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Peixoto AB, Guimarães DS, Maia e Cruz L, de Oliveira ML, Macedo Filho SDS, de Souza LRMF, Tonni G, Araujo Júnior E. Influence of Cesarean Section Scar on the Mean Pulsatility Index of the Uterine Artery Doppler between 20 and 34 Weeks of Gestation. Geburtshilfe Frauenheilkd 2024; 84:747-759. [PMID: 39114383 PMCID: PMC11303013 DOI: 10.1055/a-2348-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024] Open
Abstract
Objective The aim of this study was to assess the influence of the cesarean section scars on the mean pulsatility index (PI) of the uterine artery Doppler between 20 and 34 weeks of gestation. A secondary objective was to assess the association between previous cesarean section and adverse maternal/perinatal outcomes. Methods A retrospective cohort study was conducted with pregnant women who had their deliveries between March 2014 and February 2023. PI of the uterine arteries Doppler was performed transvaginally between 20-24 weeks and transabdominally between 28-34 weeks. The following variables were considered adverse perinatal outcomes: birth weight < 10th percentile for gestational age, preeclampsia, premature birth, placental abruption, perinatal death, postpartum hemorrhage, neonatal intensive care unit (NICU) admission. Results A total of 479 pregnant women were included in the final statistical analysis, being that 70.6% (338/479) had no (Group I) and 29.4% (141/479) had at least one previous cesarean section (Group II). Pregnant women with a previous cesarean had higher median of mean PI (1.06 vs. 0.97, p = 0.044) and median MoM of mean PI uterine arteries Doppler (1.06 vs. 0.98, p = 0.037) than pregnant women without previous cesarean section at ultrasound 20-24 weeks. Pregnant women with a previous cesarean section had higher median of mean PI (0.77 vs. 0.70, p < 0.001) and mean MoM PI uterine arteries Doppler (1.08 vs. 0.99, p < 0.001) than pregnant women without previous cesarean section at ultrasound 28-34 weeks. Pregnant women with ≥ 2 previous cesarean sections had a higher median of mean PI uterine arteries Doppler than those with no previous cesarean sections (1.19 vs. 0.97, p = 0.036). Group II had a lower risk of postpartum hemorrhage (aPR 0.31, 95% CI 0.13-0.75, p = 0.009) and composite neonatal outcome (aPR 0.66, 95% CI 0.49-0.88, p = 0.006). Group II had a higher risk of APGAR score at the 5th minute < 7 (aPR 0.75, 95% CI 1.49-51.29, p = 0.016). Conclusion The number of previous cesarean sections had a significant influence on the mean PI uterine arteries Doppler between 20-24 and 28-34 weeks of gestation. Previous cesarean section was an independent predictor of postpartum hemorrhage and APGAR score at the 5th minute < 7. Pregnancy-associated arterial hypertension and number of previous deliveries influenced the risk of composite neonatal outcome, but not the presence of previous cesarean section alone.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
- Uberaba Unit, Sabin Diagnostic Medicine, Uberaba, Brazil
| | - Débora Silva Guimarães
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Letícia Maia e Cruz
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Maria Laura de Oliveira
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Saulo da Silva Macedo Filho
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Luiz Ronan Marquez Ferreira de Souza
- Uberaba Unit, Sabin Diagnostic Medicine, Uberaba, Brazil
- Department of Radiology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, Brazil
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Al Khalaf SY, Heazell AEP, Kublickas M, Kublickiene K, Khashan AS. Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study. BJOG 2024; 131:1054-1061. [PMID: 38287170 DOI: 10.1111/1471-0528.17760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To investigate the risk of stillbirth in relation to (1) a previous caesarean delivery (CD) compared with those following a vaginal birth (VB); and (2) vaginal birth after caesarean (VBAC) compared with a repeat CD. DESIGN Population-based cohort study. SETTING The Swedish Medical Birth registry. POPULATION Women with their first and second singletons between 1982 and 2012. METHODS Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). MAIN OUTCOME MEASURES Stillbirth (antepartum and intrapartum fetal death). RESULTS Of the 1 771 700 singleton births from 885 850 women, 117 114 (13.2%) women had a CD in the first pregnancy, and 51 755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR 1.37; 95% CI 1.23-1.52) in women with a previous CD compared with VB. The odds of intrapartum stillbirth were higher in the previous pre-labour CD group (aOR 2.72; 95% CI 1.51-4.91) and in the previous in-labour CD group (aOR 1.35; 95% CI 0.76-2.40), although not statistically significant in the latter case. No increased odds were found for intrapartum stillbirth in women who had VBAC (aOR 0.99; 95% CI 0.48-2.06) compared with women who had a repeat CD. CONCLUSIONS This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help healthcare providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.
