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Wang J, Cao Y, Chen L, Tao Y, Huang H, Miao C. Influence factor analysis and prediction model of successful application of high-volume Foley Catheter for labor induction. BMC Pregnancy Childbirth 2023; 23:776. [PMID: 37946140 PMCID: PMC10633906 DOI: 10.1186/s12884-023-06101-7] [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: 12/21/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND This study aimed to establish a clinical-based nomogram for predicting the success rate of high-volume Foley catheterization for labor induction. METHODS This retrospective study included 1149 full-term pregnant women who received high-volume Foley catheterization for labor induction from January 2019 to December 2021 in Changshu No.1 People's Hospital. Univariate and multivariate logistic regression analyses were performed, in which the labor induction success was set as dependent variables and the characteristics (including age, height, weight, BMI, gravidity, parity, gestational age, uterine height, abdominal circumference, cervical Bishop score, amniotic fluid index, cephalic presentation, neonatal weight, pregnancy complications, etc.) were set as independent variables. A nomogram scoring model was established based on these risk factors, and a calibration curve was plotted to verify the predictive accuracy of the model. RESULTS The success rate of labor induction was 83.55% (960/1149). Univariate analysis revealed that the risk factors associated with the success rate of high-volume Foley catheterization for labor induction were height, pregnancy, birth, age, weight, BMI, uterine height, abdominal circumference, and hypertension. Multivariate logistic regression analysis showed that age (OR = 0.950; 95% CI: 0.904 ~ 0.998), height (OR = 1.062; 95% CI: 1.026 ~ 1.100), BMI (OR = 0.871; 95% CI: 0.831 ~ 0.913), and parity (OR = 8.007; 95% CI: 4.483 ~ 14.303) were independent risk factors for labor induction success by high-volume Foley catheterization. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve in the prediction model was 0.752 (95% CI 0.716 ~ 0.788). A nomogram was constructed based on the final multivariate analysis with a corrected C-index of 0.748, which indicated that the model was calibrated reasonably. CONCLUSION Four risk factors were used to construct a nomogram to evaluate the success rate of high-volume Foley catheterization for labor induction. The nomogram provides a visual clinical tool to assist in the selection of the most appropriate mode of labor induction for pregnant women of different risk levels.
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Affiliation(s)
- Jia Wang
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Yu Cao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Lu Chen
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Yan Tao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Huanhuan Huang
- School of Biotechnology and Food Engineering, Changshu Institute of Technology, Suzhou, 215500, China
| | - Chunju Miao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China.
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Jean Simon D, Jean-Baptiste S, Nazaire R, Joseph G, Carmil JA, Joseph F, Kondo Tokpovi VC. Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey. Trop Med Health 2023; 51:21. [PMID: 37069696 PMCID: PMC10108480 DOI: 10.1186/s41182-023-00513-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.
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Affiliation(s)
- David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Roodjmie Nazaire
- Université d'Etat d'Haïti (UEH), Faculté de Médecine et de Pharmacie (FMP), Port-au-Prince, Haiti
| | - Ghislaine Joseph
- Centre de Recherche Cultures Arts Sociétés (CELAT), University of Laval, Quebec City, Canada
| | | | - Fanor Joseph
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
- University of Antananarivo, Doctoral School of Social and Human Sciences, Antananarivo, Madagascar
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Gantt A, Metz TD, Kuller JA, Louis JM, Cahill AG, Turrentine MA. Obstetric Care Consensus #11, Pregnancy at age 35 years or older. Am J Obstet Gynecol 2023; 228:B25-B40. [PMID: 35850202 DOI: 10.1016/j.ajog.2022.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those found in younger pregnant populations, even in healthy individuals with no other comorbidities. There are several studies that suggest that advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetrical care with anticipated delivery at the age of 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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Karai A, Gyurkovits Z, Németh G, Orvos H, Paulik E. Adverse Maternal and Perinatal Outcome of Women Aged 40 Years or Over: A Retrospective Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDAdvanced maternal age is traditionally described to be 35 years of age or over. In recent years, new trends have suggested that it may be 40 years of age or over; this occurs in Hungary.AIMThe aim of this study was to determine the association between advanced maternal age and various adverse maternal and neonatal outcomes.METHODSA retrospective analysis was performed among women who delivered between 2015 and 2017. All women aged 40 years or over (cases) were involved into the analysis (n = 374). The controls (n = 378) were randomly selected from women aged 25 to 29 years who delivered during the same period considering the number of previous gestations and previous deliveries. The data collected from the medical records comprised the mothers’ demographic and obstetric characteristics and neonatal data. To assess the contribution of maternal age to various maternal and neonatal outcomes, multiple logistic regression analyses were used.RESULTSThe logistic regression analyses showed higher odds of gestational diabetes (AOR, adjusted odds ratio: 2.81), preeclampsia (AOR: 13.05), threatened preterm delivery (AOR: 3.62), and cesarean section (AOR: 3.31) in mothers of higher age. The odds of low birth weight (AOR: 2.56) and intensive care (AOR: 2.03) were significantly higher in older vs. younger mothers, while no significant associations were between maternal age and fetal macrosomia and congenital malformations.CONCLUSIONSConsidering our results, it is important to educate women about the consequences of delayed childbearing and the need of continuous observation within prenatal care.
