1
|
Butler SE, Wallace EM, Bisits A, Selvaratnam RJ, Davey MA. Induction of labor and cesarean birth in lower-risk nulliparous women at term: A retrospective cohort study. Birth 2024; 51:521-529. [PMID: 38173333 DOI: 10.1111/birt.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. METHODS Population-based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi-square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. RESULTS Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower-risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13-1.32)), 39 (aOR 1.31(1.23-1.40)), 40 (aOR 1.42(1.35-1.50)), and 41 weeks of gestation (aOR 1.43(1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. DISCUSSION For lower-risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only.
Collapse
Affiliation(s)
- Sarah E Butler
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Health, Melbourne, Victoria, Australia
| | - Andrew Bisits
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Roshan J Selvaratnam
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Etcheverry C, Betrán AP, de Loenzien M, Robson M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project. BMC Pregnancy Childbirth 2024; 24:67. [PMID: 38233792 PMCID: PMC10792793 DOI: 10.1186/s12884-024-06257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Improving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso. METHODS A cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women's characteristics. RESULTS A total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%. CONCLUSION Our results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women's preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care. TRIAL REGISTRATION The QUALI-DEC trial is registered on the Current Controlled Trials website ( https://www.isrctn.com/ ) under the number ISRCTN67214403.
Collapse
Affiliation(s)
- Camille Etcheverry
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
| | | | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
| |
Collapse
|
3
|
Bizuayehu HM, Harris ML, Chojenta C, Kiross GT, Loxton D. Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review. Midwifery 2023; 123:103704. [PMID: 37196576 DOI: 10.1016/j.midw.2023.103704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/11/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas. METHODS Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools. RESULTS Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals. CONCLUSIONS Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.
Collapse
Affiliation(s)
- Habtamu Mellie Bizuayehu
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
| | - Melissa L Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Catherine Chojenta
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| | - Girmay Tsegay Kiross
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | - Deborah Loxton
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia
| |
Collapse
|
4
|
Changes in maternal risk factors and their association with changes in cesarean sections in Norway between 1999 and 2016: A descriptive population-based registry study. PLoS Med 2021; 18:e1003764. [PMID: 34478464 PMCID: PMC8452082 DOI: 10.1371/journal.pmed.1003764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/20/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increases in the proportion of the population with increased likelihood of cesarean section (CS) have been postulated as a driving force behind the rise in CS rates worldwide. The aim of the study was to assess if changes in selected maternal risk factors for CS are associated with changes in CS births from 1999 to 2016 in Norway. METHODS AND FINDINGS This national population-based registry study utilizes data from 1,055,006 births registered in the Norwegian Medical Birth Registry from 1999 to 2016. The following maternal risk factors for CS were included: nulliparous/≥35 years, multiparous/≥35 years, pregestational diabetes, gestational diabetes, hypertensive disorders, previous CS, assisted reproductive technology, and multiple births. The proportion of CS births in 1999 was used to predict the number of CS births in 2016. The observed and predicted numbers of CS births were compared to determine the number of excess CS births, before and after considering the selected risk factors, for all births, and for births stratified by 0, 1, or >1 of the selected risk factors. The proportion of CS births increased from 12.9% to 16.1% (+24.8%) during the study period. The proportion of births with 1 selected risk factor increased from 21.3% to 26.3% (+23.5%), while the proportion with >1 risk factor increased from 4.5% to 8.8% (+95.6%). Stratification by the presence of selected risk factors reduced the number of excess CS births observed in 2016 compared to 1999 by 67.9%. Study limitations include lack of access to other important maternal risk factors and only comparing the first and the last year of the study period. CONCLUSIONS In this study, we observed that after an initial increase, proportions of CS births remained stable from 2005 to 2016. Instead, both the size of the risk population and the mean number of risk factors per birth continued to increase. We observed a possible association between the increase in size of risk population and the additional CS births observed in 2016 compared to 1999. The increase in size of risk population and the stable CS rate from 2005 and onward may indicate consistent adherence to obstetric evidence-based practice in Norway.
Collapse
|
5
|
Saroukhani S, Samms-Vaughan M, Lee M, Bach MA, Bressler J, Hessabi M, Grove ML, Shakespeare-Pellington S, Loveland KA, Rahbar MH. Perinatal Factors Associated with Autism Spectrum Disorder in Jamaican Children. J Autism Dev Disord 2020; 50:3341-3357. [PMID: 31538260 DOI: 10.1007/s10803-019-04229-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Mode of delivery, preterm birth, and low birth weight (LBW) are hypothesized to be associated with autism spectrum disorder (ASD) in the offspring. Using data from 343 ASD cases (2-8 years) and their age- and sex-matched typically developing controls in Jamaica we investigated these hypotheses. Our statistical analyses revealed that the parish of residence could modify the association between cesarean delivery and ASD, with a difference found in this relationship in Kingston parish [matched odds ratio (MOR) (95% confidence interval (CI)) 2.30 (1.17-4.53)] and other parishes [MOR (95% CI) 0.87 (0.48-1.59)]. Although the associations of LBW and preterm birth with ASD were not significant, we observed a significant interaction between LBW and the household socioeconomic status. These findings require replication.
Collapse
Affiliation(s)
- Sepideh Saroukhani
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.,Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Maureen Samms-Vaughan
- Department of Child & Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - MinJae Lee
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.,Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6410 Fannin Street, UT Professional Building Suite 1100.05, Houston, TX, 77030, USA
| | - MacKinsey A Bach
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.,Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Jan Bressler
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.,Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Megan L Grove
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.,Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | | | - Katherine A Loveland
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 77054, USA
| | - Mohammad H Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA. .,Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA. .,Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6410 Fannin Street, UT Professional Building Suite 1100.05, Houston, TX, 77030, USA.
| |
Collapse
|
6
|
Zaigham M, Hellström-Westas L, Domellöf M, Andersson O. Prelabour caesarean section and neurodevelopmental outcome at 4 and 12 months of age: an observational study. BMC Pregnancy Childbirth 2020; 20:564. [PMID: 32977763 PMCID: PMC7517619 DOI: 10.1186/s12884-020-03253-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background With prelabour caesarean section rates growing globally, there is direct and indirect evidence of negative cognitive outcomes in childhood. The objective of this study was to assess the short-term neurodevelopmental outcomes after prelabour caesarean section as compared to vaginally born infants. Methods We conducted a prospective, observational study of infants delivered by prelabour caesarean section at the Hospital of Halland, Halmstad, Sweden and compared their development with an historical group of infants born by non-instrumental vaginal delivery. Results Infants born by prelabour caesarean section were compared with a group of vaginally born infants. Follow-up assessments were performed at 4 and 12 months. Prelabour caesarean infants (n = 66) had significantly lower Ages and Stages Questionnaire, second edition (ASQ-II) scores in all domains (communication, gross motor, fine motor, problem solving and personal-social) at 4 months of age with an adjusted mean difference (95% CI) of − 20.7 (− 28.7 to − 12.6) in ASQ-II total score as compared to vaginally born infants (n = 352). These differences remained for gross-motor skills at the 12 month assessment, adjusted mean difference (95% CI) -4.7 (− 8.8 to − 0.7), n = 62 and 336. Conclusions Adverse neurodevelopmental outcomes in infants born by prelabour caesarean section may be apparent already a few months after birth. Additional studies are warranted to explore this relationship further.
Collapse
Affiliation(s)
- Mehreen Zaigham
- Department of Obstetrics & Gynaecology, Lund University and Skåne University Hospital, 205 01, Malmö, Sweden.
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Sindiani A, Rawashdeh H, Obeidat N, Zayed F, Alhowary AA. Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery. Ann Med Surg (Lond) 2020; 55:124-130. [PMID: 32477510 PMCID: PMC7251298 DOI: 10.1016/j.amsu.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. MATERIAL AND METHODS A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. RESULTS About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients' choice that our study revealed was "being informed about the complications of TOLAC". The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. CONCLUSION Proper counselling is a main factor that affected the patients' choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.
