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Simpson AN, Sutradhar R, Benchimol EI, Chan WC, Porter J, Moore S, Dossa F, Huang V, Maxwell C, Targownik L, Liu N, Baxter NN. Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102463. [PMID: 38631434 DOI: 10.1016/j.jogc.2024.102463] [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: 10/21/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. METHODS Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. RESULTS We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20-1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03; 95% CI 1-1.07). CONCLUSIONS The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Joan Porter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Sarah Moore
- Department of Surgery, MacKenzie Health, Vaughan, ON
| | - Fahima Dossa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian Huang
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Laura Targownik
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Patamasingh Na Ayudhaya O, Kittikraisak W, Phadungkiatwatana P, Hunt DR, Tomyabatra K, Chotpitayasunondh T, Galang RR, Chang K, Brummer T, Puttanavijarn L, Malek P, Dawood FS, Mott JA. Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand. BMC Pregnancy Childbirth 2024; 24:149. [PMID: 38383397 PMCID: PMC10880209 DOI: 10.1186/s12884-024-06314-4] [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: 10/06/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. METHODS In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies. RESULTS Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. CONCLUSIONS Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.
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Affiliation(s)
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health (DDC building 7), Tiwanon Road, Nonthaburi, 11000, Thailand.
| | | | | | | | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Romeo R Galang
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Chang
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Fatimah S Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health (DDC building 7), Tiwanon Road, Nonthaburi, 11000, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Jin Y, Yu X, Hu S, Liu L, Wang B, Feng Y, Li Y, Xiong B, Wang L. Efficacy of electroacupuncture combined with intravenous patient-controlled analgesia after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5:100826. [PMID: 36464237 DOI: 10.1016/j.ajogmf.2022.100826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Electroacupuncture is a nonpharmacologic intervention for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture combined with patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery remains unclear. OBJECTIVE This study aimed to assess the efficacy of electroacupuncture + patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery, determine the optimal frequency for the best analgesic effect, and explore the underlying mechanism of action. STUDY DESIGN This single-center, randomized, single-blinded, sham acupuncture controlled clinical trial was conducted at a tertiary university hospital in China. Female patients who underwent cesarean delivery and received fentanyl as patient-controlled intravenous analgesia for postoperative analgesia were enrolled. Patients were after surgery randomized to receive 2 Hz electroacupuncture treatment (n=53), 20/100 Hz electroacupuncture treatment (n=53), or sham electroacupuncture treatment (n=52) (controls). The 2 electroacupuncture groups received electroacupuncture treatment at 2 or 20/100 Hz at the ST36 and SP6 points, whereas, in the sham electroacupuncture group, sham electroacupuncture was performed at nonmeridian points with nonenergized electroacupuncture instruments. Of note, 4 electroacupuncture treatments were performed in all groups at 6, 12, 24, and 48 hours after surgery. The primary outcome was the number of analgesic pump compressions at 48 hours after surgery. The secondary outcomes included number of analgesic pump compressions at 6, 12, and 24 hours after surgery; pain scores at 6, 12, 24, and 48 hours after surgery; fentanyl consumption at 48 hours after surgery; interleukin 6 and procalcitonin levels at 12 and 48 hours after surgery; and time to first exhaust. RESULTS Overall, 174 primigravida women were included in the intention-to-treat analysis. The number of analgesic pump compressions and pain scores at all 4 time points and fentanyl consumption at 48 hours after surgery were significantly lower in the electroacupuncture treatment groups than in the sham electroacupuncture group (P<.001). CONCLUSION Electroacupuncture + patient-controlled intravenous analgesia had a significantly better analgesic effect than sham electroacupuncture + patient-controlled intravenous analgesia within 48 hours after surgery. Thus, electroacupuncture can be considered safe and effective and may improve the efficacy of patient-controlled intravenous analgesia for pain management after cesarean delivery. Electroacupuncture can be recommended as a routine complementary therapy for pain control after cesarean delivery.
