McDonald's Omega, Composite reliability and maximum reliability H of the five extracted factors were excellent (> 0.9). Also, the AIC values of the factors were good (between 0.721 to 0.859). Conclusion The 38-item Persian version of the postpartum quality of life questionnaire is adequately reliable for postpartum women in Iran. Given its appropriate psychometric properties, this scale is fit to be used in future studies on postpartum women.
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Affiliation(s)
- Tahereh Mokhtaryan-Gilani
- Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Vali-Asr and Neiaiesh Highway Intersection, Opposite Rajaee Heart Hospital, P.O. Box: 1996835119, Tehran, Islamic Republic of Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Vali-Asr and Neiaiesh Highway Intersection, Opposite Rajaee Heart Hospital, P.O. Box: 1996835119, Tehran, Islamic Republic of Iran.
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahbobeh Ahmadi Doulabi
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Malihe Nasiri
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Sultan P, Sharawi N, Blake L, Ando K, Sultan E, Aghaeepour N, Carvalho B, Sadana N. Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery: A Systematic Review. JAMA Netw Open 2021; 4:e2111600. [PMID: 34042993 PMCID: PMC8160591 DOI: 10.1001/jamanetworkopen.2021.11600] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery. OBJECTIVE To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. EVIDENCE REVIEW An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended). FINDINGS In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations). CONCLUSIONS AND RELEVANCE This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- Clinical Services,University of Arkansas for Medical Sciences, Little Rock
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ellile Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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de Jersey S, Meloncelli N, Guthrie T, Powlesland H, Callaway L, Chang AT, Wilkinson S, Comans T, Eakin E. Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study. JMIR Res Protoc 2021; 10:e27196. [PMID: 33734093 PMCID: PMC8086782 DOI: 10.2196/27196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID) DERR1-10.2196/27196
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Affiliation(s)
- Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Allied Health, Metro North Hospital and Health Service, Brisbane, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Leonie Callaway
- Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Angela T Chang
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Shelley Wilkinson
- School of Human Movements and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Kyrou M. Mode of delivery and traumatic birth experience: The role of the midwife. Eur J Midwifery 2021; 4:39. [PMID: 33537640 PMCID: PMC7839155 DOI: 10.18332/ejm/127264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maria Kyrou
- National School of Public Health, Athens, Greece
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15
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Shen M, Li L. Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role? ECONOMICS AND HUMAN BIOLOGY 2020; 36:100824. [PMID: 31675612 DOI: 10.1016/j.ehb.2019.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/28/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023]
Abstract
To investigate whether elements of Chinese culture, such as son preference, influence women's mode of child delivery, this paper analyzes how fetal sex affects C-section rates among Chinese mothers compared with Japanese mothers in the United States. It uses birth certificate data from 1990 to 2000, a period when women were routinely able to learn the sex of the fetus during pregnancy. Compared with Japanese mothers, Chinese mothers were 1 percentage point more likely to undergo C-section when giving birth to boys than when giving birth to girls. This result is robust to the addition of a rich set of controls and the restriction of the sample to infants without congenital diseases or anomalies at birth. The effects are concentrated in subgroups that are more likely to prefer sons-specifically, where both parents are Asian or where mothers are first-generation immigrants. The findings offer valuable insights for health professionals into culturally driven pregnancy behaviors among Chinese women, potentially enabling them to offer more culturally appropriate healthcare as they support women in making a healthy transition to motherhood.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, No. 135 Xin Gang Xi Road, Guangzhou, 510275, China.
| | - Linyan Li
- Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA.