Collapse
Affiliation(s)
- Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Faheem Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ala”a A. Alhowary
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan
| |
Collapse
|
8
|
Visser L, Slaager C, Kazemier BM, Rietveld AL, Oudijk MA, de Groot C, Mol BW, de Boer MA. Risk of preterm birth after prior term cesarean. BJOG 2020; 127:610-617. [PMID: 31883402 PMCID: PMC7317970 DOI: 10.1111/1471-0528.16083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
Objective To determine the risk of overall preterm birth (PTB) and spontaneous PTB in a pregnancy after a caesarean section (CS) at term. Design Longitudinal linked national cohort study. Setting The Dutch Perinatal Registry (1999–2009). Population 268 495 women with two subsequent singleton pregnancies were identified. Methods A cohort study based on linked registered data from two subsequent pregnancies in the Netherlands. Main outcome measures The incidence of overall PTB and spontaneous PTB with subgroup analysis on gestational age at first delivery and type of CS (planned or unplanned). Results Of 268 495 women with a singleton first pregnancy who delivered at term, 15.76% (n = 42 328) had a CS. The incidence of PTB in the second pregnancy was 2.79% (n = 1182) in women with a previous CS versus 2.46% (n = 5570) in women with a previous vaginal delivery (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.07–1.21). This increased risk is mainly driven by an increased risk of spontaneous PTB after previous CS at term (aOR 1.50, 95% CI 1.38–1.70). Analysis for type of CS compared with vaginal delivery showed an aOR on spontaneous PTB of 1.86 (95% CI 1.58–2.18) for planned CS and an aOR of 1.40 (95% CI 1.24–1.58) for unplanned CS. Conclusions CS at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Tweetable abstract Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy. Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.
Collapse
Affiliation(s)
- L Visser
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - C Slaager
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - B M Kazemier
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A L Rietveld
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynaecology Located at the Meibergdreef, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Cjm de Groot
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - M A de Boer
- Department of Obstetrics and Gynaecology Located at the Boelelaan, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Morton R, Burton AE, Kumar P, Hyett JA, Phipps H, McGeechan K, de Vries BS. Cesarean delivery: Trend in indications over three decades within a major city hospital network. Acta Obstet Gynecol Scand 2020; 99:909-916. [PMID: 31976544 DOI: 10.1111/aogs.13816] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 01/08/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The cesarean delivery rate has been increasing globally in recent decades. The reasons for this are complex and subject to ongoing debate. Investigation of the indications for cesarean delivery and how these have changed over an extended period of time could provide insight into the reasons for changing obstetric practice. Our objective was to explore contributing factors to the increasing rate of cesarean delivery by examining the incidence of and indications for cesarean delivery over the past three decades at our institutions. MATERIAL AND METHODS We conducted a retrospective observational study of all cesarean deliveries, from 24 weeks' gestational age onwards, within an inner-city hospital network in Sydney, Australia, between August 1989 and December 2016. The primary outcome measures were the rates of and indications for emergency and planned cesarean delivery. We also examined our data within the Robson 10-Group Classification system. RESULTS There were 147 722 births over the study period, with 37 309 cesarean deliveries for an overall rate of 25.3%. The rate of cesarean delivery increased from 18.7% in 1989-1994 (8.7% emergency, 10% planned) to 30.4% in 2010-2016 (11.4% emergency, 19% planned). Emergency cesarean delivery for slow progress increased from 3.4% to 5.5% of all births (a relative increase of 62%) and other emergency cesareans mainly performed for suspected intrapartum fetal compromise increased from 5.2% to 5.6% (a relative increase of 8%). Previous uterine surgery (predominantly cesarean section) was the largest contributor to the increase in planned procedures from 3.8% to 9.0% of all births, and 29% of all cesarean deliveries. Primary cesarean delivery for planned antenatal fetal indications, previous pregnancy problems, multiple gestation and maternal choice all increased substantially in combined rate from 0.7% to 4.9%. Cesarean rates in Robson groups 6, 7 and 8 (term breech and multiple gestations) increased most over time. CONCLUSIONS The increased rate of cesarean delivery is mainly attributable to a greater number of procedures performed for slow progress in labor, breech presentation or repeat cesarean section.
Collapse
Affiliation(s)
- Rhett Morton
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Praneel Kumar
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jon Anthony Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Hala Phipps
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
10
|
Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study. Sleep Health 2020; 6:65-70. [DOI: 10.1016/j.sleh.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 11/20/2022]
|
11
|
Relationship between parity and the problems that appear in the postpartum period. Sci Rep 2019; 9:11763. [PMID: 31409871 PMCID: PMC6692385 DOI: 10.1038/s41598-019-47881-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/24/2019] [Indexed: 12/31/2022] Open
Abstract
Parity is associated with the incidence of problems in pregnancy, delivery and the puerperium. The influence of parity in the postpartum period has been poorly studied and the results are incongruous. The objective of this study was to identify the association between parity and the existence of distinct discomfort and problems during the postpartum period. Cross-sectional study with puerperal women in Spain. Data was collected on demographic and obstetric variables and maternal manifestations of discomfort and problems during the postpartum period. An ad hoc online questionnaire was used. Crude odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. 1503 primiparous and 1487 multiparous participated in the study. 53.4% (803) of the primiparous women affirmed to have feelings of sadness, as opposed to 36.2% (539) of multiparous women (aOR: 1.60; 95% CI: 1.35-1.89). 48.3% (726) of primiparous had lactation problems vs 24.7% (367) of multiparous (aOR: 2.46; 95% CI: 2.05-2.94). 37.2% (559) of primiparous reported anxiety, while the percentage in multiparous was 25.7% (382) (aOR: 1.34; 95% CI: 1.12-1.61). 22.2% (333) of primiparous had depressive symptoms, and 11.6% (172) of multiparous (aOR: 1.65; CI 95%: 1.31-2.06). Faecal incontinence was more present in primiparous than in multiparous, 6.5% (97) and 3.3% (49) respectively (aOR: 1.60; 95% CI: 1.07-2.38). Parity is associated with the presence of certain problems in the postpartum period. Thus, primiparous are more likely to have lactation problems, depressive symptoms, anxiety, sadness, and faecal incontinence.
Collapse
|
12
|
Xie M, Lao TT, Du M, Sun Q, Qu Z, Ma J, Song X, Wang M, Xu D, Ma R. Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China. J Obstet Gynaecol Res 2019; 45:1866-1875. [PMID: 31264353 DOI: 10.1111/jog.14048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. METHODS This retrospective single-center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. RESULTS In this 12-year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. CONCLUSION AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy.
Collapse
Affiliation(s)
- Min Xie
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Mingyu Du
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qian Sun
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zaiqing Qu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Junnan Ma
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinyan Song
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingfang Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongqiong Xu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Runmei Ma
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Obstetrics and Gynaecology, Kunming Angel Women and Children's Hospital, Kunming, China
| |
Collapse
|
13
|
Wong Shee A, Nagle C, Corboy D, Versace VL, Robertson C, Frawley N, McKenzie A, Lodge J. Implementing an intervention to promote normal labour and birth: A study of clinicians' perceptions. Midwifery 2018; 70:46-53. [PMID: 30579098 DOI: 10.1016/j.midw.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/31/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. DESIGN This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. PARTICIPANTS Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. FINDINGS Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (β = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. KEY CONCLUSIONS This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. IMPLICATIONS FOR PRACTICE Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.