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Affiliation(s)
- Ying Jin
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Jin and Xiong); Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Jiangsu, China (Drs Jin and Liu); Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China (Drs Jin and Li)
| | - Xiaoshuai Yu
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (Dr Yu)
| | - Shen Hu
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang)
| | - Lanying Liu
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Jiangsu, China (Drs Jin and Liu)
| | - Bin Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Dr B Wang)
| | - Yuanling Feng
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang)
| | - Yubo Li
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China (Dr Li); Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China (Drs Jin and Li)
| | - Bing Xiong
- Department of Rehabilitation in Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Jin and Xiong).
| | - Liquan Wang
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China (Drs Hu, Feng, and L Wang).
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Kastora SL, Eley J, Kounidas G, Dighero I. Fertility and reproductive outcomes following high-energy pelvic fractures: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023. [PMID: 36605023 DOI: 10.1002/ijgo.14652] [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: 07/21/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a need to decipher the effect of pelvic fractures (PFs) upon female fertility and live birth rate, as data including treatment regimens in large, unselected populations remain scarce. OBJECTIVES To assess the effect of high energy PFs upon female fertility and live birth rate. SEARCH STRATEGY Literature search for relevant studies was performed up to March 2022 in five databases: Embase, MEDLINE, CAB Abstracts, ClinicalTrials.gov, and Google Scholar. SELECTION CRITERIA Retrospective studies assessing live birth, infertility, and dyspareunia rates following PFs. DATA COLLECTION AND ANALYSIS Data were extracted from studies independently by two authors. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies. MAIN RESULTS A total of 763 female patients of median age 27.8 years (95% CI 22-38 years) were included with median follow up of 5 years. Among PF patients, infertility hazard ratio (HR) 1.18 (95% CI 0.76-1.84, P = 0.47; I2 = 18%) and dyspareunia HR 0.60 (95% CI 0.34-1.08, P = 0.09; I2 = 66%), did not significantly differ from the age-matched literature-reported rates among non-PF patients. CONCLUSIONS No significant differences of live birth, infertility, and dyspareunia rates across patients with PFs were found compared with non-PF counterparts.
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Affiliation(s)
- Stavroula L Kastora
- EGA Institute for Women's Health, University College London, London, UK.,Barnet Hospital, Royal Free NHS Trust, London, UK
| | - Jonathan Eley
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Georgios Kounidas
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Fortin SP, Swerdel J, Sarnecki M, Doua J, Colasurdo J, Geurtsen J. Performance characteristics of code‐based algorithms to identify urinary tract infections in large United States administrative claims databases. Pharmacoepidemiol Drug Saf 2022; 31:953-962. [DOI: 10.1002/pds.5492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen P. Fortin
- Janssen Research & Development Observational Health Data Analytics Raritan New Jersey USA
| | - Joel Swerdel
- Janssen Research & Development Observational Health Data Analytics Raritan New Jersey USA
| | - Michal Sarnecki
- Janssen Vaccines Branch of Cilag GmbH International Bern Switzerland
| | - Joachim Doua
- Janssen Research & Development Infectious Diseases and Vaccines Beerse Belgium
| | - Jamie Colasurdo
- Janssen Research & Development, Epidemiology Raritan New Jersey USA
| | - Jeroen Geurtsen
- Janssen Vaccines & Prevention Bacterial Vaccines Research & Early Development Leiden Netherlands
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Sultana J, Sutradhar I, Rahman MJ, Khan ANS, Chowdhury MAK, Hasib E, Chhetri C, Mahmud SMH, Kashem T, Kumar S, Myint ZT, Rahman M, Huda TMN, Arifeen SE, Billah SM. An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031465. [PMID: 35162487 PMCID: PMC8835678 DOI: 10.3390/ijerph19031465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023]
Abstract
The decision-making process and the information flow from physicians to patients regarding deliveries through cesarean section (C-section) has not been adequately explored in Bangladeshi context. Here, we aimed to explore the extent of information received by mothers and their family members and their involvement in the decision-making process. We conducted a qualitative exploratory study in four urban slums of Dhaka city among purposively selected mothers (n = 7), who had a cesarean birth within one-year preceding data collection, and their family members (n = 12). In most cases, physicians were the primary decision-makers for C-sections. At the household level, pregnant women were excluded from some crucial steps of the decision-making process and information asymmetry was prevalent. All interviewed pregnant women attended at least one antenatal care visit; however, they neither received detailed information regarding C-sections nor attended any counseling session regarding decisions around delivery type. In some cases, pregnant women and their family members did not ask health care providers for detailed information about C-sections. Most seemed to perceive C-sections as risk-free procedures. Future research could explore the best ways to provide C-section-related information to pregnant women during the antenatal period and develop interventions to promote shared decision-making for C-sections in urban Bangladeshi slums.
