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Chrzan-Dętkoś M, Murawska N, Łockiewicz M, de la Fe Rodriguez Muñoz M. Self-harm thoughts among postpartum women - associated factors. J Reprod Infant Psychol 2024:1-14. [PMID: 38319751 DOI: 10.1080/02646838.2024.2313487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.
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Affiliation(s)
| | - Natalia Murawska
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
| | - Marta Łockiewicz
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
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Corsi Decenti E, Salvatore MA, Mandolini D, Sampaolo L, D'Aloja P, Donati S. Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy. BMC Public Health 2023; 23:2562. [PMID: 38129838 PMCID: PMC10740257 DOI: 10.1186/s12889-023-17390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy. METHODS A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother-child separation at birth; rooming-in; breastfeeding. Logistic regression models including women' socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases. RESULTS During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births. CONCLUSIONS Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies.
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Affiliation(s)
- Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Donatella Mandolini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Letizia Sampaolo
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
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de Vries PLM, Deneux-Tharaux C, Baud D, Chen KK, Donati S, Goffinet F, Knight M, D'Souzah R, Sueters M, van den Akker T. Postpartum haemorrhage in high-resource settings: Variations in clinical management and future research directions based on a comparative study of national guidelines. BJOG 2023; 130:1639-1652. [PMID: 37259184 DOI: 10.1111/1471-0528.17551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/15/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare guidelines from eight high-income countries on prevention and management of postpartum haemorrhage (PPH), with a particular focus on severe PPH. DESIGN Comparative study. SETTING High-resource countries. POPULATION Women with PPH. METHODS Systematic comparison of guidance on PPH from eight high-income countries. MAIN OUTCOME MEASURES Definition of PPH, prophylactic management, measurement of blood loss, initial PPH-management, second-line uterotonics, non-pharmacological management, resuscitation/transfusion management, organisation of care, quality/methodological rigour. CONCLUSIONS Our study highlights areas where strong evidence is lacking. There is need for a universal definition of (severe) PPH. Consensus is required on how and when to quantify blood loss to identify PPH promptly. Future research may focus on timing and sequence of second-line uterotonics and non-pharmacological interventions and how these impact maternal outcome. Until more data are available, different transfusion strategies will be applied. The use of clear transfusion-protocols are nonetheless recommended to reduce delays in initiation. There is a need for a collaborative effort to develop standardised, evidence-based PPH guidelines. RESULTS Definitions of (severe) PPH varied as to the applied cut-off of blood loss and incorporation of clinical parameters. Dose and mode of administration of prophylactic uterotonics and methods of blood loss measurement were heterogeneous. Recommendations on second-line uterotonics differed as to type and dose. Obstetric management diverged particularly regarding procedures for uterine atony. Recommendations on transfusion approaches varied with different thresholds for blood transfusion and supplementation of haemostatic agents. Quality of guidelines varied considerably.
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Affiliation(s)
- Pauline L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - David Baud
- Department of Gynaecology and Obstetrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kenneth K Chen
- Departments of Medicine & ObGyn, Brown University, Providence, Rhode Island, USA
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Francois Goffinet
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rohan D'Souzah
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Departments of Obstetrics & Gynaecology and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Obstetrics and Gynaecology, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
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Ahmed SMA, Cresswell JA, Say L. Incompleteness and misclassification of maternal death recording: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:794. [PMID: 37968585 PMCID: PMC10647144 DOI: 10.1186/s12884-023-06077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated with incompleteness and/or misclassification of maternal death data. METHODS We conducted a systematic review of incompleteness and/or misclassification of maternal and pregnancy-related deaths. We conducted a narrative synthesis to identify methods used to capture and classify maternal deaths, as well as general and context specific factors affecting the completeness and misclassification of maternal death recording. We conducted a meta-analysis of proportions to obtain estimates of incompleteness and misclassification of maternal death recording, overall and disaggregated by income and surveillance system types. FINDINGS Of 2872 title-abstracts identified, 29 were eligible for inclusions in the qualitative synthesis, and 20 in the meta-analysis. Included studies relied principally on record linkage and review for identifying deaths, and on review of medical records and verbal autopsies to correctly classify cause of death. Deaths to women towards the extremes of the reproductive age range, those not classified by a medical examiner or a coroner, and those from minority ethnic groups in their setting were more likely misclassified or unrecorded. In the meta-analysis, we found maternal death recording to be incomplete by 34% (95% CI: 28-48), with 60% sensitivity (95% CI: 31-81.). Overall, we found maternal mortality was under-estimated by 39% (95% CI: 30-48) due to incompleteness and/or misclassification. Reporting of deaths away from the intrapartum, due to indirect causes or occurring at home were less complete than their counterparts. There was substantial between and within group variability across most results. CONCLUSION Maternal deaths were under-estimated in almost all contexts, but the extent varied across settings. Countries should aim towards establishing Civil Registration and Vital Statistics systems where they are not instituted. Efforts to improve the completeness and accuracy of maternal cause of death recording, such as Confidential Enquiries into Maternal Deaths, are needed even where CRVS is considered to be well-functioning.
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Affiliation(s)
- Sahar M A Ahmed
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - Jenny A Cresswell
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
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Laksono AD, Wulandari RD, Matahari R, Rohmah N. The choice of delivery place in Indonesia: Does home residential status matter? Heliyon 2023; 9:e15289. [PMID: 37095903 PMCID: PMC10122013 DOI: 10.1016/j.heliyon.2023.e15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
Background To care for their health needs, women in Indonesia who live with their parents or in-laws frequently lose their independence, including the choice of delivery place. Aim The study aimed to analyze the effect of home residential status on the choice of delivery place in Indonesia. Methods The study design was a cross-sectional study. The study employed secondary data from 2017 Indonesian Demographic and Health Survey (IDHS). The research included 15,357 women aged 15-49 with live births in the last five years. Meanwhile, the study used place of delivery as an outcome variable and home residential status as an exposure variable. Moreover, the research employed nine control variables: type of residence, age group, education level, employment status, marital status, parity, wealth status, health insurance, and antenatal care visits-the final analysis using binary logistic regression. Findings The result shows that women with home residential status in the alone category were 1.248 times more likely than those in the joint category to choose to give birth to healthcare facilities (AOR 1.248; 95% CI 1.143-1.361). In addition to home residential status, the study also found seven control variables to have a relationship with the choice of place of delivery. The seven control variables were the type of residence, age group, education level, parity, wealth status, health insurance, and antenatal care. Conclusion The study concluded that home residential status affects the choice of delivery place in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
| | - Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Corresponding author.