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Mahumud RA, Ali N, Sheikh N, Akram R, Alam K, Gow J, Sarker AR, Sultana M. Measuring perinatal and postpartum quality of life of women and associated factors in semi-urban Bangladesh. Qual Life Res 2019; 28:2989-3004. [PMID: 31312976 DOI: 10.1007/s11136-019-02247-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of this study was to measure the health-related quality of life (HRQoL) among pregnant women in the perinatal and postpartum periods and determine influencing factors that predict their HRQoL. METHODS The study was conducted among pregnant women who live in a semi-urban area of Chandpur, Bangladesh. A total of 465 women were recruited. The EuroQoL 5-Dimension 3-Level (EQ-5D-3L) and EuroQoL visual analog scale (EQ-VAS) instruments were used to measure the HRQoL of participants. Two-sample mean test (t test) was performed to examine the changes in HRQoL between the perinatal and postnatal periods of the same individuals. Multivariate linear regression was employed to identify the factors influencing HRQoL during the two periods. RESULTS Overall, the HRQoL scores improved significantly from the perinatal (0.49) to postpartum (0.86) period. Approximately 58% of women experienced moderate or extreme levels of health problems during the perinatal period regardless of their health status. However, most women had significantly improved health status in the postpartum period. Gestational weight gain and recommended postnatal care were significantly associated with improved HRQoL. Factors that negatively influenced changes in HRQoL included adolescent motherhood, caesarean delivery, inadequate antenatal care consultations and living in a poor household, during both the perinatal and postpartum periods. CONCLUSIONS Overall health status is found to be poor among women during the perinatal period compared with the postpartum period. The study indicates that interventions to address the influencing factors are needed to ensure better quality of life for women both pre- and post-birth. Community-based initiatives, such as awareness building, might address negative factors and subsequently improve health status and reduce adverse health outcomes related to pregnancy and postnatal care.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
- School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Nausad Ali
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurnabi Sheikh
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Raisul Akram
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde Business School, Glasgow, UK
| | - Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Health & Social Development, Deakin University, Melbourne, Australia
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Tucker Edmonds B, McKenzie F, Downs SM, Carroll AE. Women's Preferences for Maternal and Neonatal Morbidity and Mortality in Childbirth. Med Decis Making 2019; 39:755-764. [PMID: 31556790 DOI: 10.1177/0272989x19869910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To measure utility values that describe women's willingness to tradeoff maternal morbidity for fetal benefit among pregnant and nonpregnant women of reproductive age. Methods. We recruited English-speaking women aged 18 to 45 years in clinical and community-based settings. Eight health states were studied: 4 maternal (healthy, stroke, hysterectomy, death) and 4 neonatal (healthy, severe cerebral palsy [CP], severe mental retardation [MR], death). Utilities were assessed on a subset of 9 pairs of mom/baby delivery outcomes. Participants ranked the 9 pairs of outcomes in order of preference, then standard gamble methods were used to calculate utilities. Numeracy skills were assessed. Results. Utilities were obtained from 477 participants (recruitment rate = 94%). Twenty-one percent were pregnant, 63% were parents, and 54% were African American. Utilities did not differ significantly between pregnant and nonpregnant women or based on numeracy score. The highest (nonhealthy) values were assigned to baby healthy/mom hysterectomy (0.999), baby healthy/mom stroke (0.946), and baby CP/mom healthy (0.940). The lowest values were assigned to baby death/mom hysterectomy (0.203), baby MR/mom death (0.150), and baby death/mom stroke (0.087). Nonwhite participants assigned a significantly higher value to baby MR/mom death (P = 0.01), baby MR/mom stroke (P = 0.02), baby MR/mom healthy (P < 0.01), and baby MR/mom hysterectomy (P = 0.02) than white participants. Conclusion. When asked to value pairs of maternal/fetal outcomes that required a tradeoff of morbidity and mortality, women tended to assign the highest utility to combinations that resulted in a "healthy baby." They assigned the lowest values to combinations that resulted in a baby's death or MR. Our findings highlight the importance of 1) assessing individual preferences and goals of care for pregnancy outcomes and 2) measuring utilities among reproductive-aged women when modeling obstetric decision making.
