1
|
Etcheverry C, Betrán AP, de Loenzien M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries. Midwifery 2024; 132:103979. [PMID: 38520954 DOI: 10.1016/j.midw.2024.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DESIGN A cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SETTING Thirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. PARTICIPANTS A total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FINDINGS The overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and "avoid pain in labour" was the most common perceived benefit of caesarean section. KEY CONCLUSIONS Our results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. CLINICAL TRIAL REGISTRY The QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.
Collapse
Affiliation(s)
- Camille Etcheverry
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France.
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
| | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
| |
Collapse
|
2
|
Wang M, Ji Y, Chen S, Wang M, Lin X, Yang M. Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis. Midwifery 2024; 132:103981. [PMID: 38574440 DOI: 10.1016/j.midw.2024.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention. METHODS Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies. FINDINGS A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible. CONCLUSION Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.
Collapse
Affiliation(s)
- Meiyu Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Yuting Ji
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Shanxia Chen
- Health Management & Biotechnology School, Guangdong Food and Drug Vocational College, No.321, Longdong North Road, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Minyi Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Xiaoli Lin
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China.
| |
Collapse
|
3
|
Kesrouani A, Abdallah W, Hatoum I, Khalil K, Nagib B, Choueiry E, Nasr B. Association between Fetal Adrenal Gland Ultrasound Measurements in the 9th Month and Mode of Delivery. Am J Perinatol 2024; 41:879-883. [PMID: 35240701 DOI: 10.1055/a-1787-7173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Several studies have previously assessed the value of changes in the fetal adrenal gland to predict preterm labor. The aim of this study is to evaluate the correlation between fetal adrenal gland measurements after 36 weeks and obstetrical outcomes. METHODS Abdominal two-dimensional (2D) ultrasound is used to measure in the transversal plane the length of fetal zone (D1), the width (D2), and the length (D3) of fetal adrenal gland, and, subsequently, the fetal zone enlargement (FZE), in 98 primigravida women after 36 weeks. Labor and delivery outcomes were assessed and compared with these measurements. RESULTS FZE changes had no association with spontaneous onset of labor. No association was found between all adrenal gland measurements and delivery onset. There was a significant relationship between D1, D2, and D3 and the delivery method. Patients delivered by cesarean section had smaller fetal adrenal gland dimensions, defining D1= 0.16 cm, D2 = 0.7 cm, and D3 = 2.37 cm as cutoff levels based on receiver operator characteristics curves. CONCLUSION The 2D measurement of the fetal adrenal gland after 36 weeks seems to predict the delivery method in low-risk primigravida women. KEY POINTS · We evaluate fetal adrenal gland measurements after 36 weeks versus the obstetrical outcome.. · No association was found between all adrenal gland measurements and delivery onset.. · Patients delivered by cesarean section had smaller fetal adrenal gland dimensions..
Collapse
Affiliation(s)
- Assaad Kesrouani
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
- Prenatal Unit, Bellevue Medical Center Hospital, Lebanon
| | - Wael Abdallah
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
| | - Inaam Hatoum
- Rafic Hariri University Hospital, Beirut, Lebanon
| | - Khalil Khalil
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
| | - Bernard Nagib
- Obstetrics and-Gynecology Department, St Joseph University, Beirut, Lebanon
| | - Elie Choueiry
- Pediatrics Department, St. Joseph University, Beirut, Lebanon
| | - Bernard Nasr
- Hotel-Dieu de France Hospital, Beirut, Lebanon
- Prenatal Unit, Bellevue Medical Center Hospital, Lebanon
| |
Collapse
|
4
|
DeBolt CA, Rao MG, Limaye MA, London V, Sagaram D, Roman AS, Minkoff H, Bernstein PS, Overbey JR, Kaplowitz E, Meislin R, Toner LE, Khander A, Bigelow CA, Stone J. Grand Multiparity and Obstetric Outcomes in a Contemporary Cohort: The Role of Increasing Parity. Am J Perinatol 2024; 41:815-825. [PMID: 38057090 DOI: 10.1055/a-2223-6093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Evidence is inconsistent regarding grand multiparity and its association with adverse obstetric outcomes. Few large American cohorts of grand multiparas have been studied. We assessed if increasing parity among grand multiparas is associated with increased odds of adverse perinatal outcomes. STUDY DESIGN Multicenter retrospective cohort of patients with parity ≥ 5 who delivered a singleton gestation in New York City from 2011 to 2019. Outcomes included postpartum hemorrhage, preterm delivery, hypertensive disorders of pregnancy, shoulder dystocia, birth weight > 4,000 and <2,500 g, and neonatal intensive care unit (NICU) admission. Parity was analyzed continuously, and multivariate analysis determined if increasing parity and other obstetric variables were associated with each adverse outcome. RESULTS There were 2,496 patients who met inclusion criteria. Increasing parity among grand multiparas was not associated with any of the prespecified adverse outcomes. Odds of postpartum hemorrhage increased with history (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [1.83, 3.84]) and current cesarean delivery (aOR: 4.59 [3.40, 6.18]). Preterm delivery was associated with history (aOR: 12.36 [8.70-17.58]) and non-White race (aOR: 1.90 [1.27, 2.84]). Odds of shoulder dystocia increased with history (aOR: 5.89 [3.22, 10.79]) and birth weight > 4,000 g (aOR: 9.94 [6.32, 15.65]). Birth weight > 4,000 g was associated with maternal obesity (aOR: 2.92 [2.22, 3.84]). Birth weight < 2,500 g was associated with advanced maternal age (aOR: 1.69 [1.15, 2.48]), chronic hypertension (aOR: 2.45 [1.32, 4.53]), and non-White race (aOR: 2.47 [1.66, 3.68]). Odds of hypertensive disorders of pregnancy increased with advanced maternal age (aOR: 1.79 [1.25, 2.56]), history (aOR: 10.09 [6.77-15.04]), and non-White race (aOR: 2.79 [1.95, 4.00]). NICU admission was associated with advanced maternal age (aOR: 1.47 [1.06, 2.02]) and non-White race (aOR: 2.57 [1.84, 3.58]). CONCLUSION Among grand multiparous patients, the risk factor for adverse maternal, obstetric, and neonatal outcomes appears to be occurrence of those adverse events in a prior pregnancy and not increasing parity itself. KEY POINTS · Increasing parity is not associated with adverse obstetric outcomes among grand multiparas.. · Prior adverse pregnancy outcome is a risk factor for the outcome among grand multiparas.. · Advanced maternal age is associated with adverse obstetric outcomes among grand multiparas..
Collapse
Affiliation(s)
- Chelsea A DeBolt
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manasa G Rao
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meghana A Limaye
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
| | - Viktoriya London
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Deepika Sagaram
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Peter S Bernstein
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Jessica R Overbey
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Rachel Meislin
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lorraine E Toner
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amrin Khander
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine A Bigelow
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
5
|
Williams A, Little SE, Bryant AS, Smith NA. Mode of Delivery and Unplanned Cesarean: Differences in Rates and Indication by Race, Ethnicity, and Sociodemographic Characteristics. Am J Perinatol 2024; 41:834-841. [PMID: 35235955 DOI: 10.1055/a-1785-8843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE We aimed to examine the relationship of sociodemographic variables with racial/ethnic disparities in unplanned cesarean births in a large academic hospital system. Secondarily, we investigated the relationship of these variables with differences in cesarean delivery indication, cesarean delivery timing, length of second stage and operative delivery. STUDY DESIGN We conducted a retrospective cohort study of births >34 weeks between 2017 and 2019. Our primary outcome was unplanned cesarean delivery after a trial of labor. Multiple gestations, vaginal birth after cesarean, elective repeat or primary cesarean delivery, and contraindications for vaginal delivery were excluded. Associations between mode of delivery and patient characteristics were assessed using Chi-square, Fisher exact tests, or t-tests. Odds ratios were estimated by multivariate logistic regression. Goodness of fit was assessed with Hosmer Lemeshow test. RESULTS Among 18,946 deliveries, the rate of cesarean delivery was 14.8% overall and 21.3% in nulliparous patients. After adjustment for age, body mass index (BMI), and parity, women of Black and Asian races had significantly increased odds of unplanned cesarean delivery; 1.69 (95% CI: 1.45,1.96) and 1.23 (1.08, 1.40), respectively. Single Hispanic women had adjusted odds of 1.65 (1.08, 2.54). Single women had increased adjusted odds of cesarean delivery of 1.18, (1.05, 1.31). Fetal intolerance was the indication for 39% (613) of cesarean deliveries among White women as compared to 63% (231) of Black women and 49% (71) of Hispanic women (p <0.001). CONCLUSION Rates of unplanned cesarean delivery were significantly higher in Black and Asian compared to White women, even after adjustment for age, BMI, parity, and zip code income strata, and rates of unplanned cesarean delivery were higher for Hispanic women self-identifying as single. Racial and ethnic differences were seen in cesarean delivery indications and operative vaginal deliveries. Future work is urgently needed to better understand differences in provider care or patient attributes, and potential provider bias, that may contribute to these findings. KEY POINTS · Racial, ethnic, and socioeconomic differences exist in the odds of unplanned cesarean.. · Indications for unplanned cesarean delivery differed significantly among racial and ethnic groups.. · There may be unmeasured provider level factors which contribute to disparities in cesarean rates..
Collapse
Affiliation(s)
- Alexandria Williams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Sarah E Little
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison S Bryant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General, Boston, Massachusetts
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
6
|
McElrath TF, Druzin M, Van Marter LJ, May RC, Brown C, Stek A, Grobman W, Dolan M, Chang P, Flood-Schaffer K, Parker L, Meador KJ, Pennell PB. The Obstetrical Care and Delivery Experience of Women with Epilepsy in the MONEAD Study. Am J Perinatol 2024; 41:935-943. [PMID: 35253116 DOI: 10.1055/a-1788-4791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examined mode of delivery among pregnant women with epilepsy (PWWE) versus pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean. STUDY DESIGN The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multicenter investigation of pregnancy outcomes funded by the National Institute of Health (NIH). MONEAD enrolled patients from December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an α = 0.05. RESULTS This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7 vs. 28.6%; p = 0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2 vs. 50.0%) but in nonrecruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8 vs. 30.8%; p = 0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC or by type of antiepileptic drug among the PWWE. CONCLUSION These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in nonrecruitment hospitals. As the study recruitment hospitals were tertiary academic centers and nonrecruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference. KEY POINTS · Unlabored cesarean rates higher among women with epilepsy.. · Provider preference may influence delivery mode among women with epilepsy.. · Type and amount of antiepileptic drug was not associated with mode of delivery..