Collapse
Affiliation(s)
- Anna Wong Shee
- Ballarat Health Services, Ballarat, Australia; Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia.
| | - Cate Nagle
- James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814, Australia; Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia
| | | | - Vincent L Versace
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | | | | | | | - Julie Lodge
- Ballarat Health Services, Ballarat, Australia
| |
Collapse
|
14
|
Chi C, Pang D, Aris IM, Teo WT, Li SW, Biswas A, Yong EL, Chong YS, Tan K, Kramer MS. Trends and predictors of cesarean birth in Singapore, 2005-2014: A population-based cohort study. Birth 2018; 45:399-408. [PMID: 29453821 DOI: 10.1111/birt.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rates of cesarean birth have continued to rise in many high-income countries. We examined the temporal trends and predictors of cesarean birth in Singapore. METHODS Linked hospitalization and Birth Registry data were used to examine all live births to Singaporean citizens and permanent residents between January 1, 2005 and December 31, 2014 (n = 342 932 births). We calculated cesarean rates and age-adjusted average annual percent change (AAPC) in those rates and used sequential multivariable regression modeling to assess the contribution of changes in predictors to the change in cesarean rates over time. RESULTS The overall cesarean rate in Singapore rose from 32.2% in 2005 to 37.4% in 2014. Among singleton, cephalic, term pregnancies, the two major predictions of cesarean were nulliparity and previous cesarean, each accounting for just over one-third of all cesareans. Higher AAPC was observed in nulliparous women of Indian ethnicity (0.74% [95% confidence interval 0.68-0.80]) compared with Chinese (0.62% [0.60-0.65]) or Malay women (0.63% [0.59-0.68]), and in women who delivered in private hospitals (0.62% [0.60-0.64]) compared with those delivered under subsidized care in public hospitals (0.58% [0.52-0.63]). Parity and education had the largest influences on cesarean birth trend (attenuation of AAPC from 0.62% [0.59-0.66] to 0.39% [0.38-0.40] after adjustment). CONCLUSION Cesarean birth has continued to rise at a steady rate in Singapore. Strategies to curb this temporal increase include avoidance of medically unnecessary primary cesarean and attempts at trial of labor and vaginal delivery among women with a history of prior cesarean.
Collapse
Affiliation(s)
- Claudia Chi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Izzuddin M Aris
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Wei Ting Teo
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Sarah Weiling Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kelvin Tan
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Michael S Kramer
- Faculty of Medicine, Pediatrics and Epidemiology and Biostatistics, McGill University, Montreal, Canada
| |
Collapse
|
15
|
Cesarean delivery rate and staffing levels of the maternity unit. PLoS One 2018; 13:e0207379. [PMID: 30485335 PMCID: PMC6261590 DOI: 10.1371/journal.pone.0207379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates. METHODS This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models. RESULTS Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively. CONCLUSION Staffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.
Collapse
|
16
|
Mola GDL, Unger HW. Strategies to reduce and maintain low perinatal mortality in resource-poor settings - Findings from a four-decade observational study of birth records from a large public maternity hospital in Papua New Guinea. Aust N Z J Obstet Gynaecol 2018; 59:394-402. [PMID: 30209806 DOI: 10.1111/ajo.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/13/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND In many low- to middle-income countries (LMIC) assisted vaginal birth rates have fallen, while caesarean section (CS) rates have increased, with potentially deleterious consequences for maternal and perinatal mortality. AIMS To review birth mode and perinatal mortality in a large LMIC hospital with strict labour management protocols and expertise in vacuum extraction. MATERIALS AND METHODS We conducted a retrospective observational study at Port Moresby General Hospital in Papua New Guinea. Birth registers from 1977 to 2015 (39 years) were reviewed. Overall and modified (fresh stillbirths and early neonatal deaths ≥500 g) perinatal mortality rates (PMRs) were calculated by birthweight/birth mode. RESULTS There were 365 056 births (5215 in 1977; 14 927 in 2015), of which 14 179 (3.9%) were vacuum extractions, 609 (0.2%) forceps births and 14 747 (4.4%) CS (increase from 2% to 5%). The failure rate of vacuum extraction was 2.5% (range 0.5-5.4%). Symphysiotomy was employed for 184 births. From 1989 to 2015, the modified mean PMR for babies ≥2500 g was 8.1/1000 births (range 5.6-12.1; 6.9 in 2015), 9.1/1000 for babies ≥1500 g (7.3-14.8; 9.1 in 2015) and 7.5/1000 (0-21.7; 9.0 in 2015) for vacuum extractions (98% were ≥2500 g). The overall PMR for these years was 29.7/1000 births. CONCLUSIONS In an LMIC with rapidly increasing birth numbers a comparatively low PMR can be achieved while maintaining low CS rates. This may be in part accomplished through strict use of second-stage protocols, perinatal audit, and supportive training that promotes judicious and proficient use of vacuum extraction and CS.
Collapse
Affiliation(s)
- Glen D L Mola
- Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.,Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Holger W Unger
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Victoria Hospital, Kirkcaldy, UK
| |
Collapse
|
17
|
Filardi T, Tavaglione F, Di Stasio M, Fazio V, Lenzi A, Morano S. Impact of risk factors for gestational diabetes (GDM) on pregnancy outcomes in women with GDM. J Endocrinol Invest 2018; 41:671-676. [PMID: 29150756 DOI: 10.1007/s40618-017-0791-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/30/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE In this study, we evaluated the impact of risk factors for gestational diabetes on clinical/biochemical parameters and maternal/fetal outcomes. METHODS One hundred eighty-three (n 183) women (age 33.8 ± 5.5 years, 59% Caucasians, 41% non-Caucasians) with gestational diabetes were included in the study. Anamnestic information, anthropometric and laboratory parameters, and maternal and fetal outcomes at delivery were collected. RESULTS Insulin therapy prevalence was higher in Asians vs Caucasians (p = 0.006), despite lower pre-pregnancy BMI in Asians (p = 0.0001) and in pre-pregnancy overweight vs normal weight patients (p = 0.04). Insulin-treated patients had higher fasting OGTT glucose than patients on diet therapy (p = 0.003). In multivariate analysis, Asian ethnicity, age ≥ 35 years and pre-pregnancy BMI ≥ 25 kg/m2 were independent predictors of insulin therapy. Cesarean section occurred more in women aged ≥ 35 years than < 35 years (p = 0.02). Duration of pregnancy and age showed inverse correlation (r - 0.3 p = 0.013). Week of delivery was lower in patients ≥ 35 years vs patients < 35 years (p = 0.013). Fasting OGTT glucose was higher in overweight than in normal weight patients (p = 0.016). 1-h OGTT glucose was lower in obese vs normal weight (p = 0.03) and overweight patients (p = 0.03). Prevalence of prior gestational diabetes was higher in overweight/obese women (p = 0.002). CONCLUSIONS Ethnicity, age, and BMI have the heaviest impact on pregnancy outcomes.
Collapse
Affiliation(s)
- T Filardi
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Tavaglione
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Di Stasio
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - V Fazio
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Morano
- Department of Experimental Medicine, Policlinico Umberto I, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy.
| |
Collapse
|
18
|
Yip BHK, Leonard H, Stock S, Stoltenberg C, Francis RW, Gissler M, Gross R, Schendel D, Sandin S. Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births. Int J Epidemiol 2018; 46:429-439. [PMID: 28017932 DOI: 10.1093/ije/dyw336] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/16/2022] Open
Abstract
Background The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did not differentiate between emergency and planned CS. Methods Using population-based registries of four Nordic countries and Western Australia, our study population included 4 987 390 singletons surviving their first year of life, which included 671 646 CS deliveries and 31 073 ASD children. We used logistic regression to estimate odds ratios (OR) and their 95% confidence intervals (CI) for CS, adjusted for gestational age, site, maternal age and birth year. Stratified analyses were conducted by both gestational age subgroups and by week of gestation. We compared emergency versus planned CS to investigate their potential difference in the risk of ASD. Results Compared with vaginal delivery, the overall adjusted OR for ASD in CS delivery was 1.26 (95% CI 1.22-1.30). Stratified ORs were 1.25 (1.15-1.37), 1.16 (1.09-1.23), 1.34 (1.28-1.40) and 1.17 (1.04-1.30) for subgroups of gestational weeks 26-36, 37-38, 39-41 and 42-44, respectively. CS was significantly associated with risk of ASD for each week of gestation, from week 36 to 42, consistently across study sites (OR ranged 1.16-1.38). There was no statistically significant difference between emergency and planned CS in the risk of ASD. Conclusion Across the five countries, emergency or planned CS is consistently associated with a modest increased risk of ASD from gestational weeks 36 to 42 when compared with vaginal delivery.
Collapse
Affiliation(s)
- Benjamin Hon Kei Yip
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helen Leonard
- Telethon Kids Institute.,Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
| | - Sarah Stock
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.,Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard W Francis
- Telethon Kids Institute.,Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Child Psychiatry, Turku University and Turku University Hospital, Turku, Finland
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Diana Schendel
- Department of Public Health, Institute of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark.,Department of Economics and Business, National Centre for Register-based Research, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus University, Aarhus, Denmark
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA and
| |
Collapse
|
19
|
Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. HEALTH ECONOMICS REVIEW 2018; 8:7. [PMID: 29525909 PMCID: PMC5845483 DOI: 10.1186/s13561-018-0190-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/02/2018] [Indexed: 05/23/2023]
Abstract
Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.
