1
|
Paixao ES, Bottomley C, Pescarini JM, Wong KLM, Cardim LL, Ribeiro Silva RDC, Brickley EB, Rodrigues LC, Oliveira Alves FJ, Leal MDC, Costa MDCN, Teixeira MG, Ichihara MY, Smeeth L, Barreto ML, Campbell OMR. Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil. PLoS Med 2021; 18:e1003791. [PMID: 34637451 PMCID: PMC8509988 DOI: 10.1371/journal.pmed.1003791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. METHODS AND FINDINGS We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. CONCLUSIONS In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.
Collapse
Affiliation(s)
- Enny S. Paixao
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- * E-mail:
| | - Christian Bottomley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M. Pescarini
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Kerry L. M. Wong
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana L. Cardim
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro Silva
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Nutrition School, Federal University of Bahia, Salvador, Brazil
| | - Elizabeth B. Brickley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Maria do Carmo Leal
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria da Conceicao N. Costa
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Gloria Teixeira
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Liam Smeeth
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Oona M. R. Campbell
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Malagon-Maldonado G, Connelly CD, Bush RA. Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice. Worldviews Evid Based Nurs 2017; 14:118-127. [PMID: 28226190 DOI: 10.1111/wvn.12208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. AIMS The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. METHODS The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. RESULTS Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. LINKING EVIDENCE TO ACTION The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.
Collapse
Affiliation(s)
- Gabriella Malagon-Maldonado
- Director of Education, Research, and Professional Practice, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Cynthia D Connelly
- Director of Nursing Research and Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, CA, USA
| | - Ruth A Bush
- Clinical Associate Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, CA, USA
| |
Collapse
|
3
|
Declercq E, MacDorman M, Osterman M, Belanoff C, Iverson R. Prepregnancy Obesity and Primary Cesareans among Otherwise Low-Risk Mothers in 38 U.S. States in 2012. Birth 2015; 42:309-18. [PMID: 26489891 PMCID: PMC4750476 DOI: 10.1111/birt.12201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The United States has recently experienced increases in both its rate of obesity and its cesarean rate. Our objective was to use a new item measuring prepregnancy body mass index (BMI) on the U.S. Standard Certificate of Live Birth to examine at a population level the relationship between maternal obesity and primary cesarean delivery for women at otherwise low risk for cesarean delivery. METHODS By 2012, 38 states with 86 percent of United States births had adopted the U.S. Standard Certificate. The sample was limited to the 2,233,144 women who had a singleton, vertex, term (37-41 weeks) birth in 2012 and no prior cesarean. We modeled the likelihood of a primary cesarean by BMI category, controlling for maternal socio-demographic and medical characteristics. RESULTS Overall, 46.4 percent of otherwise low-risk mothers had a prepregnancy BMI in the overweight (25.1%) or obese (21.3%) categories, with the obese category distributed as follows: obese I (BMI 30.0-34.9, 12.4%); obese II (BMI 35.0-39.9, 5.5%); and obese III (BMI 40+, 3.5%). Obesity rates were highest among American Indian and Alaska Native (32.5%) and non-Hispanic black mothers (30.5%). After adjustment for demographic and medical risks, the adjusted risk ratios (95% confidence intervals) of cesarean for low-risk primiparas were: 1.61 (1.60-1.63) for obese I, 1.86 (1.83-1.88) for obese II, and 2.21 (2.18-2.25) for obese III mothers compared with mothers in the normal weight category. DISCUSSION A relationship between prepregnancy obesity and primary cesarean delivery among relatively low-risk mothers remained even after controlling for social and medical risk factors.