Collapse
Affiliation(s)
- Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maurice Druzin
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Linda J Van Marter
- Division of Newborn Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | | | - Alice Stek
- Department of Obstetrics-Gynecology, University of Southern California, Los Angeles, California
| | - William Grobman
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Mary Dolan
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
| | - Patricia Chang
- Department of Obstetrics-Gynecology, Minnesota Epilepsy Group, St. Paul, Minnesota
| | | | - Lamar Parker
- Department of Obstetrics-Gynecology, Wake Forest University, Winston-Salem, North Carolina
| | - Kimford J Meador
- Department of Neurology, Stanford University, Standford, California
| | - Page B Pennell
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
7
|
Torres JA, Leite TH, Fonseca TCO, Domingues RMSM, Figueiró AC, Pereira APE, Theme-Filha MM, da Silva Ayres BV, Scott O, de Cássia Sanchez R, Borem P, de Maio Osti MC, Rosa MW, Andrade AS, Filho FMP, Nakamura-Pereira M, do Carmo Leal M. An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals. Reprod Health 2024; 20:190. [PMID: 38671479 DOI: 10.1186/s12978-024-01773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paulo Borem
- Institute for Healthcare Improvement, Brasília, Brazil
| | | | | | | | - Fernando Maia Peixoto Filho
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
| | - Marcos Nakamura-Pereira
- Oswaldo Cruz Foundation, National Institute of Health for Women, Children and Adolescents Fernandes Figueira, Rio de Janeiro, Brazil
| | | |
Collapse
|
8
|
Sanchez-Samaniego G, Mäusezahl D, Hartinger-Peña SM, Hattendorf J, Verastegui H, Fink G, Probst-Hensch N. Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:304. [PMID: 38654289 DOI: 10.1186/s12884-024-06466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND During the last two decades, Caesarean section rates (C-sections), overweight and obesity rates increased in rural Peru. We examined the association between pre-pregnancy body mass index (BMI) and C-section in the province of San Marcos, Northern Andes-Peru. METHODS This is a prospective cohort study. Participants were women receiving antenatal care in public health establishments from February 2020 to January 2022, who were recruited and interviewed during pregnancy or shortly after childbirth. They answered a questionnaire, underwent a physical examination and gave access to their antenatal care card information. BMI was calculated using maternal height, measured by the study team and self-reported pre-pregnancy weight measured at the first antenatal care visit. For 348/965 (36%) women, weight information was completed using self-reported data collected during the cohort baseline. Information about birth was obtained from the health centre's pregnancy surveillance system. Regression models were used to assess associations between C-section and BMI. Covariates that changed BMI estimates by at least 5% were included in the multivariable model. RESULTS This study found that 121/965 (12.5%) women gave birth by C-section. Out of 495 women with pre-pregnancy normal weight, 46 (9.3%) had C-sections. Among the 335 women with pre-pregnancy overweight, 53 (15.5%) underwent C-sections, while 23 (18.5%) of the 124 with pre-pregnancy obesity had C-sections. After adjusting for age, parity, altitude, food and participation in a cash transfer programme pre-pregnancy overweight and obesity increased the odds of C-section by more than 80% (aOR 1.82; 95% CI 1.16-2.87 and aOR 1.85; 95% CI 1.02-3.38) compared to women with a normal BMI. CONCLUSIONS High pre-pregnancy BMI is associated with an increased odds of having a C-section. Furthermore, our results suggest that high BMI is a major risk factor for C-section in this population. The effect of obesity on C-section was partially mediated by the development of preeclampsia, suggesting that C-sections are being performed due to medical reasons.
Collapse
Affiliation(s)
- Giuliana Sanchez-Samaniego
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Stella Maria Hartinger-Peña
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Hector Verastegui
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Swiss TPH, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
9
|
Tian H, Liu J. Comment on "Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study". Rev Assoc Med Bras (1992) 2024; 70:e20231309. [PMID: 38656009 PMCID: PMC11042810 DOI: 10.1590/1806-9282.20231309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/22/2023] [Indexed: 04/26/2024]
Affiliation(s)
- Hua Tian
- Shiyan Maternal and Child Health Hospital, Department of Maternity – Shiyan, China
| | - Jinjin Liu
- Shiyan Maternal and Child Health Hospital, Department of Maternity – Shiyan, China
| |
Collapse
|
10
|
AlJohi A, Alohali A, Alsaeed S, Sakkijah HM, Obeid DA. Outcome of pregnant women admitted to critical care unit with confirmed severe COVID-19: A center experience. Saudi Med J 2024; 45:379-386. [PMID: 38657988 DOI: 10.15537/smj.2024.45.4.20240022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To explore the traits and risk factors of pregnant women admitted to intensive care units (ICUs) with COVID-19. Moreover, the study classifies outcomes based on differing levels of required respiratory support during their intensive care stay. METHODS This retrospective and descriptive study included all pregnant women with COVID-19 admitted to the adult critical care unit at a specialized tertiary hospital in Riyadh, Saudi Arabia. Between January 2020 and December 2022. A total of 38 pregnant women were identified and were eligible for our study. RESULTS The mean age of the patients was 32.9 (19-45) years, and the average Acute Physiology and Chronic Health Evaluation IV (APACHI IV) score was 49.9 (21-106). Approximately 60.5% of the patients suffered from superimposed infections during their ICU stay. Approximately 81.6% patients were delivered by C-section, 33 of the newborns survived, and 5 died. The crude mortality rate among pregnant women in our cohort was 15.8%. Patients treated with high-flow nasal cannula (HFNC) were mostly discharged or delivered normally, while the mechanical ventilation (MV) and extracorporeal membrane oxygenation groups mostly underwent C-sections. Most of the surviving newborns were on HFNC and MV. Patients with multiple infections had the longest ICU stay and had the highest risk of death. CONCLUSION The results of this study highlight the characteristics of pregnant women admitted to the ICU at a specialized tertiary healthcare center in Saudi Arabia. The APACHI IV scores accurately predicted patient's mortality, duration of MV, and length of ICU stay. In our study, we shared our experience of managing severe COVID-19 infections in pregnant patients.
Collapse
Affiliation(s)
- Amani AlJohi
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alohali
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Saffanah Alsaeed
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hussam M Sakkijah
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Dalia A Obeid
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
11
|
Newby-Kew A, Sandström A, Wikström AK, Stephansson O, Snowden JM. Severe Perineal Lacerations in First Delivery: Association with Subsequent Reproductive Outcomes. J Womens Health (Larchmt) 2024; 33:542-550. [PMID: 38061037 DOI: 10.1089/jwh.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background: Severe perineal lacerations (SPLs), common worldwide, are associated with short- and long-term complications: pelvic floor disorders, fecal incontinence, fistula, and profound psychological impacts. Limited research suggests that experiencing SPL may influence future reproductive intentions, but research on outcomes is lacking. Methods: We analyzed the effect of experiencing SPL during a first delivery among a large cohort of Swedish births between 1992 and 2013. We used linear and multinomial logistic regression to estimate the associations between SPL and four reproductive outcomes: subsequent total birth number, probability of a second birth, interpregnancy interval (IPI), and subsequent scheduled cesarean birth. Results: Among 947,035 singleton live-born first-births, we found that experiencing SPL was associated with slightly fewer overall births in fully adjusted models (a decrease of -0.020 births; 95% confidence interval [CI]: -0.028 to -0.012), but no difference in the probability of a second birth (risk ratio [RR]: 1.00; 95% CI: 0.99 to 1.00) or IPI. Scheduled cesarean was increased in births after SPL (adjusted RR: 4.57; 95% CI: 4.42 to 4.73). A secondary comparison of SPL to severe postpartum hemorrhage suggests that some of these observed differences may be related to experiencing any severe outcome, and some specifically to perineum disruption. Conclusion: This study provides a deeper understanding of the long-term impacts of SPL, which may be useful in informing best clinical practices for supporting women who have experienced SPL.
Collapse
Affiliation(s)
- Abigail Newby-Kew
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon, USA
| | - Anna Sandström
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan M Snowden
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
12
|
Mallick LM, Shenassa ED. Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study. Breastfeed Med 2024; 19:262-274. [PMID: 38535749 DOI: 10.1089/bfm.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
Collapse
Affiliation(s)
- Lindsay M Mallick
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Avenir Health, Glastonbury, Connecticut, USA
| | - Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Cunha JF, Gama SGND, Thomaz EBAF, Gomes MADSM, Ayres BVDS, Silva CMFPD, Leal MDC, Bittencourt SDDA. [Factors associated with breastfeeding at birth in maternity hospitals linked to the Rede Cegonha, Brazil, 2016-2017]. Cien Saude Colet 2024; 29:e04332023. [PMID: 38655952 DOI: 10.1590/1413-81232024294.04332023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 04/26/2024] Open
Abstract
Breastfeeding (BF) is a human right, and it must start from birth. The adequacy of Rede Cegonha (RC) strategies can contribute to the promotion of BF. The objective was to identify factors associated with BF in the first and 24 hours of live births at full-term maternity hospitals linked to CR. Cross-sectional study with data from the second evaluation cycle 2016-2017 of the RC that covered all of Brazil. Odds ratios were obtained through binary logistic regression according to a hierarchical model, with 95% confidence intervals and p-value < 0.01. The prevalence of BF in the first hour was 31% and in the 24 hours 96.6%. The chances of BF in the first hour increased: presence of a companion during hospitalization, skin-to-skin contact, vaginal delivery, delivery assistance by a nurse and accreditation of the unit in the Baby-Friendly Hospital Initiative. Similar results at 24 hours, and association with maternal age below 20 years. BF in the first hour was less satisfactory than in the 24 hours, probably due to the high prevalence of cesarean sections, a factor associated with a lower chance of early BF. Continuous training of professionals about BF and the presence of an obstetric nurse during childbirth are recommended to expand BF in the first hour.
Collapse
Affiliation(s)
- Joice Ferreira Cunha
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Silvana Granado Nogueira da Gama
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | | | | | | | - Maria do Carmo Leal
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Sonia Duarte de Azevedo Bittencourt
- Departamento de Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| |
Collapse
|
14
|
Chen YW, Kim TD, Molina RL, Chang DC, Oseni TO. Minority-Serving Hospitals Are Associated With Low Within-Hospital Disparity. Am Surg 2024; 90:567-574. [PMID: 37723949 DOI: 10.1177/00031348231175117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Disparities in obstetric care have been well documented, but disparities in the within-hospital population have not been as extensively explored. The objective is to assess cesarean delivery rate disparities at the hospital level in a nationally recognized low risk of cesarean delivery group. METHODS An observational study using a national population-based database, Nationwide Inpatient Sample, from 2008 to 2011 was conducted. All patients with nulliparous, term, singleton, vertex pregnancies from Black and White patients were included. The primary outcome was delivery mode (cesarean vs vaginal). The primary independent variable was race (Black vs White). RESULTS A total of 1,064,351 patients were included and the overall nulliparous, term, singleton, and vertex pregnancies cesarean delivery rate was 14.1%. The within-hospital disparities of cesarean delivery rates were lower in minority-serving hospitals (OR: 1.20 95% CI: 1.12-1.28), rural hospitals (OR 1.11 95% CI: 1.02-1.20), and the South (OR 1.24 95% CI 1.19-1.30) compared to their respective counterparts. Non-minority serving hospitals (OR: 1.20 95% CI 0.12-1.25), and urban hospitals (OR1.32 95% CI 1.28-1.37), the Northeast (OR 1.41 95% CI 1.30-1.53) or West (OR 1.52 95% CI 1.38-1.67), had higher within-hospital racial disparities of cesarean delivery rates. The odds ratios reported are comparing within-hospital cesarean delivery rates in Black and White patients. DISCUSSION Significant within-hospital disparities of cesarean delivery rates across hospitals highlight the importance of facility-level factors. Policies aimed at advancing health equity must address hospital-level drivers of disparities in addition to structural racism.
