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Walker HGM, Brown AJ, Vaz IP, Reed R, Schofield MA, Shao J, Nanjayya VB, Udy AA, Jeffcote T. Composite outcome measures in high-impact critical care randomised controlled trials: a systematic review. Crit Care 2024; 28:184. [PMID: 38807143 PMCID: PMC11134769 DOI: 10.1186/s13054-024-04967-3] [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: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The use of composite outcome measures (COM) in clinical trials is increasing. Whilst their use is associated with benefits, several limitations have been highlighted and there is limited literature exploring their use within critical care. The primary aim of this study was to evaluate the use of COM in high-impact critical care trials, and compare study parameters (including sample size, statistical significance, and consistency of effect estimates) in trials using composite versus non-composite outcomes. METHODS A systematic review of 16 high-impact journals was conducted. Randomised controlled trials published between 2012 and 2022 reporting a patient important outcome and involving critical care patients, were included. RESULTS 8271 trials were screened, and 194 included. 39.1% of all trials used a COM and this increased over time. Of those using a COM, only 52.6% explicitly described the outcome as composite. The median number of components was 2 (IQR 2-3). Trials using a COM recruited fewer participants (409 (198.8-851.5) vs 584 (300-1566, p = 0.004), and their use was not associated with increased rates of statistical significance (19.7% vs 17.8%, p = 0.380). Predicted effect sizes were overestimated in all but 6 trials. For studies using a COM the effect estimates were consistent across all components in 43.4% of trials. 93% of COM included components that were not patient important. CONCLUSIONS COM are increasingly used in critical care trials; however effect estimates are frequently inconsistent across COM components confounding outcome interpretations. The use of COM was associated with smaller sample sizes, and no increased likelihood of statistically significant results. Many of the limitations inherent to the use of COM are relevant to critical care research.
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Affiliation(s)
- Humphrey G M Walker
- Department of Critical Care, St Vincent's Hospital, Melbourne, VIC, Australia.
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia.
| | - Alastair J Brown
- Department of Critical Care, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Ines P Vaz
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
| | - Rebecca Reed
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
| | - Max A Schofield
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
| | | | - Vinodh B Nanjayya
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Andrew A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Toby Jeffcote
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
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Rosta K, Binder J, Kuczwara V, Horvath M, Heinzl F, Hörhager C, Mayrhofer D, Mandl P, Fritsch-Stork R, Ott J, Mazzucato-Puchner A. Periconceptional Counselling in Women with Autoimmune Inflammatory Rheumatic Diseases. J Clin Med 2024; 13:2483. [PMID: 38731018 PMCID: PMC11084745 DOI: 10.3390/jcm13092483] [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: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Systemic autoimmune rheumatic diseases (SARDs) in pregnancy represent a complex challenge for both patients and healthcare providers. Timely preparation for pregnancy enables adequate disease control, thereby reducing the risk of disease flare and pregnancy complications. Interdisciplinary care starting from the pre-pregnancy period throughout pregnancy and during breastfeeding ensures better fetal and maternal outcomes. This review provides a comprehensive guide to pre-pregnancy counselling in SARDs, an overview of medication management strategies tailored to pregnancy, disease activity and pregnancy monitoring in patients, and the promotion of shared decision making between healthcare providers and patients. Guidelines from international organizations were selected to provide a basis for this review and guidance through the quintessential discussion points of care.
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Affiliation(s)
- Klara Rosta
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Julia Binder
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Valerie Kuczwara
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Mira Horvath
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Florian Heinzl
- Division of Obstetrics and Fetomaternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Christina Hörhager
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Mayrhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Ruth Fritsch-Stork
- Health Care Centre Mariahilf, ÖGK and Rheumatology Department, Sigmund Freud Private University, 1060 Vienna, Austria
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Antonia Mazzucato-Puchner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
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Dooley J, Jardine J, Ibrahim B, Mongru R, Pradhan F, Wolstenholme D, Lenguerrand E, Draycott T, Bruce F, Iliodromiti S. A positive deviant approach to examining the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100971. [PMID: 38692137 DOI: 10.1016/j.srhc.2024.100971] [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: 11/29/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities. METHODS A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. RESULTS The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. CONCLUSIONS Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.
