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Kearney L, Nugent R, Maher J, Shipstone R, Thompson JM, Boulton R, George K, Robins A, Bogossian F. Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review. Women Birth 2024; 37:63-78. [PMID: 37704535 DOI: 10.1016/j.wombi.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
PROBLEM Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. BACKGROUND There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. AIM To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. METHODS Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. FINDINGS Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. DISCUSSION Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. CONCLUSION Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia; Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Australia.
| | - Rachael Nugent
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | - Jane Maher
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | | | - John Md Thompson
- School of Health, University of the Sunshine Coast, Australia; Faculty of Medicine, University of Auckland, New Zealand
| | - Rachel Boulton
- Department of Obstetrics and Gynaecology, Sunshine Coast Hospital and Health Service, Australia
| | - Kendall George
- Women's and Newborn Services, Townsville Hospital and Health Service, Australia
| | - Anna Robins
- School of Health, University of the Sunshine Coast, Australia
| | - Fiona Bogossian
- School of Health, University of the Sunshine Coast, Australia
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Kappelt J, Meigen C, Schild CE, Kiess W, Poulain T. Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low-risk environment. Child Care Health Dev 2024; 50:e13177. [PMID: 37737540 DOI: 10.1111/cch.13177] [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: 03/20/2023] [Revised: 07/20/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Despite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low-risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age. METHODS Within the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education. RESULTS Mean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development. CONCLUSIONS Several factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.
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Affiliation(s)
- Jonas Kappelt
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Clara Elise Schild
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
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Israel E, Abayneh S, Utalo D, Geta T, Kassaw T, Shonde T, Gebre M. Determinants of fetomaternal complication of instrumental vaginal delivery among women who gave childbirth in Southern Ethiopia: a facility-based cross-sectional study. BMC Res Notes 2023; 16:308. [PMID: 37919825 PMCID: PMC10623779 DOI: 10.1186/s13104-023-06583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In Ethiopia, one in five instrumental deliveries among women giving birth resulted in an unfavourable outcome. This study aimed to assess the determinants of feto-maternal complications of instrumental delivery in selected public hospitals of Gamo and Gofa zones, Southern Ethiopia. METHODS An institution-based cross-sectional study was conducted among 399 women attending selected public hospitals in the Gamo and Gofa zones. Data were collected using data extraction tools using a systematic random sampling technique. The collected data was entered into Epi-data version 3.1 and then analyzed using SPSS version 25. Logistic regression analysis was conducted to determine an association. RESULTS One hundred eighty-three (45.9%, n = 183/399) instrumental deliveries were found to be complicated. Primigravida women (AOR: 95% CI: 2.21 (1.35, 3.63), infant birth weight (AOR: 95% CI: 2.56 (1.37, 4.77), post-term pregnancy (AOR: 95% CI: 12.77 (2.92, 55.78), and maternal age (AOR: 95% CI: 7.00 (2.16, 22.64) were associated with fetomaternal complications in instrumental delivery among women who gave birth. CONCLUSIONS AND RECOMMENDATION A high proportion of women developed fetomaternal complications when compared to local studies. Promotion of antenatal care services, increasing women's education and empowerment as well as working on capacity building of health care professionals through education and training is cost-effective to reduce the occurrence of fetomaternal complications.
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Affiliation(s)
- Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Samuel Abayneh
- Department of Maternal and Child Health, Gofa Zone Health Department, Sawula, Ethiopia
| | - Dawit Utalo
- Departement of Public Health, Consortium Project at Women Empowerment Action with Amref Health Africa, Wolaita Sodo, Ethiopia
| | - Temesgen Geta
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tamirat Kassaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tamirayehu Shonde
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Merihun Gebre
- Department of Maternal and Child Health, Southern Ethiopia Regional Health Beurea, Jinka, Ethiopia
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Romero S, Lindström K, Listermar J, Westgren M, Ajne G. Long-term neurodevelopmental outcome in children born after vacuum-assisted delivery compared with second-stage caesarean delivery and spontaneous vaginal delivery: a cohort study. BMJ Paediatr Open 2023; 7:e002048. [PMID: 37848264 PMCID: PMC10582903 DOI: 10.1136/bmjpo-2023-002048] [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: 05/04/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To evaluate long-term neurodevelopment in children born after low-or mid-station vacuum-assisted delivery (VAD) compared with children delivered by second-stage caesarean delivery (SSCD) or spontaneous vaginal delivery (SVD). DESIGN Cross-sectional cohort study. SETTING Two delivery wards, Karolinska University Hospital, Sweden. PATIENTS 253 children born by low-station or mid-station VAD, 247 children born after an SVD, and 86 children born via an SSCD accepted to participate. INTERVENTIONS The Five-to-Fifteen questionnaire was used as a validated screening method for neurodevelopmental difficulties, assessed by parents. MAIN OUTCOMES MEASURES Results in the Five-to-Fifteen questionnaire. In addition, registered neurodevelopmental ICD-10 diagnoses were collected. Regression analyses estimated associations between delivery modes. RESULTS Children born after VAD exhibited an increased rate of long-term neurodevelopmental difficulties in motor skills (OR 2.2, 95% CI 1.3 to 3.8) and perception (OR 1.7, 95% CI 1.002 to 2.9) compared with SVD. Similar findings were seen in the group delivered with an SSCD compared with SVD (motor skills: OR 3.3, 95% CI 1.8 to 6.4 and perception: OR 2.3, 95% CI 1.2 to 4.4). The increased odds for motor skills difficulties after VAD and SSCD remained after adjusting for proposed confounding variables. There were significantly more children in the VAD group with registered neurodevelopmental ICD-10 diagnoses such as attention deficit/hyperactivity disorders. CONCLUSIONS The differences in long-term neurodevelopmental difficulties in children delivered with a VAD or SSCD compared with SVD in this study indicate the need for increased knowledge in the field to optimise the management of second stage of labour.
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Affiliation(s)
- Stefhanie Romero
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
- Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Lindström
- Neuropaediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Paediatrics, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
| | | | - Magnus Westgren
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
| | - Gunilla Ajne
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
- Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
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Della PR, Huang H, Roberts PA, Porter P, Adams E, Zhou H. Risk factors associated with 31-day unplanned hospital readmission in newborns: a systematic review. Eur J Pediatr 2023; 182:1469-1482. [PMID: 36705723 PMCID: PMC10167195 DOI: 10.1007/s00431-023-04819-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
UNLABELLED The purpose of this study is to synthesize evidence on risk factors associated with newborn 31-day unplanned hospital readmissions (UHRs). A systematic review was conducted searching CINAHL, EMBASE (Ovid), and MEDLINE from January 1st 2000 to 30th June 2021. Studies examining unplanned readmissions of newborns within 31 days of discharge following the initial hospitalization at the time of their birth were included. Characteristics of the included studies examined variables and statistically significant risk factors were extracted from the inclusion studies. Extracted risk factors could not be pooled statistically due to the heterogeneity of the included studies. Data were synthesized using content analysis and presented in narrative and tabular form. Twenty-eight studies met the eligibility criteria, and 17 significant risk factors were extracted from the included studies. The most frequently cited risk factors associated with newborn readmissions were gestational age, postnatal length of stay, neonatal comorbidity, and feeding methods. The most frequently cited maternal-related risk factors which contributed to newborn readmissions were parity, race/ethnicity, and complications in pregnancy and/or perinatal period. CONCLUSION This systematic review identified a complex and diverse range of risk factors associated with 31-day UHR in newborn. Six of the 17 extracted risk factors were consistently cited by studies. Four factors were maternal (primiparous, mother being Asian, vaginal delivery, maternal complications), and two factors were neonatal (male infant and neonatal comorbidities). Implementation of evidence-based clinical practice guidelines for inpatient care and individualized hospital-to-home transition plans, including transition checklists and discharge readiness assessments, are recommended to reduce newborn UHRs. WHAT IS KNOWN • Attempts have been made to identify risk factors associated with newborn UHRs; however, the results are inconsistent. WHAT IS NEW • Six consistently cited risk factors related to newborn 31-day UHRs. Four maternal factors (primiparous, mother being Asian, vaginal delivery, maternal complications) and 2 neonatal factors (male infant and neonatal comorbidities). • The importance of discharge readiness assessment, including newborn clinical fitness for discharge and parental readiness for discharge. Future research is warranted to establish standardised maternal and newborn-related variables which healthcare providers can utilize to identify newborns at greater risk of UHRs and enable comparison of research findings.
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Affiliation(s)
- Phillip R Della
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Haichao Huang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Pamela A Roberts
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Paul Porter
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Elizabeth Adams
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,European Federation of Nurses Associations, Clos du Parnasse, Brussels, 11A B-1050, Belgium
| | - Huaqiong Zhou
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia. .,General Surgical Ward, Perth Children's Hospital, Nedlands, Western Australia, Australia.
