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Abouzaid M, Howidi N, Badran Z, Mohammed G, Mousa NA. The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications. Front Med (Lausanne) 2023; 10:1168625. [PMID: 37342498 PMCID: PMC10277493 DOI: 10.3389/fmed.2023.1168625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women's risk for each disorder.
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Affiliation(s)
- Maryam Abouzaid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nourhan Howidi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Zahi Badran
- Periodontology Unit, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Unal C, Fadiloglu E, Cagan M, Ziyadova G, Kaya E, Tanacan A, Beksac MS. Refusal of the hospitalization: a distressed dilemma in obstetric practice. Ther Adv Reprod Health 2023; 17:26334941231216531. [PMID: 38152477 PMCID: PMC10752054 DOI: 10.1177/26334941231216531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/15/2023] [Indexed: 12/29/2023] Open
Abstract
Background Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns. Objectives We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations. Design We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019. Methods Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients. Results A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters. Conclusion Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.
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Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Hospital, Ankara 06100, Turkey
| | - Gunel Ziyadova
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Esra Kaya
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Association of Neighborhood Income with Clinical Outcomes Among Pregnant Patients with Cardiac Disease. Reprod Sci 2022; 29:3007-3014. [PMID: 35819577 PMCID: PMC9537116 DOI: 10.1007/s43032-022-00978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/18/2022] [Indexed: 11/11/2022]
Abstract
Cardiovascular disease is the leading cause of pregnancy mortality. Socioeconomic and racial disparities in pregnancy are well established. Despite this, little is known about the impact of social determinants of health in pregnant patients with heart disease. This study aims to determine whether pregnant patients with heart disease living in lower income neighborhoods and managed at cardio-obstetrics programs have higher rates of cardiac events or preterm deliveries compared with those living in higher income neighborhoods. This is a retrospective cohort study of 206 patients between 2010 and 2020 at a quaternary care hospital in Northern California. The exposure was household income level based on neighborhood defined by the US Census data. Patients in lower income neighborhoods (N = 103) were 45% Hispanic, 34% White, and 14% Asian versus upper income neighborhoods (N = 103), which were 48% White, 31% Asian, and 12% Hispanic (p < 0.001). There was no significant difference in the rates of intrapartum cardiac events (10% vs. 4%; p = 0.16), postpartum cardiac events (14% vs. 17%; p = 0.7), and preterm delivery (24% vs. 17%; p = 0.23). The rates of antepartum hospitalization were higher for lower income neighborhoods (42% vs 22%; p = 0.004). While there is no significant difference in cardiac events and preterm delivery rates between patients from low versus high income neighborhoods, patients from lower income neighborhoods have higher antepartum hospitalization rates. Earlier identification of clinical deterioration provided by a cardio-obstetrics team may contribute to increased hospitalizations, which might mitigate socioeconomic disparities in outcomes for these pregnant patients with heart disease.
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Stock SJ, Horne M, Bruijn M, White H, Boyd KA, Heggie R, Wotherspoon L, Aucott L, Morris RK, Dorling J, Jackson L, Chandiramani M, David AL, Khalil A, Shennan A, van Baaren GJ, Hodgetts-Morton V, Lavender T, Schuit E, Harper-Clarke S, Mol BW, Riley RD, Norman JE, Norrie J. Development and validation of a risk prediction model of preterm birth for women with preterm labour symptoms (the QUIDS study): A prospective cohort study and individual participant data meta-analysis. PLoS Med 2021; 18:e1003686. [PMID: 34228732 PMCID: PMC8259998 DOI: 10.1371/journal.pmed.1003686] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Timely interventions in women presenting with preterm labour can substantially improve health outcomes for preterm babies. However, establishing such a diagnosis is very challenging, as signs and symptoms of preterm labour are common and can be nonspecific. We aimed to develop and externally validate a risk prediction model using concentration of vaginal fluid fetal fibronectin (quantitative fFN), in combination with clinical risk factors, for the prediction of spontaneous preterm birth and assessed its cost-effectiveness. METHODS AND FINDINGS Pregnant women included in the analyses were 22+0 to 34+6 weeks gestation with signs and symptoms of preterm labour. The primary outcome was spontaneous preterm birth within 7 days of quantitative fFN test. The risk prediction model was developed and internally validated in an individual participant data (IPD) meta-analysis of 5 European prospective cohort studies (2009 to 2016; 1,783 women; mean age 29.7 years; median BMI 24.8 kg/m2; 67.6% White; 11.7% smokers; 51.8% nulliparous; 10.4% with multiple pregnancy; 139 [7.8%] with spontaneous preterm birth within 7 days). The model was then externally validated in a prospective cohort study in 26 United Kingdom centres (2016 to 2018; 2,924 women; mean age 28.2 years; median BMI 25.4 kg/m2; 88.2% White; 21% smokers; 35.2% nulliparous; 3.5% with multiple pregnancy; 85 [2.9%] with spontaneous preterm birth within 7 days). The developed risk prediction model for spontaneous preterm birth within 7 days included quantitative fFN, current smoking, not White ethnicity, nulliparity, and multiple pregnancy. After internal validation, the optimism adjusted area under the curve was 0.89 (95% CI 0.86 to 0.92), and the optimism adjusted Nagelkerke R2 was 35% (95% CI 33% to 37%). On external validation in the prospective UK cohort population, the area under the curve was 0.89 (95% CI 0.84 to 0.94), and Nagelkerke R2 of 36% (95% CI: 34% to 38%). Recalibration of the model's intercept was required to ensure overall calibration-in-the-large. A calibration curve suggested close agreement between predicted and observed risks in the range of predictions 0% to 10%, but some miscalibration (underprediction) at higher risks (slope 1.24 (95% CI 1.23 to 1.26)). Despite any miscalibration, the net benefit of the model was higher than "treat all" or "treat none" strategies for thresholds up to about 15% risk. The economic analysis found the prognostic model was cost effective, compared to using qualitative fFN, at a threshold for hospital admission and treatment of ≥2% risk of preterm birth within 7 days. Study limitations include the limited number of participants who are not White and levels of missing data for certain variables in the development dataset. CONCLUSIONS In this study, we found that a risk prediction model including vaginal fFN concentration and clinical risk factors showed promising performance in the prediction of spontaneous preterm birth within 7 days of test and has potential to inform management decisions for women with threatened preterm labour. Further evaluation of the risk prediction model in clinical practice is required to determine whether the risk prediction model improves clinical outcomes if used in practice. TRIAL REGISTRATION The study was approved by the West of Scotland Research Ethics Committee (16/WS/0068). The study was registered with ISRCTN Registry (ISRCTN 41598423) and NIHR Portfolio (CPMS: 31277).
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Affiliation(s)
- Sarah J. Stock
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
- * E-mail:
| | - Margaret Horne
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Merel Bruijn
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Helen White
- Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Kathleen A. Boyd
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Robert Heggie
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Lisa Wotherspoon
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Rachel K. Morris
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Jon Dorling
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom
| | - Andrew Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, Kings College London, United Kingdom
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Tina Lavender
- Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Ewoud Schuit
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Ben W. Mol
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Richard D. Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, United Kingdom
| | - Jane E. Norman
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Esin S, Okuyan E, Gunakan E, Zengin HY, Hayran M, Tohma YA. A novel technique for prediction of preterm birth: fetal nasal flow Doppler. J Perinat Med 2021; 49:319-325. [PMID: 33180051 DOI: 10.1515/jpm-2020-0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/18/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. METHODS This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). RESULTS Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24 h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48 h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24 h (0.98±0.2 vs. 1.25±0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) <1.25 detects 94.6% of patients who will eventually deliver in the first 24 h after admission. CONCLUSIONS Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.
