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Bartholomew V, Hundley V, Clark CJ, Parris BA. The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100941. [PMID: 38104503 DOI: 10.1016/j.srhc.2023.100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine the prevalence of pain catastrophising and identify whether it impacts on the timing of hospital admission when in labour. METHODS A longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25 and 33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, including the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) (2) at three weeks postnatal. RESULTS A total of 389 eligible participants entered the study. The percentage of women who were pain catastrophisers (PCS ≥ 20) was 28.1 %, while 7.6 % had a high pain catastrophising score (PCS ≥ 30). There was no association between pain catastrophising and the timing of hospital admission. The percentage of women reporting fear of childbirth (WDEQ-A score of ≥ 85) was 10.6 %. Fear of childbirth was highly associated with PCS scores (p <.001) at both the lower (≥20) and higher (≥30) thresholds. CONCLUSION Although not statistically significant, there was a tendency for women who pain catastrophise to present to hospital in the latent phase. The highly significant association between PCS and WDEQ-A scores has implications for the identification of these women and suggests that the PCS can be used as a screening tool to identify those women who have heightened fear around pain and who may also go on to develop clinically relevant fear of childbirth. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women.
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Affiliation(s)
- V Bartholomew
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom.
| | - V Hundley
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - C J Clark
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - B A Parris
- Department of Psychology, Bournemouth University, Poole House P331, Talbot Campus, Fern Barrow, Poole BH12 5BB, United Kingdom
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Validation of birth certificate and maternal recall of events in labor and delivery with medical records in the Iowa health in pregnancy study. BMC Pregnancy Childbirth 2022; 22:232. [PMID: 35317778 PMCID: PMC8939232 DOI: 10.1186/s12884-022-04581-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
Background Epidemiological research of events related to labor and delivery frequently uses maternal interview or birth certificates as a primary method of data collection; however, the validity of these data are rarely confirmed. This study aimed to examine the validity of birth certificate data and maternal interview of maternal demographics and events related to labor and delivery with data abstracted from medical records in a US setting. Methods Birth certificate and maternal recall data from the Iowa Health in Pregnancy Study (IHIPS), a population-based case-control study of risk factors for preterm and small-for-gestational age births, were linked to medical record data to assess the validity of events that occurred during labor and delivery along with reported maternal demographics. Sensitivity, specificity, positive and negative predictive values, and kappa scores were calculated. Results Postpartum maternal recall and birth certificate data were excellent for infant characteristics (birth weight, gestational age, infant sex) and variables related to labor and delivery (mode of delivery) when compared with medical records. Birth certificate data for labor induction had low sensitivity (46.3%) and positive predictive value (18.3%) compared to medical records. Compared to maternal interview, birth certificate data also had poor agreement for smoking and alcohol use during pregnancy. Agreement between all three methods of data collection was very low for pregnancy weight gain (kappa = 0.07-0.08). Conclusions Maternal interview and birth certificate data can be a valid source for collecting data on infant characteristics and events that occurred during labor and delivery. However, caution should be used if solely using birth certificate data to gather data on maternal demographic and/or lifestyle factors.
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Ameen S, Siddique AB, Peven K, Rahman QSU, Day LT, Shabani J, Kc A, Boggs D, Shamba D, Tahsina T, Rahman AE, Zaman SB, Hossain AT, Ahmed A, Basnet O, Malla H, Ruysen H, Blencowe H, Arnold F, Requejo J, Arifeen SE, Lawn JE. Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:238. [PMID: 33765956 PMCID: PMC7995710 DOI: 10.1186/s12884-020-03425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. METHODS EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. RESULTS 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses. CONCLUSIONS Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.
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Affiliation(s)
- Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Dorothy Boggs
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | - Honey Malla
- Research Division, Golden Community, Lalitpur, Nepal
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Fred Arnold
- Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, United Nations Children's Fund, Headquarters, New York, New York, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Abstract
OBJECTIVE Mothers are known to be reliable reporters of smoking during pregnancy, type of delivery, and birth weight when compared with medical records. Few studies have considered whether the timing of retrospective collection affects the mother's retrospective self-report. We examined the consistency of maternal retrospective recall of prenatal experiences, behaviors, and basic birth outcomes between 6 months and 8 years postpartum. METHOD We examined 117 mothers (62% White, 44% living in a committed relationship, median high school education) from the Early Growth and Development Study (EGDS). EGDS is a longitudinal adoption study that includes birth mothers of children born between 2003 and 2009 who were involved in a domestic adoption. Using the modified life history calendar and a pregnancy screener, mothers reported on their prenatal health behaviors, prenatal substance use, and labor and delivery at 6 months and 8 years postpartum. Cohen κ was calculated to examine consistency, and χ tests were used to test differences by parity and maternal education. RESULTS Mothers' recall was very good for recall of the type of delivery and good for smoking during pregnancy, medicine used for labor induction, and specific medical problems (i.e., pre-eclampsia, sexually transmitted infections, and kidney infections). Recall consistency was poor for illicit drug use, specific prenatal tests performed (i.e., amniocentesis and emergency room visits), and using drugs other than an epidural during delivery. CONCLUSION This study provides support for using retrospective collection of maternal self-report on some prenatal experiences up to 8 years postpartum and offers a potential way to more accurately collect self-reported prenatal experiences.
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Dahan O. Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:794-808. [DOI: 10.1177/1745691620901546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this article, I present the concept of “birthing consciousness,” a psychophysical altered state of women that can occur during natural and undisturbed birth. I demonstrate that this altered state of consciousness (ASC) has phenomenological and cognitive features of hypofrontality; thus, birthing consciousness probably shares a similar brain mechanism to that postulated by the transient-hypofrontality theory (THT). I argue that until recently (with the advent of modern medical intervention), in evolutionary terms, women lacking the proclivity for this specific brain mechanism had a lower chance of reproducing successfully. Hence, I suggest a general and preliminary hypothesis concerning THT: Birthing consciousness is one example of an adaptive pain-induced ASC associated with transient hypofrontality.
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Affiliation(s)
- Orli Dahan
- Faculty of Social Sciences & Humanities, Tel-Hai College
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Valadez JJ, Devkota B, Jeffery C, Hadden WC. How well do mothers recall their own and their infants' perinatal events? A two-district study using cross-sectional stratified random sampling in Bihar, India. BMJ Open 2019; 9:e031289. [PMID: 31857302 PMCID: PMC6937048 DOI: 10.1136/bmjopen-2019-031289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Global monitoring of maternal, newborn and child health (MNCH) programmes use self-reported data subject to recall error which may lead to incorrect decisions for improving health services and wasted resources. To minimise this risk, samples of mothers of infants aged 0-2 and 3-5 months are sometimes used. We test whether a single sample of mothers of infants aged 0-5 months provides the same information. DESIGN An annual MNCH household survey in two districts of Bihar, India (n=6 million). PARTICIPANTS Independent samples (n=475 each) of mothers of infants aged 0-5, 0-2 and 3-5 months. OUTCOME MEASURES Main analyses compare responses from the samples of infants aged 0-5 and 0-2 months with Mantel-Haenszel-Cochran statistics using 51 indicators in two districts. RESULTS No measurable differences are detected in 79.4% (81/102) comparisons; 20.6% (21/102) display differences for the main comparison. Subanalyses produce similar results. A difference detected for exclusive breast feeding is due to premature complementary feeding by older infants. Measurable differences are detected in 33% (8/24) of the indicators on Front Line Worker (FLW) support, 26.9% (7/26) of indicators of birth preparedness and place of birth and attendant, and 9.5% (4/42) of the indicators on neonatal and antenatal care. CONCLUSIONS Differences in FLW visits and compliance with their advice may be due to seasonal effects: mothers of older infants aged 3-5 months were pregnant during the dry season; mothers of infants aged 0-2 months were pregnant during the monsoons, making transportation difficult. Useful coverage estimates can be obtained by sampling mothers with infants aged 0-5 months as with two samples suggesting that mothers of young infants recall their own perinatal events and those of their children. For some indicators (eg, exclusive breast feeding), it may be necessary to adjust targets. Excessive stratification wastes resources, does not improve the quality of information and increases the burden placed on data collectors and communities which can increase non-sampling error.
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Affiliation(s)
- Joseph James Valadez
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Baburam Devkota
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Wilbur C Hadden
- Department of Sociology, University of Maryland at College Park, College Park, Maryland, USA
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Draycott T, Kubiak K, Arthur E, Crofts J. Causation of permanent brachial plexus injuries to the anterior arm after shoulder dystocia – Literature review. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043518791897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Not all neonatal brachial plexus injuries should be deemed the fault of the accoucheur. However, there is a small (<10%) subset of neonatal brachial plexus injuries that are related to excessive traction by the accoucheur: permanent injuries to the anterior arm after SD. The position regarding posterior injuries remains predominantly the same; if the injury is to the posterior shoulder, the injury is likely to have been caused by maternal propulsion against the sacral promontory before the foetal head is delivered, rather than excessive and inappropriate traction. However, there is no reliable evidence that a combination of maternal propulsion and diagnostic traction alone causes significant and permanent injury to the anterior shoulder after shoulder dystocia. This was recognised in Deith vs. Lanarkshire where the judge found: that where there is a severe injury to an anterior arm after SD, excessive traction is overwhelmingly likely to be the cause.