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Affiliation(s)
- Jemima Dooley
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
| | - Jen Jardine
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Buthaina Ibrahim
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Rohan Mongru
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Farrah Pradhan
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Daniel Wolstenholme
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, BS10 5NB, UK
| | - Tim Draycott
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Faye Bruce
- Caribbean and African Health Network, Transformation Community Resource Centre, 1st Floor, Richmond House, 11 Richmond Grove, Manchester, M13 0LN, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Ramasubramani P, Krishnamoorthy Y, Ganesh K, Kathiresan L, Kadir V. Association between domestic violence and unintended, terminated pregnancy and complications during pregnancy among Indian women: Findings from nationally representative survey. Heliyon 2024; 10:e27158. [PMID: 38455545 PMCID: PMC10918217 DOI: 10.1016/j.heliyon.2024.e27158] [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: 03/23/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Background Women experiencing domestic violence might have restrictions in the pregnancy-related decision-making and care-seeking process leading to adverse pregnancy outcomes. We explored the association between domestic violence and undesirable pregnancy events. Methods 63,796 women aged 18-49 years covered under the domestic violence module of National Family Health Survey-5, 2019-21. Stratification and clustering in the complex sampling design of the survey were accounted in analysis. Using Poisson regression, prevalence ratio (PR) was reported to provide association of domestic violence with undesirable pregnancy events. Results Prevalence of undesirable pregnancy events was 25.0% (95%CI: 24.4%-25.7%) amongst women aged 18-49 years. Prevalence of unintended, terminated pregnancy and complications during pregnancy was 3.2%, 5.1% and 20.9%, respectively. Women aged ≥35 years, educated, unemployed, primi or multi parity, intimate partner/husband being uneducated, facing problem with access to healthcare, belonging to large number of household members (≥4) and poorest or poorer quintile had significantly higher chance of having undesirable pregnancy events. Sexual violence (aPR: 1.11, p = 0.02) had higher chance of having undesirable pregnancy events. Conclusion One-fourth of reproductive-age group women had undesirable pregnancy events. Sexual violence was significantly associated with these events. Effective policy should protect women from domestic violence to promote maternal well-being.
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Affiliation(s)
- Premkumar Ramasubramani
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Yuvaraj Krishnamoorthy
- PROPUL Evidence Synthesis Unit (PROPUL ESU), PROPUL (Partnership for Research Opportunity Planning Upskilling and Leadership) Evidence, Chennai, Tamilnadu, India
| | - Karthika Ganesh
- Department of Community Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
| | | | - Vinodhini Kadir
- Department of Obstetrics and Gynaecology, AIIMS, Bhubaneshwar, Odissa, India
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Moss N, Singh M, Gale C, Fagbamigbe AF, Azcoaga-Lorenzo A, Subramanian A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Dolk H, Hope H, Phillips K, Abel KM, Eastwood KA, Kent L, Locock L, Loane M, Mhereeg M, Brocklehurst P, McCann S, Brophy S, Wambua S, Hemali Sudasinghe SPB, Thangaratinam S, Nirantharakumar K, Black M. The development of a core outcome set for studies of pregnant women with multimorbidity. BMC Med 2023; 21:314. [PMID: 37605204 PMCID: PMC10441728 DOI: 10.1186/s12916-023-03013-3] [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: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity. METHODS We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations. RESULTS Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs. CONCLUSIONS Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Ngawai Moss
- Patient and public representative, London, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Hospital Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
| | | | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- Center for Epidemiology and Research in Population Health (CERPOP), INSERM, Toulouse, France
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Ulster University, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Louise Locock
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sharon McCann
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Giles-Clark HJ, Skinner SM, Rolnik DL, Mol BW. Should we use composite outcomes in obstetric clinical prediction models? Eur J Obstet Gynecol Reprod Biol 2023; 285:193-197. [PMID: 37148646 DOI: 10.1016/j.ejogrb.2023.04.031] [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: 03/18/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
Clinical prediction models assist clinicians to estimate the natural course of a condition, and thus facilitate treatment decisions. The development of prediction models is increasingly common in obstetric research. Composite outcomes, whereby multiple outcomes are combined into a single endpoint, are frequently used in obstetric prediction models to increase statistical power when predicting rare events. Although existing literature has reviewed the positives and negatives of using composite outcomes in clinical trials, there has been minimal commentary on the implications of their use in the development and reporting of prognostic models. In this article, we review these issues, in particular, highlighting how unequal individual relationships between predictors and individual component outcomes can result in misleading conclusions, which may result in the omission of important but rare predictors or inappropriately inform clinical decisions to implement an intervention. We propose careful use, or where possible avoidance, of composite outcomes in the development of prognostic models in obstetrics. Methodological standards for developing prognostic models should be updated to standardise and appraise composite outcomes when their use is necessary. We also support previous recommendations to report on the accuracy of key components and inconsistencies among predictor variables.