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Affiliation(s)
- Sertac Esin
- Department of Perinatology, Baskent University School of Medicine, Ankara, Turkey
| | | | - Emre Gunakan
- Department of Perinatology, Baskent University School of Medicine, Ankara, Turkey
| | - Hatice Yagmur Zengin
- Department of Biostatistics, Baskent University School of Medicine, Ankara, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey
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Antenatal Admissions Among Women with Opioid-Affected and Non-Opioid-Affected Deliveries. Matern Child Health J 2020; 24:1179-1188. [PMID: 32557132 DOI: 10.1007/s10995-020-02959-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES (1) To compare the prevalence of antenatal admissions and mean length of stay among women with opioid-affected and non-opioid-affected deliveries; (2) examine predictors of admission; and (3) describe the most common discharge diagnoses in each group. METHODS Using data from seven states in the State Inpatient Databases for varying years between 2009 and 2014, delivery hospitalizations among women 18 years of age and older were identified and classified as opioid-affected or non-opioid-affected. Antenatal admissions were linked to deliveries. The antenatal admission ratio and mean length of stay for each group were calculated; the percentage of deliveries in each group with no, any, one, two, or three or more antenatal admissions were compared with t-tests. Logistic regression models estimated odds of any antenatal admission, stratified by opioid-affected and non-opioid-affected deliveries. Frequencies were tabulated for the ten most common discharge diagnoses in each group. RESULTS Of 2,684,970 deliveries, 14,765 were opioid-affected. Admissions among women with opioid-affected deliveries were more prevalent (26.4 per 100 deliveries) compared to 6.7 among women with non-opioid-affected deliveries and were associated with a 1.5-day longer mean length of stay. The presence of a behavioral health condition was associated with higher odds of antenatal admission in both groups, with a particularly strong association among women with opioid-affected deliveries. Six of the ten most common diagnoses for admissions prior to opioid-affected deliveries were behavioral health-related. CONCLUSIONS FOR PRACTICE These results highlight the importance of addressing the large burden of behavioral health conditions among pregnant women, especially those with opioid dependence and abuse.
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Griffin JB, Jobe AH, Rouse D, McClure EM, Goldenberg RL, Kamath-Rayne BD. Evaluating WHO-Recommended Interventions for Preterm Birth: A Mathematical Model of the Potential Reduction of Preterm Mortality in Sub-Saharan Africa. GLOBAL HEALTH, SCIENCE AND PRACTICE 2019; 7:215-227. [PMID: 31249020 PMCID: PMC6641817 DOI: 10.9745/ghsp-d-18-00402] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm birth, a leading cause of neonatal mortality, has the highest burden in low-income countries. In 2015, the World Health Organization (WHO) published recommendations for interventions to improve preterm outcomes. Our analysis uses the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model to evaluate the potential effects that WHO-recommended interventions could have had on preterm mortality in sub-Saharan Africa in 2015. METHODS We modeled preterm birth subconditions causing mortality (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, birth asphyxia, and low birth weight). For each subcondition, models were populated with estimates of WHO-recommended intervention prevalence, case fatality, coverage, and efficacy. Various scenarios modeled improved coverage of single and combined interventions compared with baseline. RESULTS In 2015, approximately 500,000 neonatal deaths due to preterm birth occurred in sub-Saharan Africa. Single interventions with the greatest impact on preterm mortality included oxygen/continuous positive airway pressure (44,000 lives saved), cord care (38,500 lives saved), and breastfeeding (30,200 lives saved). Combined with improved diagnosis/transfer to a hospital, the impact of interventions showed greater reductions in mortality (oxygen/continuous positive airway pressure, 134,100 lives saved; antibiotics, 28,600 lives saved). Combined interventions had the greatest impact. Together, hospital delivery with comprehensive care for respiratory distress syndrome saved 190,600 lives, and comprehensive thermal care, breastfeeding, and prevention/treatment for sepsis saved 94,400 lives. CONCLUSION In 2015, WHO-recommended interventions could have saved the lives of nearly 300,000 infants born preterm in sub-Saharan Africa. Combined interventions are necessary to maximize impact. Mathematical models such as MANDATE can estimate effects on health outcomes to allow health officials to prioritize implementation strategies.
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Affiliation(s)
| | - Alan H Jobe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Cho GJ, Choi S, Lee K, Han SW, Kim HY, Ahn K, Hong S, Kim H, Oh M. Women with threatened preterm labour followed by term delivery have an increased risk of spontaneous preterm birth in subsequent pregnancies: a population‐based cohort study. BJOG 2019; 126:901-905. [DOI: 10.1111/1471-0528.15653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- GJ Cho
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
| | - S‐J Choi
- Department of Obstetrics and Gynaecology Samsung Medical Centre Sungkyunkwan University School of Medicine Seoul Korea
| | - K‐M Lee
- School of Industrial Management Engineering Korea University Seoul Korea
| | - SW Han
- School of Industrial Management Engineering Korea University Seoul Korea
| | - HY Kim
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
| | - K‐H Ahn
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
| | - S‐C Hong
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
| | - H‐J Kim
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
| | - M‐J Oh
- Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul Korea
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Melchor JC, Khalil A, Wing D, Schleussner E, Surbek D. Prediction of preterm delivery in symptomatic women using PAMG-1, fetal fibronectin and phIGFBP-1 tests: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:442-451. [PMID: 29920825 DOI: 10.1002/uog.19119] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the accuracy of placental alpha microglobulin-1 (PAMG-1), fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) tests in predicting spontaneous preterm birth (sPTB) within 7 days of testing in women with symptoms of preterm labor, through a systematic review and meta-analysis of the literature. The test performance of each biomarker was also assessed according to pretest probability of sPTB ≤ 7 days. METHODS The Cochrane, MEDLINE, PubMed and ResearchGate bibliographic databases were searched from inception until October 2017. Cohort studies that reported on the predictive accuracy of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB within 7 days of testing in women with symptoms of preterm labor were included. Summary receiver-operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR-) likelihood ratios were generated using indirect methods for the calculation of pooled effect sizes with a bivariate linear mixed model for the logit of sensitivity and specificity, with each diagnostic test as a covariate, as described by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. RESULTS Bivariate mixed model pooled sensitivity of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB ≤ 7 days was 76% (95% CI, 57-89%), 58% (95% CI, 47-68%) and 93% (95% CI, 88-96%), respectively; pooled specificity was 97% (95% CI, 95-98%), 84% (95% CI, 81-87%) and 76% (95% CI, 70-80%) respectively; pooled PPV was 76.3% (95% CI, 69-84%) (P < 0.05), 34.1% (95% CI, 29-39%) and 35.2% (95% CI, 31-40%), respectively; pooled NPV was 96.6% (95% CI, 94-99%), 93.3% (95% CI, 92-95%) and 98.7% (95% CI, 98-99%), respectively; pooled LR+ was 22.51 (95% CI, 15.09-33.60) (P < 0.05), 3.63 (95% CI, 2.93-4.50) and 3.80 (95% CI, 3.11-4.66), respectively; and pooled LR- was 0.24 (95% CI, 0.12-0.48) (P < 0.05), 0.50 (95% CI, 0.39-0.64) and 0.09 (95% CI, 0.05-0.16), respectively. The areas under the ROC curves for PAMG-1, fFN and phIGFBP-1 for sPTB ≤ 7 days were 0.961, 0.874 and 0.801, respectively. CONCLUSIONS In the prediction of sPTB within 7 days of testing in women with signs and symptoms of preterm labor, the PPV of PAMG-1 was significantly higher than that of phIGFBP-1 or fFN. Other diagnostic accuracy measures did not differ between the three biomarker tests. As prevalence affects the predictive performance of a diagnostic test, use of a highly specific assay for a lower-prevalence syndrome such as sPTB may optimize management. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Melchor
- Cruces University Hospital (UPV/EHU), BioCruces Health Research Institute, Vizcaya, Spain
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D Wing
- Formerly of the University of California, Irvine, Orange, CA, USA
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - D Surbek
- Department of Obstetrics and Gynecology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Abstract
Objective This study aims to quantitate the incidence of preterm labor (PTL) admissions and determine the frequency and predictors of preterm delivery (PTD) during these admissions. Study Design Retrospective cohort of singleton pregnancies within Kaiser Permanente Northern California, 2001 to 2011. PTL admissions were defined as inpatient encounters > 24 hours with an International Classification of Diseases, 9th Revision code for PTL. Results Total study population was 365,897 with PTL admission rate 11%. PTD occurred in 85% of pregnancies with PTL admission. Delivery occurred within 48 hours of admission in 96% ≥34 weeks, 67% 31 to 33 weeks, and 51.9% <31 weeks. Predictors of delivery during PTL admission included gestational age 34 to 36 weeks (adjusted odds ratio [aOR], 6.90), chorioamnionitis (aOR, 105.58), and preterm rupture of membranes (aOR 19.29). Conclusion We demonstrate a high rate of PTD per PTL admission in a highly integrated health care system. More work is needed to determine optimal practices for hospitalization and treatment of women diagnosed with PTL.