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Abstract
SUMMARY Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetric care with anticipated delivery at age 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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Zhang J, Williams GJ, Wang G, Chen J, Zhang M, Du W, Zhu J, Zhang J, Hua J. Early-term birth and its association with universal two-child policy: a national cross-sectional study in China. BMJ Open 2021; 11:e054959. [PMID: 34876437 PMCID: PMC8655521 DOI: 10.1136/bmjopen-2021-054959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy. DESIGN Cross-sectional study. PARTICIPANTS The cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB. RESULTS The weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05). CONCLUSION The incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.
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Affiliation(s)
- Jie Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Gareth J Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Guanghua Wang
- Department of Obstetrics and Gynecology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingjing Chen
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Mengyu Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Jing Zhu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
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Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar MZ, Fischer F. Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018. BMC Pregnancy Childbirth 2020; 20:753. [PMID: 33267787 PMCID: PMC7709280 DOI: 10.1186/s12884-020-03457-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15-49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. METHODS Secondary data from Pakistan Demographic and Health Surveys (1990-2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990-91, 2006-07, 2012-13 and 2017-18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). RESULTS The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990-91 to 19.6% in 2017-18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births. CONCLUSIONS The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.
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Affiliation(s)
- Aaisha Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Abeeha Imran
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Nabeeha Shahram
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Ahmed Usman
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
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Seidu AA, Hagan JE, Agbemavi W, Ahinkorah BO, Nartey EB, Budu E, Sambah F, Schack T. Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:114. [PMID: 32070303 PMCID: PMC7029601 DOI: 10.1186/s12884-020-2792-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The increasing rate of caesarean deliveries (CD) has become a serious concern for public health experts globally. Despite this health concern, research on factors associated CD in many low- and -middle countries like Ghana is sparse. This study, therefore, assessed the prevalence and determinants of CD among child-bearing women aged 15-49 in Ghana. METHODS The study used data from the 2014 Ghana Demographic and Health Survey. The analysis was limited to mothers (n = 2742) aged 15-49 , who had given birth in health facilities 5 years preceding the survey. Association between CD and its determinants was assessed by calculating adjusted odds ratios (AOR) with their respective 95% confidence intervals using a binary logistic regression. RESULTS The percentage of mothers who delivered their babies through caesarean section (CS) was 18.5%. Using multivariable logistic regression, the results showed that women aged 45-49 (AOR = 10.5; 95% CI: 3.0-37.4), and women from a household that are headed by a female (AOR = 1.3; 95% CI = 1.1-1.7) had higher odds to deliver through CS. Women from the Upper East (AOR =0.4; 95% CI = 0.2-0.7) and Upper West (AOR = 0.4; 95% CI = 0.2-0.8) regions had lower odds to deliver their children through CS. Women with parity 4 or more (AOR = 0.3; 95% CI = 0.2-0.5) had lower odds of CD compared to those with parity 1. Women with female babies had lower odds (AOR = 0.8; CI = 0.7-0.9) of delivering them through CS compared to those with male children. CONCLUSION The percentage of women delivering babies through the CS in Ghana is high. The high rates of CD noted do not essentially indicate good quality care or services. Hence, health facilities offering this medical protocol need to adopt comprehensive and strict measures to ensure detailed medical justifications by doctors for performing these caesarean surgeries.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Wonder Agbemavi
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | | | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Francis Sambah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
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Abstract
PURPOSE OF REVIEW The proportion of pregnancies occurring in women of at least 35 years of age has increased from 6.2% in 1980 to 22.3% of births in 2016. This review summarizes recent epidemiological and basic scientific studies investigating the association between older maternal age and adverse pregnancy outcome(s), and clinical studies which investigate the effects of intervention to reduce adverse events. RECENT FINDINGS Women of at least 35 years of age have increased risk of maternal and foetal complications in pregnancy including: stillbirth, a small for gestational age baby, preterm birth, preeclampsia and maternal death. These risks increase with increasing age. The reasons for this increased risk are incompletely understood, but likely involve ageing of the maternal cardiovascular and endocrine systems which impacts upon placental function. Intervention, by induction of labour (IOL) at 39-week gestation does not increase operative deliveries or short-term adverse maternal and neonatal outcomes and would reduce perinatal mortality. SUMMARY The additional risks of pregnancy should be discussed with women of at least 35 years of age; additional foetal surveillance may be required in the antenatal period. The benefits and risks of IOL at 39-week gestation should be discussed with women at least 35 years of age.
