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Mallick LM, Shenassa ED. Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study. Breastfeed Med 2024; 19:262-274. [PMID: 38535749 DOI: 10.1089/bfm.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
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Affiliation(s)
- Lindsay M Mallick
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Avenir Health, Glastonbury, Connecticut, USA
| | - Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Nohr EA, Taastrøm KA, Kjeldsen ACM, Wu C, Pedersen FH, Brown WJ, Davis DL. Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort. Birth 2024; 51:198-208. [PMID: 37849409 DOI: 10.1111/birt.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.
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Affiliation(s)
- Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | - Katja A Taastrøm
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Cathrine M Kjeldsen
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Chunsen Wu
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Deborah L Davis
- ACT Government, Health Directorate and Faculty of Health, University of Canberra, New South Wales, Australia
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Vassilopoulou E, Rallis D, Milani GP, Agostoni C, Feketea G, Lithoxopoulou M, Stefanaki E, Ladomenou F, Douladiris N, Cronin C, Popescu CA, Pop RM, Bocsan IC, Tsabouri S. Nurturing Infants to Prevent Atopic Dermatitis and Food Allergies: A Longitudinal Study. Nutrients 2023; 16:21. [PMID: 38201851 PMCID: PMC10780847 DOI: 10.3390/nu16010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Atopic dermatitis (AD) at a young age often precedes the development of food allergies. Although AD affects millions of infants worldwide, prenatal and postnatal risk factors, and their association with the development of food allergies later on, are not fully elucidated. This study seeks to investigate AD epidemiology in infancy and its risk factors, examining early-life factors (both prenatal and postnatal) that could contribute to the later development of food allergies. METHODS Between January 2019 and December 2019, 501 infants were included in this prospective cohort study. Longitudinal data collection was performed through maternal interviews, the first one conducted within three days after the delivery and the second within 24 to 36 months after the delivery, encompassing variables such as demographics, family history of atopy, maternal smoking, antibiotic use during pregnancy, the mode of delivery, breastfeeding history, food practices, and greenness exposure within 3 days from delivery, while they were still in the hospital. RESULTS Maternal smoking during pregnancy (p = 0.001) and an older sibling atopy history (p = 0.03) was significantly linked to AD incidence. Cesarean section delivery (p = 0.04) was associated with a higher risk of food allergies in infants with AD. Having a garden at home correlated with a higher likelihood of AD (p = 0.01), and food elimination without medical guidance (p = 0.02) due to AD correlated with an elevated risk of food allergies. CONCLUSIONS Encouraging timely allergenic food introduction while promoting dietary diversity, rich in plant-based foods, maternal smoking cessation, and professional dietary guidance may help minimize AD and food allergy risk. Future studies should address the role of greenness in the development of AD and food allergies.
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Affiliation(s)
- Emilia Vassilopoulou
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece; (D.R.); (S.T.)
| | - Gregorio Paolo Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gavriela Feketea
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (I.C.B.)
- Pediatric Allergy Outpatient Clinic, Department of Pediatrics, “Karamandaneio” Children’s Hospital of Patra, 26331 Patras, Greece
| | - Maria Lithoxopoulou
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Evangelia Stefanaki
- Pediatric Allergy Outpatient Clinic, Department of Pediatrics, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece;
| | - Fani Ladomenou
- Pediatric Infectious Unit, Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Nikolaos Douladiris
- Allergy Unit, 2nd Pediatric Clinic, University of Athens, 11527 Athens, Greece;
| | - Caoimhe Cronin
- Department of Paediatrics and Child Health, University College Cork, T12 K8AF Cork, Ireland;
| | - Codruta Alina Popescu
- Department of Abilities Human Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 40012 Cluj-Napoca, Romania;
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (I.C.B.)
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (R.M.P.); (I.C.B.)
| | - Sophia Tsabouri
- Neonatal Intensive Care Unit, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece; (D.R.); (S.T.)
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4
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Cadman V, Soltani H, Spencer R, Marvin-Dowle K, Harrop D. Cesarean birth rates among migrants in Europe: A systematic review. Birth 2023; 50:657-671. [PMID: 36939837 DOI: 10.1111/birt.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. METHODS A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta-analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. RESULTS From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from "Sub Saharan Africa" and the "South East Asia, Asia and Pacific" region than rates in the receiving country. Statistical significance was not found between other populations. CONCLUSIONS This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care.
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Affiliation(s)
- Victoria Cadman
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Hora Soltani
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Rachael Spencer
- Department of Nursing and Midwifery College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Katie Marvin-Dowle
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Deborah Harrop
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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Sarker AR, Zabeen I, Hossain Z, Ali N, Khan JAM. Increasing rates of cesarean birth in Bangladesh: A household-level pooled analysis. Birth 2023. [PMID: 37994253 DOI: 10.1111/birt.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/24/2022] [Accepted: 10/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh. METHODS We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15-49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables. RESULTS The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003-04; this rate increased to 33.22% in 2017-18. The annual percentage change in CB rate was 16.34% from 2004 to 2017-18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh. CONCLUSIONS This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Irfat Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Zakir Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Jahangir A M Khan
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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6
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Montanari Vergallo G, Ricci P, Gulino M. The choice of Caesarean section between clinical indication and patient autonomy: The physician between rock and hard place. J Eval Clin Pract 2023; 29:1068-1072. [PMID: 36793133 DOI: 10.1111/jep.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Caesarean delivery carries a higher risk of short- and long-term complications for both mother and baby than vaginal delivery. However, over the past two decades, data show a considerable increase in requests for Caesarean sections. This manuscript analyses the case of Caesarean Section on maternal request without a clinical indication from a medico-legal and ethical perspective. METHOD Medical associations and bodies databases were searched for published guidelines and recommendations on the use of caesarean sections on maternal requests. As derived from the literature, medical risks, attitudes, and reasons for this choice have also been summarized. RESULTS International guidelines and medical associations recommend strengthening the doctor-patient relationship by setting up an information process to make the pregnant woman understand the danger of Caesarean delivery without clinical indications and to make her consider whether she can survive natural childbirth. CONCLUSION Caesarean section on maternal request and without clinical indications is an emblematic case of how the physician could be between two opposing interests. Our analysis shows that if the woman's rejection of natural birth persists and clinical indications for Caesarean delivery are lacking, the physician must respect the patient's choice.