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Gallo D, Bresesti I, Bossi A, Lissoni D, Cromi A, Tataranno ML, Bertù L, Ghezzi F, Agosti M. Cranial ultrasound screening in term and late preterm neonates born by vacuum-assisted delivery: Is it worthwhile? Pediatr Neonatol 2023; 64:75-80. [PMID: 36182569 DOI: 10.1016/j.pedneo.2022.06.010] [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: 04/05/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Vacuum extraction is the most common choice to assist vaginal delivery, but there are still concerns regarding the neonatal injuries it may cause. This study aimed to evaluate the rate of intracranial injuries assessed by cranial ultrasound (cUS) among infants born by vacuum extraction, and the relationship with maternal and perinatal factors. METHODS This was a single-center retrospective study carried out in a level-3 neonatal unit. A total of 593 term and late preterm infants born by vacuum-assisted delivery were examined with a cUS scan within 3 days after birth. RESULTS Major head injuries were clinically silent and occurred in 2% of the infants, with a rate of intracranial haemorrhage of 1.7%. Regardless of obstetric factors, the risk of cranial injury was increased in infants requiring resuscitation at birth (p = 0.04, OR 4.1), admitted to NICU (p = 0.01, OR 5.5) or with perinatal asphyxia (p < 0.01, OR 21.3). Maternal age ≥40 years correlated both with adverse perinatal outcomes (p < 0.05) and the occurrence of major injury (p = 0.02, OR 4.6). CONCLUSION Overall, vacuum extraction is a safe procedure for neonates. Head injuries are usually mild and asymptomatic, and with spontaneous recovery. However, the rate of major cranial injuries in our cohort warrants further investigation to support a cUS screening, particularly for infants requiring respiratory support at birth. Also, maternal age might be taken into account when evaluating the risk for neonatal complications after vacuum application.
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Affiliation(s)
- Dario Gallo
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
| | - Ilia Bresesti
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Angela Bossi
- Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
| | - Donatella Lissoni
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Luisa Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht 3584, the Netherlands
| | - Lorenza Bertù
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Division of Obstetrics and Gynaecology, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Division of Neonatology, "F. Del Ponte" Hospital, Woman and Child Department, University of Insubria, Varese, Italy
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Romero S, Pettersson K, Yousaf K, Westgren M, Ajne G. Traction force profile in children with severe perinatal outcomes delivered with a digital vacuum extraction handle: A case-control study. Acta Obstet Gynecol Scand 2022; 101:1238-1244. [PMID: 36030477 PMCID: PMC9812099 DOI: 10.1111/aogs.14444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION During the second stage of labor, vacuum-assisted delivery is an alternative to forceps delivery and emergency cesarean section. Extensive research concerning perinatal outcomes has indicated that the risk of complications, although rare, is higher than with a spontaneous vaginal delivery. An important factor related to perinatal outcomes is the traction force applied. Our research group previously developed a digital extraction handle, the Vacuum Intelligent Handle-3 (VIH3), that measures and records traction force. The objective of this study was to compare traction force profiles in children with and without severe perinatal outcomes delivered with the digital handle. A secondary aim was to establish a safe force limit. MATERIAL AND METHODS This was an observational case-control study at the delivery ward at Karolinska University Hospital, Sweden. In total, 573 children delivered with the digital handle between 2012 and 2018 were included. Cases were defined as a composite of severe perinatal outcomes, including subgaleal hematoma, intracranial hemorrhage, hypoxic ischemic encephalopathy 1-3, seizures or death. The cases in the cohort were matched 1:3 based on five matching variables. Traction profiles were analyzed using the MATLAB® software and conditional logistic regression. RESULTS The incidence of severe perinatal outcomes was 2.3%. The 13 cases were matched with three controls each (n = 39). A statistically significant increased odds for higher total traction forces was seen in the case group (odds ratio [OR] 1.004; 95% confidence interval [CI] 1.001-1.007) and for the peak force (OR 1.022; 95% CI 1.004-1.041). Several procedure-related parameters were significantly increased in the case group. As expected, some neonatal characteristics also differed significantly. An upper force limit of 343 Newton minutes (Nmin) revealed an 86% reduction in severe perinatal outcomes (adjusted OR 0.14; 95% CI 0.04-0.5). CONCLUSIONS Children with severe perinatal outcomes had traction force profiles with significantly higher forces. The odds for severe perinatal outcomes increased for every increase in Nmin and Newton used during the extraction procedure. A calculated total force level of 343 Nmin is suggested as an upper safety limit, but this must be tested prospectively to provide validity.
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Affiliation(s)
- Stefhanie Romero
- Pregnancy Care & Delivery, Karolinska University HospitalStockholmSweden,Division of Obstetrics and GynecologyCLINTEC, Karolinska InstitutetStockholmSweden
| | - Kristina Pettersson
- Pregnancy Care & Delivery, Karolinska University HospitalStockholmSweden,Division of Obstetrics and GynecologyCLINTEC, Karolinska InstitutetStockholmSweden
| | - Khurram Yousaf
- School of Technology and HealthRoyal Institute of TechnologyStockholmSweden
| | - Magnus Westgren
- Pregnancy Care & Delivery, Karolinska University HospitalStockholmSweden,Division of Obstetrics and GynecologyCLINTEC, Karolinska InstitutetStockholmSweden
| | - Gunilla Ajne
- Pregnancy Care & Delivery, Karolinska University HospitalStockholmSweden,Division of Obstetrics and GynecologyCLINTEC, Karolinska InstitutetStockholmSweden
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Schreiber H, Cohen G, Farladansky-Gershnabel S, Sharon-Weiner M, Shechter Maor G, Biron-Shental T, Markovitch O. Vacuum-Assisted Delivery Complication Rates Based on Ultrasound-Estimated Fetal Weight. J Clin Med 2022; 11:jcm11123480. [PMID: 35743550 PMCID: PMC9225495 DOI: 10.3390/jcm11123480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
This retrospective cohort study investigated the association between ultrasonographic estimated fetal weight (EFW) and adverse maternal and neonatal outcomes after vacuum-assisted delivery (VAD). It included women with singleton pregnancies at 34−41 weeks gestation, who underwent ultrasonographic pre-labor EFW and VAD in an academic institution, over 6 years. Adverse neonatal and maternal outcomes included shoulder dystocia, clavicular fracture, or third- and fourth-degree perineal tears. A receiver−operator characteristic curve was used to identify the optimal weight cut-off value to predict adverse outcomes. Fetuses above and below this point were compared. Multivariate analysis was used to control for factors that could lead to adverse outcomes. Eight-hundred and fifty women met the inclusion criteria and had sonographic EFW within two-weeks before delivery. Receiver−operator characteristic curve analysis found that ultrasonographic EFW 3666 g is the optimal threshold for adverse outcomes. Based on these results, outcomes were compared using EFW 3700 g. The average EFW in the ≥3700 g group (n = 220, 25.9%) was 3898 ± 154 g (average birthweight 3710 ± 324 g). In the group <3700 g (n = 630, 74.1%), average EFW was 3064 ± 411 g (birthweight 3120 ± 464 g). Shoulder dystocia and clavicular fractures were more frequent in the higher EFW group (6.4% and 2.3% vs. 1.6% and 0.5%, respectively; p < 0.05). Women in the ≥3700 g group experienced more third- and fourth-degree perineal tears (3.2% vs. 1%, p = 0.02). Multivariate logistic regression analysis found maternal age, diabetes and sonographic EFW ≥ 3700 g as independent risk-factors for adverse outcomes. Sonographic EFW ≥ 3700 g is an independent risk-factor for adverse outcomes in VAD. This should be considered when choosing the optimal mode of delivery.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-9-7472561 or +972-53-3323248
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maya Sharon-Weiner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gil Shechter Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel; (G.C.); (S.F.-G.); (M.S.-W.); (G.S.M.); (T.B.-S.); (O.M.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Roy A, Hossain MM, Ullah MB, Mridha MK. Maternal and neonatal peripartum factors associated with late initiation of breast feeding in Bangladesh: a secondary analysis. BMJ Open 2022; 12:e051004. [PMID: 35584874 PMCID: PMC9119162 DOI: 10.1136/bmjopen-2021-051004] [Citation(s) in RCA: 1] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Late initiation of breast feeding (LIBF) is associated with increased neonatal mortality and morbidity. This study aimed to assess the association between intrapartum, early postpartum and neonatal factors, and LIBF in Bangladesh. DESIGN, SETTING AND PARTICIPANTS In this analysis, we used data from the mothers participating in a cluster-randomised controlled trial (Rang-Din Nutrition Study) conducted in rural northwest Bangladesh. Mothers (n=3594) were interviewed about the time of initiation of breast feeding, and peripartum maternal and neonatal complications within the first 72 hours of delivery. LIBF was defined as initiation of breast feeding 1 hour after birth. Factors associated with LIBF were identified by multivariable logistic regression analysis. MAIN OUTCOME MEASURES Prevalence and associated factors of LIBF. RESULTS The prevalence of LIBF was 18.5%. Factors significantly associated with LIBF in multivariable logistic regression were assisted vaginal delivery (adjusted OR (AOR) 2.17, 95% CI 1.44 to 3.27); delivery by caesarean section (AOR 9.67, 95% CI 7.21 to 12.96); maternal health problems during childbirth (AOR 1.61, 95% CI 1.30 to 2.00); preterm newborns (AOR 1.39, 95% CI 1.09 to 1.78); newborns moved slowly immediately after birth (AOR 1.43, 95% CI 1.05 to 1.94); and sick newborns (AOR 1.60, 95% CI 1.12 to 2.29). CONCLUSIONS Findings from this study suggest that to reduce LIBF, peripartum maternal and neonatal complications should be prevented and treated. TRIAL REGISTRATION NUMBER NCT01715038.