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Affiliation(s)
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Medical and Health, University of Manchester, Manchester, UK
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Unit of Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Clinical factors associated with preeclampsia recurrence. Pregnancy Hypertens 2022; 30:31-35. [DOI: 10.1016/j.preghy.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022]
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Garrido-Gómez T, Castillo-Marco N, Cordero T, Simón C. Decidualization resistance in the origin of preeclampsia. Am J Obstet Gynecol 2022; 226:S886-S894. [PMID: 33007270 DOI: 10.1016/j.ajog.2020.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a major obstetrical complication with short- and long-term life-threatening consequences for both mother and child. Shallow cytotrophoblast invasion through the uterine decidua into the spiral arteries is implicated in the pathogenesis of preeclampsia, although the cause of deficient arterial invasion remains unknown. Research that is focused on the "soil"-the maternal decidua-highlights the importance of this poorly understood but influential uterine layer. Decidualization of endometrial cells regulates embryo invasion, which is essential for spiral artery remodeling and establishing the maternal-fetal interface. Exploration of the association between impaired decidualization and preeclampsia revealed suboptimal endometrial maturation and uterine natural killer cells present in the decidua before preeclampsia development. Furthermore, decidualization defects in the endometrium of women with severe preeclampsia, characterized by impaired cytotrophoblast invasion, were detected at the time of delivery and persisted 5 years after the affected pregnancy. Recently, a maternal deficiency of annexin A2 expression was found to influence aberrant decidualization and shallow cytotrophoblast invasion, suggesting that decidualization resistance, which is a defective endometrial cell differentiation during the menstrual cycle, could underlie shallow trophoblast invasion and the poor establishment of the maternal-fetal interface. Based on these findings, the transcriptional signature in the endometrium that promotes decidualization deficiency could be detected before (or after) conception. This would serve to identify women at risk of developing severe preeclampsia and aid the development of therapies focused on improving decidualization, perhaps also preventing severe preeclampsia. Here, we discuss decidualization deficiency as a contributor to the pathogenesis of pregnancy disorders with particular attention to severe preeclampsia. We also review current diagnostic strategies and discuss future directions in diagnostic methods based on decidualization.
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Zhang X, Lou H, Tang X, Chen X. Socio-demographic characteristics and outcomes of pregnant women who delivered prior to and after the termination of the one-child policy in China: a comparative study. BMC Pregnancy Childbirth 2021; 21:318. [PMID: 33882886 PMCID: PMC8061051 DOI: 10.1186/s12884-021-03740-6] [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: 12/28/2020] [Accepted: 03/16/2021] [Indexed: 01/25/2023] Open
Abstract
Background The new Chinese fertility policy has recently received widespread public attention. However, there are few studies available on the comprehensive epidemiology of maternal and infant health with respect to the characteristic changes of childbearing women. In the study, we compared the maternal characteristics and pregnancy outcomes at different time points according to policy adjustments, accessed the possible relationship among these factors, and evaluated the impacts of these policies for medical and policy assistance. Methods This was a retrospective study. Data were collected from three representative hospitals in Zhejiang Province using stratified random sampling. The annual number of births, and maternal and child healthcare levels were the determining factors of sampling. Women who gave birth in November of 2012, 2014, and 2016 were recruited in accordance with the time of the change in the fertility policy, and we explored the differences in maternal socio-demographic characteristics, delivery mode and pregnancy outcomes. Results A total of 11,718 women were recruited, including 3480, 4044, and 4194 in November of 2012, 2014, and 2016, respectively. The proportions of multiparous women, women who aged ≥35 years, who received higher education, who had previous cesarean sections (CS), and who delivered in a high level hospital increased over time. In 2016, multipara accounted for 49.12, 14.47% were aged ≥35 years, nearly half of women had previous CS and delivered in a provincial hospital, 41.73% gave birth by CS, and 31.62% suffered pregnancy complications. The results of multiple logistic regression mode showed CS risk decreased significantly in 2014 (ORadj = 0.62; 95% CI, 0.55–0.67) relative to 2012, and risks of pregnancy complications (ORadj = 2.30; 95% CI, 1.86–2.83) and multiple births (ORadj = 3.25; 95% CI, 2.19–4.83) only increased in 2016 compared to 2012. Conclusions Some pregnancy outcomes increased as several key characteristics of childbearing women changed after China ended its “one-child” policy. This suggests that policy providers and medical staff need to strengthen healthcare in a consistent fashion regarding changes in birth policy.