Collapse
Affiliation(s)
- Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Tommy D Kim
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
- UMass Chan Medical School, Worcester, MA, USA
| | | | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Tawakalitu O Oseni
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Clark RRS, Peele ME, Srinivas S, Lake ET. Racial disparities in low-risk cesarean birth rates across hospitals. Birth 2024; 51:176-185. [PMID: 37800376 PMCID: PMC10922231 DOI: 10.1111/birt.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND We compared low-risk cesarean birth rates for Black and White women across hospitals serving increasing proportions of Black women and identified hospitals where Black women had low-risk cesarean rates less than or equal to White women. METHODS In this cross-sectional analysis of secondary data from four states, we categorized hospitals by their proportion of Black women giving birth from "low" to "high". We analyzed the odds of low-risk cesarean for Black and White women across hospital categories. RESULTS Our sample comprised 493 hospitals and the 65,524 Black and 251,426 White women at low risk for cesarean who birthed in them. The mean low-risk cesarean rate was significantly higher for Black, compared with White, women in the low (20.1% vs. 15.9%) and medium (18.1% vs. 16.9%) hospital categories. In regression models, no hospital structural characteristics were significantly associated with the odds of a Black woman having a low-risk cesarean. For White women, birthing in a hospital serving the highest proportion of Black women was associated with a 21% (95% CI: 1.01-1.44) increase in the odds of having a low-risk cesarean. DISCUSSION Black women had higher odds of a low-risk cesarean than White women and were more likely to access care in hospitals with higher low-risk cesarean rates. The existence of hospitals where low-risk cesarean rates for Black women were less than or equal to those of White women was notable, given a predominant focus on hospitals where Black women have poorer outcomes. Efforts to decrease the low-risk cesarean rate should focus on (1) improving intrapartum care for Black women and (2) identifying differentiating organizational factors in hospitals where cesarean birth rates are optimally low and equivalent among racial groups as a basis for system-level policy efforts to improve equity and reduce cesarean birth rates.
Collapse
Affiliation(s)
- Rebecca R. S. Clark
- Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Morgan E. Peele
- University of Pennsylvania Population Studies Center, Philadelphia, Pennsylvania, USA
| | - Sindhu Srinivas
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Dulles 5-Dept OBGYN, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| |
Collapse
|
16
|
Osterman MJK, Juiz Gallego MM. Trends in Cesarean Delivery in Puerto Rico, 2018-2022. NCHS Data Brief 2024:1-7. [PMID: 38252408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Cesarean delivery is major surgery associated with higher costs and adverse outcomes, such as surgical complications, compared with vaginal delivery (1-3). The cesarean delivery rate in Puerto Rico rose from just over 30% in the early to mid-1990s to over 40% by the early 2000s (4,5). During this time, cesarean delivery rates in Puerto Rico were 40%-70% higher than rates in the U.S. mainland and up to 78% higher than rates for Hispanic women in the U.S. mainland (4,5). This report describes trends in Puerto Rico's cesarean delivery rate from 2010 to 2022 and explores changes by maternal age, gestational age, and municipality from 2018 to 2022.
Collapse
|
17
|
Abstract
OBJECTIVE Maternal race and ethnicity have been identified as significant independent predictors of obstetric morbidity and mortality in the United States. An appreciation of the clinical contexts in which maternal racial and ethnic disparities are most pronounced can better target efforts to alleviate these disparities and improve outcomes. It remains unknown whether cesarean delivery precipitates these divergent outcomes. This study assessed the association between maternal race and ethnicity and cesarean complications. STUDY DESIGN We conducted a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Nulliparous women with non-anomalous singleton gestations who underwent primary cesarean section were included. Race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal cesarean complications including hysterectomy, uterine atony, blood transfusion, surgical injury, arterial ligation, infection, wound complication, and ileus. A composite of neonatal morbidity was evaluated as a secondary outcome. We created a multivariable logistic regression model adjusting for selected demographic and obstetric variables that may influence the likelihood of the primary outcome. RESULTS A total of 14,570 women in the parent trial met inclusion criteria with an 18.8% incidence of the primary outcome (2,742 women). After adjusting for potential confounding variables, maternal surgical morbidity was found to be significantly higher for non-Hispanic Black (adjusted odds ratios [aORs] 1.96, 95% confidence intervals [CIs] 1.63-2.35) and Hispanic (aOR 1.66, 95% CI 1.37-2.01) women as compared with non-Hispanic white women. Neonatal morbidity was similarly found to be significantly associated with the Black race and Hispanic ethnicity. CONCLUSION In this cohort, the odds of cesarean-related maternal and neonatal morbidity were significantly higher for non-Hispanic Black and Hispanic women. These findings suggest race as a distinct risk factor for cesarean complications, and efforts to alleviate disparities should highlight cesarean section as an opportunity for improvement in outcomes. KEY POINTS · Non-Hispanic Black and Hispanic women experienced more cesarean complications than non-Hispanic White women.. · These findings suggest that disparities in maternal and neonatal outcomes exist specifically following cesarean section.. · Efforts to alleviate disparities in obstetrics should highlight cesarean section as an opportunity for improvement..
Collapse
Affiliation(s)
- Adina R Kern-Goldberger
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Whitney Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alexander Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
18
|
Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
| |
Collapse
|
19
|
Abdallah W, Abi Tayeh G, Kesrouani A, Nassar M, Finan R, Mansour F, Attieh E, Suidan J, Bou Saba C, El Kassis N, Yaghi N, Aouad N, Atallah D. The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon. Int J Gynaecol Obstet 2023; 161:314-319. [PMID: 36479965 DOI: 10.1002/ijgo.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. METHODS A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period. RESULTS The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P = 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P = 0.02 and 0.01, respectively). CONCLUSION The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.
Collapse
Affiliation(s)
- Wael Abdallah
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Abi Tayeh
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Assaad Kesrouani
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malek Nassar
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ramzi Finan
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Fersan Mansour
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Elie Attieh
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joe Suidan
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Camille Bou Saba
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nancy Yaghi
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Norma Aouad
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
20
|
Gartner DR, Debbink MP, Brooks JL, Margerison CE. Inequalities in cesarean births between American Indian & Alaska Native people and White people. Health Serv Res 2023; 58:291-302. [PMID: 36573019 PMCID: PMC10012218 DOI: 10.1111/1475-6773.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. DATA SOURCES AND STUDY SETTING We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. STUDY DESIGN We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality. DATA COLLECTION/EXTRACTION METHODS Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate. PRINCIPAL FINDINGS After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0-34.8), 3.2 percentage points (95% CI: 1.8-4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). CONCLUSIONS The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.
Collapse
Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Michelle P. Debbink
- Department of Obstetrics and GynecologyUniversity of Utah Health and Intermountain HealthcareSalt Lake CityUtahUSA
| | - Jada L. Brooks
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| |
Collapse
|
21
|
Suarez EA, Huybrechts KF, Straub L, Hernández-Díaz S, Jones HE, Connery HS, Davis JM, Gray KJ, Lester B, Terplan M, Mogun H, Bateman BT. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. N Engl J Med 2022; 387:2033-2044. [PMID: 36449419 PMCID: PMC9873239 DOI: 10.1056/nejmoa2203318] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Opioid agonist therapy is strongly recommended for pregnant persons with opioid use disorder. Buprenorphine may be associated with more favorable neonatal and maternal outcomes than methadone, but existing data are limited. METHODS We conducted a cohort study involving pregnant persons who were enrolled in public insurance programs in the United States during the period from 2000 through 2018 in which we examined outcomes among those who received buprenorphine as compared with those who received methadone. Exposure to the two medications was assessed in early pregnancy (through gestational week 19), late pregnancy (gestational week 20 through the day before delivery), and the 30 days before delivery. Risk ratios for neonatal and maternal outcomes were adjusted for confounders with the use of propensity-score overlap weights. RESULTS The data source for the study consisted of 2,548,372 pregnancies that ended in live births. In early pregnancy, 10,704 pregnant persons were exposed to buprenorphine and 4387 to methadone. In late pregnancy, 11,272 were exposed to buprenorphine and 5056 to methadone (9976 and 4597, respectively, in the 30 days before delivery). Neonatal abstinence syndrome occurred in 52.0% of the infants who were exposed to buprenorphine in the 30 days before delivery as compared with 69.2% of those exposed to methadone (adjusted relative risk, 0.73; 95% confidence interval [CI], 0.71 to 0.75). Preterm birth occurred in 14.4% of infants exposed to buprenorphine in early pregnancy and in 24.9% of those exposed to methadone (adjusted relative risk, 0.58; 95% CI, 0.53 to 0.62); small size for gestational age in 12.1% and 15.3%, respectively (adjusted relative risk, 0.72; 95% CI, 0.66 to 0.80); and low birth weight in 8.3% and 14.9% (adjusted relative risk, 0.56; 95% CI, 0.50 to 0.63). Delivery by cesarean section occurred in 33.6% of pregnant persons exposed to buprenorphine in early pregnancy and 33.1% of those exposed to methadone (adjusted relative risk, 1.02; 95% CI, 0.97 to 1.08), and severe maternal complications developed in 3.3% and 3.5%, respectively (adjusted relative risk, 0.91; 95% CI, 0.74 to 1.13). Results of exposure in late pregnancy were consistent with results of exposure in early pregnancy. CONCLUSIONS The use of buprenorphine in pregnancy was associated with a lower risk of adverse neonatal outcomes than methadone use; however, the risk of adverse maternal outcomes was similar among persons who received buprenorphine and those who received methadone. (Funded by the National Institute on Drug Abuse.).