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Affiliation(s)
- Abhijeet Roy
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Md Barkat Ullah
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
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10
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Bjelke M, Thurn L, Oscarsson M. Prolonged passive second stage of labor in nulliparous women-Prevalence and risk factors: A historical cohort study. Acta Obstet Gynecol Scand 2022; 101:499-505. [PMID: 35293611 DOI: 10.1111/aogs.14342] [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: 10/21/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. MATERIAL AND METHODS This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. RESULTS The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90-5.34), malpresentation (aOR 2.26; 95% CI 1.27-4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50-2.65) and birthweight ≥ 4 kg (aOR 1.50; 95% CI 1.05-2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34-0.79) and noncohabiting (aOR 0.51; 95% CI 0.30-0.89) reduced the odds of prolonged passive second stage. CONCLUSIONS A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.
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Affiliation(s)
- Maria Bjelke
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Lars Thurn
- Department of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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11
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Dickmark M, Ågren J, Hellström-Westas L, Jonsson M. Risk factors for seizures in the vigorous term neonate: A population-based register study of singleton births in Sweden. PLoS One 2022; 17:e0264117. [PMID: 35176121 PMCID: PMC8853521 DOI: 10.1371/journal.pone.0264117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Neonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures. Objectives Our aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates. Methods This was a national cohort study of singleton infants born at term in Sweden from 2009–2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results The incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2–7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1–5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4–3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4–4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7–3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7–4.1). Conclusion A number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.
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Affiliation(s)
- Malin Dickmark
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Ågren
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Maria Jonsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
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12
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Yeh KW, He D, Hansen J, Carpenter CL, Ritz B, Olsen J, Heck JE. The risk of childhood brain tumors associated with delivery interventions: A Danish matched case-control study. Cancer Epidemiol 2022; 76:102077. [PMID: 34864576 PMCID: PMC8840805 DOI: 10.1016/j.canep.2021.102077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Head trauma has been associated with increased brain tumor risk in adults. Instrument assisted delivery can be a cause of head trauma in newborns. The goal of this study was to determine if instrument-assisted deliveries influenced the odds of childhood brain tumors in Denmark. METHODS We conducted a matched case-control study of childhood (<20 years) brain tumors in Denmark born between 1978 and 2013 and diagnosed 1978-2016. A total of 1678 brain tumor cases were identified and 25 controls were matched to each case based on the child's sex and birth date (N = 40,934). Conditional logistic regression was used to estimate effects (odds ratios (OR) and 95% confidence intervals (95%CI)) for variables of interest. RESULTS Compared to children birthed by spontaneous vaginal delivery, children who later developed ependymomas (N = 118) had a greater likelihood of having experienced vacuum assisted deliveries (OR=1.74, 95% CI 1.02-2.96). Forceps use was low, and declined across the study period. We did not observe an overall increase in all CNS tumors (combined) with either vacuum delivery (OR=0.99, 95% CI 0.84-1.18) or forceps delivery (OR=1.26, 95% CI 0.78-2.03). CONCLUSION Our findings suggest an association between vacuum assisted deliveries and ependymomas.
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Affiliation(s)
- Karen W. Yeh
- Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Catherine L. Carpenter
- Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200 Aarhus N, Aarhus, Denmark
| | - Julia E. Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA,College of Health and Public Service, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA
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13
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Prediction of neonatal subgaleal hemorrhage using first stage of labor data: a machine-learning based model. J Gynecol Obstet Hum Reprod 2022; 51:102320. [DOI: 10.1016/j.jogoh.2022.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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14
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Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study. Neurol Res Int 2021; 2021:9993912. [PMID: 34966561 PMCID: PMC8712143 DOI: 10.1155/2021/9993912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/07/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country. Objective To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019. Methods An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27. Results Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31-68.88), central nervous system infections (AOR: 0.02, 95% CI: 0-0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03-0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15-161.73). Conclusion Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.
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15
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Risk Factors for Cerebral Palsy in Moldova. ACTA ACUST UNITED AC 2021; 57:medicina57060540. [PMID: 34071238 PMCID: PMC8228264 DOI: 10.3390/medicina57060540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This is the first study assessing risk factors for cerebral palsy (CP) among children born in Moldova. The aim of this study was to identify and describe risk factors for cerebral palsy (CP) among children born in Moldova, which is one of the low-middle income countries in Europe. Materials and Methods: We identified 351 children with CP born during 2009 and 2010 in Moldova. Detailed information on 417 children without CP served as a reference group. Logistic regression analyses were applied to the calculate crude and adjusted odds ratios (OR) for CP with 95% confidence intervals (CI) in addition to attributable fraction (AF). Results: Among children with CP (40.5% girls), 26% had spastic unilateral, 54% bilateral, 13% dyskinetic, 5% ataxic and 2% unclassified CP. Significant risk factors for CP included maternal alcohol consumption during pregnancy (OR 1.7, p = 0.002), maternal hypertension (OR 2.0, p < 0.001), children born to mothers from the rural areas (OR 1.6, p < 0.001), maternal age ≥35 years (OR 0.6, p = 0.018), maternal epilepsy (OR 4.3, p < 0.001), breech delivery (OR 3.1, p = 0.001), home births (OR 6.3, p = 0.001), umbilical cord around neck (OR 2.2, p < 0.001), AVD (OR 3.1, p < 0.001), male gender (OR 1.3, p < 0.001), SGA (OR 1.3, p = 0.027), multiple gestations (OR 1.7, p < 0.001) and hyperbilirubinemia (OR 4.5, p < 0.001). Multivariable analyses showed that the AF of CP was 64% for rural residence (OR 2.8, p = 0.002), 87% for home birth (7.6, p = 0.005), 79% for pre-labor rupture of membrane (OR 4.9, p = 0.001), 66% for breech delivery (OR 2.9, p = 0.002) and 81% for hyperbilirubinemia (OR 5.4, p < 0.001). Conclusions: A combination of factors related to the mother, the delivery and the child were risk factors for CP in Moldova, many of them possibly avoidable. Improved pregnancy and maternity care would potentially reduce the risk of CP. A national CP registry in Moldova is suggested as an opportunity to follow up on these findings.
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16
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Maternal and perinatal factors are associated with risk of pediatric central nervous system tumors and poorer survival after diagnosis. Sci Rep 2021; 11:10410. [PMID: 34001927 PMCID: PMC8129132 DOI: 10.1038/s41598-021-88385-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/06/2021] [Indexed: 11/09/2022] Open
Abstract
Central nervous system (CNS) tumors are the most common solid tumors in children. Findings on the role of maternal and perinatal factors on the susceptibility or outcome of these tumors are inconclusive. Therefore, we investigated the association between these early-life factors, risk, and survival of pediatric CNS tumors, using data from one of the world’s largest and most diverse cancer registries. Information on pediatric CNS tumor cases (n = 1950) for the period 1995–2011 was obtained from the Texas Cancer Registry. Birth certificate controls were frequency-matched on birth year at a ratio of 10:1 for the same period. Evaluated maternal and perinatal variables were obtained from birth records. Unconditional logistic regression was used to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for etiological factors. Additionally, Cox proportional hazards regression was employed to assess adjusted hazard ratios (HRs) and 95% CIs for survival factors. The results indicated that Hispanic and non-Hispanic black mothers were less likely to have children with CNS tumors compared to non-Hispanic white mothers (OR 0.88 [95% CI 0.78–0.98] P-value = 0.019; OR 0.79 [95% CI 0.67–0.93 P-value = 0.004], respectively). Infants born large for gestational age (OR 1.26 [95% CI 1.07–1.47] P-value = 0.004) and those delivered pre-term (OR 1.19 [95% CI 1.04–1.38] P-value = 0.013) showed an increased risk of CNS tumors. Infants born by vaginal forceps or vacuum delivery had a higher risk of CNS tumors compared to those born by spontaneous vaginal delivery (OR 1.35 [95% CI 1.12–1.62] P-value = 0.002). Additionally, offspring of Hispanic and non-Hispanic black mothers showed a higher risk of death (HR 1.45 [95% CI 1.16–1.80] P-value = 0.001; HR 1.53 [95% CI 1.12–2.09] P-value = 0.008, respectively). Infants born by cesarean had a higher risk of death compared to those delivered vaginally (HR 1.28 [95% CI 1.05–1.57] P-value = 0.016). These findings indicate the important role of maternal and perinatal characteristics in the etiology and survival of these clinically significant malignancies.