Collapse
Affiliation(s)
- Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Marian MacDorman
- Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Michelle Osterman
- Division of Vital Statistics, Reproductive Statistics Branch, National Center for Health Statistics, CDC, Hyattsville, MD, USA
| | - Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Ronald Iverson
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
4
|
Kozhimannil KB, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database. PLoS Med 2014; 11:e1001745. [PMID: 25333943 PMCID: PMC4205118 DOI: 10.1371/journal.pmed.1001745] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors-such as hospital policies, practices, and culture--in determining cesarean section use. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Mariana C. Arcaya
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
5
|
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Development and Validation of a National Data Registry for Midwife‐Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset. J Midwifery Womens Health 2014; 59:8-16. [DOI: 10.1111/jmwh.12165] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
|
7
|
Trends and Characteristics of Home Vaginal Birth After Cesarean Delivery in the United States and Selected States. Obstet Gynecol 2012; 119:737-44. [DOI: 10.1097/aog.0b013e31824bb050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Campbell C. Elective cesarean delivery: trends, evidence and implications for women, newborns and nurses. Nurs Womens Health 2011; 15:308-319. [PMID: 21884496 DOI: 10.1111/j.1751-486x.2011.01651.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
9
|
Ananth CV, Vintzileos AM. Trends in cesarean delivery at preterm gestation and association with perinatal mortality. Am J Obstet Gynecol 2011; 204:505.e1-8. [PMID: 21457916 DOI: 10.1016/j.ajog.2011.01.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/04/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to examine the extent to which a temporal increase in preterm cesarean delivery is associated with gestational age-specific changes in perinatal survival in preterm gestations. STUDY DESIGN We utilized data on singleton births in the United States (1990 through 2004) delivered between 24-36 weeks' gestation. Associations between changes in cesarean delivery at preterm gestations and trends in the risk of preterm stillbirth, and neonatal and perinatal mortality were estimated before and after adjustments for a variety of potential confounders. RESULTS From 1990 through 2004, cesarean delivery rates increased by 50.6%, 40.7%, and 35.8% at 24-27, 28-33, and 34-36 weeks, respectively. The largest incremental effect of cesarean was associated with a reduction in stillbirths by 5.8%, 14.2%, and 23.1% at 24-27, 28-33, and 34-36 weeks, respectively, leading to an 11.4%, 4.9%, and 0.6% reduction in perinatal deaths at 24-27, 28-33, and 34-36 weeks, respectively. CONCLUSION Increasing rates of preterm cesarean were associated with improved perinatal survival. This association was evident largely because of dramatic incremental declines in stillbirths.
Collapse
|
10
|
Kim HK. Impact Factors of Korean Women's Cesarean Section according to Ecological Approach. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2011; 17:109-117. [PMID: 37697560 DOI: 10.4069/kjwhn.2011.17.2.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
PURPOSE This study examined the impact factors of cesarean section based on the ecological approach in Korea. METHODS Population-based data (Korea Institute for Health and Social Affairs) were used from 2,849 delivery cases during 2003~2009. Data were analyzed using geographic statistics with STATA 10.0 and hierarchical logistic regression with SPSS/WIN 12.0. RESULTS The range of cesarean section rate was 28.8~44.7% with geographic distribution. The proportion of mother's problem was increasing in choice of cesarean section. According to the ecological model, age of mother (OR=1.08), time of birth (OR=0.79), delivery in hospital (OR=1.83), delivery in clinic (OR=1.46), and education of mother (OR=2.61) had significant impact on cesarean section. CONCLUSION This study contributes to provide the impact factors of the high cesarean rate in Korea ecologically. Policy maker and health care provider can consider these results to reduce cesarean section rate.
Collapse
Affiliation(s)
- Hyun Kyoung Kim
- Division of Nursing Science, College of Health Science, Ewha Womans University, Seoul, Korea
| |
Collapse
|
11
|
Go MDA, Emeis C, Guise JM, Schelonka RL. Fetal and neonatal morbidity and mortality following delivery after previous cesarean. Clin Perinatol 2011; 38:311-9. [PMID: 21645798 DOI: 10.1016/j.clp.2011.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article examines data from a recent systematic evidence review on term deliveries conducted for the National Institutes of Health Consensus Conference sponsored by the Agency for Healthcare Research and Quality on vaginal birth after caesarean, from a meta-analysis of associated perinatal outcomes, and subsequent publications that meet stringent quality review standards. We present a summary of fetal and neonatal outcomes emphasizing information that clinicians and patients need to make decisions regarding mode of delivery after prior cesarean and look for areas where future studies may provide important insights.
Collapse
Affiliation(s)
- Mitzi Donabel A Go
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Mail code CDRCP, Portland, OR 97239-2998, USA
| | | | | | | |
Collapse
|