Collapse
Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
| |
Collapse
|
20
|
Identifying better systems design in Australian maternity care: a Boundary Critique analysis. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
21
|
Polidano C, Zhu A, Bornstein JC. The relation between cesarean birth and child cognitive development. Sci Rep 2017; 7:11483. [PMID: 28904336 PMCID: PMC5597642 DOI: 10.1038/s41598-017-10831-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022] Open
Abstract
This is the first detailed study of the relation between cesarean birth and child cognitive development. We measure differences in child cognitive performance at 4 to 9 years of age between cesarean-born and vaginally-born children (n = 3,666) participating in the Longitudinal Study of Australian Children (LSAC). LSAC is a nationally representative birth cohort surveyed biennially. Using multivariate regression, we control for a large range of confounders related to perinatal risk factors and the socio-economic advantage associated with cesarean-born children. Across several measures, we find that cesarean-born children perform significantly below vaginally-born children, by up to a tenth of a standard deviation in national numeracy test scores at age 8–9. Estimates from a low-risk sub-sample and lower-bound analysis suggest that the relation is not spuriously related to unobserved confounding. Lower rates of breastfeeding and adverse child and maternal health outcomes that are associated with cesarean birth are found to explain less than a third of the cognitive gap, which points to the importance of other mechanisms such as disturbed gut microbiota. The findings underline the need for a precautionary approach in responding to requests for a planned cesarean when there are no apparent elevated risks from vaginal birth.
Collapse
Affiliation(s)
- Cain Polidano
- Melbourne Institute of Applied Economic and Social Research, Level 5, Faculty of Business and Economics Building, University of Melbourne, Carlton, 3010, Australia.
| | - Anna Zhu
- Melbourne Institute of Applied Economic and Social Research, Level 5, Faculty of Business and Economics Building, University of Melbourne, Carlton, 3010, Australia
| | - Joel C Bornstein
- Department of Physiology, Level 6, North Wing, Medical Building, University of Melbourne, Carlton, 3010, Australia
| |
Collapse
|
22
|
Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø. Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study. BJOG 2017; 125:202-210. [PMID: 28516500 DOI: 10.1111/1471-0528.14750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes. DESIGN Population-based pregnancy cohort study. SETTING The Norwegian Mother and Child Cohort Study. SAMPLE A total of 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous. METHODS Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway. MAIN OUTCOME MEASURES Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery. RESULTS Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% CI 9.4-10.7) compared with women with a previous live birth (mean 6.0; 95% CI 5.8-6.2) and previously nulliparous women (mean 6.3; 95% CI 6.1-6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3-5.0) compared with women with previous live birth and 3.7 (1.8-7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, whereas dread of childbirth was not a significant mediator for elective CS. CONCLUSIONS Women pregnant after stillbirth were more ample users of healthcare services and more often had induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. TWEETABLE ABSTRACT Women pregnant after stillbirth are ample users of healthcare services and interventions during childbirth.
Collapse
Affiliation(s)
- I K Gravensteen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - E-M Jacobsen
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - P M Sandset
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - L B Helgadottir
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - I Rådestad
- Sophiahemmet University, Stockholm, Sweden
| | - L Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ø Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
23
|
Perinatal and social factors predicting caesarean birth in a 2004 Australian birth cohort. Women Birth 2017; 30:506-510. [PMID: 28688791 DOI: 10.1016/j.wombi.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The proportion of babies born by caesarean section in Australia has almost doubled over the last 25 years. Factors known to contribute to caesarean such as higher maternal age, mothers being overweight or obese, or having had a previous caesarean do not completely account for the increased rate and it is clear that other influences exist. AIM To identify previously unsuspected risk factors associated with caesarean using nationally-representative data from the Longitudinal Study of Australian Children. METHODS Data were from the birth cohort, a long-term prospective study of approximately 5000 children that includes richly-detailed data regarding maternal health and exposures during pregnancy. Logistic regression was used to examine the contribution of a wide range of pregnancy, birth and social factors to caesarean. FINDINGS 28% of 4862 mothers were delivered by caesarean. The final adjusted analyses revealed that use of diabetes medication (OR=3.1, 95% CI=1.7-5.5, p<0.001) and maternal mental health problems during pregnancy (OR=1.3, CI=1.1-1.6, p=0.003) were associated with increased odds of caesarean. Young maternal age (OR=0.6, CI=0.5-0.7, p<0.001), having two or more children (OR=0.7, CI=0.6-0.9, p<0.001), and fathers having an unskilled occupation (OR=0.7, CI=0.6-1.0, p=0.036) were associated with reduced odds of caesarean. CONCLUSION Our findings raise the prospect that the effect of additional screening and support for maternal mental health on caesarean rate should be subject of prospective study.
Collapse
|
24
|
Robson SJ, Costa CM. Thirty years of the World Health Organization's target caesarean section rate: time to move on. Med J Aust 2017; 206:181-185. [DOI: 10.5694/mja16.00832] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/28/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Stephen J Robson
- Centenary Hospital for Women and Children, ANU Medical School, Canberra, ACT
| | - Caroline M Costa
- Department of Obstetrics and Gynaecology, James Cook University School of Medicine, Cairns, QLD
| |
Collapse
|
25
|
Thompson F, Dempsey K, Mishra G. Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study. BJOG 2016; 123:1814-23. [PMID: 26777399 DOI: 10.1111/1471-0528.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine trends in caesarean section deliveries and factors associated with these trends for Indigenous and non-Indigenous mothers. DESIGN Total population-based study. SETTING Northern Territory of Australia, 1986-2012. POPULATION Pregnancies among Northern Territory residents, limited to singleton live births with cephalic presentations delivered at 37-42 weeks' gestation (n = 78 561). METHODS Descriptive analyses of demographic and obstetric risk factors. Poisson regression with robust variance to estimate the likelihood of caesarean delivery with and without labour compared with vaginal delivery, over time and between Indigenous and non-Indigenous mothers, adjusting for risk factors. MAIN OUTCOME MEASURES Trends in caesarean sections and risk of caesarean delivery compared with vaginal delivery. RESULTS The total rate of caesarean deliveries in the Northern Territory increased between 1986 and 2012. From the year 2000, the rise was driven by increases in caesareans with labour among nulliparous mothers and no labour caesareans among multiparous mothers. Increases in demographic and obstetric risk factors explained the rise in caesareans with labour among nulliparous Indigenous mothers, whereas other unmeasured variables contributed to the rise among non-Indigenous mothers. Increases in previous caesarean delivery contributed to the rise in all caesareans among multiparous mothers. Following adjustment, the risk of Indigenous nulliparous mothers having a caesarean with labour was 47% greater than for non-Indigenous nulliparous mothers [adjusted risk ratio 1.47 (95% CI 1.34-1.60)]. CONCLUSIONS Increases in demographic and obstetric risk factors partially explained the increase in caesarean rates in the Northern Territory and the contribution of these factors differed between Indigenous and non-Indigenous mothers. TWEETABLE ABSTRACT Caesarean section rates increased between 1986 and 2012 in the Northern Territory of Australia.
