1
|
Hamilton EF, Zhoroev T, Warrick PA, Tarca AL, Garite TJ, Caughey AB, Melillo J, Prasad M, Neilson D, Singson P, McKay K, Romero R. New labor curves of dilation and station to improve the accuracy of predicting labor progress. Am J Obstet Gynecol 2024; 231:1-18. [PMID: 38423450 PMCID: PMC11288087 DOI: 10.1016/j.ajog.2024.02.289] [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: 12/20/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The diagnosis of failure to progress, the most common indication for intrapartum cesarean delivery, is based on the assessment of cervical dilation and station over time. Labor curves serve as references for expected changes in dilation and fetal descent. The labor curves of Friedman, Zhang et al, and others are based on time alone and derived from mothers with spontaneous labor onset. However, labor induction is now common, and clinicians also consider other factors when assessing labor progress. Labor curves that consider the use of labor induction and other factors that influence labor progress have the potential to be more accurate and closer to clinical decision-making. OBJECTIVE This study aimed to compare the prediction errors of labor curves based on a single factor (time) or multiple clinically relevant factors using two modeling methods: mixed-effects regression, a standard statistical method, and Gaussian processes, a machine learning method. STUDY DESIGN This was a longitudinal cohort study of changes in dilation and station based on data from 8022 births in nulliparous women with a live, singleton, vertex-presenting fetus ≥35 weeks of gestation with a vaginal delivery. New labor curves of dilation and station were generated with 10-fold cross-validation. External validation was performed using a geographically independent group. Model variables included time from the first examination in the 20 hours before delivery; dilation, effacement, and station recorded at the previous examination; cumulative contraction counts; and use of epidural anesthesia and labor induction. To assess model accuracy, differences between each model's predicted value and its corresponding observed value were calculated. These prediction errors were summarized using mean absolute error and root mean squared error statistics. RESULTS Dilation curves based on multiple parameters were more accurate than those derived from time alone. The mean absolute error of the multifactor methods was better (lower) than those of the single-factor methods (0.826 cm [95% confidence interval, 0.820-0.832] for the multifactor machine learning and 0.893 cm [95% confidence interval, 0.885-0.901] for the multifactor mixed-effects method and 2.122 cm [95% confidence interval, 2.108-2.136] for the single-factor methods; P<.0001 for both comparisons). The root mean squared errors of the multifactor methods were also better (lower) than those of the single-factor methods (1.126 cm [95% confidence interval, 1.118-1.133] for the machine learning [P<.0001] and 1.172 cm [95% confidence interval, 1.164-1.181] for the mixed-effects methods and 2.504 cm [95% confidence interval, 2.487-2.521] for the single-factor [P<.0001 for both comparisons]). The multifactor machine learning dilation models showed small but statistically significant improvements in accuracy compared to the mixed-effects regression models (P<.0001). The multifactor machine learning method produced a curve of descent with a mean absolute error of 0.512 cm (95% confidence interval, 0.509-0.515) and a root mean squared error of 0.660 cm (95% confidence interval, 0.655-0.666). External validation using independent data produced similar findings. CONCLUSION Cervical dilation models based on multiple clinically relevant parameters showed improved (lower) prediction errors compared to models based on time alone. The mean prediction errors were reduced by more than 50%. A more accurate assessment of departure from expected dilation and station may help clinicians optimize intrapartum management.
Collapse
Affiliation(s)
- Emily F Hamilton
- Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; PeriGen, Inc, Cary, NC.
| | - Tilekbek Zhoroev
- PeriGen, Inc, Cary, NC; Faculty of Science, Department of Applied Mathematics, North Carolina State University, Raleigh, NC
| | - Philip A Warrick
- PeriGen, Inc, Cary, NC; Faculty of Medicine and Health Sciences, Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Adi L Tarca
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Computer Science, Wayne State University College of Engineering, Detroit, MI
| | - Thomas J Garite
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA; Sera Prognostics, The Pregnancy Company, Salt Lake City, UT
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, OR
| | - Jason Melillo
- Department of Obstetrics and Gynecology, OhioHealth, Columbus, OH
| | - Mona Prasad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, OhioHealth, Columbus, OH
| | | | - Peter Singson
- Women's Health Services, Legacy Health, Portland, OR
| | - Kimberlee McKay
- PeriGen, Inc, Cary, NC; Sanford School of Medicine at the University of South Dakota, Vermillion, SD; Perinatal Quality and Obstetrics and Gynecology Service Line, Avera Health, Sioux Falls, SD
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| |
Collapse
|
2
|
Fineberg AE, Harley K, Lahiff M, Main EK. The relative impact of labor induction versus improved labor management: Before and after the ARRIVE (a randomized trial of induction vs. expectant management) trial. Birth 2024. [PMID: 38877812 DOI: 10.1111/birt.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 05/02/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To evaluate the association of labor induction on cesarean delivery and other maternal and neonatal outcomes in low-risk, full-term patients in community hospitals during a period of concerted effort to safely prevent cesarean delivery. METHODS We performed a retrospective cohort study using the California Maternal Data Center comprised linked discharge diagnoses and birth certificate data for all low-risk, nulliparous, term, singleton, vertex (NTSV) individuals between 39 and 41 weeks from three Sacramento Valley community hospitals from 2016 to 2022 (N = 10,821) during a period of state-wide efforts to safely reduce cesarean rates. Logistic regression was used to calculate odds ratios (ORs) and adjusted odds ratios (aORs) after labor induction in two time periods before and after the ARRIVE trial. RESULTS During the study period, labor induction increased from 14.7% to 23.1%. Controlling for maternal age, pre-pregnancy BMI, birthweight, maternal race and ethnicity, birthplace, English language, gestational age, Medicaid status, delivery year, and labor induction was associated with an increased aOR of 1.67 (95% CI 1.48-1.89) for cesarean delivery. We found a trend toward increased aOR of chorioamnionitis but no differences in blood transfusion, severe maternal morbidity, unexpected newborn complications, chorioamnionitis, operative vaginal delivery, maternal lacerations, and shoulder dystocia with labor induction. A decrease aOR of cesarean delivery was observed comparing all births in 2019-2021 to 2016-2018. CONCLUSION Labor induction was associated with an increased aOR for cesarean delivery both before and after the ARRIVE trial. A decreased aOR for cesarean delivery was observed during the period of statewide efforts to safely reduce cesarean delivery both with and without labor induction.
