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Gregory S, Caffrey L, Daly D. "It could not have been more different." Comparing experiences of hospital-based birth and homebirth in Ireland: A mixed-methods survey. Women Birth 2023:S1871-5192(23)00035-5. [PMID: 36804152 DOI: 10.1016/j.wombi.2023.02.003] [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: 10/10/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
PROBLEM Internationally, little is known about the experiences of the minority who have birthed both in hospital and at home. This group are in a unique position to provide experiential evidence regarding perceptions of care under each approach. BACKGROUND Obstetric care within the hospital setting is the hegemonic approach to birth in western cultures. Homebirth is at least as safe as hospital birth for those with low-risk pregnancies, yet access is strictly regulated. AIM To explore how those who have experienced both hospital and homebirth maternity care in Ireland perceived the care received, and experienced birth in each setting. METHODS 141 participants who birthed both in hospital and at home between 2011 and 2021 completed an online survey. FINDINGS Participants' overall experience scores were significantly higher for homebirth (9.7/10) than hospital birth (5.5/10). In hospital, midwifery-led care scored significantly higher (6.4/10) than consultant-led care (4.9/10). Qualitative data revealed four explanatory themes: 1) Regulation of birth; 2) Continuity of care and/or carer and establishing relationships; 3) Bodily integrity and informed consent; and 4) Lived experiences of labour and birth at home and in hospital. DISCUSSION Homebirth was perceived far more positively than hospital birth experiences across all aspects of care surveyed. Findings suggest that those who have experienced both models of care have unique perspectives and aspirations about childbirth. CONCLUSION This study provides evidence regarding the need for genuine choices for maternity care and reveals the importance of care which is respectful and responsive to divergent ideologies about birth.
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Affiliation(s)
- Soma Gregory
- School of Social Work and Social Policy, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland.
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women's views and experiences of augmentation of labour with synthetic oxytocin infusion: A qualitative evidence synthesis. Midwifery 2023; 116:103512. [PMID: 36323076 DOI: 10.1016/j.midw.2022.103512] [Citation(s) in RCA: 4] [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: 08/01/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore and synthesise women's views and experiences of augmentation of labour with synthetic oxytocin infusion. DESIGN A qualitative evidence synthesis was conducted. The SPIDER acronym was used to develop the search terms and determine the inclusion criteria. Six bibliographic databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection were searched in October 2021. Grey literature sources, EThOS, DART-Europe, and the World Health Organization's Clinical Trials Registry were searched, and reference lists of included studies were reviewed. Methodological quality of included studies was assessed using the Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre assessment tool. Data were synthesised thematically. The confidence of each review finding was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Research ethical approval was not required. SETTING AND PARTICIPANTS Women of any age, parity, and cultural background who underwent augmentation of labour with synthetic oxytocin infusion were included. FINDINGS A total of 9306 citations were retrieved. Twenty-five studies conducted across 14 countries met the inclusion criteria and contributed data. Three principal analytical themes emerged: feeling stuck; past and present shaping the future; and cause and effect of augmentation of labour. The decision to augment women's labour was often performed without their informed consent. Women's views and experiences of augmentation of labour were shaped according to their knowledge, beliefs and support received during labour. Irrespective of the context, women consistently associated augmentation of labour with pain. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Clinical guidelines on augmentation of labour need to be informed by research that includes women's views and experiences as a main outcome. Future research exploring the experience of augmentation of labour rather than the experience of labour dystocia would be beneficial. Increasing women's awareness and knowledge of augmentation of labour may help to ensure that their informed consent is obtained. Healthcare providers should discuss the effects, side effects and implications of augmentation of labour with women, ideally before labour.
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Affiliation(s)
- Silvia Alòs-Pereñíguez
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland.
| | - Deirdre O'Malley
- Nursing, Midwifery & Health Studies, Dundalk Institute of Technology, Dundalk, A91 K584, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Daly D, Moran P, Wuytack F, Cusack C, Hannon K, Begley C. Prevention and treatment of peripartum urinary incontinence-a survey of hospital-based maternity services in Ireland. Int Urogynecol J 2022; 33:3481-3489. [PMID: 36173427 DOI: 10.1007/s00192-022-05361-9] [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: 07/07/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Considerable proportions of pregnant and postpartum women experience urinary incontinence, but to our knowledge, there are no national data on the preventative and treatment services available in Ireland's 19 maternity hospitals. METHODS Ethical approval was granted. A national benchmarking survey on the range and type of services on prevention and treatment of urinary incontinence during pregnancy and postpartum was developed. Directors of Midwifery and Nursing in each hospital identified midwives and women's health physiotherapists to complete the survey. Data were analysed descriptively, and results presented as proportions. RESULTS Responses were received from 17 hospitals. Women were asked about urinary incontinence during their first booking visit in 6 hospitals, during all antenatal visits in 2 and the onus was on women self-reporting symptoms in 9. Pelvic floor muscle exercises were taught in antenatal classes in 14 hospitals and management of urinary incontinence in 9. In hospital postpartum, midwives in 13 hospitals asked women about urinary incontinence. All women were seen by a physiotherapist in 7 hospitals and only those who were referred in 6. Women could access the hospital's physiotherapy services up to 6 weeks postpartum in 3 hospitals, up to 6 months or 1 year in 5 and beyond 1 year in 6. CONCLUSIONS Geographical inequity exists in the services offered to pregnant and postpartum women nationally. This indicates that many pregnant and postpartum women, both continent and incontinent, cannot avail themselves of preventative and treatment services within the maternity hospital system and points to the need to review, reconfigure and resource services.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland. .,Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland.
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland
| | - Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland
| | - Cinny Cusack
- Physiotherapy Department, Rotunda Hospital, Parnell Square East, Dublin, D01 P5W9, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland.,Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland.,Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D'Olier Street, Dublin, D02T283, Ireland
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Panda S, Begley C, Corcoran P, Daly D. Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study. Birth 2022; 49:812-822. [PMID: 35695041 PMCID: PMC9796356 DOI: 10.1111/birt.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/28/2021] [Accepted: 05/09/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is widespread concern around the rising rates of cesarean births (CBs), especially among first-time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first-time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women. METHODS A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self-administered surveys antenatally and at 3 months postpartum and from consenting women's hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs. RESULTS Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural. CONCLUSIONS Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.
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Affiliation(s)
- Sunita Panda
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Cecily Begley
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Paul Corcoran
- National Perinatal Epidemiology CentreUniversity College CorkCorkIreland
| | - Deirdre Daly
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
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Bovbjerg ML, Leitao S, Corcoran P, O'Regan L, Greene RA, Manning E, Byrne B, Cooley S, Daly D, Fallon A, Higgins M, Jones C, Kinsells I, Murphy C, Murphy J, Ni Bhuinneain M. Critical care in obstetrics: Clinical audit in the Republic of Ireland, 2014–2016. Eur J Obstet Gynecol Reprod Biol 2022; 279:183-190. [DOI: 10.1016/j.ejogrb.2022.10.008] [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: 08/12/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
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Leutenegger V, Grylka-Baeschlin S, Wieber F, Daly D, Pehlke-Milde J. The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review. BMC Pregnancy Childbirth 2022; 22:856. [PMCID: PMC9675115 DOI: 10.1186/s12884-022-05178-w] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined. Aim Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes. Methods The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I. Results Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies. Conclusions Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05178-w.