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Affiliation(s)
- Xiaohui Zhang
- Department of women's health, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Road 1, Hangzhou, Zhejiang, 310006, P.R. China.
| | - Haifeng Lou
- Women's Hospital, School of Medicine, Zhejiang University, Xueshi Road 1, Hangzhou, Zhejiang, 310006, P.R. China
| | - Xuejuan Tang
- Department of women's health, Jiaxing Maternal and Child Health Hospital, Jia Xing, Zhonghuan Eastern Road, 2468, Zhejiang, P.R. China
| | - Xiaoli Chen
- Department of pathology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Road 1, Hangzhou, Zhejiang, 310006, P.R. China
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Işıkalan MM, Yeniçeri H, Toprak E, Güleroğlu FY, Acar A. Effect of previous cesarean sections on second-trimester uterine artery Doppler. J Obstet Gynaecol Res 2020; 46:1766-1771. [PMID: 32875650 DOI: 10.1111/jog.14357] [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: 01/21/2020] [Revised: 05/03/2020] [Accepted: 05/31/2020] [Indexed: 11/27/2022]
Abstract
AIM In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. METHODS This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. RESULTS The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. CONCLUSION The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.
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Affiliation(s)
- Mehmet M Işıkalan
- Department of Obstetrics and Gynecology, Division of Maternal -Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Haççe Yeniçeri
- Department of Obstetrics and Gynecology, Division of Maternal -Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Erzat Toprak
- Department of Obstetrics and Gynecology, Division of Maternal -Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Y Güleroğlu
- Department of Obstetrics and Gynecology, Division of Maternal -Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Acar
- Department of Obstetrics and Gynecology, Division of Maternal -Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Sukmawati S, Sunarno I, Arsyad MA, Idris I. Vaginal and cesarean section delivery with severe preeclampsia and preeclampsia with complications. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Visser L, Slaager C, Kazemier BM, Rietveld AL, Oudijk MA, de Groot C, Mol BW, de Boer MA. Risk of preterm birth after prior term cesarean. BJOG 2020; 127:610-617. [PMID: 31883402 PMCID: PMC7317970 DOI: 10.1111/1471-0528.16083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
Objective To determine the risk of overall preterm birth (PTB) and spontaneous PTB in a pregnancy after a caesarean section (CS) at term. Design Longitudinal linked national cohort study. Setting The Dutch Perinatal Registry (1999–2009). Population 268 495 women with two subsequent singleton pregnancies were identified. Methods A cohort study based on linked registered data from two subsequent pregnancies in the Netherlands. Main outcome measures The incidence of overall PTB and spontaneous PTB with subgroup analysis on gestational age at first delivery and type of CS (planned or unplanned). Results Of 268 495 women with a singleton first pregnancy who delivered at term, 15.76% (n = 42 328) had a CS. The incidence of PTB in the second pregnancy was 2.79% (n = 1182) in women with a previous CS versus 2.46% (n = 5570) in women with a previous vaginal delivery (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.07–1.21). This increased risk is mainly driven by an increased risk of spontaneous PTB after previous CS at term (aOR 1.50, 95% CI 1.38–1.70). Analysis for type of CS compared with vaginal delivery showed an aOR on spontaneous PTB of 1.86 (95% CI 1.58–2.18) for planned CS and an aOR of 1.40 (95% CI 1.24–1.58) for unplanned CS. Conclusions CS at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Tweetable abstract Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.
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Affiliation(s)
- L Visser
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - C Slaager
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - B M Kazemier
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A L Rietveld
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Cjm de Groot
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - M A de Boer
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Park JH, Lee KE, Yu YM, Park YH, Choi SA. Incidence and Risk Factors for Venous Thromboembolism After Spine Surgery in Korean Patients. World Neurosurg 2019; 128:e289-e307. [PMID: 31028984 DOI: 10.1016/j.wneu.2019.04.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data regarding the incidence of venous thromboembolism (VTE) after spine surgery are scarce. Identifying ideal candidates for pharmacologic thromboprophylaxis and balancing the risk of thromboembolic complications against the risk of permanent neurologic deficits from a spinal epidural hematoma (SEH) are difficult. Even guidelines cannot suggest the standard of thromboprophylaxis. OBJECTIVES This study aimed to identify the incidence of and risk factors for VTE after spine surgery in the Korean population. In addition, the rate of pharmacoprophylaxis and the incidence of SEH after spine surgery were analyzed. METHODS The study cohort was generated by extracting patients with disease codes of spine surgery and VTE from the Health Insurance Review & Assessment Service National Inpatient Sample in 2014. After analyzing the incidence of VTE after spine surgery, a univariate comparison was performed to examine the possible relationship between the incidence of VTE and the independent variable. Variables found to be significant were included in a multivariable analysis model for further analysis. RESULTS The incidence of VTE was 2.09% among all 21,261 patients who had spine surgery, and prophylaxis was applied to 7.89% of all patients who had spine surgery. Comorbidities and surgery-related risk factors were venous disease, cancer, respiratory disease, prolonged surgery hours, and increased total blood loss. Hospital-related risk factors were the location and hospital size. CONCLUSIONS On the basis of the incidence of VTE and the risk factors, more active prophylaxis is suggested for patients in the Korean population who undergo spine surgery.