Collapse
Affiliation(s)
- Annette E Fineberg
- Sutter Medical Group, Sacramento, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Kim Harley
- Maternal Child and Adolescent Health School of Public Health, University of California, Berkeley, California, USA
| | - Maureen Lahiff
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Elliott K Main
- California Maternal Quality Care Collaborative, Palo Alto, California, USA
- Clinical Professor of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
3
|
Selvaratnam RJ, Wallace EM, Rolnik DL, Mol BW, Butler SE, Bisits A, Lawson J, Davey MA. Elective induction of labour at full-term gestations and childhood school outcomes. J Paediatr Child Health 2023; 59:1028-1034. [PMID: 37294278 DOI: 10.1111/jpc.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
AIM To explore the association between induction of labour at full-term gestations in low-risk nulliparous women and childhood school outcomes. METHODS A retrospective whole-of-population cohort study linking perinatal data to educational test scores at grades 3, 5 and 7 in Victoria, Australia. Low-risk nulliparous women with singleton pregnancies induced at 39 and 40 weeks without a medical indication were compared to those expectantly managed from that week of gestation. Multivariable logistic regressions were used as well as generalised estimating equations on longitudinal data. RESULTS At 39 weeks, there were 3687 and 103 164 infants in the induction and expectant arms, respectively. At 40 weeks' gestation, there were 7914 and 70 280 infants, respectively. Infants born to nulliparous women induced at 39 weeks' gestation had significantly poorer educational outcomes at grade 3 (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.13-1.70) but not grades 5 (aOR = 1.05, 95% CI: 0.84-1.33) and 7 (aOR = 1.07, 95% CI: 0.81-1.40) compared to those expectantly managed. Infants born to nulliparous women induced at 40 weeks had comparable educational outcomes at grade 3 (aOR = 1.06, 95% CI: 0.90-1.25) but poorer educational outcomes at grades 5 (aOR = 1.23, 95% CI: 1.05-1.43) and 7 (aOR = 1.23, 95% CI: 1.03-1.47) compared to those expectantly managed. CONCLUSIONS There were inconsistent associations between elective induction of labour at full-term gestations in low-risk nulliparous women and impaired childhood school outcomes.
Collapse
Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Health, Victorian Government, Melbourne, Victoria, Australia
| | - Daniel L Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Ben W Mol
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Sarah E Butler
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Andrew Bisits
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Janna Lawson
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Oxytocin Exposure in Labor and its Relationship with Cognitive Impairment and the Genetic Architecture of Autism. J Autism Dev Disord 2023; 53:66-79. [PMID: 34982326 DOI: 10.1007/s10803-021-05409-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
Whether there is a relationship between oxytocin (OXT) use in labor and the risk of autism (ASD), and the nature of such relationship, is unclear. By integrating genetic and clinical data in a sample of 176 ASD participants, we tested the hypothesis that OXT is a marker for abnormal prenatal development which leads to impairments in the process of labor. OXT-exposed ASD had more obstetric complications (P = 0.031), earlier onset of symptoms (P = 0.027), poorer cognitive development (P = 0.011), higher mutation burden across neurodevelopment genes (P = 0.020; OR = 5.33) and lower transmission of polygenic risk for ASD (P = 0.0319), than non-exposed ASD. OXT seems to constitute a risk indicator rather than a risk factor for ASD, which is relevant for diagnostic and genetic counselling.
Collapse
|
5
|
Fox H, Topp SM, Lindsay D, Callander E. A cascade of interventions: A classification tree analysis of the determinants of primary cesareans in Australian public hospitals. Birth 2021; 48:209-220. [PMID: 33570208 DOI: 10.1111/birt.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both globally and in Australia, there has been a sharp rise in cesarean births (CB). Commonly, this rise has been attributed to the changing epidemiology of women giving birth. A significant body of knowledge exists on the risk factors associated with a greater need for cesarean. Yet, we have little information on the reasons recorded by clinicians as to why cesareans are provided. This study aimed to explore the drivers of primary cesareans in Australian public hospitals. METHODS Using a linked administrative data set, the frequency and percent of mothers' characteristics were compared between those who had a cesarean birth and those who had a vaginal birth (n = 98 967) with no history of previous cesareans in Queensland public hospitals between July 1, 2012, and June 30, 2015. The top 10 reasons recorded by clinicians for a primary cesarean were reported. Using a machine-learning algorithm, two decision trees were built to determine factors driving primary cesarean birth. RESULTS "Labour and delivery complicated by fetal heart rate anomaly" (23%) and "primary inadequate contractions" (22.8%) were the top two reasons for a primary cesarean birth. The most common characteristics among mothers who had fetal heart rate anomalies were as follows: artificial rupture of membranes (39%), oxytocin (32%), no obstruction of labor (42%), and epidural (52%). For women who had primary inadequate contractions, the most common characteristics were as follows: epidural (33%), oxytocin (49%), artificial rupture of membranes (45%), and fetal stress (56%). CONCLUSIONS Efforts should be made by health practitioners during the antenatal period to maximize the use of preventative measures that minimize the need for medical interventions.