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Williams L, Jenkinson B, Lee N, Gao Y, Allen J, Morrow J, Kildea S. Does introducing a dedicated early labour area improve birth outcomes? A pre-post intervention study. Women Birth 2019; 33:259-264. [PMID: 31113743 DOI: 10.1016/j.wombi.2019.05.001] [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: 09/20/2018] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
PROBLEM Women increasingly present to hospital in early labour, but admission before active labour contributes to overuse of interventions, poorer clinical and psychological outcomes, and higher healthcare costs. BACKGROUND Innovative models of early labour care have so far not improved birth outcomes. AIM To examine if reconfiguring the early labour service in a large Australian maternity service improved (1) the birth outcomes of women who presented in early labour and (2) alleviated bed blockages by decreasing length of stay in the Pregnancy Assessment and Observation Unit. METHODS Pre-post intervention design, using routinely collected clinical data before and after the implementation of the reconfigured early labour service. FINDINGS There were 527 women in pre-intervention cohort and 747 in the post-intervention cohort. The two groups were similar in age, body mass index, marital status, education level and gestation at birth. Post intervention, epidural use did not change significantly, but rates of amniotomy (35.7% vs. 49.9%, p = <0.001), meconium-stained liquor (20.1% vs 26.1%, p = 0.04), and neonatal nursery admission (2.7% vs. 5.8% p = 0.01) increased. The proportion of women staying in the Assessment unit more than two hours decreased, but not significantly. CONCLUSION Changing the location and model of early labour care did not influence epidural use, nor improve women's birth outcomes. For women in early labour, admission to any location within the hospital may be as problematic as admission to birth suite specifically.
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Affiliation(s)
- Lauren Williams
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Mater Mothers' Hospital, Mater Health Services, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Bec Jenkinson
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Lee
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
| | - Yu Gao
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Mater Mothers' Hospital, Mater Health Services, South Brisbane, Queensland, Australia
| | - Jyai Allen
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Jane Morrow
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Sue Kildea
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Amjad A, Amjad U, Zakar R, Usman A, Zakar MZ, Fischer F. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012-13. BMC Pregnancy Childbirth 2018; 18:113. [PMID: 29685129 PMCID: PMC5914047 DOI: 10.1186/s12884-018-1743-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15-49 years in Pakistan. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012-2013. The analysis was limited to mothers aged 15-49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression. RESULTS Of the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries. CONCLUSIONS The study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.
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Affiliation(s)
- Aaisha Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Uzair Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Ahmed Usman
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
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Martinelli KG, Garcia ÉM, Santos Neto ETD, Gama SGND. Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis. CAD SAUDE PUBLICA 2018; 34:e00206116. [PMID: 29489954 DOI: 10.1590/0102-311x00206116] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/09/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.
