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Prediger B, Heu-Parvaresch A, Polus S, Bühn S, Neugebauer EAM, Dawid P. A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0-6) weeks of gestation. Syst Rev 2021; 10:176. [PMID: 34127077 PMCID: PMC8201675 DOI: 10.1186/s13643-021-01718-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/25/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0-6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review, we are looking for implementation strategies trying to implement these recommendations to reduce elective caesarean section before 39 + (0-6) weeks of gestation. METHODS We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL on 3rd of March 2021. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥ 39 + (0-6) weeks of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39 + (0-6) weeks of gestation. We used the ROBINS-I Tool for the assessment of risk of bias. We did a narrative analysis of the results. RESULTS We included 10 studies, of which were 2 interrupted time series and 8 before-after studies, covering 205,954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed < 39 + (0-6) weeks of gestation. Risk difference differed from - 7 (95% CI - 8; - 7) to - 45 (95% CI - 51; - 31). Three studies reported the rate of neonatal intensive care unit admission and showed little reduction. CONCLUSION This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39 + (0-6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. Included studies are either before-after studies (8) or interrupted time series (2) and the overall quality of the evidence is rather low. However, most of the studies identified specific barriers in the implementation process. For planning an implementation strategy to reduce elective caesarean section before 39 + (0-6) weeks of gestation, it is necessary to consider specific barriers and facilitators and take all obstetric personal into account. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017078231.
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Affiliation(s)
- Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Anahieta Heu-Parvaresch
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, The University Hospital of Cologne (AöR), Cologne, Germany
| | - Stephanie Polus
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Edmund A. M. Neugebauer
- Faculty of Health, Brandenburg Medical School — Theodor Fontane, Campus Neuruppin, Fehrbelliner Str.38, 16816 Neuruppin, Germany
| | - Pieper Dawid
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
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2
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Alterman N, Kurinczuk JJ, Quigley MA. Caesarean section and severe upper and lower respiratory tract infections during infancy: Evidence from two UK cohorts. PLoS One 2021; 16:e0246832. [PMID: 33592033 PMCID: PMC7886211 DOI: 10.1371/journal.pone.0246832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have reported that birth by caesarean section is associated with increased risk of lower respiratory tract infections in the child, but it is unclear whether this applies to any caesarean section or specifically to planned caesareans. Furthermore, although infections of the upper respiratory tract are very common during childhood, there is a scarcity of studies examining whether caesarean is also a risk factor for this site of infection. METHODS We obtained data from two UK cohorts: the Millennium Cohort Study (MCS) and linked administrative datasets of the population of Wales through the Secure Anonymised Information Linkage (SAIL) databank. The study focused on term-born singleton infants and included 15,580 infants born 2000-2002 (MCS) and 392,145 infants born 2002-2016 (SAIL). We used information about mode of birth (vaginal delivery, assisted vaginal delivery, planned caesarean and emergency caesarean) from maternal report in the MCS and from hospital birth records in SAIL. Unplanned hospital admission for lower respiratory tract infection (LRTI) was ascertained from maternal report in the MCS and from hospital record ICD codes in SAIL. Information about admissions for upper respiratory tract infection (URTI) was available from SAIL only. Cox regression was used to estimate hazard ratios for each outcome and cohort separately while accounting for a wide range of confounders. Gestational age at birth was further examined as a potential added, indirect risk of planned caesarean birth due to the early delivery. FINDINGS The rate of hospital admission for LRTI was 4.6 per 100 child years in the MCS and 5.9 per 100 child years in SAIL. Emergency caesarean was not associated with LRTI admission during infancy in either cohort. In the MCS, planned caesarean was associated with a hazard ratio of 1.39 (95% CI 1.03, 1.87) which further increased to 1.65 (95% CI 1.24, 2.19) when gestational age was not adjusted for. In SAIL, the adjusted hazard ratio was 1.10 (95% CI 1.05, 1.15), which increased to 1.17 (95% CI 1.12, 1.22) when gestational age was not adjusted for. The rate of hospital admission for URTI was 5.9 per 100 child years in SAIL. Following adjustments, emergency caesarean was found to have a hazard ratio of 1.09 (95% CI 1.05, 1.14) for hospital admission for URTI. Planned caesarean was associated with a hazard ratio of 1.11 (95% CI 1.06, 1.16) which increased to 1.17 (95% CI 1.12, 1.22) when gestational age was not adjusted for. CONCLUSIONS The risk of severe LRTIs during infancy is moderately elevated in infants born by planned caesarean compared to those born vaginally. Infants born by any type of caesarean may also be at a small increased risk of severe URTIs. The estimated effect sizes are stronger if including the indirect effect arising from planning the caesarean birth for an earlier gestation than would have occurred spontaneously. Further studies are needed to confirm these results.
