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Guerby P, Audibert F, Johnson JA, Okun N, Giguère Y, Forest JC, Chaillet N, Mâsse B, Wright D, Ghesquiere L, Bujold E. Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study). Hypertension 2024. [PMID: 38708601 DOI: 10.1161/hypertensionaha.123.22584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/05/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women. METHODS We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks. Maternal characteristics, mean arterial blood pressure, PAPP-A (pregnancy-associated plasma protein A), PlGF (placental growth factor) in maternal blood, and uterine artery pulsatility index were collected at recruitment. The risk of preterm preeclampsia was calculated by a third party blinded to pregnancy outcomes. Receiver operating characteristic curves were used to estimate the detection rate (sensitivity) and the false-positive rate (1-specificity) for preterm (<37 weeks) and for early-onset (<34 weeks) preeclampsia according to the FMF screening test and according to the American College of Obstetricians and Gynecologists criteria. RESULTS We recruited 7554 participants including 7325 (97%) who remained eligible after 20 weeks of which 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early-onset preeclampsia. Using the FMF algorithm (cutoff of ≥1 in 110 for preterm preeclampsia), the detection rate was 63.1% for preterm preeclampsia and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. Using the American College of Obstetricians and Gynecologists criteria, the equivalent detection rates would have been 61.5% and 59.1%, respectively, for a false-positive rate of 34.3%. CONCLUSIONS The first-trimester FMF preeclampsia screening test predicts two-thirds of preterm preeclampsia and three-quarters of early-onset preeclampsia in nulliparous women, with a false-positive rate of ≈16%. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02189148.
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Affiliation(s)
- Paul Guerby
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
- Department of Gynecology and Obstetrics, Infinity CNRS, Inserm UMR 1291, CHU Toulouse, France (P.G.)
| | - Francois Audibert
- Department of Obstetrics and Gynecology, CHU Ste-Justine Research Center, Université de Montréal, Canada (F.A.)
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, AB, Canada (J.-A.J.)
| | - Nanette Okun
- Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada (N.O.)
| | - Yves Giguère
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Canada. (Y.G., J.-C.F.)
| | - Jean-Claude Forest
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
- Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Canada. (Y.G., J.-C.F.)
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
| | - Benoit Mâsse
- École de Santé Publique de l'Université de Montréal, QC, Canada (B.M.)
| | - David Wright
- Institute of Health Research, University of Exeter, United Kingdom (D.W.)
| | - Louise Ghesquiere
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
- Department of Obstetrics, Université de Lille, CHU de Lille, France (L.G.)
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center, Université Laval, Canada. (P.G., Y.G., J.-C.F., N.C., L.G., E.B.)
- Department of Gynecology, Obstetrics and Reproduction, Université Laval, Canada. (E.B.)
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Ghesquière L, Bujold E, Dubé E, Chaillet N. Comparison of National Factor-based Models for Preeclampsia Screening. Am J Perinatol 2024. [PMID: 38490251 DOI: 10.1055/s-0044-1782676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE This study aimed to compare the predictive values of the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the Society of Obstetricians and Gynecologists of Canada (SOGC) factor-based models for preeclampsia (PE) screening. STUDY DESIGN We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE, and the SOGC models. Our primary outcomes were PE and preterm PE (PE combined with preterm birth) using the ACOG criteria. We calculated the detection rate (DR or sensitivity), the false positive rate (FPR or 1 - specificity), the positive (PPV) and negative (NPV) predictive values of each model for PE and for preterm PE using receiver operator characteristic (ROC) curves. RESULTS We used 130,939 deliveries including 4,635 (3.5%) cases of PE and 823 (0.6%) cases of preterm PE. The ACOG model had a DR of 43.6% for PE and 50.3% for preterm PE with FPR of 15.6%; the NICE model had a DR of 36.2% for PE and 41.3% for preterm PE with FPR of 12.8%; and the SOGC model had a DR of 49.1% for PE and 51.6% for preterm PE with FPR of 22.2%. The PPV for PE of the ACOG (9.3%) and NICE (9.4%) models were both superior than the SOGC model (7.6%; p < 0.001), with a similar trend for the PPV for preterm PE (1.9 vs. 1.9 vs. 1.4%, respectively; p < 0.01). The area under the ROC curves suggested that the ACOG model is superior to the NICE for the prediction of PE and preterm PE and superior to the SOGC models for the prediction of preterm PE (all with p < 0.001). CONCLUSION The current ACOG factor-based model for the prediction of PE and preterm PE, without considering race, is superior to the NICE and SOGC models. KEY POINTS · Clinical factor-based model can predict PE in approximately 44% of the cases for a 16% false positive.. · The ACOG model is superior to the NICE and SOGC models to predict PE.. · Clinical factor-based models are better to predict PE in parous than in nulliparous..
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Affiliation(s)
- Louise Ghesquière
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Université de Lille, CHU de Lille, Lille, France
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Eric Dubé
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [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] [Received: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Chaillet N, Masse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser W, Gagnon R, Monnier P, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Ducruet T, Girard M, Bujold E. A cluster-randomized trial to reduce perinatal morbidity among women with a prior cesarean delivery (PRISMA). Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bujold L, Audibert F, Chaillet N. Optimal Gestational Weight Gain for Women With Obesity. J Obstet Gynaecol Can 2022; 44:1143-1152. [PMID: 35952925 DOI: 10.1016/j.jogc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the optimal gestational weight gain interval for women with obesity in order to minimize neonatal and maternal adverse events. METHODS Secondary analysis of the QUARISMA trial, including women with obesity who delivered a full-term singleton in cephalic presentation from 2008 to 2011 in Québec. The primary outcome was a composite risk of major neonatal morbidity. Secondary outcomes were composite risks of major maternal morbidity, minor neonatal and maternal morbidity, and cesarean delivery. Various ranges of weight gain were compared with the current recommendations (reference group) using logistic regression to identify an optimal gestational weight gain interval. In a secondary analysis, women with obesity were stratified by obesity class (I-III). RESULTS Among 16 808 eligible women with obesity, 3270 gained less weight than recommended, 4355 gained weight as recommended (5-9.09 kg), and 9183 gained more weight than recommended. Optimal gestational weight change for all women with obesity was -1 to +4 kg and was associated with reduced risk of major neonatal morbidity (aOR 0.49; 95%CI 0.33-0.73, P < 0.001) compared with the reference group. Analysis by class of obesity showed a reduced risk of major neonatal morbidity with a weight change of -1 to +4 kg for class I, -2 to +2 for class II), and -2 to +3 kg for class III. CONCLUSION Compared with the current guidelines, a gestational weight change of -1 to +4 kg is associated with reduced risk of adverse perinatal outcomes. While similar findings were seen among women with class I obesity, women with class II or III obesity could benefit from a lower weight gain.
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Affiliation(s)
- Laurence Bujold
- Research Center of CHU de Québec, Laval University, Québec City, QC
| | - François Audibert
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montréal, Montréal, QC
| | - Nils Chaillet
- Research Center of CHU de Québec, Laval University, Québec City, QC; Department of Obstetrics and Gynecology, Faculty of Medicine, Laval University, Québec City, QC.
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Bujold L, Audibert F, Chaillet N. Impact of Gestational Weight Gain Recommendations for Obese Women on Neonatal Morbidity. Am J Perinatol 2022. [PMID: 35688438 DOI: 10.1055/s-0042-1748844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION In 2013, the American College of Obstetricians and Gynecologists (ACOGs) developed gestational weight gain guidelines to minimize the risks associated with obesity during pregnancy. However, a growing body of evidence suggests that current recommendations should be revised for obese women. OBJECTIVES The objective of this study is to assess the impact of gestational weight gain recommendations for obese women (body mass index ≥ 30 kg/m2) on neonatal and maternal outcomes in Quebec. STUDY DESIGN Secondary analysis of the QUARISMA trial was performed including obese women who delivered a full-term singleton in cephalic presentation from 2008 to 2011 in Quebec. Outcomes assessed were composite risks of major neonatal and maternal complications, minor neonatal and maternal complications, as well as obstetrical interventions. Outcomes were compared between weight gain recommendations (reference group) and three weight gain/loss categories using logistic regressions. In second analysis, obese women were stratified by obesity class. RESULTS Among the 16,808 eligible obese women, 605 lost weight during pregnancy, 2,665 gained between 0 and 4.9 kg, 4,355 gained weight within the recommendations (5-9.09 kg), and 9,183 gained at least 9.1 kg. Results showed a significant reduction in major neonatal morbidity (adjusted odds ratio [aOR] = 0.69, 95% confidence interval [CI] = 0.51-0.94), minor maternal morbidity (aOR = 0.79, 95%CI = 0.67-0.93), and assisted vaginal delivery (aOR = 0.82, 95%CI = 0.68-0.99) among women who gained 0 to 4.9 kg compared with the reference group. Cesarean delivery and preeclampsia/eclampsia were significantly reduced with weight loss (aOR = 0.76, 95%CI = 0.64-0.89 and 0.58, 95%CI = 0.42-0.78) compared with the reference group. Weight gain above recommendations was associated with an increased risk of minor neonatal morbidity, major and minor maternal morbidity, as well as cesarean delivery. CONCLUSIONS Compared with a weight gain within the recommendations, a gestational weight gain/loss of less than 5 kg in obese women is associated with a reduced risk of major neonatal morbidity, minor maternal morbidity, preeclampsia/eclampsia, cesarean delivery, and assisted vaginal delivery. Guidelines on gestational weight gain for obese women should be updated. KEY POINTS · Gestational weight gain/loss of less than 5 kg reduces the risk of perinatal complications.. · As suggested by ACOG recommendations, guidelines for obese women should be updated.. · Recommendations stratified by obesity class should be included in revised guidelines..