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Affiliation(s)
- Katrini Guidolini Martinelli
- Universidade Federal do Espírito Santo, Vitória, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Rahmanou P, Caudwell-Hall J, Kamisan Atan I, Dietz HP. The association between maternal age at first delivery and risk of obstetric trauma. Am J Obstet Gynecol 2016; 215:451.e1-7. [PMID: 27131580 DOI: 10.1016/j.ajog.2016.04.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/06/2016] [Accepted: 04/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are a number of poor birth outcomes with advancing maternal age. Although there is some evidence of a higher risk of trauma to obstetric anal sphincter and the levator ani muscle with advancing age, findings to date are inconclusive. OBJECTIVE The aim of this study was to assess the risk of pelvic floor injury using translabial 3- and 4-dimensional ultrasound relative to advancing maternal age in primiparous women after a singleton vaginal delivery at term and to determine any association between maternal age and obstetric trauma, including obstetric anal sphincter injuries, levator avulsion, and irreversible overdistension of the levator hiatus. STUDY DESIGN This is a subanalysis of a perinatal intervention trial conducted in a specialist urogynecology referral unit at 2 tertiary units. All primiparous women with singleton birth at term underwent 3- and 4-dimensional translabial pelvic floor ultrasound both ante- and postnatally for the assessment of the obstetric trauma including levator ani muscle avulsion, hiatal overdistension to 25 cm(2) or more, and obstetric anal sphincter injuries. A multivariate logistic regression analysis was performed to examine the association between maternal age and obstetric trauma diagnosed on 3- and 4-dimensional translabial ultrasound. Multiple confounders were included, and the most significant (forceps and vacuum delivery) were used for probability modeling. RESULTS Of 660 women recruited for the original study, a total of 375 women who had a vaginal delivery with complete data sets were analyzed. A total of 174 women (46.4%) showed evidence of at least 1 form of major pelvic floor trauma. Advancing maternal age at first delivery carries with it a significant incremental risk of major pelvic floor trauma with an odds ratio of 1.064 for overall risk of injury for each increasing year of age past age 18 years (P = .003). The probability of any type of trauma appears to be substantially higher for forceps delivery. Vacuum delivery appears to increase the risk of obstetric anal sphincter injuries but not of levator avulsion. CONCLUSION There is a significant association between the risk of major pelvic floor injury and increasing maternal age at first delivery.
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Affiliation(s)
- Philip Rahmanou
- Department of Urogynecology, Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia.
| | - Jessica Caudwell-Hall
- Department of Urogynecology, Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia
| | - Ixora Kamisan Atan
- Department of Urogynecology, Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia
| | - Hans P Dietz
- Department of Urogynecology, Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia
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Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M. Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG 2016; 124:1097-1106. [PMID: 27581343 PMCID: PMC5484369 DOI: 10.1111/1471-0528.14269] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
Objectives To describe the characteristics, management and outcomes of women giving birth at advanced maternal age (≥48 years). Design Population‐based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All UK hospitals with obstetrician‐led maternity units. Population Women delivering at advanced maternal age (≥48 years) in the UK between July 2013 and June 2014 (n = 233) and 454 comparison women. Methods Cohort and comparison group identification through the UKOSS monthly mailing. Main outcome measures Pregnancy complications. Results Older women were more likely than comparison women to be overweight (33% versus 23%, P = 0.0011) or obese (23% versus 19%, P = 0.0318), nulliparous (53% versus 44%, P = 0.0299), have pre‐existing medical conditions (44% versus 28%, P < 0.0001), a multiple pregnancy (18% versus 2%, P < 0.0001), and conceived following assisted conception (78% versus 4%, P < 0.0001). Older women appeared more likely than comparison women to have pregnancy complications including gestational hypertensive disorders, gestational diabetes, postpartum haemorrhage, caesarean delivery, iatrogenic and spontaneous preterm delivery on univariable analysis and after adjustment for demographic and medical factors. However, adjustment for multiple pregnancy or use of assisted conception attenuated most effects, with significant associations remaining only with gestational diabetes (adjusted odds ratio [aOR] 4.81, 95% CI 1.93–12.00), caesarean delivery (aOR 2.78, 95% CI 1.44–5.37) and admission to an intensive care unit (aOR 33.53, 95% CI 2.73–412.24). Conclusions Women giving birth at advanced maternal age have higher risks of a range of pregnancy complications. Many of the increased risks appear to be explained by multiple pregnancy or use of assisted conception. Tweetable abstract The pregnancy complications in women giving birth aged 48 or over are mostly explained by multiple pregnancy. The pregnancy complications in women giving birth aged 48 or over are mostly explained by multiple pregnancy.
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Affiliation(s)
- K E Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Tuffnell
- Department of Obstetrics and Gynaecology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kalayci H, Ozdemir H, Alkas D, Cok T, Tarim E. Is primiparity a risk factor for advanced maternal age pregnancies? J Matern Fetal Neonatal Med 2016; 30:1283-1287. [PMID: 27406982 DOI: 10.1080/14767058.2016.1211633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients. METHODS The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015. RESULTS Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups. CONCLUSION Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.