Collapse
Affiliation(s)
- Elizabeth A Suarez
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Krista F Huybrechts
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Loreen Straub
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Sonia Hernández-Díaz
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Hendrée E Jones
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Hilary S Connery
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Jonathan M Davis
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Kathryn J Gray
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Barry Lester
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Mishka Terplan
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Helen Mogun
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| | - Brian T Bateman
- From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (K.J.G.), Brigham and Women's Hospital, the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.A.S., K.F.H., L.S., H.M.), and the Department of Psychiatry (H.S.C.), Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health (S.H.-D.), and the Department of Pediatrics, Tufts Medical Center and the Tufts Clinical and Translational Science Institute (J.M.D.), Boston, and the Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont (H.S.C.) - all in Massachusetts; UNC Horizons and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill (H.E.J.); the Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Warren Alpert Medical School of Brown University, and Women and Infants Hospital - both in Providence, RI (B.L.); Friends Research Institute, Baltimore (M.T.); and the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA (B.T.B.)
| |
Collapse
|
22
|
Afridi SA, Ahmad K, Sultana R. Analysis Of Caesarean Sections Rates Using Robson's Ten Group Classification System, Unit B Mchc, Ath Abbottabad. J Ayub Med Coll Abbottabad 2022; 34:537-539. [PMID: 36377171 DOI: 10.55519/jamc-03-10986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is growing international concern about the increased rate of caesarean sections (CS), Caesarean procedures performed in the absence of a clinical justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% Achieving reductions in maternal and infant morbidity and mortality are, among others, the objectives promoted by the World Health Organization (WHO) for 2030. The analysis of unjustified C/S rate is done by Using Robson's Ten Group Classification system. METHODS Cross-sectional study by using Robson's Ten Group classification, in Unit B MCHC, ATH Abbottabad during 6 months, from 1st August 2021-31st January 2022. RESULTS Total Patients Delivered during this duration of study were 777, among which 352 were delivered by C/S were 352. Analysis by Robson ten-group classification system showed C/S Rate as: Group 1:16.81%, Group 2: 78.95%, group 3:1.56%, group 4:77.14%, group 5:89.22%, group 6: 83.33, Group 7:67.86, Group 8:40, group 9:100%, Group 10:46.97. The total Caesarean section rate was 45.3%. CONCLUSIONS By RTGCS analysis, C/S rates Group 5, 4 and 2 are major contributions in overall C/S rates in studied clinical setup. Group 1 and 10 are also contributing. Overall C/S rates can be decreased by working on them.
Collapse
Affiliation(s)
| | | | - Ruqqiya Sultana
- Department of Gynae & Obs, Ayub Medical College, Abbottabad, Pakistan
| |
Collapse
|
23
|
Fayed A, Wahabi HA, Esmaeil S, Elkouny R, Elmorshedy H, Bakhsh H. Independent effect of gestational weight gain and prepregnancy obesity on pregnancy outcomes among Saudi women: A sub-cohort analysis from Riyadh mother and baby cohort study (RAHMA). PLoS One 2022; 17:e0262437. [PMID: 35015784 PMCID: PMC8751991 DOI: 10.1371/journal.pone.0262437] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Gestational weight gain (GWG) and prepregnancy obesity are garnering more attention as determining factors of pregnancy outcomes when it comes to the wellbeing of both the mother and her baby. This study was conducted to describe the pattern of GWG among participants of Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) and to investigate the detrimental effects of excessive GWG and prepregnancy obesity on pregnancy outcomes. Methods RAHMA is a multicentre cohort study conducted in three hospitals in Riyadh, Saudi Arabia. Participants were categorized according to the Institute of Medicine into inadequate, adequate, and excessive GWG, and stratified by body mass index (BMI) into under/normal weight, overweight, and obese. To examine the independent effect of maternal prepregnancy obesity and GWG, a multivariate regression model was used and adjusted odds ratio (AOR) and 95% Confidence Interval (CI) for each outcome were calculated. Results A total of 7029 participants were included in this study; 31.8% had adequate GWG, 25.9% had excessive GWG and 42.3% had inadequate GWG, while 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Excessive GWG was independently associated with increased risk of hypertensive events, (AOR = 1.77, 95% CI 1.20–2.63). Obesity was associated with higher risk of gestational diabetes (AOR 2.11, 95% CI 1.76–2.53), hypertensive events (AOR 2.06, 95% CI 1.48–3.01), and delivery by emergency caesarean section (AOR = 1.63, 95% CI 1.35–1.97). Infants of obese women had increased odds of macrosomia (AOR 3.11, 95% CI 1.94–4.99) and lower odds of low birth weight (AOR = 0.68, 95% CI 0.53–0.88). Conclusion In comparison to excessive GWG, which increases the risk of hypertensive events during pregnancy, prepregnancy obesity is associated with more adverse outcomes including GDM, hypertensive events in pregnancy and emergency CS.
Collapse
Affiliation(s)
- Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hayfaa A. Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
- * E-mail:
| | - Samia Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Roaa Elkouny
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Hala Elmorshedy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hanadi Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| |
Collapse
|
24
|
Lemaitre M, Ternynck C, Bourry J, Baudoux F, Subtil D, Vambergue A. Association Between HbA1c Levels on Adverse Pregnancy Outcomes During Pregnancy in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e1117-e1125. [PMID: 34694409 PMCID: PMC8852207 DOI: 10.1210/clinem/dgab769] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite optimization of metabolic balance during pregnancy in type 1 diabetes (T1D), maternal-fetal complications remain higher than in the background population. OBJECTIVE We examined whether there is an association between glycated hemoglobin (HbA1c) levels and these complications. METHODS Retrospective study of pregnancies in 678 T1D subjects at Lille Hospital (1997-2019). The association between variations in HbA1c levels and complications was examined. The composite criterion (CC) was defined as having at least 1 of the following complications: prematurity, pre-eclampsia, large for gestational age (LGA), small for gestational age (SGA), or cesarean section. RESULTS Among the 678 births, median preconception HbA1c was 7.2% (55 mmol/mol), 361 were LGA (56%), 29 were SGA (4.5%), and 504 were births without preterm delivery (76.1%). The CC occurred in 81.8%. Higher HbA1c during the first trimester was associated with the CC (OR 1.04; 95% CI 1.02-1.06 per 0.1% increase; P < .001). Higher HbA1c during the third trimester was associated with the CC (OR 1.07; 95% CI 1.03-1.10 per 0.1% increase; P < .001). The group defined by a first trimester Hba1c >6.5% (48 mmol/mol) and a third trimester HbA1c <6% was associated with an increased rate of the CC (OR 2.81; 95% CI 1.01-7.86) and an increased rate of LGA (OR 2.20; 95% CI 1.01- 4.78). CONCLUSION Elevated HbA1c is associated with maternal-fetal complications. Despite optimization of metabolic balance during the third trimester, for patients with early glycemic imbalance the risk of LGA persists.
Collapse
Affiliation(s)
- Madleen Lemaitre
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
| | - Camille Ternynck
- , ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, University of Lille, CHU Lille, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Julien Bourry
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
| | - Florence Baudoux
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
| | - Damien Subtil
- Department of Medicine, University of Lille, France
- Department of Gynecology and Obstetrics, CHU Lille, Lille University Hospital, Lille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
- Correspondence: Anne Vambergue, Department of Diabetology, Endocrinology, Metabolism, and Nutrition Claude Huriez Hospital, Polonovski Street, 59037 Lille, cedex, France.
| |
Collapse
|
25
|
Bailey C, Skouteris H, Harrison CL, Hill B, Thangaratinam S, Teede H, Ademi Z. A Comparison of the Cost-Effectiveness of Lifestyle Interventions in Pregnancy. Value Health 2022; 25:194-202. [PMID: 35094792 DOI: 10.1016/j.jval.2021.07.013] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Lifestyle interventions during pregnancy improve maternal and infant outcomes. We aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types with standard care. METHODS A decision tree model was constructed to compare lifestyle intervention effects from a novel meta-analysis. The target population was women with singleton pregnancies and births at more than 20 weeks' gestation. Interventions were categorized as diet, diet with physical activity, physical activity, and mixed (lacking structured diet and, or, physical activity components). The outcome of interest was cost per case prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth) expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public healthcare perspective. Scenario analyses were included for all structured interventions combined and by adding neonatal intensive care unit costs. Costs were estimated from published data and consultations with experts and updated to 2019 values. Discounting was not applied owing to the short time horizon. RESULTS Physical activity interventions reduced adverse maternal events by 4.2% in the intervention group compared with standard care and could be cost saving. Diet and diet with physical activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020), respectively. Mixed interventions did not reduce events and were dominated by standard care. In scenario analysis, all structured interventions combined and all interventions when including neonatal intensive care unit costs (except mixed) may be cost saving. Probabilistic sensitivity analysis showed that for physical activity and all structured interventions combined, the probability of being cost saving was 58% and 41%, respectively. CONCLUSIONS Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide.
Collapse
Affiliation(s)
- Cate Bailey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Warwick Business School, Warwick University, Coventry, England, UK
| | - Cheryce L Harrison
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shakila Thangaratinam
- World Health Organization Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England, UK
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health Endocrine and Diabetes Units, Monash Health, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| |
Collapse
|
26
|
Asghar AK, Nkabinde TC, Naidoo M. An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa. PLoS One 2022; 17:e0262269. [PMID: 34982786 PMCID: PMC8726481 DOI: 10.1371/journal.pone.0262269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Internationally, there has been a focus on ensuring that Caesarean deliveries are performed only when indicated, to ensure the best outcome for mother and baby. In South Africa, despite a variety of health system interventions, maternal and perinatal mortality remain unacceptably high. Objectives To describe and compare the clinical outcomes related to the mode of delivery, for patients managed at rural primary healthcare level. Methods This retrospective cross-sectional observational analytical study was conducted at a deep rural district hospital in northern KwaZulu-Natal, South Africa. Maternity Case Records and Caesarean delivery audit tools from 2018 were reviewed. Results In total, 634 files were retrieved. The Caesarean delivery rate in the sample was 30.8% (193 of 634 deliveries), and according to the Robson classification, groups 5 and 1 were the biggest contributors to Caesarean delivery. All Caesarean deliveries were deemed to have been medically indicated. As compared to those whose delivery was normal vaginal, the odds of having post-partum haemorrhage were 25 times higher, and the odds of having any complication were three times higher, if a mother delivered by Caesarean (p<0.001). In neonates who were delivered by Caesarean, the odds of being admitted to nursery were four times higher than those delivered vaginally (p<0.001). Conclusion Showing a significantly higher risk of maternal and neonatal complications, this study validated Caesarean delivery at rural primary care as a potentially dangerous undertaking, for which adequate precautions should be taken. There is a need for interventions targeting rural healthcare in South Africa, to ensure that obstetric services are offered to patients in as safe a manner as possible in this environment.