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Affiliation(s)
- Laurence Bujold
- Research Center of CHU de Québec, Laval University, Quebec City, Quebec, Canada
| | - François Audibert
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Nils Chaillet
- Research Center of CHU de Québec, Laval University, Quebec City, Quebec, Canada
- Faculty of Medicine, Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada
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Wu Y, Marc I, Bouchard L, Ouyang F, Luo ZC, Fan J, Dubois L, Mâsse B, Zhang J, Leung PCK, Liao XP, Herba CM, Booij L, Shen J, Lewin A, Jiang H, Wang L, Xu J, Wu W, Sun W, Wu J, Li H, Lei C, Kozyrskyj A, Semenic S, Chaillet N, Fortier I, Masse L, Zhan J, Allard C, Knoppers B, Zawati M, Baillargeon JP, Velez MP, Zhang H, Yu Y, Yu W, Ding Y, Vaillancourt C, Liu H, Tetu A, Fang W, Zhang R, Zhao X, Jin Y, Liu XM, Zhang H, Chen Z, Yang X, Hao YH, Abdelouahab N, Fraser W, Huang HF. Study protocol for the Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI): a multicentre, cluster-randomised, parallel-group, superiority trial of a multifaceted community-family-mother-child intervention to prevent childhood overweight and obesity. BMJ Open 2021; 11:e045192. [PMID: 33795307 PMCID: PMC8021741 DOI: 10.1136/bmjopen-2020-045192] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood overweight and obesity (OWO) is a primary global health challenge. Childhood OWO prevention is now a public health priority in China. The Sino-Canadian Healthy Life Trajectories Initiative (SCHeLTI), one of four trials being undertaken by the international HeLTI consortium, aims to evaluate the effectiveness of a multifaceted, community-family-mother-child intervention on childhood OWO and non-communicable diseases risk. METHODS AND ANALYSIS This is a multicentre, cluster-randomised, controlled trial conducted in Shanghai, China. The unit of randomisation is the service area of Maternal Child Health Units (N=36). We will recruit 4500 women/partners/families in maternity and district level hospitals. Participants in the intervention group will receive a multifaceted, integrated package of health promotion interventions beginning in preconception or in the first trimester of pregnancy, continuing into infancy and early childhood. The intervention, which is centred on a modified motivational interviewing approach, will target early-life maternal and child risk factors for adiposity. Through the development of a biological specimen bank, we will study potential mechanisms underlying the effects of the intervention. The primary outcome for the trial is childhood OWO (body mass index for age ≥85th percentile) at 5 years of age, based on WHO sex-specific standards. The study has a power of 0.8 (α=0.05) to detect a 30% risk reduction in the proportion of children with OWO at 5 years of age, from 24.4% in the control group to 17% in the intervention group. Recruitment was launched on 30 August 2018 for the pilot study and 10 January 2019 for the formal study. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, and the Research Ethics Board of the Centre Intégré Universitaire de Santé et Services Sociaux de l'Estrie-CHUS in Sherbrooke, Canada. Data sharing policies are consistent with the governance policy of the HeLTI consortium and government legislation. TRIAL REGISTRATION NUMBER ChiCTR1800017773. PROTOCOL VERSION November 11, 2020 (Version #5).
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Affiliation(s)
- Yanting Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Luigi Bouchard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fengxiu Ouyang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Zhong-Cheng Luo
- Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianxia Fan
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Lise Dubois
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jun Zhang
- Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai, China
| | - Peter C K Leung
- The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Xiang Peng Liao
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C M Herba
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Linda Booij
- CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Department of Psychology, Concordia University, Montreal, Québec, Canada
| | - Jian Shen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Antoine Lewin
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hong Jiang
- Department of Maternal and Child Care, School of Public Health, Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jian Xu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Weibin Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Wenguang Sun
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Jiahao Wu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Chen Lei
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - N Chaillet
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Louise Masse
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Janelle Zhan
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Catherine Allard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Québec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Hanqiu Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wen Yu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Ding
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Caroline Vaillancourt
- Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHUQ, Quebec City, Quebec, Canada
| | - Han Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Amelie Tetu
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Wenli Fang
- Changing Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, Shanghai Fengxian Central Hospital, Shanghai, China
| | - Xinzhi Zhao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan Jin
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xin-Mei Liu
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Huijuan Zhang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Zhirou Chen
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Xi Yang
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Yan-Hui Hao
- International Peace Maternity and Child Health Hospital, Shanghai, China
| | - Nadia Abdelouahab
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - William Fraser
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, Shanghai, China
- Key Laboratory of Embryo Molecular Biology, Ministry of Health, Shanghai, China
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Roberge P, Provencher MD, Gaboury I, Gosselin P, Vasiliadis HM, Benoît A, Carrier N, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial. Psychol Med 2020; 52:1-11. [PMID: 33261700 PMCID: PMC9647541 DOI: 10.1017/s0033291720004316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/03/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care. METHODS In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis. RESULTS A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79]. CONCLUSIONS Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | | | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke (Québec), Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Québec (Québec), Canada
| | - Annie Benoît
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Nathalie Carrier
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Martin M. Antony
- Department of Psychology, Ryerson University, Toronto (Ontario), Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec (Québec), Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal (Québec), Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
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9
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Affiliation(s)
- Emmanuel Bujold
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada.
| | - Nils Chaillet
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - John Kingdom
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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10
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Kaboré C, Ridde V, Chaillet N, Yaya Bocoum F, Betrán AP, Dumont A. DECIDE: a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso. BMC Med 2019; 17:87. [PMID: 31046752 PMCID: PMC6498483 DOI: 10.1186/s12916-019-1320-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries. METHODS We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. The evidence-based intervention was designed to promote the use of clinical algorithms for caesarean decision-making using in-site training, audits and feedback of caesarean indications and SMS reminders. The primary outcome was the change in the percentage of unnecessary caesarean deliveries. Unnecessary caesareans were defined on the basis of the literature review and expert consensus. Data were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. Caesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm. RESULTS A total of 2138 and 2036 women who delivered by caesarean section were analysed in the pre and post-intervention periods, respectively. A significant reduction in the percentage of unnecessary caesarean deliveries was evident from the pre- to post-intervention period in the intervention group compared with the control group (18.96 to 6.56% and 18.27 to 23.30% in the intervention and control groups, respectively; odds ratio [OR] for incremental change over time, adjusted for hospital and patient characteristics, 0.22; 95% confidence interval [CI], 0.14 to 0.34; P < 0.001; adjusted risk difference, - 17.02%; 95% CI, - 19.20 to - 13.20%). The intervention did not significantly affect the rate of maternal death (0.75 to 0.19% and 0.92 to 0.40% in the intervention and control groups, respectively; adjusted OR 0.32; 95% CI 0.04 to 2.23; P = 0.253) or intrapartum-related neonatal death (4.95 to 6.32% and 5.80 to 4.29% in the intervention and control groups, respectively, adjusted OR 1.73; 95% CI 0.82 to 3.66; P = 0.149). The overall perinatal mortality data were not available. CONCLUSION Promotion and training on clinical algorithms for decision-making, audit and feedback and SMS reminders reduced unnecessary caesarean deliveries, compared with usual care in a low-resource setting. TRIAL REGISTRATION The DECIDE trial is registered on the Current Controlled Trials website: ISRCTN48510263 .
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Affiliation(s)
- Charles Kaboré
- IRD (French Institute for Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France. .,Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
| | - Valéry Ridde
- IRD (French Institute for Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France.,University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Nils Chaillet
- Hospital Center of Laval University (CHUL), Quebec, Canada
| | | | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Alexandre Dumont
- IRD (French Institute for Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
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11
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Roberge S, Boutin A, Bujold E, Dubé E, Blouin S, Chaillet N. Impact of Audits and Multifaceted Intervention on Vaginal Birth After Caesarean: Secondary Analysis of the QUARISMA Trial. J Obstet Gynaecol Can 2019; 41:608-615. [PMID: 30642816 DOI: 10.1016/j.jogc.2018.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study estimated the effect that a multifaceted intervention aiming to improve the quality of obstetrical care and reduce Caesarean section (CS) had on the rate of vaginal birth after Caesarean (VBAC). METHODS This is a secondary analysis of the cluster randomized controlled trial Quality of Care, Obstetrics Risk Management, and Mode of Delivery involving (1) audits regarding the indications for CS, (2) provision of feedback to health professionals, and (3) implementation of best practices to reduce CS rates in Quebec. The impact of intervention on VBAC, trial of labour (TOL), and maternal and neonatal morbidity was reported using adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Out of 105 351 women who delivered during the pre- and postintervention period, 12 493 (11.9%) had a previous CS. We observed no significant impact of the multifaceted intervention on the rates of TOL (adjusted OR 1.22; 95% CI 0.96-1.56, P = 0.11) and VBAC (adjusted OR 1.20; 95% CI 0.97-1.48, P = 0.10) in women with one previous CS. However, the rate of TOL was reduced (adjusted OR 0.38; 95% CI 0.14-0.99) in women with more than one previous CS. The intervention has no influence on maternal and neonatal morbidity. CONCLUSIONS A multifaceted intervention including audits, feedback to health professionals, and implementation of best practices did not affect VBAC rates or maternal and neonatal morbidity. Our results pointed out the need for decision-making processand risk management tools specific to women with previous CS.
