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Wydall S, Zolger D, Owolabi A, Nzekwu B, Onwochei D, Desai N. Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis. Can J Anaesth 2023; 70:406-442. [PMID: 36720838 DOI: 10.1007/s12630-022-02389-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/02/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE In labour, neuraxial analgesia is the standard in the provision of pain relief. However, the optimal mode of delivering epidural solution has not been determined, and some parturients may need an alternative to epidural analgesia. We sought to conduct a systematic review and network meta-analysis to compare continuous epidural infusion (CEI), programmed intermittent epidural bolus (PIEB), computer-integrated CEI, computer-integrated PIEB, patient-controlled epidural bolus (PCEA), fentanyl patient-controlled analgesia (PCA), and remifentanil PCA, either alone or in combination. METHODS We searched CENTRAL, CINAHL, Ovid Embase, Ovid Medline, and Web of Science for randomized controlled trials that included nulliparous and/or multiparous parturients in spontaneous or induced labour. The maintenance epidural solution had to include a low concentration local anesthetic and an opioid. Specific subgroups in the obstetric population such as preeclampsia were excluded. Network meta-analysis was performed with a frequentist method, and continuous and dichotomous outcomes are presented as mean differences and odds ratios, respectively, with 95% confidence intervals. RESULTS Overall, 73 trials were included. For the first coprimary outcome, the need for rescue analgesia, CEI was inferior to PIEB and PIEB + PCEA was superior to PCEA alone, with a low certainty of evidence given the presence of serious limitations and imprecision. The second coprimary outcome, the maternal satisfaction, was improved by PIEB + PCEA compared with CEI + PCEA and PCEA alone, with a low quality of evidence in view of the presence of serious limitations and imprecision. Fentanyl PCA increased the requirement for rescue analgesia and decreased maternal satisfaction relative to many methods of delivering epidural solution. In terms of secondary outcomes, PIEB increased analgesic efficacy compared with CEI, and PCEA reduced local anesthetic consumption at the expense of inferior analgesia relative to CEI and PIEB. PIEB + PCEA was superior to CEI + PCEA in regard to the pain score at 2 h and 4 h, consumption of local anesthetic, incidence of lower lower limb motor blockade and the rate of spontaneous vaginal delivery. Fentanyl and remifentanil PCA did not provide the same level of analgesia as all epidural methods, resulted in increasing analgesic ineffectiveness with time spent in labour, and predisposed to a higher incidence of side effects such as nausea and/or vomiting and sedation. Remifentanil PCA was superior to fentanyl PCA for analgesia at an early time point, and it increased the incidence of oxygen desaturation relative to other strategies of delivering epidural solution. CONCLUSIONS Opioid PCA did not provide the same level of analgesia as epidural methods with a higher incidence of side effects. We interpret the findings of our systematic review and network meta-analysis as suggesting PIEB + PCEA to be the optimal delivery mode of epidural solution. Nevertheless, the potential differing importance of the various maternal, fetal, and neonatal outcomes in determining which is optimal has not, to our knowledge, been elucidated yet. STUDY REGISTRATION PROSPERO (CRD42021254978); registered 27 May 2021.
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Affiliation(s)
- Simon Wydall
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Danaja Zolger
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adetokunbo Owolabi
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernadette Nzekwu
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Desire Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
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Giddings HL, Wong J, Meagher AP. Should we inform women about the recognised risks of childbirth? Aust N Z J Obstet Gynaecol 2021; 62:37-39. [PMID: 34328214 DOI: 10.1111/ajo.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/08/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND At present in Australia women are not routinely, systematically informed of the risks of childbirth. AIMS It is hoped this presentation of the perspective of some women who suffer unexpected obstetric complications will encourage change. MATERIALS AND METHODS The experience of women involved in obstetric medicolegal reports prepared by a colorectal surgeon over ten years is analysed. RESULTS Twenty women were identified. Sixteen had vaginal deliveries. All 16 suffered third or fourth-degree tears, six developed rectovaginal fistulae, six required stomas and 11 developed faecal incontinence. Of the four women who delivered by caesarean section, there were two post-operative caecal perforations, one unrecognised small bowel enterotomy, and one patient developed sepsis due to an infected haematoma. Seventeen of the 20 women were noted to suffer psychological sequalae. None of the women recollected being warned of the complication they suffered, and there was no record of such warnings in their medical records. CONCLUSION Informed written 'consent' for natural vaginal delivery is, understandably, a contentious topic. Although learning from medicolegal cases may go against the grain, as medical professionals it is very difficult to ethically justify the status quo, where women are not routinely simply informed of the risks of childbirth. This is not fair. Even if informing women does not decrease the incidence of complications, the women who subsequently suffer these complications may well handle them much better, recognising they could occur.