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Affiliation(s)
- Vanessa Leutenegger
- grid.19739.350000000122291644School of Health Sciences, Institute of Midwifery, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Susanne Grylka-Baeschlin
- grid.19739.350000000122291644ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Midwifery, Winterthur, Switzerland
| | - Frank Wieber
- grid.19739.350000000122291644ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Public Health, Winterthur, Switzerland ,grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Constance, Germany
| | - Deirdre Daly
- grid.8217.c0000 0004 1936 9705School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jessica Pehlke-Milde
- grid.19739.350000000122291644ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Midwifery, Winterthur, Switzerland
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8
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Hannon K, Nilsen ABV, Murphy M, Eri TS, Leahy-Warren P, Corcoran P, Downe S, Daly D. What women identify as positive aspects and areas for improvement of maternity care and services in Ireland: An online survey. Women Birth 2022:S1871-5192(22)00355-9. [DOI: 10.1016/j.wombi.2022.11.009] [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: 05/31/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
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Shakeshaft A, Laiou P, Abela E, Stavropoulos I, Richardson MP, Pal DK, Howell A, Hyde A, McQueen A, Duran A, Gaurav A, Collingwood A, Kitching A, Shakeshaft A, Papathanasiou A, Clough A, Gribbin A, Swain A, Needle A, Hall A, Smith A, Macleod A, Chhibda A, Fonferko-Shadrach B, Camara B, Petrova B, Stuart C, Hamilton C, Peacey C, Campbell C, Cotter C, Edwards C, Picton C, Busby C, Quamina C, Waite C, West C, Ng CC, Giavasi C, Backhouse C, Holliday C, Mewies C, Thow C, Egginton D, Dickerson D, Rice D, Mullan D, Daly D, Mcaleer D, Gardella E, Stephen E, Irvine E, Sacre E, Lin F, Castle G, Mackay G, Salim H, Cock H, Collier H, Cockerill H, Navarra H, Mhandu H, Crudgington H, Hayes I, Stavropoulos I, Daglish J, Smith J, Bartholomew J, Cotta J, Ceballos JP, Natarajan J, Crooks J, Quirk J, Bland J, Sidebottom J, Gesche J, Glenton J, Henry J, Davis J, Ball J, Selmer KK, Rhodes K, Holroyd K, Lim KS, O’Brien K, Thrasyvoulou L, Makawa L, Charles L, Richardson L, Nelson L, Walding L, Woodhead L, Ehiorobo L, Hawkins L, Adams L, Connon M, Home M, Baker M, Mencias M, Richardson MP, Sargent M, Syvertsen M, Milner M, Recto M, Chang M, O'Donoghue M, Young M, Ray M, Panjwani N, Ghaus N, Sudarsan N, Said N, Pickrell O, Easton P, Frattaroli P, McAlinden P, Harrison R, Swingler R, Wane R, Ramsay R, Møller RS, McDowall R, Clegg R, Uka S, White S, Truscott S, Francis S, Tittensor S, Sharman SJ, Chung SK, Patel S, Ellawela S, Begum S, Kempson S, Raj S, Bayley S, Warriner S, Kilroy S, MacFarlane S, Brown T, Samakomva T, Nortcliffe T, Calder V, Collins V, Parker V, Richmond V, Stern W, Haslam Z, Šobíšková Z, Agrawal A, Whiting A, Pratico A, Desurkar A, Saraswatula A, MacDonald B, Fong CY, Beier CP, Andrade D, Pauldhas D, Greenberg DA, Deekollu D, Pal DK, Jayachandran D, Lozsadi D, Galizia E, Scott F, Rubboli G, Angus-Leppan H, Talvik I, Takon I, Zarubova J, Koht J, Aram J, Lanyon K, Irwin K, Hamandi K, Yeung L, Strug LJ, Rees M, Reuber M, Kirkpatrick M, Taylor M, Maguire M, Koutroumanidis M, Khan M, Moran N, Striano P, Bala P, Bharat R, Pandey R, Mohanraj R, Thomas R, Belderbos R, Slaght SJ, Delamont S, Sastry S, Mariguddi S, Kumar S, Kumar S, Majeed T, Jegathasan U, Whitehouse W. Heterogeneity of resting-state EEG features in juvenile myoclonic epilepsy and controls. Brain Commun 2022; 4:fcac180. [PMID: 35873918 PMCID: PMC9301584 DOI: 10.1093/braincomms/fcac180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalized epilepsy in both ictal and interictal states. Here, we characterize differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. Ninety-five control EEGs were acquired from two independent studies [Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project]. We extracted frequency and functional network-based features from 10 to 20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. In addition, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2-5 Hz) (P = 0.0007, hedges' g = 0.55) and low-alpha (6-9 Hz) (P = 2.9 × 10-8, g = 0.80) frequency bands, peak alpha frequency (P = 0.000007, g = 0.66), functional network mean degree (P = 0.0006, g = 0.48) and brain network ictogenicity (P = 0.00006, g = 0.56) between epilepsy and controls. Since age (P = 0.009) and epoch length (P = 1.7 × 10-8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared with controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalized epilepsy particularly for their use as biomarkers.
