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Hadid S, Tomsis Y, Perez E, Sharabi L, Shaked M, Haze S. The role of expectations, subjective experience, and pain in the recovery from an elective and emergency caesarean section: A structural equation model. J Reprod Infant Psychol 2024; 42:915-933. [PMID: 36879419 DOI: 10.1080/02646838.2023.2187357] [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: 03/02/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. OBJECTIVE This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. METHODS Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. RESULTS Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. CONCLUSION The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted.
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Affiliation(s)
- Salam Hadid
- Nursing school, Zefat academic college, Zefat, Israel
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Yeela Tomsis
- Nursing school, Zefat academic college, Zefat, Israel
| | - Ester Perez
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Limor Sharabi
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Moshit Shaked
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Shani Haze
- Maternity ward, Galilee medical center, Nahariya, Israel
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Qin PP, Zou BY, Liu D, Li MX, Liu XN, Wei K. Lateral quadratus lumborum block vs acupuncture for postcesarean analgesia: a randomized clinical trial. Am J Obstet Gynecol MFM 2024; 6:101433. [PMID: 39019211 DOI: 10.1016/j.ajogmf.2024.101433] [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: 03/15/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. OBJECTIVE This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. STUDY DESIGN In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. RESULTS Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2-4] vs 3 [2-4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0-19.0] hours vs 15.3 [13.3-17.0] hours, estimated median difference, 1.5; 95% CI, 1-2; P<.001). CONCLUSION As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.
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Affiliation(s)
- Pei-Pei Qin
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing-Yu Zou
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Liu
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Xi Li
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Nan Liu
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- The Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Keshk EA, Alghamdi GS, Alghamdi MA, Alzahrani MS, Alzahrani RM, Alzahrani AS, Alzahrani RS. Knowledge and Attitude Toward Modes of Delivery and Possible Complications Among Women in Al-Baha Region, Saudi Arabia. Cureus 2024; 16:e59988. [PMID: 38854325 PMCID: PMC11162276 DOI: 10.7759/cureus.59988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The experience of childbirth significantly influences women's perspectives and attitudes, which are shaped by whether their experiences were positive or negative. This study aims to assess knowledge and attitudes regarding childbirth methods and potential complications among women in Al-Baha, Saudi Arabia. METHODS This cross-sectional study was conducted in the Al-Baha region of Saudi Arabia with 500 participants. Data collection was facilitated through online surveys. The survey was responded to by women residing in Al-Baha of reproductive age (18-45), including those who had given birth vaginally or via cesarean section within the past five years. The questionnaire covered sociodemographic aspects and assessed knowledge and attitudes toward vaginal delivery, cesarean section, and their respective complications. RESULTS The study encompassed 500 participants, predominantly under 36 years of age (224 participants, 44.8%). A majority were married (355 participants, 71%) and held a university degree (358 participants, 71.6%). Notably, half of the participants were unemployed, and 365 (65.4%) were multiparous. Preferences for childbirth methods showed that 296 women (59.2%) favored vaginal delivery, while 100 women (20%) preferred cesarean section. Regarding knowledge about childbirth, 200 participants (40%) rated their knowledge as very good. CONCLUSION The study reveals a preference for vaginal delivery among the women surveyed, with over half possessing adequate knowledge about postpartum complications. Women with only a diploma or expressing a preference for cesarean section displayed lower knowledge levels about these complications. It is recommended that medical professionals provide comprehensive information about various childbirth methods and their complications, indications, and benefits to expectant women.