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Affiliation(s)
- Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Division of Neonatology, Kaiser Permanente Northern California, San Francisco, California.,Department of Pediatrics, University of California, San Francisco, California
| | - Libby Black
- GlaxoSmithKline, Value Evidence and Outcomes, North Carolina
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sherian X Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Mara Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California
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Olgan S, Celiloglu M. Contraction-based uterine artery Doppler velocimetry: novel approach for prediction of preterm birth in women with threatened preterm labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:757-764. [PMID: 26823022 DOI: 10.1002/uog.15871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/17/2016] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate whether uterine artery (UtA) Doppler velocimetry during peak uterine contraction is a useful marker for the prediction of preterm delivery. METHODS In this prospective cohort study, 172 patients admitted with preterm (24-35 weeks' gestation) uterine contractions were evaluated by UtA Doppler velocimetry during peak uterine contraction and by common obstetric measurements including cervical length. For UtA Doppler velocimetry, flow-velocity waveforms during peak uterine contraction (determined visually on tocodynamometry) were recorded during three consecutive heart cycles, and the mean UtA pulsatility index (UtA-PI) was calculated. RESULTS UtA-PI during the peak of contractions was significantly higher in patients who delivered within 7 days than in those who did not (P < 0.001). On receiver-operating characteristics curve analysis of UtA-PI on contraction, the areas under the curve for prediction of delivery within 48 h, 7 days or 14 days, ≤ 35 weeks and ≤ 37 weeks were 0.92, 0.88, 0.81, 0.83 and 0.74, respectively. Multiple regression analysis identified UtA-PI on contraction (P < 0.001) and cervical length (P < 0.001) as predictors of admission-to-delivery interval. The corresponding adjusted odds ratios for delivery within 7 days were 16.5 (95% CI, 5.7-47.2) for UtA-PI on contraction ≥ 1.32, and 14.7 (95% CI, 5.2-41.8) for cervical length ≤ 28 mm. CONCLUSION Use of UtA Doppler velocimetry during peak uterine contraction for patients exhibiting symptoms of preterm labor might be effective for the identification of pregnant women at risk of preterm delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Olgan
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - M Celiloglu
- Department of Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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12
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Devkota R, Khan GM, Alam K, Regmi A, Sapkota B. Medication utilization pattern for management of pregnancy complications: a study in Western Nepal. BMC Pregnancy Childbirth 2016; 16:272. [PMID: 27644958 PMCID: PMC5029070 DOI: 10.1186/s12884-016-1068-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/13/2016] [Indexed: 01/17/2023] Open
Abstract
Background Drugs used during pregnancy can adversely affect the health and life of the mother and unborn child. However, the fact that drugs are needed to mitigate complications during pregnancy cannot be avoided. The present study was designed to identify the common complications during pregnancy and assess the medications that have been used to mitigate those complications in an attempt to improve drug prescribing during pregnancy. Methods A hospital based cross sectional study was conducted at Manipal Teaching Hospital, Nepal in 275 pregnant women presenting with at least one complication and the drugs prescribed for the management of those complications were analyzed. Results Majority of the patients in this study were in the age group 20–24 (44 %) and in the third trimester (53.8 %). Maximum patients complained pain (back, abdominal, lower abdominal, neck, pelvic) as primary complication (24.3 %) which was followed by nausea/vomiting, upper respiratory tract complications, acid reflux disease and others. Of the total prescriptions eighty six (86) did not have any medicines prescribed to the patients except multivitamins and nutritional supplements. The average drugs prescribed per patient was 2.78 in outpatient setting and 5.41 in in-patients. Ranitidine, hyoscine butylbromide, paracetamol were the most frequently prescribed medications. Antimicrobials comprised 12.8 % of total drugs prescribed and 18 % of total drugs were fixed dose combinations. Two hundred and thirty four (234) prescriptions out of 275 were prescribed by brand names. Most of the prescribed drugs were from FDA pregnancy category B and C. Conclusion The present finding showed that pregnant patients were prescribed medications almost only when necessary and those considered safe during pregnancy were chosen to a large extent. However, few teratogenic drugs (2.49 % of total drugs prescribed) were also found to be prescribed which might need further assessments. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1068-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - G M Khan
- Pokhara University, Kaski, Nepal
| | | | - Amisha Regmi
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Gomi H, Goto Y, Laopaiboon M, Usui R, Mori R. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Cochrane Database Syst Rev 2015; 2015:CD009216. [PMID: 25679346 PMCID: PMC6823257 DOI: 10.1002/14651858.cd009216.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition. OBJECTIVES To assess the effectiveness of routine blood cultures to improve health outcomes in the management of pyelonephritis in pregnant women. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register without language or date restrictions (31 December 2014). SELECTION CRITERIA Randomised controlled trials and quasi-randomised trials comparing outcomes among pregnant women with pyelonephritis who received initial management with or without blood cultures. Cluster-randomised trials were eligible for inclusion in this review but none were identified. Clinical trials using a cross-over design were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed one trial report for inclusion. MAIN RESULTS We identified one trial report but this was excluded. No clinical trials met the inclusion criteria for this review. AUTHORS' CONCLUSIONS There are no large-scale randomised controlled trials to assess outcomes in the management of pyelonephritis in pregnancy with or without blood cultures. Randomised controlled trials are needed to evaluate the effectiveness of managing pyelonephritis in pregnant women with or without blood cultures, and to assess any adverse outcomes as well as the cost-effectiveness of excluding blood cultures from treatment.
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Affiliation(s)
- Harumi Gomi
- University of TsukubaCenter for Global Health, Mito Kyodo General Hospital3‐2‐7, MiyamachiMitoIbarakiJapan310‐0015
| | - Yoshihito Goto
- Kyoto University School of Public HealthDepartment of Health InformaticsYoshida Konoecho, Sakyo‐kuKyotoJapan606‐8501
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Rie Usui
- Jichi Medical UniversityDepartment of Obstetrics and Gynecology3311‐1 YakushijiShimotsukeTochigiJapan329‐0431
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraSetagaya‐kuTokyoTokyoJapan166‐0014
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Keskin U, Ulubay M, Kurt YG, Fidan U, Koçyiğit YK, Honca T, Aydin FN, Ergün A. Increased neopterin level and chitotriosidase activity in pregnant women with threatened preterm labor. J Matern Fetal Neonatal Med 2014; 28:1077-81. [PMID: 25005858 DOI: 10.3109/14767058.2014.943174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine whether the cellular inflammatory markers of activated macrophages, neopterin (NEO), chitotriosidase activity and the acute-phase inflammatory marker C-reactive protein (CRP) are elevated in pregnancy with threatened preterm labor (TPL). METHODS Thirty-two pregnant women with TPL and 32 women with uncomplicated pregnancy (UP) were included this study. The primary aim was to compare the NEO, chitotriosidase activity and CRP levels between women with TPL and women with UP. RESULTS NEO levels were all significantly elevated in patients with TPL compared to UP (median 25-75%; 9.61 [8.47-12.29] versus 4.46 [3.59-6.92], respectively; p < 0.001). Chitotriosidase activity was significantly elevated in pregnant women with TPL compared to UP (median 25-75%; 59.00 [38.00-87.25] versus 43.50 [23.25-65.25], respectively; p = 0.036). However, CRP levels were not different in women with TPL compared to UP (p = 0.573). Furthermore, a significant moderate negative correlation was found between delivery week and NEO level (r = -0.557, p = 0.001). However, a significant correlation was not seen between delivery week and chitotriosidase activity (r = -0.042, p = 0.741). CONCLUSIONS Inflammatory markers such as NEO and chitotriosidase activity, which are markers of macrophages, are more elevated in pregnant women with TPL than in women with UP. These data suggest that there are striking increases in inflammation and cellular immune activation in TPL.