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Affiliation(s)
- Amy Shakeshaft
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Petroula Laiou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Eugenio Abela
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Mark P Richardson
- Correspondence may also be addressed to: Professor Mark P Richardson Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London, 5 Cutcombe Road, London SE5 9RX, UK E-mail:
| | - Deb K Pal
- Correspondence to: Professor Deb K Pal Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London 5 Cutcombe Road, London SE5 9RX, UK E-mail:
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Tierney A, Holmes N, Kinsella E, O’Sullivan D, Daly D. P197 Bone health status over time in people with cystic fibrosis and adherence to assessment of bone health guidelines at University Hospital Limerick. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00526-4] [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] [Indexed: 10/18/2022]
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Leitao S, Manning E, Greene RA, Corcoran P, Byrne B, Cooley S, Daly D, Fallon A, Higgins M, Jones C, Kinsella I, Murphy C, Murphy J, Bhuinneain MN. Author reply: Interventions in low/middle‐income countries to reduce severe maternal morbidity due to placenta accreta spectrum and major obstetric haemorrhage. BJOG 2022. [DOI: 10.1111/1471-0528.17198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sara Leitao
- National Perinatal Epidemiology Centre University College Cork Cork Ireland
| | - Edel Manning
- National Perinatal Epidemiology Centre University College Cork Cork Ireland
| | - Richard A. Greene
- National Perinatal Epidemiology Centre University College Cork Cork Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre University College Cork Cork Ireland
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion. A protocol for a qualitative evidence synthesis. HRB Open Res 2022; 4:127. [PMID: 35187397 PMCID: PMC8822135 DOI: 10.12688/hrbopenres.13467.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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Affiliation(s)
- Silvia Alòs-Pereñíguez
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
| | - Deirdre O'Malley
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
- Nursing, Midwifery & Health Studies, Dundalk Institute of Technology, Dundalk, A91 K584, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, D02 T283, Ireland
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Corrigan L, Moran P, McGrath N, Eustace-Cook J, Daly D. The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:250. [PMID: 35337282 PMCID: PMC8957136 DOI: 10.1186/s12884-022-04474-9] [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] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Yoga is a popular mind-body medicine frequently recommended to pregnant women. Gaps remain in our understanding of the core components of effective pregnancy yoga programmes. This systematic review and meta-analysis examined the characteristics and effectiveness of pregnancy yoga interventions, incorporating the FITT (frequency, intensity, time/duration and type) principle of exercise prescription. Methods Nine electronic databases were searched: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga interventions were eligible. Covidence was used to screen titles, abstracts, and full-text articles. Outcomes of interest were stress, anxiety, depression, quality of life, labour duration, pain management in labour and mode of birth. The Cochrane Collaboration’s Risk of Bias Assessment tool was used to assess methodological quality of studies and GRADE criteria (GRADEpro) evaluated quality of the evidence. Meta-analysis was performed using RevMan 5.3. Results Of 862 citations retrieved, 31 studies met inclusion criteria. Twenty-nine studies with 2217 pregnant women were included for meta-analysis. Pregnancy yoga interventions reduced anxiety (SMD: -0.91; 95% CI: − 1.49 to − 0.33; p = 0.002), depression (SMD: -0.47; 95% CI: − 0.9 to − 0.04, P = 0.03) and perceived stress (SMD: -1.03; 95% CI: − 1.55 to − 0.52; p < 0.001). Yoga interventions also reduced duration of labour (MD = − 117.75; 95% CI − 153.80 to − 81.71, p < 0.001) and, increased odds of normal vaginal birth (OR 2.58; 95% CI 1.46–4.56, p < 0.001) and tolerance for pain. The quality of evidence (GRADE criteria) was low to very low for all outcomes. Twelve or more yoga sessions delivered weekly/bi-weekly had a statistically significant impact on mode of birth, while 12 or more yoga sessions of long duration (> 60 min) had a statistically significant impact on perceived stress. Conclusion The evidence highlights positive effects of pregnancy yoga on anxiety, depression, perceived stress, mode of birth and duration of labour. Systematic review registration: PROSPERO, CRD42019119916. Registered on 11th January 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04474-9.
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Affiliation(s)
- Lisa Corrigan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Patrick Moran
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Niamh McGrath
- School of Public Health, University College Dublin, Dublin, Ireland
| | | | - Deirdre Daly
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Daly D, McSorley A. 764 ROCKWOOD CLINICAL FRAILTY SCALE TO PREDICT LENGTH OF STAY,INPATIENT MORTALITY & READMISSION RATE IN A COMMUNITY HOSPITAL SETTING. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Frailty is prevalent in elderly patients in acute medical wards. It is recognised that length of stay (LOS), inpatient mortality and readmission rates rise with increasing frailty. (Reference: Specialised Clinical Frailty Network: Clinical frailty Scale. 2018. https://www.scfn.org.uk/clinical-frailty-scale) The Rockwood clinical frailty scale (CFS) is a well-recognised and validated tool, which can be easily incorporated into the comprehensive geriatric assessment to identify the frailest patients and aid in clinical decision making. We collected data on elderly patients in a non-acute community setting to assess the relationship between degree of frailty and outcomes, in this subset of inpatients.
Methods
Data was collected on 200 patients admitted to a geriatrician led community hospital over an 8 month period. Patients were all transferred from the affiliated acute hospital site (both medical and surgical wards).Commonest acute diagnoses were: falls, fractures, infections, delirium and heart failure. Premorbid CFS was recorded and patients were divided into 2 groups: CFS ≤ 4: versus CFS ≥5, and outcomes compared to degree of frailty.
Results
Of 200 patients, aged ≥65 years, admitted from the acute hospital setting to the community hospital,28.5% had premorbid CFS ≤4,and 71.5% had premorbid CFS ≥5. Median LOS in the community hospital was 10 days in the less frail group compared to 13 days in the frailer group. One year emergency readmission rate was 58.5% in those with CFS ≤4,and 67% in those with CFS ≥5.
Conclusion(s)
Accurate recording of premorbid CFS in the non-acute hospital setting can be used to help predict patient outcomes. Used in conjunction with the CGA it is a tool that can aid decision making and prompt discussions with patients and/or families re advance care planning, specifically re suitability of transfer back to the acute hospital setting in the event of a decline in health.
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Affiliation(s)
- D Daly
- Ards Community Inpatient Ward –South Eastern Trust
| | - A McSorley
- Ards Community Inpatient Ward –South Eastern Trust
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Alòs-Pereñíguez S, O'Malley D, Daly D. Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion: a protocol for a qualitative evidence synthesis. HRB Open Res 2021; 4:127. [DOI: 10.12688/hrbopenres.13467.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions. Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)
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Wuytack F, Moran P, Panda S, Hannon K, Cusack C, O'Donovan M, Daly D. Response to letter to the editor regarding our manuscript: A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence. Neurourol Urodyn 2021; 41:512. [PMID: 34609022 DOI: 10.1002/nau.24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Sunita Panda
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Maggie O'Donovan
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Wuytack F, Moran P, Daly D, Begley C. Is there an association between parity and urinary incontinence in women during pregnancy and the first year postpartum?: A systematic review and meta-analysis. Neurourol Urodyn 2021; 41:54-90. [PMID: 34529861 DOI: 10.1002/nau.24785] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 11/08/2022]