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Affiliation(s)
- Hugh L Giddings
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, Australia
| | - Jean Wong
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, Australia
| | - Alan P Meagher
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, Australia
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Donate-Manzanares M, Rodríguez-Cano T, Rodríguez-Almagro J, Hernández-Martínez A, Santos-Hernández G, Beato-Fernández L. Mixed-method study of women's assessment and experience of childbirth care. J Adv Nurs 2021; 77:4195-4210. [PMID: 34297861 DOI: 10.1111/jan.14984] [Citation(s) in RCA: 3] [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: 03/03/2021] [Revised: 06/24/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine women's evaluations of quality of care from their perspectives. BACKGROUND Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce. DESIGN Mixed-methods explanatory sequential design. METHODS A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis. RESULTS The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care. CONCLUSION Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified. IMPACT This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.
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Affiliation(s)
| | - Teresa Rodríguez-Cano
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Facultad de Enfermería de Ciudad Real, Campus de Ciudad Real, Calle de Camilo José Cela, Ciudad Real, Spain
| | - Gloria Santos-Hernández
- Servicio de Obstetricia y Ginecología del Hospital Virgen de la Salud de Toledo, Toledo, Spain
| | - Luis Beato-Fernández
- Servicio de Psiquiatría del Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija, Ciudad Real, Spain
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Gardiner FW, Richardson A, Roxburgh C, Gillam M, Churilov L, McCuaig R, Carter S, Arthur C, Wong C, Morton A, Callaway L, Lust K, Davidson SJ, Foxcroft K, Oates K, Zhang L, Jayawardane S, Coleman M, Peek M. Characteristics and in-hospital outcomes of patients requiring aeromedical retrieval for pregnancy, compared to non-retrieved metropolitan cohorts. Aust N Z J Obstet Gynaecol 2021; 61:519-527. [PMID: 33426679 DOI: 10.1111/ajo.13308] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited access to obstetrics and gynaecology (O&G) services in rural and remote Australia is believed to contribute to suboptimal birth outcomes. AIMS To describe the characteristics of pregnancy aeromedical transfers, in-hospital outcomes, and patient access to O&G services, as compared to whole of Australia data. MATERIALS AND METHODS We conducted a cohort study of women who required aeromedical retrieval for pregnancy-related issues between the 1 January 2015 and 31 December 2017. RESULTS Hospital outcome data were collected on 2171 (65.2%) mothers and 2438 (100.0%) babies. The leading retrieval reason was threatened preterm labour and delivery (n = 883; 40.7%). Most patients were retrieved from rural and remote areas (n = 2224; 93.0%). Retrieved patients were significantly younger (28.0 vs 30.0 years, 95% CI 27.7-28.3), more likely to be overweight or obese (52.2% vs 45.1%, 95% CI 47.5-56.9) and to have smoked during their pregnancy (14.0% vs 9.9%, 95% CI 12.5-15.5) compared to Australian pregnant women overall. Over one-third of transferred women gave birth by Caesarean section (n = 812; 37.4%); the median gestational age at birth was 33.0 (95% CI 32.7-33.3) weeks. Early gestation is associated with low birth weights (median = 2579.5 g; 95% CI 2536.1-2622.9), neonatal resuscitation (35.4%, 95% CI 33.5-37.3), and special care nursery admission (41.2%, 95% CI 39.3-43.2). There were 42 (1.7%, 95% CI 1.2-2.2) stillbirths, which was significantly higher than seen Australia-wide (n = 6441; 0.7%). CONCLUSION This study found that pregnant women retrieved by the Royal Flying Doctor Service were younger, with higher rates of obesity and smoking.