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Affiliation(s)
- Tim Draycott
- Department of Women’s Health, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | | | | | - Joanna Crofts
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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Blanc AK, Warren C, McCarthy KJ, Kimani J, Ndwiga C, RamaRao S. Assessing the validity of indicators of the quality of maternal and newborn health care in Kenya. J Glob Health 2018; 6:010405. [PMID: 27231541 PMCID: PMC4871064 DOI: 10.7189/jogh.06.010405] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The measurement of progress in maternal and newborn health often relies on data provided by women in surveys on the quality of care they received. The majority of these indicators, however, including the widely tracked "skilled attendance at birth" indicator, have not been validated. We assess the validity of a large set of maternal and newborn health indicators that are included or have the potential to be included in population-based surveys. METHODS We compare women's reports of care received during labor and delivery in two Kenyan hospitals prior to discharge against a reference standard of direct observations by a trained third party (n = 662). We assessed individual-level reporting accuracy by quantifying the area under the receiver operating curve (AUC) and estimated population-level accuracy using the inflation factor (IF) for each indicator with sufficient numbers for analysis. FINDINGS Four of 41 indicators performed well on both validation criteria (AUC>0.70 and 0.75<IF<1.25). These were: main provider during delivery was a nurse/midwife, a support companion was present at birth, cesarean operation, and low birthweight infant (<2500 g). Twenty-one indicators met acceptable levels for one criterion only (11 for AUC; 9 for IF). The skilled birth attendance indicator met the IF criterion only. INTERPRETATION Few indicators met both validation criteria, partly because many routine care interventions almost always occurred, and there was insufficient variation for robust analysis. Validity is influenced by whether the woman had a cesarean section, and by question wording. Low validity is associated with indicators related to the timing or sequence of events. The validity of maternal and newborn quality of care indicators should be assessed in a range of settings to refine these findings.
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Keenan K, Hipwell A, McAloon R, Hoffmann A, Mohanty A, Magee K. Concordance between maternal recall of birth complications and data from obstetrical records. Early Hum Dev 2017; 105:11-15. [PMID: 28095344 PMCID: PMC5382715 DOI: 10.1016/j.earlhumdev.2017.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/07/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prenatal complications are associated with poor outcomes in the offspring. Access to medical records is limited in the United States and investigators often rely on maternal report of prenatal complications. STUDY DESIGN AND AIMS We tested concordance between maternal recall and birth records in a community-based sample of mothers participating in a longitudinal study in order to determine the accuracy of maternal recall of perinatal complications. SUBJECTS Participants were 151 biological mothers, who were interviewed about gestational age at birth, birthweight, and the most commonly occurring birth complications: nuchal cord and meconium aspiration when the female child was on average 6years old, and for whom birth records were obtained. OUTCOME MEASURES Concordance between reports was assessed using one-way random intra-class coefficients for continuous measures and kappa coefficients for dichotomous outcomes. Associations between maternal demographic and psychological factors and discrepancies also were tested. RESULTS Concordance was excellent for continuously measured birthweight (ICC=0.85, p<0.001) and good for gestational age (ICC=0.68, p<0.001). Agreement was good for low birthweight (<2500g) (kappa=0.67, p<0.001), fair for preterm delivery (<37weeks gestation) (kappa=0.44, p<0.001), and poor for nuchal cord or meconium aspiration. Most discrepancies were characterized by presence according to birth record and absence according to maternal recall. Receipt of public assistance was associated with a decrease in discrepancy in report of nuchal cord. CONCLUSIONS Concordance between maternal retrospective report and medical birth records varies across different types of perinatal events. There was little evidence that demographic or psychological factors increased the risk of discrepancies. Maternal recall based on continuous measures of perinatal factors may yield more valid data than dichotomous outcomes.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
| | - Alison Hipwell
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Ave, Pittsburgh, PA, USA 15213
| | - Rose McAloon
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Ave, Pittsburgh, PA, USA 15213
| | - Amy Hoffmann
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Ave, Pittsburgh, PA, USA 15213
| | - Arpita Mohanty
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Ave, Pittsburgh, PA, USA 15213
| | - Kelsey Magee
- Department of Psychiatry, University of Pittsburgh, 121 Meyran Ave, Pittsburgh, PA, USA 15213
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Concordance between Women's Self-Reported Reasons for Cesarean Delivery and Hospital Discharge Records. Womens Health Issues 2017; 27:329-335. [PMID: 28100403 DOI: 10.1016/j.whi.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women's self-reports of whether they had a cesarean delivery are nearly 100% accurate, but there is little extant research on how accurately women self-report reasons for cesarean delivery when asked to recall this information in the postpartum period. OBJECTIVE We compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. METHODS Data are from the First Baby Study, a cohort of 3,006 women who gave birth to their first baby between 2009 and 2011. Survey data were linked to hospital discharge records. Among women who delivered by cesarean (n = 846), we assessed the probability that women's self-reported reasons for cesarean delivery were confirmed by hospital discharge records (positive predictive value [PPV]), and whether agreement differed by reason for cesarean or by women's characteristics. RESULTS Overall, 91% of women reported a reason for their cesarean that was present in the discharge data. PPV varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1%), and lower PPV for malposition (81.7%). In multivariable models, women with more education and higher family income had higher odds of concordance. CONCLUSIONS Despite some variation in the probability that women's self-reported reason for cesarean is supported by the hospital discharge record, more than 90% of women reported a reason that was found in their discharge record. Accurate recall of reasons for prior cesarean may help women and clinicians to manage future pregnancies.
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Chen C, Smith LJ, Pierce CB, Blomquist JL, Handa VL. Do symptoms of pelvic floor disorders bias maternal recall of obstetrical events up to 10 years after delivery? Female Pelvic Med Reconstr Surg 2016; 21:129-34. [PMID: 25730426 DOI: 10.1097/spv.0000000000000158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this prospective study was to investigate whether symptoms of incontinence and prolapse bias maternal recall of obstetrical events up to 10 years after delivery. METHODS In this secondary analysis of data gathered from the Mothers' Outcomes After Delivery study, we compared obstetrical medical records with maternal recall of delivery events. We calculated the agreement between maternal recall and the medical record across 1821 deliveries from 1011 participants for events including macrosomia, mode of delivery, prolonged second of labor, episiotomy, spontaneous laceration, anal sphincter laceration, and operative delivery. Women with symptomatic pelvic floor disorders were identified through administration of the Epidemiology of Prolapse and Incontinence Questionnaire or a clinical history of therapy for a pelvic floor disorder. We determined whether agreement between maternal recall and the medical record differed for those with or without symptoms using the medical record as a criterion standard. RESULTS Agreement between maternal recall and the medical record was excellent for macrosomia and forceps deliveries (κ > 0.8), fair to good for episiotomy (κ = 0.61) and anal sphincter laceration (κ = 0.57), and poor for spontaneous perineal laceration (κ = 0.41). Symptomatic pelvic floor disorders did not impact maternal recall of macrosomia, prolonged second stage, episiotomy, spontaneous laceration, or operative delivery. However, recall of anal sphincter lacerations was biased by symptoms of pelvic floor disorders. Specifically, symptomatic women were significantly more likely to report a history of anal sphincter laceration, regardless of whether a sphincter laceration was documented (P = 0.025). CONCLUSIONS Maternal recall of anal sphincter laceration may be biased by symptomatic pelvic floor disorders. In research based on maternal recall of obstetrical events, this could strengthen the apparent association between sphincter laceration and pelvic floor disorders.
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Affiliation(s)
- Crystal Chen
- From the *Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; and ‡Department of Gynecology, Greater Baltimore Medical Center, Baltimore, MD
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Nygaard IE, Shaw JM, Bardsley T, Egger MJ. Lifetime physical activity and female stress urinary incontinence. Am J Obstet Gynecol 2015; 213:40.e1-40.e10. [PMID: 25640047 DOI: 10.1016/j.ajog.2015.01.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous, and strenuous activity during the teen years. STUDY DESIGN Recruitment for this case-control study was conducted in primary-care-level family medicine and gynecology clinics. A total of 1538 enrolled women ages 39-65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls had no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. In all, 213 cases were frequency matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. RESULTS SUI odds increased slightly with overall lifetime activity (odds ratio [OR], 1.20 per 70 additional metabolic equivalent of task-h/wk; 95% confidence interval [CI], 1.02-1.41), and were not associated with lifetime strenuous activity (OR, 1.11; 95% CI, 0.99-1.25). In quintile analysis of lifetime leisure activity, which demonstrated a nonlinear pattern, all quintiles incurred about half the odds of SUI compared to reference (second quintile; P = .009). Greater strenuous activity in teen years modestly increased SUI odds (OR, 1.37 per 7 additional h/wk; 95% CI, 1.09-1.71); OR, 1.75; 95% CI, 1.15-2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/wk during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21-65 years. CONCLUSION In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.