Abstract
AIMS To systematically review the literature on possible associations between parity and urinary incontinence (UI) during pregnancy and in the first year postpartum. METHODS We searched the databases Pubmed, CINAHL, Embase, the Cochrane Library, PsycINFO, MIDIRS, ClinicalTrials.gov (inception-18 April 2020). One reviewer screened all titles. Two reviewers independently selected studies by abstract and full text. Risk of bias was assessed using the Quality In Prognosis Studies tool. Findings were synthesised in meta-analysis or narratively. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group approach adopted for prognostic studies. RESULTS We identified 16 643 records and 39 were included. Thirty studies examined UI during pregnancy and 12 examined UI postpartum. Multiparity was associated with UI at any point in the last pregnancy (odds ratio [OR]: 1.59 [1.26-2.00], 5 studies, 1565 participants) and in the third trimester when measured by ICIQ-SF (OR: 2.67 [1.53-4.67], 4 studies, 1150 participants), but not when studies measured the UI point prevalence (OR: 2.48 [0.91-6.79], 4 studies, 52 976 participants), or if they measured the prevalence at one point in any trimester (OR: 1.09 (0.60-1.95), 3 studies, 872 participants). At 3 months postpartum, UI was associated with multiparity (OR: 2.03 [1.35-3.06], 4 studies, 6781 participants). CONCLUSIONS Increased parity was associated with UI in the first year postpartum, but studies on UI during pregnancy had conflicting results. The evidence was (very) uncertain. Future studies should use comparable definitions and further explore UI sub-types.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Patrick Moran
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
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Newnham EC, Moran PS, Begley CM, Carroll M, Daly D. Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study. Women Birth 2021; 34:e435-e441. [DOI: 10.1016/j.wombi.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Wuytack F, Moran P, Daly D, Panda S, Hannon K, Cusack C, O'Donovan M. A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence. Neurourol Urodyn 2021; 40:1275-1303. [PMID: 34082483 DOI: 10.1002/nau.24678] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
AIM This systematic review aims to identify disease-specific and generic quality of life (QoL) outcome measurement instruments used in populations of women with urinary incontinence (UI) and to determine the most psychometrically robust and appropriate disease-specific and generic tools for measuring the quality of life in this population. METHODS A systematic search was conducted of PubMed, Embase, SCIELO, and CINAHL databases for studies evaluating measurement properties of QoL instruments in women with UI. The methodological quality of studies and the quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement INtruments (COSMIN) checklist and quality criteria. Overall, evidence for measurement properties was graded using the modified grading of recommendations, assessment, development & evaluation approach. RESULTS A total of 73 studies were included, and 27 specific and 6 generic instruments were identified. The Incontinence QoL questionnaire (IQoL) had the highest overall psychometric quality for English-speaking populations and was the most widely translated tool. Evidence for generic QoL tools in this population is limited. Few studies evaluated measurement error or cross-cultural validity. CONCLUSION The IQoL is the most psychometrically robust disease-specific tool for use in this population. More research is needed to determine the most psychometrically robust generic tool. Future studies should also evaluate measurement error and cross-cultural validity as evidence for these properties is particularly lacking.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Maggie O'Donovan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Corrigan L, O'Farrell A, Moran P, Daly D. Hypertension in pregnancy: Prevalence, risk factors and outcomes for women birthing in Ireland. Pregnancy Hypertens 2021; 24:1-6. [PMID: 33618054 DOI: 10.1016/j.preghy.2021.02.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/29/2020] [Accepted: 02/04/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the number of pregnancies affected by hypertension in Ireland and report on possible risk factors and adverse pregnancy outcomes for women and their babies. STUDY DESIGN Data on maternity hospital discharges for women giving birth in Ireland in 2016 were extracted from the national Hospital In-Patient Enquiry data system. Women with a diagnosis of a hypertensive disorder of pregnancy were identified using relevant ICD codes. Descriptive statistics were used to present prevalence, and Pearson's Chi-square and multivariable regression analyses were conducted to identify risk factors and pregnancy outcomes. Differences between proportions were analysed by Pearson's Chi-squared test of independence. RESULTS Of 60,188 maternities reported for the year 2016, 5.9% of women (n = 3531) had a hypertensive disorder of pregnancy and 4.6% (n = 2790) had pre-eclampsia. Rates were higher among women with pre-existing diabetes, gestational diabetes, obesity and those aged ≥40 years. After adjusting for maternal age, pre-existing DM, GDM, obesity and tobacco use, obesity (AOR 4.3; 95% CI: 3.2-5.7; p < 0.001), pre-existing diabetes (AOR 3.5; 95% CI: 2.5-4-9; p < 0.001), gestational diabetes (AOR 1.5; 95% CI: 1.3-1.8; p < 0.001) and being aged ≥40 years (AOR 1.5; 95% CI: 1.3-1.7; p < 0.001) remained significantly associated with being diagnosed with a hypertensive disorder of pregnancy in the Republic of Ireland. CONCLUSION In Ireland where maternal age at childbirth is increasing, the association of hypertension with advancing age will undoubtedly contribute to a greater prevalence of hypertensive disorders of pregnancy and their potential adverse outcomes for pregnant women and their babies. This retrospective study highlights the prevalence rates in Ireland while also identifying possible risk factors and associated adverse pregnancy outcomes. They pinpoint the need for further research to look in more detail at risk factors and adverse outcomes for the 79% (n = 2790) of women presenting with pre-eclampsia among this large nationally representative sample of women.
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Affiliation(s)
- Lisa Corrigan
- School of Nursing & Midwifery, Trinity College Dublin, Ireland.
| | - Anne O'Farrell
- Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Patrick Moran
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
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Daly D, Moran P, Wuytack F, Hannon S, Hannon K, Martin Y, Peoples M, Begley C, Newnham E. The maternal health-related issues that matter most to women in Ireland as they transition to motherhood - A qualitative study. Women Birth 2021; 35:e10-e18. [PMID: 33582046 DOI: 10.1016/j.wombi.2021.01.013] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many studies on women's maternity care experiences reveal recurring issues that are poor or less than optimal. Women's opinions on the maternal health-related issues that matter most to them are essential if care and services are to be improved. AIMS To identify the maternal health-related issues that matter most to women in Ireland, based on their own experiences of maternity care, services and motherhood. METHODS A qualitative exploratory study with 24 women. Following university ethical approval, audio-recorded one-to-one telephone interviews were conducted and thematically analysed. FINDINGS We identified two themes, each with four subthemes, connected to a central concept of the invisible woman. Pendulum of care, and subthemes Inconsistent services, All about the baby, Induced anxiety and Information seesaw, illustrated the extremes of care and services that women experienced. Magnitude of motherhood, and subthemes Weight of responsibility, Real-time reassurance, Change of identity and Growth into advocacy, depicted the intensity of their new role while transitioning to motherhood. DISCUSSION Findings articulate the issues that mattered most to women in Ireland as they transitioned to motherhood. Some women identified specific research topics/areas, but all of the issues identified can be translated into researchable topics that seek to improve local care and service provision. CONCLUSION Given the recurring nature of women's less than satisfactory experiences of aspects of maternity care in many countries, it is likely that conducting research on issues that matters most to women will have the greatest impact on their health, wellbeing and lives as they transition to motherhood.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland.