Collapse
Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Emily Callander
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia
| |
Collapse
|
6
|
Selvaratnam RJ, Davey MA, Mol BW, Wallace EM. Increasing obstetric intervention for fetal growth restriction is shifting birthweight centiles: a retrospective cohort study. BJOG 2020; 127:1074-1080. [PMID: 32180311 DOI: 10.1111/1471-0528.16215] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN Retrospective cohort study of births in five 2-year epochs: 1983-84, 1993-94, 2003-2004, 2013-2014 and 2016-2017. POPULATION 665 205 singleton births at ≥32 weeks' gestation. SETTING All maternity services in Victoria, Australia. METHODS For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation. We calculated rates of iatrogenic delivery over time. We then calculated the number of babies whose birthweight would have classified them as ≥3rd centile based on 1983-84 centile definitions but as <3rd centile based on 2016-2017 centile definitions. MAIN OUTCOME MEASURES Birthweight centile, and gestation at delivery. RESULTS From 1983-84 to 2016-2017, the rate of iatrogenic delivery for singleton pregnancies increased at all term gestations: 1.6-6.4% at 37 weeks', 4.5-18.3% at 38 weeks', 7.6-23.9% at 39 weeks' and 18.4-25.1% at 40 weeks' (all P < 0.001). Over the same period, the birthweight cutoffs defining the 3rd, 5th and 10th centiles increased significantly at term, but not preterm, gestations. This led to increasing numbers of term births being classified as small for gestational age (SGA). Of the 2748 babies born in 2016-2017 at 37-39 weeks' gestation with a birthweight <3rd centile in that period, 1478 (53.8%) would have been classified as ≥3rd centile based on 1983-84 centile definitions. CONCLUSION Increasing intervention is shifting the birthweight cutoffs that define birthweight centiles and thereby redefining what constitutes SGA. This undermines the use of population-derived birthweight centiles to audit clinical care. TWEETABLE ABSTRACT Increasing obstetric intervention is shifting birthweight centiles and therefore definitions of normality.
Collapse
Affiliation(s)
- R J Selvaratnam
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| |
Collapse
|
7
|
Jeong YA, Chung CW. Pregnant Women's Labor Progress, Childbirth Outcome, and Childbirth Satisfaction according to the Presence or Absence of Labor Induction. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2018; 24:58-70. [PMID: 37684913 DOI: 10.4069/kjwhn.2018.24.1.58] [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: 12/26/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.
Collapse
Affiliation(s)
- Yun Ah Jeong
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
| | - Chae Weon Chung
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
| |
Collapse
|
8
|
Jou J, Kozhimannil KB, Johnson PJ, Sakala C. Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.S. Women. Health Serv Res 2015; 50:961-81. [PMID: 25250981 PMCID: PMC4545342 DOI: 10.1111/1475-6773.12231] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine whether patient-perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures. DATA SOURCES/STUDY SETTING Listening to Mothers III, a nationally representative survey of women 18-45 years who delivered a singleton infant in a U.S. hospital July 2011-June 2012 (N = 2,400). STUDY DESIGN Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure. PRINCIPAL FINDINGS Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5-5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3-3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2-8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4-11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0-11.3). CONCLUSIONS Patient-perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider-patient miscommunication and minimize potentially unnecessary procedures may be warranted.
Collapse
Affiliation(s)
- Judy Jou
- Address correspondence to Judy Jou, M.A., Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455; e-mail:
| | - Katy B Kozhimannil
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
| | - Pamela Jo Johnson
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
| | - Carol Sakala
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
| |
Collapse
|
9
|
Teixeira C, Silva S, Severo M, Barros H. Socioeconomic position early in adolescence and mode of delivery later in life: findings from a Portuguese birth cohort. PLoS One 2015; 10:e0119517. [PMID: 25799142 PMCID: PMC4370463 DOI: 10.1371/journal.pone.0119517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022] Open
Abstract
Objective This study assessed the influence of socioeconomic position at 12 years of age (SEP-12) on the variability in cesarean rates later in life. Methods As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005–September/2006). Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women’s SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR) and respective 95% confidence interval (95% CI). Results The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p = 0.100) among primiparous women; 14.2%, 11.6% and 15.5% (p = 0.04) among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p = 0.08) among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR = 1.12;95%CI:1.01–1.24 comparing high with low SEP-12 and RR = 1.03:95%CI:0.94–1.14 comparing intermediate with low SEP-12) not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean. Conclusions The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth.
Collapse
Affiliation(s)
- Cristina Teixeira
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
- * E-mail:
| | - Susana Silva
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Milton Severo
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Henrique Barros
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| |
Collapse
|
10
|
Ha SU, Thompson LA, Kearney G, Roth J, Xu X. Population attributable risks of neurobehavioral disorders due to low birth weight in US children. ADVANCES IN PEDIATRIC RESEARCH 2014; 1:2. [PMID: 29057332 PMCID: PMC5648072 DOI: 10.12715/apr.2014.1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of low birth weight (LBW) and neurobehavioral disorders (N) has increased over the last three decades. However, it is unclear how many excess cases of ND can be attributed to LBW among U.S. children. The objectives of this study were to a) determine the association between LBW and ND including attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), behavior and conduct disorder (BCD) and learning disability (LD); and b) determine the population attributable risk (PAR) of these disorders due to LBW. METHODS Study subjects were a nationally representative cross-sectional sample of 85,637 children ages 2 to 17 years old who participated in the 2011 National Survey of Children's Health. Birth weight and ND were reported by parents. RESULTS LBW accounted for 6.0% (95% confidence interval [CI] 2.3-10.4) of all ASD cases, 2.4% (CI 0.1-5.1) of BCD, and 6.8% (CI 4.8-9.0) of LD among the study population. There was not a significant association between LBW and ADHD. The percentages of these ND due to LBW were found to be higher among those who were pre-term and among ethnic minority groups. CONCLUSIONS Based on our results and given that over 8% of U.S. children are born with LBW, with higher rates among minorities and preterm births, prospective planning for neurobehavioral services is warranted. Efforts to reduce ND in children align with national efforts to reduce LBW.