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Affiliation(s)
- Neora Alterman
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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3
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Nutri-Epigenetics and Gut Microbiota: How Birth Care, Bonding and Breastfeeding Can Influence and Be Influenced? Int J Mol Sci 2020; 21:ijms21145032. [PMID: 32708742 PMCID: PMC7404045 DOI: 10.3390/ijms21145032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Maternal lifestyle is an important factor in the programming of an infant's epigenome, in particular when considered alongside the mode of birth and choice of feeding method (i.e., breastfeeding or formula feeding). Beginning in utero, and during the first two years of an infant's life, cells acquire an epigenetic memory of the neonatal exposome which can be influential across the entire lifespan. Parental lifestyle (e.g., malnutrition, alcohol intake, smoke, stress, exposure to xenobiotics and/or drugs) can modify both the maternal and paternal epigenome, leading to epigenetic inheritance in their offspring. This review aims to outline the origin of early life modulation of the epigenome, and to share this fundamental concept with all the health care professionals involved in the development and provision of care during childbirth in order to inform future parents and clinicians of the importance of the this process and the key role it plays in the programming of a child's health.
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4
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Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, Neugebauer EAM, Pieper D. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth 2020; 20:395. [PMID: 32641019 PMCID: PMC7341650 DOI: 10.1186/s12884-020-03036-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG. METHODS We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed. RESULTS We identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0-6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG. CONCLUSION Our systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO (CRD42017078231).
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Affiliation(s)
- Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stephanie Polus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Angelina Glatt
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, Witten/Herdecke University, Marien Hospital Witten, Marienplatz 2, 58452 Witten, Germany
| | - Edmund A. M. Neugebauer
- Brandenburg Medical School - Theodor Fontane, Faculty of Health, Campus Neuruppin, Fehrbelliner Str.38, 16816 Neuruppin, Germany
- Interdisciplinary Centre for Health Services Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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5
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Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2019; 29:200-209. [PMID: 31532326 DOI: 10.1089/jwh.2019.7750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
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Affiliation(s)
- Yanfang Chen
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lixing Guo
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
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6
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Macallister KJ, Tho LW, Epee-Bekima M, Resnick S, Davis JW. Impact of elective caesarean section on neonatal retrieval in Western Australia during a 12-year period. J Perinatol 2019; 39:34-38. [PMID: 30341400 DOI: 10.1038/s41372-018-0263-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/24/2018] [Accepted: 09/17/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether 2006 Australian national guidance to delay elective caesarean section until 39 weeks' gestation would reduce the need for neonatal retrieval for respiratory compromise following elective caesarean. STUDY DESIGN This is a retrospective cohort study comparing infants born by elective caesarean section who required retrieval for respiratory distress in Western Australia before and after the national guidance (2003-2006 vs. 2008-2014). RESULTS The proportion of infants born by elective caesarean section who required retrieval for respiratory distress was reduced in the later cohort (0.77% (153/19 780) vs. 0.55% (227/40 875); p = 0.0012). The diagnosis of surfactant-deficient lung disease amongst retrieved infants was also reduced (26% (40/153) vs. 17.4% (40/227); p = 0.04). CONCLUSION A reduction in the proportion of elective caesarean sections before 39 weeks in Western Australia was associated with a reduction in retrieval for respiratory compromise related to surfactant deficiency in infants born by elective caesarean section.