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Affiliation(s)
- Hakan Kalayci
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Halis Ozdemir
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Didem Alkas
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Tayfun Cok
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
| | - Ebru Tarim
- a Baskent University Adana Hospital Obstetrics and Gynaecology Clinic , Adana , Turkey
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Briscoe L, Lavender T, McGowan L. A concept analysis of women's vulnerability during pregnancy, birth and the postnatal period. J Adv Nurs 2016; 72:2330-45. [DOI: 10.1111/jan.13017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lesley Briscoe
- SL Midwifery Education; Edge Hill University; Lancashire UK
| | - Tina Lavender
- Centre for Global Women's Health, University of Manchester; UK
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de Souza Buriol VC, Hirakata V, Goldani MZ, da Silva CH. Temporal evolution of the risk factors associated with low birth weight rates in Brazilian capitals (1996-2011). Popul Health Metr 2016; 14:15. [PMID: 27147908 PMCID: PMC4855447 DOI: 10.1186/s12963-016-0086-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/25/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze the trend of low birth weight (LBW) and its determinants in Brazilian state capitals between 1996 and 2011. We intended to determine which variables are associated with LBW during the period studied. Methods This is a cross-sectional study that used data from the National Information System of Live Births from 26 state capitals and Brasilia (the federal capital), divided into five geographical regions. The Average Annual Percentage of Change (AAPC) was used to assess the possible time trend in the low birth weight rates for considering all regions together and each region separately, according to each variable, and the Poisson regression was calculated in order to demonstrate time trends in low birth weight and the impact of variables (age and educational maternal level, antenatal visits, type of delivery, and gestational age) during the period. All variables were analyzed together using the Poisson regression as well. Results From the total of 11,200,255 live births used in this study, there was a significant reduction in the number of live births, especially in the more developed regions. The low birth weight rate was 8 %, and it was stable during the period. Considering regional trends, the rate was higher in the Southeast and South regions, and significantly higher in the North, Northeast, and Central West regions. Improvements in maternal education and antenatal care coverage reduced the risk for low birth weight in all regions. Also, there was an increase in caesarean sections in all regions, with a small impact on low birth weight rates. Conclusions Improvements in education and health care reduced the risk for low birth weight in all Brazilian regions during the period of study. Trends in low birth weight rates and the associated factors differ from region to region, showing different stages of demographic, epidemiological and developmental transition in Brazil. The present study was approved by the Research Ethics Committee at the Hospital de Clínicas de Porto Alegre (Protocol 120323).
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Affiliation(s)
- Viviane Costa de Souza Buriol
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vânia Hirakata
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo Zubaran Goldani
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clécio Homrich da Silva
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2° andar. Barrio Santa Cecilia, Porto Alegre, RS 90035-003 Brazil ; Child and Adolescent Health Study Centre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ; Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Thompson F, Dempsey K, Mishra G. Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study. BJOG 2016; 123:1814-23. [PMID: 26777399 DOI: 10.1111/1471-0528.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine trends in caesarean section deliveries and factors associated with these trends for Indigenous and non-Indigenous mothers. DESIGN Total population-based study. SETTING Northern Territory of Australia, 1986-2012. POPULATION Pregnancies among Northern Territory residents, limited to singleton live births with cephalic presentations delivered at 37-42 weeks' gestation (n = 78 561). METHODS Descriptive analyses of demographic and obstetric risk factors. Poisson regression with robust variance to estimate the likelihood of caesarean delivery with and without labour compared with vaginal delivery, over time and between Indigenous and non-Indigenous mothers, adjusting for risk factors. MAIN OUTCOME MEASURES Trends in caesarean sections and risk of caesarean delivery compared with vaginal delivery. RESULTS The total rate of caesarean deliveries in the Northern Territory increased between 1986 and 2012. From the year 2000, the rise was driven by increases in caesareans with labour among nulliparous mothers and no labour caesareans among multiparous mothers. Increases in demographic and obstetric risk factors explained the rise in caesareans with labour among nulliparous Indigenous mothers, whereas other unmeasured variables contributed to the rise among non-Indigenous mothers. Increases in previous caesarean delivery contributed to the rise in all caesareans among multiparous mothers. Following adjustment, the risk of Indigenous nulliparous mothers having a caesarean with labour was 47% greater than for non-Indigenous nulliparous mothers [adjusted risk ratio 1.47 (95% CI 1.34-1.60)]. CONCLUSIONS Increases in demographic and obstetric risk factors partially explained the increase in caesarean rates in the Northern Territory and the contribution of these factors differed between Indigenous and non-Indigenous mothers. TWEETABLE ABSTRACT Caesarean section rates increased between 1986 and 2012 in the Northern Territory of Australia.