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Affiliation(s)
- Ji Hyun Park
- College of Pharmacy, Korea University, Sejong-si, Republic of Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, Republic of Korea
| | - Yun Mi Yu
- College of Pharmacy, Yonsei University, Incheon, Yeonsu-gu, Republic of Korea
| | | | - Soo An Choi
- College of Pharmacy, Korea University, Sejong-si, Republic of Korea.
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Hu HT, Xu JJ, Lin J, Li C, Wu YT, Sheng JZ, Liu XM, Huang HF. Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:273. [PMID: 29954355 PMCID: PMC6027796 DOI: 10.1186/s12884-018-1895-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/12/2018] [Indexed: 01/07/2023] Open
Abstract
Background Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non-indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.05–1.55), placenta previa (3.18, 2.15–4.71), placenta accreta (2.75, 1.75–4.31), and polyhydramnios (2.60, 1.57–4.31) in the mother and preterm delivery (1.37, 1.06–1.78), low birth weight (3.78, 2.07–6.90), macrosomia (5.04, 3.95–6.44), and neonatal jaundice (1.72, 1.39–2.14) in the baby. Conclusions CS in the first delivery markedly increases the risk of repeated CS and maternal-fetal complications in the subsequent pregnancy, especially in women with a non-indicated CS.
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Affiliation(s)
- Hong-Tao Hu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Jing Xu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Lin
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Ting Wu
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Zhong Sheng
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xin-Mei Liu
- Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
| | - He-Feng Huang
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
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Kim JW, Lee CK, Rhee SY, Oh CH, Shim JJ, Kim HJ. Trends in health-care costs and utilization for inflammatory bowel disease from 2010 to 2014 in Korea: A nationwide population-based study. J Gastroenterol Hepatol 2018; 33:847-854. [PMID: 29055148 DOI: 10.1111/jgh.14027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/28/2017] [Accepted: 10/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Data regarding health-care costs and utilization for inflammatory bowel disease (IBD) at the population level are limited in Asia. We aimed to investigate the nationwide prevalence and health-care cost and utilization of IBD in Korea. METHODS We tracked the IBD-attributable health-care costs and utilization from 2010 to 2014 using the public dataset obtained from Korean National Health Insurance Service claims. We estimated the nationwide prevalence of IBD using population census data from Statistics Korea during the same period. RESULTS In total, 236 106 IBD patients were analyzed. The estimated IBD prevalence significantly increased from 85.1/100 000 in 2010 to 106/100 000 in 2014. The overall annual health-care costs for IBD increased from $23.2 million (US dollars) in 2010 to $49.7 million in 2014 (P < 0.001). During the same period, the health-care cost per capita also increased from $572.3 to $983.7 (P < 0.001). The outpatient to total cost ratio increased from 45.5% in 2010 to 66.6% in 2014. Regarding health-care utilization, the outpatient to total days of service use ratio increased from 73.1% in 2010 to 76.9% in 2014. Of the total days of service used, the proportions of tertiary, general, and community hospitals increased significantly with a concomitant decrease in that of primary clinics (all P values < 0.001). CONCLUSIONS This population-based study confirmed the steadily rising rate of prevalence of IBD in Korea. It also demonstrated that the shifting to outpatient care and advanced care settings are drivers for the dramatic increase in IBD-related health-care costs in Korea.