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Affiliation(s)
- Fergus W Gardiner
- Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Alice Richardson
- Statistical Consulting Unit, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Ruth McCuaig
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Carter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Cynthia Wong
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Adam Morton
- Mater Health Services Public Hospital, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Karin Lust
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Sarah J Davidson
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Katie Foxcroft
- Royal Brisbane Women`s Hospital, Brisbane, Queensland, Australia
| | - Kiri Oates
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | - Lucy Zhang
- Dubbo Hospital, Dubbo, New South Wales, Australia
| | | | - Mathew Coleman
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Western Australia, Australia
| | - Michael Peek
- Australian National University Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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Delpero E, Tannenbaum E, Thomas J. Labour Management in Trial of Labour After Cesarean Delivery (TOLAC): A Gap Analysis and Quality Improvement Initiative. J Obstet Gynaecol Can 2020; 43:967-972. [PMID: 33310163 DOI: 10.1016/j.jogc.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/09/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This quality improvement (QI) initiative was designed to identify gaps between evidence-based or hospital recommendations for trial of labour after cesarean delivery (TOLAC) labour management and clinical practice. METHODS Viable, singleton pregnancies from January 1, 2016, to December 31, 2018, undergoing TOLAC were extracted from the electronic medical record. Sixty randomly selected charts were reviewed for (1) consent, (2) induction methods, (3) oxytocin use, (4) continuous fetal monitoring, (5) admission indication, (6) examination regularity, (7) duration of dystocia before decision to perform cesarean delivery (CD), and (8) maternal complications. RESULTS The institutional vaginal birth after cesarean rate was 71%. Documented consent to TOLAC on admission was present in 50% of cases. Oxytocin augmentation was used in 38% of cases, and the median maximum dose was 4 mU/min (interquartile range [IQR] 3-7.5 mU/min). Delays in initiating oxytocin were identified in 47% of those patients. Decisions to deliver by cesarean were made after a median time of 5 hours and 40 minutes (IQR 3 hours and 30 minutes to 6 hours and 35 minutes) of failure to progress despite adequate contractions. After this decision, median time to delivery was 1 hour and 11 minutes (IQR 57 minutes to 2 hours and 16 minutes). Complications included postpartum hemorrhage (5%) and chorioamnionitis (6.7%). Surgical injury occurred in 10% of intrapartum CD. Peripartum complications were associated with delay in oxytocin implementation (χ2 (1) = 9.80; P < 0.001) in secondary analysis. CONCLUSION Areas for QI were identified in (1) consent, (2) duration of dystocia before decision to proceed with CD and delay to CD, and (3) peripartum complications. We recognize the potential use of this as a tool to identify areas for QI and prospective study.
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Affiliation(s)
- Emily Delpero
- Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
| | - Evan Tannenbaum
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Sinai Health System, Toronto, ON
| | - Jacqueline Thomas
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Sinai Health System, Toronto, ON
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Keag OE, Murphy L, Bradley A, Deakin N, Whyte S, Norman JE, Stock SJ. Postal recruitment for genetic studies of preterm birth: A feasibility study. Wellcome Open Res 2020; 5:26. [PMID: 32322692 PMCID: PMC7160603 DOI: 10.12688/wellcomeopenres.15207.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Preterm birth (PTB) represents the leading cause of neonatal death. Large-scale genetic studies are necessary to determine genetic influences on PTB risk, but prospective cohort studies are expensive and time-consuming. We investigated the feasibility of retrospective recruitment of post-partum women for efficient collection of genetic samples, with self-collected saliva for DNA extraction from themselves and their babies, alongside self-recollection of pregnancy and birth details to phenotype PTB. Methods: 708 women who had participated in the OPPTIMUM trial (a randomised trial of progesterone pessaries to prevent PTB [ISRCTN14568373]) and consented to further contact were invited to provide self-collected saliva from themselves and their babies. DNA was extracted from Oragene OG-500 (adults) and OG-575 (babies) saliva kits and the yield measured by Qubit. Samples were analysed using a panel of Taqman single nucleotide polymorphism (SNP) assays. A questionnaire designed to meet the minimum data set required for phenotyping PTB was included. Questionnaire responses were transcribed and analysed for concordance with prospective trial data using Cohen’s kappa (
k). Results: Recruitment rate was 162/708 (23%) for self-collected saliva samples and 157/708 (22%) for questionnaire responses. 161 samples from the mother provided DNA with median yield 59.0µg (0.4-148.9µg). 156 samples were successfully genotyped (96.9%). 136 baby samples had a median yield 11.5µg (0.1-102.7µg); two samples failed DNA extraction. 131 baby samples (96.3%) were successfully genotyped. Concordance between self-recalled birth details and prospective birth details was excellent (
k>0.75) in 4 out of 10 key fields for phenotyping PTB (mode of delivery, labour onset, ethnicity and maternal age at birth). Conclusion: This feasibility study demonstrates that self-collected DNA samples from mothers and babies were sufficient for genetic analysis but yields were variable. Self-recollection of pregnancy and birth details was inadequate for accurately phenotyping PTB, highlighting the need for alternative strategies for investigating genetic links with PTB.