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Affiliation(s)
- Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.)
- Correspondence: ; Tel.: +880-1717-997-182
| | - Ipsita Sutradhar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka 1213, Bangladesh; (I.S.); (M.A.K.C.)
| | - Musarrat Jabeen Rahman
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St Suite E8527, Baltimore, MD 21205, USA;
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (A.N.S.K.); (S.E.A.); (S.M.B.)
| | | | - Enam Hasib
- Family Health International, Dhaka 1212, Bangladesh;
| | | | - S. M. Hasan Mahmud
- Bangladesh National Nutrition Council, Mohakhali, Dhaka 1212, Bangladesh;
| | - Tahsin Kashem
- Bangladesh Palliative and Supportive Care Foundation, Dhaka 1212, Bangladesh;
| | - Sanjeev Kumar
- Health Systems Transformation Platform, New Delhi 110070, India;
| | - Zaw Toe Myint
- Health Systems Strengthening, Community Partners International, Yangon 11201, Myanmar;
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.)
| | - Tarique Md. Nurul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.)
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (A.N.S.K.); (S.E.A.); (S.M.B.)
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (A.N.S.K.); (S.E.A.); (S.M.B.)
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
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Akgün M, Boz İ. The effects of acupressure on post-cesarean pain and analgesic consumption: a randomized single-blinded placebo-controlled study. Int J Qual Health Care 2021; 32:609-617. [PMID: 32877509 DOI: 10.1093/intqhc/mzaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the effects of P6 and LI4 acupressure on post-caesarean pain and analgesic consumption. DESIGN This was a randomized, single-blinded, placebo-controlled study conducted in a university-affiliated obstetrics clinic between July 2017 and July 2018. PARTICIPANTS Women (n = 132) were randomly assigned to acupressure (n = 44), placebo (n = 44) and control (n = 44) groups. SETTING All groups received routine nursing care and analgesia protocol for post-cesarean pain. Acupressure was performed in two sessions, the postpartum second and fourth hours, with the following protocol: bilaterally to P6 (point on wrist) and LI4 (point on hand) points (for 3 minutes on each point). In the placebo group, it was just touched without the pressure on acupressure points, but the main difference was that touching was too superficial to have a therapeutic effect. The control group received only routine nursing care and analgesia protocol for post-cesarean pain. MAIN OUTCOME MEASURES The post-caesarean pain was evaluated four times before and after each session using Visual Analog Scale for pain. Also, the analgesia protocol for post-cesarean pain was recorded for all women. RESULTS The acupressure group experienced the lowest level of post-cesarean pain compared with the placebo and control groups (P = 0.000). The consumption of pethidine hydrochloride and paracetamol was statistically lower in the acupressure group compared with the placebo and control groups (respectively, P = 0.002 and P = 0.040). CONCLUSION Acupressure is an effective method for reducing post-cesarean pain and analgesic consumption. Clinical trial registration: ClinicalTrials.gov: NCT04337801.