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Affiliation(s)
- Stéphanie Roberge
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Amélie Boutin
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Emmanuel Bujold
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC
| | - Eric Dubé
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Simon Blouin
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC
| | - Nils Chaillet
- Centre de recherche du CHU de Québec-Université Laval, Québec City, QC; Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
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12
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Roberge P, Provencher MD, Gosselin P, Vasiliadis HM, Gaboury I, Benoit A, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol. BMC Psychiatry 2018; 18:320. [PMID: 30285672 PMCID: PMC6169021 DOI: 10.1186/s12888-018-1898-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 03/20/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. METHODS/DESIGN The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. STATISTICAL ANALYSIS Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. DISCUSSION This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458 .
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Affiliation(s)
- Pasquale Roberge
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, QC G1V 0A6 Canada
| | - Patrick Gosselin
- Institut universitaire de première ligne en santé et services sociaux (CIUSSS de l’Estrie- CHUS), Department of Psychology, Université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, QC J1K 2R1 Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Centre de recherche Hôpital Charles LeMoyne, 3120, boul. Taschereau, Greenfield Park, QC J4V 2H1 Canada
| | - Isabelle Gaboury
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Annie Benoit
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, 2705, boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC H3C 3P8 Canada
| | - Catherine Hudon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Peter J Norton
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC 3800 Australia
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Roch G, Borgès Da Silva R, de Montigny F, Witteman HO, Pierce T, Semenic S, Poissant J, Parent AA, White D, Chaillet N, Dubois CA, Ouimet M, Lapointe G, Turcotte S, Prud'homme A, Painchaud Guérard G, Gagnon MP. Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services. BMC Health Serv Res 2018; 18:382. [PMID: 29843691 PMCID: PMC5975463 DOI: 10.1186/s12913-018-3204-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father’s involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users’ health status, as well as on networks of perinatal educational services maintained with community-based partners. Methods This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). Discussion This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services. Protocol version Version 1 (February 9 2018).
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Affiliation(s)
- Geneviève Roch
- Faculty of Nursing, Université Laval, 1050 avenue de la Médecine, Québec, QC, G1V 0A6, Canada. .,CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada. .,Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada.
| | - Roxane Borgès Da Silva
- Université de Montréal Public Health Research Institute, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada.,Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1A8, Canada
| | - Francine de Montigny
- Department of Nursing, Université du Québec en Outaouais, 283 boulevard Alexandre-Taché CP 1250, Gatineau, QC, J8X 3X7, Canada
| | - Holly O Witteman
- CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada.,Faculty of Medicine, Université Laval, 1050 avenue de la Médecine, Québec City, QC, G1V 0A6, Canada
| | - Tamarha Pierce
- School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Québec City, QC, G1V 0A6, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, QC, H3A 2M7, Canada
| | - Julie Poissant
- Institut national de santé publique du Québec, 945 av Wolfe, Québec City, QC, G1V 5B3, Canada
| | - André-Anne Parent
- School of Social Work, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada
| | - Deena White
- Département de sociologie, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada
| | - Nils Chaillet
- Université de Montréal Public Health Research Institute, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada.,Department of Political Science, Faculty of Social Sciences, Université Laval, 1030 avenue des Sciences Humaines, Québec, QC, G1V 0A6, Canada
| | - Carl-Ardy Dubois
- Université de Montréal Public Health Research Institute, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada.,School of Public Health, Université de Montréal, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada
| | - Mathieu Ouimet
- CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada.,Department of Political Science, Faculty of Social Sciences, Université Laval, 1030 avenue des Sciences Humaines, Québec, QC, G1V 0A6, Canada
| | - Geneviève Lapointe
- Faculty of Nursing, Université Laval, 1050 avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada.,Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Alexandre Prud'homme
- Université de Montréal Public Health Research Institute, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada
| | - Geneviève Painchaud Guérard
- CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, 1050 avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,CHU de Québec Research Centre - Université Laval, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada
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Bermúdez-Tamayo C, Johri M, Chaillet N. Budget impact of a program for safely reducing caesarean sections in Canada. Midwifery 2018; 60:20-26. [PMID: 29477053 DOI: 10.1016/j.midw.2018.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION audits of indications for cesarean section (CS), feedback for health professionals, and implementation of best practices, as compared with usual care (QUARISMA study), resulted in a small reduction in the rate of CS in Quebec and important cost savings from a health care payer perspective. Determining the budget impact would enable estimation of the financial consequences if the program is extended nationwide. MATERIAL AND METHODS a retrospective pre-post study design was used to estimate cost prior to and after the implementation of QUARISMA in Quebec (105,351 subjects). A prospective analysis was performed to measure the budget impact in Canada's provinces. The primary analytic perspective was that of the Minister of Health, for a 4-year time horizon. Data were taken from the trial for Quebec and extrapolated to Canada's provinces. A sensitivity analysis was conducted by varying more than one probability at a time. FINDINGS over 4 years, there was a decrease of more than $7.8 million in CS burden in Quebec, $11.9 million in vaginal birth and $9.8 million for neonatal complications. The impact on high-risk women was lower than that on low-risk. In years 1 and 2, the provinces would have to cover the cost of program implementation. CONCLUSIONS QUARISMA led to savings of $27 million in Quebec over 4 years. In the short to medium term, extending the QUARISMA program nationwide could lead to savings of $150.5 million.
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Affiliation(s)
- Clara Bermúdez-Tamayo
- Centre de recherche du CHUS, 12e Avenue Nord, Sherbrooke, QC, Canada J1H 5 N4; Andalusian School of Public Health, Cuesta del Observatorio 4, 18010 Granada, Spain; CIBERESP, Ciber de Epidemiologia y Salud Publica, Madrid, Spain.
| | - Mira Johri
- Division of Global Health, University of Montreal, Hospital Research Centre (CRCHUM), 900, rue Saint-Denis, Montreal, QC, Canada H2X 0A9; Department of Health Administration, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Nils Chaillet
- Centre Hospitalier de l'Université Laval (CHUL), Québec, Canada
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Bonapace J, Gagné GP, Chaillet N, Gagnon R, Hébert E, Buckley S. N° 355-Fondements physiologiques de la douleur pendant le travail et l'accouchement: approche de soulagement basée sur les données probantes. Journal of Obstetrics and Gynaecology Canada 2018; 40:246-266. [DOI: 10.1016/j.jogc.2017.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bonapace J, Gagné GP, Chaillet N, Gagnon R, Hébert E, Buckley S. No. 355-Physiologic Basis of Pain in Labour and Delivery: An Evidence-Based Approach to its Management. Journal of Obstetrics and Gynaecology Canada 2018; 40:227-245. [DOI: 10.1016/j.jogc.2017.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F. Effect of maternal age on the risk of preterm birth: A large cohort study. PLoS One 2018; 13:e0191002. [PMID: 29385154 PMCID: PMC5791955 DOI: 10.1371/journal.pone.0191002] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maternal age at pregnancy is increasing worldwide as well as preterm birth. However, the association between prematurity and advanced maternal age remains controversial. OBJECTIVE To evaluate the impact of maternal age on the occurrence of preterm birth after controlling for multiple known confounders in a large birth cohort. STUDY DESIGN Retrospective cohort study using data from the QUARISMA study, a large Canadian randomized controlled trial, which collected data from 184,000 births in 32 hospitals. Inclusion criteria were maternal age over 20 years. Exclusion criteria were multiple pregnancy, fetal malformation and intra-uterine fetal death. Five maternal age categories were defined and compared for maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Risk factors for preterm birth <37 weeks, either spontaneous or iatrogenic, were evaluated for different age groups using multivariate logistic regression. RESULTS 165,282 births were included in the study. Chronic hypertension, assisted reproduction techniques, pre-gestational diabetes, invasive procedure in pregnancy, gestational diabetes and placenta praevia were linearly associated with increasing maternal age whereas hypertensive disorders of pregnancy followed a "U" shaped distribution according to maternal age. Crude rates of preterm birth before 37 weeks followed a "U" shaped curve with a nadir at 5.7% for the group of 30-34 years. In multivariate analysis, the adjusted odds ratio (aOR) of prematurity stratified by age group followed a "U" shaped distribution with an aOR of 1.08 (95%CI; 1.01-1.15) for 20-24 years, and 1.20 (95% CI; 1.06-1.36) for 40 years and older. Confounders found to have the greatest impact were placenta praevia, hypertensive complications, and maternal medical history. CONCLUSION Even after adjustment for confounders, advanced maternal age (40 years and over) was associated with preterm birth. A maternal age of 30-34 years was associated with the lowest risk of prematurity.