| | - Ratu Matahari
- Faculty of Public Health, Ahmad Dahlan University, Jogjakarta, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, Jember, Indonesia
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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. Int J Environ Res Public Health 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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Ornaghi S, Fumagalli S, Galimberti S, Ornago AM, Brivio V, Lambicchi L, Nespoli A, Vergani P. Adverse Childbirth and Perinatal Outcomes Among Healthy, Low-Risk Pregnant Women with Abnormal Total Gestational Weight Gain. J Womens Health (Larchmt) 2023; 32:521-528. [PMID: 36735590 DOI: 10.1089/jwh.2022.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: Little is known on the potential effects of abnormal gestational weight gain (GWG) among low-risk, healthy pregnant women with no comorbidities or gestational complications. We investigated perinatal outcomes of these pregnancies according to GWG as per the 2009 National Academy of Medicine (NAM) recommendations. Materials and Methods: A retrospective analysis of prospectively collected data of low-risk pregnant women giving birth at term between January 2016 and December 2020. Inclusion criteria were normal pregestational body mass index (pBMI) (18.5-24.9 kg/m2) and no pregestational or gestational complication. Self-reported prepregnancy weight was used to calculate pBMI; GWG was the difference between maternal weight at childbirth and prepregnancy weight. Women were classified according to the 2009 NAM guidelines for GWG: insufficient (iGWG, <11.5 kg), adequate (aGWG, 11.5-16 kg), and excessive (eGWG, >16 kg). Logistic regression analysis with aGWG as referent was performed to independently estimate dose-response associations. Results: During the study period, there were 4,127 (33.1%) births fulfilling the inclusion criteria. Fifty-two percent of women gained outside the recommended range: 33.5% had iGWG and 18.7% had eGWG. iGWG women were 40% more likely to have early-term births and small for gestational age neonates. In turn, eGWG women displayed increased odds of prolonged pregnancy (adjusted odds ratio [aOR] 1.32), cesarean section in labor (aOR 1.50), high-degree perineal tears (aOR 2.04), postpartum hemorrhage ≥1,000 mL (aOR 1.54), and large for gestational age newborns (aOR 1.83). Conclusion: Our data show that abnormal GWG independently associates with heightened risk of adverse outcomes among healthy, low-risk pregnant women with normal pBMI and no comorbidity or gestational complication.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sofia Galimberti
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Alice Margherita Ornago
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Valentina Brivio
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Laura Lambicchi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Antonella Nespoli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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Ornaghi S, Maraschini A, Buoncristiano M, Corsi Decenti E, Colciago E, Cetin I, Donati S, On Behalf Of The ItOSS-Regional Working Group. Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study. Microorganisms 2022; 11. [PMID: 36677397 DOI: 10.3390/microorganisms11010105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks' gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80-6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.
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Maraschini A, Salvi S, Colciago E, Corsi E, Cetin I, Lovotti M, Donati S. Eclampsia in Italy: A prospective population-based study (2017–2020). Pregnancy Hypertens 2022; 30:204-209. [DOI: 10.1016/j.preghy.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
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Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, Donati S, Gissler M, Johansen M, Knight M, Korbel M, Kristufkova A, Nyflot LT, Deneux-Tharaux C. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ 2022; 379:e070621. [PMID: 36384872 PMCID: PMC9667469 DOI: 10.1136/bmj-2022-070621] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare maternal mortality in eight countries with enhanced surveillance systems. DESIGN Descriptive multicountry population based study. SETTING Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. POPULATION 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). OUTCOME MEASURES Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country's office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women's origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. RESULTS Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. CONCLUSIONS Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
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Affiliation(s)
- Caroline Diguisto
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, 37 044 Tours, France; Université de Tours, 37032 Tours, France
| | - Monica Saucedo
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Athanasios Kallianidis
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Miroslav Korbel
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Lill T Nyflot
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
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11
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Mazzocco MI, Donati S, Maraschini A, Corsi E, Colciago E, Guelfi F, Cetin I. Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1220-1226. [PMID: 36047477 PMCID: PMC9812087 DOI: 10.1111/aogs.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Spontaneous hemoperitoneum in pregnancy is defined as a sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths. MATERIAL AND METHODS This is a prospective population-based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42 days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes. RESULTS Twenty-nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR = 6.60, 95% CI 2.52-17.29), in the case of multiple pregnancies (RR = 6.57, 95% CI 1.99-21.69) and maternal age ≥35 years (RR 2.10, 95% CI 1.01-4.35). In 17/29 cases the bleeding site was intra-pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900 mL, one hysterectomy was necessary, and two women died. Twenty-two preterm births were recorded. CONCLUSIONS Spontaneous hemoperitoneum in pregnancy is a rare, life-threatening condition associated with high perinatal morbidity and mortality. Maternal age ≥35 years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.
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Affiliation(s)
- Martina Ilaria Mazzocco
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly
| | - Alice Maraschini
- Technical‐scientific statistical serviceItalian National Institute of HealthRomeItaly
| | - Edoardo Corsi
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly,Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | | | - Fabiola Guelfi
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Irene Cetin
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
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12
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Lisi F, Zullino S, Vangelisti M, Fanelli F, Micaglio M, Petraglia F, Mecacci F. Placenta accreta spectrum: experience of conservative surgery during cesarean section and clinical and radiological management during pregnancy and follow-up. Minerva Obstet Gynecol 2022; 74:393-397. [PMID: 35920359 DOI: 10.23736/s2724-606x.21.04973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion including placenta accreta, increta and percreta and is a major cause of maternal morbidity and mortality. Recently, a conservative surgical technique has been proposed as a valid alternative to peri-partum hysterectomy to reduce the short- and long-term risks for the mothers and to preserve fertility. Magnetic resonance imaging (MRI) seems to be useful first of all at the time of diagnosis and furthermore to investigate the course of conservative management of PAS. We describe three cases of PAS treated with conservative procedure and managed with clinic, ultrasound and MRI by a multidisciplinary equipe.