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Experiences during the first four years of a postpartum perineal clinic in the USA. Int J Gynaecol Obstet 2014; 128:68-71. [DOI: 10.1016/j.ijgo.2014.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/15/2014] [Accepted: 09/01/2014] [Indexed: 11/22/2022]
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NYGAARD IE, SHAW JM, BARDSLEY T, EGGER MJ. Lifetime physical activity and pelvic organ prolapse in middle-aged women. Am J Obstet Gynecol 2014; 210:477.e1-12. [PMID: 24486225 PMCID: PMC4011990 DOI: 10.1016/j.ajog.2014.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/11/2013] [Accepted: 01/23/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine, in a case-control study, whether pelvic organ prolapse (POP) is associated with overall lifetime physical activity (combined leisure, outdoor, household, occupational), and lifetime leisure, lifetime strenuous, and teen years strenuous activity. STUDY DESIGN One hundred ninety-one POP cases (defined as maximal vaginal descent ≥1 cm below the hymen) and 191 age and recruitment-site matched controls (defined as maximal vaginal descent ≤1 cm above the hymen) between 39-65 years with no or mild urinary incontinence, were recruited chiefly from primary care clinics. Participants completed Lifetime Physical Activity and Occupation Questionnaires, recalling activities during 4 age epochs. We performed separate logistic regression models for physical activity measures. RESULTS Compared with controls, POP cases had greater body mass index and parity. Median overall lifetime activity, expressed in metabolic equivalents-hours/week, did not differ significantly between cases and controls. In adjusted analyses, we observed no associations between odds of POP and overall lifetime physical activity, lifetime leisure activity, or lifetime strenuous activity. There was a marginally significant nonlinear relationship between teen strenuous activity and POP with an increase in the log-odds of POP for women reporting ≥21 hours/week of strenuous activity (P = .046). CONCLUSION Lifetime physical activity does not increase the odds of anatomic POP in middle-aged women not seeking care for POP. Strenuous activity during teenage years may confer higher odds of POP. This relationship and the potential role of physical activity and POP incidence should be evaluated prospectively.
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Affiliation(s)
| | - Janet M. SHAW
- Department of Exercise and Sport Science, University of Utah
| | - Tyler BARDSLEY
- Department of Obstetrics and Gynecology, University of Utah
| | - Marlene J. EGGER
- Department of Family and Preventive Medicine, University of Utah
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Tinker SC, Gibbs C, Strickland MJ, Devine OJ, Crider KS, Werler MM, Anderka MT, Reefhuis J. Impact of time to maternal interview on interview responses in the National Birth Defects Prevention Study. Am J Epidemiol 2013; 177:1225-35. [PMID: 23645625 DOI: 10.1093/aje/kws352] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prenatal exposures often are assessed using retrospective interviews. Time from exposure to interview may influence data accuracy. We investigated the association of time to interview (TTI) with aspects of interview responses in the National Birth Defects Prevention Study, a population-based case-control study of birth defects in 10 US states. Mothers completed a computer-assisted telephone interview 1.5-24 months after their estimated date of delivery. Proxy metrics for interview quality were whether certain exposures were reported, whether the start month of reported medication use or illness was reported, or whether responses were missing. Interaction by case status was assessed. Interviews were completed with 30,542 mothers (22,366 cases and 8,176 controls) who gave birth between 1997 and 2007. Mothers of cases were interviewed later than were mothers of controls (11.7 months vs. 9.5 months, respectively). In adjusted analyses, having a TTI that was greater than 6 months was associated with only a few aspects of interview responses (e.g., start month of pseudoephedrine use). Interaction by case-control status was observed for some exposures; mothers of controls had a greater reduction in interview quality with increased TTI in these instances (e.g., report of morning sickness, start month of acetaminophen use and ibuprofen use). The results suggest that TTI might impact interview responses; however, the impact may be minimal and specific to the type of exposure.
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Affiliation(s)
- Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail-Stop E86, Atlanta, GA 30333, USA.
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Measuring coverage in MNCH: testing the validity of women's self-report of key maternal and newborn health interventions during the peripartum period in Mozambique. PLoS One 2013; 8:e60694. [PMID: 23667427 PMCID: PMC3646219 DOI: 10.1371/journal.pone.0060694] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum. METHODS AND FINDINGS The study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75<IF<1.25). Two of these indicators are considered high demand and are recommended for incorporation into international survey programs: presence of a support person during labor/delivery and placement of the newborn skin to skin against the mother. Nine indicators met acceptability criteria for one of the validity measures. All 13 indicators are recommended for use in in-depth maternal/newborn health surveys. CONCLUSIONS Women are able to report on some aspects of peripartum care. Larger studies may be able to validate some indicators that this study could not assess due to the sample size. Future qualitative research may assist in improving question formulation for some indicators. Studies of similar design in other low-income settings are needed to confirm these results.
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Liu L, Li M, Yang L, Ju L, Tan B, Walker N, Bryce J, Campbell H, Black RE, Guo Y. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China. PLoS One 2013; 8:e60762. [PMID: 23667429 PMCID: PMC3646215 DOI: 10.1371/journal.pone.0060762] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 02/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background Accurate data on coverage of key maternal, newborn, and child health (MNCH) interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China. Method and Findings We conducted a validation study by comparing women’s self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6%) completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI): 0.50–0.63] to 0.99 [95% CI: 0.98–1.00]) and low to high specificity (0 to 0.83 [95% CI: 0.80–0.86]). Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC) ranging between 0.49 [95% CI: 0.39–0.57] and 0.90 [95% CI: 0.88–0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP) ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings. Conclusions The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The study provides insights into the accuracy of self-reports based on a population survey in low- and middle-income countries. Similar studies applying an improved reference standard are warranted in the future.
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Affiliation(s)
- Li Liu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mengying Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Li Yang
- Guangxi Medical University, School of Public Health, Nanning, China
| | - Lirong Ju
- Capital Medical University, School of Public Health, Beijing, China
| | - Biqin Tan
- Gongcheng County Maternal and Child Health Hospital, Gongcheng County, China
| | - Neff Walker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer Bryce
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Harry Campbell
- University of Edinburgh Medical School, Edinburgh, United Kingdom
| | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Yan Guo
- Peking University Health Science Center, School of Public Health, Beijing, China
- * E-mail:
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Lecarpentier E, Tsatsaris V, Goffinet F, Cabrol D, Sibai B, Haddad B. Risk factors of superimposed preeclampsia in women with essential chronic hypertension treated before pregnancy. PLoS One 2013; 8:e62140. [PMID: 23671584 PMCID: PMC3645999 DOI: 10.1371/journal.pone.0062140] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To determine risk factors of superimposed preeclampsia in women with essential chronic hypertension receiving antihypertensive therapy prior to conception. Methods A retrospective study of 211 patients that analyzed risk factors of superimposed preeclampsia at first prenatal visit. Variables with a p<.1 at univariate analysis were included in a logistic regression analysis. P<.05 was considered as significant. Results Superimposed preeclampsia occurred in 49 (23.2%) women. In logistic regression analysis, previous preeclampsia [OR: 4.05 (1.61–10.16)], and mean arterial blood pressure of 95 mmHg or higher [OR: 4.60 (1.94–10.93)] were associated with increased risk of superimposed preeclampsia. When both variables were present, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for superimposed preeclampsia were 43%, 94%, 70%, 85%, and 7.71 (95% CI: 3.20–18.57), respectively. Conclusion In essential chronic hypertensive women, previous preeclampsia and mean arterial blood pressure of 95 mmHg or higher are associated with increased risks of superimposed preeclampsia.
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Affiliation(s)
| | - Vassilis Tsatsaris
- University Paris 5, AP-HP Cochin Port-Royal, Paris, France
- PREMUP Foundation, Paris, France
| | - François Goffinet
- University Paris 5, AP-HP Cochin Port-Royal, Paris, France
- PREMUP Foundation, Paris, France
| | - Dominique Cabrol
- University Paris 5, AP-HP Cochin Port-Royal, Paris, France
- PREMUP Foundation, Paris, France
| | - Baha Sibai
- University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Bassam Haddad
- University Paris 12, CHI Creteil, Creteil, France
- PREMUP Foundation, Paris, France
- CRC CHI Creteil, Creteil, France
- * E-mail:
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Obstetric sphincter injury interacts with diarrhea and urgency to increase the risk of fecal incontinence in women with irritable bowel syndrome. Female Pelvic Med Reconstr Surg 2013; 19:40-5. [PMID: 23321658 DOI: 10.1097/spv.0b013e31827bfd64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study aimed to confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with irritable bowel syndrome, and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI. METHODS The study is a supplement to a diary study of bowel symptoms in 164 female patients with irritable bowel syndrome. Subjects completed daily bowel symptom diaries for 90 consecutive days and rated each bowel movement for stool consistency and presence of urgency, pain, and FI. All female participants from the parent study were invited to complete a telephone-administered 33-item bowel symptom and obstetric history questionnaire, which included the fecal incontinence severity index. RESULTS Of the 164 women in the parent study, 115 (70.1%) completed the interview. Seventy-four (45.1%) reported FI on their diary including 34 (29.6%) who reported at least 1 episode per month, 112 (97.4%) reported episodes of urgency, and 106 (92.2%) reported episodes of diarrhea. The mean fecal incontinence severity index score was 13.9 (9.7). On multivariable analysis, FI was significantly associated with parity (P = 0.007), operative abdominal delivery (P = 0.049), obstetrical sphincter lacerations (P = 0.007), fecal urgency (P = 0.005), diarrhea (P = 0.008), and hysterectomy (P = 0.004), but was not associated with episiotomy, pelvic organ prolapse, or urinary incontinence. The synergistic interactions of obstetric anal sphincter laceration with urgency (P = 0.002) and diarrhea (P = 0.004) were significant risk factors for FI. CONCLUSIONS Fecal urgency and diarrhea are independent risk factors for FI, and they interact with obstetric anal sphincter laceration to amplify the risk of FI.