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Affiliation(s)
- Florent Fuchs
- Division of Obstetric Medicine, Department of Obstetrics and Gynecology CHU Sainte Justine, Montréal, Québec, Canada
- Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and child development, Villejuif, France
- Department of Obstetrics and Gynecology CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, Montpellier, France
- * E-mail:
| | - Barbara Monet
- Division of Obstetric Medicine, Department of Obstetrics and Gynecology CHU Sainte Justine, Montréal, Québec, Canada
| | - Thierry Ducruet
- CHU Sainte-Justine Research Center, Université de Montréal, Montréal, Québec, Canada
| | - Nils Chaillet
- Clinical Research Center Étienne-Le Bel, CHU Sherbrooke, Sherbrooke, Québec, Canada
| | - Francois Audibert
- Division of Obstetric Medicine, Department of Obstetrics and Gynecology CHU Sainte Justine, Montréal, Québec, Canada
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Shah PS, McDonald SD, Barrett J, Synnes A, Robson K, Foster J, Pasquier JC, Joseph KS, Piedboeuf B, Lacaze-Masmonteil T, O'Brien K, Shivananda S, Chaillet N, Pechlivanoglou P. The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families. CMAJ Open 2018; 6:E44-E49. [PMID: 29348260 PMCID: PMC5878956 DOI: 10.9778/cmajo.20170128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. INTERPRETATION These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates.
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Affiliation(s)
- Prakesh S Shah
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sarah D McDonald
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jon Barrett
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Anne Synnes
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Kate Robson
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jonathan Foster
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jean-Charles Pasquier
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - K S Joseph
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Bruno Piedboeuf
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Thierry Lacaze-Masmonteil
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Karel O'Brien
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sandesh Shivananda
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Nils Chaillet
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Petros Pechlivanoglou
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
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Gasse C, Boutin A, Demers S, Chaillet N, Bujold E. Body mass index and the risk of hypertensive disorders of pregnancy: the great obstetrical syndromes (GOS) study. J Matern Fetal Neonatal Med 2017; 32:1063-1068. [DOI: 10.1080/14767058.2017.1399117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Cédric Gasse
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Amélie Boutin
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
| | - Suzanne Demers
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Nils Chaillet
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Emmanuel Bujold
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, Canada
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Chaillet N, Bujold E, Masse B, Grobman WA, Rozenberg P, Pasquier JC, Shorten A, Johri M, Beaudoin F, Abenhaim H, Demers S, Fraser W, Dugas M, Blouin S, Dubé E, Gauthier R. A cluster-randomized trial to reduce major perinatal morbidity among women with one prior cesarean delivery in Québec (PRISMA trial): study protocol for a randomized controlled trial. Trials 2017; 18:434. [PMID: 28931404 PMCID: PMC5608183 DOI: 10.1186/s13063-017-2150-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean. Methods/design The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis. Discussion The intervention is designed to facilitate: (1) women’s decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine rupture risk during TOL using ultrasound evaluation of low-uterine segment thickness, (3) an estimate of chance of TOL success, using a validated prediction tool, and (4) the implementation of best practices for intrapartum management. Trial registration Current Controlled Trials, ID: ISRCTN15346559. Registered on 20 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2150-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Chaillet
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada. .,Faculté de Médecine, Département d'Obstétrique & Gynécologie, Université Laval, Centre de recherche du CHUQ, 2705, Boul. Laurier, local T-R-92, Quebec, QC, G1V 4G2, Canada.
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - B Masse
- Department of Epidemiology and Biostatistics, University of Montréal, Montréal, QC, Canada
| | - W A Grobman
- Department of Obstetrics and Gynaecology, Northwestern University, Chicago, IL, USA
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303, Poissy, France
| | - J C Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - A Shorten
- UAB School of Nursing, University of Alabama, Birmingham, AL, USA
| | - M Johri
- University of Montreal, Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - F Beaudoin
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - H Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Jewish Hospital, Montreal, QC, Canada
| | - S Demers
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - W Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - M Dugas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC, Canada
| | - S Blouin
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - E Dubé
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - R Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
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Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC, Girard M, Chaillet N, Boulvain M, Jastrow N. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017; 217:65.e1-65.e5. [PMID: 28263751 DOI: 10.1016/j.ajog.2017.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/11/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. OBJECTIVE To estimate the impact of previous uterine closure on lower uterine segment thickness. STUDY DESIGN Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number of layers sutured and according to the type of thread for uterine closure, using weighted mean differences and multivariate logistic regression analyses. RESULTS Of 1613 women recruited, with operative reports available, 495 (31%) had a single-layer and 1118 (69%) had a double-layer closure. The mean third-trimester lower uterine segment thickness was 3.3 ± 1.3 mm and the proportion with lower uterine segment thickness <2.0 mm was 10.5%. Double-layer closure of the uterus was associated with a thicker lower uterine segment than single-layer closure (weighted mean difference: 0.11 mm; 95% confidence interval [CI], 0.02 to 0.21 mm). In multivariate logistic regression analyses, a double-layer closure also was associated with a reduced risk of lower uterine segment thickness <2.0 mm (odd ratio [OR], 0.68; 95% CI, 0.51 to 0.90). Compared with synthetic thread, the use of catgut for uterine closure had no significant impact on third-trimester lower uterine segment thickness (WMD: -0.10 mm; 95% CI, -0.22 to 0.02 mm) or on the risk of lower uterine segment thickness <2.0 mm (OR, 0.95; 95% CI, 0.67 to 1.33). Finally, double-layer closure was associated with a reduced risk of uterine scar defect (RR, 0.32; 95% CI, 0.17 to 0.61) at birth. CONCLUSION Compared with single-layer closure, a double-layer closure of the uterus at previous cesarean delivery is associated with a thicker third-trimester lower uterine segment and a reduced risk of lower uterine segment thickness <2.0 mm in the next pregnancy. The type of thread for uterine closure has no significant impact on lower uterine segment thickness.
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Johri M, Ng ESW, Bermudez-Tamayo C, Hoch JS, Ducruet T, Chaillet N. A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis. BMC Med 2017; 15:96. [PMID: 28528578 PMCID: PMC5439122 DOI: 10.1186/s12916-017-0859-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/20/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions. METHODS A prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3 months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clinical subgroups of high-risk versus low-risk pregnancies and estimated the joint uncertainty in cost-effectiveness over 20,000 trial simulations. We decomposed costs to identify drivers of change. RESULTS The intervention group experienced per-patient reductions of 0.005 CS (95% confidence interval (CI): -0.015 to 0.004, P = 0.09) and $180 (95% CI: -$277 to - $83, P < 0.001). Women with low-risk pregnancies experienced statistically significant reductions in CS rates and costs; changes for the high-risk subgroup were not significant. The intervention was "dominant" (effective in reducing CS and less costly than usual care) in 86.08% of simulations. It reduced costs in 99.99% of simulations. Cost reductions were driven by lower rates of neonatal complications in the intervention group (-$190, 95% CI: -$255 to - $125, P < 0.001). Given 88,000 annual provincial births, a similar intervention could save $15.8 million (range: $7.3 to $24.4 million) in Quebec annually. CONCLUSIONS From a healthcare payer perspective, a multifaceted intervention involving audits and feedback resulted in a small reduction in caesarean deliveries and important cost savings. Cost reductions are consistent with improved quality of care in intervention group hospitals. TRIAL REGISTRATION International Clinical Trials Registry Platform, ISRCTN95086407 . Registered on 23 October 2007.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-910, 850, rue St-Denis, Montréal, Québec, H2X 0A9, Canada. .,Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, Québec, Canada. .,Department of Maternal, Neonatal, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
| | - Edmond S W Ng
- Director's Office, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Clara Bermudez-Tamayo
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire (CHU) de Sherbrooke, Sherbrooke, Québec, Canada.,Andalusian School of Public Health, Granada, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jeffrey S Hoch
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Excellence in Economic Analysis and Research (CLEAR), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Public Health Sciences, University of California, Davis, California, USA
| | - Thierry Ducruet
- Department of Biostatistics, Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nils Chaillet
- Département Obstétrique et Gynécologie, Centre Hospitalier de l'Université Laval (CHUL), Québec, Québec, Canada
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Maltais S, Roy-Lacroix MÈ, Chaillet N. P-OBS-MD-073 Morbidity Associated With Fetal Macrosomia among the James Bay Cree Nation. Journal of Obstetrics and Gynaecology Canada 2017. [DOI: 10.1016/j.jogc.2017.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roberge S, Dubé E, Blouin S, Chaillet N. Reporting Caesarean Delivery in Quebec Using the Robson Classification System. Journal of Obstetrics and Gynaecology Canada 2017; 39:152-156. [DOI: 10.1016/j.jogc.2016.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/24/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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Jastrow N, Demers S, Chaillet N, Girard M, Gauthier RJ, Pasquier JC, Abdous B, Vachon-Marceau C, Marcoux S, Irion O, Brassard N, Boulvain M, Bujold E. Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study. Am J Obstet Gynecol 2016; 215:604.e1-604.e6. [PMID: 27342045 DOI: 10.1016/j.ajog.2016.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/03/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery. STUDY DESIGN In 4 tertiary-care centers, we prospectively recruited women between 34 and 38 weeks of gestation who were contemplating a vaginal birth after a previous single low-transverse cesarean delivery. Lower uterine segment thickness was measured by ultrasound imaging and integrated in the decision of delivery route. According to lower uterine segment thickness, women were classified in 3 risk categories for uterine rupture: high risk (<2.0 mm), intermediate risk (2.0-2.4 mm), and low risk (≥2.5 mm). Our primary outcome was symptomatic uterine rupture, which was defined as requiring urgent laparotomy. We calculated that 942 women who were undergoing a trial of labor after cesarean delivery should be included to be able to show a risk of uterine rupture <0.8%. RESULTS We recruited 1856 women, of whom 1849 (99%) had a complete follow-up data. Lower uterine segment thickness was <2.0 mm in 194 women (11%), 2.0-2.4 mm in 217 women (12%), and ≥2.5 mm in 1438 women (78%). Rate of trial of labor was 9%, 42%, and 61% in the 3 categories, respectively (P<.0001). Of 984 trials of labor, there were no symptomatic uterine ruptures, which is a rate that was lower than the 0.8% expected rate (P=.0001). CONCLUSION The inclusion of lower uterine segment thickness measurement in the decision of the route of delivery allows a low risk of uterine rupture during trial of labor after cesarean delivery.
