1
|
Longo CJ, Harrold J, Dunn S, Smith G. Elective Repeat Caesarean Section in Low-Risk Women-Economic Evaluation Comparing Births Before vs. After 39 Weeks Gestation in Ontario, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1600-1607. [PMID: 30361158 DOI: 10.1016/j.jogc.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To undertake an economic analysis of repeat Caesarean births in low-risk women (LRW) not in labour in Ontario who delivered at 37-38 weeks (<39 weeks) vs. 39-40 weeks (≥39 weeks) gestation. METHODS Data from the Better Outcomes Registry & Network (BORN) Information System for fiscal years 2012-2013 and 2013-2014 meeting the definition for elective repeat CS (ERCS) for LRW between 37 and 40 weeks gestation. Costs were obtained from the Ottawa Hospital Data Warehouse and applied through to discharge. RESULTS For April 2012 to March 2013, we extracted 3637 ERCS dyads at <39 weeks and 3282 dyads at ≥39 weeks. There were 334 NICU admissions at <39 weeks (0.92%) and 235 at ≥39 weeks (0.72%). Average neonate cost was $1247.99 (<39 weeks) vs. $1200.77 (≥39 weeks)-a difference of $47.22. Average dyad cost was $3608.92 (<39 weeks) vs. $3577.04 (≥39 weeks)-a difference of $31.88 per birth. If these births were delayed to ≥39 weeks, net savings of $173 864 and $115 947 annually would be realized on "baby only" and "dyad" costs, respectively. For April 2013 to March 2014, we extracted 2875 ERCS dyads at ≤39 weeks and 3892 dyads at ≥39 weeks. There were 216 NICU admissions ≤39 weeks (0.75%) and 224 at ≥39 weeks (0.58%). Average neonate cost was $1268.56 (<39 weeks) vs. $1126.56 (≥39 weeks)-a difference of $142.00 per birth. Average dyad cost was $3605.70 (≤39 weeks) vs. $3456.61 (≥39 weeks)-a difference of $149.08. If these births were delayed to ≥39 weeks, net annual savings of $404 842 and $428 605 would be realized on "baby only" and "dyad" costs respectively. CONCLUSIONS Restricting repeat CS in LRW to ≥39 weeks is a cost-effective strategy.
Collapse
Affiliation(s)
- Christopher J Longo
- DeGroote School of Business, Member Centre for Health Economics and Policy Analysis, McMaster University, Burlington, ON; Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
| | - JoAnn Harrold
- Faculty of Medicine, University of Ottawa, Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON
| | - Sandra Dunn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; School of Nursing, University of Ottawa, Ottawa, ON
| | - Graeme Smith
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Queen's University, Kingston, ON
| |
Collapse
|
2
|
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
|
3
|
Konstantelos D, Ifflaender S, Dinger J, Burkhardt W, Rüdiger M. Analyzing support of postnatal transition in term infants after c-section. BMC Pregnancy Childbirth 2014; 14:225. [PMID: 25011378 PMCID: PMC4096413 DOI: 10.1186/1471-2393-14-225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/09/2014] [Indexed: 12/03/2022] Open
Abstract
Background Whereas good data are available on the resuscitation of infants, little is known regarding support of postnatal transition in low-risk term infants after c-section. The present study was performed to describe current delivery room (DR) management of term infants born by c-section in our institution by analyzing videos that were recorded within a quality assurance program. Methods DR- management is routinely recorded within a quality assurance program. Cross-sectional study of videos of term infants born by c-section. Videos were analyzed with respect to time point, duration and number of all medical interventions. Study period was between January and December 2012. Results 186 videos were analyzed. The majority of infants (73%) were without support of postnatal transition. In infants with support of transition, majority of infants received respiratory support, starting in median after 3.4 minutes (range 0.4-14.2) and lasting for 8.8 (1.5-28.5) minutes. Only 33% of infants with support had to be admitted to the NICU, the remaining infants were returned to the mother after a median of 13.5 (8-42) minutes. A great inter- and intra-individual variation with respect to the sequence of interventions was found. Conclusions The study provides data for an internal quality improvement program and supports the benefit of using routine video recording of DR-management. Furthermore, data can be used for benchmarking with current practice in other centers.
Collapse
Affiliation(s)
| | | | | | | | - Mario Rüdiger
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, Dresden 01307, Germany.
| |
Collapse
|
4
|
Doan E, Gibbons K, Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37-41 weeks' gestation. Aust N Z J Obstet Gynaecol 2014; 54:340-7. [PMID: 24836174 DOI: 10.1111/ajo.12220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/18/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Births by elective caesarean section (CS) are rising, particularly before 39 weeks' gestation, which may be associated with unacceptably high risk of adverse neonatal outcomes. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39 weeks. AIMS To evaluate the association between gestational age (GA) at delivery and neonatal outcomes after elective CS between 37 and 41 weeks. MATERIALS AND METHODS Retrospective cohort study of viable singleton neonates delivered by elective CS at Mater Mothers' Hospitals (1998-2009). Neonates were stratified into two GA groups with early term (ET, 37-38 weeks) compared with the reference group of full and late term (FLT, 39-41 weeks). The primary outcome examined was serious respiratory morbidity; secondary outcomes included depression at birth, nursery admission and assisted ventilation. RESULTS Fourteen thousand and four hundred and forty-seven mother-baby pairs were included (59.9% delivered before 39 weeks). There was a significantly decreasing risk of adverse neonatal outcomes with increasing GA. Compared to FLT, delivery at ET almost tripled the risk of the primary outcome (AOR 2.74; 95% CI 1.79-4.21). Rates of most secondary outcomes were at least doubled. CONCLUSION Elective CS performed at 37-38 weeks is associated with poorer neonatal outcomes compared to those delivered at 39-41 weeks. This study supports recent recommendations to delay delivery by elective CS until week 39 if possible.