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Affiliation(s)
- Federica Lisi
- Department of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy -
| | - Sara Zullino
- Department of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Marco Vangelisti
- Department of Radiodiagnosis and Imaging, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fabrizio Fanelli
- Department of Vascular and Interventional Radiology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Massimo Micaglio
- Department of Anesthesia and Intensive Care, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Federico Mecacci
- Department of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
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13
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Ramler PI, Beenakkers ICM, Bloemenkamp KWM, Van der Bom JG, Braams-Lisman BAM, Cornette JMJ, Kallianidis AF, Kuppens SMI, Rietveld AL, Schaap TP, Schutte JM, Stekelenburg J, Zwart JJ, Van den Akker T. Nationwide confidential enquiries into maternal deaths because of obstetric hemorrhage in the Netherlands between 2006 and 2019. Acta Obstet Gynecol Scand 2022; 101:450-460. [PMID: 35238018 DOI: 10.1111/aogs.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstetric hemorrhage-related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage-related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage-related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage-related deaths, and identify lessons learned. MATERIAL AND METHODS Nationwide mixed-methods prospective case-series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019. RESULTS The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 was 0.7 per 100 000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100 000 livebirths in 1993-2005 (odds ratio 0.70, 95% confidence interval 0.38-1.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage-related deaths. CONCLUSIONS The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 has not substantially changed compared to the MMR of the previous enquiry in 1993-2005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.
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Affiliation(s)
- Paul I Ramler
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna G Van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Simone M I Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Anna L Rietveld
- Department of Obstetrics and Gynecology, Amsterdam VU University Medical Center, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Thomas Van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, Faculty of Science, VU University, Amsterdam, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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14
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Kallianidis AF, Schutte JM, Schuringa LEM, Beenakkers ICM, Bloemenkamp KWM, Braams-Lisman BAM, Cornette J, Kuppens SM, Rietveld AL, Schaap T, Stekelenburg J, Zwart JJ, van den Akker T. Confidential enquiry into maternal deaths in the Netherlands, 2006-2018. Acta Obstet Gynecol Scand 2022; 101:441-449. [PMID: 35352820 DOI: 10.1111/aogs.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To calculate the maternal mortality ratio (MMR) for 2006-2018 in the Netherlands and compare this with 1993-2005, and to describe women's characteristics, causes of death and improvable factors. MATERIAL AND METHODS We performed a nationwide, cohort study of all maternal deaths between January 1, 2006 and December 31, 2018 reported to the Audit Committee Maternal Mortality and Morbidity. Main outcome measures were the national MMR and causes of death. RESULTS Overall MMR was 6.2 per 100 000 live births, a decrease from 12.1 in 1993-2005 (risk ratio [RR] 0.5). Women with a non-western ethnic background had an increased MMR compared with Dutch women (MMR 6.5 vs. 5.0, RR 1.3). The MMR was increased among women with a background from Surinam/Dutch Antilles (MMR 14.7, RR 2.9). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 171 pregnancy-related deaths within 1 year postpartum, 102 (60%) had a direct and 69 (40%) an indirect cause of death. Leading causes within 42 days postpartum were cardiac disease (n = 21, 14.9%), hypertensive disorders (n = 20, 14.2%) and thrombosis (n = 19, 13.5%). Up to 1 year postpartum, the most common cause of death was cardiac disease (n = 32, 18.7%). Improvable care factors were identified in 76 (47.5%) of all deaths. CONCLUSIONS Maternal mortality halved in 2006-2018 compared with 1993-2005. Cardiac disease became the main cause. In almost half of all deaths, improvable factors were identified and women with a background from Surinam/Dutch Antilles had a threefold increased risk of death compared with Dutch women without a background of migration.
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Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands
| | - Louise E M Schuringa
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jerome Cornette
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Simone M Kuppens
- Department of Obstetrics and Gynecology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Anna L Rietveld
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Timme Schaap
- Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,Athena Institute, VU, Amsterdam, the Netherlands
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15
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Ornaghi S, Bellante N, Abbamondi A, Maini M, Cesana F, Trabucchi M, Corsi D, Arosio V, Mariani S, Scian A, Colciago E, Lettino M, Vergani P. Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification. Open Heart 2022; 9:openhrt-2021-001947. [PMID: 35332050 PMCID: PMC8948382 DOI: 10.1136/openhrt-2021-001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal-fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes. METHODS A retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed. RESULTS We identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II-III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates. CONCLUSIONS Even in a maternal-fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy .,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Nicolo' Bellante
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alessandra Abbamondi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Marzia Maini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Davide Corsi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Viola Arosio
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Silvana Mariani
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Antonietta Scian
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Patrizia Vergani
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
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16
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Reid HE, Pratt D, Edge D, Wittkowski A. Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors. Front Psychiatry 2022; 13:765118. [PMID: 35401283 PMCID: PMC8987004 DOI: 10.3389/fpsyt.2022.765118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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17
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Orsi M, Ossola MW, Iurlaro E, Perugino G, Somigliana E, Ferrazzi E. The impact of a multilevel approach to reduce emergency hysterectomy for postpartum haemorrhage: insights from a tertiary referral centre in Northern Italy. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
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18
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Lazzerini M, Covi B, Mariani I, Giusti A, Valente EP, Ćerimagić A, Drandić D, Kurbanović M, Virginie R, Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Verardi G, Zanin B, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Vaska A, Jakovicka D, Rudzīte P, Ērmane E, Vilcāne KP, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Yarotskaya E, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Viver AC, Elden H, Linden K, Zaigham M, Sengpiel V, De Labrusse C, Abderhalden A, Pfund A, Thorn H. Quality of care at childbirth: findings of IMAgiNE EURO in Italy during the first year of the COVID‐19 pandemic. Int J Gynaecol Obstet 2022; 157:405-417. [PMID: 35092692 PMCID: PMC9087757 DOI: 10.1002/ijgo.14119] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Objective Investigate the quality of maternal and newborn care (QMNC) during childbirth in the first year of COVID‐19 pandemic in Italy, from the mothers' perspective, as key service users. Methods Women who gave birth in an Italian facility from March 1, 2020 to February 29, 2021 answered an online questionnaire including 40 WHO Standard‐based Quality Measures. Descriptive and multivariate quantile regression analyses were performed. Results In total, 4824 women were included, reporting heterogeneity of practices across regions: among 3981 women who underwent labour 78.4% (63.0%–92.0%) were not allowed a companion of choice, 44.6% (28.9%–53.3%) had difficulties in attending routine antenatal visits, 36.3% (24.9%–61.1%) reported inadequate breastfeeding support, 39.2% (23.3%–62.2%) felt not involved in medical choices, 33.0% (23.9%–49.3%) experienced unclear communication from staff, 24.8% (15.9%–39.4%) were not always treated with dignity and 12.7% (10.1%–29.3%) reported abuses. Findings in the group of women who did not experience labour were substantially similar. Multivariate analyses confirmed a significant lower QMNC index for regions in southern Italy compared to North and Central regions. Conclusion Mothers reported substantial inequities in the QMNC across Italian regions. Future studies should monitor QMNC over time. Meanwhile, actions to ensure high QMNC for all mothers and newborns across Italy are urgently required. Mothers giving birth in the first year of the COVID‐19 pandemic reported substantial inequities across Italian regions in the QMNC around the time of childbirth.