Collapse
Affiliation(s)
- Adam Konrad Asghar
- Department of Family Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- * E-mail:
| | - Thandaza Cyril Nkabinde
- Department of Family Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Mergan Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| |
Collapse
|
27
|
Uribe-Leitz T, Matsas B, Dalton MK, Lutgendorf MA, Moberg E, Schoenfeld AJ, Goralnick E, Weissman JS, Hamlin L, Cooper Z, Koehlmoos TP, Jarman MP. Geospatial Analysis of Access to Emergency Cesarean Delivery for Military and Civilian Populations in the US. JAMA Netw Open 2022; 5:e2142835. [PMID: 35006244 PMCID: PMC8749478 DOI: 10.1001/jamanetworkopen.2021.42835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Many women in the US, particularly those living in rural areas, have limited access to obstetric care. Military-civilian partnership could improve access to obstetric care and benefit military personnel, their civilian dependents, and the civilian population as a whole. OBJECTIVE To identify medical facilities within military and civilian geographic areas that present opportunities for military-civilian partnership in obstetric care and to assess whether civilian use of military medical treatment facilities (MTFs) could improve access to emergency cesarean delivery care in the US. DESIGN, SETTING, AND PARTICIPANTS This geospatial epidemiological population-based cross-sectional study was conducted from November 2020 to March 2021. ArcGIS Pro software, version 2.7 (Esri), was used to assess population coverage for TRICARE (military insurance) beneficiaries and civilian populations and to estimate 30-minute travel time to 2392 total military and civilian medical facilities that were capable of providing emergency cesarean delivery care in the continental US. Data on health insurance coverage for TRICARE beneficiaries and their civilian dependents per county were obtained from the American Community Survey tables available through ArcGIS Pro software. Demographic characteristics of the general population were obtained from the 2020 key demographic indicators published by Esri. Race and ethnicity were not examined because the data used for this study were aggregated and did not include further categorization by race or ethnicity. MAIN OUTCOMES AND MEASURES Population coverage rates (measured in percentages) within 30-minute catchment areas, defined as areas that were within a 30-minute travel time to a medical facility capable of providing emergency cesarean delivery care. RESULTS A total of 29 MTFs and 2363 civilian hospitals capable of providing emergency cesarean delivery were identified across the contiguous US. Overall, an estimated 167 759 762 women (3 640 000 TRICARE beneficiaries and 164 119 762 civilians) were included in these service areas. The analysis identified 17 of 29 MTFs (58.6%) capable of providing emergency cesarean delivery care that were located within 30-minute catchment areas. Of those, 3 MTFs were the only facilities capable of providing emergency cesarean delivery care within a 30-minute travel time in those regions, and 14 additional MTFs had catchment areas partially overlapping with civilian hospitals that also covered areas without alternative access to emergency cesarean delivery. Expanded use of these 14 MTFs could enhance access to emergency cesarean delivery care not otherwise covered by current civilian hospitals. CONCLUSIONS AND RELEVANCE In this study, 58.6% of MTFs capable of providing emergency cesarean delivery care were located in areas with the potential to improve access to obstetric care within a 30-minute travel time. Maintenance of MTFs in these important access regions could be prioritized in the context of restructuring MTFs. This prioritization has the potential to improve access to emergency cesarean delivery care for underserved civilian populations in the US, particularly among those living in rural areas.
Collapse
Affiliation(s)
- Tarsicio Uribe-Leitz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Michael K. Dalton
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Monica A. Lutgendorf
- Division of Maternal-Fetal Medicine, Naval Medical Center San Diego, San Diego, California
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Esther Moberg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew J. Schoenfeld
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Eric Goralnick
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joel S. Weissman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lynette Hamlin
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tracey P. Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Molly P. Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
28
|
Quach D, Ten Eikelder M, Jozwiak M, Davies-Tuck M, Bloemenkamp KWM, Mol BW, Li W. Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials. Ultrasound Obstet Gynecol 2022; 59:83-92. [PMID: 34490668 DOI: 10.1002/uog.24764] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/08/2021] [Revised: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Induction of labor (IOL) is one of the most widely used obstetric interventions. However, one-fifth of IOLs result in Cesarean section (CS). We aimed to assess maternal and fetal characteristics that influence the likelihood of CS following IOL, according to the indication for CS. METHODS This was a secondary analysis of pooled data from four randomized controlled trials, including women undergoing IOL at term who had a singleton pregnancy and an unfavorable cervix, intact membranes and the fetus in cephalic presentation. The main outcomes of this analysis were CS for failure to progress (FTP) and CS for suspected fetal compromise (SFC). Restricted cubic splines were used to determine whether continuous maternal and fetal characteristics had a non-linear relationship with outcome. Optimal cut-offs for those characteristics with a non-linear pattern were determined based on the maximum area under the receiver-operating-characteristics curve. Adjusted odds ratios (aOR) were computed, using multivariable logistic regression analysis, for the associations between optimally categorized characteristics and outcome. RESULTS Of a total of 2990 women undergoing IOL, 313 (10.5%) had CS for FTP and 227 (7.6%) had CS for SFC. The risk of CS for FTP was increased in women aged 31-35 years compared with younger women (aOR, 1.51 (95% CI, 1.15-1.99)), in nulliparous compared with parous women (aOR, 8.07 (95% CI, 5.34-12.18)) and in Sub-Saharan African compared with Caucasian women (aOR, 2.09 (95% CI, 1.33-3.28)). Higher body mass index (BMI) increased incrementally the risk of CS for FTP (aOR, 1.06 (95% CI, 1.04-1.08)). High birth-weight percentile was also associated with an increased risk of CS due to FTP (aOR, 2.66 (95% CI, 1.74-4.07) for birth weight between the 80.0th and 89.9th percentiles and aOR, 4.08 (95% CI, 2.75-6.05) for birth weight ≥ 90th percentile, as compared with birth weight between the 20.0th and 49.9th percentiles). For CS due to SFC, higher maternal age (aOR, 1.09 (95% CI, 1.05-1.12)) and BMI (aOR, 1.05 (95% CI, 1.03-1.08)) were associated with an incremental increase in risk. The risk of CS for SFC was increased in nulliparous compared with parous women (aOR, 5.91 (95% CI, 3.76-9.28)) and in South Asian compared with Caucasian women (aOR, 2.50 (95% CI, 1.23-5.10)). Birth weight < 10.0th percentile increased significantly the risk of CS due to SFC (aOR, 1.93 (95% CI, 1.22-3.05)), as compared with birth weight between the 20.0th and 49.9th percentiles. Bishop score did not demonstrate a significant association with the risk of CS for FTP or for SFC. CONCLUSIONS In women undergoing IOL, maternal age, BMI, parity, ethnicity and birth-weight percentile are predictors of CS due to FTP and of CS due to SFC, but the direction and magnitude of the associations differ according to the indication for CS. These characteristics should be considered in combination with the Bishop score to stratify the risk of CS for different indications in women undergoing IOL. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Quach
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Women's, Monash Health, Clayton, Australia
| | - M Ten Eikelder
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Jozwiak
- Department of Gynecologic Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - K W M Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| |
Collapse
|
29
|
Recio Alcaide A, Arranz JM. An impact evaluation of the strategy for normal birth care on caesarean section rates and perinatal mortality in Spain. Health Policy 2022; 126:24-34. [PMID: 34848110 DOI: 10.1016/j.healthpol.2021.11.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022]
Abstract
The objectives of this research are to evaluate the impact of a health policy (the Strategy for Normal Birth Care, EAPN) on caesarean rates and perinatal mortality in Spanish public hospitals belonging to the National Health System (NHS) and to assess the related cost savings. Data from the Spanish Ministry of Health for the period 2002-2011 and quantitative impact evaluation techniques (double difference method) are used to compare the effects of this policy in a treatment group composed of the NHS hospitals and a control group made up of private for-profit hospitals outside the scope of the EAPN. Both groups are compared some years before and after the health policy initiated in 2006 and approved in October 2007. The estimation results show that the EAPN had a significant effect in reducing caesarean rates of approximately 2 percentage points between 2007 and 2011, with increasing cost savings over the years ranging from 24 to 44 million euros depending on the year. Furthermore, EAPN reduced perinatal mortality levels by 0.08% in years 2008-2009.
Collapse
Affiliation(s)
- Adela Recio Alcaide
- Instituto de Estudios Fiscales. Avda. Cardenal Herrera Oria, 378 Ed. B 1.59 28035 Madrid (Spain); Public Health Unit, School of Medicine, Universidad de Alcalá, Alcalá de Henares 28871 Madrid-España.
| | - José M Arranz
- Departamento de Economía. Facultad de CCEE y Turismo. Universidad de Alcalá. Plaza de la Victoria 2. Alcalá de Henares 28802 Madrid-España.
| |
Collapse
|
30
|
Thang NM, Anh NTH, Thanh PH, Linh PT, Cuong TD. Emergent versus planned delivery in patients with placenta accreta spectrum disorders: A retrospective study. Medicine (Baltimore) 2021; 100:e28353. [PMID: 34941147 PMCID: PMC8702197 DOI: 10.1097/md.0000000000028353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam.The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed.A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 ± 0.33 vs 4.5 ± 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group (P < .001). The mean gestational age at delivery for the emergent group was 35.1 ± 0.27 weeks compared with 38.0 ± 0.10 weeks for the planned group (P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59-5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13-14.29).Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery.
Collapse
Affiliation(s)
- Nguyen Manh Thang
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| | - Nguyen Thi Huyen Anh
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Pham Thi Linh
- Thai Binh Obstetrics and Gynecology Hospital, Thai Binh, Vietnam
| | - Tran Danh Cuong
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| |
Collapse
|
31
|
Bi SL, Zhang LZ, Liang XY, Huang LJ, Zeng SS, Liang YY, Li YL, Huang MS, Jia JP, Wen SW, Feng L, Du LL, Wang ZJ, Chen DJ. Is the Trial of Labor after Two Previous Cesarean Sections Contraindicated in China? Biomed Environ Sci 2021; 34:1005-1009. [PMID: 34981724 DOI: 10.3967/bes2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/17/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Shi Lei Bi
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Li Zi Zhang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Xin Yue Liang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Li Jun Huang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Shan Shan Zeng
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Ying Yu Liang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Yu Lian Li
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Min Shan Huang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Jin Ping Jia
- Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou 510800, Guangdong, China
| | - Sui Wen Wen
- Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangzhou 511500, Guangdong, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hunan, China
| | - Li Li Du
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China;Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, Guangdong, China
| | - Zhi Jian Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Dun Jin Chen
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China;Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou 510150, Guangdong, China
| |
Collapse
|
32
|
Xiao X, Ding R, Peng L, Liu H, Zhu Y. Diagnostic performance of magnetic resonance imaging and ultrasonography on the detection of cesarean scar pregnancy: A meta-analysis. Medicine (Baltimore) 2021; 100:e27532. [PMID: 35049166 PMCID: PMC9191567 DOI: 10.1097/md.0000000000027532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND : There is still a debate on which imaging method is the best to diagnose cesarean scar pregnancy (CSP). Accordingly, this study aimed to analyze the diagnostic performance of magnetic resonance imaging (MRI) and ultrasonography (US) on the detection of CSP based on current evidence in the literature. METHODS PubMed, Embase, Cochrane, Chinese Biomedical Documentation Service System, WanFang, and China National Knowledge Infrastructure databases were searched up to June 2020. The included studies were all comparisons of MRI and US in the diagnosis of CSP that adopted postoperative histological examination as the reference standard. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating characteristic curve (AUC) were calculated for MRI and US. RESULTS Thirteen studies were included, with a total sample size of 948 patients. The pooled sensitivity, specificity, PLR, NLR, and AUC of MRI in diagnosing CSP were 0.93 (95% CI, 0.91-0.95), 0.83 (95% CI, 0.75-0.89), 5.46 (95% CI, 3.70-8.05), 0.08 (95% CI, 0.06-0.11), and 0.96 (95% CI, 0.93-0.97), respectively; for US they were 0.84 (95% CI, 0.79-0.88), 0.73 (95% CI, 0.62-0.81), 3.06 (95% CI, 2.22-4.21), 0.23 (95% CI, 0.18-0.28), and 0.86 (95% CI, 0.83-0.89), respectively. CONCLUSION We found that both MRI and US effectively diagnosed CSP; however, MRI had a higher diagnostic performance in detecting CSP than US.