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Affiliation(s)
- Oonagh E Keag
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Lee Murphy
- Edinburgh Clinical Research Facility, Western General Hospital, Edinburgh, EH4 2XU, UK
| | | | - Naomi Deakin
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Sonia Whyte
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, BS8 1UD, UK
| | - Sarah J Stock
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH16 4UX, UK
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Seong CH, Park KM, Moon KJ. Effects of a labour and delivery simulated practice programme for elderly primigravidas. Nurs Open 2020; 7:776-782. [PMID: 32257265 PMCID: PMC7113517 DOI: 10.1002/nop2.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 12/03/2022] Open
Abstract
Aim Increasing numbers of older gravidas compel research into best practices for their labour-related outcomes. Responding to this need, this study sought to develop and evaluate a programme for older primigravidas. Design The authors developed a simulated practice programme for older primigravidas and tested its effects. Methods A non-equivalent control group pre- and post-test design was used with 49 community-dwelling primigravidas. The programme taught the stages of labour using a realistic scenario-based practice and a debriefing session. Data were collected between June and September 2015. Participants were divided into intervention (N = 25) and control (N = 24) groups. Postintervention group effects were analysed with independent t tests. Results The intervention group's levels of anxiety and stress decreased and their knowledge and self-confidence increased. The intervention group's labour duration was also shorter than that of the control group.
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Dawes L, Buksh M, Sadler L, Waugh J, Groom K. Perinatal care provided for babies born at 23 and 24 weeks of gestation. Aust N Z J Obstet Gynaecol 2019; 60:158-161. [PMID: 31774934 DOI: 10.1111/ajo.13094] [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: 06/23/2019] [Accepted: 10/13/2019] [Indexed: 11/28/2022]
Abstract
In recent years, significant improvements in survival and survival-free of major morbidity in babies born at 23+0 to 24+6 weeks of gestation have led to a more pro-active approach to resuscitation at these peri-viable gestations. Antenatal counselling and interventions, intrapartum care and postnatal advice should be part of the package of care provided to optimise outcomes for these babies and their families. This observational study assesses the perinatal care provided to mothers and their babies who were born at 23 and 24 weeks of gestations over a two-year period at a tertiary maternity hospital in New Zealand.
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Affiliation(s)
- Lisa Dawes
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Mariam Buksh
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Lynn Sadler
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Jason Waugh
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Kanmaz AG, İnan AH, Beyan E, Ögür S, Budak A. Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital. J OBSTET GYNAECOL 2019; 39:1104-1111. [PMID: 31334677 DOI: 10.1080/01443615.2019.1606172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35-40 years old. (2) 40-45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate.
