1
|
Association of Maternal Anemia and Cesarean Delivery: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020490. [PMID: 36675421 PMCID: PMC9867340 DOI: 10.3390/jcm12020490] [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: 11/06/2022] [Revised: 12/24/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023] Open
Abstract
Anaemia during pregnancy is associated with an increased incidence of caesarean delivery (CD). This study was conducted to explore the association between CD and maternal anaemia. The PubMed/MEDLINE, Cochrane, Google, Google Scholar and ScienceDirect databases were searched for relevant studies on this topic. The assessment and review were conducted with the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. The studies were assessed using the modified Newcastle−Ottawa quality assessment scale. Data were collected in an Excel sheet, and the ‘meta’ package of the R 4.0.3 software was used for statistical analysis. Fourteen studies that enrolled 336,128 pregnant women were included in the meta-analysis. Women with anaemia were found to be at a higher risk for CD (OR = 1.63, 95% CI = 1.23−2.17). As heterogeneity was detected in the studies, the random-effects model was used for the pooled meta-analysis (Q = 96.7, p < 0.001). In the subgroup analysis, anaemic women were found to be at higher risk for CD in studies from both low-middle-income (7) and high-income countries (7). In meta-regression analysis, none of the investigated covariates were associated with the pooled OR of CD. This evidence demonstrates with a moderate level of certainty that anaemic pregnant women are more likely to have CD than non-anaemic pregnant women.
Collapse
|
2
|
Ribeiro M, Monteiro-Santos J, Castro L, Antunes L, Costa-Santos C, Teixeira A, Henriques TS. Non-linear Methods Predominant in Fetal Heart Rate Analysis: A Systematic Review. Front Med (Lausanne) 2021; 8:661226. [PMID: 34917624 PMCID: PMC8669823 DOI: 10.3389/fmed.2021.661226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
The analysis of fetal heart rate variability has served as a scientific and diagnostic tool to quantify cardiac activity fluctuations, being good indicators of fetal well-being. Many mathematical analyses were proposed to evaluate fetal heart rate variability. We focused on non-linear analysis based on concepts of chaos, fractality, and complexity: entropies, compression, fractal analysis, and wavelets. These methods have been successfully applied in the signal processing phase and increase knowledge about cardiovascular dynamics in healthy and pathological fetuses. This review summarizes those methods and investigates how non-linear measures are related to each paper's research objectives. Of the 388 articles obtained in the PubMed/Medline database and of the 421 articles in the Web of Science database, 270 articles were included in the review after all exclusion criteria were applied. While approximate entropy is the most used method in classification papers, in signal processing, the most used non-linear method was Daubechies wavelets. The top five primary research objectives covered by the selected papers were detection of signal processing, hypoxia, maturation or gestational age, intrauterine growth restriction, and fetal distress. This review shows that non-linear indices can be used to assess numerous prenatal conditions. However, they are not yet applied in clinical practice due to some critical concerns. Some studies show that the combination of several linear and non-linear indices would be ideal for improving the analysis of the fetus's well-being. Future studies should narrow the research question so a meta-analysis could be performed, probing the indices' performance.
Collapse
Affiliation(s)
- Maria Ribeiro
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - João Monteiro-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Castro
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Luís Antunes
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Teixeira
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Adam I, Kheiri S, Sharif ME, Ahmed ABA, Rayis DA. Anaemia is associated with an increased risk for caesarean delivery. Int J Gynaecol Obstet 2019; 147:202-205. [PMID: 31420866 DOI: 10.1002/ijgo.12946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/03/2019] [Accepted: 08/15/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between anemia and cesarean delivery. METHODS A case-control study was conducted in Saad Abu-Alela Hospital in Khartoum, Sudan from March 1 to November 30, 2107. The cases were women who had cesarean delivery; women who delivered vaginally were the controls. Obstetrics history was gathered using a questionnaire. RESULTS There was no significant difference in age, parity, residence, job, education, and newborn gender between women who delivered by cesarean (n=130) and women who delivered vaginally (n=260). While mean (SD) of the body mass index (29.3 (5.4) kg/m2 vs 26.3 (5.6) kg/m2 , P<0.001) was significantly higher, hemoglobin level (103.0 (8.0) g/L vs 107.0 (8.0) g/L, P=0.001) was significantly lower in women who delivered by cesarean compared with women who delivered vaginally. In logistic regression analyses, age, gravidity, occupation, education, history of miscarriage, and newborn gender were not associated with cesarean delivery; overweight (adjusted odds ratio [AOR] 2.30, 95% confidence interval [CI] 1.24-4.26), obesity (AOR 7.17, 95% CI 3.64-14.13) and anemia (AOR 2.45, 95% CI 1.47-4. 11) were associated with cesarean delivery. CONCLUSION The significant association between anemia and cesarean delivery has important implications for the prevention and treatment of anemia among these women.