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Abbas RA, Qadi YH, Bukhari R, Shams T. Maternal and Neonatal Complications Resulting From Vacuum-Assisted and Normal Vaginal Deliveries. Cureus 2021; 13:e14962. [PMID: 34123659 PMCID: PMC8191856 DOI: 10.7759/cureus.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Operative vaginal delivery is a procedure that is performed using forceps or vacuum to extract an infant from the birth canal. It has many indications, one of which is prolonged second stage of labor. Although rare, vacuum extraction (VE) can lead to various neonatal and maternal complications. The objective of this study was to compare the rates of different neonatal and maternal complications between vacuum-assisted deliveries and spontaneous vaginal deliveries. Methods This is a retrospective cohort study that was conducted in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The data were collected from the Labor and Delivery Unit at KAMC-J. A total of 745 samples was included (586 delivered spontaneously and 157 delivered by VE). Analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 27.0. Results The median age was 30 years (IQR=36-34). Of all deliveries, vacuum was used in 21.1%. Perineal tear was the most frequent maternal complication (20.9%), while caput succedaneum was the commonest neonatal complication (11.8%). Post-partum hemorrhage was significantly higher among vacuum deliveries (RR=18.8; 95% CI: 5.5-64.15), as well as cephalohematoma (RR=28.9; 95% CI: 8.79-95.04) and caput succedaneum (RR=18.6; 95% CI: 10.99-31.49). The first-minute Apgar score was lower with VE (p < 0.001), and higher perineal tear degrees were reported with VE (p < 0.001). Conclusion The rates of maternal and neonatal complications were significantly higher among vacuum-assisted deliveries. The most serious neonatal complication was subgaleal hematoma, which is considered life-threatening. Further research is recommended to investigate subgaleal hematoma risk factors.
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Affiliation(s)
- Renad A Abbas
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Yasmin H Qadi
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Rima Bukhari
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Taghreed Shams
- Clinical Research, King Abdullah International Medical Research Center, Jeddah, SAU.,Obstetrics and Gynecology, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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18
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Romero S, Pettersson K, Yousaf K, Westgren M, Ajne G. Perinatal outcome after vacuum assisted delivery with digital feedback on traction force; a randomised controlled study. BMC Pregnancy Childbirth 2021; 21:165. [PMID: 33637058 PMCID: PMC7913459 DOI: 10.1186/s12884-021-03604-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background Low and mid station vacuum assisted deliveries (VAD) are delicate manual procedures that entail a high degree of subjectivity from the operator and are associated with adverse neonatal outcome. Little has been done to improve the procedure, including the technical development, traction force and the possibility of objective documentation. We aimed to explore if a digital handle with instant haptic feedback on traction force would reduce the neonatal risk during low or mid station VAD. Methods A two centre, randomised superiority trial at Karolinska University Hospital, Sweden, 2016–2018. Cases were randomised bedside to either a conventional or a digital handle attached to a Bird metal cup (50 mm, 80 kPa). The digital handle measured applied force including an instant notification by vibration when high levels of traction force were predicted according to a predefined algorithm. Primary outcome was a composite of hypoxic ischaemic encephalopathy, intracranial haemorrhage, seizures, death and/or subgaleal hematoma. Three hundred eighty low and mid VAD in each group were estimated to decrease primary outcome from six to 2 %. Results After 2 years, an interim analyse was undertaken. Meeting the inclusion criteria, 567 vacuum extractions were randomized to the use of a digital handle (n = 296) or a conventional handle (n = 271). Primary outcome did not differ between the two groups: (2.7% digital handle vs 2.6% conventional handle). The incidence of primary outcome differed significantly between the two delivery wards (4% vs 0.9%, p < 0.05). A recalculation of power revealed that 800 cases would be needed in each group to show a decrease in primary outcome from three to 1 %. This was not feasible, and the study therefore closed. Conclusions The incidence of primary outcome was lower than estimated and the study was underpowered. However, the difference between the two delivery wards might reflect varying degree of experience of the technical equipment. An objective documentation of the extraction procedure is an attractive alternative in respect to safety and clinical training. To demonstrate improved safety, a multicentre study is required to reach an adequate cohort. This was beyond the scope of the study. Trial registration ClinicalTrials.gov NCT03071783, March 1, 2017, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03604-z.
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Affiliation(s)
- Stefhanie Romero
- Pregnancy Care & Delivery K57, Karolinska University Hospital, 141 86, Stockholm, Sweden. .,Division of Obstetrics and Gynecology, Clintec, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | - Kristina Pettersson
- Pregnancy Care & Delivery K57, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Clintec, Karolinska Institutet, 141 86, Stockholm, Sweden
| | - Khurram Yousaf
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Magnus Westgren
- Pregnancy Care & Delivery K57, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Clintec, Karolinska Institutet, 141 86, Stockholm, Sweden
| | - Gunilla Ajne
- Pregnancy Care & Delivery K57, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Clintec, Karolinska Institutet, 141 86, Stockholm, Sweden
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Elsawaf Y, Zeinomar M, Scherer A, Gandhi RH. Onyx Embolization of a Distal Middle Cerebral Artery Pseudoaneurysm in a Five-Week-Old: A Case Report and Review of Current Treatment Options. Cureus 2020; 12:e11974. [PMID: 33425546 PMCID: PMC7790325 DOI: 10.7759/cureus.11974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Intracranial pseudoaneurysms secondary to traumatic birth are a rare finding in infants. Definitive diagnosis of such findings is challenging, and no standard management is delineated for management of pseudoaneurysms in the pediatric population. Commonly attempted treatments include endovascular embolization or surgical clipping. A 5-week-old female presented with a two day history of right hand focal seizures. The patient was found to have a dysplastic superficial intra-axial aneurysm arising from the distal left middle cerebral artery (MCA) branch in the setting of a left posterior frontal lobe hemorrhage noted on brain magnetic resonance imaging/magnetic resonance angiography (MRI/MRA). The patient underwent diagnostic cerebral angiogram demonstrating a left distal MCA pseudoaneurysm, which was treated with Onyx embolization. Post-embolization period was complicated by recurrent left central localized seizures and a left hemispheric temporoparietal hemorrhagic infarction. The patient was managed on levetiracetam, phenytoin, phenobarbital with stable seizure control. Herein, we highlight the youngest case to date of a 5-week-old infant with a left distal MCA pseudoaneurysm treated with Onyx embolization. Pseudoaneurysmal incidence, diagnosis and accepted management is discussed.
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Kekki M, Salonen A, Tihtonen K, Mattila VM, Gissler M, Huttunen TT. The incidence of birth injuries decreased in Finland between 1997 and 2017: A nationwide register study. Acta Paediatr 2020; 109:2562-2569. [PMID: 32201987 DOI: 10.1111/apa.15267] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
AIM Birth injuries are rare complications that can have a significant impact on neonates and their families. This population-based study describes the rates and trends of all birth injuries in Finland over a 21-year period. METHODS The study is based on a national Medical Birth Register that includes all live-born neonates of more than 22 gestational weeks or 500 g who were born in Finland between 1997 and 2017. The ICD-10 codes of the birth injuries were obtained from the Finnish Medical Birth Register and the Care Register for Health Care. The incidence of birth injury, changes over time and incidence at different gestational ages were determined. RESULTS A total of 28 551 birth injuries were diagnosed, and the total incidence decreased from 34.0 to 16.6 per 1000 live births. The incidence of clavicle fracture, cephalohaematoma, and Erb paralysis decreased while the incidence of chignon and epicranial subaponeurotic haemorrhage increased. CONCLUSION The incidence of birth injury halved during the 20-year study period. This was mainly due to a decrease in the number of clavicle fractures. The incidence of birth injury increased with gestational age, and most injuries occurred after 37 weeks of gestation.
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Affiliation(s)
- Maiju Kekki
- Department of Obstetrics and Gynecology Tampere University Hospital Tampere Finland
| | - Anne Salonen
- Department of Pediatric and Adolescent Surgery Tampere University Hospital Tampere Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology Tampere University Hospital Tampere Finland
| | - Ville M. Mattila
- Department of Orthopedics and Traumatology Department of Trauma, Musculoskeletal Surgery and Rehabilitation Tampere University Hospital Tampere Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare Helsinki Finland
- Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
| | - Tuomas T. Huttunen
- Department of Emergency, Anesthesia and Pain Medicine Tampere University Hospital Tampere Finland
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21
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Haj Yahya R, Karavani G, Abu-Rabia A, Chill HH, Rosenbloom JI, Kabiri D, Eventov-Friedaman S, Ezra Y. The association between low birth weight and outcomes of vacuum assisted vaginal delivery. Eur J Obstet Gynecol Reprod Biol 2020; 256:252-255. [PMID: 33248381 DOI: 10.1016/j.ejogrb.2020.11.031] [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: 09/09/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It is often hypothesized that poor neonatal outcomes are more frequently observed in low birth weight (LBW) neonates following vacuum assisted vaginal delivery (VAVD). We sought to assess the association between low birth weight (< 2500 g) and neonatal outcomes, following vacuum extraction. STUDY DESIGN This was a retrospective cohort study, including 1085 deliveries in a tertiary medical center between 2003 and 2015. Maternal and neonatal outcomes, including birth trauma related complications, were compared between women with singleton pregnancies beyond 34 weeks' gestation and fetal weight < 2500 g who were delivered by vacuum extraction (n=345) and a control group (n=740) with fetal weight ≥ 2500 g, matched in maternal age, parity and gestational week. RESULTS During the study period, 370 women met the inclusion criteria for the study group, with 25 cases eventually excluded due to missing neonatal birth trauma related data. 740 patients were included in the matched control group. Induction of labor and non-reassuring fetal heart rate as an indication for VAVD were more prevalent in the LBW group. The composite birth trauma related adverse outcome was higher in the control group (9.1 % vs. 4.4 %, p = 0.008), mainly due to increased rate of cephalohematoma in this group (6.8 % vs. 2.9 %, p = 0.01). All other adverse neonatal outcomes rates did not differ between the groups. Women in the control group were more prone to post-partum hemorrhage (p < 0.001), had more episiotomies (p = 0.004) and a higher failed VAVD rate (11.4 % vs. 2.6 %, p < 0.001), leading to emergency cesarean delivery. A sub-group analysis of failed VAVD did not reveal a difference in neonatal complications between the LBW and the control group. CONCLUSION Neonatal birth trauma and adverse outcomes following vacuum extraction are no more common in neonates weighing less than 2500 g than those with higher birth weights, even in failed vacuum cases.