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Affiliation(s)
- Marzia Lazzerini
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Angela Giusti
- National Centre for Diseases Prevention and Health Promotion National Institute of Health Rome Italy
| | - Emanuelle Pessa Valente
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
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19
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Chen Y, Zheng Y, Yu K, Wu B. Maternal deaths among patients with cancer in the United States. Medicine (Baltimore) 2021; 100:e27922. [PMID: 34797349 PMCID: PMC8601337 DOI: 10.1097/md.0000000000027922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/06/2021] [Indexed: 01/05/2023] Open
Abstract
Our objective was to characterize the risks of maternal deaths in cancer patients compared to the general population using a large population-based cohort.Female patients with a cancer first diagnosed at ages 15 to 39 years between 2000 and 2016 (N = 240,561) from the surveillance, epidemiology, and end results database were extracted, among which 165 maternal deaths were observed.We found Hispanic ethnic groups, advanced cancer stage, receiving chemotherapy were associated with a higher risk of maternal deaths compared to the general the United States population. Patients with cancers of the respiratory system were at the highest risk of maternal deaths, followed by cancers of the digestive system, and hematological malignancies.
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Affiliation(s)
- Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Maternal morbidity and mortality are rising due in part to the rising prevalence of chronic illness, socioeconomic and racial disparities, and advanced maternal age. Prevention of maternal adverse outcomes requires prompt escalation of care to facilities with appropriate capabilities including intensive care services. The development of obstetrical-specific risk assessment tools and protocolized care for the most common causes of maternal intensive care unit (ICU) admission has helped to reduce preventable complications. However, significant work remains to address barriers to the escalation of maternal care and minimize delays in appropriate management.
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Affiliation(s)
- Elisa C Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, USA
| | - Emily E Naoum
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, USA.
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21
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Donati S, Fano V, Maraschini A. Uterine rupture: Results from a prospective population-based study in Italy. Eur J Obstet Gynecol Reprod Biol 2021; 264:70-75. [PMID: 34274701 DOI: 10.1016/j.ejogrb.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the incidence of uterine rupture (UR), and evaluate risk factors, management, and associated maternal and perinatal outcomes. STUDY DESIGN This multicentre prospective population-based study involved six regions in Italy accounting for 49% of national births. The study population comprised all women aged 11-59 years delivering at ≥22 gestational weeks with a diagnosis of UR from September 2014 to August 2016. Maternal and pregnancy characteristics and information on potential risk factors were collected. Unadjusted relative risks (RR) and 95% confidence intervals (CI) were computed with respect to the background population. RESULTS In total, 74 cases of UR occurred among the study population (rate 0.16/1000 pregnancies; mean age 34 years; 14 perinatal deaths, one maternal death). A significantly higher risk of UR was observed for maternal age ≥ 35 years (RR = 1.58, 95% CI 1.00-2.51), multiparity (RR = 5.71, 95% CI 3.14-10.04), previous caesarean section (RR = 20.5, 95% CI 11.11-37.74) and uterine scarring (RR = 6.44, 95% CI 2.94-14.12). A significant association was observed between UR and caesarean section as the mode of delivery (RR = 27.9, 95% CI 10.2-76.5) and gestational age < 37 weeks (RR = 11.82, 95% CI 7.46-18.71). CONCLUSIONS This study found a low rate of UR compared with other European countries, probably due to the high rate of primary caesarean sections and to resistance towards trial of labour and vaginal delivery after caesarean section among obstetricians in Italy. The unforeseen increase in caesarean sections -and, as a result, an increase in placenta accreta spectrum disorders, peripartum hysterectomy and related maternal and perinatal morbidity and mortality as a consequence of previous uterine scarring - failed to ensure better maternal and perinatal outcomes.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | | | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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22
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Ornaghi S, Maraschini A, Donati S. Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study. PLoS One 2021; 16:e0252654. [PMID: 34086797 PMCID: PMC8177430 DOI: 10.1371/journal.pone.0252654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Foundation MBBM at San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
- * E-mail:
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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23
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Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One 2021; 16:e0250373. [PMID: 33891629 PMCID: PMC8064507 DOI: 10.1371/journal.pone.0250373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- * E-mail:
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - for the ItOSS working group
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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24
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Donati S, Corsi E, Salvatore MA, Maraschini A, Bonassisa S, Casucci P, Cataneo I, Cetin I, D’Aloja P, Dardanoni G, De Ambrosi E, Ferrazzi E, Fieni S, Franchi MP, Gargantini G, Iurlaro E, Leo L, Liberati M, Livio S, Locci M, Marozio L, Martini C, Maso G, Mecacci F, Meloni A, Mignuoli AD, Patanè L, Pellegrini E, Perotti F, Perrone E, Prefumo F, Ramenghi L, Rusciani R, Savasi V, Schettini SCA, Simeone D, Simeone S, Spinillo A, Steinkasserer M, Tateo S, Ternelli G, Tironi R, Trojano V, Vergani P, Zullino S. Childbirth Care among SARS-CoV-2 Positive Women in Italy. Int J Environ Res Public Health 2021; 18:ijerph18084244. [PMID: 33923642 PMCID: PMC8074190 DOI: 10.3390/ijerph18084244] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room; the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother’s milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to “better safe than sorry” care choices. An improvement of the peripartum care indicators was observed over time.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