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Bat-Erdene U, Metcalfe A, McDonald SW, Tough SC. Validation of Canadian mothers' recall of events in labour and delivery with electronic health records. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S3. [PMID: 23445768 PMCID: PMC3561172 DOI: 10.1186/1471-2393-13-s1-s3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Maternal report of events that occur during labour and delivery are used extensively in epidemiological research; however, the validity of these data are rarely confirmed. This study aimed to validate maternal self-report of events that occurred in labour and delivery with data found in electronic health records in a Canadian setting. Methods Data from the All Our Babies study, a prospective community-based cohort of women’s experiences during pregnancy, were linked to electronic health records to assess the validity of maternal recall at four months post-partum of events that occurred during labour and delivery. Sensitivity, specificity and kappa scores were calculated. Results were stratified by maternal age, gravidity and educational attainment. Results Maternal recall at four months post-partum was excellent for infant characteristics (gender, birth weight, gestational age, multiple births) and variables related to labour and delivery (mode of delivery, epidural, labour induction) (sensitivity and specificity >85%). Women who had completed a university degree had significantly better recall of labour induction and use of an epidural. Conclusion Maternal recall of infant characteristics and events that occurred during labour and delivery is excellent at four months post-partum and is a valid source of information for research purposes.
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Affiliation(s)
- Uilst Bat-Erdene
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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Maternal Recall of Prescription Medication Use During Pregnancy Using a Paper-Based Questionnaire. Drug Saf 2012; 36:43-54. [DOI: 10.1007/s40264-012-0004-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evers EC, Blomquist JL, McDermott KC, Handa VL. Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth. Am J Obstet Gynecol 2012; 207:425.e1-6. [PMID: 22831810 DOI: 10.1016/j.ajog.2012.06.055] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/17/2012] [Accepted: 06/27/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the long-term impact of anal sphincter laceration on anal incontinence. STUDY DESIGN Five to 10 years after first delivery, anal incontinence and other bowel symptoms were measured with the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetric exposures were assessed with review of hospital records. Symptoms and quality-of-life impact were compared among 90 women with at least 1 anal sphincter laceration, 320 women who delivered vaginally without sphincter laceration, and 527 women who delivered by cesarean delivery. RESULTS Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio, 2.32; 95% confidence interval, 1.27-4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality-of-life scores were similar between women who delivered by cesarean section and those who delivered vaginally without sphincter laceration. CONCLUSION Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery.
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Affiliation(s)
- Emily C Evers
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Nygaard I, Shaw J, Egger MJ. Exploring the association between lifetime physical activity and pelvic floor disorders: study and design challenges. Contemp Clin Trials 2012; 33:819-27. [PMID: 22521947 PMCID: PMC3361559 DOI: 10.1016/j.cct.2012.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/11/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND One in four women has moderate to severe symptoms of at least one pelvic floor disorder. Lifetime physical activity, a modifiable risk factor, may theoretically predispose women to, or protect them from, developing pelvic floor disorders. It is neither feasible nor ethical to test this association using the most rigorous (level I) study design. PURPOSE The aim of this manuscript is to describe the methods for the PHysical ACtivity Study (PHACTS), which encompasses two case-control studies and the development of a registry, and to describe challenges and solutions to study progress to date. For each of the case-control studies, the primary aims are to determine, compared to controls with neither pelvic organ prolapse nor urinary incontinence, whether 1) pelvic organ prolapse or 2) stress urinary incontinence is associated with a) increased or decreased current leisure activity or b) increased or decreased overall lifetime activity (including leisure, household, outdoor, and occupational) measured in MET-hours per week, as well as in strenuous hours per week. METHODS To obtain 175 pelvic organ prolapse cases, 175 stress urinary incontinence cases, and an equal number of age, body mass index and recruitment site matched controls, we plan to enroll 1500 women from about 20 primary care level clinics. RESULTS We have encountered various challenges leading to lessons learned about minimizing bias, recruitment from community clinics, the lifetime physical activity instrument used, and data management. CONCLUSIONS Our experiences can help guide future investigators studying risk factors, particularly physical activity, and pelvic floor disorders.
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Affiliation(s)
- Ingrid Nygaard
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT 84132-0001, USA.
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Gartland D, Lansakara N, Flood M, Brown SJ. Assessing obstetric risk factors for maternal morbidity: congruity between medical records and mothers' reports of obstetric exposures. Am J Obstet Gynecol 2012; 206:152.e1-10. [PMID: 22177183 DOI: 10.1016/j.ajog.2011.10.863] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 09/14/2011] [Accepted: 10/19/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to assess congruity between data abstracted from medical records with answers to self-administered questionnaires. STUDY DESIGN This was a multicenter prospective nulliparous pregnancy cohort. RESULTS A total of 1507 women enrolled. Analyses were reported for 1296 with medical record data and 3-month postpartum follow-up. There was near-perfect agreement (κ ≥ 0.80) between maternal report and abstracted data for reproductive history, induction/augmentation method, epidural/spinal analgesia, method of birth, perineal repair, infant birthweight, and gestation. Agreement was poor to moderate for maternal position in second stage and duration of pushing. CONCLUSION Maternal report of pregnancy, labor, and birth factors was very reliable and considered more accurate in relation to maternal position in labor and birth, smoking, prior terminations, and miscarriages. Use of routine birthing outcome summaries may introduce measurement error as hospitals differ in their definitions and reporting practices. Using primary data sources (eg, partograms) with clearly defined prespecified criteria will provide the most accurate obstetric exposure and outcome data.
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Affiliation(s)
- Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Gupta V, Gu K, Chen Z, Lu W, Shu XO, Zheng Y. Concordance of self-reported and medical chart information on cancer diagnosis and treatment. BMC Med Res Methodol 2011; 11:72. [PMID: 21592352 PMCID: PMC3118949 DOI: 10.1186/1471-2288-11-72] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 05/18/2011] [Indexed: 11/23/2022] Open
Abstract
Background Self-reported information is an important tool for collecting clinical information for epidemiologic studies and in clinical settings where electronic medical records are not employed and shared. Methods Using data collected from the Shanghai Breast Cancer Survival Study (SBCSS), a population-based, prospective cohort study of 5,042 women diagnosed with breast cancer in Shanghai, China, we compared the concordance of patient questionnaire responses to a survey administered approximately 6 months after cancer diagnosis with medical chart information obtained from the diagnostic hospitals for several disease and treatment-related variables. Results Of 5,042 SBCSS participants, medical chart information was available for 4,948 women (98.1%). Concordance between patient self-reported and medical chart information was high for the majority of disease-related variables, including: diagnosing hospital (agreement: 98.7%, kappa: 0.99), type of surgery conducted (94.0%, 0.53), ER/PR status (94.5%, 0.91), and tumor position (98.2%, 0.97), as well as for important calendar dates, such as date of diagnosis, surgery, and first chemotherapy treatment. The 10 most commonly used chemotherapeutic drugs were all reported with agreement rates of at least 82%, with associated kappa values that ranged from 0.41 for calcium folinate to 0.76 for vinorelbine. Conclusions Our study found high validity for patient self-reported information for a variety of disease and treatment-related variables, suggesting the utility of self-reports as an important source of clinical information for both epidemiological research and patient care.
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Affiliation(s)
- Vinay Gupta
- Department of Cancer Control & Prevention, Shanghai Municipal Center for Disease Control and Prevention, 1380 Zhongshan Road West, Shanghai 200336, China
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Brown SJ, Gartland D, Donath S, MacArthur C. Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study. BJOG 2011; 118:991-1000. [PMID: 21489125 DOI: 10.1111/j.1471-0528.2011.02928.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. DESIGN Prospective pregnancy cohort. SETTING Six metropolitan public hospitals in Victoria, Australia. SAMPLE A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). METHOD Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. MAIN OUTCOME MEASURE Urinary incontinence 3 months postpartum in women continent before the index pregnancy. RESULTS Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). CONCLUSIONS In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence.
