Intrauterine Pressure Catheter Use Is Associated with an Increased Risk of Postcesarean Surgical Site Infections

Abstract Objective This study aimed to determine if intrapartum placement of an intrauterine pressure catheter (IUPC) is associated with an increased rate of surgical site infections in women undergoing a cesarean delivery. Study Design This was a secondary analysis of the prospective observational Maternal–Fetal Medicine Units Network Vaginal Birth after Cesarean Registry. We compared patients with and without IUPC use. A multivariable logistic regression was performed to evaluate for an association between IUPC use and postcesarean surgical site infections. Results The study included 16,887 women: 7,441 with IUPC use and 9,446 without IUPC use. After adjustment for potential cofounders, IUPC use was associated with an increased risk of postcesarean infections compared with those without IUPC use (adjusted odds ratio: 1.28; 95% confidence interval: 1.10–1.50; p = 0.002). Conclusion IUPC use is associated with an increased risk of postcesarean surgical site infections. This supports the judicious use of IUPC for limited clinical indications and provides a potential area of focus for reduction in postcesarean infections.

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How Low Is Too Low? Postpartum Hemorrhage Risk among Women with Thrombocytopenia

American Journal of Perinatology ◽

10.1055/s-0037-1604194 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1135-1141 ◽

Cited By ~ 2

Author(s):

Sarah Dotters-Katz ◽

Marcela Smid ◽

Tracy Manuck ◽

Laura Carlson

Keyword(s):

Postpartum Hemorrhage ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Clinical Evidence ◽

Secondary Analysis ◽

Vaginal Birth After Cesarean ◽

Maternal Fetal Medicine ◽

Laboratory Evidence ◽

Ordinal Variable ◽

Hemorrhage Risk

Objective To estimate the association between severity of thrombocytopenia and postpartum hemorrhage. Study Design We performed a secondary analysis of a prospective cohort of women delivering by cesarean or vaginal birth after cesarean conducted by the National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Unit. Women delivering ≥ 20 weeks with platelets < 400,000/mL were included. Thrombocytopenia was defined as predelivery platelets of < 150,000/mL. Primary outcomes were (1) laboratory evidence of hemorrhage, defined as a decrease in hemoglobin ≥ 4 mg/dL and (2) clinical evidence of hemorrhage, a composite of atony, transfusion, coagulopathy, hysterectomy, laparotomy, or intensive care unit admission. Odds ratios were calculated for primary outcomes using thrombocytopenia as a dichotomous and ordinal variable. Results A total of 54,597 women were included; 5,611 (10.3%) had antepartum thrombocytopenia, 1,976 (3.6%) women had laboratory evidence of hemorrhage, and 3,862 (7.1%) had clinical evidence of hemorrhage. Thrombocytopenia was associated with both laboratory evidence of hemorrhage (adjusted odds ratio [aOR]: 1.60, 95% CI: 1.38–1.86) and clinical evidence of hemorrhage (aOR: 1.68, 95% CI: 1.52–1.83). The odds of laboratory and clinical evidence of hemorrhage increased incrementally with severity of thrombocytopenia. Conclusion Thrombocytopenia is associated with both laboratory and clinical evidence of hemorrhage; risk increases dramatically as platelet count decreases.

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Effect of Trial of Labor before Cesarean and Risk of Subsequent Placenta Accreta Spectrum Disorders

American Journal of Perinatology ◽

10.1055/s-0039-1685449 ◽

2019 ◽

Vol 37 (06) ◽

pp. 633-637

Author(s):

Katharine N. O'Malley ◽

Mary E. Norton ◽

Sarah S. Osmundson

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Primary Outcome ◽

Placenta Accreta ◽

Secondary Analysis ◽

Subsequent Pregnancy ◽

Trial Of Labor ◽

Increased Risk ◽

Placenta Accreta Spectrum ◽

Spectrum Disorders

Abstract Objective This study aimed to examine whether labor before cesarean affects the risk of placenta accreta spectrum (PAS) disorders in a subsequent pregnancy. Study Design This is a secondary analysis of the Cesarean Registry, a prospective cohort study of women undergoing cesarean between 1999 and 2002. Women with one prior cesarean with known indications, which were categorized as likely associated with labor (labored cesarean) versus likely not associated with labor (unlabored cesarean), were included. Primary outcome was PAS disorder. Results Of 34,224 women, 60% had a “labored cesarean” and 40% had an “unlabored cesarean.” Women with prior unlabored cesarean were more likely to have subsequent PAS disorder compared with women with a prior labored cesarean after adjusting for confounders (0.28 vs. 0.13%; adjusted odds ratio: 2.03; 95% confidence interval: 1.22–3.38). Conclusion Prior unlabored cesarean is associated with an increased risk of PAS disorders in a subsequent pregnancy. This association may aid in risk stratification in women with suspected PAS disorders and help counsel about risks associated with cesarean on maternal request.