Collapse
Affiliation(s)
- Sandie U. Ha
- Department of Epidemiology, University of Florida, Gainesville, USA
| | | | - Greg Kearney
- Department of Public Health, East Carolina University, Greenville, USA
| | - Jeffrey Roth
- Department of Neonatology, University of Florida, Gainesville, USA
| | - Xiaohui Xu
- Department of Epidemiology, University of Florida, Gainesville, USA
| |
Collapse
|
11
|
Bernier R, Golzio C, Xiong B, Stessman HA, Coe BP, Penn O, Witherspoon K, Gerdts J, Baker C, Vulto-van Silfhout AT, Schuurs-Hoeijmakers JH, Fichera M, Bosco P, Buono S, Alberti A, Failla P, Peeters H, Steyaert J, Vissers LELM, Francescatto L, Mefford HC, Rosenfeld JA, Bakken T, O'Roak BJ, Pawlus M, Moon R, Shendure J, Amaral DG, Lein E, Rankin J, Romano C, de Vries BBA, Katsanis N, Eichler EE. Disruptive CHD8 mutations define a subtype of autism early in development. Cell 2014; 158:263-276. [PMID: 24998929 DOI: 10.1016/j.cell.2014.06.017] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous disease in which efforts to define subtypes behaviorally have met with limited success. Hypothesizing that genetically based subtype identification may prove more productive, we resequenced the ASD-associated gene CHD8 in 3,730 children with developmental delay or ASD. We identified a total of 15 independent mutations; no truncating events were identified in 8,792 controls, including 2,289 unaffected siblings. In addition to a high likelihood of an ASD diagnosis among patients bearing CHD8 mutations, characteristics enriched in this group included macrocephaly, distinct faces, and gastrointestinal complaints. chd8 disruption in zebrafish recapitulates features of the human phenotype, including increased head size as a result of expansion of the forebrain/midbrain and impairment of gastrointestinal motility due to a reduction in postmitotic enteric neurons. Our findings indicate that CHD8 disruptions define a distinct ASD subtype and reveal unexpected comorbidities between brain development and enteric innervation.
Collapse
Affiliation(s)
- Raphael Bernier
- Department of Psychiatry, University of Washington, Seattle, WA 98195, USA
| | - Christelle Golzio
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Bo Xiong
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Holly A Stessman
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Bradley P Coe
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Osnat Penn
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Kali Witherspoon
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jennifer Gerdts
- Department of Psychiatry, University of Washington, Seattle, WA 98195, USA
| | - Carl Baker
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | | | | | - Marco Fichera
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy; Medical Genetics, University of Catania, Catania 95123, Italy
| | - Paolo Bosco
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy
| | - Serafino Buono
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy
| | - Antonino Alberti
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy
| | - Pinella Failla
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy
| | - Hilde Peeters
- Center for Human Genetics, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium; Leuven Autism Research (LAuRes), 3000 Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), 3000 Leuven, Belgium; Department of Child and Adolescent Psychiatry, KU Leuven, 3000 Leuven, Belgium; Department of Clinical Genetics, Academic Hospital Maastricht, and Research Institute Growth & Development (GROW), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lisenka E L M Vissers
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Ludmila Francescatto
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Heather C Mefford
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Jill A Rosenfeld
- Signature Genomics Laboratories, PerkinElmer, Inc., Spokane, WA 99207, USA
| | - Trygve Bakken
- Allen Institute for Brain Science, Seattle, WA 98103, USA
| | - Brian J O'Roak
- Molecular & Medical Genetics, Oregon Health & Science University (OHSU), Portland, OR 97208, USA
| | - Matthew Pawlus
- Department of Pharmacology, University of Washington, Seattle, WA 98109, USA
| | - Randall Moon
- Department of Pharmacology, University of Washington, Seattle, WA 98109, USA; Howard Hughes Medical Institute, Seattle, WA 98195, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - David G Amaral
- Autism Phenome Project, MIND Institute, University of California-Davis, Sacramento, CA 95817, USA
| | - Ed Lein
- Allen Institute for Brain Science, Seattle, WA 98103, USA
| | - Julia Rankin
- Peninsula Clinical Genetics Service, Exeter EX1 2ED, UK
| | - Corrado Romano
- I.R.C.C.S. Associazione Oasi Maria Santissima, Troina 94018, Italy
| | - Bert B A de Vries
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC 27710, USA
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA; Howard Hughes Medical Institute, Seattle, WA 98195, USA.
| |
Collapse
|
12
|
|
13
|
Abstract
Elective labor induction is an increasingly common practice not only in high-income countries but also in many low-income and middle-income countries. Many questions remain unanswered on the safety and cost-effectiveness of elective labor induction, particularly in resource-constrained settings wherein there may be a high unmet need for medically indicated inductions, as well as limited or no access to appropriate medications and equipment for induction and monitoring, comprehensive emergency obstetric care, safe, and timely cesarean section, and appropriate supervision from health professionals. This article considers the global perspective on the epidemiology, practices, safety, and costs associated with elective labor induction.
Collapse
Affiliation(s)
- DARIOS GETAHUN
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, , 626-564-5658
| |
Collapse
|
14
|
Rossignol M, Chaillet N, Boughrassa F, Moutquin JM. Interrelations between four antepartum obstetric interventions and cesarean delivery in women at low risk: a systematic review and modeling of the cascade of interventions. Birth 2014; 41:70-8. [PMID: 24654639 DOI: 10.1111/birt.12088] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To critically appraise the literature on the relations between four intrapartum obstetric interventions-electronic fetal monitoring (EFM), epidural analgesia, labor induction, and labor acceleration; and two types of delivery-instrumental (forceps and vacuum) and cesarean section. METHODS This review included meta-analyses published between January 2000 and April 2012 including at least one randomized clinical trial published after 1995 and presenting results on low-risk pregnancies between 37 and 42 weeks of gestation, searched in the databases Medline, Cochrane Library, and EMBASE with no language restriction. RESULTS Of 306 documents identified, 8 fulfilled the inclusion criteria and presented results on women at low risk. EFM at admission (vs intermittent auscultation) was associated with cesarean delivery (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.00-1.44) and epidural analgesia (OR = 1.25, 95% CI 1.09-1.43). Epidural on request was associated with cesarean delivery (OR = 1.60, 95% CI 1.18-2.18), instrumental delivery (OR = 1.21, 95% CI 1.03-1.44), and oxytocin use (OR = 1.20, 95% CI 1.01-1.43) when compared with epidural on request plus nonpharmacological labor pain control methods such as one-to-one support, breathing techniques, and relaxation. Induction and acceleration of labor showed heterogeneous patterns of associations with cesarean delivery and instrumental delivery. CONCLUSIONS Complex patterns of associations between obstetric interventions and modes of delivery were illustrated in an empirical model. Intermittent auscultation and nonpharmacological labor pain control interventions, such as one-to-one support during labor, have the potential for substantially reducing cesarean deliveries.