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Affiliation(s)
- S J Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
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Lain SJ, Ford JB, Hadfield RM, Roberts CL. A prevalence survey of every-day activities in pregnancy. BMC Pregnancy Childbirth 2010; 10:41. [PMID: 20682081 PMCID: PMC2922080 DOI: 10.1186/1471-2393-10-41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 08/04/2010] [Indexed: 12/16/2022] Open
Abstract
Background Research into the effects of common activities during pregnancy is sparse and often contradictory. To examine whether common activities are an acute trigger of pregnancy complications the prevalence of these activities are necessary to determine sample size estimates. The aim of this study is to ascertain the prevalence of selected activities in any seven day period during pregnancy. Methods The study was conducted in the antenatal clinic of a teaching hospital with tertiary obstetric and neonatal care in Sydney, Australia between August 2008 and April 2009. Women who were at least 20 weeks pregnant and able to read English completed a questionnaire to assess whether they had performed a list of activities in the seven days prior to survey completion. Results were analysed using frequency tabulations, contingency table analyses and chi square tests. Results A total of 766 surveys were completed, 29 surveys were excluded as the women completing them were less than 20 weeks pregnant, while 161 women completed the survey more than once. Ninety seven per cent of women completed the survey when approached for the first time, while 87% completed the survey when approached a subsequent time. In the week prior to completing the survey 82.6% of women had consumed a caffeinated beverage, 42.1% had had sexual intercourse, 32.7% had lifted something over 12 kilograms, 21.4% had consumed alcohol and 6.4% had performed vigorous exercise. The weekly prevalence of heavy lifting was higher for multiparous women compared to nulliparous women. Conclusions The results of this study can be used to inform future research into activities as acute triggers of pregnancy complications.
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Affiliation(s)
- Samantha J Lain
- Perinatal Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia.
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Abstract
OBJECTIVE To estimate the effect of anal incontinence on postpartum quality of life (QOL). METHODS We conducted a longitudinal follow-up study of women reporting anal incontinence on a statewide postpartum survey to estimate the effect of anal incontinence on QOL up to 2 years postpartum. Quality of life was assessed every 6 months for 2 years based on the Uebersax incontinence impact questionnaire. The effect of severe anal incontinence on QOL was determined by multivariate logistic regression. RESULTS A total of 1,050 women reported persistent anal incontinence and returned at least two completed QOL surveys during the 2-year study period. Among women with anal incontinence, 51% reported frustration caused by anal incontinence, 26% reported that anal incontinence affected their emotional health, 18.5% reported anal incontinence affected their child-caring abilities, and 16.2% reported a negative effect on social activities. One in three women with anal incontinence reported severe symptoms. Compared with women with mild anal incontinence, women with severe anal incontinence were four to seven times as likely to report that anal incontinence affected emotional health and the ability to perform daily activities. However, only 10% of women sought medical help for anal incontinence at 6 months, 13.5% at 1 year, and 16.7% at 2 years. CONCLUSION Even 2 years after delivery, more than a quarter of women who experience a new onset of anal incontinence after childbirth report persistently negative QOL. Despite this, few women discuss anal incontinence with their medical providers. LEVEL OF EVIDENCE III.
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Raza-Khan F, Cunkelman J, Lowenstein L, Shott S, Kenton K. Prevalence of bowel symptoms in women with pelvic floor disorders. Int Urogynecol J 2010; 21:933-8. [DOI: 10.1007/s00192-010-1143-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 03/10/2010] [Indexed: 11/30/2022]
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Lain SJ, Algert CS, Tasevski V, Morris JM, Roberts CL. Record linkage to obtain birth outcomes for the evaluation of screening biomarkers in pregnancy: a feasibility study. BMC Med Res Methodol 2009; 9:48. [PMID: 19589172 PMCID: PMC2714855 DOI: 10.1186/1471-2288-9-48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/09/2009] [Indexed: 11/24/2022] Open
Abstract
Background Linking population health data to pathology data is a new approach for the evaluation of predictive tests that is potentially more efficient, feasible and efficacious than current methods. Studies evaluating the use of first trimester maternal serum levels as predictors of complications in pregnancy have mostly relied on resource intensive methods such as prospective data collection or retrospective chart review. The aim of this pilot study is to demonstrate that record-linkage between a pathology database and routinely collected population health data sets provides follow-up on patient outcomes that is as effective as more traditional and resource-intensive methods. As a specific example, we evaluate maternal serum levels of PAPP-A and free β-hCG as predictors of adverse pregnancy outcomes, and compare our results with those of prospective studies. Methods Maternal serum levels of PAPP-A and free β-hCG for 1882 women randomly selected from a pathology database in New South Wales (NSW) were linked to routinely collected birth and hospital databases. Crude relative risks were calculated to investigate the association between low levels (multiples of the median ≤ 5th percentile) of PAPP-A or free β-hCG and the outcomes of preterm delivery (<37 weeks), small for gestational age (<10th percentile), fetal loss and stillbirth. Results Using only full name, sex and date of birth for record linkage, pregnancy outcomes were available for 1681 (89.3%) of women included in the study. Low levels of PAPP-A had a stronger association with adverse pregnancy outcomes than a low level of free β-hCG which is consistent with results in published studies. The relative risk of having a preterm birth with a low maternal serum PAPP-A level was 3.44 (95% CI 1.96–6.10) and a low free β-hCG level was 1.31 (95% CI 0.55–6.16). Conclusion This study provides data to support the use of record linkage for outcome ascertainment in studies evaluating predictive tests. Linkage proportions are likely to increase if more personal identifiers are available. This method of follow-up is a cost-efficient technique and can now be applied to a larger cohort of women.
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Affiliation(s)
- Samantha J Lain
- Perinatal Research, Kolling Institute of Medical Research, University of Sydney, Syndey, NSW, Australia.
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Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol 2009; 113:134-141. [PMID: 19104369 DOI: 10.1097/aog.0b013e318191bb37] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the effect of mode of delivery on the incidence of urinary incontinence in primiparous women. METHODS A population-based survey was mailed to all Oregon women who delivered a liveborn neonate in a 1-year period. Data were collected on urinary incontinence, childbirth experience, and other risk factors for incontinence at 3-6 months postpartum. Univariable analyses were conducted using t tests and Wilcoxon rank-sum tests for continuous variables and chi tests for categorical variables. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals for demographic and clinical risk factors. RESULTS A total of 15,787 women completed the survey, for a response rate of 39%. Of these women, 5,599 were primiparous, completed the survey in the desired timeframe, submitted information on their urinary continence, and did not have incontinence before pregnancy. A total of 955 (17.1%) reported leakage of urine. Women who had vaginal deliveries were more likely to have urinary incontinence than women who had cesarean deliveries (odds ratio 4.96 [95% confidence interval 3.82-6.44], P<.001). This risk increased with assisted delivery and perineal laceration. No statistical difference in the incidence of urinary incontinence was found among women who had elective cesarean deliveries (6.1%), women who had cesarean deliveries after laboring (5.7%), and women who had cesarean deliveries after laboring and pushing (6.4%). CONCLUSION Urinary incontinence is common in the immediate postpartum period after a woman's first pregnancy. Although vaginal delivery increases the risk of urinary incontinence, labor and pushing alone without vaginal delivery do not appear to increase this risk significantly. LEVEL OF EVIDENCE II.
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Guise JM, Boyles SH, Osterweil P, Li H, Eden KB, Mori M. Does cesarean protect against fecal incontinence in primiparous women? Int Urogynecol J 2008; 20:61-7. [PMID: 18949441 DOI: 10.1007/s00192-008-0729-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 09/06/2008] [Indexed: 11/26/2022]
Abstract
The objective of this study was to identify factors associated with new onset of postpartum fecal incontinence in primiparous women. A population-based study was conducted that surveyed all women delivering between 2002 and 2003 in Oregon. Factors associated with fecal incontinence were identified using logistic regression analysis. A total of 6,152 primiparous women completed the survey 3-6 months postpartum with 2,482 reporting a new onset of fecal incontinence (FI) after childbirth. Vaginal delivery was associated with a greater risk of FI compared to cesarean (odds ratio = 1.45; 95% confidence interval, 1.29 to 1.64). However, vaginal delivery without laceration or instrument assistance did not increase the risk of FI over cesarean. Being overweight (body mass index >/=30 kg/m(2)), pushing for greater than 2 h, and constipation were independently associated with postpartum FI (p < 0.05) regardless of route of delivery. This study provides important data to inform counseling and management of primiparous women.
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Affiliation(s)
- Jeanne-Marie Guise
- Department of OB/GYN, Oregon Health & Science University, Portland, OR, USA.
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Perinatal factors reported by mothers: do they agree with medical records? Eur J Epidemiol 2008; 23:557-64. [PMID: 18560979 DOI: 10.1007/s10654-008-9268-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
Abstract
As perinatal events have been linked with diseases of later onset, epidemiological studies on child development and adult health require information on the perinatal period. When national neonatal registers do not exist, review of medical records may be impractical. However, neonatal information could be obtained by asking mothers to complete a postal questionnaire using data from the Personal Child Health Record (PCHR). We assessed agreement between medical records and mothers' reports for information on delivery and the newborn's condition at birth, based on the PCHR, a short time after delivery. Of 711 women giving birth in 3 French hospitals and invited to participate in the study, 580 (82%) completed a postal questionnaire 6 weeks after delivery, copying the data recorded in the PCHR when available. Information on pregnancy, delivery and the newborn's health at birth was independently extracted from medical records by physicians of the maternity departments. Agreement between medical records and maternal reports for a range of perinatal factors was assessed in 580 newborn-mother dyads using kappa coefficients. Agreement was excellent for first and second stages of delivery, gestational age, birth weight, birth size and head circumference (kappa coefficients 0.80-1.00) and good for hospitalization during pregnancy, but poor for Apgar scores. With this exception, mothers' reports appeared reliable when compared with medical records. As PCHRs exist in most developed countries, this approach could be used in epidemiological studies on child development to increase the reliability of mothers' reports of their newborn's condition at birth.