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Vachon-Marceau C, Demers S, Goyet M, Gauthier R, Roberge S, Chaillet N, Laroche J, Bujold E. Labor Dystocia and the Risk of Uterine Rupture in Women with Prior Cesarean. Am J Perinatol 2016; 33:577-83. [PMID: 26731182 DOI: 10.1055/s-0035-1570382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective The objective of this study was to evaluate the association between labor dystocia and uterine rupture. Methods We performed a secondary analysis of a multicenter case-control study that included women with single, prior, low-transverse cesarean section who experienced complete uterine rupture during a trial of labor (TOL). For each case, three women who underwent a TOL without uterine rupture were selected as controls. Data were collected on cervical dilatations from admission to delivery. We evaluated the relationship between uterine rupture and labor dystocia according to several criteria, including the World Health Organization's (WHO's) partogram. Results Data were available for 90 cases and 260 controls. Compared with the controls, uterine rupture was associated with less cervical dilatation on admission, slower cervical dilatation in the first stage of labor and longer second stage of labor (all with p < 0.05). Performing cesarean when the labor curve crossed the ACTION line of WHO's partogram or when the second stage was greater than 2 hours could have (1) prevented up to 56% of uterine rupture and (2) reduced the duration of labor in 57% of women with failed TOL. Conclusion Labor dystocia is a significant risk factor for uterine rupture. Labor progression should be assessed regularly in women with prior cesarean.
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Affiliation(s)
- Chantale Vachon-Marceau
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
| | - Suzanne Demers
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
| | - Martine Goyet
- Department of Obstetrics and Gynecology, Hôpital de LaSalle, Montréal, Québec, Canada
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Roberge
- Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Nils Chaillet
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jasmin Laroche
- Centre de Recherche, Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, Canada
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Roberge S, Demers S, Girard M, Vikhareva O, Markey S, Chaillet N, Moore L, Paris G, Bujold E. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol 2016; 214:507.e1-507.e6. [PMID: 26522861 DOI: 10.1016/j.ajog.2015.10.916] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incomplete healing of uterine scar after cesarean has been associated with adverse gynecological and obstetrical outcomes. Several studies reported that uterine closure at cesarean influences the healing of uterine scar and the risk of uterine rupture at subsequent pregnancies: the commonly used locked single-layer suture including the decidua being associated with a 4-fold increased risk of uterine rupture. However, data from randomized trials are lacking. OBJECTIVE We sought to evaluate the impact of 3 techniques of uterine closure after cesarean delivery on uterine scar healing. STUDY DESIGN This was a 3-arm 1:1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery at ≥38 weeks' gestation. Closure of the uterine scar was carried out by locked single layer including the decidua, double layer with locked first layer including the decidua, or double layer with unlocked first layer excluding the decidua. Primary outcome was residual myometrial thickness (RMT) at the site of the scar, measured by transvaginal ultrasound 6 months after delivery. Secondary outcome was the RMT as a percentage of the myometrial thickness above the scar (healing ratio). Intent-to-treat analyses using Student t test were performed to compare each double-layer technique to the single-layer closure, and P < .025 was considered significant. RESULTS Complete follow-up was obtained from 73 (90%) of the 81 participants. Compared to single-layer closure, double-layer closure with unlocked first layer was associated with thicker RMT (3.8 ± 1.6 mm vs 6.1 ± 2.2 mm; P < .001) and greater healing ratio (54 ± 20% vs 73 ± 23%; P = .004). In contrast, double-layer closure with locked first layer was not significantly different than single-layer closure in either RMT (4.8 ± 1.3; P = .032) or healing ratio (60 ± 21%; P = .287). CONCLUSION Double-layer closure with unlocked first layer is associated with better uterine scar healing than locked single layer.
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Bermúdez-Tamayo C, Johri M, Perez-Ramos FJ, Maroto-Navarro G, Caño-Aguilar A, Garcia-Mochon L, Aceituno L, Audibert F, Chaillet N. Erratum to: 'Evaluation of quality improvement for cesarean sections programmes through mixed methods'. Implement Sci 2016; 11:37. [PMID: 26984271 PMCID: PMC4793735 DOI: 10.1186/s13012-016-0402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Clara Bermúdez-Tamayo
- Centre de recherche du CHUS, 12e Avenue Nord, Sherbrooke, QC, J1H 5 N4, Canada. .,Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain. .,CIBERESP, Ciber de Epidemiologia y Salud Publica, València, Spain.
| | - Mira Johri
- Division of Global Health, University of Montreal, Hospital Research Centre (CRCHUM), 900, rue Saint-Denis, H2X 0A9, Montreal, QC, Canada.,Department of Health Administration, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francisco Jose Perez-Ramos
- General Secretary of Quality iInnovation and Public Health, Consejería de Igualdad, Salud y Políticas Sociales, Junta de Andalucía, Avd. De Hytasa n° 14, 41006, Sevilla, Spain
| | - Gracia Maroto-Navarro
- Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain.,CIBERESP, Ciber de Epidemiologia y Salud Publica, València, Spain
| | - Africa Caño-Aguilar
- UGC Obstetrics and Gynaecology, Hospital Universitario San Cecilio, Av Doctor Oloriz, 16, 18012, Granada, Spain
| | - Leticia Garcia-Mochon
- Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain
| | - Longinos Aceituno
- UGC Gynaecology, Hospital La Inmaculada, Av. Dra. Parra, S/N., 04600, Huercal-Overa, Almeria, Spain
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada.,Sainte Justine Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nils Chaillet
- Department of Obstetrics and Gynaecology, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, J1H 5 N4, Canada
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Belaid L, Dumont A, Chaillet N, De Brouwere V, Zertal A, Hounton S, Ridde V. Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC. Syst Rev 2015; 4:124. [PMID: 26420571 PMCID: PMC4589108 DOI: 10.1186/s13643-015-0102-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions. METHODS/DESIGN We will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR) DISCUSSION: The systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in PROSPERO (CRD 42015017549).
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Affiliation(s)
- Loubna Belaid
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Alexandre Dumont
- UMR 216 IRD-Université Paris Descartes, 4 Avenue de l'Observatoire, 75 006, Paris, France.
| | - Nils Chaillet
- Département d'obstétrique et gynécologie et département de Médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Centre de recherche du CHUS: Axe Santé: populations, organisation, pratiques, Université de Sherbrooke, Sherbrooke, Canada.
| | - Vincent De Brouwere
- Maternal and Reproductive Health Unit, Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
| | - Amel Zertal
- Centre de recherche du CHUM, Axe Évaluation, Systèmes de soins et services, Université de Montréal, 850, rue Saint Denis-Tour S, Local S03-814, Montréal, QC, H2X 0A9, Canada.
| | - Sennen Hounton
- Commodity Security Branch, Technical Division, United Nations Population Fund, 605 3rd Avenue, New York, NY, 10158, USA.
| | - Valéry Ridde
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), 7101 Avenue du Parc, bureau 3187-03, Montréal, Québec, H3N1X9, Canada. .,ESPUM (école de santé publique de l'Université de Montréal), Montréal, Canada.
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Kaboré C, Chaillet N, Kouanda S, Bujold E, Traoré M, Dumont A. Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries. BJOG 2015; 123:2147-2155. [PMID: 26374554 DOI: 10.1111/1471-0528.13615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. DESIGN A prospective 4-year observational study. SETTING Senegal and Mali. SAMPLE A cohort of 9712 women with one previous caesarean delivery. METHODS Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. MAIN OUTCOME MEASURES The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. CONCLUSION Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. TWEETABLE ABSTRACT Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.