- Correspondence: ; Tel.: +39-0649904318
| | - Edoardo Corsi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy;
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Silvia Bonassisa
- Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, 28100 Novara, Italy;
| | - Paola Casucci
- Sistema Informativo e Mobilità Sanitaria, Umbria Region, 06121 Perugia, Italy;
| | - Ilaria Cataneo
- Department of Obstetrics and Gynecology, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Gabriella Dardanoni
- Osservatorio Epidemiologico Assessorato Salute Regione Siciliana, Sicily Region, 90145 Palermo, Italy;
| | | | - Enrico Ferrazzi
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Stefania Fieni
- Department of Obstetrics and Gynecology, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Gianluigi Gargantini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Enrico Iurlaro
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Livio Leo
- Hospital “Beauregard” Valle D’Aosta, 11100 Aosta, Italy;
| | - Marco Liberati
- D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Stefania Livio
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | | | - Luca Marozio
- Department of Obstetrics and Gynecology, University of Turin, 10124 Turin, Italy;
| | - Claudio Martini
- Territorio e Integrazione Ospedale Territorio, Marche Region, 60122 Ancona, Italy;
| | - Gianpaolo Maso
- Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Federico Mecacci
- Department of Biomedical, Division of Obstetrics and Gynecology, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy;
| | - Alessandra Meloni
- Maternal and Neonatal Department, Azienda Ospedaliero Universitaria, 09042 Cagliari, Italy;
| | - Anna Domenica Mignuoli
- Dipartimento Regionale Tutela della Salute, Calabria Region, 88100 Reggio Calabria, Italy;
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Edda Pellegrini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Francesca Perotti
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Enrica Perrone
- Servizio Assistenza Territoriale, Direzione Generale Cura Della Persona, Salute e Welfare, Emilia-Romagna Region, 40127 Bologna, Italy;
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, ASST Spedali Civili, University of Brescia, 25123 Brescia, Italy;
| | - Luca Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Raffaella Rusciani
- Department of Epidemiology, ASL TO3 Piedmont Region, 10095 Turin, Italy;
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milan, 20157 Milan, Italy;
| | | | - Daniela Simeone
- Ospedale Civile Antonio Cardarelli, 86100 Campobasso, Italy;
| | - Serena Simeone
- Department of Woman and Child’s Health, Careggi University Hospital, 50141 Florence, Italy;
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Martin Steinkasserer
- Central Teaching Hospital of Bozen, Division of Gynecology and Obstetrics, 39100 Bozen, Italy;
| | | | - Giliana Ternelli
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | | | | | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation/San Gerardo Hospital, University of Milan–Bicocca, 20900 Monza, Italy;
| | - Sara Zullino
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, 56126 Pisa, Italy;
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Berdzuli N, Lomia N, Staff AC, Lazdane G, Pestvenidze E, Jacobsen AF. Audit of Early and Late Maternal Deaths in Georgia: Potential for Improving Substandard Obstetric Care. Int J Womens Health 2021; 13:205-219. [PMID: 33628061 PMCID: PMC7899038 DOI: 10.2147/ijwh.s288763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Quality of care is an important factor in reducing preventable maternal deaths, yet it is a significant challenge in many countries. Substandard and poor quality of care is the leading factor in two-thirds of maternal deaths in European countries. Our study investigated the deaths of all women of reproductive age in 2012 in Georgia. The aim was to define the underlying causes of maternal deaths and to identify the factors in women’s care which contributed to the fatal outcomes. Methods A national Reproductive Age Mortality Survey was conducted in Georgia in 2014–15. Data from multiple sources was triangulated to identify all deaths of women of reproductive age. This was followed by verbal autopsy diagnoses. Each case of early and late maternal death was investigated through interviews and medical record reviews at the last medical facility providing care for the deceased woman. A specialist panel reviewed and assigned underlying causes of death, assessed the management of each woman’s condition, and identified elements of suboptimal care. Results We identified a total of 23 maternal deaths, including 15 (65%) early and eight (35%) late deaths. The maternal mortality ratio was 26.3 per 100 000 live births. The four leading causes of early maternal deaths were: sepsis, hemorrhage, embolism, and pregnancy-induced hypertension. Embolism and sepsis were the direct causes of the eight late maternal deaths. Cancer, tuberculosis, and postpartum suicide constituted the indirect causes of death. Improvements in care which would have made a difference to the outcomes were identified in 87% of early maternal deaths and 67% of late maternal deaths due to direct obstetric causes. Discussion Delayed recognition and inappropriate management of maternal complications were common across almost all cases studied. The findings from Georgia highlight the conclusion that most maternal deaths were preventable and that improvement in obstetric care is urgently required.
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Affiliation(s)
- Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunta Lazdane
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Giurazza F, Angileri SA, Corvino F, Granata G, Grillo P, Savoldi AP, Albano G, Bracchi L, Carrafiello G, Niola R. Postpartum Hemorrhages: Prevention. Semin Ultrasound CT MR 2021; 42:85-94. [PMID: 33541592 DOI: 10.1053/j.sult.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The strict correlation between abnormal invasive placentation and postpartum hemorrhage suggests that a widespread antenatal diagnosis of placental anomalies would improve the management of these challenging patients; acting preventive solutions at the moment of delivery reduces blood loss and avoid hysterectomies. The role of endovascular procedures in this field has been encouraged by multiple studies reporting prophylactic uterine arteries embolization and iliac/aortic balloon catheters positioning. This paper aims to review the main imaging diagnostic findings of placental implant anomalies and summarize the principal preventive endovascular strategies proposed in literature.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy.
| | | | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Giuseppe Granata
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Pasquale Grillo
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Anna Paola Savoldi
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | | | - Laura Bracchi
- Diagnostic and Therapeutic Imaging Department, Cerba Healthcare Italia, Milan, Italy
| | | | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
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27
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McCall SJ, Henriquez D, Edwards HM, van den Akker T, Bloemenkamp KWM, van der Bom J, Bonnet MP, Deneux-Tharaux C, Donati S, Gillissen A, Kurinczuk JJ, Li Z, Maraschini A, Seco A, Sullivan E, Stanworth S, Knight M. A total blood volume or more transfused during pregnancy or after childbirth: Individual patient data from six international population-based observational studies. PLoS One 2021; 16:e0244933. [PMID: 33481835 PMCID: PMC7822517 DOI: 10.1371/journal.pone.0244933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to compare incidence, management and outcomes of women transfused their blood volume or more within 24 hours during pregnancy or following childbirth. Methods Combined analysis of individual patient data, prospectively collected in six international population-based studies (France, United Kingdom, Italy, Australia, the Netherlands and Denmark). Massive transfusion in major obstetric haemorrhage was defined as transfusion of eight or more units of red blood cells within 24 hours in a pregnant or postpartum woman. Causes, management and outcomes of women with massive transfusion were compared across countries using descriptive statistics. Findings The incidence of massive transfusion was approximately 21 women per 100,000 maternities for the United Kingdom, Australia and Italy; by contrast Denmark, the Netherlands and France had incidences of 82, 66 and 69 per 100,000 maternities, respectively. There was large variation in obstetric and haematological management across countries. Fibrinogen products were used in 86% of women in Australia, while the Netherlands and Italy reported lower use at 35–37% of women. Tranexamic acid was used in 75% of women in the Netherlands, but in less than half of women in the UK, Australia and Italy. In all countries, women received large quantities of colloid/crystalloid fluids during resuscitation (>3·5 litres). There was large variation in the use of compression sutures, embolisation and hysterectomy across countries. There was no difference in maternal mortality; however, variable proportions of women had cardiac arrests, renal failure and thrombotic events from 0–16%. Interpretation There was considerable variation in the incidence of massive transfusion associated with major obstetric haemorrhage across six high-income countries. There were also large disparities in both transfusion and obstetric management between these countries. There is a requirement for detailed evaluation of evidence underlying current guidance. Furthermore, cross-country comparison may empower countries to reference their clinical care against that of other countries.
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Affiliation(s)
- Stephen J. McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
- * E-mail:
| | - Dacia Henriquez
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hellen McKinnon Edwards
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Thomas van den Akker
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johanna van der Bom
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marie-Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics (CRESS), Paris University, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics (CRESS), Paris University, Paris, France
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Ada Gillissen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
| | - Zhuoyang Li
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Aurélien Seco
- Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - Elizabeth Sullivan
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Simon Stanworth
- Oxford University Hospitals NHS Trust, Department of Haematology, Oxford, United Kingdom
- NIHR BRC Blood Theme, University of Oxford, Oxford, United Kingdom
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
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Frigo MG, Agostini V, Brizzi A, Ragusa A, Svelato A. Practical approach to transfusion management of post-partum haemorrhage. Transfus Med 2021; 31:11-15. [PMID: 33400316 DOI: 10.1111/tme.12755] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe transfusion management during post-partum haemorrhage (PPH) and the usefulness of standard or point-of-care (POC) laboratory tests for guiding haemostatic management. BACKGROUND PPH is the leading cause of maternal mortality and severe maternal morbidity worldwide. Despite the efforts made in recent years, PPH is often burdened by preventable death. Recent data from the active Italian Obstetric Surveillance System (ItOSS) highlighted the following main critical issues: inadequate communication between healthcare professionals, inability to correctly and promptly assess the severity of haemorrhage, delays in diagnosis and treatment, failure to request blood promptly and inappropriate monitoring post-partum. MATERIALS AND METHODS Data in the literature have been compared with the rotational thromboelastometry (ROTEM)- and the thromboelastography (TEG)-guided algorithms applied in the authors' departments. RESULTS PPH transfusion therapy may have an empirical approach based on the standard use of blood products or a targeted approach based on coagulation monitoring by laboratory or POC tests. Here, the authors describe how they manage PPH in their departments, according to the Italian guidelines, along with the addition of a ROTEM- and a TEG-guided algorithms developed by themselves. CONCLUSION Although the proposed algorithms have not been validated by trials or observational studies conducted in our departments, we believe that these indications could be useful for supporting clinical practice. Furthermore, we deem it appropriate to emphasise the importance of a multidisciplinary approach and the need for standardised and shared protocols to support the decisions of healthcare professionals.
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Affiliation(s)
- Maria Grazia Frigo
- Department of Anesthesia and Resuscitation in Obstetrics, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Vanessa Agostini
- Transfusion Medicine Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Agostino Brizzi
- General and Locoregional Anesthesia Department, Santa Maria Clinic, Bari, Italy
| | - Antonio Ragusa
- Obstetric and Gynaecology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Alessandro Svelato
- Obstetric and Gynaecology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Savasi VM, Parisi F, Patanè L, Ferrazzi E, Frigerio L, Pellegrino A, Spinillo A, Tateo S, Ottoboni M, Veronese P, Petraglia F, Vergani P, Facchinetti F, Spazzini D, Cetin I. Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2020; 136:252-8. [PMID: 32433453 DOI: 10.1097/AOG.0000000000003979] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the clinical evolution of coronavirus disease 2019 (COVID-19) in hospitalized pregnant women and potential factors associated with severe maternal outcomes. METHODS We designed a prospective multicenter cohort study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to 12 Italian maternity hospitals between February 23 and March 28, 2020. Clinical records, laboratory and radiologic examinations, and pregnancy outcomes were collected. A subgroup of patients with severe disease was identified based on intensive care unit (ICU) admission, delivery for respiratory compromise, or both. RESULTS Seventy-seven patients were included, 14 of whom had severe disease (18%). Two thirds of the patients in the cohort were admitted during the third trimester, and 84% were symptomatic on admission. Eleven patients underwent urgent delivery for respiratory compromise (16%), and six were admitted to the ICU (8%). One woman received extracorporeal membrane oxygenation; no deaths occurred. Preterm delivery occurred in 12% of patients, and nine newborns were admitted to the neonatal intensive care unit. Patients in the severe subgroup had significantly higher pregestational body mass indexes (BMIs) and heart and respiratory rates and a greater frequency of fever or dyspnea on admission compared with women with a nonsevere disease evolution. CONCLUSION In our cohort, one in five women hospitalized with COVID-19 infection delivered urgently for respiratory compromise or were admitted to the ICU. None, however, died. Increased pregestational BMI and abnormal heart and respiratory rates on admission were associated with severe disease.