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Affiliation(s)
- Holly J Giles-Clark
- Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - Sasha M Skinner
- Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Women's and Newborns, Monash Health, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Lau MC, Tanaka K, Amoako A, Rudra T. Safety of performing classical versus low transverse caesarean sections in extremely preterm and very preterm births: Maternal and neonatal complications. Aust N Z J Obstet Gynaecol 2023. [PMID: 36789730 DOI: 10.1111/ajo.13652] [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: 07/12/2022] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
AIMS Improved survivability of extremely preterm infants has led to increased rates of caesarean sections. Short-term maternal and neonatal risks of classical caesarean sections (CCS) in the context of extreme prematurity remain unclear. The aim was to examine maternal and neonatal complications associated with CCSs versus low transverse caesarean sections (LTCS) at extremely preterm (23 0/7-27 6/7 weeks) and very preterm gestational ages (28 0/7-31 6/7 weeks). METHODS A retrospective cohort study was conducted at Royal Brisbane and Womens Hospital, Queensland, Australia between 2016 and 2020. Maternal and neonatal outcomes were examined using univariate and multivariate statistical analysis. RESULTS CCSs (extremely preterm: n = 93; very preterm: n = 83) were associated with higher estimated blood loss than LTCS (extremely preterm: n = 70; very preterm: n = 287) in very preterm births (CCS: 638 ± 410 mL; LTCS: 556 ± 397 mL; P = 0.01). There was no significant difference in composite maternal outcomes between CCS and LTCS for extremely preterm (adjusted odds ratio (aOR): 1.11; 95% confidence interval (CI): 0.58-2.12; P = 0.75) or very preterm births (aOR: 1.08; 95% CI: 0.63-1.94; P = 0.79) after accounting for multiple pregnancy, placenta accreta and non-cephalic fetal presentations. Although CCSs were associated with lower Apgar scores at 1 min post-birth than LTCSs at very preterm gestational ages (CCS: 5.58 ± 2.10; LTCS: 6.25 ± 2.14; P = 0.02), there was no statistical difference in the rates of intraoperative neonatal injuries or composite outcomes when corrected for low birth weight. CONCLUSION Short-term maternal and neonatal outcomes do not significantly differ between CCS and LTCS for extremely preterm or very preterm births.
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Affiliation(s)
- Max C Lau
- Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Keisuke Tanaka
- Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Akwasi Amoako
- Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Thangeswaran Rudra
- Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
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Comparing apples and oranges? Variation in choice and reporting of short-term perinatal outcomes of term labor: a systematic review of Cochrane reviews. Eur J Obstet Gynecol Reprod Biol 2022; 276:1-8. [DOI: 10.1016/j.ejogrb.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100731. [PMID: 35500476 DOI: 10.1016/j.srhc.2022.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. METHODS A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. RESULTS A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90-2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71-0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). CONCLUSIONS The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of the Congo, The
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10
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Walker S, Dasgupta T, Shennan A, Sandall J, Bunce C, Roberts P. Development of a core outcome set for effectiveness studies of breech birth at term (Breech-COS)—an international multi-stakeholder Delphi study: study protocol. Trials 2022; 23:249. [PMID: 35379305 PMCID: PMC8978154 DOI: 10.1186/s13063-022-06136-9] [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: 04/27/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Women pregnant with a breech-presenting foetus at term are at increased risk of adverse pregnancy outcomes. The most common intervention used to improve neonatal outcomes is planned delivery by caesarean section. But this is not always possible, and some women prefer to plan a vaginal birth. A number of providers have proposed alternative interventions, such as delivery protocols or specialist teams, but heterogeneity in reported outcomes and their measurements prevents meaningful comparisons. The aim of this paper is to present a protocol for a study to develop a Breech Core Outcome Set (Breech-COS) for studies evaluating the effectiveness of interventions to improve outcomes associated with term breech birth.