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Affiliation(s)
- C Kaboré
- Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France.,Health Sciences Research Institute, Ouagadougou, Burkina Faso
| | - N Chaillet
- Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - S Kouanda
- Health Sciences Research Institute, Ouagadougou, Burkina Faso
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - M Traoré
- URFOSAME, Referral Health Centee of the Commune V, Bamako, Mali
| | - A Dumont
- Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France
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Chaillet N, Dumont A, Abrahamowicz M, Pasquier JC, Audibert F, Monnier P, Abenhaim HA, Dubé E, Dugas M, Burne R, Fraser WD. A cluster-randomized trial to reduce cesarean delivery rates in Quebec. N Engl J Med 2015; 372:1710-21. [PMID: 25923551 DOI: 10.1056/nejmoa1407120] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [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: 11/19/2022]
Abstract
BACKGROUND In Canada, cesarean delivery rates have increased substantially over the past decade. Effective, safe strategies are needed to reduce these rates. METHODS We conducted a cluster-randomized, controlled trial of a multifaceted 1.5-year intervention at 32 hospitals in Quebec. The intervention involved audits of indications for cesarean delivery, provision of feedback to health professionals, and implementation of best practices. The primary outcome was the cesarean delivery rate in the 1-year postintervention period. RESULTS Among the 184,952 participants, 53,086 women delivered in the year before the intervention and 52,265 women delivered in the year following the intervention. There was a significant but small reduction in the rate of cesarean delivery from the preintervention period to the postintervention period in the intervention group as compared with the control group (change, 22.5% to 21.8% in the intervention group and 23.2% to 23.5% in the control group; odds ratio for incremental change over time, adjusted for hospital and patient characteristics, 0.90; 95% confidence interval [CI], 0.80 to 0.99; P=0.04; adjusted risk difference, -1.8%; 95% CI, -3.8 to -0.2). The cesarean delivery rate was significantly reduced among women with low-risk pregnancies (adjusted risk difference, -1.7%; 95% CI, -3.0 to -0.3; P=0.03) but not among those with high-risk pregnancies (P=0.35; P = 0.03 for interaction). The intervention group also had a reduction in major neonatal morbidity as compared with the control group (adjusted risk difference, -0.7%; 95% CI, -1.3 to -0.1; P=0.03) and a smaller increase in minor neonatal morbidity (adjusted risk difference, -1.7%; 95% CI, -2.6 to -0.9; P<0.001). Changes in minor and major maternal morbidity did not differ significantly between the groups. CONCLUSIONS Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies. (Funded by the Canadian Institutes of Health Research; QUARISMA Current Controlled Trials number, ISRCTN95086407.).
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Affiliation(s)
- Nils Chaillet
- From the Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire (CHU) de Sherbrooke, Sherbrooke, QC (N.C., J.-C.P., E.D., W.D.F.), Department of Epidemiology and Biostatistics, McGill University (M.A., R.B.), Department of Obstetrics and Gynecology, University of Montreal, Centre Hospitalier Universitaire Sainte-Justine (F.A.), Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital (P.M.), and Department of Obstetrics and Gynecology, McGill University, Jewish Hospital (H.A.A.), Montreal, and the Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC (M.D.) - all in Canada; and the Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris (A.D.)
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Pasquier JC, Blouin S, Corriveau S, Roy-Lacroix MÈ, Chaillet N. 328: Cysteinyl leukotriene receptor antagonist montelukast for the management of spontaneous preterm labour - a pilot randomized controlled trial. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bermúdez-Tamayo C, Johri M, Perez-Ramos FJ, Maroto-Navarro G, Caño-Aguilar A, Garcia-Mochon L, Aceituno L, Audibert F, Chaillet N. Evaluation of quality improvement for cesarean sections caesarean section programmes through mixed methods. Implement Sci 2014; 9:182. [PMID: 25496430 PMCID: PMC4268855 DOI: 10.1186/s13012-014-0182-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/24/2014] [Indexed: 12/03/2022] Open
Abstract
Background The rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Canada and Spain. Objectives Their objectives are as follows: 1) Toto identify clusters in each setting with similar results in terms of cost-consequences, 2) Toto investigate whether demographic, clinical or context characteristics can distinguish these clusters, and 3) Toto explore the implementation of QICS in the 2 regions, in order to identify factors that have been facilitators in changing practices and reducing the use of obstetric intervention, as well as the challenges faced by hospitals in implementing the recommendations. Methods Descriptive study with a quantitative and qualitative approach. 1) Cluster analysis at patient level with data from 16 hospitals in Quebec (Canada) (n = 105,348) and 15 hospitals in Andalusia (Spain) (n = 64,760). The outcome measures are CS and costs. For the cost, we will consider the intervention, delivery and complications in mother and baby, from the hospital perspective. Cluster analysis will be used to identify participants with similar patterns of CS and costs based, and t tests will be used to evaluate if the clusters differed in terms of characteristics: Hospital level (academic status of hospital, level of care, supply and demand factors), patient level (mother age, parity, gestational age, previous CS, previous pathology, presentation of the baby, baby birth weight). 2) Analysis of in-depth interviews with obstetricians and midwives in hospitals where the QICS were implemented, to explore the differences in delivery-related practices, and the importance of the different constructs for positive or negative adherence to CPGs. Dimensions: political/management level, hospital level, health professionals, mothers and their birth partner. Discussion This work sets out a new approach for programme evaluation, using different techniques to make it possible to take into account the specific context where the programmes were implemented.
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Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a prediction model for predicting the probability of morbidity related to a trial of labour in Quebec. J Obstet Gynaecol Can 2014; 34:820-825. [PMID: 22971449 DOI: 10.1016/s1701-2163(16)35379-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnant women with a history of previous Caesarean section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). Both choices are associated with their own risks of maternal and neonatal morbidity. We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making. METHODS We used a perinatal database including 185,437 deliveries from 32 obstetrical centres in Quebec between 2007 and 2011 and selected women with one previous Caesarean section who were eligible for a TOLAC. We compared the frequency of maternal and neonatal morbidity between women who underwent TOLAC and those who underwent an ERCS according to the probability of success of TOLAC calculated from a published model of prediction. RESULTS Of 8508 eligible women, including 3113 who underwent TOLAC, both maternal and neonatal morbidities became less frequent as the predicted chance of VBAC increased (P < 0.05). Women undergoing a TOLAC were more likely to have maternal morbidity than those who underwent an ERCS when the predicted probability of VBAC was less than 60% (relative risk [RR] 2.3; 95% CI 1.4 to 4.0); conversely, maternal morbidity was not different between the two groups when the predicted probability of VBAC was at least 60% (RR 0.8; 95% CI 0.6 to 1.1). Neonatal morbidity was similar between groups when the probability of VBAC success was 70% or greater (RR 1.2; 95% CI 0.9 to 1.5). CONCLUSION The use of a prediction model for TOLAC success could be useful in the prediction of TOLAC success and perinatal morbidity in a Canadian population. Neither maternal nor neonatal morbidity are increased with a TOLAC when the probability of VBAC success is at least 70%.
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Affiliation(s)
- Nils Chaillet
- Research Centre of Sainte-Justine Hospital, University of Montreal, Montreal QC
| | - Emmanuel Bujold
- Department of Obstetric and Gynaecology, University of Laval, Quebec QC
| | - Eric Dubé
- Research Centre of Sainte-Justine Hospital, University of Montreal, Montreal QC
| | - William A Grobman
- Department of Obstetric and Gynaecology, Northwestern University, Chicago IL
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Chaillet N, Belaid L, Crochetière C, Roy L, Gagné GP, Moutquin JM, Rossignol M, Dugas M, Wassef M, Bonapace J. Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth 2014; 41:122-37. [PMID: 24761801 DOI: 10.1111/birt.12103] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the effects of nonpharmacologic approaches to pain relief during labor, according to their endogenous mechanism of action, on obstetric interventions, maternal, and neonatal outcomes. DATA SOURCE Cochrane library, Medline, Embase, CINAHL and the MRCT databases were used to screen studies from January 1990 to December 2012. STUDY SELECTION According to Cochrane criteria, we selected randomized controlled trials that compared nonpharmacologic approaches for pain relief during labor to usual care, using intention-to-treat method. RESULTS Nonpharmacologic approaches, based on Gate Control (water immersion, massage, ambulation, positions) and Diffuse Noxious Inhibitory Control (acupressure, acupuncture, electrical stimulation, water injections), are associated with a reduction in epidural analgesia and a higher maternal satisfaction with childbirth. When compared with nonpharmacologic approaches based on Central Nervous System Control (education, attention deviation, support), usual care is associated with increased odds of epidural OR 1.13 (95% CI 1.05-1.23), cesarean delivery OR 1.60 (95% CI 1.18-2.18), instrumental delivery OR 1.21 (95% CI 1.03-1.44), use of oxytocin OR 1.20 (95% CI 1.01-1.43), labor duration (29.7 min, 95% CI 4.5-54.8), and a lesser satisfaction with childbirth. Tailored nonpharmacologic approaches, based on continuous support, were the most effective for reducing obstetric interventions. CONCLUSION Nonpharmacologic approaches to relieve pain during labor, when used as a part of hospital pain relief strategies, provide significant benefits to women and their infants without causing additional harm.