Collapse
Affiliation(s)
- F Thompson
- Department of Health, Northern Territory Government, Darwin, NT, Australia. .,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia. .,The Centre for Chronic Disease Prevention, The Cairns Institute, James Cook University, Cairns, Qld, Australia.
| | - K Dempsey
- Department of Health, Northern Territory Government, Darwin, NT, Australia.,Australia Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - G Mishra
- School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia
| |
Collapse
|
26
|
‘What about the mother?’ Women׳s and caregivers׳ perspectives on caesarean birth in a low-resource setting with rising caesarean section rates. Midwifery 2015; 31:713-20. [DOI: 10.1016/j.midw.2015.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/11/2015] [Accepted: 03/20/2015] [Indexed: 01/15/2023]
|
27
|
Einarsdóttir K, Ball S, Pereira G, Griffin C, Jacoby P, de Klerk N, Leonard H, Stanley FJ. Changes in Caesarean Delivery Rates in Western Australia from 1995 to 2010 by Gestational Age at Birth. Paediatr Perinat Epidemiol 2015; 29:290-8. [PMID: 26111442 DOI: 10.1111/ppe.12202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The caesarean delivery rate in the developed world has been increasing. It is not well understood how caesarean delivery rates have changed by gestational age at birth in Western Australia, particularly in relation to the introduction of the early-term delivery guidelines in Australia in 2006. METHODS Data from the Western Australian Midwives Notification System were used to identify 193,136 singletons born to primiparous women at 34-42 weeks' gestation during 1995-2010. Caesarean delivery rates were calculated by gestational age group (34-36 weeks, 37-38 weeks, and 39-42 weeks) and stratified into pre-labour and in-labour caesarean delivery. The average annual percent change (AAPC) for the caesarean delivery rates was calculated using joinpoint regression. Log-binomial regression was used to estimate the risk of having a caesarean delivery while adjusting for maternal and antenatal factors. RESULTS Caesarean delivery rates rose steadily from 1995 to 2005 (AAPC = 5.9%, [95% confidence interval (CI) 4.9, 6.9]), but stabilised since then (AAPC = 0.9%, [95% CI -1.9, 3.8]). The rate of in-labour caesarean deliveries rose consistently from 1995 to 2010 across all gestational age groups. The pre-labour caesarean delivery rate rise was most dominant at 37-38 weeks' gestation from 1995 to 2005 (AAPC = 6.8%, [95% CI 5.4, 8.2]), but declined during 2006-10 (AAPC = -4.5, [95% CI -6.7, -2.3]), while at the same time the rate at 39-42 weeks rose slightly. CONCLUSIONS The rise in pre-labour caesarean deliveries during 1995-2005 occurred predominantly at 37-38 weeks' gestation, but declined again from 2006 to 2010. This suggests that the recently developed Australian early-term delivery guidelines may have had some success in reducing early-term deliveries in Western Australia.
Collapse
Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Centre of Public Health Sciences and Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Stephen Ball
- Pre-Hospital, Resuscitation & Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery & Paramedicine, Curtin University, Bentley, WA, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Center for Perinatal Pediatric and Environmental Epidemiology, School of Medicine, Yale University, New Haven, CT
| | | | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
28
|
Robinson M, Pennell CE, McLean NJ, Tearne JE, Oddy WH, Newnham JP. Risk Perception in Pregnancy. EUROPEAN PSYCHOLOGIST 2015. [DOI: 10.1027/1016-9040/a000212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite huge advances in obstetric management and technology in recent decades, there has not been an accompanying decrease in patients’ perception of risk during pregnancy. The aim of this paper is to examine the context of risk perception in pregnancy and what practitioners can do to manage it. The modern pregnancy may induce a heightened perception of risk due to increased prenatal testing and surveillance, medico-legal complexity, fertility treatment, and the increasing use of the internet and social media as a source of information. The consequences of an inflated perception of risk during pregnancy include stress, anxiety, and depression, and these issues may have long-lasting implications for patients, their babies, and their families. There are numerous resilience and vulnerability factors that can help care providers identify those who may be predisposed to increased risk perception in pregnancy, and there is a role for both obstetric care providers and psychologists engaged in obstetric settings to manage and reduce risk perception in patients where possible. Ultimately, the medical management of risk during pregnancy can be complex but a thorough understanding of the social and emotional context can assist providers to support their patients through both high- and low-risk pregnancy and birth.
Collapse
Affiliation(s)
- Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Craig E. Pennell
- School of Women’s and Infants’ Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Australia
| | - Neil J. McLean
- School of Psychology, The University of Western Australia, Perth, Australia
| | - Jessica E. Tearne
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Psychology, The University of Western Australia, Perth, Australia
| | - Wendy H. Oddy
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - John P. Newnham
- School of Women’s and Infants’ Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Australia
| |
Collapse
|
29
|
M'soka NC, Mabuza LH, Pretorius D. Cultural and health beliefs of pregnant women in Zambia regarding pregnancy and child birth. Curationis 2015; 38. [PMID: 26017848 PMCID: PMC6091768 DOI: 10.4102/curationis.v38i1.1232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Health beliefs related to pregnancy and childbirth exist in various cultures globally. Healthcare practitioners need to be aware of these beliefs so as to contextualise their practice in their communities. OBJECTIVES To explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. METHOD This was a descriptive, cross-sectional survey of women attending antenatal care(n = 294) who were selected by systematic sampling. A researcher-administered questionnaire was used for data collection. RESULTS Results indicated that women attending antenatal care at Chawama Clinic held certain beliefs relating to diet, behaviour and the use of medicinal herbs during pregnancy and post-delivery. The main beliefs on diet related to a balanced diet, eating of eggs, okra, bones, offal, sugar cane, alcohol consumption and salt intake. The main beliefs on behaviour related to commencement of antenatal care, daily activities, quarrels, bad rituals, infidelity and the use of condoms during pregnancy. The main beliefs on the use of medicinal herbs were on their use to expedite the delivery process, to assist in difficult deliveries and for body cleansing following a miscarriage. CONCLUSION Women attending antenatal care at the Chawama Clinic hold a number of beliefs regarding pregnancy and childbirth. Those beliefs that are of benefit to the patients should be encouraged with scientific explanations, whilst those posing a health risk should be discouraged respectfully.
Collapse
Affiliation(s)
| | - Langalibalele H Mabuza
- Department of Family Medicine, Sefako Makgatho Health Sciences University (formerly known as University of Limpopo, Medunsa).
| | | |
Collapse
|
30
|
Cho GJ, Kim LY, Min KJ, Sung YN, Hong SC, Oh MJ, Seo HS, Kim HJ. Prior cesarean section is associated with increased preeclampsia risk in a subsequent pregnancy. BMC Pregnancy Childbirth 2015; 15:24. [PMID: 25879208 PMCID: PMC4335660 DOI: 10.1186/s12884-015-0447-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the impact of a prior cesarean section on preeclampsia risk in a subsequent pregnancy. Methods Study data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2006–2010. Patients who had their first delivery in 2006 and subsequent delivery between 2007 and 2010 in Korea were enrolled. The overall incidence of preeclampsia during the second pregnancy was estimated and to evaluate the risk of preeclampsia in the second pregnancy, a model of multivariate logistic regression analysis was performed with preeclampsia as the final outcome Results The risk of preeclampsia in any pregnancy was 2.17%; the risk in the first pregnancy was 2.76%, and that in the second pregnancy was 1.15%. During the second pregnancy, the risk of preeclampsia was 13.30% for women who had developed preeclampsia in their first pregnancy and 0.85% for those who had not. In the entire population, prior cesarean section was associated with preeclampsia risk in their subsequent pregnancy (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.13–1.41). Among women with and without preeclampsia in their first pregnancy, a prior cesarean section was associated with preeclampsia risk in their second pregnancy (OR, 1.35; 95% CI, 1.09–1.67; OR, 1.23; 95% CI, 1.08–1.40, respectively). Conclusions Our study showed that cesarean section in a first pregnancy was associated with increased preeclampsia risk in the second pregnancy. These results provide physicians with a preeclampsia risk evaluation method for a second pregnancy that they may aid counseling in patients.
Collapse
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Log Young Kim
- The Health Insurance Review and Assessment Service of Korea, Seoul, Korea.
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Ye Na Sung
- The Health Insurance Review and Assessment Service of Korea, Seoul, Korea.