Collapse
Affiliation(s)
- Michel Rossignol
- Institut national d'excellence en santé et en services sociaux (INESSS), QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | | | | |
Collapse
|
15
|
Vogel JP, West HM, Dowswell T. Titrated oral misoprostol for augmenting labour to improve maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 2013:CD010648. [PMID: 24058051 PMCID: PMC9634341 DOI: 10.1002/14651858.cd010648.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Labour dystocia is associated with a number of adverse maternal and neonatal outcomes. Augmentation of labour is a commonly used intervention in cases of labour dystocia. Misoprostol is an inexpensive and stable prostaglandin E1 analogue that can be administered orally, vaginally, sublingually or rectally. Misoprostol has proven to be effective at stimulating uterine contractions although it can have serious, and even life-threatening side-effects. Titration refers to the process of adjusting the dose, frequency, or both, of a medication on the basis of frequent review to achieve optimal outcomes. Studies have reported on a range of misoprostol titration regimens used for labour induction and titrated misoprostol may potentially be effective and safe for augmentation of labour. OBJECTIVES To examine the effects and safety of titrated oral misoprostol compared with placebo, oxytocin, other interventions, or no active treatment, in women with labour dystocia. SEARCH METHODS The Trials Search Co-ordinator of the Cochrane Pregnancy and Childbirth Group searched the Cochrane Pregnancy and Childbirth Group's Trials Register; date of search: 29 May 2013. We also searched the reference lists of retrieved studies SELECTION CRITERIA Randomised trials (including quasi-randomised and cluster-randomised trials) comparing titrated oral misoprostol with placebo, other interventions (e.g. oxytocin, other prostaglandins), or no treatment in women requiring augmentation of labour were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility for inclusion, carried out data extraction and assessed risk of bias in included studies. Data were entered by one author and checked for accuracy. MAIN RESULTS We included two randomised trials with a total of 581 women each comparing different regimens of titrated oral misoprostol with intravenous oxytocin. One study compared 20 mcg doses of misoprostol dissolved in water (repeated every hour up to four hours, after which the dose was increased to 40 mcg per hour up to a maximum total dose of 1600 mcg), while the second study gave women 75 mcg doses (repeated after four hours provided there were no adverse effects observed).Neither trial reported maternal death, severe maternal morbidity, or fetal/neonatal mortality outcomes, and only a few fetal/neonatal morbidity outcomes were considered, none of which were significantly different between groups. For several outcomes (such as maternal side-effects, instrumental birth, maternal blood transfusion for hypovolaemia and epidural analgesia), the number of events was generally too low for sufficient statistical power to be achieved. Maternal satisfaction was not reported in either trial. One trial reported a slight reduction in the median duration of labour from the start of augmentation to vaginal delivery in the oxytocin group.Neither trial reported significantly higher rates of caesarean section (CS) in the oral misoprostol group. Rates of vaginal delivery within 12 and 24 hours of commencing augmentation were not significantly different in the trial using a 20 mcg misoprostol dose. Neither trial had significantly higher rates of uterine hyperstimulation with fetal heart rate changes in the titrated oral misoprostol group. However, the rates of this outcome varied so greatly between the two studies as to suggest that other factors were at play. The only significant differences between groups related to uterine hyperstimulation (without fetal heart rate changes), and results were not consistent in the two trials. In the trial examining the higher dose of misoprostol, more women in the misoprostol group experienced hyperstimulation of labour measured over a 10-minute period compared with those receiving oxytocin (risk ratio (RR) 1.17, 95% confidence interval (CI) 1.02 to 1.35, 350 women). In the study examining the lower titrated dose of misoprostol, there was a lower incidence of tachysystole when labour was augmented with titrated oral misoprostol than with oxytocin (RR 0.39, 95% CI 0.17 to 0.91, 231 women) with no occurrences of hypertonus in either group of women. AUTHORS' CONCLUSIONS Important uncertainties still exist on the safety and acceptability of titrated oral misoprostol compared with intravenous oxytocin regimens in women with dystocia following spontaneous onset of labour. Although in facilities where electronic oxytocin infusion is not available, low-dose titrated misoprostol may offer a better alternative to an uncontrolled oxytocin infusion to avoid hyperstimulation. Further research is needed in both high- and low-resource settings More trials should be conducted to evaluate the effect of a standard titration oral misoprostol regimen, both following spontaneous labour and labour induction. Comparisons with other augmentation methods are also warranted, as are any effects on women's birth experiences.
Collapse
Affiliation(s)
- Joshua P Vogel
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
- University of Western AustraliaSchool of Population Health, Faculty of Medicine, Dentistry and Health Sciences35 Stirling HighwayCrawleyPerthWestern AustraliaAustralia6009
| | - Helen M West
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | | |
Collapse
|
16
|
Aghideh FK, Mullin PM, Ingles S, Ouzounian JG, Opper N, Wilson ML, Miller DA, Lee RH. A comparison of obstetrical outcomes with labor induction agents used at term. J Matern Fetal Neonatal Med 2013; 27:592-6. [DOI: 10.3109/14767058.2013.831066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Teixeira C, Correia S, Barros H. Risk of caesarean section after induced labour: do hospitals make a difference? BMC Res Notes 2013; 6:214. [PMID: 23714240 PMCID: PMC3668278 DOI: 10.1186/1756-0500-6-214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour. Methods As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed. Results The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present]. Conclusions Caesarean section after induced labour varied significantly across hospitals where similar outcomes were expected. The effect was more evident when the induction was not based on the unequivocal presence of commonly accepted indications.