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Affiliation(s)
- Nils Chaillet
- Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada
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Rossignol M, Chaillet N, Boughrassa F, Moutquin JM. Interrelations between four antepartum obstetric interventions and cesarean delivery in women at low risk: a systematic review and modeling of the cascade of interventions. Birth 2014; 41:70-8. [PMID: 24654639 DOI: 10.1111/birt.12088] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To critically appraise the literature on the relations between four intrapartum obstetric interventions-electronic fetal monitoring (EFM), epidural analgesia, labor induction, and labor acceleration; and two types of delivery-instrumental (forceps and vacuum) and cesarean section. METHODS This review included meta-analyses published between January 2000 and April 2012 including at least one randomized clinical trial published after 1995 and presenting results on low-risk pregnancies between 37 and 42 weeks of gestation, searched in the databases Medline, Cochrane Library, and EMBASE with no language restriction. RESULTS Of 306 documents identified, 8 fulfilled the inclusion criteria and presented results on women at low risk. EFM at admission (vs intermittent auscultation) was associated with cesarean delivery (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.00-1.44) and epidural analgesia (OR = 1.25, 95% CI 1.09-1.43). Epidural on request was associated with cesarean delivery (OR = 1.60, 95% CI 1.18-2.18), instrumental delivery (OR = 1.21, 95% CI 1.03-1.44), and oxytocin use (OR = 1.20, 95% CI 1.01-1.43) when compared with epidural on request plus nonpharmacological labor pain control methods such as one-to-one support, breathing techniques, and relaxation. Induction and acceleration of labor showed heterogeneous patterns of associations with cesarean delivery and instrumental delivery. CONCLUSIONS Complex patterns of associations between obstetric interventions and modes of delivery were illustrated in an empirical model. Intermittent auscultation and nonpharmacological labor pain control interventions, such as one-to-one support during labor, have the potential for substantially reducing cesarean deliveries.
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Affiliation(s)
- Michel Rossignol
- Institut national d'excellence en santé et en services sociaux (INESSS), QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Chaillet N, Dumont A, Bujold E, Pasquier JC, Audibert F, Dubé E, Dugas M, Burne R, Abrahamowicz M, Fraser W. 1: Quality of care, obstetrics risk management and mode of delivery in Quebec (QUARISMA): a cluster-randomized trial. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marceau CV, Demers S, Goyet M, Gauthier R, Chaillet N, Laroche J, Roberge S, Bujold E. 639: Labor dystocia and the risk of uterine rupture in women with a prior cesarean. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jastrow N, Bujold E, Chaillet N, Pasquier JC, Gauthier R, Boulvain M, Girard M, Demers S, Marcoux S, Brassard N. 614: Lower uterine segment thickness measurement for prevention of uterine rupture: a prosective study. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rossignol M, Moutquin JM, Boughrassa F, Bédard MJ, Chaillet N, Charest C, Ciofani L, Dumas-Pilon M, Gagné GP, Gagnon A, Gagnon R, Senikas V. Preventable obstetrical interventions: how many caesarean sections can be prevented in Canada? J Obstet Gynaecol Can 2013; 35:434-443. [PMID: 23756274 DOI: 10.1016/s1701-2163(15)30934-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Public health authorities have been alarmed by the progressive rise in rates of Caesarean section in Canada, approaching one birth in three in several provinces. We aimed therefore to consider what were preventable obstetrical interventions in women with a low-risk pregnancy and to propose an analytic framework for the reduction of the rate of CS. We obtained statistical variations of CS rates over time, across regions, and within professional practices from MED-ÉCHO, the Quebec hospitalization database, from 1969 to 2009. Data were extracted from a recent systematic review of the cascade of obstetrical interventions to calculate the population-attributable fractions for each intervention associated with an increased probability of CS. We thereby identified expectant management (as an alternative to labour induction) and planned vaginal birth after CS as the leading strategies for potentially reducing rates of CS in women at low risk. For vaginal birth after CS, an increase to its 1995 level could lower the current CS rate of 23.2% (2009 to 2010) to 21.0%. Other alternatives to obstetrical interventions with a potential for lowering CS rates included non-pharmacological pain control methods (such as continuous support during childbirth) in addition to usual care, intermittent auscultation of the fetal heart (instead of electronic fetal monitoring), and multidisciplinary internal quality assessment audits. We believe, therefore, that the concept of preventable CS is supported by empirical evidence, and we identified realistic strategies to maintain a CS rate in Quebec near 20%.
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Affiliation(s)
- Michel Rossignol
- department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal QC; Institut national d'excellence en santé et en services sociaux, Quebec QC
| | - Jean-Marie Moutquin
- Institut national d'excellence en santé et en services sociaux, Quebec QC; Département d'obstétrique et gynécologie, Université de Sherbrooke, Quebec QC
| | - Faiza Boughrassa
- Département d'obstétrique et gynécologie, Université de Sherbrooke, Quebec QC
| | - Marie-Josée Bédard
- Département d'obstétrique et gynécologie, Université de Montréal, Montreal QC
| | - Nils Chaillet
- Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal QC
| | - Christiane Charest
- Centre de santé et des services sociaux La Pommeraie, Cowansville, Quebec QC
| | - Luisa Ciofani
- Canadian Association of Perinatal and Women's Health Nurses and McGill University Health Centre, Quebec QC
| | - Maxine Dumas-Pilon
- Centre hospitalier de Saint-Mary, Département de médecine familiale, Université McGill, Quebec QC
| | - Guy-Paul Gagné
- Centre hospitalier de Lasalle, Département d'obstétrique et gynécologie, Université McGill, Quebec QC
| | - Andrée Gagnon
- Hôpital régional de Saint-Jerôme, Centre de santé et de services sociaux de Saint-Jérôme, Quebec QC
| | - Raymonde Gagnon
- Programme en pratique sage-femme, Université du Québec à Trois-Rivières, Quebec QC
| | - Vyta Senikas
- Society of Obstetricians and Gynaecologists of Canada, Ottawa ON
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Bonapace J, Chaillet N, Gaumond I, Paul-Savoie E, Marchand S. Evaluation of the Bonapace Method: a specific educational intervention to reduce pain during childbirth. J Pain Res 2013; 6:653-61. [PMID: 24043953 PMCID: PMC3772779 DOI: 10.2147/jpr.s46693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE As pain during childbirth is very intense, several educational programs exist to help women prepare for the event. This study evaluates the efficacy of a specific pain management program, the Bonapace Method (BM), to reduce the perception of pain during childbirth. The BM involves the father, or a significant partner, in the use of several pain control techniques based on three neurophysiological pain modulation models: (1) controlling the central nervous system through breathing, relaxation, and cognitive structuring; (2) using non-painful stimuli as described in the Gate Control Theory; and (3) recruiting descending inhibition by hyperstimulation of acupressure trigger points. METHODS A multicenter case control study in Quebec on pain perception during labor and delivery compared traditional childbirth training programs (TCTPs) and the BM. Visual analog scales were used to measure pain perception during labor. In all, 25 women (TCTP: n = 12; BM: n = 13) successfully reported their perceptions of pain intensity and unpleasantness every 15 minutes. RESULTS A POSITIVE CORRELATION BETWEEN THE PROGRESSION OF LABOR AND PAIN WAS FOUND (PAIN INTENSITY: P < 0.01; pain unpleasantness: P < 0.01). When compared to TCTP, the BM showed an overall significant lower pain perception for both intensity (45%; P < 0.01) and unpleasantness (46%; P < 0.01). CONCLUSION These significant differences in pain perception between TCTP and the BM suggest that the emphasis on pain modulation models and techniques during labor combined with the active participation of a partner in BM are important variables to be added to the traditional childbirth training programs for childbirth pain management.
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Affiliation(s)
- Julie Bonapace
- Département des Sciences de l'Éducation, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec
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Gravel J, D'Angelo A, Carrière B, Crevier L, Beauchamp MH, Chauny JM, Wassef M, Chaillet N. Interventions provided in the acute phase for mild traumatic brain injury: a systematic review. Syst Rev 2013; 2:63. [PMID: 23924958 PMCID: PMC3750385 DOI: 10.1186/2046-4053-2-63] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most patients who sustain mild traumatic brain injury (mTBI) have persistent symptoms at 1 week and 1 month after injury. This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mTBI. METHODS We performed a systematic review of all randomized clinical trials evaluating any intervention initiated in an acute setting for patients experiencing acute mTBI. All possible outcomes were included. The primary sources of identification were MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central register of Controlled Trials, from 1980 to August 2012. Hand searching of proceedings from five meetings related to mTBI was also performed. Study selection was conducted by two co-authors, and data abstraction was completed by a research assistant specialized in conducting systematic reviews. Study quality was evaluated using Cochrane's Risk of Bias assessment tool. RESULTS From a potential 15,156 studies, 1,268 abstracts were evaluated and 120 articles were read completely. Of these, 15 studies fulfilled the inclusion/exclusion criteria. One study evaluated a pharmacological intervention, two evaluated activity restriction, one evaluated head computed tomography scan versus admission, four evaluated information interventions, and seven evaluated different follow-up interventions. Use of different outcome measures limited the possibilities for analysis. However, a meta-analysis of three studies evaluating various follow-up strategies versus routine follow-up or no follow-up failed to show any effect on three outcomes at 6 to 12 months post-trauma. In addition, a meta-analysis of two studies found no effect of an information intervention on headache at 3 months post-injury. CONCLUSIONS There is a paucity of well-designed clinical studies for patients who sustain mTBI. The large variability in outcomes measured in studies limits comparison between them.