Collapse
Affiliation(s)
- Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Sumeya Kheiri
- Faculty of Medicine, Bahria University, Khartoum, Sudan
| | - Manal E Sharif
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Abdel B A Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Duria A Rayis
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| |
Collapse
|
4
|
Weaver B, Guerreso K, Conner EA, Russell K, Vogel R, Rodriguez M. Hemodynamics and Perfusion in Premature Infants During Transfusion. AACN Adv Crit Care 2019; 29:126-137. [PMID: 29875109 DOI: 10.4037/aacnacc2018402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Premature infants may require packed red blood cell transfusions, but current guidelines lack empirical evidence and vary among institutions and prescribers. OBJECTIVE To compare the physiological changes in cardiovascular hemodynamics and oxygen delivery between premature infants with anemia who receive packed red blood cell transfusions and premature infants without anemia. METHODS The study was a prospective observational cohort investigation of 75 premature infants. Comparisons among the data were made before, during, and after transfusion in infants with anemia and over time in infants in the control group. In infants with anemia, feedings were withheld 12 hours before and after transfusions. RESULTS Electrical cardiometry and near-infrared spectroscopy measurements in premature infants with anemia revealed changes in hemodynamic parameters not detected by standard bedside monitoring. Statistically significant changes were seen before and after transfusions in cardiac output, fractional tissue oxygen extraction, heart rate variability, heart rate complexity, and splanchnic regional tissue oxygen saturation. CONCLUSION Bedside monitoring of cardiovascular hemodynamics and oxygen delivery during packed red blood cell transfusion may inform individualized care for the premature infant with anemia and could be useful for the development of evidence-based practice guidelines.
Collapse
Affiliation(s)
- Barbara Weaver
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| | - Kelsey Guerreso
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| | - E Alexander Conner
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| | - Kendra Russell
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| | - Robert Vogel
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| | - Mitch Rodriguez
- Barbara Weaver is Adjunct Faculty, Georgia College and State University, Campus Box 063, Milledgeville, GA 31061-0490 . Kelsey Guerreso is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. E. Alexander Conner is Medical Student IV, Mercer University School of Medicine, Macon, Georgia. Kendra Russell is Professor and Director, Program Innovation & Evaluation-Nursing, Middle Georgia State University, Macon, Georgia. Robert Vogel is Professor, Department of Biostatistics and Epidemiology, Jian-Ping Hsu College of Public Health, Georgia Southern University, Macon, Georgia. Mitch Rodriguez is Medical Director, Neonatal Intensive Care Unit, Navicent Health/Mercer University Pediatrics Residency Program, Macon, Georgia
| |
Collapse
|
5
|
Bassi D, Cabiddu R, Mendes RG, Tossini N, Arakelian VM, Caruso FCR, Bonjorno Júnior JC, Arena R, Borghi-Silva A. Effects of Coexistence Hypertension and Type II Diabetes on Heart Rate Variability and Cardiorespiratory Fitness. Arq Bras Cardiol 2018; 111:64-72. [PMID: 30110046 PMCID: PMC6078357 DOI: 10.5935/abc.20180105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/14/2018] [Indexed: 12/17/2022] Open
Abstract
Background Type 2 diabetes Mellitus (T2DM) is associated with cardiac autonomic
dysfunction, which is an independent predictor of mortality in chronic
diseases. However, whether the coexistence of systemic arterial hypertension
(HTN) with DMT2 alters cardiac autonomic modulation remains unknown. Objective To evaluate the influence of HTN on cardiac autonomic modulation and
cardiorespiratory fitness in subjects with DMT2. Methods 60 patients of both genders were evaluated and allocated to two groups: DMT2
patients (n = 32; 51 ± 7.5 years old) and DMT2 + HTN patients (n =
28; 51 ± 6.9 years old). RR intervals were obtained during rest in
supine position. Linear and nonlinear indices of heart rate variability
(HRV) were computed using Kubios HRV software. Pulmonary gas exchange was
measured breath-by-breath, using a portable telemetric system during maximal
incremental exercise testing on a cycle ergometer. Statistical analysis
included Shapiro-Wilk test followed by Student’s t Test, Pearson correlation
and linear regression. Results We found that patients in the DMT2+HTN group showed lower values of mean RR
intervals (801.1 vs 871.5 ms), Shannon entropy (3
vs 3.2) and fractal dimension SD 1 (9.5 vs 14.5), when
contrasted with patients in the DMT2 group. Negative correlations were found
between some HRV nonlinear indices and exercise capacity indices. Conclusion HTN negatively affects the cardiac autonomic function in diabetic patients,
who are already prone to develop autonomic dysfunction. Strategies are need
to improve cardiac autonomic functionality in this population.