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Affiliation(s)
- Mehtap Akgün
- Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Nursing Faculty, Akdeniz University, Antalya, Turkey
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THE EFFECT OF TRANEXAMIC ACID, CARBETOCIN AND ARGON PLASMA COAGULATION ON UTERINE INVOLUTION AFTER REPEAT CESAREAN SECTION. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Repeat cesarean sections (CS) are associated with additional risks of perioperative complications. The aim of our study was ultrasound evaluation of uterine involution in women after repeat traditional cesarean delivery and after repeat CS using argon plasma coagulation and prophylactic use of tranexamic acid and carbetocin. Materials and methods. Prospective cohort study has been conducted on 140 patients who underwent second CS. Group I included 70 women who had repeat CS with the use of argon plasma coagulation and administration of 100 mcg carbetocin after cutting the umbilical cord. Ten minutes before the operation, 15 mg/kg of tranexamic acid was injected intravenously. Group II consisted of 70 women who had traditional CS, 10 IU dose of oxytocin, divided between 5 UI intravenous bolus dose and slow intravenous infusion, was administered after delivery of the baby. A serial ultrasonographic examination was carried out on the 2nd and 5th day of the postpartum period. Results. A study of the dynamics of changes in uterine body and uterine cavity volume revealed a faster rate of uterine cavity involution in group I compared with group II (p<0.05). In group I on the 5th day in comparison to the 2nd day the mean uterine body volume decreased by 27.75%, in group II – by 20.17%. In group I mean uterine cavity volume declined in three days by 21.09%, in group II – 14.22%. Uterine subinvolution was diagnosed in 3 (4,29%) cases in group I and in 19 (27,14%) cases in group II (p<0.05). Faster uterine involution in group I is probably associated with techniques, that were applied during intraoperative period. In addition, 2.86% (2 cases) from the group I versus 31.43% (22 cases) from the group II, needed additional uterotonic therapy after surgery (methylergometrine, misoprostol) (p<0.001). Conclusion. We have found differences in the course of uterine involution in women in group I in comparison with group II, such as significantly smaller uterine length on the 2nd and 5th day, significantly smaller uterine body and uterine cavity volume, faster rates of involution of the uterine cavity during the first 5 days of the postpartum period, thinner anterior uterine wall in the sutured area. We therefore conclude that complex use of tranexamic acid, carbetocin and argon plasma coagulation appears to be effective to maintain adequate uterine involution after repeat CS and prevent postoperative complications.
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9
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Poprzeczny AJ, Grivell RM, Louise J, Deussen AR, Dodd JM. Skin and subcutaneous fascia closure at caesarean section to reduce wound complications: the closure randomised trial. BMC Pregnancy Childbirth 2020; 20:606. [PMID: 33032560 PMCID: PMC7545895 DOI: 10.1186/s12884-020-03305-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/30/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Wound infection is a common complication following caesarean section. Factors influencing the risk of infection may include the suture material for skin closure, and closure of the subcutaneous fascia. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section. METHODS Women undergoing caesarean birth at an Adelaide maternity hospital were eligible for recruitment to a randomised trial using a 2 × 2 factorial design. Women were randomised to either closure or non-closure of the subcutaneous fascia and to subcuticular skin closure with an absorbable or non-absorbable suture. Participants were randomised to each of the two interventions into one of 4 possible groups: Group 1 - non-absorbable skin suture and non-closure of the subcutaneous fascia; Group 2 - absorbable skin suture and non-closure of the subcutaneous fascia; Group 3 - non-absorbable skin suture and closure of the subcutaneous fascia; and Group 4 - absorbable skin suture and closure of the subcutaneous fascia. The primary outcomes were reported wound infection and wound haematoma or seroma within the first 30 days after birth. RESULTS A total of 851 women were recruited and randomised, with 849 women included in the analyses (Group 1: 216 women; Group 2: 212 women; Group 3: 212 women; Group 4: 211 women). In women who underwent fascia closure, there was a statistically significant increase in risk of wound infection within 30 days post-operatively for those who had skin closure with an absorbable suture (Group 4), compared with women who had skin closure with a non-absorbable suture (Group 3) (adjusted RR 2.17; 95% CI 1.05, 4.45; p = 0.035). There was no significant difference in risk of wound infection for absorbable vs non-absorbable sutures in women who did not undergo fascia closure. CONCLUSION The combination of subcutaneous fascia closure and skin closure with an absorbable suture may be associated with an increased risk of reported wound infection after caesarean section. TRIAL REGISTRATION Prospectively registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12608000143325 , on the 20th March, 2008.