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Affiliation(s)
| | - Fatima McKenzie
- Department of OB/GYN, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen M Downs
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Fobelets M, Beeckman K, Buyl R, Healy P, Grylka-Baeschlin S, Nicoletti J, Canepa M, Devane D, Gross MM, Morano S, Daly D, Begley C, Putman K. Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries. Midwifery 2019; 79:102536. [PMID: 31561129 DOI: 10.1016/j.midw.2019.102536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Women who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either 'vaginal birth after caesarean' (VBAC) or 'elective repeat caesarean section' (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. DESIGN Prospective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) SETTING: Fifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). PARTICIPANTS Women (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. MEASUREMENTS Women's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: "match VBAC-VBAC" (preference for vaginal birth, actual mode of birth vaginal birth), "match ERCS-ERCS" (preference for caesarean section, actual mode of birth elective repeat caesarean section), "match ERCS-EMCS" (preference for caesarean section, actual mode of birth emergency repeat caesarean section), "mismatch VBAC-ERCS" (preference for vaginal birth, actual mode of birth elective repeat caesarean section), "mismatch VBAC-EMCS" (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and "no preference". Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. FINDINGS Women with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. KEY CONCLUSIONS The results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. IMPLICATIONS FOR PRACTICE Attention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women.
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Affiliation(s)
- Maaike Fobelets
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium; Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium.
| | - Katrien Beeckman
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Nursing and Midwifery, Nursing and Midwifery research group, Universitair Ziekenhuis Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jane Nicoletti
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Matilde Canepa
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sandra Morano
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Koen Putman
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium
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Determinants of Maternal Health-Related Quality of Life after Childbirth: The Generation R Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183231. [PMID: 31487782 PMCID: PMC6765914 DOI: 10.3390/ijerph16183231] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022]
Abstract
Having good health-related quality of life (HRQoL) is essential, particularly for women after childbirth. However, little is known about its determinants. We aimed to identify the determinants of HRQoL after childbirth in a large community sample in the Netherlands. We have included 4312 women in the present study. HRQOL was assessed by a 12-Item Short Form Survey (SF-12) at around two months after childbirth; Physical and Mental Component Summary scores were calculated. Information on 27 potential determinants of HRQoL was collected through questionnaires and medical records. Multivariate linear regression models were applied to assess significant determinants of physical and mental HRQoL. Our study showed that older maternal age, shorter time since childbirth, elective/emergency cesarean delivery, loss of energy, maternal psychopathology, and the hospital admission of the infant were significantly associated with worse physical HRQoL (p < 0.05); older maternal age, non-western background, low household income, loss of energy, and maternal psychopathology were significantly associated with worse mental HRQoL (p < 0.05). We identified multiple determinants of suboptimal physical and mental HRQoL after childbirth. In particular, maternal psychopathology after childbirth was profoundly associated with mental HRQoL. These women may need support. We therefore call for awareness among health care professionals.
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Evaluation of the Obstetric Quality-of-Recovery score (ObsQoR-11) following non-elective caesarean delivery. Int J Obstet Anesth 2019; 39:51-59. [DOI: 10.1016/j.ijoa.2019.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 01/08/2023]
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21
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Wastlund D, Moraitis AA, Thornton JG, Sanders J, White IR, Brocklehurst P, Smith G, Wilson E. The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis. BJOG 2019; 126:1243-1250. [PMID: 31066982 PMCID: PMC6771727 DOI: 10.1111/1471-0528.15809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
Objective To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy. Design Health economic simulation model. Setting All English NHS antenatal services. Population Nulliparous women in the third trimester treated within the UK NHS. Methods A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature. Main outcome measures Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy. Results Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected. Conclusions The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective. Tweetable abstract Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted. Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted.