Collapse
Affiliation(s)
- Daniela Bassi
- Departamento de Fisioterapia, Universidade Ceuma, São Luís, MA - Brazil
| | - Ramona Cabiddu
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil
| | - Renata G Mendes
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil
| | - Natália Tossini
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil
| | - Vivian M Arakelian
- Departamento de Fisioterapia, Universidade Nove de Julho, São Paulo, SP - Brazil
| | - Flávia C R Caruso
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil
| | | | - Ross Arena
- Departamento de Fisioterapia, Universidade de Illinois em Chicago, Chicago, IL - EUA
| | - Audrey Borghi-Silva
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP - Brazil
| |
Collapse
|
6
|
Park JY, Lee SW. A history of repetitive cesarean section is a risk factor of anemia in healthy perimenopausal women: The Korea National Health and Nutrition Examination Survey 2010-2012. PLoS One 2017; 12:e0188903. [PMID: 29190715 PMCID: PMC5708789 DOI: 10.1371/journal.pone.0188903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine whether the delivery method is associated with the rate of anemia in later life, using the data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS This study used data from the KNHANES 2010-2012. Among 25,534 participants, 8,126 cases were included in this study after exclusion of males and other inappropriate data. The study population was divided into three groups according to the delivery modes: vaginal delivery (VD) only group, single cesarean delivery (SCD) group and repetitive cesarean delivery (RCD) group. The primary outcome was anemia and iron deficiency. Anemia was defined as hemoglobin <12 g/dl in accordance with the World Health Organization criteria. Iron deficiency was defined as low transferrin saturation (TSAT) or ferritin levels. Multivariate analysis was used for determination of association between the delivery modes and anemia. RESULTS The mean age was 53.4 years and the median time from the last delivery to the survey was 25 years. The VD only group was composed of 6,493 (79.9%) women, while 685 (8.4%) were classified as the SCD group and 948 (11.7%) were classified as a RCD group. The rates of anemia were 11.8%, 13.9%, and 19.7% in VD only group, SCD group, and RCD group, respectively. However, those groups were significantly different in many confounding factors. Therefore, to adjust those factors, multivariate analysis and subgroup analysis were followed. The odds of SCD for anemia and iron deficiency were not different from those of VD only. However, RCD was independently associated with anemia [Odds ratio(OR) 1.47, 95% Confidence interval (CI) 1.21-1.79, P <0.001] and iron deficiency (OR 1.42, 95% CI 1.21-1.67, P <0.001) compared to VD only. In the subgroup analysis, RCD was significantly associated with anemia in perimenopausal women, women with iron deficiency, those without any comorbidity and those without anemia-prone treatment. CONCLUSION Repetitive cesarean section may be a risk factor for future development of anemia in later life, especially in perimenopausal period. Therefore, evaluation and management of anemia in longer postpartum period should be considered for women who experience repetitive cesarean section.
Collapse
Affiliation(s)
- Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Seoul National University Postgraduate School, Seoul, Korea
- Department of Nephrology, Internal Medicine, Nowon Eulji Medical center, Eulji University, Seoul, Korea
- * E-mail:
| |
Collapse
|
7
|
Chen C, Jin Y, Lo IL, Zhao H, Sun B, Zhao Q, Zheng J, Zhang XD. Complexity Change in Cardiovascular Disease. Int J Biol Sci 2017; 13:1320-1328. [PMID: 29104498 PMCID: PMC5666530 DOI: 10.7150/ijbs.19462] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
With the fast development of wearable medical device in recent years, it becomes critical to conduct research on continuously measured physiological signals. Entropy is a key metric for quantifying the irregularity and/or complexity contained in human physiological signals. In this review, we focus on exploring how entropy changes in various physiological signals in cardiovascular diseases. Our review concludes that the direction of entropy change relies on the physiological signals under investigation. For heart rate variability and pulse index, the entropy of a healthy person is higher than that of a patient with cardiovascular diseases. For diastolic period variability and diastolic heart sound, the direction of entropy change is reversed. Our conclusion should not only give valuable guidance for further research on the application of entropy in cardiovascular diseases but also provide a foundation for using entropy to analyze the irregularity and/or complexity of physiological signals measured by wearable medical device.
Collapse
Affiliation(s)
- Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau
| | - Hansen Zhao
- Department of Cardiovascular Diseases, Beijing Hospital of Chinese Medicine, Capital Medical University, Beijing, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | | |
Collapse
|
8
|
Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion 2015; 55:2799-806. [DOI: 10.1111/trf.13252] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Lior Drukker
- Department of Obstetrics & Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Yael Hants
- Department of Obstetrics & Gynecology; Hadassah Medical Center, Hebrew University-Hadassah Medical School; Jerusalem Israel
| | - Rivka Farkash
- Department of Obstetrics & Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Rosa Ruchlemer
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Arnon Samueloff
- Department of Obstetrics & Gynecology; Shaare Zedek Medical Center; Jerusalem Israel
| | | |
Collapse
|