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Affiliation(s)
- Uğur Keskin
- Department of Obstetrics and Gynaecology and
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de Lau H, Rabotti C, Oosterbaan HP, Mischi M, Oei GS. Study protocol: PoPE-Prediction of Preterm delivery by Electrohysterography. BMC Pregnancy Childbirth 2014; 14:192. [PMID: 24898548 PMCID: PMC4057931 DOI: 10.1186/1471-2393-14-192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background Traditional methods used for prediction of preterm delivery are subjective and inaccurate. The Electrohysterogram (EHG) and in particular the estimation of the EHG conduction velocity, is a relatively new promising method for detecting imminent preterm delivery. To date the analysis of the conduction velocity has relied on visual inspection of the signals. As a next step towards the introduction of EHG analysis as a clinical tool, we propose an automated method for EHG conduction velocity estimation for both the speed and direction of single spike propagation. Methods/Design The study design will be an observational cohort study. 100 pregnant women, gestational age between 23 + 5 and 34 weeks, admitted for threatening preterm labor or preterm prelabor rupture of membranes, will be included. The length of the cervical canal will be measured by transvaginal ultrasound. The EHG will be recorded using 4 electrodes in a fixed configuration. Contractions will be detected by analysis of the EHG and using an estimation of the intra uterine pressure. In the selected contractions, the delays between channels will be estimated by cross-correlation, and subsequently, the average EHG conduction velocity will be derived. Patients will be classified as labor group and non-labor group based on the time between measurement and delivery. The average conduction velocity and cervical length will be compared between the groups. The main study endpoints will be sensitivity, specificity, and area under the ROC curve for delivery within 1,2,4,7, and 14 days from the measurement. Discussion In this study, the diagnostic accuracy of EHG conduction velocity analysis will be evaluated for detecting preterm labor. Visual and automatic detection of contractions will be compared. Planar wave propagation will be assumed for the calculation of the CV vector. Trial registration Current Controlled Trials ISRCTN07603227.
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Affiliation(s)
- Hinke de Lau
- Department of Electrical Engineering, University of Technology Eindhoven, Den Dolech 2, 5612 AZ Eindhoven, the Netherlands.
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Nair M, Kurinczuk JJ, Knight M. Ethnic variations in severe maternal morbidity in the UK- a case control study. PLoS One 2014; 9:e95086. [PMID: 24743879 PMCID: PMC3990615 DOI: 10.1371/journal.pone.0095086] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/23/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. METHODS Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. RESULTS Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39-2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14-2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05-2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05-2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07-1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. DISCUSSION This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Makrydimas G, Sotiriadis A. Prediction of preterm birth in twins. Best Pract Res Clin Obstet Gynaecol 2014; 28:265-72. [DOI: 10.1016/j.bpobgyn.2013.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/24/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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Boots AB, Sanchez-Ramos L, Bowers DM, Kaunitz AM, Zamora J, Schlattmann P. The short-term prediction of preterm birth: a systematic review and diagnostic metaanalysis. Am J Obstet Gynecol 2014; 210:54.e1-54.e10. [PMID: 24021995 DOI: 10.1016/j.ajog.2013.09.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/08/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of fetal fibronectin (fFN), fetal breathing movements (FBM), and cervical length (CL) for the short-term prediction of preterm birth in symptomatic patients. STUDY DESIGN Diagnostic metaanalysis using bivariate methods. RESULTS Pooled sensitivities for fFN, FBM, and CL for delivery within 48 hours of testing were 0.62 (95% confidence interval [CI], 0.43-0.78), 0.75 (95% CI, 0.57-0.87) and 0.77 (95% CI, 0.54-0.90), respectively. Pooled specificities for fFN, FBM, and CL for delivery within 48 hours were 0.81 (95% CI, 0.74-0.86), 0.93 (95% CI, 0.75-0.98) and 0.88 (95% CI, 0.84-0.91). Pooled sensitivities for fFN, FBM, and CL for delivery within 7 days were 0.75 (95% CI, 0.69-0.80), 0.67 (95% CI, 0.43-0.84), and 0.74 (95% CI, 0.58-0.85). Pooled specificities for fFN, FBM, and CL for delivery within 7 days were 0.79 (95% CI, 0.76-0.83), 0.98 (95% CI, 0.83-1.00) and 0.89 (95% CI, 0.85-0.92). Based on a pretest probability of 10% for delivery within 48 hours, posttest probabilities (positive and negative) were 27% and 5% for fFN, 54% and 3% for fFN, and 42% and 3% for CL. For a pretest probability of 20% for delivery within 7 days, posttest probabilities (positive and negative) were 48% and 7% for fFN, 89% and 8% for FBM, and 63% and 7% for CL. CONCLUSION In symptomatic patients, for fFN, absence of FBM, and CL have diagnostic use as predictors of delivery within 48 hours and within 7 days of testing. Absence of FBM appears to be the best test for predicting preterm birth.
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Cabacungan ET, Ngui EM, McGinley EL. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin. Matern Child Health J 2012; 16:1455-67. [PMID: 22105738 DOI: 10.1007/s10995-011-0914-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.
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Affiliation(s)
- Erwin T Cabacungan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
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Hoque M. Incidence of Obstetric and Foetal Complications during Labor and Delivery at a Community Health Centre, Midwives Obstetric Unit of Durban, South Africa. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:259308. [PMID: 21822497 PMCID: PMC3147131 DOI: 10.5402/2011/259308] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/31/2011] [Indexed: 11/23/2022]
Abstract
The objectives of this retrospective cohort study were to estimate the incidence of obstetric complications during labor and delivery and their demographic predictors. A total of 2706 pregnant women were consecutively admitted to a midwife obstetric unit with labor pain between January and December 2007 constituted the sample. Among them 16% were diagnosed with obstetrical and foetal complications. The most frequently observed foetal and obstetric complications were foetal distress (35.5/1000) and poor progress of labor (28.3/1000), respectively. Primigravid and grandmultiparity women were 12 (OR = 11.89) and 5 (OR = 4.575) times, respectively, more likely to have complications during labor and delivery. Women without antenatal care had doubled (OR = 1.815, 95% CI, 1.310; 2.515) the chance of having complications. Mothers age <20 years was protective (OR = 0.579, 95% CI, 0.348; 0.963) of complications during delivery compared to women who were ≥35 years. National and local policies and intervention programmes must address the need of the risk groups of pregnant women during labor and delivery.
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Affiliation(s)
- Monjurul Hoque
- Kwadabeka Community Health Centre, KwaZulu-Natal, P. O. Box 2468, New Germany 3610, South Africa
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Gomi H, Mori R, Laopaiboon M, Usui R, Shibuya K. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Cochrane Database Syst Rev 2011. [DOI: 10.1002/14651858.cd009216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ahijado-Porres A, Vernich-Oliver M, Veloso-Carrasco C, Gil-Prieto R, Gil-de Miguel A. [Hospitalizations during pregnancy in Spain in 1997-2007]. ENFERMERIA CLINICA 2011; 21:91-8. [PMID: 21450504 DOI: 10.1016/j.enfcli.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/24/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the non-delivery pregnancy associated hospitalizations in Spain during the period 1997-2007. METHODS A descriptive epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data (Minimum Basic Data Set [MBDS]). Records of all pregnant women admitted to hospital with a pregnancy associated complication (excluding delivery) as a principal admitting diagnosis were studied. RESULTS There were a total of 4,506,449 deliveries reported in Spain during the study period (1997-2007), with a hospitalization rate of 11.86% deliveries (95% CI, 11.83%-11.89%). The principal admitting diagnoses were abortions (10%), abnormal products of conception and non-viable pregnancies (1.5%). The mortality rate was 2.35 per 100,000 deliveries (95% CI, 1.9%-2.8%) and the case-fatality rate was 0.02% (95% CI, 0.016%-0.024%). Adolescents and women over 45 years had higher hospitalization and mortality rates. CONCLUSIONS The main causes for hospitalization in pregnant women in Spain were abortions, abnormal products of conception and non-viable pregnancies. Hospitalization and mortality rates were higher in adolescents and women over 45 years, and did not vary during the study period.
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Affiliation(s)
- Alicia Ahijado-Porres
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología médicas, Universidad Rey Juan Carlos, Madrid, Spain
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Fong IW. Litigation in Infections of Obstetrics and Gynecology. MEDICO-LEGAL ISSUES IN INFECTIOUS DISEASES 2011. [PMCID: PMC7119939 DOI: 10.1007/978-1-4419-8053-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 28-year-old female Native AmericanIndian, in her third trimester of pregnancy (34 weeks), presented to an isolated, stand-alone medical center serving the local community (Indian Reservation) at 6 p.m. on a Sunday evening. This center serves the dual purpose of medical clinic and emergency facility. Available teleconsultation and transportation to a tertiary care center via air ambulance were accessible 24 h/day. Normally, air ambulance transfer to a distant tertiary care hospital can be accomplished within 3–4 h after notification by phone.