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Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Ricci
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Gulino
- Department of Clinical Sciences and Translational Medicine, TorVergata University of Rome, Rome, Italy
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Giaxi P, Gourounti K, Vivilaki V, Metallinou D, Zdanis P, Galanos A, Lykeridou A. Can the Day of the Week and the Time of Birth Predict the Mode of Delivery According to Robson Classification? Healthcare (Basel) 2023; 11:2158. [PMID: 37570398 PMCID: PMC10418404 DOI: 10.3390/healthcare11152158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Worldwide, the cesarean section rate has steadily increased from 6.7% in 1990 to 21.1% in 2018 and is expected to rise even more. The World Health Organization propose the adoption of the Robson classification system as a global standard for monitoring, evaluating, and comparing delivery rates. The purpose of the current study is to use the Robson classification system to investigate how, independently of medical factors, the day of the week and time of delivery may be related to the mode of birth. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. Over 60% of deliveries during the study period were performed by cesarean section, 30.6% by vaginal delivery, and 8.5% of deliveries were performed by operative vaginal delivery. The results of this study indicate that the lowest birth rates are observed on Monday, Saturday, and Sunday. Nulliparous women with no previous cesarean delivery, with a singleton in cephalic presentation ≥37 weeks with spontaneous labor (group 1) are 73% more likely to deliver by cesarean section between 08:00 A.M. and 03:59 P.M. compared to those who give birth between 12:00 A.M. and 07:59 A.M. Also, multiparous women with a single cephalic term pregnancy and one previous cesarean section (group 5.1) are 16.7 times more likely to deliver by cesarean section in the morning compared to overnight deliveries. These results point out two non-clinical variables that influences the CS rate. The Robson classification system was a useful tool for the above comparisons.
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Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
| | - Kleanthi Gourounti
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
| | - Victoria Vivilaki
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
| | - Panagiotis Zdanis
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
| | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 14561 Athens, Greece;
| | - Aikaterini Lykeridou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece; (K.G.); (V.V.); (D.M.); (P.Z.); (A.L.)
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Badri H, Fowler G, Lane S. Follow up of women after obstetric anal sphincter injuries (OASI)-What is the role of anorectal testing? Neurourol Urodyn 2023. [PMID: 37269480 DOI: 10.1002/nau.25220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/09/2023] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
AIMS To evaluate the benefit of performing anorectal studies on all women following primary obstetric anal sphincter injury (OASI) repair over performing them on symptomatic women only. METHODS Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months postpartum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group. RESULTS A total of 1348 women were seen in the perineal clinic over 13 years. A total of 454 (33.7%) women were symptomatic. A total of 894 (66.3%) women were asymptomatic. A total of 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone, and 86 (9.6%) had abnormal EAUS alone. A total of 221 (24.7%) asymptomatic women had normal anorectal studies. CONCLUSION Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence following further vaginal birth. Without anorectal study results, women would not receive accurate counseling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.
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Affiliation(s)
- Hawra Badri
- Department of Urogynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Gillian Fowler
- Department of Urogynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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Vila-Candel R, Piquer-Martín N, Perdomo-Ugarte N, Quesada JA, Escuriet R, Martin-Arribas A. Indications of Induction and Caesarean Sections Performed Using the Robson Classification in a University Hospital in Spain from 2010 to 2021. Healthcare (Basel) 2023; 11:healthcare11111521. [PMID: 37297661 DOI: 10.3390/healthcare11111521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background: The Robson Ten Group Classification System (RTGCS) enables the assessment, monitoring, and comparison of caesarean section rates both within healthcare facilities and between them, and the indications of caesarean sections (CS) performed in a maternity ward. The aims of the present study were to conduct an analysis to assess the levels and distribution of birth from a descriptive approach by CS in La Ribera University Hospital (Spain) between 2010-2021 using the Robson classification; to describe the indications for the induction of labour and the causes of caesarean sections performed; and to examine the association between the induction of labour and CS birth. Methods: A retrospective study between 1 January 2010 and 31 December 2021. All eligible women were classified according to the RTGCS to determine the absolute and relative contribution by each group to the overall CS rate. The odds ratio (OR) of the variables of interest was estimated by logistic regression. In an analysis of the subgroups, the level of significance was adjusted using the Bonferroni method. Results: 20,578 women gave birth during the study period, 19% of them by CS. In 33% of births, induction was performed, and the most common cause was the premature rupture of membranes. Group 2 (nulliparous with induced labour/elective CS before labour) accounted for the largest contribution to the overall rate of CS (31.5%) and showed an upward trend from 23.2% to 39.7% in the time series, increasing the CS rate by 6.7%. The leading cause of CS was suspected fetal distress, followed by induction failure. Conclusions: In our study, Robson Group 2 was identified as the main contributor to the hospital's overall CS rate. Determining the causes of induction and CS in a population sample classified using the RTGCS enables the identification of the groups with the greatest deviation from the optimal rate of CS and the establishment of improvement plans to reduce the overall rate of caesarean sections in the maternity unit.
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Affiliation(s)
- Rafael Vila-Candel
- Department of Nursing, Universitat de València, 46007 Valencia, Spain
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO-SP), 46020 Valencia, Spain
| | - Nadia Piquer-Martín
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO-SP), 46020 Valencia, Spain
| | - Nerea Perdomo-Ugarte
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO-SP), 46020 Valencia, Spain
| | - José Antonio Quesada
- Department of Clinical Medicine, Universidad Miguel Hernández, 03202 Elche, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 Alicante, Spain
| | - Ramón Escuriet
- School of Health Sciences Blanquerna, Universitat Ramon Llull, C/Padilla 326, 08025 Barcelona, Spain
| | - Anna Martin-Arribas
- School of Health Sciences Blanquerna, Universitat Ramon Llull, C/Padilla 326, 08025 Barcelona, Spain
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10
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Rosman AN, van der Vliet-Torij HWH, Hilberink SR. Trends in perinatal outcomes of women with chronic medical conditions: A 10-year population-based study in the Netherlands. Midwifery 2023; 118:103572. [PMID: 36587471 DOI: 10.1016/j.midw.2022.103572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To gain insight into perinatal outcomes in women with chronic medical conditions, in order to contribute to the optimization of personalized perinatal care. We hypothesize that women with a chronic medical condition have poorer perinatal outcomes than women without a known chronic medical condition. DESIGN Population-based study using data of the Netherlands Perinatal Registry between 2010-2019. SETTING Nationwide study in the Netherlands. PARTICIPANTS Pregnancies of women who were diagnosed with chronic medical conditions by a medical specialist before pregnancy (n=36,835), divided into seven sub-groups and a reference group of pregnancies of women without known chronic medical conditions (n=1,084,623). MEASUREMENTS AND FINDINGS The primary outcome measure was mode of birth. Secondary outcomes measures were onset of labour, preterm birth, asphyxia, Neonatal Intensive Care Unit (NICU) admission, and perinatal mortality. Spontaneous birth ranged from 45.0% (orthopaedic conditions) to 71.3% (neurological conditions) to 82.6% in the reference group. Assisted vaginal birth, planned caesarean birth, and emergency caesarean birth occurred significantly more in all groups compared to the reference group (p<0.001). Preterm birth was significantly more likely in the studied groups as well as perinatal asphyxia and NICU admission (all p<0.001). Adjusting for mode of birth, parity, age and ethnicity did not change the outcomes for the group of women with chronic medical conditions. Perinatal mortality was seen in all groups but in none of the separate groups significantly more than in the reference group. Descriptive statistics, univariate and multivariable logistic regression analyses were applied. KEY CONCLUSIONS Women with chronic medical conditions are more likely to experience preterm birth, caesarean births and NICU admission of the new-born. IMPLICATIONS FOR PRACTICE Knowledge about perinatal outcomes of women with chronic medical conditions is a first step for obstetrics care providers in order to optimize personalized care.