Collapse
|
18
|
Jansen L, Gibson M, Bowles BC, Leach J. First do no harm: interventions during childbirth. J Perinat Educ 2013; 22:83-92. [PMID: 24421601 PMCID: PMC3647734 DOI: 10.1891/1058-1243.22.2.83] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although medical and technological advances in maternity care have drastically reduced maternal and infant mortality, these interventions have become commonplace if not routine. Used appropriately, they can be life-saving procedures. Routine use, without valid indications, can transform childbirth from a normal physiologic process and family life event into a medical or surgical procedure. Every intervention presents the possibility of untoward effects and additional risks that engender the need for more interventions with their own inherent risks. Unintended consequences to intrapartum interventions make it imperative that nurse educators work with other professionals to promote natural childbirth processes and advocate for policies that focus on ensuring informed consent and alternative choices. Interdisciplinary collaboration can ensure that intrapartum caregivers "first do no harm."
Collapse
|
19
|
Enabor OO, Olayemi OO, Bello FA, Adedokun BO. Cervical ripening and induction of labour-awareness, knowledge and perception of antenatal attendees in Ibadan, Nigeria. J OBSTET GYNAECOL 2012; 32:652-6. [PMID: 22943711 DOI: 10.3109/01443615.2012.657271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The levels of awareness, knowledge and the perceptions of women about cervical ripening and induction of labour were assessed in a cross-sectional questionnaire-based interview of 265 antenatal attendees of the University College Hospital, Ibadan, Nigeria from 1 March to 30 April 2009. Questions included evaluated sociodemographic data, obstetric history, awareness of both procedures and knowledge of specific methods. Data analysis was done using SPSS v.14.0 for Windows; frequency tables were utilised to determine proportions and significant variables from χ(2) analysis were entered into a logistic regression model. The majority of respondents were between 26 and 34 years; 56.4% were nulliparous. Awareness of cervical ripening and induction of labour was found in 71% of respondents. Knowledge of misoprostol and Foley's catheter however, was present in 25% and 13% of all women, respectively. Both procedures were perceived to prevent caesarean section or reduce burden of health workers in 16% of respondents. No significant predictor of knowledge was found but history of previous induction was a predictor of awareness (p < 0.05). Improved counselling is required to further increase knowledge of methods for induction and correct wrong perceptions, particularly in women at risk of labour induction.
Collapse
Affiliation(s)
- O O Enabor
- Department of Obstetrics and Gynaecology, University College Hospital, Nigeria.
| | | | | | | |
Collapse
|
20
|
Elective induction of labor prior to 39 weeks: initiating a change in culture. J Perinat Neonatal Nurs 2012; 26:190-2. [PMID: 22842999 DOI: 10.1097/jpn.0b013e3182611bb7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Abstract
The use of oxytocin, a high-alert medication, has increased dramatically in recent years as induction rates have risen. Methods for administration of oxytocin and subsequent outcomes have long been a source of debate. Furthermore, one of the leading causes of obstetrical liability claims involves the administration of oxytocin leading to tachysystole. This article describes how a collaborative of Perinatal Clinical Nurse Specialists and Obstetric Nurse Educators for a 9-hospital healthcare system throughout Colorado undertook a system-wide process-improvement project to increase safety for pregnant women receiving oxytocin. The goal of this initiative was to decrease risk exposure by successfully implementing a standardized evidence-based protocol and processes across the healthcare system. There has been implementation of standardized oxytocin mixtures, low-dose administration guidelines, and safety checklists to assure fetal and maternal well-being before initiation of oxytocin and increases in oxytocin dosages. The associated outcomes after this initiative have been shorter lengths of labor, decreased incidence of tachysystole, and decreased incidence of primary cesarean birth.
Collapse
|
22
|
Inpatient versus outpatient cervical priming for induction of labour: Therapeutic landscapes and women's preferences. Health Place 2011; 17:379-85. [DOI: 10.1016/j.healthplace.2010.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 11/22/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022]
|
23
|
Simpson KR. Intrauterine Resuscitation During Labor: Review of Current Methods and Supportive Evidence. J Midwifery Womens Health 2010; 52:229-37. [PMID: 17467589 DOI: 10.1016/j.jmwh.2006.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When the fetal heart rate pattern is suggestive of fetal compromise during labor, various methods to promote fetal well-being are traditionally initiated. They include maternal repositioning, reduction of uterine activity, an intravenous fluid bolus, oxygen administration, correction of maternal hypotension, amnioinfusion, and alteration of second-stage labor pushing efforts. Although these intrauterine resuscitation techniques are commonly used, and in some cases considered standard care, supportive data could be more robust. Nevertheless, there is enough evidence to suggest they are beneficial to the fetus and there is minimal risk of harm when used with clinical common sense. Until more data are available, it seems reasonable to err on the side of fetal safety by using these techniques when appropriate, based on the specific fetal heart rate pattern.
Collapse
|
24
|
Jordan R, Farley CL. The Confidence to Practice Midwifery: Preceptor Influence on Student Self-Efficacy. J Midwifery Womens Health 2010; 53:413-20. [DOI: 10.1016/j.jmwh.2008.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 04/13/2008] [Accepted: 05/12/2008] [Indexed: 11/27/2022]
|
25
|
Abstract
Our objective was to describe the historical pattern of the decline in weekend births. Data on 906,100 health maintenance organization enrollees' birthdates were analyzed to show patterns of birth by day of week from 1910 to 1999. The decline in Sunday births dates to the 1930s, and the decline in Saturday births dates to the 1950s, far earlier than previously demonstrated in the literature. The expected natural birth process has been significantly modified. By examining a much longer time series than in other literature, it is also possible to see that the trend is not abating and may be increasing.