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Affiliation(s)
- Eman A Keshk
- Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, EGY
- Obstetrics and Gynecology, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
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Zhang T, Wang J, Hua Z, Yao X, Zhang F, Zhou Y. Effect of adjunctive prophylactic macrolides used at the caesarean section on endometritis and surgical site wound infection: A meta-analysis. Int Wound J 2023; 20:3307-3314. [PMID: 37161646 PMCID: PMC10502253 DOI: 10.1111/iwj.14211] [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: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023] Open
Abstract
A meta-analysis investigation was executed to measure the outcome of adjunctive prophylactic macrolides (APM) used at caesarean section (CS) on endometritis and surgical site wound infection (SSWI). A comprehensive literature inspection till February 2023 was applied and 1023 interrelated investigations were reviewed. The 10 chosen investigations enclosed 22 676 females with CS were in the chosen investigations' starting point, 14 034 of them were utilising APM, and 8642 were utilising control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of APM used at CS on endometritis and SSWI by the dichotomous approaches and a fixed or random model. Adjunctive prophylactic macrolides had significantly lower SSWI (OR, 0.43; 95% CI, 0.34-0.55, P < .001), and endometritis (OR, 0.34; 95% CI, 0.20-0.60, P = .005) compared with those with control in females with CS. Adjunctive prophylactic macrolides had significantly lower SSWI, and endometritis compared with those with control in females with CS. However, care must be exercised when dealing with its values because of the low number of nominated investigations for the meta-analysis.
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Affiliation(s)
- Taiwei Zhang
- Department of ObstetricsThe First Affiliated Hospital of Guizhou University of Chinese MedicineGuiyangGuizhouChina
| | - Jiuchong Wang
- Department of Infectious Diseases, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Zhaozhao Hua
- Department of ObstetricsThe Second Affiliated Hospital of Guizhou University of Chinese MedicineGuiyangGuizhouChina
| | - Xiaoyun Yao
- Department of ObstetricsThe First Affiliated Hospital of Guizhou University of Chinese MedicineGuiyangGuizhouChina
| | - Fang Zhang
- Department of ObstetricsThe First Affiliated Hospital of Guizhou University of Chinese MedicineGuiyangGuizhouChina
| | - Yiyuan Zhou
- Eugenics Research CenterThe First Affiliated Hospital of Guizhou University of Chinese MedicineGuiyangGuizhouChina
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Odogwu NM. Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1082199. [PMID: 36685092 PMCID: PMC9845938 DOI: 10.3389/frph.2022.1082199] [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: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.
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Affiliation(s)
- Nkechi Martina Odogwu
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States,School of Public Health, University of Minnesota, Minneapolis, MN, United States,Correspondence: Nkechi Martina Odogwu ,
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Factors affecting the use of antibiotics and antiseptics to prevent maternal infection at birth: A global mixed-methods systematic review. PLoS One 2022; 17:e0272982. [PMID: 36048776 PMCID: PMC9436089 DOI: 10.1371/journal.pone.0272982] [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] [Received: 10/14/2021] [Accepted: 07/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Over 10% of maternal deaths annually are due to sepsis. Prophylactic antibiotics and antiseptic agents are critical interventions to prevent maternal peripartum infections. We conducted a mixed-method systematic review to better understand factors affecting the use of prophylactic antibiotics and antiseptic agents to prevent peripartum infections. Methods We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health, Global Index Medicus, and Maternity and Infant Care for studies published between 1 January 1990 and 27 May 2022. We included primary qualitative, quantitative, and mixed-methods studies that focused on women, families, and healthcare providers’ perceptions and experiences of prophylactic antibiotic and antiseptics during labour and birth in health facilities. There were no language restrictions. We used a thematic synthesis approach for qualitative evidence and GRADE-CERQual approach for assessing confidence in these review findings. Quantitative study results were mapped to the qualitative findings and reported narratively. Results We included 19 studies (5 qualitative, 12 quantitative and 2 mixed-methods studies), 16 relating to antibiotics, 2 to antiseptic use, and 1 study to both antibiotic and antiseptic use. Most related to providers’ perspectives and were conducted in high-income countries. Key themes on factors affecting antibiotic use were providers’ beliefs about benefits and harms, perceptions of women’s risk of infection, regimen preferences and clinical decision-making processes. Studies on antiseptic use explored women’s perceptions of vaginal cleansing, and provider’s beliefs about benefits and the usefulness of guidelines. Conclusion We identified a range of factors affecting how providers use prophylactic antibiotics at birth, which can undermine implementation of clinical guidelines. There were insufficient data for low-resource settings, women’s perspectives, and regarding use of antiseptics, highlighting the need for further research in these areas. Implications for practice include that interventions to improve prophylactic antibiotic use should take account of local environments and perceived infection risk and ensure contextually relevant guidance.