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Affiliation(s)
- D Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - A A Moraitis
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - J G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - I R White
- MRC Clinical Trials Unit, University College London, London, UK
| | - P Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Ecf Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.,Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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22
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GÜNEŞ ÖZTÜRK G, KARAÇAM Z, TAZEGÜL K, KESER LN. Doğum Şeklinin Gençlerin Sağlık Durumu ile İlişkisi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.484320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Wastlund D, Moraitis AA, Dacey A, Sovio U, Wilson ECF, Smith GCS. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. PLoS Med 2019; 16:e1002778. [PMID: 30990808 PMCID: PMC6467368 DOI: 10.1371/journal.pmed.1002778] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality. This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women. METHODS AND FINDINGS The Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated ultrasound. Where breech presentation was detected, an external cephalic version (ECV) was routinely offered. If the ECV was unsuccessful or not performed, the women were offered either planned cesarean section at 39 weeks or attempted vaginal breech delivery. To compare the likelihood of different mode of deliveries and associated long-term health outcomes for universal ultrasound to current practice, a probabilistic economic simulation model was constructed. Parameter values were obtained from the POP study, and costs were mainly obtained from the English National Health Service (NHS). One hundred seventy-nine out of 3,879 women (4.6%) were diagnosed with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation. ECV was attempted for 84 (46.9%) women and was successful in 12 (success rate: 14.3%). Overall, 19 of the 179 women delivered vaginally (10.6%), 110 delivered by elective cesarean section (ELCS) (61.5%) and 50 delivered by emergency cesarean section (EMCS) (27.9%). There were no women with undiagnosed breech presentation in labour in the entire cohort. On average, 40 scans were needed per detection of a previously undiagnosed breech presentation. The economic analysis indicated that, compared to current practice, universal late-pregnancy ultrasound would identify around 14,826 otherwise undiagnosed breech presentations across England annually. It would also reduce EMCS and vaginal breech deliveries by 0.7 and 1.0 percentage points, respectively: around 4,196 and 6,061 deliveries across England annually. Universal ultrasound would also prevent 7.89 neonatal mortalities annually. The strategy would be cost effective if foetal presentation could be assessed for £19.80 or less per woman. Limitations to this study included that foetal presentation was revealed to all women and that the health economic analysis may be altered by parity. CONCLUSIONS According to our estimates, universal late pregnancy ultrasound in nulliparous women (1) would virtually eliminate undiagnosed breech presentation, (2) would be expected to reduce foetal mortality in breech presentation, and (3) would be cost effective if foetal presentation could be assessed for less than £19.80 per woman.
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Affiliation(s)
- David Wastlund
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, Cambridge, United Kingdom
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Alexandros A. Moraitis
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Alison Dacey
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Edward C. F. Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, Cambridge, United Kingdom
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Gordon C. S. Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
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24
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Alderdice F, Henderson J, Opondo C, Lobel M, Quigley M, Redshaw M. Psychosocial factors that mediate the association between mode of birth and maternal postnatal adjustment: findings from a population-based survey. BMC WOMENS HEALTH 2019; 19:42. [PMID: 30832642 PMCID: PMC6399915 DOI: 10.1186/s12905-019-0738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mode of birth has been found to be associated with maternal postnatal adjustment with women who have Caesarean Sections (CS) thought to be at higher risk of emotional distress. However the relationship is complex and studies have demonstrated mixed findings. The aim of this study is to evaluate a model that explores the direct relationship between mode of birth and postnatal maternal adjustment at 3 months and indirect relationships through psychosocial variables. METHODS A secondary analysis of a population-based survey conducted in England, UK in 2014. The analysis included primiparous women with singleton babies who provided information about mode of birth (n = 2139). RESULTS Maternal postnatal adjustment, as measured by Maternal postnatal wellbeing and Satisfaction with care during labour and birth, varied by mode of birth. Women who had an unplanned CS had the poorest postnatal adjustment. Mode of birth was not associated with Maternal/infant sense of belonging. Four out of the five proposed mediation variables (Perceived control, Maternal expectation, Support in labour, How long until the mother held her baby), showed partial mediation of the relationship between mode of birth and both Maternal postnatal wellbeing and Satisfaction with care during labour and birth. The strongest mediator was Perceived control and the only variable not to show a significant mediation effect was Health of the infant at 3 months. CONCLUSIONS Birth by unplanned, but not planned, caesarean section was associated with poorer maternal adjustment and instrumental birth was associated with lower maternal satisfaction with labour and birth. These relationships were found to be partially mediated by psychosocial variables. Psychosocial interventions in the perinatal period should be considered to optimise maternal postnatal adjustment.