Collapse
Affiliation(s)
- Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Rixing Ding
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Peng
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Huaping Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yun Zhu
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| |
Collapse
|
33
|
Rosen G, Lavie A, Yackobovitch-Gavan M, Almashanu S, Priel M, Many A, Lebenthal Y, Brener A. Congenital Hypothyroidism Can Dictate the Mode of Delivery and Intra-Labor Medication Usage. Thyroid 2021; 31:1878-1885. [PMID: 34617463 DOI: 10.1089/thy.2021.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Pregnancy and parturition reflect the complex interaction between physiological conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We aimed to investigate the characteristics of the mother-infant dyad of term infants detected as having congenital hypothyroidism (CH). Methods: A retrospective cohort study of 108,717 term infants delivered liveborn at Lis Maternity and Women's Hospital between 2010 and 2017. Infants were detected by the National Newborn Screening Program as having CH (131, 0.12%). Three years of surveillance in the Pediatric Endocrine Clinic revealed that 65 infants had transient CH and 66 had permanent CH. Data on maternal, pregnancy, delivery, and perinatal characteristics of the mother-infant dyads were retrieved from the hospital's electronic database. Results: Mode of delivery differed: a higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared with the general population (p < 0.001). Medication during labor also differed, with higher rates of oxytocin (p < 0.001) and antibiotics (p = 0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH. Conclusions: Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function may affect the development and progress of labor and delivery, in response to oxytocin.
Collapse
Affiliation(s)
- Gil Rosen
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Almashanu
- The National Newborn Screening Program, Ministry of Health, Tel-Hashomer, Israel
| | - Meital Priel
- Department of Pediatrics, Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
34
|
Khan DSA, Hamid LR, Ali A, Salam RA, Zuberi N, Lassi ZS, Das JK. Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:801. [PMID: 34852783 PMCID: PMC8633904 DOI: 10.1186/s12884-021-04250-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is dearth of information on COVID-19's impact on pregnant women. However, literature reported trends of COVID-19 differ, depending on the presence of clinical features upon presentation. OBJECTIVE This systematic review aimed to assess differences in risk factors, management, complications, and pregnancy and perinatal outcomes in symptomatic vs. asymptomatic pregnant women with confirmed SARS-CoV-2 infection. METHODS A search was run on electronic databases to identify studies reporting COVID-19 in pregnancy. Meta-analysis was performed and odds ratios and mean difference with 95% confidence intervals were calculated using Review Manager 5.4. Review Prospero registration number CRD42020204662. RESULTS We included ten articles reporting data from 3158 pregnancies; with 1900 symptomatic and 1258 asymptomatic pregnant women. There was no significant difference in the mean age, gestational age, and body mass index between the two groups. The meta-analysis suggested that pregnant women who were obese (OR:1.37;95%CI:1.15 to 1.62), hypertensive (OR:2.07;95%CI:1.38 to 3.10) or had a respiratory disorder (OR:1.64;95%CI:1.25 to 2.16), were more likely to be symptomatic when infected with SARS-CoV-2. Pregnant women with Black (OR:1.48;95%CI:1.19 to 1.85) or Asian (OR:1.64;95%CI:1.23 to 2.18) ethnicity were more likely to be symptomatic while those with White ethnicity (OR:0.63;95%CI:0.52 to 0.76) were more likely to be asymptomatic. Cesarean-section delivery (OR:1.40;95%CI:1.17 to 1.67) was more likely amongst symptomatic pregnant women. The mean birthweight(g) (MD:240.51;95%CI:188.42 to 293.51), was significantly lower, while the odds of low birthweight (OR:1.85;95%CI:1.06 to 3.24) and preterm birth (< 37 weeks) (OR:2.10;95%CI:1.04 to 4.23) was higher amongst symptomatic pregnant women. Symptomatic pregnant women had a greater requirement for maternal ICU admission (OR:13.25;95%CI:5.60 to 31.34) and mechanical ventilation (OR:15.56;95%CI:2.96 to 81.70) while their neonates had a higher likelihood for Neonatal Intensive Care Unit admission (OR:1.96;95%CI:1.59 to 2.43). The management strategies in the included studies were poorly discussed, hence could not be analyzed. CONCLUSION The evidence suggests that the presence of risk factors (co-morbidities and ethnicity) increased the likelihood of pregnant women being symptomatic. Higher odds of complications were also observed amongst symptomatic pregnant women. However, more adequately conducted studies with adjusted analysis and parallel comparison groups are required to reach conclusive findings.
Collapse
Affiliation(s)
| | - La-Raib Hamid
- Department of Pediatrics, Aga Khan University, Karachi, 74800 Pakistan
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, 5005 Australia
| | - Rehana A. Salam
- Department of Pediatrics, Aga Khan University, Karachi, 74800 Pakistan
| | - Nadeem Zuberi
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, 74800 Pakistan
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, 5005 Australia
| | - Jai K. Das
- Department of Pediatrics, Aga Khan University, Karachi, 74800 Pakistan
| |
Collapse
|
35
|
Hailegebreal S, Gilano G, Seboka BT, Ahmed MH, Simegn AE, Tesfa GA, Yehualashet DE. Prevalence and associated factors of caesarian section in Ethiopia: a multilevel analysis of the 2019 Ethiopia Mini Demographic Health Survey. BMC Pregnancy Childbirth 2021; 21:798. [PMID: 34847876 PMCID: PMC8630861 DOI: 10.1186/s12884-021-04266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Caesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia. METHODS Data from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results. RESULT The prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively. CONCLUSION Although evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women's age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.
Collapse
Affiliation(s)
- Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Arba Minch University, Arba Minch, Ethiopia.
| | - Girma Gilano
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | | | - Atsedu Endale Simegn
- Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Getanew Aschalew Tesfa
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | | |
Collapse
|
36
|
Wei J, Li Q, Zhai H. Umbilical artery thrombosis diagnosed at different gestational ages and fetal outcomes: a case series. BMC Pregnancy Childbirth 2021; 21:788. [PMID: 34809600 PMCID: PMC8607721 DOI: 10.1186/s12884-021-04264-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Umbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes. METHODS Our Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems. RESULTS Three patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive. CONCLUSIONS Umbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.
Collapse
Affiliation(s)
- Jing Wei
- Department of obstetrics and gynecology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, 310006, China
| | - Qiaoyun Li
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, 310006, China
| | - Hongbo Zhai
- Department of obstetrics and gynecology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, 310006, China.
| |
Collapse
|
37
|
Chen Y, Shi J, Zhu Y, Kong X, Lu Y, Chu Y, Mishu MM. Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study. BMC Pregnancy Childbirth 2021; 21:784. [PMID: 34798869 PMCID: PMC8602992 DOI: 10.1186/s12884-021-04237-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of "maternal near-misses" is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization's MNM approach. METHODS A five-year retrospective study was conducted in Subei People's Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. RESULTS Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40-7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66-14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53-11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20-18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). CONCLUSIONS Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.
Collapse
Affiliation(s)
- Ying Chen
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jiaoyang Shi
- Department of Obstetrics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yuting Zhu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xiang Kong
- Department of Obstetrics and Gynecology, Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China.
| | - Yang Lu
- Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yanru Chu
- Ningbo Center for Disease Control and Prevention, Ningbo, China
| | | |
Collapse
|
38
|
Fruscalzo A, Reinecke K, Londero AP, Gantert M. Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study. BMC Pregnancy Childbirth 2021; 21:783. [PMID: 34798862 PMCID: PMC8603588 DOI: 10.1186/s12884-021-04245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. MATERIALS AND METHODS Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd-/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. RESULTS The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57-0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48-3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57-0.93, p = 0.010). CONCLUSIONS The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.
Collapse
Affiliation(s)
- A. Fruscalzo
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
- Present address: Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - K. Reinecke
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
| | - A. P. Londero
- Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy
- Ennergi Research (non-profit organisation), Lestizza, UD 33050 Italy
| | - M. Gantert
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
| |
Collapse
|
39
|
McCall SJ, Semaan A, Altijani N, Opondo C, Abdel-Fattah M, Kabakian-Khasholian T. Trends, wealth inequalities and the role of the private sector in caesarean section in the Middle East and North Africa: A repeat cross-sectional analysis of population-based surveys. PLoS One 2021; 16:e0259791. [PMID: 34784384 PMCID: PMC8594794 DOI: 10.1371/journal.pone.0259791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in the Middle East and North Africa (MENA). Methods Secondary data analysis of nationally representative household surveys conducted between 2008–2020 across nine Arab countries in the MENA region. The study population was women aged 15–49 years with a live birth in the two years preceding the survey. Temporal changes in the proportion of deliveries by caesarean section in each country were calculated using generalised linear models and presented as risk differences (RD) with 95% confidence intervals (95%CI). Caesarean section was disaggregated by household wealth index and type of healthcare facility. Results Use of caesarean section ranged from 57.3% (95%CI:55.6–59.1%) in Egypt to 5.7% of births (95%CI:4.9–6.6%) in Yemen. Overall, the use of caesarean section has increased across the MENA region, except in Jordan, where there was no evidence of change (RD -2.3 (95%CI: -6.0 ‒1.4)). Across most countries, caesarean section use was highest in the richest quintile compared to the poorest quintile, for example, 42.8% (95%CI:38.0–47.6%) vs. 22.6% (95%CI:19.6–25.9%) in Iraq, respectively. Proportion of caesarean section was higher in private sector facilities compared to public sector: 21.8% (95%CI:18.2–25.9%) vs. 15.7% (95%CI:13.3–18.4%) in Yemen, respectively. Conclusion Variations in caesarean section exist within and between Arab countries, and it was more commonly used amongst the richest quintiles and in private healthcare facilities. The private sector has a prominent role in observed trends. Urgent policies and interventions are required to address non-medically indicated intervention.