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Susan Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Yvonne Martin
- Study participant, c/o Deirdre Daly, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Maeve Peoples
- Study participant, c/o Deirdre Daly, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Elizabeth Newnham
- School of Nursing and Midwifery, Griffith University, L05 Room 1.46, Logan Campus, University Drive, Meadowbrook, Queensland 4131, Australia
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Greene RA, McKernan J, Manning E, Corcoran P, Byrne B, Cooley S, Daly D, Fallon A, Higgins M, Jones C, Kinsella I, Murphy C, Murphy J, Bhuinneain MN. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257:114-120. [DOI: 10.1016/j.ejogrb.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP. METHODS We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded. RESULTS We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety. CONCLUSIONS A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Cecily Begley
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, Ireland
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24
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Daly D, Minnie KCS, Blignaut A, Blix E, Vika Nilsen AB, Dencker A, Beeckman K, Gross MM, Pehlke-Milde J, Grylka-Baeschlin S, Koenig-Bachmann M, Clausen JA, Hadjigeorgiou E, Morano S, Iannuzzi L, Baranowska B, Kiersnowska I, Uvnäs-Moberg K. How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries. PLoS One 2020; 15:e0227941. [PMID: 32722667 PMCID: PMC7386656 DOI: 10.1371/journal.pone.0227941] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/18/2019] [Indexed: 01/24/2023] Open
Abstract
Objective To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. Design Observational study Setting Twelve countries, eleven European and South Africa. Sample National, regional or institutional-level regimens on oxytocin for induction and augmentation labour Methods Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67μg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused Results Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. Conclusion Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution’s mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Karin C. S. Minnie
- NuMIQ research focus area: Research to promote quality of Nursing and Midwifery, North-West University, Potchefstroom, South Africa
| | - Alwiena Blignaut
- NuMIQ research focus area: Research to promote quality of Nursing and Midwifery, North-West University, Potchefstroom, South Africa
| | - Ellen Blix
- Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, Oslo, Norway
| | - Anne Britt Vika Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences (HVL), Bergen, Norway
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katrien Beeckman
- Department of Public Health, Nursing and Midwifery Research group (NUMID), UZ Brussel, Vrije Universiteit Brussel; Midwifery Research Education and Policymaking (MidRep), University of Antwerp, Brussel, Belgium
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Jessica Pehlke-Milde
- Research Unit for Midwifery Science, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Susanne Grylka-Baeschlin
- Research Unit for Midwifery Science, Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Jette Aaroe Clausen
- Bachelor Degree Program in Midwifery, Copenhagen University College, Copenhagen, Denmark
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Science, Cyprus University of Technology, Limassol, Cyprus
| | - Sandra Morano
- Department of Neurologic, Oculist, Gynaecologic, Maternal and Infant Sciences, University of Genoa, Genoa, Italy
| | - Laura Iannuzzi
- Department of Midwifery and Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Iwona Kiersnowska
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Warsaw, Poland
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Moran PS, Normand C, Gillen P, Wuytack F, Turner M, Begley C, Daly D. Economic implications of reducing caesarean section rates - Analysis of two health systems. PLoS One 2020; 15:e0228309. [PMID: 32722668 PMCID: PMC7386590 DOI: 10.1371/journal.pone.0228309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/17/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
Caesarean section (CS) rates throughout Europe have risen significantly over the last two decades. As well as being an important clinical issue, these changes in mode of birth may have substantial resource implications. Policy initiatives to curb this rise have had to contend with the multiplier effect of women who had a CS for their first birth having a greater likelihood of requiring one during subsequent births, thus making it difficult to decrease CS rates in the short term. Our study examines the long-term resource implications of reducing CS rates among first-time mothers, as well as improving rates of vaginal birth after caesarean section (VBAC), among an annual cohort of women over the course of their most active childbearing years (18 to 44 years) in two public health systems in Europe. We found that the economic benefit of improvements in these two outcomes is considerable, with the net present value of the savings associated with a five-percentage-point change in nulliparous CS rates and VBAC rates being €1.1million and £9.8million per annual cohort of 18-year-olds in Ireland and England/Wales, respectively. Reductions in CS rates among first-time mothers are associated with a greater payoff than comparable increases in VBAC rates. The net present value of achieving CS rates comparable to those currently observed in the best performing Scandinavian countries was €3.5M and £23.0M per annual cohort in Ireland and England/Wales, respectively.
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Affiliation(s)
- Patrick S. Moran
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Patricia Gillen
- School of Nursing Research, Institute of Nursing and Health Research, Ulster University, Coleraine, United Kingdom
| | - Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Michael Turner
- School Of Medicine, University College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Tierney A, O’Connell S, Daly D. P269 Exploring gastrointestinal symptoms in paediatric patients with cystic fibrosis and impact on quality of life. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30601-9] [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] [Indexed: 11/24/2022]
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Panda S, Begley C, Daly D. Influence of women's request and preference on the rising rate of caesarean section - a comparison of reviews. Midwifery 2020; 88:102765. [PMID: 32531664 DOI: 10.1016/j.midw.2020.102765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/17/2018] [Revised: 05/10/2020] [Accepted: 05/24/2020] [Indexed: 01/12/2023]
Abstract
The rising caesarean section (CS) rates have been, in part, attributed to women's requests. Several individual studies and literature reviews have attempted to determine the degree of influence of women's requests on overall CS rates, and the common reasons behind these requests, from women's, midwives' and obstetricians' viewpoints. Despite many similarities in their findings, there is both a lack of clarity and disparity on the degree of influence women's requests actually has on the decision to perform a CS. This paper presents a critique of a key finding from a recently published systematic review of clinicians' (midwives' and obstetricians') views of factors that influenced their decision to perform a CS, which identified their belief in 'women's request' as a key factor. This finding is contrasted with findings from three other published reviews, which concluded that women's request contributed minimally to the overall rising rates of CS indicating a disparity in evidence around influence and contribution of women's request. Some of the possible reasons for this disparity can be explained by differences in views of women and clinicians, women's decision being guided by clinicians' beliefs of what is 'safe' and unsafe', and women's concerns being interpreted as their request and preferences to birth by CS. An insight into the possible reasons for the disparity in findings can help explain whether maternal request has any influence on the rising rates of CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
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Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E, Beeckman K, Bogaerts A, Binfa L, Frith L, Gross MM, Misselwitz B, Hálfdánsdóttir B, Daly D, Corcoran P, Calleja-Agius J, Calleja N, Gatt M, Vika Nilsen AB, Declercq E, Gissler M, Heino A, Lindgren H, de Jonge A. Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study. PLoS Med 2020; 17:e1003103. [PMID: 32442207 PMCID: PMC7244098 DOI: 10.1371/journal.pmed.1003103] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. METHODS AND FINDINGS In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman's rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = -0.71/-0.66), prelabour CS (rho = -0.61/-0.65), overall CS (rho = -0.61/-0.67), and episiotomy (multiparous: rho = -0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = -0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. CONCLUSIONS Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Rydahl
- University College Copenhagen, Department of Midwifery, Copenhagen NV, Denmark
| | - Katrien Beeckman
- Nursing and Midwifery Research unit, faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
| | - Lorena Binfa
- Department of Women´s and Newborn Health Promotion-School of Midwifery, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucy Frith
- Department of Health Services Research, The University of Liverpool, Liverpool, United Kingdom
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Berglind Hálfdánsdóttir
- Midwifery Programme, Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Neville Calleja
- Directorate for Health Information and Research, Gwardamangia, Malta
- Department of Public Health Department, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Miriam Gatt
- Directorate for Health Information and Research, Gwardamangia, Malta
| | - Anne Britt Vika Nilsen
- Western Norway University of Applied Sciences (HVL), Department of Health and Caring Sciences, Bergen, Norway
| | - Eugene Declercq
- Boston University School of Public Health, Boston, United States of America
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Anna Heino
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
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Di Meglio L, Derraz I, Solonomenjanahary M, Daly D, Chodraui Filho S, Ben Maacha M, Labreuche J, Desal H, Consoli A, Lapergue B, Blanc R, Piotin M, Mazighi M, Ho-Tin-Noé B, Desilles JP, Bourcier R. Two-layered susceptibility vessel sign is associated with biochemically quantified thrombus red blood cell content. Eur J Neurol 2020; 27:1264-1271. [PMID: 32243692 DOI: 10.1111/ene.14241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Better characterization of the thrombus could be useful to determine acute ischaemic stroke (AIS) aetiology and predict response to thrombolysis and endovascular therapy (EVT). To test the hypothesis that susceptibility vessel sign (SVS) on baseline magnetic resonance imaging (MRI) is related to red blood cell (RBC) content of AIS thrombi, the total haemoglobin contents (HbCs) of AIS thrombi retrieved by EVT from patients with or without SVS or two-layered SVS (TLSVS) were compared. METHODS Baseline MRI of 84 anterior AIS patients was reviewed by neuro-radiologists blinded to clinical and biochemical data. Thrombi from these patients were retrieved by EVT and analysed for HbC by quantitative enzyme-linked immunosorbent assay and measurement of haem concentration. RESULTS Susceptibility vessel sign and TLSVS were respectively observed in 85.7% and 50.0% of cases. The median HbC content was 253 µg/mg thrombus (interquartile range 177-333) and the median haem content was 219 µg/mg thrombus (131-264). Thrombus HbC and haem content were highly correlated with thrombus RBC content determined by flow cytometry (r = 0.94). Thrombi from patients with TLSVS weighed more [31.1 (16.5-68.3) mg vs. 17.7 (11.7-33.3) mg; P = 0.005] and had a higher HbC content [278 (221-331) µg/mg vs. 196 (139-301) µg/mg; P = 0.010] compared to thrombi from patients without TLSVS. There was no difference in thrombus weight or HbC content according to SVS status. CONCLUSIONS Our study shows that TLSVS is significantly associated with a higher thrombus weight and RBC content, as determined by quantitative assays.