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Affiliation(s)
- Fiona Alderdice
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Charles Opondo
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Marci Lobel
- Professor of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Maria Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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25
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Kohler S, Sidney Annerstedt K, Diwan V, Lindholm L, Randive B, Vora K, De Costa A. Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system. BMC Pregnancy Childbirth 2018; 18:427. [PMID: 30373545 PMCID: PMC6206933 DOI: 10.1186/s12884-018-2038-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women. Methods A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30 days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics. Results Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0–3 days postpartum: 0.28 vs. 0.57, 3–7 days postpartum: 0.59 vs. 0.81; P < 0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, pain or discomfort; P ≤ 0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21–30 days postpartum: 0.85 vs. 0.93; P < 0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P = 0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P < 0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3. Conclusions Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is a suitable instrument to assess postpartum QOL in Indian women.
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Affiliation(s)
- Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany. .,Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Kristi Sidney Annerstedt
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Vishal Diwan
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health and Environment, R. D. Gardi Medical College, Ujjain, India.,International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain, India
| | - Lars Lindholm
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bharat Randive
- Department of Public Health and Environment, R. D. Gardi Medical College, Ujjain, India.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kranti Vora
- Indian Institute of Public Health, Ahmedabad, India
| | - Ayesha De Costa
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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26
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Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum—part II. Int Urogynecol J 2018; 30:893-899. [DOI: 10.1007/s00192-018-3785-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
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27
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Fobelets M, Beeckman K, Buyl R, Daly D, Sinclair M, Healy P, Grylka-Baeschlin S, Nicoletti J, Gross MM, Morano S, Putman K. Mode of birth and postnatal health-related quality of life after one previous cesarean in three European countries. Birth 2018; 45:137-147. [PMID: 29205463 DOI: 10.1111/birt.12324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND How a woman gives birth can affect her health-related quality of life (HRQoL). This study explored HRQoL at 3 months postpartum in women with a history of one previous cesarean in three European countries. METHODS A prospective longitudinal survey, embedded within a cluster randomized trial in three countries, exploring women's postnatal HRQoL up to 3 months postpartum. The Short-Form Six-Dimensions (SF-6D) was used to measure HRQoL, and multivariate analyses were used to examine the relationship with mode of birth. RESULTS Complete data were available from 880 women. Women with a spontaneous vaginal birth had the highest HRQoL scores, whereas women with an emergency repeat cesarean (P = .01) had the lowest. Postnatal readmission of the mother (P = .03), having public health insurance (P = .04), and a low antenatal HRQoL score (P < .01) contributes to poorer HRQoL scores. More specifically, women with a spontaneous vaginal birth had significantly higher HRQoL scores on the vitality dimension compared with women with an emergency repeat cesarean (P = .04). CONCLUSIONS In women with low-risk factors, repeat cesareans result in a poorer HRQoL compared with vaginal birth. When there are no contraindications for vaginal birth, women with a history of one previous cesarean should be encouraged to give birth vaginally rather than have an elective repeat cesarean.
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Affiliation(s)
- Maaike Fobelets
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Katrien Beeckman
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Nursing and Midwifery, Nursing and Midwifery research group, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health, Biostatistics and Medical Informatics Research group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Marlene Sinclair
- University of Ulster, Institute of Nursing and Health Research, Jordanstown, Newtownabbey, Northern Ireland, UK
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | | | | | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Sandra Morano
- IRCCS Azienda Ospedaliera Universitaria S. Martino IST, Largo R. Benzi, Genova, Italy
| | - Koen Putman
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
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