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Affiliation(s)
- Ageeth N Rosman
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands; Perined, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
| | | | - Sander R Hilberink
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands
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11
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Hidalgo-Lopezosa P, Cubero-Luna AM, García-Fernández R, Jiménez-Ruz A, Maestre-Luna MI, Liébana-Presa C, Rodríguez-Borrego MA, López-Soto PJ. Prevalence and Mode of Birth in Late Fetal Mortality in Spain, 2016-2019. Int J Environ Res Public Health 2023; 20:1777. [PMID: 36767143 PMCID: PMC9914757 DOI: 10.3390/ijerph20031777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: The rate of cesarean sections in late fetal mortality remains high. We aimed to determine the prevalence of late fetal mortality in Spain and risk factors for cesarean birth in women with stillbirth ≥ 28 weeks gestation between 2016-2019. (2) Methods: A retrospective observational study with national data between 2016-2019. A total of 3504 births with fetal dead were included. Sociodemographic, obstetrical and neonatal variables were analyzed using univariate and multivariate logistic regression (MLR), with cesarean birth with a stillborn ≥ 28 weeks gestation as the dependent variable. (3) Results: The late fetal mortality rate was 2.8 × 1000; 22.7% of births were by cesarean section. Factors associated with cesarean were having a multiple birth (aOR 6.78); stillbirth weight (aOR 2.41); birth taking place in towns with over 50,000 inhabitants (aOR 1.34); and mother's age ≥ 35 (aOR 1.23). (4) Conclusions: The late fetal mortality rate increased during the period. The performance of cesarean sections was associated with the mother's age, obstetric factors and place of birth. Our findings encourage reflection on how to best put into practice national clinical and socio-educational prevention strategies, as well as the approved protocols on how childbirth should be correctly conducted.
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Affiliation(s)
- Pedro Hidalgo-Lopezosa
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Ana María Cubero-Luna
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Andrea Jiménez-Ruz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
- Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
| | | | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Pablo Jesús López-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Enfermería, Farmacología y Fisioterapia, Universidad de Córdoba, 14004 Córdoba, Spain
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12
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Suarez A, Yakupova V. The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women. Front Glob Womens Health 2022; 3:1040879. [PMID: 36619591 PMCID: PMC9810808 DOI: 10.3389/fgwh.2022.1040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Women's satisfaction with their childbirth experiences has significant impacts on their health and the health of their children. Recently, childbirth and maternity care systems have been disrupted by the COVID-19 pandemic. This study aimed to investigate the association of birth satisfaction with mode of birth, medical interventions, support during labour, type of childbirth healthcare plan and antenatal education in the context of the COVID-19 pandemic in Russia. Methods 1,645 Russian women who gave birth during the first year of the COVID-19 pandemic and 611 matched controls who gave birth in the previous year participated in an anonymous Internet survey about their childbirth experience. The survey included questions regarding women's demographic and obstetric characteristics as well as their childbirth experiences. Birth satisfaction was measured using the Birth Satisfaction Scale Revised Indicator (BSS-RI). Results Birth satisfaction scores did not show notable changes before and during the pandemic (Pearson Chi-square = 19.7, p = 0.22). Women had lower BSS-RI scores if they tested positive for COVID-19 during labour (F = 9.18, p = 0.002), but not during pregnancy or postpartum (p > 0.32). In both cohorts women who had vaginal births rated birth satisfaction higher than those who had caesarean births. The more medical interventions there were, the lower were the BSS-RI scores (B = -0.234, 95% CI: -0.760; -0.506, p < 0.001), but only during the pandemic. Birth satisfaction was higher if women had a support person present during labour (F > 7.44, p < 0.001), which was not possible for over 70% of participants during the pandemic. In both cohorts birth satisfaction was associated with the childbirth healthcare plan (F > 5.27, p < 0.001), but not with antenatal education (F < 0.15, p > 0.43). Conclusions Our study highlights the significant impacts of the COVID-19 pandemic on the birth experiences of Russian women. Sustaining the rights of women to informed decisions during labour, respect for their preferred childbirth healthcare plan, presence of the birth team of choice and professional support for home birth are essential for higher birth satisfaction and better health outcomes for mothers and their infants.
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13
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Carter J, Bick D, Gallacher D, Chang Y. Mode of birth and development of maternal postnatal post-traumatic stress disorder: A mixed-methods systematic review and meta-analysis. Birth 2022; 49:616-627. [PMID: 35561055 PMCID: PMC9790679 DOI: 10.1111/birt.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) affects approximately 3% of women in the postnatal period, but less is known about risk factors for PTSD than other postnatal mental illnesses. This review aimed to analyze the literature on the impact of mode of birth on postnatal PTSD. METHODS Searches were undertaken of CINAHL, the Cochrane Library, MEDLINE, PsycINFO, and Scopus for studies investigating the link between mode of birth and postnatal PTSD in high-resource countries from January 1990 to February 2021. Quantitative and qualitative data were collected and synthesized. Meta-analysis was performed with four of the studies, and the rest were analyzed narratively. RESULTS Twelve quantitative studies, presenting data on 5567 women, and two qualitative studies, with 92 women, were included in the review. Most studies found a significant relationship between mode of birth and maternal PTSD symptoms. Meta-analysis found cesarean birth was more closely associated with PTSD than vaginal delivery (VD) (P = 0.005), emergency cesarean birth (EmCB) more than elective cesarean birth (ElCB) (P < 0.001), instrumental vaginal delivery (IVD) more than spontaneous vaginal delivery (SVD) (P < 0.001), and EmCB more than SVD (P < 0.001). Women who developed PTSD after EmCB felt less in control and less supported than those who did not develop it after the same procedure. Request for repeat ElCB appeared more common among women with pre-existing postnatal PTSD, but this may subsequently leave them feeling dissatisfied and their fears of childbirth unresolved. CONCLUSIONS Modes of birth involving emergency intervention may be risk factors for the development of postnatal PTSD. Ensuring that women feel supported and in control during emergency obstetric interventions may mediate against this risk.