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Affiliation(s)
- L Di Meglio
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - I Derraz
- Department of Neuroradiology, University Hospital Gui de Chauliac of Montpellier, Montpellier, France
| | - M Solonomenjanahary
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - D Daly
- Department of Neuroradiology, University Hospital Gui de Chauliac of Montpellier, Montpellier, France
| | - S Chodraui Filho
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Ben Maacha
- Department of Clinical Research, Rothschild Foundation Hospital, Paris, France
| | - J Labreuche
- EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Univ. Lille, CHU Lille, Lille, France
| | - H Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - A Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - B Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - R Blanc
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Piotin
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - M Mazighi
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - B Ho-Tin-Noé
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - J P Desilles
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - R Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
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Clarke M, Devane D, Gross MM, Morano S, Lundgren I, Sinclair M, Putman K, Beech B, Vehviläinen-Julkunen K, Nieuwenhuijze M, Wiseman H, Smith V, Daly D, Savage G, Newell J, Simpkin A, Grylka-Baeschlin S, Healy P, Nicoletti J, Lalor J, Carroll M, van Limbeek E, Nilsson C, Stockdale J, Fobelets M, Begley C. OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section. BMC Pregnancy Childbirth 2020; 20:143. [PMID: 32138712 PMCID: PMC7059398 DOI: 10.1186/s12884-020-2829-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/19/2019] [Accepted: 02/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. METHODS OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. RESULTS The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000. CONCLUSIONS Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances. TRIAL REGISTRATION The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.
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Affiliation(s)
- Mike Clarke
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Declan Devane
- National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Koen Putman
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Beverley Beech
- Association for Improvements in the Maternity Services, Surrey, UK
| | | | | | | | | | | | - Gerard Savage
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | - John Newell
- National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | | | | | | | | | | | - Maaike Fobelets
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
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Moran PS, Daly D, Wuytack F, Carroll M, Turner M, Normand C, Begley C. Predictors of choice of public and private maternity care among nulliparous women in Ireland, and implications for maternity care and birth experience. Health Policy 2020; 124:556-562. [PMID: 32284156 DOI: 10.1016/j.healthpol.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/26/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Maternity care in Ireland is provided through a mixture of free public and fee-based private or semi-private services. We examined factors associated with choice of care pathway among nulliparous women and how this influences the care they receive and their experience of childbirth using data from a prospective cohort study. Complete data were available for 1,789 women on choice of care pathway and birth outcomes, and for 1,336 women on birth experience. Maternal age (marginal effect [ME] 1.6 percentage points [ppts], p < 0.01), socioeconomic status (ME 0.5ppts, p < 0.01) and being born in Ireland (ME 10.3ppts, p < 0.01) were all positively associated with choosing private care, but level of risk in early pregnancy did not influence this decision. Intervention rates in public and semi-private care were comparable, but women in private care were more likely to receive epidural anaesthesia (odds ratio [OR] 1.65, p < 0.01) and give birth by caesarean section (ratio of relative risks [RRR] 1.98, p < 0.01). Private care was also associated with longer hospital stays (28 % longer, p < 0.01). Increased risk was negatively correlated with birth experience in public and semi-private care, but not in private care. Policies promoting the allocation of maternity care resources by level of risk, along with the standardisation of clinical practice across care pathways, could reduce rates of obstetric intervention and address risk-based disparities in birth experience outcomes.
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Affiliation(s)
- Patrick S Moran
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | | | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | | | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Ireland; Economics of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, United Kingdom.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
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Moran PS, Wuytack F, Turner M, Normand C, Brown S, Begley C, Daly D. Economic burden of maternal morbidity - A systematic review of cost-of-illness studies. PLoS One 2020; 15:e0227377. [PMID: 31945775 PMCID: PMC6964978 DOI: 10.1371/journal.pone.0227377] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 07/17/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Aim To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. Methods Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. Results Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. Conclusion Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
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Affiliation(s)
- Patrick S. Moran
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
- * E-mail:
| | | | | | - Charles Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
- Cicely Saunders Institute, King’s College, London, United Kingdom
| | - Stephanie Brown
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Corrigan L, Eustace-Cook J, Moran P, Daly D. The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol. HRB Open Res 2020; 2:33. [PMID: 32296751 PMCID: PMC7140767 DOI: 10.12688/hrbopenres.12967.2] [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] [Accepted: 01/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background: The purpose of this review is to systematically examine the reported clinical effectiveness of pregnancy yoga. The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies. Studies will be categorised as effectiveness or efficacy studies and this continuum of efficacy versus effectiveness will be incorporated into the full review. Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga and reporting on effect will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality. Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model. The outcomes of interest are quality of life, stress, anxiety, depression, mode of birth, labour duration and pain management in labour. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention. Registration: PROSPERO, CRD42019119916. Registered on 11th January 2019.
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Affiliation(s)
- Lisa Corrigan
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
| | | | - Patrick Moran
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
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Begley K, Daly D, Panda S, Begley C. Shared decision-making in maternity care: Acknowledging and overcoming epistemic defeaters. J Eval Clin Pract 2019; 25:1113-1120. [PMID: 31338953 PMCID: PMC6899916 DOI: 10.1111/jep.13243] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/26/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
Abstract
Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of "the doctor knows best" and "patient acquiescence" that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required.
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Affiliation(s)
- Keith Begley
- Department of Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Corrigan L, Eustace-Cook J, Moran P, Daly D. The effectiveness and characteristics of pregnancy yoga interventions: a systematic review protocol. HRB Open Res 2019; 2:33. [PMID: 32296751 PMCID: PMC7140767 DOI: 10.12688/hrbopenres.12967.1] [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] [Accepted: 11/18/2019] [Indexed: 03/29/2024] Open
Abstract
Background: The purpose of the proposed review is to systematically examine the clinical effectiveness of pregnancy yoga. The review will use the FITT (frequency, intensity, time/duration and type) principle of physical activity to characterise the different types of yoga interventions that have been evaluated in the included studies. Methods/design: The following electronic databases will be searched using a detailed search strategy: MEDLINE, PsycINFO, EMBASE, CINAHL, WHOLiS, AMED, ScieLo, ASSIA and Web of Science. Randomised control trials and quasi-experimental studies examining pregnancy yoga will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. The Cochrane Collaboration's Risk of Bias Assessment tool will be used to assess study quality. Quality of the evidence will be evaluated using the GRADE criteria. A standardised data extraction form will be used to extract data. Effect sizes will be estimated using mean differences for continuous outcomes, and relative risks for dichotomous outcome. Where possible, pooling of effect estimates will be done using a random effect model. Discussion: This review will synthesise the best available evidence on the effectiveness of yoga during pregnancy and provide valuable high-quality information for clinicians and health policymakers. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant conference proceedings. The review will make recommendations for the appropriate volume, intensity and type of pregnancy yoga for maximum effect and may have implications for policy and practice relating to pregnancy yoga as an intervention. Registration: PROSPERO, CRD42019119916. Registered on 11th January 2019.