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Newport DJ, Brennan PA, Green P, Ilardi D, Whitfield TH, Morris N, Knight BT, Stowe ZN. Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation. BJOG 2008; 115:681-8. [PMID: 18410650 DOI: 10.1111/j.1471-0528.2008.01701.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Outcome investigations of prenatal maternal depression and psychotropic exposure rely extensively on maternal retrospective recall. This study compared postnatal recall to prospective documentation of illness and medication exposures. DESIGN Prospective cohort and retrospective case-control studies. SETTING Emory Women's Mental Health Program (prospective study) and Emory University Department of Psychology (retrospective study). SAMPLE A total of 164 women who participated in both the prospective and retrospective studies. METHODS Women with a history of mental illness were followed during pregnancy for prospective prenatal assessments of depression and medication exposures. At 6 months postpartum, some of these women also participated in a retrospective study during which they were asked to recall prenatal depression and medication use. Agreement between prospective and retrospective documentation of exposures was analysed. MAIN OUTCOME MEASURES Occurrence of maternal depression during pregnancy and maternal use of pharmacological agents during pregnancy. RESULTS There was only moderate agreement (k = 0.42) in prospective versus retrospective reporting of prenatal depression. Positive predictive value for recalling depression was 90.4%; however, negative predictive value for denying depression was only 53.8%. Participants accurately recalled psychotropic use but significantly underreported use of nonpsychotropic medications. CONCLUSIONS Studies using retrospective data collection may be susceptible to systematic recall bias with underreporting of maternal depression and use of nonpsychotropic agents during pregnancy.
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Affiliation(s)
- D J Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Flood M, Small R. Researching labour and birth events using health information records: methodological challenges. Midwifery 2008; 25:701-10. [PMID: 18321619 DOI: 10.1016/j.midw.2007.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES as little has been published about the particular challenges of researching labour and birth events using health information records (HIRs), this study aimed to describe the methodological and quality assurance (QA) issues encountered in reviewing such records for a study of health and recovery after operative birth, and to report on how these issues were tackled. DESIGN AND SETTING retrospective review of HIRs, recording details of the labour and birth events of 394 women for 630 confinements at 32 hospitals, chiefly situated in the State of Victoria, Australia. PARTICIPANTS three hundred and ninety-four women, a subset of a cohort of 534 women participating in the Health and Recovery after Operative Birth Project, who gave consent to review of their HIRs. METHODS a data abstraction form (DAF) and comprehensive accompanying study manual were designed, with the form's layout based on the HIR used by the hospital where the majority of confinements occurred. Amendments were made following piloting of the DAF. Three data abstractors were carefully trained for the task of reviewing records, and issues were dealt with as they arose at fortnightly meetings. Double data abstraction (cross-coding) exercises were conducted three times during the project and reported on for QA purposes. FINDINGS a number of limitations were found with labour and birth event data recorded in the HIRs. For example, maternal position in active second stage labour could not be established for 65% of births, documentation of onset of second stage was not accompanied by definitive evidence for second stage onset in 23.9% of cases, and maternal position at birth was missing in 26.4% of cases. Other relevant variables also proved problematic. For example, infant head circumference was not documented for 24.4% of births, and 52.9% of records did not document maternal height. Time and effort put into data abstractor training, and careful design and piloting of the DAF enabled both the form and data abstraction methods to be adapted following recognition of some of the limitations identified with the records, and also allowed subsequent analytic possibilities to be maximised. Cross-coding exercises also increased data abstractor reliability. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the likelihood of obtaining reliable data from HIRs is increased by a keen awareness of the challenges presented by the records themselves, careful training of staff, careful DAF design which allows for documentation of problems, conducting QA checks such as cross-coding exercises, and cautious reporting of findings with appropriate recognition of inherent limitations of the method.
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Affiliation(s)
- Margaret Flood
- Mother & Child Health Research, La Trobe University, 324-328 Little Lonsdale Street, Melbourne, Victoria 3000, Australia
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Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth 2008; 35:16-24. [PMID: 18307483 DOI: 10.1111/j.1523-536x.2007.00207.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND As cesarean rates increase worldwide, a debate has arisen over the relationship of method of delivery to maternal postpartum physical health. This study examines mothers' reports of their postpartum experiences with pain stratified by method of delivery. METHODS Listening to Mothers II was a survey of a total of 1,573 (200 telephone and 1,373 online) mothers aged 18 to 45 years, who had a singleton, hospital birth in 2005. They were interviewed by the survey research firm, Harris Interactive, in early 2006. Online respondents were drawn from an existing Harris panel. Telephone respondents were identified through a national telephone listing of new mothers. Results were weighted to reflect a United States national birthing population. Mothers were asked if they experienced any of eight postpartum conditions and the extent and the duration of the problem. Responses were compared by method of delivery. RESULTS The most frequently cited postpartum difficulty was among mothers with a cesarean section, 79 percent of whom reported experiencing pain at the incision in the first 2 months after birth, with 33 percent describing it as a major problem and 18 percent reporting persistence of the pain into the sixth month postpartum. Mothers with planned cesareans without labor were as likely as those with cesareans with labor to report problems with postpartum pain. Almost half (48%) of mothers with vaginal births (68% among those with instrumental delivery, 63% with episiotomy, 43% spontaneous vaginal birth with no episiotomy) reported experiencing a painful perineum, with 2 percent reporting the pain persisting for at least 6 months. CONCLUSIONS Substantial proportions of mothers reported problems with postpartum pain. Women experiencing a cesarean section or an assisted vaginal delivery were most likely to report that the pain persisted for an extended period.
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Affiliation(s)
- Eugene Declercq
- Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA 02118-2526, USA
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Brubaker L, Bradley CS, Handa VL, Richter HE, Visco A, Brown MB, Weber AM. Anal Sphincter Laceration at Vaginal Delivery. Obstet Gynecol 2007; 109:1141-5. [PMID: 17470596 DOI: 10.1097/01.aog.0000260958.94655.f2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the error rate for discharge coding of anal sphincter laceration at vaginal delivery in a cohort of primiparous women. METHODS As part of the Childbirth and Pelvic Symptoms study performed by the National Institutes of Health Pelvic Floor Disorders Network, we assessed the relationship between perineal lacerations and corresponding discharge codes in three groups of primiparous women: 393 women with anal sphincter laceration after vaginal delivery, 383 without anal sphincter laceration after vaginal delivery, and 107 after cesarean delivery before labor. Discharge codes for perineal lacerations were compared with data abstracted directly from the medical record shortly after delivery. Patterns of coding and coding error rates were described. RESULTS The coding error rate varied by delivery group. Of 393 women with clinically recognized and repaired anal sphincter lacerations by medical record documentation, 92 (23.4%) were coded incorrectly (four as first- or second-degree perineal laceration and 88 with no code for perineal diagnosis or procedure). One (0.3%) of the 383 women who delivered vaginally without clinically reported anal sphincter laceration was coded with a sphincter tear. No women in the cesarean delivery group had a perineal laceration diagnostic code. Coding errors were not related to the number of deliveries at each clinical site. CONCLUSION Discharge coding errors are common after delivery-associated anal sphincter laceration, with omitted codes representing the largest source of errors. Before diagnostic coding can be used as a quality measure of obstetric care, the clinical events of interest must be appropriately defined and accurately coded.
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Affiliation(s)
- Linda Brubaker
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, USA.
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Lobel M, DeLuca RS. Psychosocial sequelae of cesarean delivery: review and analysis of their causes and implications. Soc Sci Med 2007; 64:2272-84. [PMID: 17395349 DOI: 10.1016/j.socscimed.2007.02.028] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Indexed: 11/22/2022]
Abstract
A growing number of children around the world are being born by surgical delivery, or cesarean section. Concerns over rising rates of cesareans have focused on the risk of death and medical complications associated with surgical delivery but have largely neglected psychosocial and behavioral factors that affect and are affected by cesarean delivery. We summarize research which indicates that women who deliver by cesarean section have more negative perceptions of their birth experience, their selves, and their infants, exhibit poorer parenting behaviors, and may be at higher risk for postpartum mood disturbance compared to women delivering infants vaginally. We also review evidence that suggests that cesareans adversely influence women's moods and perceptions by restricting the control that they can exercise over birth and by violating expectations about childbirth. Based on these findings, we recommend ways to reduce the aversiveness of cesareans, offer recommendations for future research, and discuss implications of escalating rates of cesareans, including medically non-indicated cesareans by request.
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Affiliation(s)
- Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA.