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Affiliation(s)
- Rani Haj Yahya
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Abu-Rabia
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Marchini G, Martín Muñoz D, Vladic Stjernholm Y. A parietal bone fracture with subgaleal and subdural hemorrhage in association with vacuum extraction delivery. Clin Case Rep 2020; 8:2103-2106. [PMID: 33235736 PMCID: PMC7669393 DOI: 10.1002/ccr3.2119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/18/2018] [Accepted: 01/26/2019] [Indexed: 11/10/2022] Open
Abstract
A neonatal parietal bone fracture was complicated by subgaleal and subdural hematomas after a vacuum extraction delivery. Low-dose computer tomography visualized a comminuted skull fracture. Close observation of infants delivered by vacuum extraction, conservative management after a skull fracture, and further studies on vacuum traction monitoring are warranted.
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Affiliation(s)
- Giovanna Marchini
- Departments of NeonatologyKarolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Daniel Martín Muñoz
- Department of NeuroradiologyKarolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Ylva Vladic Stjernholm
- Women’s and Children’s HealthKarolinska University Hospital and Karolinska InstitutetStockholmSweden
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23
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Ayala NK, Schlichting LE, Kole MB, Clark MA, Vivier PM, Viner-Brown SI, Werner EF. Operative vaginal delivery and third grade educational outcomes. Am J Obstet Gynecol MFM 2020; 2:100221. [PMID: 33345929 DOI: 10.1016/j.ajogmf.2020.100221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Operative vaginal delivery rates continue to drop nationally with many citing neonatal safety concerns as a primary driver of this decrease. Previous evidence on short-term neonatal outcomes does not support this concern. OBJECTIVE This study aimed to better understand the impact of delivery mode on childhood educational outcomes. STUDY DESIGN A statewide retrospective cohort was created in which third grade Rhode Island Department of Education data for 2014 to 2017 were linked to Rhode Island Department of Health birth certificate data. Children's third grade reading and math proficiencies were compared by the mode of delivery listed in their birth certificates. The study population was limited to children who were term, singleton births without congenital anomalies. The mode of delivery was classified as operative vaginal (forceps or vacuum), primary cesarean, or spontaneous vaginal delivery. Children born via repeat cesarean delivery were excluded. Bivariate analyses were conducted to assess differences in demographic variables between mothers and children by mode of delivery and between reading and math proficiencies and mode of delivery. Bivariable and multivariable log-binomial regression was used to examine the association between subject proficiency and predictors including mode of delivery, gestational age, sex, race/ethnicity, and lunch subsidy. RESULTS Of the 18,247 children who met the inclusion criteria, 6% were delivered by operative vaginal delivery, 19% by primary cesarean delivery, and the remaining 75% by spontaneous vaginal delivery. After adjustment for confounders including gestational age at delivery, child's race/ethnicity, sex, and socioeconomic factors, there was no difference in reading proficiency (adjusted risk ratio, 1.03; 95% confidence interval, 0.96-1.10) or math proficiency (adjusted risk ratio, 1.01; 95% confidence interval, 0.95-1.08) in those born by operative vaginal delivery compared with primary cesarean delivery, and no difference was found in either proficiency when spontaneous vaginal delivery was compared with primary cesarean delivery (reading, adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01; math, adjusted risk ratio, 0.98; 95% confidence interval, 0.94-1.01). CONCLUSION Operative vaginal delivery was not associated with differences in later childhood educational outcomes after adjusting for baseline differences. This should assuage previous concerns about long-term safety outcomes after operative vaginal delivery and may assist in shared decision making when operative vaginal or primary cesarean delivery is being considered.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI.
| | | | - Martha B Kole
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Melissa A Clark
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Departments of Pediatrics and Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI
| | - Samara I Viner-Brown
- Center for Health Data and Analysis, Rhode Island Department of Health, Providence, RI
| | - Erika F Werner
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
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24
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Pettersson KA, Westgren M, Blennow M, Ajne G. Association of traction force and adverse neonatal outcome in vacuum-assisted vaginal delivery: A prospective cohort study. Acta Obstet Gynecol Scand 2020; 99:1710-1716. [PMID: 32644188 DOI: 10.1111/aogs.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Traction force is a possible risk factor for adverse neonatal outcome in vacuum extraction delivery, but the knowledge is scarce and further investigation is needed. Our hypothesis was that high-level traction force increases the risk of admission to the neonatal intensive care unit. MATERIAL AND METHODS The study was a hospital-based prospective cohort study on low- and mid-vacuum extractions at the labor and delivery ward, Karolinska University Hospital, Huddinge, Sweden. Traction forces were measured in 331 women. An electronical handle was used to measure and register traction force. The main exposure variable was high-level traction force (≥75th percentile) during the first three pulls and the primary outcome was admission to the neonatal intensive care unit. Logistic regression was used to estimate the adjusted risk. RESULTS Among the exposed, 14/84 (16.7%) were admitted to neonatal intensive care, and among the unexposed 10/247 (4%). The crude odds ratio (OR) of admission to the neonatal intensive care unit when exposed to high-level traction force was 4.7, and the adjusted (birthweight, gestational length, cup detachment, number of pulls, duration, duration >15 minutes, mid-cavity fetal head station, failed extraction, indication and parity) OR was 2.85 (95% confidence interval [CI] 1.09-7.48). No significant effect was seen in Apgar scores <7 at 5 minutes or pH <7.1. CONCLUSIONS High-level traction force may be a risk factor for neonatal complications. Although these results do not mandate any alterations in clinical guidelines, perioperative feedback on traction force may be useful to alert the obstetrician to a timely conversion to cesarean section. To study plausible traction force specific outcomes such as head traumas, a larger sample size is required.
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Affiliation(s)
- Kristina A Pettersson
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Mats Blennow
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatrics, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Ajne
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
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25
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Abstract
Importance Immune thrombocytopenia purpura (ITP), an autoimmune disease characterized by destruction of platelets, is a hematological disorder that can present in both pregnant and nonpregnant patients. Although thrombocytopenia in pregnancy can be caused by more common pathologies such as gestational thrombocytopenia and preeclampsia, ITP can present initially during pregnancy, further complicating diagnosis. Management must be considerate of both the pregnancy itself and the fetus. Objective Review the diagnosis, treatment, and management of ITP in pregnancy based on current recommendations. Evidence Acquisition Review articles, original research, and case studies were utilized. Results Throughout pregnancy, patients are screened for a variety of conditions or disorders of pregnancy. Thrombocytopenia is a common pathology of pregnancy, but ITP is a rare condition that a provider needs to be aware of. After ruling out secondary causes of thrombocytopenia or more common causes such as gestational thrombocytopenia or preeclampsia, ITP should be considered. After diagnosis, treatment options should be discussed and initiated to provide safety for both the mother and fetus. Conclusions After reading this article, the reader will understand the current recommendations regarding the diagnosis, treatment, and management of ITP in pregnancy. Relevance The practitioner will be comfortable treating this condition during pregnancy.