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, South Australia, 5006, Australia
| | - Rosalie M Grivell
- Flinders Medical Centre, Department of Obstetrics and Gynaecology, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia.,The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia. .,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, South Australia, 5006, Australia.
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Bhatia M, Banerjee K, Dixit P, Dwivedi LK. Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016. JAMA Netw Open 2020; 3:e2015022. [PMID: 32857148 PMCID: PMC7455857 DOI: 10.1001/jamanetworkopen.2020.15022] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE The rates of cesarean deliveries have more than doubled in India, from 8% of deliveries in 2005 to 17% of deliveries in 2016. The World Health Organization recommends that cesarean deliveries should not exceed 10% to 15% of all deliveries in any country. An understanding of the association of private and public facilities with the increase in cesarean delivery rates in India is needed. OBJECTIVE To assess the association of public vs private sector health care facilities with cesarean delivery rates in India and to estimate the potential cost savings if private sector facilities followed World Health Organization recommendation for cesarean deliveries. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used institutional delivery data from the representative National Family Health Survey (NFHS) in India, including data from the NFHS-1 (1992-1993), the NFHS-3 (2005-2006), and the NFHS-4 (2015-2016). The NFHS-3 and NFHS-4 provided data on 22 647 deliveries and 195 366 deliveries, respectively. The NHFS-4 was the first survey to provide data on out-of-pocket expenditures for delivery by facility type, allowing for a comparison of cesarean deliveries and costs between public and private facilities. The primary sample comprised all pregnant women who delivered infants in public and private institutional facilities in India and who were included the NFHS-3 and the NFHS-4; data on pregnant women who were included in the NFHS-1 were used for comparison. The study's findings were analyzed through geographic mapping, data tabulation, funnel plots, multivariate logistic regression analyses, and potential cost-savings scenario analyses. Data were analyzed from June to December 2019. MAIN OUTCOMES AND MEASURES The main outcome was the rate of cesarean deliveries by facility type (public vs private) and by participant socioeconomic, demographic, and health characteristics. Secondary outcomes were the potential number of avoidable cesarean deliveries and the potential cost savings if private sector facilities followed the World Health Organization recommendations for cesarean deliveries. RESULTS In the NFHS-3, 22 610 total births occurred at institutional facilities. Of those, 2178 births (15.2%) were cesarean deliveries in public facilities, and 3200 births (27.9%) were cesarean deliveries in private facilities. Of 195 366 total institutional births in the NFHS-4, 15 165 births (11.9%) were cesarean deliveries in public facilities, and 20 506 births (40.9%) were cesarean deliveries in private facilities. The cesarean delivery rate in public health facilities increased from 7.2% in the NFHS-1 to 11.9% in the NFHS-4, whereas in private health facilities, the rate increased from 12.3% to 40.9% during the same period. A substantial increase was found in cesarean delivery rates between the NFHS-3 (2005-2006) and the NFHS-4 (2015-2016), with 22 states exceeding the World Health Organization's upper threshold of 15% in the NFHS-4. The odds ratio for cesarean deliveries in private facilities compared with public facilities increased from 1.62 (95% CI, 1.49-1.76) in the NFHS-3 to 4.17 (95% CI, 4.04-4.30) in the NFHS-4. The number of avoidable cesarean deliveries would have been 1.83 million, with a potential cost savings of $320.60 million, if private sector facilities in India had followed the 15% threshold for cesarean delivery rates recommended by the World Health Organization. CONCLUSIONS AND RELEVANCE In this study, private sector health facilities were associated with a substantial increase in cesarean deliveries in India. Further research is needed to assess the factors underlying the increase in cesarean deliveries in private sector facilities.