Methods
The development of a Breech-COS includes three phases. First, a systematic literature review will be conducted to identify outcomes previously used in effectiveness studies of breech birth at term. A focus group discussion will be conducted with the study’s pre-established Patient and Public Involvement (PPI) group, to enable service user perspectives on the results of the literature review to influence the design of the Delphi survey instrument. Second, an international Delphi survey will be conducted to prioritise outcomes for inclusion in the Breech-COS from the point of view of key stakeholders, including perinatal care providers and families who have experienced a term breech pregnancy. Finally, a consensus meeting will be held with stakeholders to ratify the Breech-COS and disseminate findings for application in future effectiveness studies.
Discussion
The expectation is that the Breech-COS will always be collected in all clinical trials, audits of practice and other forms of observation research that concern breech birth at term, along with other outcomes of interest. This will facilitate comparing, contrasting and combining studies with the ultimate goal of improved maternal and neonatal outcomes.
Trial registration
Core Outcome Measures in Effectiveness Trials (COMET) #1749
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11
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Lee SI, Eastwood KA, Moss N, Azcoaga-Lorenzo A, Subramanian A, Anand A, Taylor B, Nelson-Piercy C, Yau C, McCowan C, O'Reilly D, Hope H, Kennedy JI, Abel KM, Locock L, Brocklehurst P, Plachcinski R, Brophy S, Agrawal U, Thangaratinam S, Nirantharakumar K, Black M. Protocol for the development of a core outcome set for studies of pregnant women with pre-existing multimorbidity. BMJ Open 2021; 11:e044919. [PMID: 34716152 PMCID: PMC8559099 DOI: 10.1136/bmjopen-2020-044919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Increasingly more pregnant women are living with pre-existing multimorbidity (≥two long-term physical or mental health conditions). This may adversely affect maternal and offspring outcomes. This study aims to develop a core outcome set (COS) for maternal and offspring outcomes in pregnant women with pre-existing multimorbidity. It is intended for use in observational and interventional studies in all pregnancy settings. METHODS AND ANALYSIS We propose a four stage study design: (1) systematic literature search, (2) focus groups, (3) Delphi surveys and (4) consensus group meeting. The study will be conducted from June 2021 to August 2022. First, an initial list of outcomes will be identified through a systematic literature search of reported outcomes in studies of pregnant women with multimorbidity. We will search the Cochrane library, Medline, EMBASE and CINAHL. This will be supplemented with relevant outcomes from published COS for pregnancies and childbirth in general, and multimorbidity. Second, focus groups will be conducted among (1) women with lived experience of managing pre-existing multimorbidity in pregnancy (and/or their partners) and (2) their healthcare/social care professionals to identify outcomes important to them. Third, these initial lists of outcomes will be prioritised through a three-round online Delphi survey using predefined score criteria for consensus. Participants will be invited to suggest additional outcomes that were not included in the initial list. Finally, a consensus meeting using the nominal group technique will be held to agree on the final COS. The stakeholders will include (1) women (and/or their partners) with lived experience of managing multimorbidity in pregnancy, (2) healthcare/social care professionals involved in their care and (3) researchers in this field. ETHICS AND DISSEMINATION This study has been approved by the University of Birmingham's ethical review committee. The final COS will be disseminated through peer-reviewed publication and conferences and to all stakeholders.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | | | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Holly Hope
- Division of Psychology and Mental Health, Faculty of Biology Medicine and Health, Centre for Women's Mental Health, The University of Manchester, Manchester, UK
| | | | - Kathryn Mary Abel
- Division of Psychology and Mental Health, Faculty of Biology Medicine and Health, Centre for Women's Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Louise Locock
- Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Sinead Brophy
- Data Science, Medical School, University of Swansea, Swansea, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Mairead Black
- School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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