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Hong-Seog Seo
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. .,The Health Insurance Review and Assessment Service of Korea, Seoul, Korea.
| |
Collapse
|
31
|
Martin T, Fenwick J, Hauck Y, Butt J, Wood J. Providing Information and Support to Postnatal Women Who Have Experienced a Cesarean Section: A Pilot Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND:Australia has a low uptake of vaginal birth after cesarean despite the evidence that this is best practice. A new midwifery-led service was introduced with the overall goal to improve the quality of care offered to women and their families that have experienced a cesarean section. The postnatal arm of the service targeted women who had experienced their first cesarean section. The service included an early hospital postnatal visit from the next birth after cesarean (NBAC) midwives whereby women were given an opportunity to share their experiences. Women were subsequently given an evidence-based resource on birth after cesarean as well as the midwives’ contact details should they wish to contact them anytime during the first 6 weeks after birth.AIM:To evaluate the effectiveness the postnatal arm of the service on women’s birth mode intentions in a subsequent pregnancy and their levels of childbirth fear and self-efficacy at 12 weeks postpartum.METHOD:Comparative descriptive design (pre-/posttest). Fifty-three women receiving standard care (comparison group) and 50 women receiving the NBAC postnatal service completed a childbirth fear measure (Wijma Delivery Expectancy/Experience Questionnaire Version B), a self-efficacy scale (New General Self-Efficacy Scale [NGSE]), and were asked their preferred birth mode for a subsequent pregnancy. Data was collected at 3–5 days and 12 weeks postpartum. Descriptive statistics and chi-square analysis were used to test several formulated hypotheses.RESULTS:Although women who received a visit from the NBAC midwives were more likely to state they intended to birth vaginally in a next pregnancy, compared to women receiving standard care, the finding was not significant (p= .272). Likewise, there was no difference in childbirth fear with both groups of women having high levels of childbirth fear (comparison [86.27] and NBAC group [84.67]). Comparison of self-efficacy items between groups at 12 weeks were not significant aside from NBAC women feeling more confident with their ability to complete tasks well (p= .005).CONCLUSION:Although the findings of this small study were not statistically significant, the simple and timely nature of the intervention seems worthy of further consideration and investigation. In addition, research needs to continue to focus on how midwives can better meet women’s emotional needs in the postpartum period helping to ameliorate women’s fear and build confidence for their next pregnancy and birth experience.
Collapse
|
32
|
Noyman-Veksler G, Herishanu-Gilutz S, Kofman O, Holchberg G, Shahar G. Post-natal psychopathology and bonding with the infant among first-time mothers undergoing a caesarian section and vaginal delivery: Sense of coherence and social support as moderators. Psychol Health 2014; 30:441-55. [DOI: 10.1080/08870446.2014.977281] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
33
|
Chung SH, Seol HJ, Choi YS, Oh SY, Kim A, Bae CW. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors. J Korean Med Sci 2014; 29:1341-52. [PMID: 25368486 PMCID: PMC4214933 DOI: 10.3346/jkms.2014.29.10.1341] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/02/2014] [Indexed: 12/04/2022] Open
Abstract
Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.
Collapse
Affiliation(s)
- Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong-Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Abstract
INTRODUCTION Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. METHOD A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. CONCLUSION Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.
Collapse
Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| |
Collapse
|
35
|
Naidoo N, Moodley J. Rising rates of Caesarean sections: an audit of Caesarean sections in a specialist private practice. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
36
|
Henriksen L, Schei B, Vangen S, Lukasse M. Sexual violence and mode of delivery: a population-based cohort study. BJOG 2014; 121:1237-44. [DOI: 10.1111/1471-0528.12923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- L Henriksen
- Section of Obstetrics; Department for Women's and Children's Health; Oslo University Hospital; Oslo Norway
| | - B Schei
- Department of Public Health and General Practice; Faculty of Medicine; The Norwegian University of Science and Technology; Trondheim Norway
- Department of Obstetrics and Gynaecology; St Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - S Vangen
- National Resource Centre for Women's Health; Department for Women's and Children's Health; Oslo University Hospital; Oslo Norway
| | - M Lukasse
- Department of Public Health and General Practice; Faculty of Medicine; The Norwegian University of Science and Technology; Trondheim Norway
- Department of Health; Nutrition and Management; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| |
Collapse
|
37
|
Al Rifai R. Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002-2012. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:195-209. [PMID: 25276577 PMCID: PMC4168617 DOI: 10.9745/ghsp-d-14-00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/21/2014] [Indexed: 12/02/2022]
Abstract
Cesarean deliveries nationally in Jordan have increased to 30%, including substantial increases among births that are likely low risk for cesarean delivery for the most part. This level is double the threshold that WHO considers reasonable. Background: Cesarean delivery conducted without medical indication places mothers and infants at risk for adverse outcomes. This study assessed changes in trends of, and factors associated with, cesarean deliveries in Jordan, from 2002 to 2012. Methods: Data for ever-married women ages 15–49 years from the 2002, 2007, and 2012 Jordan Population and Family Health Surveys were used. Analyses were restricted to mothers who responded to a question regarding the hospital-based mode of delivery for their last birth occurring within the 5 years preceding each survey (2002, N = 3,450; 2007, N = 6,307; 2012, N = 6,365). Normal birth weight infants and singleton births were used as markers for births that were potentially low risk for cesarean delivery, because low/high birth weight and multiple births are among the main obstetric variables that have been documented to increase risk of cesareans. Weighted descriptive and multivariate analyses were conducted using 4 logistic regression models: (1) among all mothers; and among mothers stratified (2) by place of delivery; (3) by birth weight of infants; and (4) by singleton vs. multiple births. Results: The cesarean delivery rate increased significantly over time, from 18.2% in 2002, to 20.1% in 2007, to 30.3% in 2012. Place of delivery, birth weight, and birth multiplicity were significantly associated with cesarean delivery after adjusting for confounding factors. Between 2002 and 2012, the rate increased by 99% in public hospitals vs. 70% in private hospitals; by 93% among normal birth weight infants vs. 73% among low/high birth weight infants; and by 92% among singleton births vs. 29% among multiple births. The changes were significant across all categories except among multiple births. Further stratification revealed that the cesarean delivery rate was 2.29 times higher in university teaching hospitals (UTHs) than in private hospitals (P< .001), and 2.31 times higher than in government hospitals (P< .001). Moreover, in UTHs, the rate was higher among normal birth weight infants (adjusted OR = 2.15) and singleton births (adjusted OR = 2.39). Conclusion: The rising cesarean delivery rate among births that may have been at low risk for cesarean delivery, particularly in UTHs, indicates that many cesarean deliveries may increasingly be performed without any medical indication. More vigilant monitoring of data from routine health information systems is needed to reduce unnecessary cesarean deliveries in apparently low-risk groups.
Collapse
Affiliation(s)
- Rami Al Rifai
- Graduate School of Tokyo Medical and Dental University, Division of Public Health, Department of International Health and Medicine , Tokyo , Japan
| |
Collapse
|
38
|
Prosser SJ, Miller YD, Thompson R, Redshaw M. Why 'down under' is a cut above: a comparison of rates of and reasons for caesarean section in England and Australia. BMC Pregnancy Childbirth 2014; 14:149. [PMID: 24767675 PMCID: PMC4021562 DOI: 10.1186/1471-2393-14-149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point. METHODS We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467). RESULTS Women in Queensland were more likely to have had a caesarean birth (36.2%) than women in England (25.1% of births; OR = 1.44, 95% CI = 1.28-1.61), after adjustment for obstetric characteristics. Between-country differences were found for rates of pre-labour caesarean (21.2% vs. 12.2%) but not for intrapartum caesarean or assisted vaginal birth. Compared to women in England, women in Queensland with a history of caesarean were more likely to have had a pre-labour caesarean and more likely to have had an intrapartum caesarean, due only to a previous caesarean. Among women with no previous caesarean, Queensland women were more likely than women in England to have had a caesarean due to suspected disproportion and failure to progress in labour. CONCLUSIONS The higher rates of caesarean birth in Queensland are largely attributable to higher rates of caesarean for women with a previous caesarean, and for the main reason of having had a previous caesarean. Variation between countries may be accounted for by the absence of a single, comprehensive clinical guideline for caesarean section in Queensland.