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Affiliation(s)
- Jemima Carter
- Faculty of Life Sciences and MedicineKing's College LondonLondonUK,St Richard's HospitalChichesterUK
| | - Debra Bick
- Warwick Medical SchoolUniversity of WarwickWarwickUK
| | | | - Yan‐Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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14
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de Labrusse C, Abderhalden‐Zellweger A, Mariani I, Pfund A, Gemperle M, Grylka‐Baeschlin S, Mueller AN, Valente E, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards. Int J Gynaecol Obstet 2022; 159 Suppl 1:70-84. [PMID: 36530005 PMCID: PMC9877813 DOI: 10.1002/ijgo.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.
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Affiliation(s)
- Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Alessia Abderhalden‐Zellweger
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Anouck Pfund
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Michael Gemperle
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | | | - Antonia N. Mueller
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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15
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Otelea MR, Simionescu AA, Mariani I, Valente EP, Nanu MI, Nanu I, Handra CM, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's assessment of the quality of hospital-based perinatal care by mode of birth in Romania during the COVID-19 pandemic: Results from the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:126-136. [PMID: 36530009 PMCID: PMC9877960 DOI: 10.1002/ijgo.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess women's perceptions of the quality of maternal and newborn care (QMNC) received in hospitals in Romania during the COVID-19 pandemic by mode of birth. METHODS A validated anonymous online questionnaire based on WHO quality measures. Subgroup analysis of spontaneous vaginal birth (SVB), emergency cesarean, and elective cesarean and multivariate analyses were performed, and QMNC indexes were calculated. Maternal age, educational level, year of birth, mother born in Romania, parity, type of hospital, and type of professionals assisting the birth were used for multivariate analysis. RESULTS A total of 620 women completed the survey. Overall, several quality measures suggested gaps in QMNC in Romania, with the lowest QMNC indexes reported for provision of care and availability of resources. Women who had either elective or emergency cesarean compared with those who had SVB more frequently lacked early breastfeeding (OR 2.04 and 2.13, respectively), skin-to-skin contact (OR 1.73 and 1.75, respectively), rooming-in (OR 2.07 and 1.96, respectively), and exclusive breastfeeding at discharge (OR 2.27 and 1.64, respectively). Compared with elective cesarean, emergency cesarean had higher odds of ineffective communication by healthcare providers (OR 1.65), lack of involvement in choices (OR 1.58), insufficient emotional support (OR 2.07), and no privacy (OR 2.06). Compared with other modes of birth, a trend for lower QMNC indexes for emergency cesarean was observed for all domains, while for elective cesarean the QMNC index for provision of care was significantly lower. CONCLUSION Quality indicators of perinatal care remain behind targets in Romania, with births by cesarean the most affected. CLINICALTRIALS GOV IDENTIFIER NCT04847336.
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Affiliation(s)
| | - Anca Angela Simionescu
- Department of Obstetrics and GynecologyUniversity of Medicine and Pharmacy Carol DavilaBucharestRomania,Department of Gynecology and ObstetricsFilantropia Clinical HospitalBucharestRomania
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Michaela Iuliana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | - Ioana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | | | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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16
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Shand AW, Lewis-Jones B, Nielsen T, Svensson J, Lainchbury A, Henry A, Nassar N. Birth outcomes by type of attendance at antenatal education: An observational study. Aust N Z J Obstet Gynaecol 2022; 62:859-867. [PMID: 35581951 PMCID: PMC10083900 DOI: 10.1111/ajo.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Antenatal education aims to prepare expectant parents for pregnancy, birth, and parenthood. Studies have reported antenatal education teaching breathing and relaxation methods for pain relief, termed psychoprophylaxis, is associated with reduction in caesarean section rates compared with general birth and parenting classes. Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended. MATERIALS AND METHODS A cross-sectional antenatal survey of nulliparous women ≥28 weeks gestation with a singleton pregnancy was conducted in two maternity hospitals in Sydney, Australia in 2018. Women were asked what type of antenatal education they attended and sent a follow-up survey post-birth. Hospital birth data were also obtained. Education was classified into four groups: psychoprophylaxis, birth and parenting, other, or none. RESULTS Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93-4.43). CONCLUSIONS Women who attended psychoprophylaxis couple-based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes.
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Affiliation(s)
- Antonia W Shand
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Hospital for Women, Sydney, New South Wales, Australia
| | | | - Timothy Nielsen
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Svensson
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anne Lainchbury
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales Medicine, Sydney, New South Wales, Australia.,St George Hospital, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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17
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Verhoeven CJM, Boer J, Kok M, Nieuwenhuijze M, de Jonge A, Peters LL. More home births during the COVID-19 pandemic in the Netherlands. Birth 2022; 49:792-804. [PMID: 35554962 PMCID: PMC9348372 DOI: 10.1111/birt.12646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The aim of this observational study was to examine whether the course of pregnancy and birth and accompanying outcomes among low-risk pregnant women changed in the COVID-19 pandemic compared to the prepandemic period. METHODS We analyzed data from the Dutch Midwifery Case Registration System (VeCaS). Differences in the course of pregnancy and birth, and accompanying maternal and neonatal outcomes, were calculated between women pregnant during the initial months of the COVID-19 pandemic (March 1 to August 3, 2020) and the prepandemic period (March 1-August 3, 2019). We also conducted a stratified analysis by parity. RESULTS We included 5913 low-risk pregnant women of whom 2963 (50.1%) were pregnant during the first surge of the COVID-19 pandemic, and 2950 (49.9%) in the prepandemic period. During the COVID-19 pandemic, more women desired and had a home birth. More women used pain medication and fewer had an episiotomy in the COVID-19 period than prior. Multiparous women had a higher suspected rate of fetal growth restriction during COVID; however, the actual rate of small for gestational age infants was not significantly increased. We observed no differences for onset and augmentation of labor or for mode of birth, though the rate of vaginal births increased. CONCLUSIONS During the COVID-19 pandemic, there was a higher rate of planned and actual home birth, and suspected growth restriction and a lower rate of episiotomy among low-risk pregnant women in the Netherlands.
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Affiliation(s)
- Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of Midwifery, School of Health SciencesUniversity of NottinghamNottinghamUK,Department of Obstetrics and GynaecologyMaxima Medical CentreVeldhoventhe Netherlands
| | - José Boer
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development CenterAmsterdam University Medical Centre, Universiteit van AmsterdamAmsterdamthe Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceZuyd UniversityMaastrichtthe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtthe Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health Research InstituteAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Lilian L. Peters
- Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development CenterAmsterdam University Medical Centres, Vrije Universiteit AmsterdamAmsterdamNetherlands,Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
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18
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Linehan K, Dempsey EM, Ryan CA, Ross RP, Stanton C. First encounters of the microbial kind: perinatal factors direct infant gut microbiome establishment. Microbiome Res Rep 2022; 1:10. [PMID: 38045649 PMCID: PMC10688792 DOI: 10.20517/mrr.2021.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 12/05/2023]
Abstract
The human gut microbiome harbors a diverse range of microbes that play a fundamental role in the health and well-being of their host. The early-life microbiome has a major influence on human development and long-term health. Perinatal factors such as maternal nutrition, antibiotic use, gestational age and mode of delivery influence the initial colonization, development, and function of the neonatal gut microbiome. The perturbed early-life gut microbiome predisposes infants to diseases in early and later life. Understanding how perinatal factors guide and shape the composition of the early-life microbiome is essential to improving infant health. The following review provides a synopsis of perinatal factors with the most decisive influences on initial microbial colonization of the infant gut.