Collapse
Affiliation(s)
- Stephen J. McCall
- Department of Epidemiology and Population Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail: (SJM); (TKK)
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Noon Altijani
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mohamed Abdel-Fattah
- Aberdeen Center for Women’s Health Research, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail: (SJM); (TKK)
| |
Collapse
|
40
|
Sugulle M, Halldórsdóttir E, Kvile J, Berntzen LSD, Jacobsen AF. Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications. PLoS One 2021; 16:e0259926. [PMID: 34784382 PMCID: PMC8594828 DOI: 10.1371/journal.pone.0259926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/02/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. STUDY DESIGN Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. RESULTS Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p< 0.001). CONCLUSION In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.
Collapse
Affiliation(s)
- Meryam Sugulle
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erna Halldórsdóttir
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Janne Kvile
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
41
|
Kim SY, Oh SY, Sung JH, Choi SJ, Roh CR, Lee SM, Jun JK, Lee MY, Lee J, Kim SH, Cha DH, Han YJ, Kim MH, Cho GJ, Kwon HS, Kim BJ, Park MH, Cho HY, Ko HS, Shim JY, Ryu HM. Validation of a Strict Obesity Definition Proposed for Asians to Predict Adverse Pregnancy Outcomes in Korean Pregnant Women. J Korean Med Sci 2021; 36:e281. [PMID: 34783214 PMCID: PMC8593408 DOI: 10.3346/jkms.2021.36.e281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/16/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND People are generally considered overweight and obese if their body mass index (BMI) is above 25 kg/m² and 30.0 kg/m², respectively. The World Health Organization proposed stricter criteria for Asians (≥ 23 kg/m²: overweight, ≥ 25 kg/m²: obese). We aimed to verify whether this criteria could predict adverse pregnancy outcomes in Korean women. METHODS We included 7,547 Korean women from 12 institutions enrolled between June 2016 and October 2018. Women with no pre-pregnancy BMI data, not Korean, or lost to follow-up were excluded, leaving 6,331. The subjects were categorized into underweight, normal, overweight, class I obesity, and class II/III obesity based on a pre-pregnancy BMI of < 18.5, 18.5-22.9, 23.0-24.9, 25.0-29.9, and ≥ 30.0 kg/m², respectively. RESULTS Overall, 13.4%, 63.0%, 11.8%, 9.1%, and 2.6% of women were underweight, normal, and overweight and had class I obesity and class II/III obesity, respectively. In the multivariable analysis adjusted for maternal age, a higher BMI significantly increased the risk of preeclampsia, gestational diabetes, preterm delivery caused by maternal-fetal indications, cesarean section, large for gestational age, and neonatal intensive care unit admission. CONCLUSION Adverse pregnancy outcomes started to increase in those with a pre-pregnancy BMI ≥ 23.0 kg/m² after adjusting for maternal age. The modified obesity criteria could help predict adverse pregnancy outcomes in Koreans.
Collapse
Affiliation(s)
- Seo-Yeon Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - JoonHo Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Hyun Cha
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | | | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Han-Sung Kwon
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Mi Hye Park
- Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae-Yoon Shim
- Mirae and Heemang Obstetrics and Gynecology Clinic, Seoul, Korea
| | - Hyun Mee Ryu
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
| |
Collapse
|
42
|
Abstract
OBJECTIVES Aim of this study is to evaluate the prognosis of pregnant women having SARS-CoV-2 infection and investigate whether there was a difference in perinatal outcomes between pregnant women who had SARS-CoV-2 infection and those who did not. MATERIALS AND METHODS This prospective observational study was conducted with 116 singleton pregnancies. Cases enrolling in the study were divided into two groups. While those in the first group had a history of SARS-CoV-2 infection (n = 46) the second group consisted of healthy pregnant women (n = 70). RESULTS Emergency Cesarean section was performed on three SARS-CoV-2 infected pregnancies (30, 33 and 34 gestational weeks). Intensive care unit admission was required for all three cases after delivery and two of them died. Among the pregnancies that had an infection in the third trimester, 71.4% (n = 20) of them had delivery in 14 days after diagnosis and 17.4% (n = 8) of their newborns were followed up at newborn intensive care unit. Overall, only one newborn had a positive swab test result for SARS-CoV-2. There was no statistically significant difference between groups regarding their delivery week (37.02 ± 5.85 vs 38.5 ± 2.33). Similarly, there was no significant difference between groups, concerning mean age, parity, and birth weight (P = 0.707, P = 0.092, P = 0.334; P < 0.05). Furthermore, the difference between SARS-CoV-2 infected pregnancies that were followed up as inpatient or outpatient with respect to the delivery week and birth weight was not significant (p > 0.05). Also, APGAR 5 scores of hospitalized women (9.3 ± 1.1) were found to be lower than the outpatient group (9.8 ± 0.8) (P = 0.043; p < 0.05). CONCLUSION No significant difference was detected between groups in terms of the delivery week, birth weight, and APGAR scores. The inpatient group was found to have lower APGAR 5 scores.
Collapse
Affiliation(s)
- Sevcan Arzu Arinkan
- Department of Obstetrics and Gynecology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Ezgi Ceren Dallı Alper
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gunes Topcu
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Muhcu
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
43
|
Picón-César MJ, Molina-Vega M, Suárez-Arana M, González-Mesa E, Sola-Moyano AP, Roldan-López R, Romero-Narbona F, Olveira G, Tinahones FJ, González-Romero S. Metformin for gestational diabetes study: metformin vs insulin in gestational diabetes: glycemic control and obstetrical and perinatal outcomes: randomized prospective trial. Am J Obstet Gynecol 2021; 225:517.e1-517.e17. [PMID: 33887240 DOI: 10.1016/j.ajog.2021.04.229] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 01/07/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gestational diabetes that is not properly controlled with diet has been commonly treated with insulin. In recent years, several studies have published that metformin can lead to, at least, similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous. OBJECTIVE This study aimed to test whether metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes that is not properly controlled with lifestyle changes. STUDY DESIGN The metformin for gestational diabetes study was a multicenter, open-label, parallel arms, randomized clinical trial performed at 2 hospitals in Málaga (Spain), enrolling women with gestational diabetes who needed pharmacologic treatment. Women at the age of 18 to 45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin (detemir or aspart). The main outcomes were (1) glycemic control (mean glycemia, preprandial and postprandial) and hypoglycemic episodes and (2) obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice). Outcomes were analyzed on an intention-to-treat basis. RESULTS Between October 2016 and June 2019, 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group. Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch or dinner in the metformin-treated-group. Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin; odds ratio, 6.118; 95% confidence interval, 3.134-11.944; P=.000). Women treated with metformin gained less weight from the enrollment to the prepartum visit (36-37 gestational weeks) (1.35±3.21 vs 3.87±3.50 kg; P=.000). Labor inductions (45.7% [metformin] vs 62.5% [insulin]; odds ratio, 0.506; 95% confidence interval, 0.283-0.903; P=.029) and cesarean deliveries (27.6% [metformin] vs 52.6% [insulin]; odds ratio, 0.345; 95% confidence interval, 0.187-0.625; P=.001) were significantly lower in the metformin-treated group. Mean birthweight, macrosomia, and large for gestational age and babies' complications were not different between treatment groups. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy. CONCLUSION Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.
Collapse
Affiliation(s)
- María J Picón-César
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - María Suárez-Arana
- Department of Obstetrics and Gynecology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Ernesto González-Mesa
- Department of Obstetrics and Gynecology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain
| | - Ana P Sola-Moyano
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Reyes Roldan-López
- Department of Neonatology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Francisca Romero-Narbona
- Department of Neonatology, Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas, Madrid, Spain.
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBER de Fisiopatología de la Obesidad y la Nutrición, Madrid, Spain.
| | - Stella González-Romero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas, Madrid, Spain
| |
Collapse
|
44
|
Epelboin S, Labrosse J, De Mouzon J, Fauque P, Gervoise-Boyer MJ, Levy R, Sermondade N, Hesters L, Bergère M, Devienne C, Jonveaux P, Ghosn J, Pessione F. Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study. PLoS Med 2021; 18:e1003857. [PMID: 34847147 PMCID: PMC8631654 DOI: 10.1371/journal.pmed.1003857] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 02/11/2021] [Accepted: 10/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic. METHODS AND FINDINGS We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected. CONCLUSIONS We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.
Collapse
Affiliation(s)
- Sylvie Epelboin
- Centre d’Assistance Médicale à la Procréation, gynécologie obstétrique, médecine de la reproduction, hôpital Bichat Claude-Bernard, AP–HP, Nord, Université de Paris, Paris, France
| | - Julie Labrosse
- Centre d’Assistance Médicale à la Procréation, gynécologie obstétrique, médecine de la reproduction, hôpital Bichat Claude-Bernard, AP–HP, Nord, Université de Paris, Paris, France
| | | | - Patricia Fauque
- Université Bourgogne Franche-Comté—INSERM UMR1231, Dijon, France
| | | | - Rachel Levy
- Inserm, équipe lipodystrophies génétiques et acquises, service de biologie de la reproduction-CECOS, Saint-Antoine research center, Sorbonne université, Paris, France
- Hôpital Tenon, AP–HP, Sorbonne université, Paris, France
| | | | - Laetitia Hesters
- Hôpital Antoine Béclère, AP–HP, Université de Paris, Clamart, France
| | | | | | | | - Jade Ghosn
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, AP–HP, Nord, Université de Paris, Paris, France
- INSERM U1137, IAME, Faculté de Médecine site Bichat, Université de Paris, Paris, France
| | | |
Collapse
|
45
|
Mappa I, Tartaglia S, Maqina P, Makatsariya A, Ghi T, Rizzo G, D'Antonio F. Ultrasound vs routine care before instrumental vaginal delivery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1941-1948. [PMID: 34314520 DOI: 10.1111/aogs.14236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/13/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective was to report the role of intrapartum ultrasound examination in affecting maternal and perinatal outcome in women undergoing instrumental vaginal delivery. MATERIAL AND METHODS MEDLINE, Embase, CINAHL, Google Scholar and ClinicalTrial.gov databases were searched. Inclusion criteria were randomized controlled trials comparing ultrasound assessment of fetal head position vs routine standard care (digital examination) before instrumental vaginal delivery (either vacuum or forceps). The primary outcome was failed instrumental delivery extraction followed by cesarean section. Secondary outcomes were postpartum hemorrhage, 3rd or 4th degree perineal lacerations, episiotomy, prolonged hospital stay, Apgar score<7 at 5 min, umbilical artery pH <7.0 and base excess greater than -12 mEq, admission to neonatal intensive care unit (NICU), shoulder dystocia, birth trauma, a composite score of adverse maternal and neonatal outcome and incorrect diagnosis of fetal head position. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB-2). The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Head-to-head meta-analyses using a random-effect model were used to analyze the data and results are reported as relative risk with their 95% confidence intervals. RESULTS Five studies were included (1463 women). There was no difference in the maternal, pregnancy or labor characteristics between the two groups. An ultrasound assessment prior to instrumental vaginal delivery did not affect the cesarean section rate compared with standard care (p = 0.805). Likewise, the risk of composite adverse maternal outcome (p = 0.428), perineal lacerations (p = 0.800), postpartum hemorrhage (p = 0.303), shoulder dystocia (p = 0.862) and prolonged stay in hospital (p = 0.059) were not different between the two groups. Composite adverse neonatal outcome was not different between the women undergoing and those not undergoing ultrasound assessment prior to instrumental delivery (p = 0.400). Likewise, there was no increased risk with abnormal Apgar score (p = 0.882), umbilical artery pH < 7.2 (p = 0.713), base excess greater than -12 (p = 0.742), admission to NICU (p = 0.879) or birth trauma (p = 0.968). The risk of having an incorrect diagnosis of fetal head position was lower when ultrasound was performed before instrumental delivery, with a relative risk of 0.16 (95% confidence interval 0.1-0.3; I2 :77%, p < 0.001). CONCLUSIONS Although ultrasound examination was associated with a lower rate of incorrect diagnoses of fetal head position and station, this did not translate to any improvement of maternal or neonatal outcomes.