Collapse
Affiliation(s)
| | - Yvette D Miller
- School of Psychology, The University of Queensland, Brisbane, Australia
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Rachel Thompson
- School of Psychology, The University of Queensland, Brisbane, Australia
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH, USA
| | - Maggie Redshaw
- School of Psychology, The University of Queensland, Brisbane, Australia
- Policy Research Unit for Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| |
Collapse
|
39
|
Baghurst P, Robson S, Antoniou G, Scheil W, Bryce R. The association between increasing maternal age at first birth and decreased rates of spontaneous vaginal birth in South Australia from 1991 to 2009. Aust N Z J Obstet Gynaecol 2014; 54:237-43. [DOI: 10.1111/ajo.12182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Baghurst
- School of Reproductive Medicine and Paediatrics; Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
| | - Stephen Robson
- Department of Obstetrics and Gynaecology; Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery; Women's and Children's Hospital; Adelaide South Australia Australia
| | - Wendy Scheil
- Pregnancy Outcome Unit; South Australian Department of Health; Adelaide South Australia Australia
| | - Robert Bryce
- Centre for Perinatal Care; Flinders Medical Centre; Adelaide South Australia Australia
| |
Collapse
|
40
|
Kottwitz A. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery. Health Place 2014; 27:9-21. [PMID: 24513591 DOI: 10.1016/j.healthplace.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 01/13/2014] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Abstract
Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.
Collapse
Affiliation(s)
- Anita Kottwitz
- German Socio-Economic Panel Study (SOEP), DIW Berlin, Mohrenstraße 58, 10117 Berlin, Germany; International Max Planck Research School on the Life Course (IMPRS LIFE), Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany.
| |
Collapse
|
41
|
Lassi ZS, Bhutta ZA. Risk factors and interventions related to maternal and pre-pregnancy obesity, pre-diabetes and diabetes for maternal, fetal and neonatal outcomes: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.841453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
42
|
Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:634-643. [PMID: 23630102 DOI: 10.1002/uog.12494] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 03/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the association between maternal age and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. METHODS This was a retrospective study in women with singleton pregnancies attending the first routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. Data on maternal characteristics, and medical and obstetric history were collected and pregnancy outcomes ascertained. Maternal age was studied, both as a continuous and as a categorical variable. Regression analysis was performed to examine the association between maternal age and adverse pregnancy outcome including pre-eclampsia, gestational hypertension, gestational diabetes mellitus (GDM), preterm delivery, small-for-gestational age (SGA) neonate, large-for-gestational age (LGA) neonate, miscarriage, stillbirth and elective and emergency Cesarean section. RESULTS The study population included 76 158 singleton pregnancies with a live fetus at 11 + 0 to 13 + 6 weeks. After adjusting for potential maternal and pregnancy confounding variables, advanced maternal age (defined as ≥ 40 years) was associated with increased risk of miscarriage (odds ratio (OR), 2.32 (95% CI, 1.83-2.93); P < 0.001), pre-eclampsia (OR, 1.49 (95% CI, 1.22-1.82); P < 0.001), GDM (OR, 1.88 (95% CI, 1.55-2.29); P < 0.001), SGA (OR, 1.46 (95% CI, 1.27-1.69); P < 0.001) and Cesarean section (OR, 1.95 (95% CI, 1.77-2.14); P < 0.001), but not with stillbirth, gestational hypertension, spontaneous preterm delivery or LGA. CONCLUSIONS Maternal age should be combined with other maternal characteristics and obstetric history when calculating an individualized adjusted risk for adverse pregnancy complications. Advanced maternal age is a risk factor for miscarriage, pre-eclampsia, SGA, GDM and Cesarean section, but not for stillbirth, gestational hypertension, spontaneous preterm delivery or LGA.
Collapse
Affiliation(s)
- A Khalil
- Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK
| | | | | | | | | |
Collapse
|
43
|
Murphy DJ, Fahey T. A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting. BMJ Open 2013; 3:e003865. [PMID: 24277646 PMCID: PMC3840346 DOI: 10.1136/bmjopen-2013-003865] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting. DESIGN Retrospective cohort study. SETTING Urban maternity hospital in Ireland. POPULATION A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011. METHODS The study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors. MAIN OUTCOME MEASURES Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator. RESULTS Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000). CONCLUSIONS Privately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences.
Collapse
Affiliation(s)
- Deirdre J Murphy
- Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Dublin, Republic of Ireland
| | - Tom Fahey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| |
Collapse
|
44
|
Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, White J, Lainchbury A, Stapleton H, Beckmann M, Bisits A, Homer C, Foureur M, Welsh A, Kildea S. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial. Lancet 2013; 382:1723-32. [PMID: 24050808 DOI: 10.1016/s0140-6736(13)61406-3] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identified risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors. METHODS In this unblinded, randomised, controlled, parallel-group trial, pregnant women at two metropolitan teaching hospitals in Australia were randomly assigned to either caseload midwifery care or standard maternity care by a telephone-based computer randomisation service. Women aged 18 years and older were eligible if they were less than 24 weeks pregnant at the first booking visit. Those who booked with another care provider, had a multiple pregnancy, or planned to have an elective caesarean section were excluded. Women allocated to caseload care received antenatal, intrapartum, and postnatal care from a named caseload midwife (or back-up caseload midwife). Controls received standard care with rostered midwives in discrete wards or clinics. The participant and the clinician were not masked to assignment. The main primary outcome was the proportion of women who had a caesarean section. The other primary maternal outcomes were the proportions who had an instrumental or unassisted vaginal birth, and the proportion who had epidural analgesia during labour. Primary neonatal outcomes were Apgar scores, preterm birth, and admission to neonatal intensive care. We analysed all outcomes by intention to treat. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000349246. FINDINGS Publicly insured women were screened at the participating hospitals between Dec 8, 2008, and May 31, 2011. 1748 pregnant women were randomly assigned, 871 to caseload and 877 to standard care. The proportion of caesarean sections did not differ between the groups (183 [21%] in the caseload group vs 204 [23%] in the standard care group; odds ratio [OR] 0·88, 95% CI 0·70-1·10; p=0·26). The proportion of women who had elective caesarean sections (before onset of labour) differed significantly between caseload and standard care (69 [8%] vs 94 [11%]; OR 0·72, 95% CI 0·52-0·99; p=0·05). Proportions of instrumental birth were similar (172 [20%] vs 171 [19%]; p=0·90), as were the proportions of unassisted vaginal births (487 [56%] vs 454 [52%]; p=0·08) and epidural use (314 [36%] vs 304 [35%]; p=0·54). Neonatal outcomes did not differ between the groups. Total cost of care per woman was AUS$566·74 (95% 106·17-1027·30; p=0·02) less for caseload midwifery than for standard maternity care. INTERPRETATION Our results show that for women of any risk, caseload midwifery is safe and cost effective. FUNDING National Health and Medical Research Council (Australia).
Collapse
Affiliation(s)
- Sally K Tracy
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, NSW, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Vaughan DA, Cleary BJ, Murphy DJ. Delivery outcomes for nulliparous women at the extremes of maternal age - a cohort study. BJOG 2013; 121:261-8. [PMID: 23755916 DOI: 10.1111/1471-0528.12311] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes. DESIGN Retrospective cohort study. SETTING Urban maternity hospital in Ireland. POPULATION A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011. METHODS The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18-19 years, 20-34 years, 35-39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors. MAIN OUTCOME MEASURES Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section. RESULTS Compared with maternal age 20-34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33-2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06-1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07-2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34-0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67-3.94). CONCLUSIONS Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.
Collapse
Affiliation(s)
- D A Vaughan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | | |
Collapse
|
46
|
Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth 2013; 13:107. [PMID: 23656693 PMCID: PMC3655870 DOI: 10.1186/1471-2393-13-107] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022] Open
Abstract
Background Rising caesarean section (CS) rates have been observed worldwide in recent decades. This study sought to analyse trends in CS rates and outcomes among a variety of obstetric groups at a university hospital in a low-income country. Methods We conducted a hospital-based panel study at Muhimbili National Hospital, Dar es Salaam, Tanzania. All deliveries between 2000 and 2011 with gestational age ≥ 28 weeks were included in the study. The 12 years were divided into four periods: 2000 to 2002, 2003 to 2005, 2006 to 2008, and 2009 to 2011. Main outcome measures included CS rate, relative size of obstetric groups, contribution to overall CS rate, perinatal mortality ratio, neonatal distress, and maternal mortality ratio. Time trends were analysed within the ten Robson groups, based on maternal and obstetric characteristics. We applied the χ2 test for trend to determine whether changes were statistically significant. Odds ratios of CS were evaluated using multivariate logistic regression, accounting for maternal age, referral status, and private healthcare insurance. Results We included 137,094 deliveries. The total CS rate rose from 19% to 49%, involving nine out of ten groups. Multipara without previous CS with single, cephalic pregnancies in spontaneous labour had a CS rate of 33% in 2009 to 2011. Adjusted analysis explained some of the increase. Perinatal mortality and neonatal distress decreased in multiple pregnancies (p < 0.001 and p = 0.003) and nullipara with breech pregnancies (p < 0.001 and p = 0.024). Although not statistically significant, there was an increase in perinatal mortality (p = 0.381) and neonatal distress (p = 0.171) among multipara with single cephalic pregnancies in spontaneous labour. The maternal mortality ratio increased from 463/100, 000 live births in 2000 to 2002 to 650/100, 000 live births in 2009 to 2011 (p = 0.031). Conclusion The high CS rate among low-risk groups suggests that many CSs might have been performed on questionable indications. Such a trend may result in even higher CS rates in the future. While CS can improve perinatal outcomes, it does not necessarily do so if performed routinely in low-risk groups.