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Affiliation(s)
- F Thompson
- Department of Health, Northern Territory Government, Darwin, NT, Australia. .,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia. .,The Centre for Chronic Disease Prevention, The Cairns Institute, James Cook University, Cairns, Qld, Australia.
| | - K Dempsey
- Department of Health, Northern Territory Government, Darwin, NT, Australia.,Australia Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - G Mishra
- School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia
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Herstad L, Klungsøyr K, Skjaerven R, Tanbo T, Forsén L, Åbyholm T, Vangen S. Maternal age and emergency operative deliveries at term: a population-based registry study among low-risk primiparous women. BJOG 2014; 122:1642-51. [PMID: 25100277 DOI: 10.1111/1471-0528.12962] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the association between maternal age and emergency operative delivery. The roles of in-labour indications, and birthweight ≥ 4000 g, gestational age ≥ 42 weeks, induction of labour, and epidural use, according to maternal age were explored. DESIGN Population-based study. SETTING Medical Birth Registry of Norway and Statistics Norway. POPULATION We studied 169 583 low-risk primiparous mothers with singleton, cephalic labours, at ≥37 weeks of gestation, from 1999 to 2009. METHODS The associations between maternal age and mode of delivery were analysed using multinomial regression analyses, adjusting for sociodemographic factors. MAIN OUTCOME MEASURES Emergency caesarean section and operative vaginal delivery. RESULTS Of women aged ≥40 years, 22% had emergency caesarean sections and 24% had operative vaginal deliveries, giving adjusted relative risk ratios (RRRs) of 6.60 (95% confidence interval, 95% CI 5.53-7.87) and 3.30 (95% CI 2.79-3.90), respectively, when compared with women aged 20-24 years. Adjustments for sociodemographic factors only slightly changed the estimates. Dystocia was the main indication, followed by fetal distress. All of the listed factors increased the level of emergency operative deliveries, mainly because of an increase in dystocia. The increase in risk for emergency caesarean section by all factors, and for operative vaginal deliveries by epidural, were greater in older than in younger women, but were significant for epidural only. CONCLUSIONS We found a close association between maternal age and emergency operative delivery in low-risk primiparas. Contributory factors increased the risk for both emergency operative delivery and epidural more in older than in younger women.
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Affiliation(s)
- L Herstad
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway
| | - K Klungsøyr
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Skjaerven
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - T Tanbo
- University of Oslo, Oslo, Norway.,Department of Gynaecology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - L Forsén
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - T Åbyholm
- University of Oslo, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - S Vangen
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Guedes M, Canavarro MC. Characteristics of primiparous women of advanced age and their partners: a homogenous or heterogenous group? Birth 2014; 41:46-55. [PMID: 24654637 DOI: 10.1111/birt.12089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have reported that primiparous women of advanced maternal age (AMA) appear to constitute a heterogeneous group, emphasizing the need to revise stereotyped views. The aims of this study were the following: 1) to describe the sociodemographic and marital characteristics of Portuguese couples who experienced first childbirth at advanced maternal age (the AMA group) compared with their younger counterparts (the comparison group); 2) to compare the reproductive characteristics of both groups and identify distinct reproductive trajectories within the AMA group; and 3) to distinguish among different subgroups of couples within the AMA group, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics. METHODS The sample consisted of 250 couples. Both partners completed sociodemographic, marital, and reproductive health forms during pregnancy. RESULTS Despite being more highly educated, having a higher socioeconomic status, and having been employed longer, the AMA group displayed diverse conjugal configurations and reproductive trajectories over time. Within the AMA group, two subgroups were distinguished: couples who experienced infertility problems and couples who did not. CONCLUSIONS Couples who experience first childbirth at AMA constitute a heterogeneous group, which includes distinct subgroups with different psychosocial needs during the transition to parenthood. To revise stereotyped views of these couples, protective social policies should be improved, and health professionals should assume nonjudgmental attitudes and promote informed reproductive decisions. Psychoeducative programs concerning the transition to parenthood should take into account the distinct subgroups of couples who experience first childbirth at AMA.