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Affiliation(s)
- I. W. Fong
- St. Michael’s Hospital, University of Toronto, Room 4179 CC 30 Bond Street, Toronto, Ontario Canada M5B 1W8
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Gavin NI, Kuo M, Adams EK, Ayadi MF, Gilbert BC. Medicaid service use and program costs for pregnant teens. Expert Rev Pharmacoecon Outcomes Res 2010; 5:683-94. [PMID: 19807611 DOI: 10.1586/14737167.5.6.683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Teen pregnancy is an important public health issue for all teens, but particularly for low-income teens who rely on the public health safety net for services. Medicaid pays for more than two-thirds of deliveries among teenagers in the USA. To discern how this public program serves pregnant teens (aged 11-19 years), the authors used Medicaid enrollment and claims data for Florida, Georgia and New Jersey in 1995 to examine teens' enrollment duration, service use and average payments relative to 20-24-year-olds on Medicaid. Teens were more likely than the older women to have been enrolled in Medicaid before pregnancy and to have maintained coverage through the third month following delivery. If not enrolled prepregnancy, teens were more likely than older women to enroll later in pregnancy. Teens were less likely to receive early prenatal care and more likely to be hospitalized during pregnancy, usually for preterm labor. While total Medicaid payments for routine prenatal and delivery-related care were equivalent between teens and older women, payments for nonroutine care during pregnancy were modestly higher for teens in Florida and Georgia. Thus, only modest cost savings can accrue from lower average costs per pregnancy and delivery among teens who delay pregnancy. Additional and larger cost savings to the Medicaid program from preventing teen pregnancy would accrue from the expected lower enrollment in Medicaid among the teens as they age.
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Affiliation(s)
- Norma I Gavin
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
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Puschett JB, Agunanne E, Uddin MN. Marinobufagenin, resibufogenin and preeclampsia. Biochim Biophys Acta Mol Basis Dis 2010; 1802:1246-53. [PMID: 20167272 DOI: 10.1016/j.bbadis.2010.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 01/15/2010] [Accepted: 02/06/2010] [Indexed: 11/18/2022]
Abstract
The bufodienolides are cardiac glycosides which have the ability to inhibit the enzyme, Na(+)/K(+) ATPase (sodium potassium adenosine triphosphatase). They are cardiac inotropes, cause vasoconstriction (and, potentially, hypertension) and are natriuretic. Evidence has accrued over time which supports the view that they are mechanistically involved in volume expansion-mediated hypertension. In this communication, the authors summarize data which support the view that the bufodienolides and, in particular, marinobufagenin (MBG) are involved in the pathogenesis of preeclampsia. In a rat model of the syndrome, MBG causes hypertension, proteinuria, intrauterine growth restriction and increased weight gain. All of these phenotypic characteristics are prevented by an antagonist to MBG, resibufogenin (RBG). The "preeclamptic" animals also develop a vascular leak syndrome, resulting in hemoconcentration. Abnormalities in the MAPK (mitogen-activated protein kinase) system play a role in the mechanism by which MBG produces the abnormalities in the pregnant rat. Studies to discover the relevance of these findings to human preeclampsia are currently underway in several laboratories and clinics.
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Affiliation(s)
- J B Puschett
- Department of Medicine, Texas A&M Health Science Center, Temple, TX 76508, USA.
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Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:54-64. [PMID: 20014326 DOI: 10.1002/uog.7457] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To integrate data on the performance of cervical length measurement for the prediction of preterm birth in symptomatic women. METHODS MEDLINE, SCOPUS and manual searches for studies with transvaginal ultrasound measurement of the cervical length in symptomatic women were carried out. Random effects models were used for data integration, and pooled test estimates of sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) were calculated along with their 95% CIs. RESULTS Twenty-eight studies fulfilled the selection criteria. For birth within 1 week from presentation, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 59.9% (95% CI, 52.7-66.8%), 90.5% (95% CI, 89.0-91.9%), 5.71 (95% CI, 3.77-8.65) and 0.51 (95% CI, 0.33-0.80), respectively. The same estimates for studies with presentation at or before 34 + 0 weeks were 71.0% (95% CI, 60.6-79.9%), 89.8% (95% CI, 87.4-91.9%), 5.19 (95% CI, 2.29-11.74) and 0.38 (95% CI, 0.11-1.34), respectively. For prediction of birth before 34 weeks, the pooled sensitivity, specificity, LR+ and LR- of cervical length < 15 mm were 46.2% (95% CI, 34.8-57.8%), 93.7% (95% CI, 90.7-96.0%), 4.31 (95% CI, 2.73-6.82) and 0.63 (95% CI, 0.38-1.04), respectively. There was considerable heterogeneity across studies in most estimates. CONCLUSIONS Measurement of cervical length in symptomatic women can detect a significant proportion of those who will deliver within 1 week and help to rationalize their management. The considerable heterogeneity across studies may be indicative of methodological flaws, which either were not reported at all or were under-reported.
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Affiliation(s)
- A Sotiriadis
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece.
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Dowswell T, Middleton P, Weeks A. Antenatal day care units versus hospital admission for women with complicated pregnancy. Cochrane Database Syst Rev 2009; 2009:CD001803. [PMID: 19821282 PMCID: PMC4171387 DOI: 10.1002/14651858.cd001803.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antenatal day care units have been widely used as an alternative to inpatient care for women with pregnancy complications including mild and moderate hypertension, and preterm prelabour rupture of the membranes. OBJECTIVES The objective of this review is to compare day care units with routine care or hospital admission for women with pregnancy complications in terms of maternal and perinatal outcomes, length of hospital stay, acceptability, and costs to women and health services providers. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009). SELECTION CRITERIA Randomised controlled trials comparing day care with inpatient or routine care for women with complicated pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently carried out data extraction and assessed studies for risk of bias. MAIN RESULTS Three trials with a total of 504 women were included. For most outcomes it was not possible to pool results from trials in meta-analyses as outcomes were measured in different ways.Compared with women in the ward/routine care group, women attending day care units were less likely to be admitted to hospital overnight (risk ratio 0.46, 95% confidence interval 0.34 to 0.62). The average length of antenatal admission was shorter for women attending for day care, although outpatient attendances were increased for this group. There was evidence from one study that women attending for day care were significantly less likely to undergo induction of labour, but mode of birth was similar for women in both groups. For other outcomes there were no significant differences between groups.The evidence regarding the costs of different types of care was mixed; while the length of antenatal hospital stays were reduced, this did not necessarily translate into reduced health service costs.While most women tended to be satisfied with whatever care they received, women preferred day care compared with hospital admission. AUTHORS' CONCLUSIONS Small studies suggest that there are no major differences in clinical outcomes for mothers or babies between antenatal day units or hospital admission, but women may prefer day care.
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Affiliation(s)
- Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive MedicineFirst Floor, Liverpool Women's NHS Foundation TrustLiverpoolUKL8 7SS
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Andrew Weeks
- The University of LiverpoolSchool of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive MedicineFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Whitehead NS, Callaghan W, Johnson C, Williams L. Racial, ethnic, and economic disparities in the prevalence of pregnancy complications. Matern Child Health J 2008; 13:198-205. [PMID: 18484175 DOI: 10.1007/s10995-008-0344-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Our objective was to use maternal self-reported data to estimate the prevalence of urinary tract infections, placenta disorders, and preterm rupture of the membranes (PROM) and to explore the association between these complications and race, ethnicity, and economic status. METHODS We used data for the years 2000-2002 from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing survey of women with a recent live birth, to examine the prevalence of and hospitalizations for self-reported urinary tract infections, placenta disorders, and PROM and to investigate differences by maternal race, Hispanic ethnicity, and economic status. Prevalence and hospitalizations were calculated as a percent of the represented population using SUDAAN to account for the sampling design. RESULTS Urinary tract infections were commonly reported, occurring in more than 17% of women during their pregnancy. Placenta disorders and PROM were each reported by approximately 6% of women. Poverty and race had independent effects on each of the pregnancy complications examined. Fewer than half of the women who experienced these pregnancy complications were hospitalized. CONCLUSIONS Pregnancy complications are common and not adequately measured by hospitalizations alone. Both more research and improved surveillance are needed to understand the effect of pregnancy complications on women's health and the reasons for the increased risk among poor or black women.