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Affiliation(s)
- Kathryn J Macallister
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Lye W Tho
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Mathias Epee-Bekima
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia.,Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, WA, Australia
| | - Steven Resnick
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia.,Newborn Emergency Transport Service, Perth Children's Hospital, Perth, WA, Australia
| | - Jonathan W Davis
- Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia. .,Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia. .,Newborn Emergency Transport Service, Perth Children's Hospital, Perth, WA, Australia.
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7
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Prediger B, Polus S, Mathes T, Bühn S, Louwen F, Neugebauer EAM, Pieper D. (Update of a) systematic review on the impact of elective early term (< 39th gestational week) caesarean sections on maternal and neonatal health - a protocol. Syst Rev 2018; 7:119. [PMID: 30111372 PMCID: PMC6094469 DOI: 10.1186/s13643-018-0787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The rate of caesarean sections increased in the last decades to about 30% of births in western populations. Many caesarean sections are electively planned without an urgent medical reason for mother or child. Especially in women with a foregoing caesarean section, the procedure is planned early. An early caesarean section though may harm the newborn. Our aim is to evaluate the gestational time point after the 37th gestational week (after prematurity = term) of performing an elective caesarean section with the lowest morbidity for mother and child. METHODS This is an update of a systematic review previously carried out on behalf of the German Federal Ministry of Health. We will perform a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL. Our primary outcome is the rate of admissions to the neonatal intensive care unit in early versus late term neonates. We will include (quasi) randomized controlled trials and cohort studies. The studies should include pregnant women who have an elective caesarean section at term. We will screen titles and abstracts and the identified full texts of studies for eligibility. Risk of bias will be assessed with the Cochrane Risk of Bias Tool for Randomized Trials or with the Risk of Bias Tool for Non-Randomized Studies of Interventions (ROBINS-I). These tasks will be performed independently by two reviewers. Data will be extracted in beforehand piloted extraction tables. A dose-response meta-analysis will be performed. DISCUSSION Our aim is to reach a higher validity in the assessment of the time point of elective caesarean sections by performing a meta-analysis to support recommendations for clinical practice. We assume to identify less randomized controlled trials but a large number of cohort studies analyzing the given question. We will discuss similarities and differences in included studies as well as methodological strengths and weaknesses. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017078231.
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Affiliation(s)
- Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Stephanie Polus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
| | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Edmund A. M. Neugebauer
- Brandenburg Medical School - Theodor Fontane, Faculty of Health, Campus Neuruppin, Fehrbelliner Str.38, 16816 Neuruppin, Germany
- Interdisciplinary Centre for Health Services Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Haus 38, 51109 Cologne, Germany
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8
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Herbert A, Wijlaars L, Zylbersztejn A, Cromwell D, Hardelid P. Data Resource Profile: Hospital Episode Statistics Admitted Patient Care (HES APC). Int J Epidemiol 2017; 46:1093-1093i. [PMID: 28338941 PMCID: PMC5837677 DOI: 10.1093/ije/dyx015] [Citation(s) in RCA: 381] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Annie Herbert
- Population, Policy and Practice Programme, UCL Institute of Child Health
- Department of Behavioural Science and Health, UCL Institute of Epidemiology and Healthcare
| | - Linda Wijlaars
- Population, Policy and Practice Programme, UCL Institute of Child Health
| | - Ania Zylbersztejn
- Population, Policy and Practice Programme, UCL Institute of Child Health
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Pia Hardelid
- Population, Policy and Practice Programme, UCL Institute of Child Health
- Department of Primary Care and Population Health, University College London, London, UK
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9
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Kadour-Peero E, Bleicher I, Vitner D, Sloma R, Bahous R, Levy E, Sagi S, Gonen R. When should repeat cesarean delivery be scheduled, after two or more previous cesarean deliveries? J Matern Fetal Neonatal Med 2017; 31:474-480. [DOI: 10.1080/14767058.2017.1288208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Einav Kadour-Peero
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Inna Bleicher
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, E.Wolfson Medical Center, Holon, Israel
| | - Ronen Sloma
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Rabea Bahous
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Eyal Levy
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
| | - Ron Gonen
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Haifa, Israel
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10