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Affiliation(s)
- Maryse Guedes
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Davey MA, McLachlan HL, Forster D, Flood M. Influence of timing of admission in labour and management of labour on method of birth: Results from a randomised controlled trial of caseload midwifery (COSMOS trial). Midwifery 2013; 29:1297-302. [DOI: 10.1016/j.midw.2013.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/14/2013] [Accepted: 05/29/2013] [Indexed: 11/26/2022]
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Regardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts. Women Birth 2013; 26:e77-81. [DOI: 10.1016/j.wombi.2012.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 11/21/2022]
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Carolan M. Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence. Midwifery 2013; 29:479-89. [DOI: 10.1016/j.midw.2012.04.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/22/2012] [Accepted: 04/01/2012] [Indexed: 10/27/2022]
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Carolan MC, Davey MA, Biro M, Kealy M. Very advanced maternal age and morbidity in Victoria, Australia: a population based study. BMC Pregnancy Childbirth 2013; 13:80. [PMID: 23537152 PMCID: PMC3637179 DOI: 10.1186/1471-2393-13-80] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/14/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. There are however, few population based studies examining perinatal outcomes among this age group. The aim of this study was to determine the maternal and perinatal outcomes of pregnancies in women aged 45 years or older compared to women aged 30-34 years. METHODS Data on births at 20 or more weeks' gestation were obtained from the Victorian Perinatal Data Collection for the years 2005 and 2006. We examined selected maternal and perinatal outcomes for women of very advanced maternal age (VAMA) aged 45 years or older (n = 217) and compared them to women aged 30-34 years (n = 48,909). Data were summarised using numbers and percentages. Categorical data were analysed by Chi-square tests and Fisher's exact test. Comparisons are presented using unadjusted odds ratios, 95 percent confidence intervals (CIs) and p-values. RESULTS Women aged 45 years and older had higher odds of gestational diabetes (OR 2.05; 95% CI 1.3-3.3); antepartum haemorrhage (OR 1.89; 95% CI 1.01-3.5), and placenta praevia (OR 4.88; 95% CI 2.4-9.5). The older age-group also had higher odds of preterm birth between 32-36 weeks (OR 2.61; 95% CI 1.8-3.8); low birth-weight (<2,500 gr) (OR 2.22; 95% CI 1.5-3.3) and small for gestational age (OR 1.53; 95% CI 1.0-2.3). Stratified analysis revealed that VAMA was most strongly associated with caesarean section in primiparous women (OR 8.24; 95% CI 4.5, 15.4) and those using ART (OR 5.75; 95% CI 2.5, 13.3), but the relationship persisted regardless of parity, ART use and plurality. Low birthweight was associated with VAMA only in first births (OR 3.90; 95% CI 2.3, 6.6), while preterm birth was more common in older women for both first (OR 3.13; 95% CI 1.8, 5.3) and subsequent (OR 2.08; 95% CI 1.2, 3.5) births, and for those having singleton births (OR 2.11; 95% CI 1.3, 3.4), and those who did not use ART (OR 2.10; 95% CI 1.3, 3.4). Preterm birth was very common in multiple births and following ART use, regardless of maternal age. CONCLUSIONS This study demonstrates that women aged 45 years and older, in Victoria, Australia, have higher rates of pregnancy and perinatal complications, compared to women aged 30-34 years.
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Affiliation(s)
- Mary C Carolan
- School of Nursing and Midwifery, Victoria University, St Alban’s Campus, PO Box 14228, Melbourne 8001, Australia
| | - Mary-Ann Davey
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Clinical Councils Unit, Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia
- Mother and Child Health Research, La Trobe University, Melbourne, Australia
| | - Maryanne Biro
- School of Nursing and Midwifery, Monash University, Clayton Campus, Wellington Road, Clayton 3800, Australia
| | - Michelle Kealy
- Mother and Child Health Research, La Trobe University, Melbourne, Australia
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Carolan M. ‘A good midwife stands out’: 3rd year midwifery students' views. Midwifery 2013; 29:115-21. [DOI: 10.1016/j.midw.2011.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 10/29/2011] [Accepted: 11/06/2011] [Indexed: 10/27/2022]
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Miller YD, Prosser, SJ, Thompson R. Going public: Do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia? Midwifery 2012; 28:627-35. [DOI: 10.1016/j.midw.2012.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/18/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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27
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Ludford I, Scheil W, Tucker G, Grivell R. Pregnancy outcomes for nulliparous women of advanced maternal age in South Australia, 1998-2008. Aust N Z J Obstet Gynaecol 2012; 52:235-41. [PMID: 22553967 DOI: 10.1111/j.1479-828x.2012.01442.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 03/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Child bearing in the later reproductive years has become increasingly common in Australia with potential implications for clinical practice. AIM To examine pregnancy outcomes for nulliparous women of advanced maternal age with singleton pregnancies. METHODS A retrospective population-based cohort study was conducted to compare the pregnancy outcomes for women aged 35-39 years and ≥40 years with women aged 25-29 years, analysing 34 695 records from the South Australian Perinatal Database between 1998 and 2008. RESULTS Pre-existing hypertension [relative risks (RR) 1.98 and 2.94 for women aged 35-39 years and ≥40 years, respectively], placenta praevia (RR 2.88 and 3.68), suspected intrauterine growth restriction (RR 1.33 and 1.77) and gestational diabetes (RR 1.97 and 2.53) increased with age. Women of advanced maternal age were more likely to have not laboured prior to birth (RR 2.19 and 3.28), be induced (RR 1.12 and 1.27) and have a breech presentation (RR 1.57 and 1.60). The likelihood of fetal distress increased with advancing maternal age (RR 1.15 and 1.24). Regression analyses revealed women of advanced maternal age were significantly more likely to have small for gestational age infants [adjusted odds ratios (AOR) 1.26 and 1.50], preterm birth (AOR 1.26 and 1.43), elective caesarean [relative risk ratios (RRR) 2.55 and 4.52], emergency caesarean (RRR 1.59 and 2.21) and experience a perinatal death (RRR 1.94 and 2.18). CONCLUSIONS The likelihood of pre-existing medical conditions, obstetric complications, adverse labour and birth outcomes and complications increased with advancing maternal age. Advanced maternal age was also independently associated with selected adverse pregnancy and infant outcomes.