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Hopkins LM, Caughey AB, Brown JS, Wassel Fyr CL, Creasman JM, Vittinghoff E, Van den Eeden SK, Thom DH. Concordance of chart abstraction and patient recall of intrapartum variables up to 53 years later. Am J Obstet Gynecol 2007; 196:233.e1-6. [PMID: 17346533 PMCID: PMC2882204 DOI: 10.1016/j.ajog.2006.10.899] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Revised: 09/01/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the concordance of patient recall compared with chart abstraction for distant intrapartum variables and to evaluate predictors of concordance. STUDY DESIGN A random sample from a cohort of diverse women aged 40-74 years. Intrapartum variables reported by participants were compared with the medical record. Outcomes were assessed for sensitivity, specificity, positive predictive value, and negative predictive value. Multivariate logistic regression was used to determine predictors of concordance of patient recall. RESULTS Four hundred one births among 178 women were analyzed. Recall of cesarean delivery had the highest concordance (sensitivity, 0.98; specificity, 1.00; positive predictive value, 1.00; negative predictive value, 0.99). Laceration that required repair had the lowest concordance (sensitivity, 0.37; specificity, 0.68; positive predictive value, 0.34; negative predictive value, 0.81). No variables predicted concordance of recall for all variables. CONCLUSION The concordance of patient recall to chart abstraction for intrapartum variables varies widely, although with a pattern of greater specificity and negative predictive value of recall. This should be kept in mind during patient interviews and in the performance of clinical research.
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Affiliation(s)
- Linda M Hopkins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco CA
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Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M. Incidence of fecal incontinence after childbirth. Obstet Gynecol 2007; 109:281-8. [PMID: 17267825 DOI: 10.1097/01.aog.0000254164.67182.78] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fecal incontinence is an embarrassing and disabling condition of which the epidemiology is poorly understood. Our goal is to estimate the incidence of fecal incontinence after childbirth. METHODS A population-based survey was mailed to all women who delivered a liveborn infant in the state of Oregon between April 2002 and September 2002. The survey estimated the incidence of fecal incontinence. Surveys were to be completed within 3-6 months postpartum. Women were considered to have fecal incontinence based upon the National Institute of Child Health and Human Development definition of fecal incontinence: recurring episodes of involuntary loss of stool or flatus. RESULTS Surveys were mailed to 21,824 eligible postpartum women. A total of 8,774 women responded (40%) to the survey, 2,569 (29%) of whom reported experiencing fecal incontinence since delivery. Almost half (46%) of all women with postpartum fecal incontinence reported incontinence of stool, and 38% reported exclusively incontinence of flatus. Approximately 46% reported onset of incontinence after delivery of their first child. Higher body mass index, longer pushing, forceps-assisted delivery, third- or fourth-degree laceration, and smoking were associated with severe fecal incontinence. CONCLUSION In this population-based study, more than one in four women reported fecal incontinence within 6 months of childbirth, with almost half reporting onset of symptoms after delivery of their first child. Four in 10 women reported loss of flatus or stool during intercourse. Given the burden of this condition, both in number and social impact coupled with the hesitancy of women to want to initiate this conversation, providers should ask women about symptoms of fecal incontinence during postpartum examinations. Additionally, these data suggest that there may be a benefit to extending postpartum follow-up visits beyond the typical 6-8 weeks to provide surveillance for potential incontinence. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology and Medical Informatics and Clinical Epidemiology, Center for Biostatistics and Bioinformatics, School of Nursing, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Quigley MA, Hockley C, Davidson LL. Agreement between hospital records and maternal recall of mode of delivery: Evidence from 12 391 deliveries in the UK Millennium Cohort Study. BJOG 2007; 114:195-200. [PMID: 17166217 DOI: 10.1111/j.1471-0528.2006.01203.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to measure the agreement between hospital records and maternal reporting of mode of delivery in a representative UK sample. DESIGN Population-based survey (Millennium Cohort Study). SETTING UK. POPULATION A total of 12,391 singleton infants born in 2000-2002. METHODS Mothers were interviewed when infants were approximately 9 months old. Information was collected by interview on many obstetric and perinatal factors including mode of delivery. Record linkage to the mother's delivery hospital records was undertaken in those who gave consent (90%). A matching record was found for 83%. Maternal report and hospital records were compared using mode of delivery classified into three (normal, assisted and caesarean) and six groups. Factors associated with disagreement between the two data sources were identified. MAIN OUTCOME MEASURE Proportion of records in which there was agreement between the two data sources. RESULTS Agreement between maternal report and hospital records was at least 94% using six mode of delivery groups and 98% using three groups. Much of the disagreement (57-63%, depending on country) was between forceps and ventouse, and between planned and emergency caesarean. Disagreement was more common in women whose babies were first born and in women not born in the UK. CONCLUSION Our study confirms that maternal reporting of mode of delivery is highly reliable. This is important for clinical staff caring for women and those conducting epidemiological studies. Additional data sources may be necessary to gather reliable data from ethnic minority women, particularly those born outside the UK, or to distinguish forceps from ventouse, or planned from emergency caesarean section.
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Affiliation(s)
- M A Quigley
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK.
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Connolly TJ, Litman HJ, Tennstedt SL, Link CL, McKinlay JB. The effect of mode of delivery, parity, and birth weight on risk of urinary incontinence. Int Urogynecol J 2007; 18:1033-42. [PMID: 17219253 DOI: 10.1007/s00192-006-0286-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/27/2006] [Indexed: 11/26/2022]
Abstract
To examine the relationship between symptoms of urinary incontinence (UI) and mode of delivery, parity, and birth weight, data were obtained from a population-based random sample of 3,205 black, Hispanic, and white women age 30-79 in the Boston Area Community Health Survey. Measures include UI symptoms [>or=3 (moderate/severe) Sandvik's severity index]; reproductive history [live birth(s), no live births, never pregnant]; mode of delivery for live births (>or=1 vaginal birth, cesarean delivery only); parity (1, 2, >or=3); and maximum birth weight of live births (<4,000 g, >or=4,000 g). Using logistic regression, women having >or=1 vaginal delivery had twice the odds of UI compared to women with no pregnancies (P = 0.002) or only cesarean deliveries (P = 0.032). There was no difference in odds of UI between cesarean delivery only and never pregnant, by parity or birth weight. Vaginal delivery contributes to risk of UI for black, Hispanic, and white women.
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Bø K, Backe-Hansen KL. Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports 2006; 17:480-7. [PMID: 17181768 DOI: 10.1111/j.1600-0838.2006.00599.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present investigation was to study prevalence of low back pain, pelvic girdle pain (PGP) and pelvic floor disorders during pregnancy and after childbirth in elite athletes. A postal questionnaire was sent to all elite athletes who had given birth registered with The Norwegian Olympic Committee and Confederation of Sports (n=40). Eighty age-matched women served as the control group. The response rates were 77.5% and 57.5% in the elite athletes and control groups, respectively. There were no significant differences in the prevalence of low back and PGP, urinary or fecal incontinence among elite athletes and controls at any time point. The prevalence of low back pain without radiation to the leg in elite athletes was 25.8%, 18.5%, 9.7% and 29% the year before pregnancy, during pregnancy, 6 weeks postpartum and at the time of completing the questionnaire, respectively. The prevalence of PGP was 0, 29.6%, 12.9% and 19.4%. Prevalence of stress urinary incontinence was 12.9%, 18.5%, 29% and 35.5%. None of the elite athletes had fecal incontinence at any time point. There were no differences in mode of delivery or birthweight between elite athletes and controls. The elite athletes had a significantly lower body mass index at 6 weeks postpartum and at present compared with the control group.
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Affiliation(s)
- K Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 2006; 107:1253-60. [PMID: 16738149 DOI: 10.1097/01.aog.0000218096.54169.34] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to assess the associations between parity, mode of delivery, and pelvic floor disorders. METHODS The prevalence of pelvic organ prolapse, stress urinary incontinence, overactive bladder, and anal incontinence was assessed in a random sample of women aged 25-84 years by using the validated Epidemiology of Prolapse and Incontinence Questionnaire. Women were categorized as nulliparous, vaginally parous, or only delivered by cesarean. Adjusted odds ratios and 95% confidence intervals (CIs) for each disorder were calculated with logistic regression, controlling for age, body mass index, and parity. RESULTS In the 4,458 respondents the prevalence of each disorder was as follows: 7% prolapse, 15% stress urinary incontinence, 13% overactive bladder, 25% anal incontinence, and 37% for any one or more pelvic floor disorders. There were no significant differences in the prevalence of disorders between the cesarean delivery and nulliparous groups. The adjusted odds of each disorder increased with vaginal parity compared with cesarean delivery: prolapse = 1.82 (95% CI 1.04-3.19), stress urinary incontinence = 1.81 (95% CI 1.25-2.61), overactive bladder = 1.53 (95% CI 1.02-2.29), anal incontinence = 1.72 (95% CI 1.27-2.35), and any one or more pelvic floor disorders = 1.85 (95% CI 1.42-2.41). Number-needed-to-treat analysis revealed that 7 women would have to deliver only by cesarean delivery to prevent one woman from having a pelvic floor disorder. CONCLUSION The risk of pelvic floor disorders is independently associated with vaginal delivery but not with parity alone. Cesarean delivery has a protective effect, similar to nulliparity, on the development of pelvic floor disorders when compared with vaginal delivery. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Emily S Lukacz
- Women's Pelvic Medicine Center, University of California, San Diego, La Jolla, California 92037, USA.