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Ghosh RE, Ashworth DC, Hansell AL, Garwood K, Elliott P, Toledano MB. Routinely collected English birth data sets: comparisons and recommendations for reproductive epidemiology. Arch Dis Child Fetal Neonatal Ed 2016; 101:F451-7. [PMID: 26837309 DOI: 10.1136/archdischild-2015-309540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/31/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND In England there are four national routinely collected data sets on births: Office for National Statistics (ONS) births based on birth registrations; Hospital Episode Statistics (HES) deliveries (mothers' information); HES births (babies' information); and NHS Numbers for Babies (NN4B) based on ONS births plus gestational age and ethnicity information. This study describes and compares these data, with the aim of recommending the most appropriate data set(s) for use in epidemiological research and surveillance. METHODS We assessed the completeness and quality of the data sets in relation to use in epidemiological research and surveillance and produced detailed descriptive statistics on common reproductive outcomes for each data set including temporal and spatial trends. RESULTS ONS births is a high quality complete data set but lacks interpretive and clinical information. HES deliveries showed good agreement with ONS births but HES births showed larger amounts of missing or unavailable data. Both HES data sets had improved quality from 2003 onwards, but showed some local spatial variability. NN4B showed excellent agreement with ONS and HES deliveries for the years available (2006-2010). Annual number of births increased by 17.6% comparing 2002 with 2010 (ONS births). Approximately 6% of births were of low birth weight (2.6% term low birth weight) and 0.5% were stillbirths. CONCLUSIONS Routinely collected data on births provide a valuable resource for researchers. ONS and NN4B offer the most complete and accurate record of births. Where more detailed clinical information is required, HES deliveries offers a high quality data set that captures the majority of English births.
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Affiliation(s)
- Rebecca E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Danielle C Ashworth
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Anna L Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Garwood
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Imperial College Healthcare NHS Trust, London, UK
| | - Mireille B Toledano
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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11
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Kotecha SJ, Gallacher DJ, Kotecha S. The respiratory consequences of early-term birth and delivery by caesarean sections. Paediatr Respir Rev 2016; 19:49-55. [PMID: 26810083 DOI: 10.1016/j.prrv.2015.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 12/20/2022]
Abstract
In England and Wales, 19% of live births in 2012 were at 37-38 weeks' gestation, equating to nearly 140 000 early-term births each year. Since caesarean sections (CS) are often performed at early-term gestations, this accounts for some of the increased proportion of the early-term births. Infants born early-term are at an increased risk of neonatal respiratory morbidity particularly if they are delivered by caesarean section. The long term lung function data are limited but available data suggest that early-term delivery is associated with respiratory morbidity in childhood. CS also appears to be associated with increased neonatal morbidity and future development of respiratory symptoms. However, future studies need to confirm the independent effects of caesarean sections and early-term deliveries particularly for long term outcomes as both are likely to affect the respiratory system differently.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
| | - David J Gallacher
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
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Einarsdóttir K, Ball S, Pereira G, Griffin C, Jacoby P, de Klerk N, Leonard H, Stanley FJ. Changes in Caesarean Delivery Rates in Western Australia from 1995 to 2010 by Gestational Age at Birth. Paediatr Perinat Epidemiol 2015; 29:290-8. [PMID: 26111442 DOI: 10.1111/ppe.12202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The caesarean delivery rate in the developed world has been increasing. It is not well understood how caesarean delivery rates have changed by gestational age at birth in Western Australia, particularly in relation to the introduction of the early-term delivery guidelines in Australia in 2006. METHODS Data from the Western Australian Midwives Notification System were used to identify 193,136 singletons born to primiparous women at 34-42 weeks' gestation during 1995-2010. Caesarean delivery rates were calculated by gestational age group (34-36 weeks, 37-38 weeks, and 39-42 weeks) and stratified into pre-labour and in-labour caesarean delivery. The average annual percent change (AAPC) for the caesarean delivery rates was calculated using joinpoint regression. Log-binomial regression was used to estimate the risk of having a caesarean delivery while adjusting for maternal and antenatal factors. RESULTS Caesarean delivery rates rose steadily from 1995 to 2005 (AAPC = 5.9%, [95% confidence interval (CI) 4.9, 6.9]), but stabilised since then (AAPC = 0.9%, [95% CI -1.9, 3.8]). The rate of in-labour caesarean deliveries rose consistently from 1995 to 2010 across all gestational age groups. The pre-labour caesarean delivery rate rise was most dominant at 37-38 weeks' gestation from 1995 to 2005 (AAPC = 6.8%, [95% CI 5.4, 8.2]), but declined during 2006-10 (AAPC = -4.5, [95% CI -6.7, -2.3]), while at the same time the rate at 39-42 weeks rose slightly. CONCLUSIONS The rise in pre-labour caesarean deliveries during 1995-2005 occurred predominantly at 37-38 weeks' gestation, but declined again from 2006 to 2010. This suggests that the recently developed Australian early-term delivery guidelines may have had some success in reducing early-term deliveries in Western Australia.