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Liu S, Heaman M, Sauve R, Liston R, Reyes F, Bartholomew S, Young D, Kramer MS. An Analysis of Antenatal Hospitalization in Canada, 1991–2003. Matern Child Health J 2006; 11:181-7. [PMID: 17089198 DOI: 10.1007/s10995-006-0154-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. METHODS A population-based cohort study was conducted using the Canadian Institute for Health Information's Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. RESULTS The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20-24 years, respectively, compared to 11.5 per 100 for women aged 35-39 years. The antenatal hospitalization ratio varied greatly by province/territory--from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. CONCLUSIONS The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Tunney's Pasture, Ottawa, Ontario, Canada.
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Geller SE, Cox SM, Callaghan WM, Berg CJ. Morbidity and mortality in pregnancy: laying the groundwork for safe motherhood. Womens Health Issues 2006; 16:176-88. [PMID: 16920522 DOI: 10.1016/j.whi.2006.06.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 06/02/2006] [Accepted: 06/05/2006] [Indexed: 10/24/2022]
Abstract
The Safe Motherhood Initiative is a global effort to reduce deaths and illnesses among women and infants. Despite the relatively low maternal mortality rate in the United States, ensuring safe motherhood is still critical. For several reasons, it is important to study maternal mortality and morbidity. First, the pregnancy-related mortality ratio has not declined; second, evidence suggests that at least half of pregnancy-related deaths may be preventable through changes in patient, provider, or system factors; and third, mortality rates are disproportionately high among certain racial and ethnic groups. In addition, deaths are only the tip of the iceberg: maternal morbidity also represents a huge burden of disease for women and their families. Broadening the research focus and prevention efforts to include the study of maternal morbidity, especially near-miss morbidity-life-threatening morbidity-can strengthen the study of maternal death. This paper presents an overview of maternal mortality and morbidity including incidence and etiology, issues and challenges for measurement, and issues of preventability. We also address specific strategies for change for health care providers, federal and state health agencies, and the public health community.
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Affiliation(s)
- Stacie E Geller
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, 60612, USA.
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Guendelman S, Thornton D, Gould J, Hosang N. Obstetric complications during labor and delivery: Assessing ethnic differences in California. Womens Health Issues 2006; 16:189-97. [PMID: 16920523 DOI: 10.1016/j.whi.2005.12.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 03/15/2006] [Accepted: 03/24/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to compare obstetric complications during labor and delivery among white non-Latina (white), black, Asian, and Latina women who delivered in California hospitals. Many intrapartum complications are preventable. METHODS We used linked 1996-1998 state hospital discharge and birth certificate data to examine obstetric complications International Classification of Diseases, 9th Revision, Clinical Modification codes considered relevant for population surveillance. We compared the observed and adjusted odds of experiencing a complication among women of color, using white women as the reference group. FINDINGS One out of 5 deliveries had >or=1 complication. White (21.3%) and Asian women (21.1%) had similar prevalence rates, whereas black women (24.2%) had higher and Latina women (19.6%) had lower rates. After adjusting for covariates, the odds of experiencing >or=1 complication was lower for Asians (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93, 0.96) and Latinas (OR = 0.97; 95% CI = 0.96, 0.98) than whites; the odds for black women remained elevated (OR = 1.25; 95% CI = 1.23, 1.27). Asian women stood a higher risk of deliveries with major lacerations, postpartum hemorrhage, and major puerperal infections. Rates for the latter complication were higher among all women of color. CONCLUSIONS The burden of morbidity is high for all women, regardless of ethnicity. Yet, compared to white women, blacks suffer more aggregate morbidities, and Asians stand a high risk of all 3 intrapartum care-sensitive conditions. Furthermore, all women of color experience disproportionate rates of puerperal infections. Collective action is needed to reduce these disparities and improve maternal health.
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Affiliation(s)
- Sylvia Guendelman
- Maternal and Child Health Program, School of Public Health, University of California, Berkeley, 94720-7360, USA.
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Guendelman S, Thornton D, Gould J, Hosang N. Social disparities in maternal morbidity during labor and delivery between Mexican-born and US-born White Californians, 1996-1998. Am J Public Health 2005; 95:2218-24. [PMID: 16257944 PMCID: PMC1449510 DOI: 10.2105/ajph.2004.051441] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess maternal health disparities, we compared maternal morbidities during labor and delivery among Mexican-born and US-born White, non-Latina women residing in California. METHODS This population-based study used linked hospital discharge and birth certificate data for 1996-1998 (862,723 deliveries). We calculated the frequency, and observed and adjusted odds ratios for obstetric complications. Covariates included maternal age, parity, education, prenatal care initiation and payment source, and hospital quality of care. RESULTS Approximately 1 in 5 deliveries resulted in a obstetric complication. After control for covariates, Mexican-born women were significantly less likely to have 1 or more maternal morbidities than White, non-Latina women but more likely to have complications that reflect the quality of intrapartum care. CONCLUSIONS Maternal morbidities during labor and delivery are a substantial burden for women in California. The favorable overall outcome of Mexican-born women over US-born White, non-Latinas is surprising given their lower educational attainment, relative poverty, and greater barriers to health care access. The favorable outcomes obscure vulnerabilities in those complications that are sensitive to the quality of intrapartum care.
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Affiliation(s)
- Sylvia Guendelman
- Maternal and Child Health Program, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
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Korst LM, Gregory KD, Lu MC, Reyes C, Hobel CJ, Chavez GF. A Framework for the Development of MaternalQuality of Care Indicators. Matern Child Health J 2005; 9:317-41. [PMID: 16160758 DOI: 10.1007/s10995-005-0001-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In collaboration with the California Department of Health Maternal and Child Health Branch, the authors formed a Working Group to identify potential clinical indicators that could be used to inform decision making regarding maternal health care quality. OBJECTIVE To develop potential indicators for the assessment of maternal health care quality. MATERIALS AND METHODS A Working Group was convened to review information from the published literature and expert opinion. Selection of potential indicators was guided by the following goals: 1) To identify key areas for routine aggregate monitoring; 2) To include perspectives of relevant stakeholders in maternal health care services; 3) To include measures that are comprehensive and reflect a balance between maternal and fetal interests; and 4) To develop measures that would be valid, generalizable, mutable, and feasible. RESULTS Ninety potential indicators were identified. Each underwent a thorough review based on: its definition, objective, and validity; its contribution to innovation; the cost and timeliness of implementation; its feasibility, acceptability, and potential effectiveness; and its compatibility with ethics, values, and social policy. This process yielded 24 final indicators from the following categories: Health Status and Access (e.g., availability of 24 h inpatient anesthesia); Preconception and Interconception Care (e.g., Pap smear use); Antenatal Care (e.g., hospitalization for uncontrolled diabetes or pyelonephritis); Labor and Delivery Care (e.g., chorioamnionitis or obstetrical hemorrhage), and Postpartum Care (e.g., rate of postpartum visits). CONCLUSIONS These potential indicators, representative of the women's health continuum, can serve as a foundation to structure the development of consensus and methods for maternal health care quality assessment.
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Affiliation(s)
- Lisa M Korst
- Saban Research Institute of Childrens Hospital Los Angeles, Los Angeles, 90033, USA.
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McPheeters ML, Miller WC, Hartmann KE, Savitz DA, Kaufman JS, Garrett JM, Thorp JM. The epidemiology of threatened preterm labor: a prospective cohort study. Am J Obstet Gynecol 2005; 192:1325-9; discussion 1329-30. [PMID: 15846230 DOI: 10.1016/j.ajog.2004.12.055] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the occurrence, timing, and outcomes of hospital-based diagnoses of preterm labor. STUDY DESIGN Administrative records identified hospital admissions for preterm labor among 2534 women in an ongoing cohort study. Factors that were considered risks for prematurity were examined by logistic regression for an association with any preterm labor diagnosis, a preterm labor diagnosis <33 weeks of gestation, or > or =33 weeks of gestation. RESULTS Of 234 women (9%) who experienced hospitalization for preterm labor, 90 women (38%) were delivered in the first episode. Previous preterm birth consistently was associated with a diagnosis of preterm labor. Reporting a sexually transmitted infection (odds ratio, 1.8; 95% CI, 1.1-3.0) or bacterial vaginosis (odds ratio, 2.6; 95% CI, 1.7-4.1) early in pregnancy was associated with hospitalization for preterm labor between 24 and 32 weeks of gestation. CONCLUSION The incidence of first-time hospitalization for preterm labor was 9%, with most episodes not resulting in preterm birth. Previous preterm birth was associated therefore with a preterm labor diagnosis.
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Affiliation(s)
- Melissa L McPheeters
- Departments of Obstetrics and Gynecology, Epidemiology, and Medicine, The University of North Carolina at Chapel Hill, NC 27599, USA.