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Affiliation(s)
- Kevin Linehan
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork P61 C996, Ireland
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Lee Maltings, Cork, Cork T12 YT20, Ireland
- School of Microbiology, University College Cork, Cork T12 YN60, Ireland
| | - Eugene M. Dempsey
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Lee Maltings, Cork, Cork T12 YT20, Ireland
- Department of Paediatrics & Child Health and INFANT Centre, University College Cork, Cork T12 YN60, Ireland
| | - C. Anthony Ryan
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Lee Maltings, Cork, Cork T12 YT20, Ireland
- Department of Paediatrics & Child Health and INFANT Centre, University College Cork, Cork T12 YN60, Ireland
| | - R. Paul Ross
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Lee Maltings, Cork, Cork T12 YT20, Ireland
- School of Microbiology, University College Cork, Cork T12 YN60, Ireland
| | - Catherine Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork P61 C996, Ireland
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Lee Maltings, Cork, Cork T12 YT20, Ireland
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Cabré S, Ratsika A, Rea K, Stanton C, Cryan JF. Animal Models for Assessing Impact of C-Section Delivery on Biological Systems. Neurosci Biobehav Rev 2022; 135:104555. [PMID: 35122781 DOI: 10.1016/j.neubiorev.2022.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/02/2022]
Abstract
There has been a significant increase in Caesarean section (C-section) births worldwide over the past two decades and although it is can be a life-saving procedure, the enduring effects on host physiology are now undergoing further scrutiny. Indeed, epidemiological data have linked C-section birth with multiple immune, metabolic and neuropsychiatric diseases. Birth by C-section is known to alter the colonisation of the neonatal gut microbiota (with C-section delivered infants lacking vaginal microbiota associated with passing along the birth canal), which in turn can impact the development and maintenance of many important biological systems. Appropriate animal models are key to disentangling the role of missing microbes in brain health and disease in C-section births. In this review of preclinical studies, we interrogate the effects of C-section birth on the development (and maintenance) of several biological systems and we discuss the involvement of the gut microbiome on C-section-related alterations.
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Affiliation(s)
- Sílvia Cabré
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Cork T12 YT20, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork T12 YT20, Ireland
| | - Anna Ratsika
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Cork T12 YT20, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork T12 YT20, Ireland
| | - Kieran Rea
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Cork T12 YT20, Ireland
| | - Catherine Stanton
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Cork T12 YT20, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork T12 YT20, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy P61 C996, Ireland
| | - John F Cryan
- APC Microbiome Ireland, Biosciences Institute, University College Cork, Cork T12 YT20, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork T12 YT20, Ireland.
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Blaga OM, Hentes E, Ungureanu MI, Forray AI. Predictors of planned caesarean section births in a sample of Romanian women. Int J Health Plann Manage 2022; 37:1555-1565. [PMID: 35083766 DOI: 10.1002/hpm.3424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Romania has one of the highest incidences of births by caesarean section (CS) in the European Union (EU). The present study aims to identify the possible predictors of planned caesarean section (PCS) in a convenience sample of Romanian women. METHODS This is a secondary analysis of the cross-sectional data collected as part of the EU-level Babies Born Better online survey from 1908 Romanian women who gave birth between 2013 and 2018. Univariable and multivariable logistic regression models were performed to identify the potential individual and health system-level predictors of PCS. RESULTS PCS was reported by 36.7% (n = 657) of the women. In the multivariable regression model, older maternal age (aOR: 1.10, 95% CI: 1.07-1.14) and presence of medical or non-medical problems during pregnancy (adjusted odds ratio [aOR]: 1.67, 95% CI: 1.31-2.12) were significantly associated with PCS. Conversely, birth at a very high level of competence hospital was inversely associated with PCS (aOR: 0.48, 95% CI: 0.30-0.76). CONCLUSIONS Our findings indicate that PCS may be associated with both individual and health system-level variables. Our results are significant because they could be used to inform decision-making processes aimed at lowering PCS incidence.
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Affiliation(s)
- Oana M Blaga
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Emanuel Hentes
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Marius I Ungureanu
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Alina I Forray
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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21
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Duong DTT, Binns C, Lee A, Zhao Y, Pham NM, Hoa DTP, Ha BTT. Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam. Int J Environ Res Public Health 2022; 19:ijerph19020884. [PMID: 35055705 PMCID: PMC8776101 DOI: 10.3390/ijerph19020884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
Background: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. Methods: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020–2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. Results: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31–0.96, p = 0.034). Conclusions: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.
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Affiliation(s)
- Doan Thi Thuy Duong
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (D.T.T.D.); (B.T.T.H.)
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (A.L.); (Y.Z.); (N.M.P.)
| | - Colin Binns
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (A.L.); (Y.Z.); (N.M.P.)
- Correspondence: (C.B.); (D.T.P.H.)
| | - Andy Lee
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (A.L.); (Y.Z.); (N.M.P.)
| | - Yun Zhao
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (A.L.); (Y.Z.); (N.M.P.)
| | - Ngoc Minh Pham
- School of Population Health, Curtin University, Bentley, WA 6102, Australia; (A.L.); (Y.Z.); (N.M.P.)
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam
| | - Dinh Thi Phuong Hoa
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (D.T.T.D.); (B.T.T.H.)
- Correspondence: (C.B.); (D.T.P.H.)
| | - Bui Thi Thu Ha
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (D.T.T.D.); (B.T.T.H.)
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22
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Kibuka M, Price A, Onakpoya I, Tierney S, Clarke M. Evaluating the effects of maternal positions in childbirth: An overview of Cochrane Systematic Reviews. Eur J Midwifery 2022; 5:57. [PMID: 35005482 PMCID: PMC8678923 DOI: 10.18332/ejm/142781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The purpose of this study is to conduct an overview of Cochrane systematic reviews (SRs) evaluating the effects of maternal positions in childbirth in order to compile existing evidence for relevant research questions that have been addressed by more than one review, to provide a succinct summary of the up-to-date evidence and to identify areas for future research. METHODS An electronic search was conducted in the Cochrane database. Two primary outcomes were the duration of labor and birth, and operative birth. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria. RESULTS We included 3 Cochrane SRs. There was a significant mean difference (MD) found in the duration of the first stage by 1 hour and 22 minutes (MD= -1.21; 95% CI: -2.35 – -0.07, I2=94%) and reduction in caesarean section rates (RR=0.71; 95% CI: 0.54–0.94, I2=0%) in the upright birth position group compared with the horizontal. Also, there was a statistically significant difference in the duration (minutes) of the second stage of labor (MD= -6.16; 95% CI: -9.74 – -2.59, I2=91%) and a reduction in assisted vaginal birth rates (RR=0.75, 95% CI: 0.66–0.86, I2=29%) in the upright group compared with the horizontal without epidural analgesia. The quality of evidence within the reviews was very low to moderate. CONCLUSIONS There is currently a limited body of evidence to clearly assess the benefits and risks of assuming upright positions during childbirth. The overview highlights the need for high-quality research studies, involving better definition and comprehensive assessment of the effects of squatting during childbirth.