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Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Centre of Public Health Sciences and Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Stephen Ball
- Pre-Hospital, Resuscitation & Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery & Paramedicine, Curtin University, Bentley, WA, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Center for Perinatal Pediatric and Environmental Epidemiology, School of Medicine, Yale University, New Haven, CT
| | | | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Edozien LC, Gurol-Urganci I, Cromwell DA, Adams EJ, Richmond DH, Mahmood TA, van der Meulen JH. Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG 2014; 121:1695-703. [DOI: 10.1111/1471-0528.12886] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- LC Edozien
- Maternal and Fetal Health Research; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - I Gurol-Urganci
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - DA Cromwell
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - EJ Adams
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - JH van der Meulen
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
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Gurol-Urganci I, Cromwell DA, Mahmood TA, van der Meulen JH, Templeton A. A population-based cohort study of the effect of Caesarean section on subsequent fertility. Hum Reprod 2014; 29:1320-6. [DOI: 10.1093/humrep/deu057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis. PLoS One 2013; 8:e84744. [PMID: 24376842 PMCID: PMC3869904 DOI: 10.1371/journal.pone.0084744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 11/26/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To compare the impact of scheduling caesarean section prior to versus after 39 completed weeks of gestation on the occurrence of unscheduled caesarean section and rescheduling of the procedure. Methods Secondary analysis from a multicentre randomised open-label trial including singleton pregnant women with a healthy foetus and a reliable due date. Women were allocated by computerized telephone randomisation to planned caesarean section at 38 weeks and three days or 39 weeks and three days. The outcomes were unscheduled deliveries with provided reasons, such as spontaneous labour onset or supervening complications, and any changes in the scheduled delivery date. Statistical analyses were according to intention-to-treat using Fisher’s exact test. Results From March 2009 to June 2011 1,274 women were included. Median difference in gestational age at delivery was six days. Compared to the 38 weeks group, the women in the 39 weeks group were more likely to have an unscheduled caesarean section (15.2% vs. 9.3%; RR 1.64, 95% CI 1.21; 2.22), to deliver between 6 pm and 8 am (10 % vs. 6%; RR 1.68, 95% CI 1.14; 2.47), or to have the procedure rescheduled (36.7% vs. 23%; RR 1.6, 95% CI 1.34;1.90). Conclusions Scheduling caesarean section after 39 weeks leads to a 60% increase in unscheduled caesarean sections and a 70% increase in delivery outside regular work hours as compared to scheduling of the procedure prior to 39 weeks. Trial Registration www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Fevre Kindberg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y. Timing of planned repeat cesarean delivery after two or more previous cesarean sections – Risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med 2013; 27:431-8. [DOI: 10.3109/14767058.2013.818130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, Templeton A, van der Meulen JH. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 2013; 120:1516-25. [PMID: 23834484 DOI: 10.1111/1471-0528.12363] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Gurol-Urganci
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - DA Cromwell
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - LC Edozien
- Maternal and Fetal Health Research; Manchester Academic Health Sciences Centre; University of Manchester; Manchester UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - EJ Adams
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - A Templeton
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - JH van der Meulen
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
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