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26
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Kumpulainen V, Lehtola SJ, Tuulari JJ, Silver E, Copeland A, Korja R, Karlsson H, Karlsson L, Merisaari H, Parkkola R, Saunavaara J, Lähdesmäki T, Scheinin NM. Prevalence and Risk Factors of Incidental Findings in Brain MRIs of Healthy Neonates-The FinnBrain Birth Cohort Study. Front Neurol 2020; 10:1347. [PMID: 31969859 PMCID: PMC6960102 DOI: 10.3389/fneur.2019.01347] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/06/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Birth is a traumatic event with molding forces directed to the fetal skull, which may result in intracranial hemorrhages. However, the knowledge on prevalence and risk factors of incidental brain magnetic resonance imaging (MRI) findings in infants is still inconclusive. Methods: The prevalence and nature of incidental MRI findings were assessed in a birth cohort of 175 asymptomatic infants. The role of delivery method as well as other potential risk factors for intracranial hemorrhages were evaluated. The infants underwent 3T MRI at the age of 2–5 weeks, and the neurological status of the infants with an incidental finding was evaluated by a pediatric neurologist. Information on the delivery method, duration of delivery, parity, used anesthesia, oxytocin induction, and Apgar score was gathered to evaluate their association with the prevalence of hemorrhages. Results: Incidental intracranial hemorrhages were detected in 12 infants (6.9%), all following spontaneous or assisted vaginal delivery. Vacuum-assistance was found to be a risk factor for subdural hemorrhages with an odds ratio (OR) of 4.7 (95% CI [1.18; 18.9], p = 0.032). All infants were evaluated to develop normally by their clinical status. Conclusions: Incidental intracranial hemorrhages are relatively common among infants born by vaginal delivery. They are often of little clinical significance within the first years of life and have unlikely consequences for later neurodevelopment either. Despite their benign character, investigators should be prepared to share this information with parents competently as the findings can cause parental anxiety, and especially as the popularity of MRI as a research tool is increasing.
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Affiliation(s)
- Venla Kumpulainen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Satu J Lehtola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Eero Silver
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Anni Copeland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland.,Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Riitta Parkkola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
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27
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Kasaye HK, Bobo FT, Yilma MT, Woldie M. Poor nutrition for under-five children from poor households in Ethiopia: Evidence from 2016 Demographic and Health Survey. PLoS One 2019; 14:e0225996. [PMID: 31860689 PMCID: PMC6924648 DOI: 10.1371/journal.pone.0225996] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Ethiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly. Methods Ethiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI). Result The prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition. Conclusion The burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target.
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Affiliation(s)
- Habtamu Kebebe Kasaye
- Department of Midwifery, Institute of Health Sciences, Wollega University; ekmete, Ethiopia
- * E-mail:
| | - Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University; Nekmete, Ethiopia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institute of Health Sciences, Wollega University; Nekmete, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University; Jimma, Ethiopia
- Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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28
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Ferraz A, Nunes F, Resende C, Almeida MC, Taborda A. Short-term neonatal outcomes of vacuum-assisted delivery. A case–control study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Yamasato K, Kimata C, Chern I, Clappier M, Burlingame J. Complications of operative vaginal delivery and provider volume and experience. J Matern Fetal Neonatal Med 2019; 34:3568-3573. [PMID: 31744361 DOI: 10.1080/14767058.2019.1688293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate associations between operative vaginal delivery complications and provider experience (operative vaginal delivery volume and time since residency).Methods: We included all operative vaginal deliveries between 2008 and 2014 at a tertiary care teaching hospital, stratified into forceps-assisted and vacuum-assisted deliveries. Complications included severe perineal lacerations (3rd and 4th degree) and neonatal injuries (subgaleal/subdural/cerebral hemorrhage, facial nerve injury, and scalp injury), which were identified by International Classification Diagnosis-9 codes. Providers were categorized by operative vaginal delivery volume (mean annual forceps- or vacuum-assisted deliveries over the study interval) and time since residency. Regression analyses were used to compare complication rates by provider volume and time since residency, adjusting for potential confounders, using 0-1 deliveries per year and <5 years since residency as reference groups.Results: Nine hundred and thirty-four forceps and 1074 vacuums occurred. For forceps-assisted deliveries, severe perineal injury was decreased among providers with >10 forceps per year (aOR 0.50 [95%CI 0.30-0.81]) and at 15-19 years (aOR 0.45 [95% CI 0.22-0.94], and ≥25 years (aOR 0.45 [0.27-0.73]) since residency. There were no associations with neonatal injuries. Among vacuum-assisted deliveries, severe perineal injury decreased at ≥25 years since residency (aOR 0.35 [95%CI 0.17-0.74], with no association with provider volume. Neonatal injury decreased at 5-9 years (aOR 0.53 [95%CI 0.30-0.93]), and 15-19 years since residency (aOR 0.53 [95%CI 0.29-0.97]), due to differences in scalp injuries. Neonatal injuries other than scalp injury were rare.Conclusion: Severe perineal lacerations decreased with increasing operative vaginal delivery experience, primarily among forceps-assisted vaginal delivery. Providers >5 years since residency may have lower scalp injury with vacuums, but this cohort was largely underpowered for neonatal injury.
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Affiliation(s)
- Kelly Yamasato
- Department of Obstetrics, Gynecology and Women's Health, John a Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Chieko Kimata
- Hawaii Pacific Health, Research Institute, Honolulu, HI, USA
| | - Ingrid Chern
- Department of Obstetrics, Gynecology and Women's Health, John a Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Mona Clappier
- Princeton Neuroscience Institute, Princeton University, NJ, USA
| | - Janet Burlingame
- Department of Obstetrics, Gynecology and Women's Health, John a Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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30
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Biru S, Addisu D, Kassa S, Animen S. Maternal complication related to instrumental delivery at Felege Hiwot Specialized Hospital, Northwest Ethiopia: a retrospective cross-sectional study. BMC Res Notes 2019; 12:482. [PMID: 31382987 PMCID: PMC6683480 DOI: 10.1186/s13104-019-4530-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aimed to determine proportion and risk factors for maternal complication related to forceps and vacuum delivery among mother who gave birth at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). RESULTS Records of 406 mothers managed with instrumental vaginal delivery were reviewed and 97% of the reviewed card had complete documentation. The proportion of maternal complications related to instrumental delivery was 12.1%. A major complication of forceps assisted delivery was 2nd-degree perineal tear (7.4%), 3rd-degree perineal tear (1.5%), cervical tear (1.5%) and episiotomy extension (1%). However, the complication of vacuum-assisted vaginal delivery was only cervical tear (0.5%) and episiotomy extension (0.5%). Episiotomy during instrumental delivery reduce maternal complication by 86% [AOR = 0.14, 95% CI 0.07-0.3]. Forceps assisted vaginal delivery had 3.4 times more risk for maternal complication compared to vacuum-assisted vaginal delivery [AOR = 3.4, 95% CI 1.08-10.67] and the same is true for primiparity that primipara women who gave birth by the help of instrument had 3.5 times more risk for maternal complication compared to a multipara women [AOR = 3.5, 95% CI 1.26-9.98].
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Affiliation(s)
- Shimeles Biru
- Department of Midwifery, College Of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu
- Department of Midwifery, College Of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simachew Kassa
- Department of Midwifery, College Of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Simachew Animen
- Department of Midwifery, College Of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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31
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Affiliation(s)
- Renee Eslick
- Clinical and Laboratory Haematologist, Haematology Department, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Claire McLintock
- Clinical and Laboratory Haematologist, Obstetric Physician, National Women’s Health, Auckland City Hospital, Auckland, New Zealand
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32
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Schwarzman P, Sheiner E, Wainstock T, Mastrolia SA, Segal I, Landau D, Walfisch A. Vacuum Extraction in Preterm Deliveries and Long-Term Neurological Outcome of the Offspring. Pediatr Neurol 2019; 94:55-60. [PMID: 30770270 DOI: 10.1016/j.pediatrneurol.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/09/2018] [Accepted: 12/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Concern exists regarding a possible harmful impact of vacuum extraction on the preterm newborn. We aimed to evaluate the long-term pediatric neurodevelopmental outcomes of the preterm offspring after vacuum extraction. METHODS A population-based cohort analysis was performed comparing the risk for long-term neurological morbidity (up to age 18 years) in preterm (less than 37 completed weeks of gestation) children born via following three delivery modes: vacuum extraction, spontaneous delivery, and Caesarean delivery performed during the second stage of labor. A Kaplan-Meier survival curve was used to compare the cumulative neurological morbidity in all groups. A Cox proportional hazards model was used to control for confounders. RESULTS During the study period 11,662 preterm newborns met the inclusion criteria, 97.2% (n = 11,338) of which were born via spontaneous vaginal delivery, 2.3% (n = 267) underwent vacuum extraction, and 0.5% (n = 57) were delivered by Caesarean section during the second stage of labor. Gestational age at delivery median (range) was 36 (29 to 36) weeks for vacuum extractions, 36 (23 to 36) for spontaneous vaginal delivery, and 35 (29 to 36) for Caesarean delivery within second stage of labor. Total pediatric hospitalizations involving neurological diagnoses were comparable between the groups as were the cumulative incidences of total neurological morbidity in the survival curves (log rank P = 0.723). In the Cox regression model, vacuum delivery in preterm newborns was not found to be associated with later pediatric neurological hospitalizations. CONCLUSIONS Vacuum extraction performed on preterm newborns does not appear to be independently associated with severe long-term neurological morbidity, as reflected by later pediatric hospitalizations.