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Affiliation(s)
- Mrigesh Bhatia
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Kajori Banerjee
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Priyanka Dixit
- Centre for Health and Social Sciences, Tata Institute of Social Sciences School of Health Systems Studies, Mumbai, India
| | - Laxmi Kant Dwivedi
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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11
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Liu F, Lv L, Jiang H, Yan R, Dong S, Chen L, Wang W, Chen YQ. Alterations in the Urinary Microbiota Are Associated With Cesarean Delivery. Front Microbiol 2018; 9:2193. [PMID: 30258432 PMCID: PMC6143726 DOI: 10.3389/fmicb.2018.02193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022] Open
Abstract
Similar to the gut, the bladder contains urinary microbiota, and its bacterial composition and structure are determined by the individual’s health status. Cesarean section is a traumatic event for women and it is correlated with postpartum complications. To better understand the urinary microbiota alterations caused by cesarean section, 16S rDNA sequencing was used to assess urine specimens collected by transurethral catheterization from 30 healthy women undergoing cesarean section pre-delivery (PreD) and post-delivery (PostD). A significant increase in bacterial diversity and more detectable bacteria at the phylum, family, and genus levels was observed in the PostD group compared to the PreD group, indicating that cesarean delivery (a process that includes surgery and delivery) altered the bacterial community. Specifically, the phylum Firmicutes and its affiliated family Lactobacillaceae and genus Lactobacillus dramatically decreased in the PostD group, suggesting that beneficial bacteria decreased after cesarean section, and clinicians should be aware that this might increase the risk of complications. Concurrently, the phylum Proteobacteria and its affiliated bacteria Pseudomonadaceae and Pseudomonas increased in the PostD group compared to the PreD group. This indicates that pathogen growth increases after cesarean section, making it important for clinicians to combat these changes to protect women from infectious diseases. Interestingly, several metabolic pathways, such as metabolism of energy, cofactors and vitamins were strengthened in the PostD group, whereas membrane transport was lessened in this group. This suggests that women’s metabolic disorders might be cured by balancing urinary microbiota. In conclusion, the altered urinary microbiota between the PreD and PostD periods appears to provide insight into how to prevent postpartum metabolic disorders.
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Affiliation(s)
- Fengping Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Longxian Lv
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ren Yan
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shurong Dong
- Key Laboratory of Advanced Micro/Nano Electronic Devices and Smart Systems of Zhejiang, College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Liping Chen
- Intensive Unit, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wei Wang
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Q Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
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Gundersen TD, Krebs L, Loekkegaard ECL, Rasmussen SC, Glavind J, Clausen TD. Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study. BMJ Open 2018. [PMID: 29540408 PMCID: PMC5857667 DOI: 10.1136/bmjopen-2017-018479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To examine the association between postpartum urinary tract infection and intended mode of delivery as well as actual mode of delivery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All live births in Denmark between 2004 and 2010 (n=450 856). Births were classified by intended caesarean delivery (n=45 053) or intended vaginal delivery (n=405 803), and by actual mode of delivery: spontaneous vaginal delivery, operative vaginal delivery, emergency or planned caesarean delivery in labour or prelabour. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was postpartum urinary tract infection (n=16 295) within 30 days post partum, defined as either a diagnosis of urinary tract infection in the National Patient Registry or redemption of urinary tract infection-specific antibiotics recorded in the Register of Medicinal Product Statistics. RESULTS We found that 4.6% of women with intended caesarean delivery and 3.5% of women with intended vaginal delivery were treated for postpartum urinary tract infection.Women with intended caesarean delivery had a significantly increased risk of postpartum urinary tract infection compared with women with intended vaginal delivery (OR 1.33, 95% CI 1.27 to 1.40), after adjustment for age at delivery, smoking, body mass index, educational level, gestational diabetes mellitus, infection during pregnancy, birth weight, preterm delivery, preterm prelabour rupture of membranes, pre-eclampsia, parity and previous caesarean delivery (adjusted OR 1.24, 95% CI 1.17 to 1.46).Using actual mode of delivery as exposure, all types of operative delivery had an equally increased risk of postpartum urinary tract infection compared with spontaneous vaginal delivery. CONCLUSIONS Compared with intended vaginal delivery, intended caesarean delivery was significantly associated with a higher risk of postpartum urinary tract infection. Future studies should focus on reducing routine catheterisation prior to operative vaginal delivery as well as improving procedures related to catheterisation.