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Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyrén O, Hammarström M. Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol 2006; 194:75-81. [PMID: 16389012 DOI: 10.1016/j.ajog.2005.06.086] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 05/24/2005] [Accepted: 06/29/2005] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study was to identify obstetric risk factors for symptomatic prolapse. STUDY DESIGN This was a population-based case-control study of prolapse prevalence. RESULTS Four hundred fifty-four women with self-reported symptomatic pelvic organ prolapse who were identified among 5489 women who participated in a population survey (cases) and 405 control subjects without symptoms were selected randomly from the same survey. All cases and control subjects received a mailed questionnaire with 72 questions about factors that were suspected to be linked to risk and that included obstetric history. The response rate was 76%. Among parous women, the odds for symptomatic pelvic organ prolapse increased with number of childbirths and were 3.3-fold higher among mothers of 4 than among mothers of 1. Indices of excessive stretching and tearing during labor (vaginal lacerations or episiotomies) were associated with increased risk for symptomatic pelvic organ prolapse. Instrumental delivery with forceps or vacuum did not seem to increase the risk of symptomatic pelvic organ prolapse, nor did length of delivery or maternal age at time for delivery. Abdominal deliveries appeared to be protective; the age- and parity-adjusted odds ratio of symptomatic pelvic organ prolapse after > or =1 abdominal deliveries was 0.5 (95% CI, 0.3-0.9), relative to women who had had only vaginal deliveries. A positive association with child birth weight in unadjusted analyses disappeared after adjustments for attained age and parity of the mother. CONCLUSION Excessive stretching and tearing and multiple deliveries seem to be the main predisposing obstetric factors for symptomatic pelvic organ prolapse. Abdominal delivery emerged as a comparably strong protective factor.
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Affiliation(s)
- Gunilla Tegerstedt
- Department of Obstetrics and Gynaecology, Stockholm Söder Hospital, Stockholm, Sweden.
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Boreham MK, Richter HE, Kenton KS, Nager CW, Gregory WT, Aronson MP, Vogt VY, McIntire DD, Schaffer JI. Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life. Am J Obstet Gynecol 2005; 192:1637-42. [PMID: 15902170 DOI: 10.1016/j.ajog.2004.11.030] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65. STUDY DESIGN Consecutive women presenting for general gynecologic care were given a bowel function questionnaire. Women with AI were prompted to complete the Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL). RESULTS The cohort was composed of 457 women with a mean age of 39.9 +/- 11 years. AI prevalence was 28.4% (95% CI 24.4-32.8). After logistic regression, IBS (OR 3.22, 1.75-5.93), constipation (OR 2.11, 1.22-3.63), age (OR 1.05, 1.03-1.07), and BMI (OR 1.04, 1.01-1.08) remained significant risk factors. The mean FISI score was 20.4 +/- 12.4. Women with only flatal incontinence scored higher, and women with liquid loss scored lower on all 4 scales of the FIQL. CONCLUSION AI is prevalent in women seeking benign gynecologic care, and liquid stool incontinence has the greatest impact upon quality of life.
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Affiliation(s)
- Muriel K Boreham
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwesten Medical Center, Dallas, USA
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Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM. Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J 2005; 16:272-84. [PMID: 15856132 DOI: 10.1007/s00192-005-1314-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 03/07/2005] [Indexed: 11/29/2022]
Abstract
The epidemiology of prolapse and incontinence questionnaire (EPIQ) was developed to screen for female pelvic floor disorders (PFD). Content and face validity, reliability, internal consistency and criterion validity of the EPIQ to detect the presence of pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) is presented. Cronbach's alpha; Spearman's, kappa, intraclass correlations, factor analysis and Chi-Squared tests were used for analysis. Questions related to PFD proved internally consistent (alpha = 0.91) and reproducible (correlations >0.70) for all but three items on the EPIQ. Positive and negative predictive values of the EPIQ to detect PFD were: POP = 76% and 97%, SUI = 88% and 87%, OAB = 77% and 90% and AI = 61% and 91% respectively. EPIQ is a psychometrically validated screening instrument that may identify women at high risk of having pelvic floor disorders in large undiagnosed populations.
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Affiliation(s)
- Emily S Lukacz
- Female pelvic Medicine and Reconstructive Surgery - Department of Reproductive Medicine, University of California, San Diego, La Jolla, 92037, USA.
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Abstract
OBJECTIVE To examine interpretations of study information by women participating in ORACLE, a trial of antibiotics in preterm labour. DESIGN Questionnaire survey sent to women recruited to the ORACLE trial. SETTING United Kingdom. POPULATION A questionnaire was sent to 3074 ORACLE participants in a purposively selected sample of 55 collaborating maternity units, chosen to reflect a range of regions and of district general and teaching hospitals. METHODS Content analysis was applied to verbatim text provided in response to an open question. Responses were also compared with a framework based on key points about the purpose of ORACLE. Closed questions were analysed using descriptive statistics. MAIN OUTCOME MEASURES Participants' interpretations of the purpose of the study. RESULTS A response rate of 61% was achieved, and 1462 participants provided written answers to a specific question on why the study was being carried out. Content analysis suggested that the information leaflet was highly valued as a source of information about the trial. There was evidence that women's interpretations of the purpose of the trial were not identical to those that the investigators intended. Of the five key points about the trial described in the information leaflet, 400 (27%) participants reported one key point, 550 (38%) two key points, 229 (16%) three key points and 23 (1.5%) four key points. None reported five key points and it was not possible to classify 46 responses (3%). Vague, confused understanding or poor recall were evident in 204 (14%) of responses. CONCLUSION Although the ORACLE trial was run as a model of good practice at the time, this study suggests that it may not be possible to demonstrate full understanding of trial purpose and design by all participants. Emphasis should be on the provision of full information that involves consumers in its design and evaluation.
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Affiliation(s)
- Sara Kenyon
- Clinical Division of Obstetrics and Gynaecology, Department of Cancer Studies and Molecular Medicine, University of Leicester, UK
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Akkad A, Jackson C, Kenyon S, Dixon-Woods M, Taub N, Habiba M. Informed consent for elective and emergency surgery: questionnaire study. BJOG 2004; 111:1133-8. [PMID: 15383117 DOI: 10.1111/j.1471-0528.2004.00240.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate women's experience of giving consent to obstetric and gynaecological surgery and to examine differences between those undergoing elective and emergency procedures. DESIGN A prospective questionnaire study. SETTING A large teaching hospital. POPULATION 1006 consecutive patients undergoing elective or emergency surgery in obstetrics and gynaecology. METHODS Questionnaires were administered to women who had given consent to surgery following the introduction of national guidelines and consent form. Differences in responses between elective and emergency patients were assessed using frequencies, single and multivariable analyses. MAIN OUTCOME MEASURES Patients' experience and recall of the consent process, their overall satisfaction and their views on what is important for adequate consent. RESULTS There were significant differences between patients undergoing elective or emergency surgery. Patients undergoing emergency surgery were less likely to have read (OR 0.22) or understood (OR 0.40) the consent form, and were more likely to report feeling frightened by signing it (OR 2.52). They were more likely to report they felt they had no choice about signing the consent form (OR 2.11), and that they would have signed regardless of its content (OR 3.14). Overall, significantly more patients undergoing elective (80%) or emergency (63%) surgery reported satisfaction with the consent process. Patients were more likely to report satisfaction if they read (OR 1.80) and agreed with (OR 3.49) the consent form, and if someone checked that they understood (OR 3.09). CONCLUSION Patients' needs may not be adequately addressed by current guidelines for consent to treatment, particularly in emergency circumstances. The introduction of more complex forms and procedures appears to conflict with patients' need for personal communication and advocacy. The implications on the ethical and legal standing of consent are considerable.
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Affiliation(s)
- Andrea Akkad
- Division of Obstetrics and Gynaecology, University of Leicester, UK
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Abstract
BACKGROUND The prevalence, severity and risk factors of faecal incontinence in women in the community are incompletely characterized. AIM To develop and validate a self-report questionnaire (faecal incontinence and constipation assessment) to address these issues. METHOD Eighty-three women completed the instrument; 20 randomly selected patients answered the faecal incontinence and constipation assessment again 6 weeks later. A gastroenterologist also completed the faecal incontinence and constipation assessment in all 83 subjects after a detailed clinical assessment. Concurrent validity was evaluated by comparing the patient's self-report to a doctor interview for every question. Reproducibility was evaluated by a test-retest approach for every question. The severity of faecal incontinence was rated by incorporating the frequency and type of faecal incontinence, rectal urgency and use of sanitary devices. RESULTS The questionnaire was well-understood. Reproducibility [median kappa statistic, 0.80 (interquartile range: 0.66-0.90)]; and concurrent validity [0.59 (0.47-0.67)] were acceptable. For the index question on faecal incontinence, the kappa for reproducibility and concurrent validity was 0.90 and 0.95, respectively. The faecal incontinence severity score was also valid (kappa = 0.5). CONCLUSION The faecal incontinence and constipation assessment has excellent reproducibility and reasonable validity for assessing the presence, risk factors and severity of faecal incontinence and associated bowel disorders in women when compared against clinical assessment.
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Affiliation(s)
- A E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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