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Usichenko TI, Henkel BJ, Klausenitz C, Hesse T, Pierdant G, Cummings M, Hahnenkamp K. Effectiveness of Acupuncture for Pain Control After Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220517. [PMID: 35226080 PMCID: PMC8886541 DOI: 10.1001/jamanetworkopen.2022.0517] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE A pharmacological approach to pain control after cesarean delivery is often insufficient on its own. Acupuncture is a promising method for mitigating postoperative pain and reducing postoperative opioid requirements. OBJECTIVE To evaluate the efficacy and effectiveness of acupuncture as an adjunctive therapy for pain control after cesarean delivery, compared with a placebo intervention and standard care alone. DESIGN, SETTING, AND PARTICIPANTS This single-center, placebo-controlled, patient- and assessor-blinded randomized clinical trial was conducted from January 13, 2015, to June 27, 2018, at a tertiary university hospital in Greifswald, Germany. Participants were women who were scheduled for elective cesarean delivery under spinal anesthesia and were randomized to either the acupuncture group (n = 60) or placebo group (n = 60). Another 60 consecutive patients who met the eligibility criteria and received the standard postoperative analgesia were selected to form a nonrandomized standard care group. The intention-to-treat analysis was performed from August 19, 2019, to September 13, 2019. INTERVENTIONS In addition to standard pain treatment, each patient in the acupuncture group received auricular and body acupuncture with indwelling intradermal needles, whereas patients in the placebo group were treated with nonpenetrating placebo needles. MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity on movement, which was measured using an 11-item verbal rating scale. Secondary outcomes were analgesia-related adverse effects, analgesics consumption, time to mobilization and Foley catheter removal, quality of patient blinding to randomization, and patient satisfaction with treatment of pain. RESULTS A total of 180 female patients (mean [SD] age, 31 [5] years) were included in the intention-to-treat analysis. The mean pain intensity on movement in the acupuncture group on the first postoperative day was lower than in the placebo group (4.7 [1.8] vs 6.0 [2.0] points; Cohen d, 0.73; 95% CI, 0.31-1.01; P = .001) and the standard care group (6.3 [1.3] points; Cohen d, 1.01; 95% CI, 0.63-1.40; P < .001). On the first postoperative day, 59 patients (98%) in the acupuncture group were fully mobilized vs 49 patients (83%) in the placebo group (relative risk [RR], 1.18; 95% CI, 1.06-1.33; P = .01) and 35 patients (58%) in the standard care group (RR, 1.69; 95% CI, 1.36-2.09; P < .001). The Foley catheter was removed in a total of 57 patients (93%) from the acupuncture group vs 43 patients (72%) from the placebo group (RR, 1.33; 95% CI, 1.12-1.57; P = .003) and 42 patients (70%) from the standard care group (RR, 1.37; 95% CI, 1.14-1.62; P = .002). Other parameters were comparable across the 3 study groups. CONCLUSIONS AND RELEVANCE Results of this trial showed that acupuncture was safe and effective in reducing pain and accelerating mobilization of patients after cesarean delivery. With consideration for personnel and time expenditures, acupuncture can be recommended as routine, supplemental therapy for pain control in patients after elective cesarean delivery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02364167.