Collapse
Affiliation(s)
- Helena Litorp
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
47
|
Einarsdóttir K, Haggar F, Pereira G, Leonard H, de Klerk N, Stanley FJ, Stock S. Role of public and private funding in the rising caesarean section rate: a cohort study. BMJ Open 2013; 3:e002789. [PMID: 23645918 PMCID: PMC3646173 DOI: 10.1136/bmjopen-2013-002789] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/26/2013] [Accepted: 04/05/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The caesarean section rates have been rising in the developed world for over two decades. This study assessed the involvement of the public and private health sectors in this increase. DESIGN Population-based, retrospective cohort study. SETTING Public and private hospitals in Western Australia. PARTICIPANTS Included in this study were 155 646 births to nulliparous women during 1996-2008. MAIN OUTCOME MEASURES Caesarean section rates were calculated separately for four patient type groups defined according to mothers' funding source at the time of birth (public/private) and type of delivery hospital (public/private). The average annual per cent change (AAPC) for the caesarean section rates was calculated using joinpoint regression. RESULTS Overall, there were 45 903 caesarean sections performed (29%) during the study period, 24 803 in-labour and 21 100 prelabour. Until 2005, the rate of caesarean deliveries increased most rapidly on average annually for private patients delivering in private hospitals (AAPC=6.5%) compared with public patients in public hospitals (AAPC=4.3%, p<0.0001). This increase could mostly be attributed to an increase in prelabour caesarean deliveries for this group of women and could not be explained by an increase in breech deliveries, placenta praevia or multiple pregnancies. CONCLUSIONS Our results indicate that an increase in the prelabour caesarean delivery rate for private patients in private hospitals has been driving the increase in the caesarean section rate for nulliparous women since 1996. Future research with more detailed information on indication for the prelabour caesarean section is needed to understand the reasons for these findings.
Collapse
Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Fatima Haggar
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
- Department of Epidemiology and Public Health, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Nick de Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Fiona J Stanley
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Sarah Stock
- School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| |
Collapse
|
48
|
Mikolajczyk RT, Schmedt N, Zhang J, Lindemann C, Langner I, Garbe E. Regional variation in caesarean deliveries in Germany and its causes. BMC Pregnancy Childbirth 2013; 13:99. [PMID: 23634820 PMCID: PMC3652783 DOI: 10.1186/1471-2393-13-99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determinants of regional variation in caesarean sections can contribute explanations for the observed overall increasing trend of caesarean sections. We assessed which mechanism explains the higher rate of caesarean sections in the former West than East Germany: a more liberal use of caesarean sections in the case of relative indications or more common caesarean sections without indications. METHODS We used a health insurance database from all regions of Germany with approximately 14 million insured individuals (about 17% of the total population in Germany). We selected women who gave birth in the years 2004 to 2006 and identified indications for caesarean section on the basis of hospital diagnoses in 30 days around birth. We classified pregnancies into three groups: those with strong indications for caesarean section (based on classification of absolute indications recommended by the Unmet Obstetrics Need network), those with moderate indications (other indications increasing the probability of caesarean section) and those with no indications. We investigated the percentage of caesarean sections among all births, presence of strong or moderate indications in all pregnancies, the probability of caesarean sections in the presence of indications and the fraction of caesarean sections attributable to strong, moderate and no indications. RESULTS In total, 294,841 births from 2004-2006 were included in the analysis. In the former West Germany, 30% births occurred by caesarean section, while in the former East Germany the caesarean section rate was 22%. Proportions of pregnancies with strong and moderate indications for caesarean section were similar in both regions. For strong indications the probability of caesarean section was similar in East and West Germany, but the probability of caesarean section among women with moderate indications was substantially higher in the former West Germany. Caesarean sections were also more common among women with no indications in the former West (8%) than in the former East (4-5%). The higher probability of caesarean section in the case of strong or moderate indications in the former West than in the East explained 87% of the difference between section rates in these two regions, while caesarean sections without indications contributed to only 13% of the difference observed. CONCLUSIONS The observed difference between caesarean section rates in the former East and West Germany was most likely due to different medical practice in handling relative indications.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
| | | | | | | | | | | |
Collapse
|
49
|
Assisted vaginal deliveries in mothers admitted as public or private patients in Western Australia. PLoS One 2013; 8:e61699. [PMID: 23610593 PMCID: PMC3627649 DOI: 10.1371/journal.pone.0061699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 03/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mothers delivering as private patients in Australia have a high rate of assisted deliveries, which could lead to adverse infant outcomes in this group of patients. We investigated whether the risk of adverse infant outcomes after assisted deliveries was different for mothers admitted as public or private patients for delivery, when compared with unassisted deliveries. METHODS AND FINDINGS We included 158,241 vaginal, singleton, term birth admissions in our study where the infant was live born and without birth defects. The study population was identified from statutory birth and hospital data collections held by the Western Australian (WA) Department of Health. We estimated odds ratios and confidence intervals using logistic regression models adjusted for a range of maternal demographic, pregnancy and birth characteristics. Interaction was assessed by including interaction terms in the models. Outcomes included low Apgar scores at five minutes (< 7), neonatal resuscitation and special care admission. Mothers delivering as private patients had an increased risk of assisted vaginal delivery compared with public patients (adjusted OR 1.74, 95% CI = 1.68-1.80). Compared with unassisted vaginal deliveries, assisted deliveries were associated with increased risk of Apgar scores at five minutes below 7 (OR 1.25, 1.08-1.45), neonatal resuscitation (OR = 1.69, 1.42-2.00) and admission to special care nursery (OR = 1.64, 1.53-1.76). The increased risk of neonatal resuscitation was higher for mothers admitted as private patients for delivery (OR = 2.13) than public patients (OR = 1 .55, p(interaction) = 0.03). CONCLUSIONS Our results suggested that the high risk of neonatal resuscitation following assisted vaginal deliveries compared to unassisted is higher in private patients than public patients. Whether this phenomenon is due to the twofold higher rate of assisted vaginal deliveries in this group of patients or a higher rate of fetal indications for assisted vaginal delivery remains to be answered.
Collapse
|
50
|
Cho GJ, Kim LY, Hong HR, Lee CE, Hong SC, Oh MJ, Kim HJ. Trends in the rates of peripartum hysterectomy and uterine artery embolization. PLoS One 2013; 8:e60512. [PMID: 23565254 PMCID: PMC3615013 DOI: 10.1371/journal.pone.0060512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 02/28/2013] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine the trends in national rates of peripartum hysterectomy (PH) and uterine arterial embolization (UAE) in Korea. We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from patients who gave birth during the period from 2005 to 2008. There were 1785,178 deliveries during the study period, including 2636 cases of PH (1.48 per 1000 deliveries). The PH rate in 2005 was 1.57 per 1000 deliveries and in 2008 it was 1.33 per 1000 deliveries. UAE was performed in 161 women (incidence, 0.38 per 1000 deliveries) and 447 women (incidence, 0.98 per 1000 deliveries) in 2005 and 2008, respectively. In Korea, the rate of PH decreased slightly, while the rate of UAE rate increased dramatically during the period from 2005 to 2008. Further studies are needed to evaluate the effects of UAE on the rate of PH performed.
Collapse
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|