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Chantry AA, Berrut S, Donati S, Gissler M, Goldacre R, Knight M, Maraschini A, Monteath K, Morris A, Teixeira C, Wood R, Zeitlin J, Deneux-Tharaux C. Monitoring severe acute maternal morbidity across Europe: A feasibility study. Paediatr Perinat Epidemiol 2020; 34:416-426. [PMID: 31502306 DOI: 10.1111/ppe.12557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated. OBJECTIVE To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe. METHODS We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity. RESULTS Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity. CONCLUSIONS In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe.
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Affiliation(s)
- Anne A Chantry
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Midwifery School of Baudelocque, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris-Descartes University, Paris, France
| | | | - Serena Donati
- Maternal and Child Health Unit, National Centre for Disease Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alice Maraschini
- Maternal and Child Health Unit, National Centre for Disease Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Kirsten Monteath
- Information Services Division, NHS National Services Scotland, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Anna Morris
- Information Services Department, NHS Wales Informatics Service, Cardiff, UK
| | - Cristina Teixeira
- EPI Unit Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Lega I, Maraschini A, D'Aloja P, Andreozzi S, Spettoli D, Giangreco M, Vichi M, Loghi M, Donati S. Maternal suicide in Italy. Arch Womens Ment Health 2020; 23:199-206. [PMID: 31104119 DOI: 10.1007/s00737-019-00977-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1 year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006-2012. The suicide rate was 1.18 per 100,000 after giving birth (n = 2,876,193), 2.77 after an induced abortion (n = 650,549) and 2.90 after a miscarriage (n = 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.
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Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Silvia Andreozzi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Daniela Spettoli
- SaPeRiDoC -Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, Bologna, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Monica Vichi
- Service of Statistics, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Marzia Loghi
- Integrated System for Health, Social Assistance, Welfare and Justice - Directorate for Social Statistics and Population Census - ISTAT, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
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PEKER N, TURAN G, AYDIN E, YAVUZ M, EGE S, BADEMKIRAN MH, KARAÇOR T, GÜL T. Analysis of Patients Undergoing Peripartum Hysterectomy for Obstetric Causes According to Delivery Methods: 13-Year Experience of a Tertiary Center. Dicle Tıp Dergisi 2020. [DOI: 10.5798/dicletip.706086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Grussu P, Lega I, Quatraro RM, Donati S. Perinatal mental health around the world: priorities for research and service development in Italy. BJPsych Int 2020; 17:8-10. [PMID: 34287421 PMCID: PMC8277529 DOI: 10.1192/bji.2019.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/23/2019] [Indexed: 12/03/2022] Open
Abstract
In Italy, most studies on perinatal mental health and initiatives aimed at improving the early detection and management of perinatal mental disorders have been carried out at the local level. National population-based studies are lacking. A study of pregnant women, recruited and diagnosed by a university hospital, found a 12.4% prevalence of minor and major depression during pregnancy, and a prevalence of 9.6% in the postpartum period. In a population-based surveillance system, covering 77% of national births, suicide was identified to be one of the main causes of maternal death within the first year after birth, yet half of those who were known to have a high suicide risk during the postpartum period had not been referred to a mental health service. The value of recognising depressive or anxiety symptoms early, during pregnancy, has been emphasised by recent research and should be linked to multi-professional psychosocial interventions. Since 2017, the Italian public primary care services that are dedicated to pregnancy assistance (Family Care Centres) have been tasked to provide free psychological assessment to pregnant and postpartum women. Action is now needed in order to improve access to Italian Family Care Centres for pregnant women and to develop an integrated care model involving obstetric and mental health services.
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Affiliation(s)
- Pietro Grussu
- Family Service Unit, South Padua District, AULSS 6 Euganea, Regione Veneto, National Health Service, Italy.
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Heath, Italy
| | - Rosa Maria Quatraro
- Hospital Psychology, Obstetrics and Gynaecology Unit, AULSS 8 Berica, Regione Veneto, National Health Service, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Heath, Italy
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Raffray M, Bayat S, Lassalle M, Couchoud C. Linking disease registries and nationwide healthcare administrative databases: the French renal epidemiology and information network (REIN) insight. BMC Nephrol 2020; 21:25. [PMID: 31992233 DOI: 10.1186/s12882-020-1692-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Record linkage is increasingly used in health research worldwide. Combining the patient information available in healthcare, administrative and clinical databases broadens the research perspectives, particularly for chronic diseases. Recent guidelines highlight the need for transparency on the used record linkage processes and the extracted data to be used by researchers. METHODS Therefore, the aim of this study was to describe the deterministic iterative approach used to link the French Epidemiology and Information Network (REIN), a French national End-Stage Renal Disease registry, with the Système National des Données de Santé (SNDS), a French nationwide medico-administrative healthcare database. RESULTS Among the 22,073 patients included in the REIN registry who started renal replacement therapy between 2014 and 2015 in France, 19,223 (87.1%) were matched with patients in the SNDS database. Comparison of matched and unmatched patients confirmed the absence of any major selection bias. Then, the record linkage was evaluated using the comorbidity status (diabetes). CONCLUSIONS This fast and efficient method of record linkage with pseudonymized data and without unique and direct identifier might inspire other research teams. It also opens the path for new research on chronic kidney disease.