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Affiliation(s)
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Holbaek Sygehus, Holbaek, Denmark
| | | | | | - Julie Glavind
- Institute for Clinical Medicine, Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Seifi M, Abbasalizadeh S, Mohammad-Alizadeh-Charandabi S, Khodaie L, Mirghafourvand M. The effect of Rosa (L. Rosa canina) on the incidence of urinary tract infection in the puerperium: A randomized placebo-controlled trial. Phytother Res 2017; 32:76-83. [PMID: 29024081 DOI: 10.1002/ptr.5950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/11/2022]
Abstract
Urinary tract infection (UTI) is an infection that can occur in any area of the urinary tract which is characterized by a positive urine culture (U/C). The risk of UTI following cesarean section (CS) increases due to procedures such as catheterization. In vitro studies have demonstrated the effect of Rosa canina fruit in preventing Escherichia coli growth. This study was conducted to determine the effect of R. canina fruit in preventing the incidence of UTI in women following CS. This triple-blind randomized clinical trial was conducted in 2016 on 400 women following CS with negative U/C in Alzahra and Taleghani educational hospitals in the city of Tabriz-Iran. Participants were assigned into two groups of 200 women using block randomization. Each group received a twice daily dose of 500 mg capsules containing R. canina or placebo from the second day after CS for 20 days. Women were assessed by U/C on the 7th-10th and 20th days following CS. UTI was significantly lower in the intervention group compared with the control in the follow-ups conducted on the 7th-10th days (odds ratio = 0.22; confidence interval 95% [0.07, 0.67]; p = .006) and 20th day (odds ratio = 0.32; confidence interval 95% [0.14, 0.75]; p = .008). But the incidence of cystitis in the two groups was not statistically significant (p > .05). R. canina fruit capsules were able to reduce the incidence of UTI after CS. Thus, it is likely that administration of this medication can promote maternal health following CS.
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Affiliation(s)
- Mahdieh Seifi
- Department of Midwifery, Students' Research Committee, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamsi Abbasalizadeh
- Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Laleh Khodaie
- Department of Phytopharmacy, Traditional Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Department of Midwifery, Social Determinants of Health Research Center Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Moulton LJ, Munoz JL, Lachiewicz M, Liu X, Goje O. Surgical site infection after cesarean delivery: incidence and risk factors at a US academic institution. J Matern Fetal Neonatal Med 2017; 31:1873-1880. [PMID: 28502188 DOI: 10.1080/14767058.2017.1330882] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify the rate of surgical site infection (SSI) after Cesarean delivery (CD) and determine risk factors predictive for infection at a large academic institution. METHODS This was a retrospective cohort study in women undergoing CD during 2013. SSIs were defined by Centers for Disease Control (CDC) criteria. Chi square and t-tests were used for bivariate analysis and multivariate logistic regression was used to identify SSI risk factors. RESULTS In 2419 patients, the rate of SSI was 5.5% (n = 133) with cellulitis in 4.9% (n = 118), deep incisional infection in 0.6% (n = 15) and intra-abdominal infection in 0.3% (n = 7). On multivariate analysis, SSI was higher among CD for labor arrest (OR 2.4; 95%CI 1.6-3.5; p <.001). Preterm labor (OR 2.8; 95%CI 1.3-6.0; p = .01) and general anesthesia (OR 4.4; 95%CI 2.0-9.8; p = .003) were predictive for SSI. Increasing BMI (OR 1.1; 95%CI 1.05-1.09; p = .02), asthma (OR 1.9; 95%CI 1.1-3.2; p = .02) and smoking (OR 1.9; 95%CI 1.1-3.2; p = .02) were associated with increased SSI. CONCLUSIONS Several patient and surgical variables are associated with increased rate of SSI after CD. Identification of risk factors for SSI after CD is important for targeted implementation of quality improvement measures and infection control interventions.