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Affiliation(s)
- Lisa Corrigan
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
| | | | - Patrick Moran
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing & Midwifery, University of Dublin, Dublin, Ireland
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Fobelets M, Beeckman K, Buyl R, Healy P, Grylka-Baeschlin S, Nicoletti J, Canepa M, Devane D, Gross MM, Morano S, Daly D, Begley C, Putman K. Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries. Midwifery 2019; 79:102536. [PMID: 31561129 DOI: 10.1016/j.midw.2019.102536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Women who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either 'vaginal birth after caesarean' (VBAC) or 'elective repeat caesarean section' (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. DESIGN Prospective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) SETTING: Fifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). PARTICIPANTS Women (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. MEASUREMENTS Women's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: "match VBAC-VBAC" (preference for vaginal birth, actual mode of birth vaginal birth), "match ERCS-ERCS" (preference for caesarean section, actual mode of birth elective repeat caesarean section), "match ERCS-EMCS" (preference for caesarean section, actual mode of birth emergency repeat caesarean section), "mismatch VBAC-ERCS" (preference for vaginal birth, actual mode of birth elective repeat caesarean section), "mismatch VBAC-EMCS" (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and "no preference". Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. FINDINGS Women with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. KEY CONCLUSIONS The results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. IMPLICATIONS FOR PRACTICE Attention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women.
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Affiliation(s)
- Maaike Fobelets
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium; Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Laarbeeklaan 121, 1090 Brussels, Belgium.
| | - Katrien Beeckman
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Nursing and Midwifery, Nursing and Midwifery research group, Universitair Ziekenhuis Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jane Nicoletti
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Matilde Canepa
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sandra Morano
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Largo R. Benzi, 10-16132 Genova, Italy
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Koen Putman
- Department of Public Health, I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium
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Helbig S, Petersen A, Sitter E, Daly D, Gross MM. Inter-institutional variations in oxytocin augmentation during labour in German university hospitals: a national survey. BMC Pregnancy Childbirth 2019; 19:238. [PMID: 31288780 PMCID: PMC6617790 DOI: 10.1186/s12884-019-2348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/14/2017] [Accepted: 05/31/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.
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Affiliation(s)
- Sonja Helbig
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D - 30625, Hannover, Germany
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D - 30625, Hannover, Germany
| | - Erika Sitter
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D - 30625, Hannover, Germany
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D - 30625, Hannover, Germany.
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Fobelets M, Beeckman K, Healy P, Grylka-Baeschlin S, Nicoletti J, Devane D, Gross MM, Morano S, Daly D, Begley C, Putman K. Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section. BJOG 2019; 126:1043-1051. [PMID: 30957402 DOI: 10.1111/1471-0528.15673] [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] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. DESIGN Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). SETTING Fifteen maternity units in three European countries - Germany (five), Ireland (five), and Italy (five) - with relatively low VBAC rates. POPULATION Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. METHODS A cost-utility analysis from both societal and health-services perspectives, using a decision tree. MAIN OUTCOME MEASURES Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost-utility ratios were calculated per country. RESULTS The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258-268) and 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, €456 (95% CI €448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and €1174 (95% CI €1170-1178) and 0.006 QALYs (95% CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. CONCLUSION The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. TWEETABLE ABSTRACT The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.
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Affiliation(s)
- M Fobelets
- Department of Public Health I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
| | - K Beeckman
- Department of Public Health I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Nursing and Midwifery, Nursing and Midwifery Research Group, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - P Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - S Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - J Nicoletti
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Genoa, Italy
| | - D Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.,HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - M M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - S Morano
- School of Medicine and Midwifery, Department of Neurology, Ophthalmology, Maternal and Childhood Sciences, Genoa University, Genoa, Italy
| | - D Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - C Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Putman
- Department of Public Health I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Daly D, Rasmussen AV, Dalsgaard A. Learning about midwifery in another country from a distance: Evaluation of a virtual classroom learning session. Nurse Educ Today 2019; 75:47-52. [PMID: 30716684 DOI: 10.1016/j.nedt.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/08/2017] [Revised: 12/12/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Studying abroad promotes cultural awareness and understanding of different healthcare settings and practices but family or financial constraints prevent some students from taking advantage of these opportunities. We developed a virtual classroom learning session to give Danish and Irish midwifery students an opportunity to explore midwifery and maternity care in another country. OBJECTIVES To evaluate the content of midwifery students' chat room discussions about the differences in maternity and midwifery care during an international online learning session, and their opinions of the session. PARTICIPANTS 27 Danish and 37 Irish undergraduate direct entry midwifery students. METHODS Content analysis of students' chat room discussions and post-session survey. FINDINGS Students engaged enthusiastically in the chat room discussions throughout the session. Almost all of the interactivity was between students themselves, and questions raised by students from one country were answered by students in the other country. Discussions centred on the lecture content, rates of interventions and birth outcomes, but developed into broader issues relating to one-to-one midwifery care during labour, factors that facilitate normal birth, national data availability, staffing levels, and financial and cultural aspects of having children at earlier or later ages. In the survey, students described the session as awakening curiosity and a fun way to learn. They found it 'cool' to talk with real students from another country, a memorable way of discussing differences between the two maternity care systems and expanding knowledge. Negative comments related to technological problems. CONCLUSION An international virtual classroom learning session can give midwifery students insights into midwifery elsewhere, stimulate curiosity and be an engaging way to learn. Our students' experiences show that it can offer a real, engaging and positive learning experience and enrich students' knowledge of cultural differences.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland.
| | - Annemette Vibeke Rasmussen
- Midwifery Programme, Department of Midwifery and Therapeutic Sciences, Faculty of Health, University College Copenhagen, Sigurdsgade 26, SIG.D022, 2200 København N, Denmark.
| | - Annette Dalsgaard
- Midwifery Programme, Department of Midwifery and Therapeutic Sciences, Faculty of Health, University College Copenhagen, Sigurdsgade 26, SIG.D022, 2200 København N, Denmark
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Grylka-Baeschlin S, Clarke M, Begley C, Daly D, Healy P, Nicoletti J, Devane D, Morano S, Krause G, Karch A, Savage G, Gross MM. Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries. Midwifery 2019; 74:36-43. [PMID: 30925415 DOI: 10.1016/j.midw.2019.03.013] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/23/2019] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. DESIGN We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. SETTING Fifteen study sites in Ireland, Italy and Germany, five in each country. PARTICIPANTS 790 participants going into labour for planned VBAC. MEASUREMENTS Descriptive statistics and random-effects logistic regression models were applied. FINDINGS The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. KEY CONCLUSION Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. IMPLICATION FOR PRACTICE Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Zurich University of Applied Sciences, Technikumstr. 81, Winterthur CH-8401, Switzerland.