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Affiliation(s)
- Jocelyn Gravel
- Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
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Demers S, Roberge S, Afiuni YA, Chaillet N, Girard I, Bujold E. Survey on uterine closure and other techniques for Caesarean section among Quebec's obstetrician-gynaecologists. J Obstet Gynaecol Can 2013; 35:329-333. [PMID: 23660040 DOI: 10.1016/s1701-2163(15)30960-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the preferred types of uterine closure at Caesarean section among Quebec's obstetrician-gynaecologists. METHODS An anonymous survey with multiple-choice and open questions was sent by email to all members of the Association des Obstétriciens-Gynécologues du Québec in clinical practice. The primary response of interest was the type of uterine closure that would be favoured for a primigravida undergoing an elective CS at term for a breech fetus. Secondary responses of interest included type of uterine closure for CS performed for other indications, and methods of closure for the bladder flap, parietal peritoneum, rectus abdominis muscle, subcutaneous tissue, and skin. Results were stratified according to the number of years in practice. RESULTS Of 454 persons targeted, 176 (39%) responded. Responders were more likely to have fewer years in practice than the targeted population in general. The closures for a primigravida undergoing an elective CS at term for a breech presentation were, in order of preference: (1) a double-layer closure combining a first locked layer and an imbricating second layer (61%), (2) a double-layer closure combining a first unlocked layer and an imbricating second layer (28%), (3) a locked single layer (5%), (4) an unlocked single layer (5%), and (5) other techniques (1%). A locked single-layer closure was more frequently used for repeat CS (29%), and it was the favoured technique (40%) when tubal ligation was performed at the time of CS (P < 0.05). CONCLUSION Double-layer closure is the type of uterine closure most preferred by obstetricians in Quebec. However, the first layer is locked by two thirds of obstetricians and unlocked by the remainder.
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Affiliation(s)
- Suzanne Demers
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC
| | - Stéphanie Roberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City QC
| | - Yamal A Afiuni
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC
| | - Nils Chaillet
- Department of Obstetrics and Gynecology, University of Montreal, Montreal QC
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, St-Mary's Hospital, McGill University, Montreal QC
| | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC
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Jastrow N, Demers S, Gauthier RJ, Chaillet N, Brassard N, Bujold E. Adverse obstetric outcomes in women with previous cesarean for dystocia in second stage of labor. Am J Perinatol 2013; 30:173-8. [PMID: 22836821 DOI: 10.1055/s-0032-1322515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate obstetric outcomes in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor. METHODS A retrospective cohort study of women with one previous low transverse cesarean undergoing a first TOL was performed. Women with previous cesarean for dystocia in first stage and those with previous dystocia in second stage were compared with those with previous cesarean for nonrecurrent reasons (controls). Multivariable regressions analyses were performed. RESULTS Of 1655 women, those with previous dystocia in second stage of labor (n = 204) had greater risks than controls (n = 880) to have an operative delivery [odds ratio (OR): 1.5; 95% confidence intervals (CI) 1.1 to 2.2], shoulder dystocia (OR: 2.9; 95% CI 1.1 to 8.0), and uterine rupture in the second stage of labor (OR: 4.9; 95% CI 1.1 to 23), and especially in case of fetal macrosomia (OR: 29.6; 95% CI 4.4 to 202). The median second stage of labor duration before uterine rupture was 2.5 hours (interquartile range: 1.5 to 3.2 hours) in these women. CONCLUSION Previous cesarean for dystocia in the second stage of labor is associated with second-stage uterine rupture at next delivery, especially in cases of suspected fetal macrosomia and prolonged second stage of labor.
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Affiliation(s)
- Nicole Jastrow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Suisse
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Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a Prediction Model for Vaginal Birth After Caesarean. Journal of Obstetrics and Gynaecology Canada 2013; 35:119-124. [DOI: 10.1016/s1701-2163(15)31015-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boutin A, Jastrow N, Girard M, Roberge S, Chaillet N, Brassard N, Bujold E. Reliability of two-dimensional transvaginal sonographic measurement of lower uterine segment thickness using video sequences. Am J Perinatol 2012; 29:527-32. [PMID: 22495899 DOI: 10.1055/s-0032-1310524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To report the intra- and interobserver reliability of measurement of the lower uterine segment (LUS) thickness using transvaginal sonographic videos. METHODS A prospective study of 60 women with previous, low-transverse cesarean undergoing LUS examination (36 to 39 weeks) was performed. Two observers independently measured full LUS thickness using transvaginal sonography. A video of the LUS was recorded and analyzed more than 2 months later by both observers. Intra- and interobserver reliability was assessed with median absolute differences and interquartile range (IQR), nonparametric limits of agreement, intraclass correlation coefficients (ICC) with 95% confidence interval (95% CI), and kappa coefficients. RESULTS Median full LUS thickness was 3.6 mm (range: 0.9 to 8.0 mm). Intraobserver repeatability was excellent (median difference: 0.2 mm, IQR: 0.1 to 0.4; ICC: 0.94, 95% CI: 0.90 to 0.96; kappa: 1.00). Interobserver (median difference: 0.3 mm, IQR: 0.2 to 1.3; ICC: 0.91, 95% CI: 0.86 to 0.95; kappa: 0.76, 95% CI: 0.54 to 0.98) and intermethod reproducibility (median difference: 0.4 mm, IQR: 0.2 to 0.8; ICC: 0.82, 95% CI: 0.72 to 0.89; kappa: 0.69, 95% CI: 0.43 to 0.94) were good. However, both interobserver and intermethod reproducibility were improved when LUS thickness was below 3 mm. CONCLUSION Full LUS thickness measured from transvaginal sonographic videos has excellent intra- and interobserver reproducibility and good reproducibility with live transvaginal ultrasound.
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Affiliation(s)
- Amélie Boutin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
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Roberge S, Boutin A, Chaillet N, Moore L, Jastrow N, Demers S, Bujold E. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol 2012; 29:465-71. [PMID: 22399223 DOI: 10.1055/s-0032-1304829] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy. STUDY DESIGN A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing. RESULTS The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02). CONCLUSION Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.
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Affiliation(s)
- Stéphanie Roberge
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
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Boutin A, Jastrow N, Roberge S, Chaillet N, Bérubé L, Brassard N, Girard M, Bujold E. Reliability of 3-dimensional transvaginal sonographic measurement of lower uterine segment thickness. J Ultrasound Med 2012; 31:933-939. [PMID: 22644690 DOI: 10.7863/jum.2012.31.6.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to report the intraobserver and interobserver reliability of transvaginal 3-dimensional (3D) sonographic measurement of lower uterine segment thickness. METHODS A prospective study of 60 pregnant women with previous low transverse cesarean deliveries was performed between 35 and 39 weeks' gestation. Two observers, blinded to the clinical data, independently measured the full lower uterine segment thickness by 2-dimensional (2D) transvaginal sonography. Three-dimensional volume data sets of the lower uterine segment were captured and analyzed more than 2 months later by both observers independently. Intraobserver, interobserver, and intermethod reliability was evaluated by median absolute differences, nonparametric limits of agreement, intraclass correlation coefficients (ICCs), and κ coefficients. RESULTS The median full lower uterine segment thickness was 3.6 mm (range, 0.9-8.0 mm). Intraobserver reliability (median difference, 0.3 mm [interquartile range (IQR), 0.1-0.6 mm]; ICC, 0.88 [95% confidence interval (CI), 0.81-0.93]; κ, 0.87 [95% CI, 0.69-1.00]) and interobserver reliability (median difference, 0.3 mm [IQR, 0.1-0.5 mm]; ICC, 0.88 [95% CI, 0.81-0.93]; κ, 0.86 [95% CI, 0.66-1.00]) were excellent. Reliability between 3D and 2D sonography was moderate (median difference, 0.6 mm [IQR, 0.2-0.9 mm]; ICC, 0.78 [95% CI, 0.66-0.86]; κ, 0.56 [95% CI, 0.28-0.85]). However, intermethod reproducibility was improved when the full lower uterine segment thickness was less than 3.0 mm (median difference, 0.4 mm [IQR, 0.2-0.9 mm]). CONCLUSIONS Full lower uterine segment thickness measured with 3D transvaginal sonographic data sets has excellent intraobserver and interobserver reliability. It also has good reproducibility with 2D sonography when the full lower uterine segment thickness is less than 3.0 mm.
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Affiliation(s)
- Amélie Boutin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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Affiliation(s)
- Philippe Kadhel
- Department of Obstetrics and Gynecology, Centre Hospitalier et Universitaire de Pointe à Pitre / Abymes, Service de Gynécologie et Obstétrique, Route de Chauvel, Pointe-à-Pitre, France
- Inserm (Institut National de la Santé et de la Recherche Médicale), U1085, IRSET, Campus de Fouillole, Pointe-à-Pitre, France
| | - Patricia Monnier
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University Health Centre, Quebec, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Research Center of Sainte-Justine Hospital, University of Montreal, Ste-Catherine, Montreal, Quebec, Canada
| | - Nils Chaillet
- Department of Obstetrics and Gynecology, Research Center of Sainte-Justine Hospital, University of Montreal, Ste-Catherine, Montreal, Quebec, Canada
| | - William D. Fraser
- Department of Obstetrics and Gynecology, Research Center of Sainte-Justine Hospital, University of Montreal, Ste-Catherine, Montreal, Quebec, Canada
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