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Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Ospedale dei Bambini "Vittore Buzzi", University of Milan, Milan, Italy
| | | | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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33
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Ferraz A, Nunes F, Resende C, Almeida MC, Taborda A. [Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study]. An Pediatr (Barc) 2019; 91:378-385. [PMID: 30981643 DOI: 10.1016/j.anpedi.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. MATERIAL AND METHODS We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. RESULTS The risk of soft tissue trauma (aOR, 2.4; P<.001), cephalohaematoma (aOR, 5.5; P<.001), jaundice (aOR, 4.4; P<.001), intensive phototherapy (aOR, 2.1; P<.001) and transient brachial plexus injury (aOR; 2.1, P=.006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P=.001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P=.046) and jaundice (OR, 1.4; P=.012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). CONCLUSION The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications.
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Affiliation(s)
- Ana Ferraz
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Filipa Nunes
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Resende
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Céu Almeida
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Pettersson K, Westgren M, Götze-Eriksson R, Ajne G. Effect of team training and monitoring on the rate of failed mid and low cavity vacuum extraction: a hospital based intervention study. BMC Pregnancy Childbirth 2019; 19:101. [PMID: 30922258 PMCID: PMC6440163 DOI: 10.1186/s12884-019-2257-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical team training has been advocated as a means to improve delivery care, and failed extractions is a suggested variable for clinical audit in instrumental vaginal delivery. Other activities may also have intended or unintended effects on care processes or outcomes. METHODS We retrospectively observed 1074 mid and low vacuum extraction deliveries during three time periods (prevalence periods): Baseline (period 0), implemented team training (period 1 and 2) and monitoring of traction force during vacuum extraction (period 2). Our primary outcome was failed extraction followed by emergency cesarean section or obstetric forceps delivery. RESULTS The prevalence proportion (relative risk) of failed extraction decreased significantly after implementation of team training, from 19% (period 0) to 8 % (period 1), corresponding to a relative risk of 0.48 [0.26-0.87]. The secondary procedural outcome complicated delivery (duration > 15 min or number of pulls > 6, or cup detachment > 1) was decreased in period 2 compared to period 1, RR 0.42 [0.23-0.76]. Secondary clinical (neonatal) outcome were not affected. CONCLUSION Clinically based educational efforts and increased monitoring improved procedural outcome without improving neonatal outcome. The study design has inherent limitations in making causal inference.
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Affiliation(s)
- Kristina Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | | | - Rebecca Götze-Eriksson
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
| | - Gunilla Ajne
- Department of Obstetrics and Gynecology, Karolinska University Hospital at Huddinge, K57, 141 86 Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
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Wang H, Luo B, Tong XM. [A single-center study of the incidence of neonatal birth trauma and its risk factors]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:249-252. [PMID: 30907349 PMCID: PMC7389357 DOI: 10.7499/j.issn.1008-8830.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the incidence of neonatal birth trauma in the department of obstetrics in a single-center medical institution and the risk factors for neonatal birth trauma. METHODS The maternal and infant medical records of all full-term singleton neonates delivered in the Department of Obstetrics, Peking University International Hospital, from October 2015 to September 2018 were collected. The neonates with birth trauma were assigned to case group, and those without birth trauma were assigned to control group. The risk factors for neonatal birth trauma were identified by multivariate logistic regression analysis. RESULTS Of the 4 682 full-term singleton neonates delivered during the study period, 201 (4.29%) were diagnosed with birth trauma. The most frequent type of birth trauma was cephalohematoma (81.7%), followed by facial nerve palsy (9.1%). The multivariate logistic regression analysis identified vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference as the risk factors for birth trauma (OR=5.020, 23.294, 1.409, 1.928 and 2.295 respectively; P<0.05). CONCLUSIONS The most frequent type of neonatal birth trauma is cephalohematoma. Vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference may increase the risk of neonatal birth trauma, and forceps-assisted delivery is the strongest independent risk factor for birth trauma.
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Affiliation(s)
- Hui Wang
- Department of Pediatrics, Peking University International Hospital, Beijing 102206, China.
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Georgakis MK, Dessypris N, Papadakis V, Tragiannidis A, Bouka E, Hatzipantelis E, Moschovi M, Papakonstantinou E, Polychronopoulou S, Sgouros S, Stiakaki E, Pourtsidis A, Psaltopoulou T, Petridou ET. Perinatal and early life risk factors for childhood brain tumors: Is instrument-assisted delivery associated with higher risk? Cancer Epidemiol 2019; 59:178-184. [PMID: 30818125 DOI: 10.1016/j.canep.2019.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The childhood peak of brain tumors suggests that early-life exposures might have a role in their etiology. Hence, we examined in the Greek National Registry for Childhood Hematological Malignancies and Solid tumors (NARECHEM-ST) whether perinatal and early-life risk factors influence the risk of childhood brain tumors. METHODS In a nationwide case-control study, we included 203 cases (0-14 years) with a diagnosis of brain tumor in NARECHEM-ST (2010-2016) and 406 age-, sex-, and center-matched hospital controls. Information was collected via interviews with the guardians and we analyzed the variables of interest in multivariable conditional logistic regression models. RESULTS Instrument-assisted delivery was associated with higher (OR: 7.82, 95%CI: 2.18-28.03), whereas caesarean delivery with lower (OR: 0.67, 95%CI: 0.45-0.99) risk of childhood brain tumors, as compared to spontaneous vaginal delivery. Maternal alcohol consumption during pregnancy (OR: 2.35, 95%CI: 1.45-3.81) and history of living in a farm (OR: 4.98, 2.40-10.32) increased the odds of childhood brain tumors. Conversely, higher birth order was associated with lower risk (OR for 2nd vs. 1st child: 0.60, 95%CI: 0.40-0.89 and OR for 3rd vs. 1st: 0.34, 95%CI: 0.18-0.63). Birth weight, gestational age, parental age, history of infertility, smoking during pregnancy, allergic diseases, and maternal diseases during pregnancy showed no significant associations. CONCLUSIONS Perinatal and early-life risk factors, and specifically indicators of brain trauma, exposure to toxic agents and immune system maturation, might be involved in the pathogenesis of childhood brain tumors. Larger studies should aim to replicate our findings and examine associations with tumor subtypes.
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Affiliation(s)
- Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Papadakis
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Athanasios Tragiannidis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Hatzipantelis
- Second Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Spyridon Sgouros
- Department of Neurosurgery, "Mitera" Childrens Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden.
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Hsieh DC, Smithers LG, Black M, Lynch JW, Dekker G, Wilkinson C, Stark MJ, Mol BW. Implications of vaginal instrumental delivery for children's school achievement: A population‐based linked administrative data study. Aust N Z J Obstet Gynaecol 2019; 59:677-683. [DOI: 10.1111/ajo.12952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- David C. Hsieh
- Department of Obstetrics and GynaecologyLyell McEwin Hospital Adelaide South Australia Australia
| | - Lisa G. Smithers
- School of Public Health University of AdelaideAdelaideSouth AustraliaAustralia
- The Robinson Institute School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Mairead Black
- Division of Applied Health SciencesUniversity of AberdeenAberdeen Maternity Hospital Aberdeen UK
| | - John W. Lynch
- School of Public Health University of AdelaideAdelaideSouth AustraliaAustralia
- The Robinson Institute School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Population Health SciencesUniversity of Bristol Bristol UK
| | - Gustaff Dekker
- Department of Obstetrics and GynaecologyLyell McEwin Hospital Adelaide South Australia Australia
- The Robinson Institute School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Chris Wilkinson
- The Robinson Institute School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Maternal and Foetal Medicine ServiceWomen's and Children's Hospital Adelaide South Australia Australia
| | - Michael J. Stark
- The Robinson Institute School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Maternal and Foetal Medicine ServiceWomen's and Children's Hospital Adelaide South Australia Australia
| | - Ben W. Mol
- Department of Obstetrics and GynaecologyMonash Medical CentreMonash University Melbourne Victoria Australia
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Åberg K, Norman M, Pettersson K, Järnbert-Pettersson H, Ekéus C. Protracted vacuum extraction and neonatal intracranial hemorrhage among infants born at term: a nationwide case-control study. Acta Obstet Gynecol Scand 2019; 98:523-532. [DOI: 10.1111/aogs.13519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Katarina Åberg
- Department of Women′s and Children′s Health; Division of Reproductive Health; Karolinska Institutet; Stockholm Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education; Södersjukhuset Hospital; Karolinska Institutet; Stockholm Sweden
| | - Cecilia Ekéus
- Department of Women′s and Children′s Health; Division of Reproductive Health; Karolinska Institutet; Stockholm Sweden
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Malmqvist O, Ohlin A, Ågren J, Jonsson M. Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study. J Matern Fetal Neonatal Med 2018; 33:799-805. [PMID: 30373414 DOI: 10.1080/14767058.2018.1505853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).Methods: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.Results: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).Conclusions: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.Rationale: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.