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Affiliation(s)
- Taras I. Usichenko
- Department of Anesthesiology, University Medicine of Greifswald, Greifswald, Germany
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Thomas Hesse
- Department of Anesthesiology, University Medicine of Greifswald, Greifswald, Germany
| | - Guillermo Pierdant
- Department of Gynecology and Obstetrics, University Medicine of Greifswald, Greifswald, Germany
| | - Mike Cummings
- British Medical Acupuncture Society, London, United Kingdom
| | - Klaus Hahnenkamp
- Department of Anesthesiology, University Medicine of Greifswald, Greifswald, Germany
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Advanced dressings for the prevention of surgical site infection in women post-caesarean section: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:226-233. [PMID: 34826671 DOI: 10.1016/j.ejogrb.2021.11.014] [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: 09/14/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) Surgical site infections (SSIs) are a common complication post-caesarean section. Advanced dressings aim to provide an optimal wound environment, primarily by physically or chemically controlling moisture, in order to promote timely healing. A systematic review and meta-analysis was conducted to evaluate the effectiveness of advanced dressings in SSI prevention post-caesarean section. Secondary effectiveness outcomes included superficial SSI, endometritis, wound dehiscence, rehospitalisation and length of rehospitalisation. STUDY DESIGN We conducted a systematic review and meta-analysis according to PRISMA guidelines. A protocol was registered a priori. MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched from inception to May 2021, without date or language restrictions. Keywords included: caesarean section; bandages; dressing and surgical wound infection. Randomised controlled trials (RCTs) were included if they investigated any advanced dressing in women post-caesarean section compared to simple dressings and assessed SSI incidence. Relative risks (RR), with 95% confidence intervals (CIs) and p-values, were calculated using Review Manager software (RevMan version 5.0, The Cochrane Collaboration). I2 percentages were reported to assess heterogeneity and a funnel plot was produced to assess publication bias. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. All data were double-extracted and discrepancies were finalised by a third reviewer. RESULTS From 253 citations identified, six RCTs were included in the systematic review and meta-analysis. Two studies investigated dialkylcarbamoyl chloride (DACC)-impregnated dressings; two investigated silver-impregnated dressings; one investigated copper-impregnated dressings and one investigated chlorhexidine gluconate dressings. The overall meta-analysis showed that advanced dressings did not reduce SSI risk (RR 0.81 [95% CI 0.52-1.24; p = 0.32]). However, subgroup analysis revealed that DACC-impregnated dressings reduced SSI risk (RR 0.33 [95% CI 0.14-0.77; p = 0.01]). Silver-impregnated dressings caused a nonsignificant increase in SSI risk (RR 1.20 [95% CI 0.77-1.88; p = 0.41]). All studies showed a high risk of bias. CONCLUSION This systematic review and meta-analysis suggests DACC dressings potentially reduce SSI. However we have shown no benefit of silver dressings. Further high-quality RCTs are required to recommend a change in clinical practice.
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Thirukumar P, Henry A, Coates D. Women's Experiences and Involvement in Decision-Making in Relation to Planned Cesarean Birth: An Interview Study. J Perinat Educ 2021; 30:213-222. [PMID: 34908820 PMCID: PMC8663766 DOI: 10.1891/j-pe-d-20-00034] [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: 11/25/2022] Open
Abstract
Actively engaging women in decision-making about their own care is critical to providing woman-centered maternity care. The aim was to understand women's mode-of-birth preferences and shared decision-making experiences during planned cesarean birth (CB). Semi-structured telephone interviews were conducted with 33 women who had planned CB at eight Australian metropolitan hospitals. Inductive thematic analysis was conducted using NVivo-12. Many women preferred a vaginal birth but were willing to have a CB if the clinician recommended. Most women looked to their clinicians for information and guidance. Although many women reported receiving enough information to make informed decisions, others felt pressured into having or not having a CB, or expected to make decisions themselves. Women wished for longer consultation times, more information, and care continuity.