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Affiliation(s)
- Isobel Ludford
- Office of Public Health, Department for Health and Ageing, 11 Hindmarsh Square, Adelaide, SA 5000, Australia.
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Biro MA, Davey MA, Carolan M, Kealy M. Advanced maternal age and obstetric morbidity for women giving birth in Victoria, Australia: A population-based study. Aust N Z J Obstet Gynaecol 2012; 52:229-34. [PMID: 22497578 DOI: 10.1111/j.1479-828x.2012.01427.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/09/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND As the proportions of older women giving birth increase, there is a growing body of evidence on the increased risks of poorer maternal and perinatal outcomes for this group. However, the associations are not completely understood. This study aimed to establish the prevalence of selected maternal morbidities and examine whether advanced maternal age is associated with a higher risk of morbidity for women giving birth in Victoria. METHOD Data on all births over 20 weeks‧ gestation for 2005 and 2006 were obtained from the Victorian Perinatal Data Collection. Unadjusted and adjusted analyses were undertaken using logistic regression to examine and quantify the association between advanced maternal age (35 years and older) and selected obstetric morbidities and complications. RESULTS There was evidence of an association between older maternal age and selected morbidities and complications. Older nulliparous women were at highest odds of gestational diabetes (AdjOR, 1.83; 95% CI, 1.67-2.02), placenta praevia (AdjOR, 2.02; 95% CI, 1.68-2.44), multiple birth (AdjOR, 1.80; 95% CI, 1.58-2.06) and caesarean delivery (AdjOR, 1.93; 95% CI, 1.84-2.02). Older multiparous women were at highest odds of gestational diabetes (AdjOR, 2.01; 95% CI, 1.88-2.15) and placenta praevia (AdjOR, 2.11; 95% CI, 1.83-2.44). CONCLUSIONS Older women giving birth in Victoria are at an increased risk of a range of obstetric morbidities. Delayed childbearing for an increasing number of women has societal and public health ramifications and will potentially place greater demand on healthcare services.
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Affiliation(s)
- Mary Anne Biro
- School of Nursing and Midwifery, Clayton Campus, Monash University, Clayton
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Favilli A, Pericoli S, Acanfora MM, Bini V, Di Renzo GC, Gerli S. Pregnancy outcome in women aged 40 years or more. J Matern Fetal Neonatal Med 2012; 25:1260-3. [DOI: 10.3109/14767058.2011.643327] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beckmann M, Kildea S, Gibbons K. Midwifery group practice and mode of birth. Women Birth 2011; 25:187-93. [PMID: 22169396 DOI: 10.1016/j.wombi.2011.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/15/2011] [Accepted: 11/02/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth. METHOD A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. FINDINGS Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5%; p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07; 95% CI 0.92-1.24; p=0.397), birth assisted by instrument (aOR 1.02; 95% CI 0.86-1.21; p=0.852) or emergency caesarean section (aOR 0.89; 95% CI 0.74-1.06; p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29; 95% CI 1.06-1.58; p=0.013). CONCLUSION Women in MGP care are no more or less likely to have an unassisted vaginal birth.
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Affiliation(s)
- Michael Beckmann
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia.
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