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Grandone E, Colaizzo D, Mastroianno M, Petruzzelli F, di Mauro L, Carella M, Tiscia GL, Ostuni A. Pulmonary embolism associated with transfusion after severe post-partum haemorrhage: is less more? Blood Transfus 2020; 18:13-19. [PMID: 31657705 PMCID: PMC7053526 DOI: 10.2450/2019.0060-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transfusion of red blood cells is associated with superficial vein thrombosis (SVT) and venous thromboembolism (deep vein thrombosis and/or pulmonary embolism, VTE). The present study investigated the prevalence of SVT and VTE in women transfused in the peri-partum period. MATERIALS AND METHODS We carried out an observational study in a tertiary level obstetrics department in the Apulia Region of Southern Italy to investigate VTE in women transfused during or after labour. The study included all women who delivered between January 1st and November 30th, 2018. A thrombotic event was defined as an admission with an ICD-9 code of SVT and VTE as a primary or secondary diagnosis. Maternal "near-miss" rate, as defined by the World Health Organization, was calculated and outcome of transfused women was recorded. RESULTS From January 1st to November 30th, a total of 1,028 women delivered, 39% of them by caesarean section (CS). One-hundred and thirty-two women (12.8%) had been classified with one or more complication codes. Most complications occurred in women who underwent CS with an odds ratio (OR) of 7.0 (95% CI: 4.0-12.5; p=0.000). Twelve women (1.2%) were transfused in the peri-partum period, 7 of them had delivered by CS. The only thrombotic events recorded in the entire cohort of 1,028 patients were isolated pulmonary embolisms observed in 2 out of 12 transfused women. Overall, patients had received a mean of 7.5 units of packed red blood cells (1 patient also received 7 plasma units, while 1 patient also received 1 platelet unit). Consequently, the near-miss rate was 2.0/1,000 deliveries, which is not significantly different from that expected in Italy and in high-income countries. CONCLUSIONS Pulmonary embolism is a life-threatening complication, which can be associated with transfusion in the peri-partum period.
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Affiliation(s)
- Elvira Grandone
- Thrombosis and Haemostasis Research Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
- Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Donatella Colaizzo
- Thrombosis and Haemostasis Research Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Mario Mastroianno
- ICT, Innovation and Research Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Francesco Petruzzelli
- Ob/Gyn Department, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Lazzaro di Mauro
- Immunohaematology and Transfusion Medicine Service, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Massimo Carella
- ICT, Innovation and Research Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Giovanni L. Tiscia
- ICT, Innovation and Research Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo (FG), Italy
| | - Angelo Ostuni
- Immunohaematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Italy
- S.R.C. Apulia Region, Bari, Italy
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Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Dell'Oro S, Donati S. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. Acta Obstet Gynecol Scand 2019; 99:274-282. [PMID: 31520414 DOI: 10.1111/aogs.13727] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage. MATERIAL AND METHODS A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. RESULTS The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13-5.96), assisted reproductive technology (RR 5.99, 95% CI 4.42-8.11) multiple pregnancy (RR 5.03, 95% CI 3.57-7.09) and maternal age ≥35 years (RR 2.69, 95% CI 2.25-3.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died. CONCLUSIONS The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.
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Affiliation(s)
- Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Stefania Dell'Oro
- Department of Obstetrics and Gynecology, Foundation MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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Cross-Sudworth F, Knight M, Goodwin L, Kenyon S. Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: a case note review study. BMJ Open 2019; 9:e029552. [PMID: 31256038 PMCID: PMC6609053 DOI: 10.1136/bmjopen-2019-029552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Local reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews. DESIGN Anonymised case notes review. PARTICIPANTS All 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012-2014. MAIN OUTCOME MEASURES The number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed. RESULTS The care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140). CONCLUSIONS This systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time.
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Affiliation(s)
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Katsuragi S, Tanaka H, Hasegawa J, Kanayama N, Nakata M, Murakoshi T, Osato K, Nakamura M, Tanaka K, Sekizawa A, Ishiwata I, Yamamoto Y, Wakasa T, Takeuchi M, Yoshimatsu J, Ikeda T. Analysis of preventability of malignancy-related maternal death from the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2019; 34:432-438. [PMID: 30999803 DOI: 10.1080/14767058.2019.1609930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: We reviewed malignancy related maternal deaths in Japan to ascertain if there were avoidable factors.Methods: Malignancy-related maternal death in Japan reported to the Maternal Death Exploratory Committee, from 2010 to 2016 inclusive.Results: There were 12 cases of maternal death caused by malignancy. There were four gastric cancers (two poorly differentiated adenocarcinoma, one signet ring cell carcinoma with adenocarcinoma, one histology not available), 3 leukemia (two acute myeloid leukemia, one aggressive NK cell leukemia), two ureteral cancers (histology not available), one malignant lymphoma (diffuse large B-cell lymphoma with translocation), one brain tumor (gliomatosis cerebri), and one cervical cancer (glassy cell carcinoma). Two gastric cancer patients had chronic gastric pain before conception. In two cases the physicians commented that they had avoided computed tomography and the brain biopsy needed for diagnosis because the patient was pregnant. At diagnosis, the clinical stages were II-IV in 9, and the performance status was 3-5 in 8. Indication for delivery was exacerbated maternal condition in 5, for treatment in 3, spontaneous labor in 3, and one patient declined elective delivery. Median [interquartile rage] (range) gestational weeks of delivery was 29 [24-30] (19-40). One cervical cancer patient had a radical hysterectomy and chemotherapy for 10 months. However, three leukemia and one gastric cancer patients had chemotherapy within 10 d because they deteriorated rapidly. Another seven cases did not have any treatment because of poor general condition or because they remained undiagnosed. In all cases, the Committee considered that there was no evidence of substandard care.Conclusion: In these cases, both the clinical stages and biological degree of malignancy were high. In two-thirds of cases, early termination of the pregnancy was indicated because of deteriorating maternal condition. Chemotherapy was not effective because of short available time for therapy and the advanced stage of the cancers when diagnosed. Encouraging women to have a thorough medical assessment before conception, and early diagnosis and treatment before pregnancy, appears to be the only practical way to reduce deaths from malignancy while a woman is pregnant.
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Affiliation(s)
- Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kanagawa, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Yoshiko Yamamoto
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoko Wakasa
- Department of Diagnostic Pathology, Kindai University Faculty of Medicine, Nara Hospital, Ikoma, Japan
| | - Makoto Takeuchi
- Department of Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Jun Yoshimatsu
- Department of Perinatology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Reardon DC. Missed opportunities and potentially misleading results in maternal mortality study. Acta Obstet Gynecol Scand 2019; 98:127. [PMID: 30091224 DOI: 10.1111/aogs.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/30/2018] [Indexed: 11/27/2022]
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Donati S, Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Manno V. In response to "missed opportunities and potentially misleading results in maternal mortality study". Acta Obstet Gynecol Scand 2019; 98:128-129. [PMID: 30288726 DOI: 10.1111/aogs.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 02/17/2024]
Affiliation(s)
- Serena Donati
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Statistics Service, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy
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