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Alrammaal HH, Batchelor HK, Chong HP, Hodgetts Morton V, Morris RK. Prophylactic perioperative cefuroxime levels in plasma and adipose tissue at the time of caesarean section (C-LACE): a protocol for a pilot experimental, prospective study with non-probability sampling to determine interpatient variability. Pilot Feasibility Stud 2021; 7:54. [PMID: 33602323 PMCID: PMC7890388 DOI: 10.1186/s40814-021-00794-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the C-LACE study is to measure cefuroxime concentration in plasma and adipose tissue of non-obese and obese pregnant women undergoing caesarean section. Methods This study plans to compare maternal cefuroxime concentrations (plasma and adipose tissue), at the time of skin incision and time of skin closure during a caesarean section from non-obese (body mass index BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2) pregnant women. The incidence of post-surgical site infection will also be measured. At least 15 participants are required for each arm (non-obese vs obese) with a total of 30 participants. The study participants will be followed up between 30 and 40 days post-caesarean section to record details of any post-caesarean surgical infection to explore correlations between BMI, measured cefuroxime concentrations and post-caesarean infection rates. Discussion This pilot study will allow the development of a model testing the inter-patient variability in plasma and adipose tissue concentrations of cefuroxime. The results will facilitate the development of a larger study to determine whether differences in cefuroxime plasma and tissue concentration in obese and non-obese women can support the development of a physiologically based pharmacokinetic model. This model can then be used to propose dosing adjustments that can be used in a further trial to optimise cefuroxime dosing for women undergoing caesarean section. Trial registration ISRCTN Registry, ISRCTN17527512. Registered on 26 October 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00794-3.
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Affiliation(s)
- Hanadi H Alrammaal
- School of Pharmacy, Institute of Clinical Sciences, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Makkah Province, Saudi Arabia.
| | - Hannah K Batchelor
- School of Pharmacy, Institute of Clinical Sciences, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK
| | - Hsu P Chong
- Rosie Maternity Hospital, Robinson Way, Cambridge, CB2 0SQ, UK.,Department of Fetal and Maternal Medicine, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
| | - Victoria Hodgetts Morton
- Department of Fetal and Maternal Medicine, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.,Institute for Metabolic and Systems Research, University of Birmingham, Birmingham, UK
| | - R Katie Morris
- Department of Fetal and Maternal Medicine, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.,Institute for Metabolic and Systems Research, University of Birmingham, Birmingham, UK
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11
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Al-Rifai RH, Elbarazi I, Ali N, Loney T, Oulhaj A, Ahmed LA. Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E36. [PMID: 33374611 PMCID: PMC7793149 DOI: 10.3390/ijerph18010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women's knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. METHODS Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba'ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into "adequate (total score 6-10)" or "lack of adequate (total score 0-5)" knowledge. Crude and multivariable models were used to identify factors associated with "lack of adequate" knowledge on the mode of delivery and factors associated with CS preference. RESULTS A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18-24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07-8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06-3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02-1.14), employment (aOR, 1.96, 95% CI, 1.13-3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71-55.73) were associated with a preference towards CS delivery. CONCLUSION This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, UAE;
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
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Thirukumar P, Coates D, Henry A. Women's experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study. Women Birth 2020; 34:e248-e254. [PMID: 32507502 DOI: 10.1016/j.wombi.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/03/2023]
Abstract
PROBLEM AND BACKGROUND Approximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women's CS experiences is vital in identifying opportunities to improve women's experience of care. AIM To identify opportunities for service improvement by investigating Australian women's experiences of care and recovery when undergoing a planned CS. METHODS Qualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women's perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12. RESULTS Women's experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care. DISCUSSION Women reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care. CONCLUSION By incorporating shared decision-making antenatally, clinicians can discuss women's birth expectations with them and better prepare them for their planned CS and recovery.
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Affiliation(s)
- Purshaiyna Thirukumar
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia.
| | - Dominiek Coates
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Sydney, Australia.