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Affiliation(s)
- Marion Kibuka
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Amy Price
- Stanford Anesthesia and Informatics Media Lab, School of Medicine, Stanford University, Palo Alto, United States.,Centre for Evidence Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mike Clarke
- All Ireland Hub for Trials Methodology Research, Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Royal Victoria Hospital, Belfast, Ireland
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23
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Fitzpatrick KE, Kurinczuk JJ, Quigley MA. Planned mode of birth after previous caesarean section and special educational needs in childhood: a population-based record linkage cohort study. BJOG 2021; 128:2158-2168. [PMID: 34216080 PMCID: PMC9291107 DOI: 10.1111/1471-0528.16828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
Objective To investigate the association between planned mode of birth after previous caesarean section and a child’s risk of having a record of special educational needs (SENs). Design Population‐based cohort study. Setting Scotland. Population A cohort of 44 892 singleton children born at term in Scotland between 2002 and 2011 to women with one or more previous caesarean sections. Methods Linkage of Scottish national health and education data sets. Main outcome measures Any SENs and specific types of SEN recorded when a child was aged 4–11 years and attending a Scottish primary or special school. Results Children born following planned vaginal birth after previous caesarean (VBAC) compared with elective repeat caesarean section (ERCS) had a similar risk of having a record of any SENs (19.24 versus 17.63%, adjusted risk ratio aRR 1.04, 95% CI 0.99–1.09) or specific types of SEN. There was also little evidence that planned VBAC with or without labour induction compared with ERCS was associated with a child’s risk of having a record of any SENs (21.42 versus 17.63%, aRR 1.09, 95% CI 1.01–1.17 and 18.78 versus 17.63%, aRR 1.03, 95% CI 0.98–1.08, respectively) or most types of SEN. However, an increased risk of sensory impairment was seen for planned VBAC with labour induction compared with ERCS (1.18 versus 0.78%, risk difference 0.4%, adjusted odds ratio aOR 1.60, 95% CI 1.09–2.34). Conclusions This study provides little evidence of an association between planned mode of birth after previous caesarean and SENs in childhood beyond a small absolute increased risk of sensory impairment seen for planned VBAC with labour induction. This finding may be the result of performing multiple comparisons or residual confounding. The findings provide valuable information to manage and counsel women with previous caesarean section concerning their future birth choices. Tweetable abstract There is little evidence planned mode of birth after previous caesarean section is associated with special educational needs in childhood. There is little evidence planned mode of birth after previous caesarean section is associated with special educational needs in childhood.
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Affiliation(s)
- K E Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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24
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Williams C, Fong R, Murray SM, Stock SJ. Caesarean birth and risk of subsequent preterm birth: a retrospective cohort study. BJOG 2020; 128:1020-1028. [PMID: 33043563 DOI: 10.1111/1471-0528.16566] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the risk of spontaneous and medically indicated preterm birth associated with mode of birth in previous term-born pregnancy. DESIGN Retrospective cohort study. SETTING Two UK maternity units. POPULATION OR SAMPLE A total of 16 340 women with first two consecutive singleton births and the first birth at term. METHODS Retrospective cohort study using routinely collected clinical data. MAIN OUTCOME MEASURES Incidence of spontaneous preterm birth and medically indicated preterm birth at less than 37 weeks of gestation after term birth, in relation to mode of birth in first pregnancy. Subgroup analysis on cervical dilatation at the time of first caesarean birth. RESULTS Compared with vaginal birth, emergency caesarean birth at full dilatation was associated with an increase in spontaneous preterm birth (2.3% vaginal birth versus 4.5% full dilatation caesarean; adjusted odds ratio [aOR] 3.29, 95% CI 2.02-5.13, P < 0.001). Elective caesarean, emergency caesarean at <4 cm dilatation, and emergency caesarean at 4-9 cm dilatation were associated with increased medically indicated preterm birth (0.8% vaginal births versus 1.9% elective caesarean, 3.3% <4 cm caesarean, 1.3% 4-9 cm caesarean; aOR 2.30, 95% CI 1.19-4.15, P = 0.009; aOR 4.68, 95% CI 2.98-7.24, P < 0.001; and aOR 2.43, 95% CI 1.43-4.00, P = 0.001, respectively). CONCLUSIONS Term caesarean in the first stage of labour or performed prelabour is associated with medically indicated preterm birth. Term caesarean in the second stage of labour is associated with spontaneous preterm birth. TWEETABLE ABSTRACT Caesarean in the second stage of labour is associated with spontaneous preterm birth.
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Affiliation(s)
- C Williams
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R Fong
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S Murray Murray
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, NINE Edinburgh BioQuarter, Edinburgh, UK
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25
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Preis H, Mor P, Grisaru-Granovsky S, Samueloff A, Gabbay-Benziv R, Chen R, Eisner M, Pardo J, Peled Y, Wiznitzer A, Benyamini Y. Women's preferences for mode of second birth-A prospective study of two Israeli birth cohorts. Birth 2020; 47:237-245. [PMID: 32052497 DOI: 10.1111/birt.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/22/2019] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.,Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Mor
- Medical Genetics Institute, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Technion School of Medicine, Hadera, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eisner
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Pardo
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Peled
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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26
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Coates D, Thirukumar P, Henry A. Women's experiences and satisfaction with having a cesarean birth: An integrative review. Birth 2020; 47:169-182. [PMID: 31891986 DOI: 10.1111/birt.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND With around one third of woman having a cesarean birth, better understanding of women's experiences of having a cesarean is vital to improve women's experiences of care. The aim of this review was to gain insight into women's experiences of and satisfaction with cesarean and to identify factors that contribute to women's poor experiences of care. METHODS Using an integrative methodology, evidence was systematically considered in relation to women's experiences of cesarean birth and whether they were satisfied with their experience of care. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. RESULTS Twenty-six studies were included. Although the majority of women were satisfied with their cesarean, a large minority of women were dissatisfied and reported a negative experience. In particular, women who had an emergency cesarean were less satisfied than women who had a vaginal birth. Nonmedical factors or experiences that appear associated with dissatisfaction include (a) feeling ignored and disempowered; (b) experiencing a loss of control; (c) not being informed; and (d) birth values that favor vaginal birth. CONCLUSIONS Women's experiences of cesarean birth appear influenced by the circumstances (emergency vs planned), the extent to which they felt involved in decision-making and in control of their experience, and their birth values and beliefs. Increasing antenatal, intrapartum, and postpartum communication and shared decision-making may help engage women as an active participant in their own birth.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Purshaiyna Thirukumar
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, NSW, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, NSW, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia.,The George Institute for Global Health, UNSW Medicine, Sydney, NSW, Australia
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27
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Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, Van Den Akker T. Epidemiological analysis of peripartum hysterectomy across nine European countries. Acta Obstet Gynecol Scand 2020; 99:1364-1373. [PMID: 32358968 PMCID: PMC7540498 DOI: 10.1111/aogs.13892] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. MATERIAL AND METHODS We performed a descriptive, multinational, population-based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. RESULTS A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0-10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4-12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05). CONCLUSIONS Prevalence of peripartum hysterectomy may vary considerably between high-income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine-fold increased risk of peripartum hysterectomy.