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Time to First Cigarette and Self-Reported Health Among US Adult Smokers

Tobacco Use Insights ◽

10.1177/1179173x18825262 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1882526 ◽

Cited By ~ 1

Author(s):

Baksun Sung

Keyword(s):

United States ◽

Propensity Score ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Smoking Behavior ◽

The United States ◽

Elevated Risk ◽

Poor Health ◽

Increased Risk ◽

Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

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Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Stroke ◽

10.1161/str.47.suppl_1.wp200 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Benjamin R Kummer ◽

Rebecca Hazan ◽

Hooman Kamel ◽

Alexander E Merkler ◽

Joshua Z Willey ◽

...

Keyword(s):

Ischemic Stroke ◽

Odds Ratio ◽

Postoperative Infection ◽

Adjusted Odds Ratio ◽

Risk Of Infection ◽

Postoperative Stroke ◽

Increased Risk ◽

Increase Risk ◽

Initiative Program ◽

The Relationship

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

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Risk of miscarriage in women with psychiatric disorders

The British Journal of Psychiatry ◽

10.1192/bjp.2020.259 ◽

2021 ◽

pp. 1-6

Author(s):

Maria C. Magnus ◽

Alexandra Havdahl ◽

Nils-Halvdan Morken ◽

Knut-Arne Wensaas ◽

Allen J. Wilcox ◽

...

Keyword(s):

Psychiatric Disorders ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Depressive Disorders ◽

Somatoform Disorders ◽

Psychiatric Diagnoses ◽

Schizophrenia Spectrum Disorders ◽

Birth Registry ◽

Increased Risk ◽

Wide Range

Background Some psychiatric disorders have been associated with increased risk of miscarriage. However, there is a lack of studies considering a broader spectrum of psychiatric disorders to clarify the role of common as opposed to independent mechanisms. Aims To examine the risk of miscarriage among women diagnosed with psychiatric conditions. Method We studied registered pregnancies in Norway between 2010 and 2016 (n = 593 009). The birth registry captures pregnancies ending in gestational week 12 or later, and the patient and general practitioner databases were used to identify miscarriages and induced abortions before 12 gestational weeks. Odds ratios of miscarriage according to 12 psychiatric diagnoses were calculated by logistic regression. Miscarriage risk was increased among women with bipolar disorders (adjusted odds ratio 1.35, 95% CI 1.26–1.44), personality disorders (adjusted odds ratio 1.32, 95% CI 1.12–1.55), attention-deficit hyperactivity disorder (adjusted odds ratio 1.27, 95% CI 1.21–1.33), conduct disorders (1.21, 95% CI 1.01, 1.46), anxiety disorders (adjusted odds ratio 1.25, 95% CI 1.23–1.28), depressive disorders (adjusted odds ratio 1.25, 95% CI 1.23–1.27), somatoform disorders (adjusted odds ratio 1.18, 95% CI 1.07–1.31) and eating disorders (adjusted odds ratio 1.14, 95% CI 1.08–1.22). The miscarriage risk was further increased among women with more than one psychiatric diagnosis. Our findings were robust to adjustment for other psychiatric diagnoses, chronic somatic disorders and substance use disorders. After mutual adjustment for co-occurring psychiatric disorders, we also observed a modest increased risk among women with schizophrenia spectrum disorders (adjusted odds ratio 1.22, 95% CI 1.03–1.44). Conclusions A wide range of psychiatric disorders were associated with increased risk of miscarriage. The heightened risk of miscarriage among women diagnosed with psychiatric disorders highlights the need for awareness and surveillance of this risk group in antenatal care.

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Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

Stroke ◽

10.1161/strokeaha.120.029942 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2997-3006

Author(s):

Li Ma ◽

Shuo Zhang ◽

Zongze Li ◽

Chun-Xue Wu ◽

Zhaozhao Wang ◽

...

Keyword(s):

Calibration Curve ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cavernous Malformation ◽

Cerebral Cavernous Malformation ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Discriminative Ability ◽

Increased Risk

Background and Purpose: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. Methods: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. Results: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]). Conclusions: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04076449.