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Affiliation(s)
- Ahkam Göksel Kanmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Abdurrahman Hamdi İnan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Emrah Beyan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital , Izmir , Turkey
| | - Suriye Ögür
- Izmir provincial health directorate , Izmir , Turkey
| | - Adnan Budak
- Izmir provincial health directorate , Izmir , Turkey
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Downing SG, Wright R, Marquardt T, Callander E. Use of fetal fibronectin testing in women transferred for threatened preterm labour in remote far north Queensland. Aust N Z J Obstet Gynaecol 2018; 59:403-407. [PMID: 30175874 DOI: 10.1111/ajo.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/14/2018] [Accepted: 07/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Threatened preterm labour is a common reason for medical transfer from remote communities; however, many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and related social and economic costs. AIM To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs. MATERIALS/METHODS Records from the Royal Flying Doctor Service and Cairns Hospital were accessed. Women transferred solely for threatened preterm labour were included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data were collated and analysed. Costs were assigned using the National Hospital Cost Data Collection, round 19. RESULTS Forty-seven women were included in the study; however, only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated AU$57 408. Aeromedical transfers were estimated to cost a further $151 500. CONCLUSION Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York have the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required.
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Affiliation(s)
- Sandra G Downing
- College of Public Health, Medical& Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | | | | | - Emily Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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11
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Eley VA, van Zundert A, Callaway L. What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m(2)compared with patients with a body mass index < 30 kg/m(2)? a retrospective pilot study. BMC Anesthesiol 2015; 15:115. [PMID: 26231175 PMCID: PMC4522121 DOI: 10.1186/s12871-015-0095-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Received: 02/23/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m(2), to those with a BMI < 30 kg/m(2). The results will be used to calculate the sample size of a planned prospective study. METHODS In this retrospective, (1:1) case-control pilot study, obese subjects and control subjects were selected from the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural analgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was extracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions. Chi-square or Fisher's exact tests were used to detect differences between groups. Multiple logistic regression was used to examine variables predictive of extension failure. RESULTS There were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m(2) and 23.9 (3.0) kg/m(2) in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal definition) was 2.48 (95 % CI:1.02 - 6.03) for the obese group compared with the control group (adjusted for age, parity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 % CI:1.43 - 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese group. CONCLUSIONS In this small retrospective cohort, patients with a BMI ≥ 40 kg/m(2) were significantly more likely to fail epidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.
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Affiliation(s)
- Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4006, Queensland, Australia.
- School of Medicine, The University of Queensland, Herston Rd, Herston, 4006, Queensland, Australia.
| | - Andre van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4006, Queensland, Australia.
- School of Medicine, The University of Queensland, Herston Rd, Herston, 4006, Queensland, Australia.
| | - Leonie Callaway
- School of Medicine, The University of Queensland, Herston Rd, Herston, 4006, Queensland, Australia.
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4006, Queensland, Australia.
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Wood S, McNeil D, Yee W, Siever J, Rose S. Neighbourhood socio-economic status and spontaneous premature birth in Alberta. Can J Public Health 2014; 105:e383-8. [PMID: 25365274 DOI: 10.17269/cjph.105.4370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 10/10/2014] [Accepted: 08/24/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate a possible association between neighbourhood socio-economic status and spontaneous premature birth in Alberta births. METHODS The study design was a retrospective cohort of all births in Alberta for the years 2001 and 2006. The primary outcome was spontaneous preterm birth at <37 weeks gestation. Neighbourhood socio-economic status was measured by the Pampalon Material Deprivation Index for each Statistics Canada census dissemination area. Births were linked to dissemination area using maternal postal codes. RESULTS The analysis comprised 73,585 births, in which the rate of spontaneous preterm delivery at <37 weeks was 5.3%. The rates of spontaneous preterm delivery for each neighbourhood socio-economic category ranged from 4.9% (95% CI 4.5%-5.2%) in the highest category to 6.3% (95% CI 6.0%-6.7%) in the lowest (p<0.001). After controlling for smoking, parity, maternal age and year, we found that women living in the highest socio-economic status neighbourhoods had an adjusted spontaneous preterm birth rate of 5.1% (95% CI 4.7%-5.5%) compared to 6.0% (95% CI 5.6%-6.4%) for women living in the lowest (p=0.003). CONCLUSION This study documented a modest increase in the risk of spontaneous preterm birth with low socio-economic status. The possibility of confounding bias cannot be ruled out.
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