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, University Road, Belfast, Northern Ireland BT12 6BJ, United Kingdom
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane Nicoletti
- Medical School and Midwifery School, Genoa University, Genoa, Italy
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - Sandra Morano
- Medical School and Midwifery School, Genoa University, Genoa, Italy
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, Braunschweig D-38124, Germany; Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Institute for Infectious Disease Epidemiology, TWINCORE, Hannover D-30625, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, Braunschweig D-38124, Germany; Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus-1, Gebäude D3, Münster D-48149, Germany
| | - Gerard Savage
- Northern Ireland Methodology Hub, Queen's University Belfast, University Road, Belfast, Northern Ireland BT12 6BJ, United Kingdom
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany
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Daly D, Sedlicka N, Begley C. Respectful and disrespectful care in the Czech Republic: An online survey. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.469] [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] [Indexed: 10/27/2022]
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Daly D, Carroll M, Barros M, Begley C. Stop, think, reflect, realize-first-time mothers' views on taking part in longitudinal maternal health research. Health Expect 2019; 22:415-425. [PMID: 30793449 PMCID: PMC6543136 DOI: 10.1111/hex.12861] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 12/23/2022] Open
Abstract
Background Longitudinal cohort studies gather large amounts of data over time, often without direct benefit to participants. A positive experience may encourage retention in the study, and participants may benefit in unanticipated ways. Objective To explore first‐time mothers’ experiences of taking part in a longitudinal cohort study and completing self‐administered surveys during pregnancy and at 3, 6, 9 and 12 months’ postpartum. Design Content analysis of comments written by participants in the Maternal health And Maternal Morbidity in Ireland study's five self‐completion surveys, a multisite cohort study exploring women's health and health problems during and after pregnancy. This paper focuses on what women wrote about taking part in the research. Ethical approval was granted by the site hospitals and university. Setting and participants A total of 2174 women were recruited from two maternity hospitals in Ireland between 2012 and 2015. Findings A total of 1000 comments were made in the five surveys. Antenatally, barriers related to surveys being long and questions being intimate. Postpartum, barriers related to being busy with life as first‐time mothers. Benefits gained included gaining access to information, taking time to reflect, stopping to think and being prompted to seek help. Survey questions alone were described as valuable sources of information. Discussion and conclusions Findings suggest that survey research can “give back” to women by being a source of information and a trigger to seek professional help, even while asking sensitive questions. Understanding this can help researchers construct surveys to maximize benefits, real and potential, for participants.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Monalisa Barros
- Departamento de Ciencias Naturais, Universidade Estadual do Sudoeste da Bahia, Vitoria Da Conquista, BA, Brazil
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Setola N, Naldi E, Cocina GG, Eide LB, Iannuzzi L, Daly D. The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces. HERD 2019; 12:67-98. [DOI: 10.1177/1937586719826058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives, Purpose, or Aim: This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals. Background: Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users’ health. Method: A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates. Results and Discussion: The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people’s behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives’ hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements. Conclusions: The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers.
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Affiliation(s)
- Nicoletta Setola
- Department of Architecture, Università di Firenze, Firenze, Italy
| | - Eletta Naldi
- Department of Architecture, Università di Firenze, Firenze, Italy
| | | | - Liv Bodil Eide
- Department of Child Welfare and Social Work, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laura Iannuzzi
- Department of Health Care Professions, Careggi University Hospital, Firenze, Italy
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Daly D, Cusack C, Begley C. Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study. Int Urogynecol J 2019; 30:965-975. [DOI: 10.1007/s00192-018-3848-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers' perceptions of respectful care provided for childbearing women in Czech Republic. METHODS Following ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling. The majority were midwives (50%) or doulas (46%) working in one of 51 hospitals, or with homebirths. Chi-square analysis was used for comparisons. RESULTS Non-evidenced-based interventions, described as 'always' or 'frequently' used in hospitals, included application of electronic fetal monitoring in normal labour (n = 40, 91%), shaving the perineum (n = 10, 29%), and closed-glottal pushing (n = 32, 94%). Positions stated as most often used for spontaneous vaginal births were semi-recumbent (n = 31, 65%) or lying flat (n = 15, 31%) in hospital, and upright at home (n = 27, 100%). Average episiotomy and induction of labour rates were estimated at 40 and 26%, respectively, higher than accepted norms. Eighteen respondents (46%) said reasons for performing vaginal examinations were not explained to women in hospitals, and 21 (51%) said consent was 'never' sought. At home, 25 (89%) said reasons were explained, and permission 'always' sought (n = 22, 81%). Thirteen (32%) said hospital clinicians explained why artificial rupture of membranes was necessary, but only ten (25%) said they 'always' sought permission. The majority said that hospital clinicians 'never'/'almost never' explained reasons for performing an episiotomy (13 = 34%), gained permission (n = 20, 54%) or gave local anaesthetic (n = 19, 51%). Contrastingly, 17 (100%) said midwives at home explained the reasons for episiotomy and asked permission. When clinicians disagreed with women's decisions, 13 (35%) respondents said women might be told to 'face the consequences', six (16%) stated that the 'psychological pressure' experienced caused women to 'give up and give their permission', and four (11%) said the intervention would be performed 'against her will.' CONCLUSIONS Findings reveal considerable levels of disrespectful, non-evidenced-based, non-consensual and abusive practices that may leave women with life-long trauma.
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Affiliation(s)
- Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, DO2 T283 Ireland
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Natalie Sedlicka
- Association for Birth Houses & Centers (APODAC), Masarykovo nábřeží 234/26, 11000 Prague 1, Czech Republic
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, DO2 T283 Ireland
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Wuytack F, Moran P, Carroll M, Begley C, Daly D. Women’s health before pregnancy in a large cohort of first-time mothers in Ireland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Wuytack
- Trinity College Dublin, Dublin, Ireland
| | - P Moran
- Trinity College Dublin, Dublin, Ireland
| | - M Carroll
- Trinity College Dublin, Dublin, Ireland
| | - C Begley
- Trinity College Dublin, Dublin, Ireland
| | - D Daly
- Trinity College Dublin, Dublin, Ireland
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Wuytack F, Daly D, Curtis E, Begley C. Prognostic factors for pregnancy-related pelvic girdle pain, a systematic review. Midwifery 2018; 66:70-78. [DOI: 10.1016/j.midw.2018.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 07/07/2018] [Accepted: 07/22/2018] [Indexed: 11/26/2022]
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Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, Hildingsson I. Factors influencing decision-making for caesarean section in Sweden - a qualitative study. BMC Pregnancy Childbirth 2018; 18:377. [PMID: 30223780 PMCID: PMC6142337 DOI: 10.1186/s12884-018-2007-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. METHODS A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin. RESULTS The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. CONCLUSION Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, 2 Clare Street, D02 CK80 Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
- Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden
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Panda S, Begley C, Daly D. Correction: Clinicians' views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PLoS One 2018; 13:e0202688. [PMID: 30110379 PMCID: PMC6093691 DOI: 10.1371/journal.pone.0202688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0200941.].
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