Collapse
Affiliation(s)
- Emily Doan
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | | | | |
Collapse
|
5
|
Liu J, Yang N, Liu Y. High-risk Factors of Respiratory Distress Syndrome in Term Neonates: A Retrospective Case-control Study. Balkan Med J 2014; 31:64-8. [PMID: 25207170 PMCID: PMC4115996 DOI: 10.5152/balkanmedj.2014.8733] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 07/24/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is a common critical disease in term neonates, but reasons for the occurrence of RDS remains unclear. AIMS This study aimed to investigate the cause of RDS in full-term neonates by a retrospective case-control study. STUDY DESIGN Case-control study. METHODS Among the patients admitted to Bayi Children's Hospital between January 2008 and December 2010, a total of 205 full-term neonates with RDS were assigned to the study group, and 410 full-term neonates without RDS were assigned to the control group. Clinical information, including the presence or absence of premature rupture of membranes (PROM), gender of the neonates, mode of delivery, birth weight, and any conditions suffered by the neonates were recorded. RESULTS THE RESULTS OF LOGISTIC REGRESSION ANALYSIS SHOWED THAT THE FOLLOWING CAUSES WERE CLOSELY CORRELATED WITH TERM NEONATAL RDS: selective cesarean section (OR: 8.737; 95% CI: 5.232-14.588), severe birth asphyxia (OR: 6.988; 95% CI: 2.990-16.333), small gestational age (OR: 6.222; 95% CI: 2.001-8.993), maternal-fetal infection (OR: 5.337; 95% CI: 1.999-8.233), PROM (OR: 3.380; 95% CI: 1.986-5.754), male sex (OR: 2.641; 95% CI: 1.721-4.053), gestational glucose intolerance or diabetes (OR: 2.415; 95% CI:1.721-4.053), and low birth weight (OR: 2.323; 95% CI: 1.329-4.060). CONCLUSION Several high-risk factors, such as selective cesarean section, severe birth asphyxia, maternal-fetal infection, PROM, and male sex are closely correlated with full-term neonatal RDS. These could provide a significant reference for the diagnosis and treatment of term neonatal RDS.
Collapse
Affiliation(s)
- Jing Liu
- Department of Neonatology, NICU, Bayi Children’s Hospital Affiliated to Beijing Military General Hospital, Beijing, China
- Address for Correspondence: Dr. Jing Liu, Department of Neonatology, NICU, Bayi Children’s Hospital Affiliated to Beijing Military General Hospital, Beijing, China. Phone: +86 133 01 19 58 69 e-mail:
| | - Na Yang
- Department of Neonatology, NICU, Bayi Children’s Hospital Affiliated to Beijing Military General Hospital, Beijing, China
- Department of Neonatology, Maternal and Child Health Care Hospital of Hefei, Hefei City, China
| | - Ying Liu
- Department of Neonatology, NICU, Bayi Children’s Hospital Affiliated to Beijing Military General Hospital, Beijing, China
| |
Collapse
|
6
|
Dunn S, Sprague AE, Fell DB, Dy J, Harrold J, Lamontagne B, Walker M. The use of a quality indicator to reduce elective repeat Caesarean section for low-risk women before 39 weeks' gestation: the Eastern Ontario experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:306-316. [PMID: 23660037 DOI: 10.1016/s1701-2163(15)30957-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Elective repeat Caesarean section (ERCS) for low-risk women at < 39 weeks' gestation has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission, and lengthier hospital stays than ERCS at 39 to 40 weeks' gestation. The objective of this quality improvement project was to reduce high rates of ERCS < 39 weeks across the Eastern Ontario region. METHODS All hospitals within the region providing care during labour and birth (n = 10) were asked to participate. Representatives from each hospital received information about their site-specific rates and knowledge-translation resources to assist them with the project. A benchmark rate for ERCS < 39 weeks was set at 30%. The rates of ERCS < 39 weeks were calculated for two different times (the 2009-2010 and 2010-2011 fiscal years) and the relative difference and 95% confidence intervals were calculated to quantify the magnitude and statistical significance of any change. Qualitative interviews were completed with key informants from each hospital. RESULTS The proportion of ERCS at < 39 weeks' gestation across the region in the fiscal year 2010-2011 (n = 197/497; 39.6%) was significantly decreased (relative difference: -21%; 95% CI -31% to -8%, P = 0.002) from the previous fiscal year 2009-2010 (n = 229/459; 49.9%). A number of barriers to, and facilitators of, practice change were identified. CONCLUSION A reduction in the rate of ERCS < 39 weeks among low-risk women was achieved across the region. Awareness of the issue, possession of site-specific data, and agreement about the evidence and the need for change are critical first steps to improving practice.
Collapse
Affiliation(s)
- Sandra Dunn
- BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON
| | - Ann E Sprague
- BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa ON
| | - Deshayne B Fell
- BORN Ontario (Better Outcomes Registry and Network), Ottawa ON
| | - Jessica Dy
- Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa ON; OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON
| | - JoAnn Harrold
- Children's Hospital of Eastern Ontario Research Institute, Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa ON
| | - Bernard Lamontagne
- Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Champlain Local Health Integration Network, Ottawa ON
| | - Mark Walker
- BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa ON; OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON; Tier 1 Research Chair, Perinatal Epidemiology, University of Ottawa, Ottawa ON
| |
Collapse
|