Collapse
|
26
|
An open source software project for obstetrical procedure scheduling and occupancy analysis. Health Care Manag Sci 2010; 14:56-73. [PMID: 20978855 DOI: 10.1007/s10729-010-9141-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the resulting occupancy on inpatient obstetrical units such as labor and delivery and postpartum. The models capture numerous important characteristics of inpatient obstetrical patient flow such as time of day and day of week dependent arrivals and length of stay, multiple patient types and clinical interventions, and multiple patient care units with inter-unit patient transfers. We have used these models in several projects at different hospitals involving design of procedure scheduling templates and analysis of inpatient obstetrical capacity. In the development of these models, we made heavy use of open source software tools and have released the entire project as a free and open source model and software toolkit.
Collapse
|
27
|
Wilson BL, Effken J, Butler RJ. The Relationship Between Cesarean Section and Labor Induction. J Nurs Scholarsh 2010; 42:130-8. [DOI: 10.1111/j.1547-5069.2010.01346.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Mandel D, Pirko C, Grant K, Kauffman T, Williams L, Schneider J. A collaborative protocol on oxytocin administration: bringing nurses, midwives and physicians together. Nurs Womens Health 2009; 13:480-485. [PMID: 20017777 DOI: 10.1111/j.1751-486x.2009.01482.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Oxytocin is a high-alert drug for which safety precautions are crucial. Clear communication between nurses, physicians and midwives is vital when oxytocin is used. A collaborative process to updating an oxytocin administration protocol results in trust and respect among health care providers.
Collapse
|
29
|
Abstract
The journey from "normal" to high-tech childbirth has taken place gradually over the past century. This article gives a historic review of maternity care and defines normal birth according to care practices adapted from the World Health Organization. The issues facing today's consumers, care providers, and caregivers that have led to the high-tech approach to birth are discussed. Recommendations for nursing practice are proposed to balance a normal approach to childbirth with a high-tech clinical environment.
Collapse
|
30
|
Abstract
BACKGROUND AND AIMS Obstetric sphincter damage is the most common cause of fecal incontinence in women. This review aimed to survey the literature, and reach a consensus, on its incidence, risk factors, and management. METHOD This systematic review identified relevant studies from the following sources: Medline, Cochrane database, cross referencing from identified articles, conference abstracts and proceedings, and guidelines published by the National Institute of Clinical Excellence (United Kingdom), Royal College of Obstetricians and Gynaecologists (United Kingdom), and American College of Obstetricians and Gynecologists. RESULTS A total of 451 articles and abstracts were reviewed. There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth, with the true incidence likely to be approximately 11% of postpartum women. Risk factors for injury included instrumental delivery, prolonged second stage of labor, birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy. First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma. The majority of sphincter tears can be identified clinically by a suitably trained clinician. In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures. Patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback. In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted. The results of primary and elective repair may deteriorate with time. Sacral nerve stimulation may be an appropriate alternative treatment modality. CONCLUSIONS Obstetric anal sphincter damage, and related fecal incontinence, are common. Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive management. Improved classification, recognition, and follow-up of at-risk patients should facilitate improved outcome. Further studies are required to determine optimal long-term management.
Collapse
|
31
|
Wilson BL. Assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions. J Nurs Scholarsh 2007; 39:208-13. [PMID: 17760792 DOI: 10.1111/j.1547-5069.2007.00170.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the likelihood of cesarean births, related to race, ethnicity, socioeconomic status (SES), maternal education and age, and gestational status for labor inductions on primiparous and multiparous women. DESIGN AND METHODS A retrospective descriptive correlational design was used with 1,325 women scheduled for induction at a large tertiary hospital in a southwestern U.S. state from January 1 through December 31, 2005. Birth outcomes were matched against inpatient hospital scheduling induction logs to verify the reason for induction, whether elective or clinically indicated. FINDINGS Age and gestation had nonlinear and significant associations with cesarean birth. Elective inductions for primiparous women significantly increased the likelihood of cesarean delivery. The independent effect of being a primiparous woman with an elective induction increased the probability of a cesarean birth by 50%, but this association was not significant for multiparous women. Mother's educational level was a significant predictor for cesarean births with multiparous women being induced. Ethnicity and SES did not increase the odds of cesarean delivery following labor induction for either primiparous women or multiparous women. CONCLUSIONS Elective inductions for primiparous women increased the probability of cesarean births. Elective labor induction for primiparous women should be offered with caution, particularly for women with advanced maternal age.
Collapse
Affiliation(s)
- Barbara L Wilson
- College of Nursing and Healthcare Innovation, Arizona State University, Tempe, AZ, USA.
| |
Collapse
|
32
|
Lerchl A. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften 2007; 95:165-70. [PMID: 17891530 DOI: 10.1007/s00114-007-0306-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 11/28/2022]
Abstract
A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states' professional midwives' organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.
Collapse
Affiliation(s)
- Alexander Lerchl
- School of Engineering and Science, Jacobs University Bremen, Campus Ring 6, D-28759 Bremen, Germany.
| |
Collapse
|
33
|
Lerchl A, Reinhard SC. Where are the Sunday babies? II. Declining weekend birth rates in Switzerland. Naturwissenschaften 2007; 95:161-4. [PMID: 17891531 DOI: 10.1007/s00114-007-0305-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
Abstract
Birth dates from almost 3 million babies born between 1969 and 2005 in Switzerland were analyzed for the weekday of birth. As in other countries but with unprecedented amplitude, a very marked non-random distribution was discovered with decreasing numbers of births on weekends, reaching -17.9% in 2005. While most of this weekend births avoidance rate is due to fewer births on Sundays (up to -21.7%), the downward trend is primarily a consequence of decreasing births on Saturdays (up to -14.5%). For 2005, these percentages mean that 3,728 fewer babies are born during weekends than could be expected from equal distribution. Most interestingly and surprisingly, weekend birth-avoiding rates are significantly correlated with birth numbers (r = 0.86), i.e. the lower the birth number per year, the lower the number of weekend births. The increasing avoidance of births during weekends is discussed as being a consequence of increasing numbers of caesarean sections and elective labor induction, which in Switzerland reach 29.2 and 20.5%, respectively, in 2004. This hypothesis is supported by the observation that both primary and secondary caesarean sections are significantly correlated with weekend birth avoidance rates. It is therefore likely that financial aspects of hospitals are a factor determining the avoidance of weekend births by increasing the numbers of caesarean sections.