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Zhang WH, Alexander S, Bouvier-Colle MH, Macfarlane A. Incidence of severe pre-eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population-based study: the MOMS-B survey. BJOG 2005; 112:89-96. [PMID: 15663404 DOI: 10.1111/j.1471-0528.2004.00303.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the incidence of three conditions of acute severe maternal morbidity in selected regions in nine European countries. DESIGN A population-based questionnaire survey. SETTING Eleven regions in nine countries of Europe. POPULATION All the pregnant women in each region who had delivered during the period covered by the study. METHODS Standard definitions of three severe obstetric conditions, pre-eclampsia, postpartum haemorrhage and sepsis were established by a steering committee. A common questionnaire was used in each participating country. The incidence of the three obstetric conditions and characteristics of the study women were compared. MAIN OUTCOME MEASURES Incidence of three severe obstetric conditions: pre-eclampsia, postpartum haemorrhage and sepsis. RESULTS The study identified 1734 women with at least one of the three conditions, with 847 experiencing severe haemorrhage, 793 experiencing severe pre-eclampsia and 142 experiencing severe sepsis. There were wide variations in incidence of three conditions combined, ranging from 14.7 per thousand deliveries in Brussels, Belgium to 6.0 per thousand deliveries in Upper Austria. CONCLUSIONS This study sets a simple and straightforward approach to the definition of three severe obstetric conditions and allows population-based comparisons between developed countries in Europe, even though difficulties may have been present with applying the definition across countries. The reported incidence of these severe obstetric conditions in general and severe haemorrhage varied significantly between countries. Overall, severe haemorrhage in particular was the most common of the three conditions, followed closely by severe pre-eclampsia.
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Affiliation(s)
- Wei-Hong Zhang
- Unité de recherche en Santé Reproductive et Epidémiologie Périnatale, Département des Politiques et Systémes de Santé, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Bacak SJ, Callaghan WM, Dietz PM, Crouse C. Pregnancy-associated hospitalizations in the United States, 1999-2000. Am J Obstet Gynecol 2005; 192:592-7. [PMID: 15696008 DOI: 10.1016/j.ajog.2004.10.638] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine nondelivery, pregnancy-associated hospitalizations in the United States and the factors associated with them. STUDY DESIGN Population-based nondelivery hospitalizations during pregnancy were obtained from the 1999 and 2000 National Hospital Discharge Survey. Ratios of hospitalizations per 100 deliveries were calculated and analyzed by age, race, and payment source. RESULTS The pregnancy-associated hospitalization ratio for 1999 through 2000 was 12.8 per 100 deliveries (95% CI, 11.8-13.8). Hospitalizations were highest among young women, African American women, and women without private insurance. Preterm labor, nausea and/or vomiting, and genitourinary complications accounted for one half of antenatal hospitalizations. CONCLUSION Pregnancy-associated hospitalizations declined during the 1990s. This may represent a decline in maternal morbidity or a change in management of pregnancy complications. Future research should be expanded to assess trends in morbidity treated in settings outside of hospitals.
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Affiliation(s)
- Stephen J Bacak
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome - results of multivariable analysis. Aust N Z J Obstet Gynaecol 2004; 44:410-8. [PMID: 15387861 DOI: 10.1111/j.1479-828x.2004.00268.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors associated with adverse pregnancy outcomes among women with hypertension during pregnancy. DESIGN A population-based retrospective multivariable analysis using the South Australian perinatal data collection. METHODS Perinatal data on 70,386 singleton births in 1998-2001 were used in multivariable analyses on three groups: all women combined, all hypertensive women and women with pregnancy hypertension only, in order to identify independent risk factors for requirement for level II/III care, preterm birth, small for gestational age (SGA) birth and maternal length of stay greater than 7 days. RESULTS The risks for the four morbidities were all increased among women with hypertension compared with normotensive women. Those with pre-existing hypertension had the lowest risk (with odds ratios (OR) 1.26-2.90). Pregnancy hypertension held the intermediate position (OR 1.52-5.70), while superimposed pre-eclampsia was associated with the highest risk (OR 2.00-8.75). Among women with hypertension, Aboriginality, older maternal age, nulliparity and pre-existing or gestational diabetes increased the risk for level II/III nursery care, preterm birth and prolonged hospital stay. Smokers had shorter stays, which may be related to their decreased risk of having a Caesarean section or operative vaginal delivery. Asian women, Aboriginal women, smokers and unemployed women had an increased risk for having an SGA baby, while women with pre-existing or gestational diabetes had a reduced risk. CONCLUSIONS Among hypertensive pregnant women, nulliparity, older maternal age, Aboriginality, unemployment and diabetes are independent risk factors for one or more major adverse pregnancy outcomes. Smoking does not always worsen the outcome for hypertensive women except for SGA births.
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Affiliation(s)
- Sophie A Vreeburg
- Department of Obstetrics and Gynaecology, University of Adelaide, Lyell McEwin Health Service, Haydown Road, Elizabeth Vale 5112, South Australia, Australia
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Lipsky S, Holt VL, Easterling TR, Critchlow CW. Police-reported intimate partner violence during pregnancy and the risk of antenatal hospitalization. Matern Child Health J 2004; 8:55-63. [PMID: 15198172 DOI: 10.1023/b:maci.0000025727.68281.aa] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Intimate partner violence (IPV) is a significant public health problem and the abuse of women during pregnancy is of particular concern. Few studies have addressed the relationship between IPV and antenatal hospitalization. This study utilized a novel approach to examine the impact of IPV during pregnancy on antenatal hospitalization not associated with delivery. METHODS This retrospective cohort study included Seattle women residents 16-49 years of age. Exposed subjects were women with a police-reported IPV incident during pregnancy in the years 1995 through 1998 and who subsequently had a singleton live birth or fetal death. The unexposed group was composed of randomly selected residents with a singleton birth or fetal death and without a police-reported IPV incident during the study period. Linked hospital discharge files and birth records were utilized to determine study outcomes. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS Women reporting any IPV during pregnancy were twice as likely as unexposed women to experience an antenatal hospitalization not associated with delivery (aAOR 2.39, CI 1.77, 3.24). Women with IPV were more likely to have been hospitalized with a substance abuse-related diagnosis (aOR 2.70, CI 1.52, 4.78) or a mental health-related diagnosis (aOR 1.93, CI 0.96, 3.91). Physical IPV was more strongly associated with antenatal hospitalization than nonphysical IPV or IPV overall. CONCLUSION This study suggests that women hospitalized during pregnancy, particularly those with substance abuse and mental health-related conditions, may be at high risk for concurrent IPV.
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Affiliation(s)
- Sherry Lipsky
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA.
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Turnbull DA, Wilkinson C, Gerard K, Shanahan M, Ryan P, Griffith EC, Kruzins G, Stamp GE. Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. Lancet 2004; 363:1104-9. [PMID: 15064028 DOI: 10.1016/s0140-6736(04)15893-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward. METHODS 395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81.0% or higher) and via the hospital's financial system. Analysis was by intention to treat. FINDINGS All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5-9] vs 57 [35-123] h; p=0.001). Overall stay was also significantly shorter in the day-care group (mean 7.22 [SE 0.31] vs 8.53 [0.44]; p=0.014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0.01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care. INTERPRETATION Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.
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Affiliation(s)
- Deborah A Turnbull
- Department of General Practice, Women's and Children's Hospital, Adelaide, Australia.
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Watts DH, Balasubramanian R, Maupin RT, Delke I, Dorenbaum A, Fiore S, Newell ML, Delfraissy JF, Gelber RD, Mofenson LM, Culnane M, Cunningham CK. Maternal toxicity and pregnancy complications in human immunodeficiency virus-infected women receiving antiretroviral therapy: PACTG 316. Am J Obstet Gynecol 2004; 190:506-16. [PMID: 14981398 DOI: 10.1016/j.ajog.2003.07.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate rates of maternal toxicity, pregnancy complications, and peripartum morbidity by type and duration of antiretroviral therapy (ART) during pregnancy. STUDY DESIGN The Pediatric AIDS Clinical Trials Group (PACTG) Protocol 316 (PACTG 316) study evaluated the addition of intrapartum/neonatal nevirapine to background ART to reduce perinatal transmission of human immunodeficiency virus-1 (HIV-1). For this secondary analysis, women were categorized into one of six groups on the basis of ART during pregnancy (monotherapy [monoRx], combination without protease inhibitor [PI], combination with PI), and start time (early: before or during first trimester; late: second or third trimester). RESULTS One thousand four hundred seven women were included: 288 monoRx late, 34 monoRx early, 327 combo, no PI late, 175 combo, no PI early, 320 combo, PI late, and 263 combo, PI early. Symptoms and laboratory abnormalities of moderate grade or more occurred in less than 5% of women. Only gestational diabetes (highest in combo PI early) varied significantly by therapy group. CONCLUSION In HIV-infected women receiving prenatal care and ART, adverse events were uncommon.