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Affiliation(s)
- Laura J Moulton
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Cleveland , OH , USA
| | - Jessian L Munoz
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Cleveland , OH , USA
| | - Mark Lachiewicz
- b Department of Gynecology and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA
| | - Xiaobo Liu
- c Quantitative Health Sciences Department , Cleveland Clinic , Cleveland , OH , USA
| | - Oluwatosin Goje
- a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Cleveland , OH , USA
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15
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Moulton L, Lachiewicz M, Liu X, Goje O. Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution. J Matern Fetal Neonatal Med 2017; 31:395-400. [DOI: 10.1080/14767058.2017.1286316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Laura Moulton
- Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Lachiewicz
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Xiaobo Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Oluwatosin Goje
- Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
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16
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The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.44119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Göymen A, Şimşek Y, Özdurak Hİ, Özkaplan ŞE, Akpak YK, Özdamar Ö, Oral S. Effect of vaginal cleansing on postoperative factors in elective caesarean sections: a prospective, randomised controlled trial. J Matern Fetal Neonatal Med 2016; 30:442-445. [PMID: 27049354 DOI: 10.1080/14767058.2016.1174995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the effect of povidone iodine versus benzalkonium chloride, which were applied preoperatively for vaginal disinfection in caesarean sections, on postoperative factors. METHODS One hundred and twenty patients underwent elective caesarean section were divided into three groups using the simple randomisation method: Group 1 (povidone iodine, n: 41); Group 2 (benzalkonium chloride, n: 39); Group 3 (control group, n: 40). Demographic data, duration of operation, amount of bleeding, postoperative pain, time to first flatulence and defaecation, haematological parameters on postoperative day 1 were compared between three groups. Pain evaluation was performed at 6th and 24th postoperative hour using Visual Analogue Scale. RESULTS No statistically significant differences were detected between the groups in demographic characteristics. There were no significant differences between the groups with respect to the duration of operation and hospital stay. The patients in the group who underwent povidone iodine vaginal cleansing had statistically significantly less postoperative pain as compared to control group. No difference was observed between the groups in haematological parameters other than C-reactive protein (CRP); however, CRP levels at 24th post-operative hour were significantly lower in Group 1 compared to the other groups. CONCLUSIONS The preoperative vaginal cleansing with povidone iodine could reduce the postoperative pain, analgesic need and infection parameter.
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Affiliation(s)
- Abdullah Göymen
- a Department of Obstetrics and Gynecology , Faculty of Medicine, SANKO University , Gaziantep , Turkey
| | - Yavuz Şimşek
- b Department of Obstetrics and Gynecology , Faculty of Medicine, Kırıkkale University , Kırıkkale , Turkey
| | - Halil İbrahim Özdurak
- a Department of Obstetrics and Gynecology , Faculty of Medicine, SANKO University , Gaziantep , Turkey
| | - Şükran Esra Özkaplan
- a Department of Obstetrics and Gynecology , Faculty of Medicine, SANKO University , Gaziantep , Turkey
| | - Yaşam Kemal Akpak
- c Department of Obstetrics and Gynecology , Ankara Mevki Military Hospital , Ankara , Turkey
| | - Özkan Özdamar
- d Department of Obstetrics and Gynecology , Gölcük Military Hospital , Kocaeli , Turkey , and
| | - Serkan Oral
- e Department of Assisted Reproduction , LIV Hospital , Istanbul , Turkey
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Chia YY, Lo Y, Chen YB, Liu CP, Huang WC, Wen CH. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e3468. [PMID: 27100449 PMCID: PMC4845853 DOI: 10.1097/md.0000000000003468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.
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Affiliation(s)
- Yuan-Yi Chia
- From the Department of Anesthesiology (Y-YC, YL, Y-BC, C-HW), Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Critical Care Center and Cardiovascular Medical Center (C-PL, W-CH), Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine (W-CH, C-PL), National Yang-Ming University, Taipei, Taiwan; and Department of Physical Therapy (W-CH), Fooyin University, Kaohsiung, Taiwan
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