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Affiliation(s)
- Jung-Wook Kim
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chang Kyun Lee
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Division of Endocrinology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chi Hyuck Oh
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Jun Shim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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12
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Torabi S, Sheikh M, Fattahi Masrour F, Shamshirsaz AA, Bateni ZH, Nassr AA, Pooransari P, Talebian M, Hantoushzadeh S. Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section. J Matern Fetal Neonatal Med 2018; 32:2221-2227. [DOI: 10.1080/14767058.2018.1430132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shirin Torabi
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Fattahi Masrour
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza A. Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
| | - Zhoobin H. Bateni
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
| | - Ahmed A. Nassr
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital Pavilion for Women, Houston, TX, USA
- Department of Obstetrics and Gynecology, Women’s Health Hospital, Assiut University, Assiut, Egypt
| | - Parichehr Pooransari
- Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Talebian
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Defective decidualization during and after severe preeclampsia reveals a possible maternal contribution to the etiology. Proc Natl Acad Sci U S A 2017; 114:E8468-E8477. [PMID: 28923940 DOI: 10.1073/pnas.1706546114] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In preeclampsia (PE), cytotrophoblast (CTB) invasion of the uterus and spiral arteries is often shallow. Thus, the placenta's role has been a focus. In this study, we tested the hypothesis that decidual defects are an important determinant of the placental phenotype. We isolated human endometrial stromal cells from nonpregnant donors with a previous pregnancy that was complicated by severe PE (sPE). Compared with control cells, they failed to decidualize in vitro as demonstrated by morphological criteria and the analysis of stage-specific antigens (i.e., IGFBP1, PRL). These results were bolstered by global transcriptional profiling data that showed they were transcriptionally inert. Additionally, we used laser microdissection to isolate the decidua from tissue sections of the maternal-fetal interface in sPE. Global transcriptional profiling revealed defects in gene expression. Also, decidual cells from patients with sPE, which dedifferentiated in vitro, failed to redecidualize in culture. Conditioned medium from these cells failed to support CTB invasion. To mimic aspects of the uterine environment in normal pregnancy, we added PRL and IGFBP1, which enhanced invasion. These data suggested that failed decidualization is an important contributor to down-regulated CTB invasion in sPE. Future studies will be aimed at determining whether this discovery has translational potential with regard to assessing a woman's risk of developing this pregnancy complication.
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14
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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15
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Löfling L, Bröms G, Bahmanyar S, Kieler H. Maternal and infant characteristics: differences and similarities between the Nordic countries and the US. Clin Epidemiol 2016; 8:285-94. [PMID: 27536160 PMCID: PMC4976813 DOI: 10.2147/clep.s106126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Data from the Nordic health care registers have been of great value in perinatal epidemiological research. It has been assumed that findings from the Nordic population (Denmark, Finland, Iceland, Norway, and Sweden) are applicable to other populations as well, including the population of the US. Objective To describe and compare maternal and infant characteristics between the Nordic and the American populations as recorded in the official statistics. Materials and methods This population-based study included data on all females who gave birth and their infants in the Nordic countries and the US. The data were obtained from the US National Center for Health Statistics and the official statistics data for the Nordic countries. The data from all six countries included births from 2006 to 2010. Results The mean maternal age at delivery was lower in the US than in the Nordic countries (27.5 vs 30.3 years). Cesarean sections (32.2% vs 17.9%), low birth weight (8.2% vs 4.8%), and preterm birth (12.3% vs 5.9%) were more common in the US than in the Nordic countries. Smoking during early pregnancy was slightly less common in the US compared with Nordic countries (9.8% vs 11.2%). Restricting the data from the US to females with a university degree, characteristics such as age at delivery, birth weight, and preterm deliveries were more in alignment with the Nordic data. Conclusion There are differences in some key maternal and neonatal characteristics between the Nordic countries and the US. However, some characteristics are related to socioeconomic status, suggesting that the Nordic data seem to be applicable to the part of the population in the US with a higher socioeconomic status.
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Affiliation(s)
- Lukas Löfling
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriella Bröms
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Choe SA, Min HS, Cho SI. The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013. SPRINGERPLUS 2016; 5:895. [PMID: 27386343 PMCID: PMC4923012 DOI: 10.1186/s40064-016-2620-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/17/2016] [Indexed: 02/07/2023]
Abstract
There is limited evidence on the effects of relatively low socioeconomic status on maternal health. Additionally, the global economic recession that began in 2008 could have worsened disparities in maternal complications. To explore disparities in maternal health, we analyzed the occurrence of preeclampsia and postpartum hemorrhage according to level of household income. A population-based cohort data set from the Korean National Health Insurance was used to calculate the age-adjusted incidence, slope index of inequality, and Kunst and Mackenbach relative index of inequality (RIIKM) for preeclampsia and postpartum hemorrhage from 2002 to 2013. In the aggregated data of 65,479 live births, women with lower household income showed a higher risk of developing preeclampsia and postpartum hemorrhage than those with higherhigher incomes after adjusting for conventional risk factors. The absolute and relative inequalities for both complications showed no significant change over the period from 2002 to 2013. Considering the difference in the trends and risks of major obstetric complications according to level of household income, policies to monitor and reduce disparities in maternal health across different economic levels need to be implemented.
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Affiliation(s)
- Seung-Ah Choe
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Hye-Sook Min
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742 Republic of Korea
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