Collapse
Affiliation(s)
- Alexander Lerchl
- School of Engineering and Science, Jacobs University Bremen, Campus Ring 6, D-28759 Bremen, Germany.
| | | |
Collapse
|
34
|
De Vries CA, De Vries RG. Childbirth education in the 21st century: an immodest proposal. J Perinat Educ 2007; 16:38-48. [PMID: 18769525 PMCID: PMC2174394 DOI: 10.1624/105812407x244958] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Childbirth education was an important social movement in the 20th century but has lost its way in recent years. We describe the reasons for the dwindling importance of childbirth education and offer a proposal for reform that will align childbirth education with the needs of today's birthing mothers. Our plan will create "Centers for the Childbearing Year" (CCBYs) and a new model of childbirth educator, which we call the "birth coach." The CCBY is the place for women to go to for information and support related to fertility, pregnancy, childbirth, and newborn care; the birth coach combines the role of childbirth educator, doula, and postpartum caregiver. In creating a fresh model of childbirth education, we not only honor our pioneers but also rediscover the wisdom in community and relationship that childbirth offers us, and we learn in new ways to journey alongside each other to create new possibilities for birthing families.
Collapse
Affiliation(s)
- Charlotte A De Vries
- CHARLOTTE DE VRIES is co-author of The Official Lamaze(R) Guide: Giving Birth with Confidence and a past president of Lamaze International. Together with Judith Lothian, Charlotte De Vries blogs on birth ( http://birthwithconfidence.blogs.lamaze.org/ )
| | | |
Collapse
|
35
|
Abstract
This analysis was conducted to describe the concept of optimality and its appropriateness for perinatal health care. The concept was identified in 24 scientific disciplines. Across all disciplines, the universal definition of optimality is the robust, efficient, and cost-effective achievement of best possible outcomes within a rule-governed framework. Optimality, specifically defined for perinatal health care, is the maximal perinatal outcome with minimal intervention placed against the context of the woman's social, medical, and obstetric history.
Collapse
Affiliation(s)
- Holly Powell Kennedy
- Department of Family Health Care Nursing, University of California, San Francisco, CA 94143, USA.
| |
Collapse
|
36
|
Simpson KR. The context & clinical evidence for common nursing practices during labor. MCN Am J Matern Child Nurs 2006; 30:356-63; quiz 364-5. [PMID: 16260939 DOI: 10.1097/00005721-200511000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this article is to review the context and current evidence for common nursing care practices during labor and birth. Although many nursing interventions during labor and birth are based on physician orders, there are a number of care processes that are mainly within the realm of nursing practice. In many cases, particularly in community hospitals, routine physician orders for intrapartum care provide wide latitude for nurses in how they ultimately carry out those orders. An important consideration of common nursing practices during labor is the context or practice model in which those practices occur. Nursing practice is not the same in all clinical environments. Intrapartum nursing practice consists of an assortment of different roles depending on the circumstances, hospital setting, and context in which it takes place. A variety of intrapartum nursing practice models have evolved as a result and in response to the range of sizes, locations, and provider practice styles found in hospitals providing obstetric services. A summary of intrapartum nursing models is presented. The evidence is reviewed for the three most common clinical practices for which nurses have primary responsibility in most settings and that comprise the majority of their time in caring for women during labor: (1) maternal-fetal assessment, (2) management of oxytocin infusions, and (3) second-stage care. Evidence exists for these nursing interventions that can be used to promote maternal-fetal well-being, minimize risk, and enhance patient safety.
Collapse
|
37
|
Lerchl A. Where are the Sunday babies? Observations on a marked decline in weekend births in Germany. Naturwissenschaften 2005; 92:592-4. [PMID: 16205906 DOI: 10.1007/s00114-005-0049-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Accepted: 09/02/2005] [Indexed: 11/30/2022]
Abstract
In 5-year intervals, data from 722,306 individuals born between 1988 and 2003 in North Rhine Westphalia, Germany's largest state, were analyzed for the weekday of birth. In contrast to data from 1900 to 1950 (n=149,267), serving as historical controls, a very marked nonrandom distribution was discovered, with decreasing numbers of births on weekends, especially on Sundays, reaching deviations from the expected distribution of -17.8% in 2003, while births on weekdays are more frequent than expected (Fridays: +8.1% in 2003). The increasing avoidance of births during weekends by elective labor induction on weekdays is discussed as a consequence of practical and increasing financial constraints of hospitals.
Collapse
Affiliation(s)
- Alexander Lerchl
- School of Engineering and Science, International University Bremen, Campus Ring 6, 28759 Bremen, Germany.
| |
Collapse
|
38
|
Simpson KR, Thorman KE. Obstetric "conveniences": elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions. J Perinat Neonatal Nurs 2005; 19:134-44. [PMID: 15923963 DOI: 10.1097/00005237-200504000-00010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Common obstetric interventions are often for "convenience" rather than for clinical indications. Before proceeding, it should be clear who is the beneficiary of the convenience. The primary healthcare provider must make sure that women and their partners have a full understanding of what is known about the associated risks, benefits, and alternative approaches of the proposed intervention. Thorough and accurate information allows women to choose what is best for them and their infant on the basis of the individual clinical situation. Ideally, this discussion takes place during the prenatal period when there is ample opportunity to ask questions, reflect on the potential implications, and confer with partners and family members. A review of common obstetric interventions is provided. While these interventions often are medically indicated for the well-being of mothers and infants, the evidence supporting their benefits when used electively is controversial.
Collapse
|