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Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Paris University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Department of Obstetrics and Gynecology, Karolinska Institute, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Van Den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Athena Institute, VU University Amsterdam, The Netherlands
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28
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Abstract
OBJECTIVES To investigate the relation between mode of birth and women's long-term sexual health. DESIGN Maternal follow-up of the Danish National Birth Cohort (1996-2002) in 2013-2014 including questions on sexual health. Logistic regression was used to relate registry-based information about mode of birth and perineal tears with data on sexual problems. SETTING Denmark. PARTICIPANTS Of 82 569 eligible mothers in the Danish National Birth Cohort, 43 639 (53%) completed the follow-up. Of these, 37 417 women had a partner, and answered at least one question on sexual health. MAIN OUTCOME MEASURES Self-reported sexual health. RESULTS Participants were on average 44 years old, and 16 years after their first birth. The frequency of sexual problems among women with only spontaneous vaginal births, the reference group, was 37%. For women who only had caesarean sections, more problems were reported (OR 1.18; 95% CI 1.09 to 1.28). For women who had a spontaneous vaginal birth subsequent to a caesarean, and for women with only vaginal births who had experienced one or more instrumental vaginal births, the odds of sexual problems did not differ from women with only spontaneous vaginal births (OR 1.00; 95% CI 0.91 to 1.11) and (OR 1.01; 95% CI 0.95 to 1.08), respectively. CONCLUSIONS These findings indicate that caesarean section does not protect against long-term sexual problems. Rather, vaginal birth, even after caesarean section, was associated with fewer long-term sexual problems.
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Affiliation(s)
- Sarah Hjorth
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Helene Kirkegaard
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Jim G Thornton
- Department of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynecology, Syddansk Universitet, Odense, Denmark
- Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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29
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Abstract
BACKGROUND Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences. AIM To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies. MATERIALS AND METHODS This was a retrospective cohort study of singleton term births at the Mater Mother's Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤-12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile. RESULTS Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06-4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30-1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60-7.75). CONCLUSIONS Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.
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Affiliation(s)
- Joanna Yu
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Ristan M Greer
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
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30
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Kean N, Turner J, Flatley C, ClinEpi M, Kumar S. Maternal age potentiates the impact of operative birth on serious neonatal outcomes. J Matern Fetal Neonatal Med 2018; 33:598-605. [PMID: 29985073 DOI: 10.1080/14767058.2018.1498478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Pregnancies at the extremes of maternal age (<20 and >35) are associated with adverse obstetric and perinatal outcomes. There is limited evidence regarding the influence of maternal age on serious neonatal outcomes by mode of delivery. The aim of this study thus was to assess the relationship between maternal age and mode of delivery and its impact on a composite of serious neonatal outcomes.Methods: This was a retrospective cohort study of low risk women birthing at term in Australia's largest maternity hospital over a 7-year period. Intrapartum and perinatal outcomes were collated and a composite of severe adverse neonatal outcomes (SANO) was generated. Multiple regression was applied to adjust for confounders and generate adjusted odds ratios for the risk of SANO according to mode of delivery and maternal age.Results: A total of 84,698 women were included in this study of which 1572 (1.9%) were aged <20 years, 7471 (8.8%) were aged 20-24 years, 20,125 (23.8%) were aged 25-29 years, 31,594 (37.3%) were aged 30-34 years, 19,371 (22.9%) were aged 35-40 years, 4280 (5.1%) were aged 40-44 years and 285 (0.3%) were aged ≥45 years. The incidence of SANO was significantly greater among adolescents compared to all other age groups. Overall, SANO was most likely to occur following Emergency Caesarean Section (EmCS) for severe intrapartum hemorrhage/uterine rupture compared to all other indications. Instrumental delivery was associated with the greatest odds of SANO (adjusted odds ratios (aOR) 3.31, 95% CI 3.08-3.55, p < .001) while spontaneous vaginal delivery (SVD) was associated with the lowest odds (aOR 0.46, 95% CI 0.43-0.48, p < .001). The adjusted odds for SANO was lowest in women aged 30-34 years (aOR 0.92, 95% CI 0.87-0.97, p < .001). The odds of SANO following an SVD increased with maternal age, with women aged 40-44 years having the highest odds. Similarly, the odds of SANO following an instrumental delivery increased with maternal age (age <20 years: aOR 2.21, 95% CI 1.38-3.54, p < .001 versus age 35-39 years: aOR 3.76, 95% CI 3.16-4.48, p < .001).Conclusion: This large retrospective cohort study has demonstrated that maternal age not only affects the mode of delivery and the incidence of adverse neonatal outcomes but that the effect of mode of delivery upon the risk of SANO is not independent of maternal age.