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Farmer N, Hodgetts-Morton V, Morris RK. Are prophylactic adjunctive macrolides efficacious against caesarean section surgical site infection: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 244:163-171. [PMID: 31810022 DOI: 10.1016/j.ejogrb.2019.11.026] [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: 09/13/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/15/2022]
Abstract
Surgical site infection (SSI) post- caesarean section (CS) remains high, prophylactic adjunctive macrolides may reduce this. This systematic review and meta-analysis evaluated whether adjunctive prophylactic macrolides administered at CS reduce the risk of endometritis and wound infection. MEDLINE, EMBASE, CINHAL and the Cochrane library were searched from inception to July-2018. Observational and randomised studies investigating women undergoing a CS receiving standard prophylactic antibiotics, adjunctive prophylactic macrolides and assessed any SSI outcome was included. Data was double-extracted. Studies were included in a meta-analysis if the same study design and SSI outcome was used. Risk ratios were calculated and heterogeneity was assessed using the I2 test. Five studies were included in the systematic review and four in the meta-analysis. Two RCT's (n = 2610) found that macrolides significantly reduce the risk of wound infection RR [0.34; 95 %, 0.22 0.53] P = 0.00001 and endometritis RR [0.66; 95 %, 0.52, 0.85] P = 0.001 with no evidence of heterogeneity (I2 = 0 %). Two cohort studies (n = 13,809) found that azithromycin significantly reduces the risk of endometritis RR [0.16; 95 %, 0.04-0.62] P = 0.008, however significant heterogeneity was seen. Macrolides significantly reduce the risk of endometritis and wound infection post-CS. An effectiveness evaluation of post-cord clamping administration is needed to eliminate fetal antibiotic exposure and the long term infant implications this may have.
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Affiliation(s)
- Nicola Farmer
- The Birmingham Women'S Hospital, Edgbaston, Birmingham, B15 2TG, United Kingdom.
| | - Victoria Hodgetts-Morton
- The Birmingham Women'S Hospital, Edgbaston, Birmingham, B15 2TG, United Kingdom; The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Rachel K Morris
- The Birmingham Women'S Hospital, Edgbaston, Birmingham, B15 2TG, United Kingdom; The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Hodgetts-Morton V, Hewitt CA, Wilson A, Farmer N, Weckesser A, Dixon E, Brocklehurst P, Hardy P, Morris RK. Vaginal preparation with chlorhexidine at cesarean section to reduce endometritis and prevent sepsis: A randomized pilot trial (PREPS). Acta Obstet Gynecol Scand 2019; 99:231-239. [PMID: 31539171 DOI: 10.1111/aogs.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cesarean sections are the most common major operation worldwide. One in 10 women develops a surgical-site infection after cesarean section. The PREPS pilot trial was developed to assess the feasibility of a randomized controlled trial of vaginal cleansing with chlorhexidine before cesarean section, to reduce infectious morbidity. MATERIAL AND METHODS A multi-center, open-label, parallel-group pilot randomized controlled trial across 4 UK maternity units. Women aged ≥16 years, undergoing elective or emergency cesarean section, ≥34 weeks of gestation, and able to give informed consent were eligible. Women were randomized 1:1 to chlorhexidine 0.05% or no cleansing and were followed up until 6 weeks after cesarean section. The feasibility of a larger randomized controlled trial was assessed by the pilot trial's recruitment, ability to use verbal consent in an emergency, adherence, follow-up and withdrawal rates. The main clinical outcome collected was Center for Disease Control and Prevention (CDC) classification of endometritis at 30 days. Trial registration number is ISRCTN33435996. RESULTS A total of 320 women (128% of target) were randomized. Of these, 93% (95% CI 89%-95%) received their allocated intervention. Of the 88 women who had an emergency cesarean section, verbal consent was initially given by 32 (36%) women, with the remainder having sufficient time to give written consent. Endometritis (CDC definition) was collected from medical notes of 96% of women, 68% (95% CI 63%-73%) were followed up at both 14 and 30 days by telephone, and we were able to collect patient-reported outcomes. In the vaginal cleansing arm 2/152 (1.3%) women had endometritis compared with 1/155 (0.7%) in the no cleansing arm (RR 2.08, 95% CI 0.19-22.31). CONCLUSIONS It is possible to perform a randomized controlled trial in women undergoing an elective or emergency cesarean section, using a verbal-followed-by-written consent process, while maintaining high adherence and retaining women in the trial.
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Affiliation(s)
- Victoria Hodgetts-Morton
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amie Wilson
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Farmer
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Annalise Weckesser
- Center for Social Care, Health and Related Research, Faculty of Health, Education and Life Sciences, Birmingham City University, City South Campus, Birmingham, UK
| | - Emily Dixon
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pollyanna Hardy
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel K Morris
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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