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Affiliation(s)
- Olle Malmqvist
- Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Andreas Ohlin
- Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Fogerty AE. Thrombocytopenia in Pregnancy: Mechanisms and Management. Transfus Med Rev 2018; 32:225-229. [PMID: 30177431 DOI: 10.1016/j.tmrv.2018.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 11/24/2022]
Abstract
Thrombocytopenia is a common hematologic issue encountered by obstetricians and hematologists, detected in about 10% of all pregnancies. In the vast majority of cases, the thrombocytopenia will be attributed to gestational thrombocytopenia (GT), where the thrombocytopenia is mild, does not necessitate active management, and does not introduce maternal or fetal bleeding risk. Although GT is common, the specific mechanism responsible for it is not known with certainty, and therefore, differentiating it from other causes of thrombocytopenia can be challenging. Previously proposed explanations for GT suggest that a decrease in platelet count is universal in pregnancy, and women diagnosed with GT are simply those with a baseline platelet count on the lower end of normal range. This concept is challenged in this review, and a possible mechanism for GT is proposed. Additionally, a framework for approaching the diagnosis and management of thrombocytopenia in pregnancy is presented.
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Affiliation(s)
- Annemarie E Fogerty
- Department of Medicine: Hematology/Oncology, Massachusetts General Hospital, Boston, MA.
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Yin Y, Li J, Lu H, Yao J, Hou R. Essential competencies for three grades of midwives in China. Int J Nurs Sci 2018; 5:18-23. [PMID: 31406795 PMCID: PMC6626219 DOI: 10.1016/j.ijnss.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/23/2017] [Accepted: 12/25/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify the essential competencies for different grades of midwives in China. METHODS A nationwide modified Delphi process was implemented to amend and screen the indicators. Thirty expert panellists including practitioners (nurse-midwives), clinical managers, academic educators and obstetricians completed a two-round Delphi study through an electronic survey that was supplemented by an expert panel meeting for discussion of comments and suggestions. RESULTS All panellists completed two rounds of Delphi study and at least 75% of them achieved a consensus on 224 items (W1 = 0.150, W2 = 0.173). Seven domains were established, namely, 'Professional quality', 'Antenatal care', 'Intrapartum care', 'Postnatal care', 'Neonatal care', 'Gynaecological care', 'Public health care & Integrative competency'. Generalised maternal and neonatal knowledge and perinatal care skills were set for 'junior' midwives, pathological care for 'senior' ones and supervisory abilities and promotion of discipline for 'expert' ones. CONCLUSIONS This research developed three grades of essential competencies for midwives in China. The next step will be assessment in clinical settings for further response. The set was in line with the concepts of International Confederation of Midwives under the domestic context. This set could be adopted as a reference in developing normalised midwifery practice, education and certification.
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Affiliation(s)
| | | | | | | | - Rui Hou
- School of Nursing, Peking University, Beijing, China
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Vacuum extraction in low birth weight (< 2500 g) neonates. Arch Gynecol Obstet 2017; 297:341-346. [DOI: 10.1007/s00404-017-4608-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
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Craniocerebral birth injuries in term newborn infants: a retrospective series. Childs Nerv Syst 2017; 33:1927-1935. [PMID: 28741228 DOI: 10.1007/s00381-017-3539-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In an attempt to further define the spectrum of cranial birth injuries, we analyzed 21 consecutive cranial birth injuries in term neonates presenting to the neurosurgical department of our institution over the period 1994-2015. METHODS We performed a retrospective chart review from the medical records of the University Hospitals of the KU Leuven, from 1994 to 2015. We included 21 infants of 36-week gestational age or older with a diagnosis of cranial birth injury. The types and locations of injuries, the presenting signs, symptoms and their timing, and the required treatment(s) were recorded. Various maternal and neonatal factors and the mode of delivery were recorded. We recorded the different modes of delivery rates at our institution in the year 2013 and the rates in the Flemish community between 1995 and 2013, in order to compare the mode of delivery rates in the study group with current practice at our institution and with general practice over the years in the Flemish community. RESULTS The most common clinical presentations were swelling (43% of cases) and seizures (19% of cases). Average Apgar scores were 6.57 at 1 min and 8.43 at 5 min; 48% of children had abnormally low Apgar scores at 1 min and 9.5% had abnormally low scores at 5 min. The most common intracranial lesion was skull fractures (33%). Operative treatment was required in 11 infants (52%). One infant died. Assisted mechanical delivery by either forceps and/or vacuum extraction occurred in 43% of infants. In comparison, in the year 2013, only 13.97% of deliveries at our institution were mechanically assisted. Over the period 1995-2013, the highest mechanically assisted delivery rates in the Flemish community were 14.1% in 1996. CONCLUSION Although our series is too small to make firm conclusions, it is remarkable that the rates of assisted mechanical deliveries in our series far exceeded the assisted mechanical delivery rates at our institution in the year 2013 and even the highest vacuum and forceps delivery rates in the Flemish community over the period 1995-2013.
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Lau Y, Tha PH, Ho-Lim SST, Wong LY, Lim PI, Citra Nurfarah BZM, Shorey S. An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28799193 DOI: 10.1111/mcn.12492] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022]
Abstract
This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pyai Htun Tha
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lai Ying Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Peng Im Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ekéus C, Wrangsell K, Penttinen S, Åberg K. Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1344631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Katarina Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
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Rabelo NN, Matushita H, Cardeal DD. Traumatic brain lesions in newborns. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:180-188. [PMID: 28355327 DOI: 10.1590/0004-282x20170016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022]
Abstract
Methods A literature review using the PubMed data base, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and clinical trials. Selected papers from 1922 to 2016 were studied. We selected 109 papers, through key-words, with inclusion and exclusion criteria. Discussion This paper discusses the risk factors for birth trauma, the anatomy of the occipito-anterior and vertex presentation, and traumatic brain lesions. Conclusion Birth-related traumatic brain injury may cause serious complications in newborn infants. Its successful management includes special training, teamwork, and an individual approach.
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Affiliation(s)
- Nícollas Nunes Rabelo
- Hospital Santa Casa de Ribeirão Preto. Departamento de Neurocirurgia, Ribeirão Preto SP, Brasil
| | - Hamilton Matushita
- Universidade de São Paulo. Divisão de Neurocirurgia Pediátrica, Faculdade de Medicina, São Paulo SP, Brasil
| | - Daniel Dante Cardeal
- Universidade de São Paulo. Divisão de Neurocirurgia Pediátrica, Faculdade de Medicina, São Paulo SP, Brasil
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Pereira RDB, Silva TME, Quadros AAJ, Orsini M, Schmidt B, Silva HCA, Oliveira ASB. Assessment of energy expenditure in individuals with post-poliomyelitis syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:147-152. [PMID: 28355321 DOI: 10.1590/0004-282x20170013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
Methods The Baecke questionnaire for the evaluation of habitual physical activity (HPA), assessment of quality of life (WHOQOL-Bref), and the Fatigue Severity Scale were administered to patients with PPS, poliomyelitis sequelae (PS) and to a control group (CG). Participated in the study 116 individuals (PPS=52,PS= 28,CG=36). Results Patients with PPS tended to increase their HPA from 10 to 20 years of age, compared with those in the PS group and the CG. In the period from 21 to 30 years of age, there was significant increase in the PPS group's occupational physical activity compared to the PS group, and the occupational physical activity (21-30 years of age) correlated with the onset of symptoms of PPS. Conclusion Patients with PPS had a higher energy expenditure during life, especially in occupational physical activity at ages 21-30 years, suggesting this decade is critical for the development of PPS.
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Affiliation(s)
| | - Tatiana Mesquita E Silva
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
| | | | - Marco Orsini
- Centro Universitário Augusto Motta, Mestrado em Ciências da Reabilitação, Bonsucesso RJ, Brasil.,Universidade Severino Sombra, Mestrado em Ciências Aplicadas a Saúde, Vassouras RJ, Brasil
| | - Beny Schmidt
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
| | | | - Acary Souza Bulle Oliveira
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
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De Bernardo G, Svelto M, Giordano M, Sordino D. Face presentation in delivery room: what is strategy? BMJ Case Rep 2017; 2017:bcr-2016-219114. [PMID: 28325723 DOI: 10.1136/bcr-2016-219114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Giuseppe De Bernardo
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Maria Svelto
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Maurizio Giordano
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
| | - Desiree Sordino
- Department of Emergency, NICU, Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Napoli, Italy
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Pettersson K, Yousaf K, Ranstam J, Westgren M, Ajne G. Predictive value of traction force measurement in vacuum extraction: Development of a multivariate prognostic model. PLoS One 2017; 12:e0171938. [PMID: 28257459 PMCID: PMC5336195 DOI: 10.1371/journal.pone.0171938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/29/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To enable early prediction of strong traction force vacuum extraction. DESIGN Observational cohort. SETTING Karolinska University Hospital delivery ward, tertiary unit. POPULATION AND SAMPLE SIZE Term mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277. METHODS Traction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction. STATISTICAL ANALYSIS A logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables. PREDICTORS Total (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull. OUTCOME Subjectively categorized extraction as strong versus non-strong. RESULTS The prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89. CONCLUSION Traction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
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Affiliation(s)
- Kristina Pettersson
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Khurram Yousaf
- Clintec, Karolinska Institute, Stockholm, Sweden
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Jonas Ranstam
- Statistician, Swedish Patient Insurance, Stockholm, Sweden
| | - Magnus Westgren
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
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Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application? Arch Gynecol Obstet 2016; 295:67-73. [DOI: 10.1007/s00404-016-4206-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
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