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The association of gout with an increased risk of hypertension and diabetes mellitus among stroke survivors in New Zealand: A cross-sectional study using routinely collected electronic health data

JRSM Cardiovascular Disease ◽

10.1177/2048004019863239 ◽

2019 ◽

Vol 8 ◽

pp. 204800401986323 ◽

Cited By ~ 2

Author(s):

Dina Eufemia D San Gabriel ◽

Julia Slark

Keyword(s):

Diabetes Mellitus ◽

New Zealand ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Stroke Survivors ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

Background There is a paucity of data relating to the association of gout with the occurrence of hypertension and diabetes mellitus in patients with stroke. This study aimed to determine the association of gout with the risk of hypertension and diabetes mellitus in a cohort of stroke patients from Auckland, Aotearoa New Zealand. Methods A cross-sectional study was conducted among stroke survivors in South and East Auckland, New Zealand from the years 2010 to 2014. Electronic health record data were collected and analysed using Statistical Package for Social Science version 23. Multivariate logistic regression modelling adjusted for age, gender, and ethnicity was conducted to determine the association of gout with the risk of hypertension and diabetes mellitus in patients discharged with a diagnosis of stroke. Results The age-, gender-, and ethnicity-adjusted odds ratio for having hypertension and diabetes mellitus among stroke survivors with gout history were 3.25 (95% confidence interval 1.32–8.03) and 1.94 (95% confidence interval 1.12–3.36), respectively. Māori stroke survivors with gout history had the highest risk of having diabetes mellitus with age- and gender-adjusted odds ratio of 5.10 (95% confidence interval 1.90–18.93). Conclusion The findings from this study suggest gout may be independently associated with an increased risk of hypertension and diabetes mellitus in patients with stroke. Māori who are the indigenous population of New Zealand show a greater risk of diabetes mellitus associated with a gout diagnosis compared to other populations. This finding highlights the importance of the need for further research with Māori stroke survivors and other indigenous populations.

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Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

François Dépret ◽

Clément Hoffmann ◽

Laura Daoud ◽

Camille Thieffry ◽

Laure Monplaisir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Smoke Inhalation ◽

Logistic Regression Models ◽

Increased Risk ◽

The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

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The effect of the 2008 recession on well-being and employment status of people with and without mental health problems

European Journal of Public Health ◽

10.1093/eurpub/ckz192 ◽

2019 ◽

Vol 30 (4) ◽

pp. 761-766 ◽

Cited By ~ 1

Author(s):

Unnur Jónsdóttir ◽

Edda Björk þórðardóttir ◽

Thor Aspelund ◽

þórarinn Jónmundsson ◽

Kristjana Einarsdóttir

Keyword(s):

Mental Health ◽

Perceived Stress ◽

Odds Ratio ◽

Employment Status ◽

Adjusted Odds Ratio ◽

Mental Health Problems ◽

Well Being ◽

Health Problems ◽

Study Cohort ◽

Increased Risk

Abstract Background The world was hit hard by the 2008 recession which led to increased unemployment and financial strain. However, how the recession affected people with pre-existing mental health problems has been understudied. This study investigates the effect of the 2008 recession in Iceland on stress, well-being and employment status of people with regard to whether they are suffering from mental health problems. Methods The study cohort included participants (18–69 years old) of the ‘Health and Wellbeing of Icelanders’, a 3-wave survey conducted before (in 2007) and after (in 2009 and 2012) the recession in 2008. Self-assessed well-being was measured with the Short Warwick-Edinburgh Mental Well-being Scale and the 4-item Perceived Stress Scale. Logistic regression was used to assess the effect of the 2008 recession on self-assessed well-being and employment status in 2009 and 2012, using 2007 as a reference year. Results Participants with no pre-recession mental health problems were at increased risk of both poor well-being, (with adjusted odds ratio at 1.66, in 2009 and 1.64 in 2012) and higher perceived stress, (with adjusted odds ratio at 1.48 in 2009 and 1.53 in 2012), after the recession. Interestingly, no significant change in well-being and perceived stress was observed among participants suffering from pre-recession mental health problems. Both groups had increased risk of unemployment after the recession. Conclusion Results indicate that after recessions, the risk of stress and poor well-being increases only among those who do not suffer from pre-recession mental health problems.

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Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

Anesthesiology ◽

10.1097/aln.0000000000002629 ◽

2019 ◽

Vol 130 (6) ◽

pp. 912-922 ◽

Cited By ~ 20

Author(s):

Jean Guglielminotti ◽

Ruth Landau ◽

Guohua Li

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Cesarean Delivery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Neuraxial Anesthesia ◽

General Anesthetics ◽

Factors Associated ◽

Increased Risk ◽

Anesthesia Complications

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay. Results During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P < 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively. Conclusions Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.

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