Collapse
Affiliation(s)
- Ilenia Mappa
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Silvio Tartaglia
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Pavjola Maqina
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| |
Collapse
|
46
|
Nethery E, Schummers L, Levine A, Caughey AB, Souter V, Gordon W. Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State. Obstet Gynecol 2021; 138:693-702. [PMID: 34619716 PMCID: PMC8522628 DOI: 10.1097/aog.0000000000004578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe rates of maternal and perinatal birth outcomes for community births and to compare outcomes by planned place of birth (home vs state-licensed, freestanding birth center) in a Washington State birth cohort, where midwifery practice and integration mirrors international settings. METHODS We conducted a retrospective cohort study including all births attended by members of a statewide midwifery professional association that were within professional association guidelines and met eligibility criteria for planned birth center birth (term gestation, singleton, vertex fetus with no known fluid abnormalities at term, no prior cesarean birth, no hypertensive disorders, no prepregnancy diabetes), from January 1, 2015 through June 30, 2020. Outcome rates were calculated for all planned community births in the cohort. Estimated relative risks were calculated comparing delivery and perinatal outcomes for planned births at home to state-licensed birth centers, adjusted for parity and other confounders. RESULTS The study population included 10,609 births: 40.9% planned home and 59.1% planned birth center births. Intrapartum transfers to hospital were more frequent among nulliparous individuals (30.5%; 95% CI 29.2-31.9) than multiparous individuals (4.2%; 95% CI 3.6-4.6). The cesarean delivery rate was 11.4% (95% CI 10.2-12.3) in nulliparous individuals and 0.87% (95% CI 0.7-1.1) in multiparous individuals. The perinatal mortality rate after the onset of labor (intrapartum and neonatal deaths through 7 days) was 0.57 (95% CI 0.19-1.04) per 1,000 births. Rates for other adverse outcomes were also low. Compared with planned birth center births, planned home births had similar risks in crude and adjusted analyses. CONCLUSION Rates of adverse outcomes for this cohort in a U.S. state with well-established and integrated community midwifery were low overall. Birth outcomes were similar for births planned at home or at a state-licensed, freestanding birth center.
Collapse
Affiliation(s)
- Elizabeth Nethery
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Laura Schummers
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Audrey Levine
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Aaron B. Caughey
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Vivienne Souter
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Wendy Gordon
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| |
Collapse
|
47
|
Matsuzaki S, Mandelbaum RS, Sangara RN, McCarthy LE, Vestal NL, Klar M, Matsushima K, Amaya R, Ouzounian JG, Matsuo K. Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States. Am J Obstet Gynecol 2021; 225:534.e1-534.e38. [PMID: 33894149 DOI: 10.1016/j.ajog.2021.04.233] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 01/19/2021] [Revised: 03/17/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although an infrequent occurrence, the placenta can adhere abnormally to the gravid uterus leading to significantly high maternal morbidity and mortality during cesarean delivery. Contemporary national statistics related to a morbidly adherent placenta, referred to as placenta accreta spectrum, are needed. OBJECTIVE This study aimed to examine national trends, characteristics, and perioperative outcomes of women who underwent cesarean delivery for placenta accreta spectrum in the United States. STUDY DESIGN This is a population-based retrospective, observational study querying the National Inpatient Sample. The study cohort included women who underwent cesarean delivery from October 2015 to December 2017 and had a diagnosis of placenta accreta spectrum. The main outcome measures were patient characteristics and surgical outcomes related to placenta accreta spectrum assessed by the generalized estimating equation on multivariable analysis. The temporal trend of placenta accreta spectrum was also assessed by linear segmented regression with log transformation. RESULTS Of 2,727,477 cases who underwent cesarean delivery during the study period, 8030 (0.29%) had the diagnosis of placenta accreta spectrum. Placenta accreta was the most common diagnosis (n=6205, 0.23%), followed by percreta (n=1060, 0.04%) and increta (n=765, 0.03%). The number of placenta accreta spectrum cases increased by 2.1% every quarter year from 0.27% to 0.32% (P=.004). On multivariable analysis, (1) patient demographics (older age, tobacco use, recent diagnosis, higher comorbidity, and use of assisted reproductive technology), (2) pregnancy characteristics (placenta previa, previous cesarean delivery, breech presentation, and grand multiparity), and (3) hospital factors (urban teaching center and large bed capacity hospital) represented the independent characteristics related to placenta accreta spectrum (all, P<.05). The median gestational age at cesarean delivery was 36 weeks for placenta accreta and 34 weeks for both placenta increta and percreta vs 39 weeks for non-placenta accreta spectrum cases (P<.001). On multivariable analysis, cesarean delivery complicated by placenta accreta spectrum was associated with increased risk of any surgical morbidities (78.3% vs 10.6%), Centers for Disease Control and Prevention-defined severe maternal morbidity (60.3% vs 3.1%), hemorrhage (54.1% vs 3.9%), coagulopathy (5.3% vs 0.3%), shock (5.0% vs 0.1%), urinary tract injury (8.3% vs 0.2%), and death (0.25% vs 0.01%) compared with cesarean delivery without placenta accreta spectrum. When further analyzed by subtype, cesarean delivery for placenta increta and percreta was associated with higher likelihood of hysterectomy (0.4% for non-placenta accreta spectrum, 45.8% for accreta, 82.4% for increta, 78.3% for percreta; P<.001) and urinary tract injury (0.2% for non-placenta accreta spectrum, 5.2% for accreta, 11.8% for increta, 24.5% for percreta; P<.001). Moreover, women in the placenta increta and percreta groups had markedly increased risks of surgical mortality compared with those without placenta accreta spectrum (increta, odds ratio, 19.9; and percreta, odds ratio, 32.1). CONCLUSION Patient characteristics and outcomes differ across the placenta accreta spectrum subtypes, and women with placenta increta and percreta have considerably high surgical morbidity and mortality risks. Notably, 1 in 313 women undergoing cesarean delivery had a diagnosis of placenta accreta spectrum by the end of 2017, and the incidence seems to be higher than reported in previous studies.
Collapse
Affiliation(s)
- Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Rauvynne N Sangara
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Lauren E McCarthy
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nicole L Vestal
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Rodolfo Amaya
- Department of Anesthesiology, University of Southern California, Los Angeles, CA
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| |
Collapse
|
48
|
Björnsdottir S, Clarke B, Mäkitie O, Sandström A, Tiblad E, Spelman T, Kämpe O. Women With Chronic Hypoparathyroidism Have Low Risk of Adverse Pregnancy Outcomes. J Clin Endocrinol Metab 2021; 106:3312-3319. [PMID: 34240167 DOI: 10.1210/clinem/dgab503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT There are scarce data on the management of chronic hypoparathyroidism (hypoPT) in pregnant women. OBJECTIVE The aim of this study was to evaluate pregnancy outcome and total number of births in maternal chronic hypoPT. METHODS The Swedish National Patient Register, The Swedish Prescribed Drug Register, Swedish Medical Birth Register, and the Total Population Register were used to identify 97 women with chronic hypoPT and 1030 age-matched controls who delivered 139 and 1577 singleton infants, respectively, following diagnosis between 1997 and 2017. RESULTS Women in the chronic hypoPT group had more frequent diabetes (DM) and chronic kidney disease (CKD) compared with the control group (P = 0.043 and P < 0.001, respectively). After adjusting for DM, CKD, maternal age at delivery, and calendar year of delivery, chronic hypoPT cases were associated with increased risk of induction of labor (OR, 1.82; 95% CI, 1.13-2.94) and birth of infants with lower birth weight (β-coefficient -188 g; 95% CI, -312.2 to -63.8) compared with controls. No difference was found in infant length, small for gestational age, or head circumference after adjustments. Mean gestational age at delivery after controlling for DM, CKD, and pre-eclampsia was not significantly younger (P = 0.119). There was no difference in congenital malformations or perinatal death and no difference in the total number of infants born between groups (P = 0.518). CONCLUSION The majority of women with chronic hypoPT had normal pregnancy outcomes, and the overall risks appear low. Maternal chronic hypoPT is, however, associated with higher risk of induction of labor and slightly lower infant birth weight.
Collapse
Affiliation(s)
- Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Bart Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Outi Mäkitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
- Center of Molecular Medicine, Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eleonor Tiblad
- Center of Molecular Medicine, Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Pregnancy Care and Delivery, Women´s Health, Karolinska University Hospital, Huddinge, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Olle Kämpe
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
49
|
Dorji T, Dorji P, Gyamtsho S, Tamang ST, Wangden T, Wangmo S, Prisno DEL. Rates and indications of caesarean section deliveries in Bhutan 2015-2019: a national review. BMC Pregnancy Childbirth 2021; 21:698. [PMID: 34663258 PMCID: PMC8522038 DOI: 10.1186/s12884-021-04173-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan. METHODS This is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015-2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital. RESULTS For the period 2015-2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were 'past caesarean section' (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%). CONCLUSION Bhutan's caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan's efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections.
Collapse
Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
| | - Phurb Dorji
- Kidu Mobile Medical Unit, His Majesty’s People’s Project, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sonam Gyamtsho
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Tshering Wangden
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sangay Wangmo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, 11001 Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | |
Collapse
|
50
|
Wang Y, Luo B, Xiang J. The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:695. [PMID: 34645422 PMCID: PMC8513326 DOI: 10.1186/s12884-021-04175-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes. METHODS Pregnant women between 13 and 24 weeks of gestation were recruited at a women's and children's hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments. RESULTS A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section. CONCLUSION Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM. TRIAL REGISTRATION Registration number: ChiCTR1900023721 . Date of registration: June 9, 2019.
Collapse
Affiliation(s)
- Yan Wang
- West China School of Nursing/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
| | - Jie Xiang
- Department of Nursing, West China Second University Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
| |
Collapse
|