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Affiliation(s)
- Nicola Kean
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia
| | - Jessica Turner
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | | | - M ClinEpi
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Sailesh Kumar
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
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31
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Siassakos D, Jackson S, Gleeson K, Chebsey C, Ellis A, Storey C, Heazell A, Draycott T, Winter C, Hillman J, Cox R, Lewis J, Davey L. All bereaved parents are entitled to good care after stillbirth: a mixed-methods multicentre study (INSIGHT). BJOG 2018; 125:160-170. [PMID: 28758375 PMCID: PMC5763319 DOI: 10.1111/1471-0528.14765] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To understand challenges in care after stillbirth and provide tailored solutions. DESIGN Multi-centre case study. SETTING Three maternity hospitals. POPULATION Parents with a stillborn baby, maternity staff. METHODS Thematic analysis of parent interviews and staff focus groups and service provision investigation. OUTCOMES 1 Themes; 2 Triangulation matrix; 3 Recommendations. RESULTS Twenty-one women, 14 partners, and 22 staff participated. Service Provision: Care for parents after stillbirth varies excessively; there are misconceptions; post-mortem does not delay follow-up. PRESENTATION Women 'do not feel right' before stillbirth; their management is haphazard and should be standardised. DIAGNOSIS Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well-designed bereavement space is critical. Birth: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies. Post-mortem: Parents are influenced by discussions with staff. Staff should 'sow seeds', clarify its respectful nature, delineate its purpose, and explain the timescale. FOLLOW-UP It is not standardised; parents wish to see their multi-professional team. CONCLUSIONS There is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision-making. Every bereaved parent is entitled to good, respectful care. TWEETABLE ABSTRACT Care too varied & interactions often insensitive after stillbirth; national pathway & training urgently needed PLAIN LANGUAGE SUMMARY: Why and how was the study carried out? Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care. At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty-five parents of 21 babies agreed to participate. Twenty-two obstetricians and midwives took part in focus group discussions. What were the main findings? Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training. Some women reported they did not 'feel right' before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken. After it had been confirmed that the baby had died, staff focussed on the mothers' needs, but the parents' priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered. Staff influenced parents' decisions about post-mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination. After discharge from hospital, there was no consistent plan for how follow-up care would be given. Parents would have liked more information about their next hospital appointment. What are the limitations of the work? The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally. What is the implication for parents? Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single parent is treated respectfully and participates in decision making.
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Affiliation(s)
- D Siassakos
- Centre for Academic Women's HealthChilterns, Women's Health, Southmead HospitalUniversity of BristolWestbury on TrymBristolUK
- International Stillbirth AllianceBristolUK
| | - S Jackson
- Psychology DepartmentUniversity of the West of EnglandBristolUK
| | | | - C Chebsey
- Severn Deanery, Health Education EnglandBristolUK
| | - A Ellis
- Severn Deanery, Health Education EnglandBristolUK
| | - C Storey
- Centre for Academic Women's HealthChilterns, Women's Health, Southmead HospitalUniversity of BristolWestbury on TrymBristolUK
- International Stillbirth AllianceBristolUK
| | - the INSIGHT Study Group
- Centre for Academic Women's HealthChilterns, Women's Health, Southmead HospitalUniversity of BristolWestbury on TrymBristolUK
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Yee LM, Kaimal AJ, Nakagawa S, Houston K, Kuppermann M. Predictors of postpartum sexual activity and function in a diverse population of women. J Midwifery Womens Health 2013; 58:654-61. [PMID: 24325662 DOI: 10.1111/jmwh.12068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The purpose of this study was to identify predictors of postpartum sexual activity and functioning in a diverse population of women using the Sexual Health Outcomes in Women Questionnaire (SHOW-Q). METHODS This was a prospective study of 160 postpartum women assessing relationships between demographic factors, mode of birth, depression, breastfeeding, and sexual activity and function. Questionnaires were administered over the telephone 8 to 10 weeks postpartum and in person 6 to 8 months postpartum. Primary outcomes were sexual activity at 8 to 10 weeks postpartum and global and subscale SHOW-Q scores at 6 to 8 months postpartum; the primary predictor was mode of birth. Associations were assessed using multiple linear and logistic regression analyses. RESULTS Seventy-five percent of this population (n = 140 at 8-10 weeks, n = 129 at 6-8 months) gave birth vaginally, and 60.7% resumed sexual activity by 8 to 10 weeks postpartum. Only multiparity was associated with increased odds of having resumed sexual activity by 8 to 10 weeks postpartum (adjusted odds ratio [aOR], 2.44; P = .03), whereas older age was associated with decreased odds (aOR, 0.92; P = .02) of having resumed sexual activity. Women who were depressed (effect estimate, -13.3; P = .01), older (-1.1, P = .01), or exclusively breastfeeding (-16.5, P < .001) had significantly poorer sexual satisfaction, whereas multiparous women reported better sexual satisfaction (11.1, P = .03). A significant relationship between mode of birth and SHOW-Q scores did not emerge, although we did observe a trend toward lower SHOW-Q scores among women who underwent cesarean compared with those giving birth vaginally. DISCUSSION Multiparity and younger age predict early resumption of sexual activity, whereas depression and breastfeeding are associated with poorer postpartum sexual functioning. The relationship between mode of birth and resumed sexual activity or postpartum sexual function remains uncertain.
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Calderon TC, Wu W, Rawson RA, Sakala EP, Sowers LC, Boskovic DS, Angeles DM. Effect of mode of birth on purine and malondialdehyde in umbilical arterial plasma in normal term newborns. J Perinatol 2008; 28:475-81. [PMID: 18368062 PMCID: PMC4158434 DOI: 10.1038/jp.2008.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the effect of mode of birth on plasma purine and malondialdehyde levels in normal term infants. STUDY DESIGN Umbilical arterial cord blood was obtained immediately after birth from a convenience sample of 119 normal term newborns born by vaginal delivery, with or without oxytocin augmentation or by elective cesarean delivery. Plasma was analyzed for purine and/or malondialdehyde levels. Numeric data were analyzed utilizing independent samples t-test and ordinal data were analyzed using Mann-Whitney test. Correlation coefficients were obtained using Spearman's rho. RESULT Uric acid levels were significantly elevated (P<0.001) in neonates undergoing vaginal birth, compared to neonates born by elective cesarean delivery. When the effect of oxytocin and length of labor was analyzed, neonates born to mothers on oxytocin had lower hypoxanthine, significantly lower xanthine (P=0.05) and higher uric acid levels. In addition, malondialdehyde levels were significantly higher (P<0.006) in neonates born to mothers who received oxytocin compared to neonates born to mothers without oxytocin augmentation. We also found significant correlations between malondialdehyde (MDA) and hypoxanthine (r=-0.465, P<0.039) and between MDA and xanthine (r=-0.753, P=0.003) in neonates born via oxytocin-augmented birth. Mode of birth had no statistically significant effect on clinical outcomes, although infants born by elective cesarean had higher incidence of acute respiratory distress and transient tachypnea of the newborn compared to those born vaginally. CONCLUSION Neonates born by elective cesarean had the lowest purine levels in cord blood compared to neonates born vaginally. Oxytocin augmentation is associated with some degree of uterine hyperstimulation which may enhance the ATP degradation pathway resulting in the rapid conversion of hypoxanthine to xanthine and xanthine to uric acid. Significantly higher MDA levels in neonates whose mothers received oxytocin as well as significant correlation between MDA and the purines hypoxanthine and xanthine, suggest free-radical production, most likely due to xanthine oxidase activation. However, despite differences in plasma purine and malondialdehyde levels, no significant differences were seen in neonatal outcome. Further studies are required to fully characterize the effect of mode of birth on purine metabolism and free-radical production.
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Affiliation(s)
- TC Calderon
- Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - W Wu
- Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - RA Rawson
- Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - EP Sakala
- Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, CA, USA
| | - LC Sowers
- Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - DS Boskovic
- Department of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | - DM Angeles
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA
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