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Affiliation(s)
- D Heather Watts
- National Institute of Child Health and Human Development, Bethesda, MD 20892, USA.
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Gregory KD, Korst LM. Age and racial/ethnic differences in maternal, fetal, and placental conditions in laboring patients. Am J Obstet Gynecol 2003; 188:1602-6; discussion 1606-8. [PMID: 12824999 DOI: 10.1067/mob.2003.391] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Most health indicators exhibit evidence of ethnic disparity. This study describes the prevalence of clinical conditions that are associated with pregnancy, stratified at age 35 years, and by ethnicity (black, white, Hispanic, other). STUDY DESIGN This was a retrospective, cross-sectional cohort study. We used International Classification of Diseases discharge diagnostic codes from California discharge data to identify 31 maternal, fetal, and placental conditions. RESULTS At least one condition was present for 26.1% of the 443,532 eligible women. There was variation in risk by age and race/ethnicity and differences by age within ethnic groups. Black women were more at risk; there are 12 conditions for older women, and there are 16 conditions for younger women. Hispanic women showed a higher risk for diabetes mellitus, macrosomia, and severe hypertension. All white women showed a higher risk for cardiac conditions and isoimmunization, whereas older white women also demonstrated an increased risk for herpes infection and multiple gestation. CONCLUSION Older women and black women have more morbidity. The degree to which these clinical conditions affect labor management and obstetric outcomes needs further evaluation.
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Affiliation(s)
- Kimberly D Gregory
- Division Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and Women's Health Services Research, Cedars Sinai Medical Center, and the George Burns Research Institute, University of California School of Medicine, Los Angeles, USA
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Danel I, Berg C, Johnson CH, Atrash H. Magnitude of maternal morbidity during labor and delivery: United States, 1993-1997. Am J Public Health 2003; 93:631-4. [PMID: 12660209 PMCID: PMC1447802 DOI: 10.2105/ajph.93.4.631] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2002] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study sought to determine the prevalence of maternal morbidity during labor and delivery in the United States. METHODS Analyses focused on National Hospital Discharge Survey data available for women giving birth between 1993 and 1997. RESULTS The prevalence of specific types of maternal morbidity was low, but the burden of overall morbidity was high. Forty-three percent of women experienced some type of morbidity during their delivery hospitalization. Thirty-one percent (1.2 million women) had at least 1 obstetric complication or at least 1 preexisting medical condition. CONCLUSIONS Maternal morbidity during delivery is frequent and often preventable. Reducing maternal morbidity is a national health objective, and its monitoring is key to improving maternal health.
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Affiliation(s)
- Isabella Danel
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abstract
Fires and unintended pregnancies are important causes of morbidity, mortality, and financial loss in the United States. Home fire extinguishers and emergency contraception are both effective preventive interventions. The disparity between access to fire extinguishers and emergency contraception is irrational and indirectly hurts women's health. Although fire extinguishers require the user to make a diagnosis, choose the appropriate treatment, and assume some risk of serious injury and death, these canisters of pressurized chemicals are widely available without restriction. In contrast, women face several unnecessary obstacles to overcome before using emergency contraception, which is both simpler and safer to use. Clearly, a double standard prevails in prevention strategies for women. The Food and Drug Administration should approve over-the-counter availability of emergency contraception without further study or delay.
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Affiliation(s)
- David A Grimes
- Family Health International, Research Triangle Park, NC 27709, USA.
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Liu S, Heaman M, Kramer MS, Demissie K, Wen SW, Marcoux S. Length of hospital stay, obstetric conditions at childbirth, and maternal readmission: a population-based cohort study. Am J Obstet Gynecol 2002; 187:681-7. [PMID: 12237648 DOI: 10.1067/mob.2002.125765] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We assessed the association between obstetric conditions, length of hospital stay for childbirth, and maternal readmission. STUDY DESIGN A population-based cohort study was conducted on obstetric deliveries (N = 2,652,726) in Canada from 1989 to 1999. Women who were readmitted to the hospital because of obstetric causes within 60 days of initial discharge were identified. RESULTS Among the readmitted cases, women with cesarean deliveries were more likely to be readmitted to the hospital in the first week after discharge than women with vaginal deliveries (53% vs 41%). After an adjustment for maternal age by means of a Cox regression model, the risk of maternal readmission after cesarean delivery was significantly increased by 21%, 18%, and 10% for mothers with a length of hospital stay of <or=2, 3, and 4 days, respectively, compared with mothers with a length of hospital stay of 5 days. Postpartum hemorrhage, major puerperal infection, and some hypertensive disorders were associated with an elevated risk for maternal readmission and were also the major causes of readmission. CONCLUSION Short length of hospital stay and several obstetric conditions appear to increase the risk of readmission in women with cesarean birth.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Healthy Human Development, Health Canada, and McLaughlin Center for Population Health Risk Assessment, University of Ottawa, ON, Canada.
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Lam F, Bergauer NK, Jacques D, Coleman SK, Stanziano GJ. Clinical and cost-effectiveness of continuous subcutaneous terbutaline versus oral tocolytics for treatment of recurrent preterm labor in twin gestations. J Perinatol 2001; 21:444-50. [PMID: 11894512 DOI: 10.1038/sj.jp.7210553] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the clinical and cost-effectiveness of treating recurrent preterm labor with continuous subcutaneous terbutaline versus oral tocolytics in twin gestations. STUDY DESIGN In a retrospective, matched-cohort design, twin pregnancies treated as outpatients with continuous subcutaneous terbutaline were identified from a perinatal database, then matched 1:1 by gestational age at recurrent preterm labor to those receiving oral tocolytics. There were 353 patients per treatment group. A cost model was used to compare antepartum hospital, nursery, and outpatient charges. RESULTS Infants of the subcutaneous terbutaline group had greater gestational age at delivery, higher birth weights, and less frequent neonatal intensive care unit admission. Charges for antepartum hospitalization and nursery were significantly less in the subcutaneous terbutaline group, while charges for outpatient services were less for the oral group. Mean total estimated charges were US$17,109 less for those receiving subcutaneous terbutaline. CONCLUSION Improved clinical outcomes and decreased nursery utilization suggest cost-effectiveness of outpatient continuous subcutaneous terbutaline versus oral tocolytics for the treatment of recurrent preterm labor.
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Affiliation(s)
- F Lam
- California Pacific Medical Center, 3838 California Street, San Francisco, CA 94118, USA
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Little RE, Little AS, Chislovska N, Hulchiy OP, Monaghan SC, Gladen BC. Hospital admissions during pregnancy in two urban areas of Ukraine. Paediatr Perinat Epidemiol 2001; 15:323-7. [PMID: 11703679 DOI: 10.1046/j.1365-3016.2001.0380a.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hospital admissions are generally regarded as a marker of severe pregnancy complications, and a low ratio of antenatal admissions to deliveries is considered an indicator of maternal-fetal well-being. We investigated the reasons for hospital admissions in a sample of deliveries from Ukraine, a country of the former eastern bloc. All hospitalisations were traced among 3099 women who delivered live singletons of at least 20 weeks gestation in two urban areas of Ukraine and data were abstracted from their medical records. More than a third of the women were admitted to hospital during their pregnancy, and 91% of the admissions were for a pregnancy complication, primarily threatened abortion or early labour. Median length of stay for all admissions was 12 days. The ratio of admissions to deliveries was 52 per 100. The Ukrainian ratio of hospitalisations to deliveries is notably higher than any that have been published in studies from the United States and Australia, reflecting patterns of care that stress hospital-based treatment. This high ratio does not necessarily mean that Ukrainian women are sicker, although that may be the case. The comparison of hospitalisation to delivery ratios is meaningful only when other factors, such as resources, patterns of care, costs and access, are taken into account.
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Affiliation(s)
- R E Little
- National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA.
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