Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods

Abstract Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed. Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58–0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61–1.06). Results were similar when stratified by the timing of the cesareans (before or during labor). Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.

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Change in Cervical Length across Pregnancies and Preterm Delivery

American Journal of Perinatology ◽

10.1055/s-0039-1685444 ◽

2019 ◽

Vol 37 (06) ◽

pp. 598-602

Author(s):

Annie Dude ◽

Emily S. Miller

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Length Change ◽

Cervical Length ◽

Subsequent Pregnancy ◽

Short Cervix ◽

Increased Risk ◽

The Difference

Abstract Objective This study aimed to determine whether a decrease in midtrimester cervical length across pregnancies is associated with preterm delivery in a subsequent pregnancy. Study Design This is a cohort study of women who had two consecutive singleton births at the same institution. Midtrimester cervical length change across pregnancies was measured as the difference in centimeters (cm) between cervical lengths using the measurement taken closest to 200/7 weeks' gestation in each pregnancy. Cervical length shortening was defined as present if the cervical length decreased by at least one standard deviation in the subsequent pregnancy. Results Among 1,552 women, 114 (7.4%) experienced a preterm delivery in the subsequent pregnancy. Compared with women whose subsequent pregnancy cervical length remained stable or increased, women whose cervical length shortened were more likely to experience a preterm delivery (10.3 vs. 6.7%; p = 0.04). Cervical length shortening remained associated with preterm delivery even when accounting for a woman's prior preterm delivery, prior pregnancy short cervix, interdelivery interval, progesterone use, and cervical length in the subsequent pregnancy (adjusted odds ratio = 1.89; 95% confidence interval = 1.11–3.20). Conclusion Midtrimester cervical length shortening across pregnancies is independently associated with an increased risk of preterm delivery.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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Low bone mineral density is a potential risk factor for symptom onset and related with hypocitraturia in urolithiasis patients: A single-center retrospective cohort study

10.21203/rs.3.rs-48011/v3 ◽

2020 ◽

Author(s):

Kazumi Taguchi ◽

Shuzo Hamamoto ◽

Atsushi Okada ◽

Yutaro Tanaka ◽

Teruaki Sugino ◽

...

Keyword(s):

Bone Mineral Density ◽

Cohort Study ◽

Bone Mineral ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Stone Formation ◽

Single Center ◽

Mineral Density ◽

Stone Formers

Abstract Background: Patients with urolithiasis have a lower bone mineral density (BMD) than those without stones, suggesting a potential correlation between calcium stone formation and bone resorption disorders, including osteopenia and osteoporosis. Methods: To investigate the influence of BMD on clinical outcomes in urolithiasis, we performed a single-center retrospective cohort study to analyze patients with urolithiasis who underwent both BMD examination and 24-hour urine collection between 2006 and 2015. Data from the national cross-sectional surveillance of the Japanese Society on Urolithiasis Research in 2015 were utilized, and additional data related to urinary tract stones were obtained from medical records. The primary outcome was the development of stone-related symptoms and recurrences during follow-up. A total of 370 patients were included in this 10-year study period. Results: Half of the patients had recurrent stones, and the two-thirds were symptomatic stone formers. While only 9% of patients had hypercalciuria, 27% and 55% had hyperoxaluria and hypocitraturia, respectively. There was a positive correlation between T-scores and urinary citrate excretion. Both univariate and multivariate analyses demonstrated that female sex was associated with recurrences (odds ratio=0.44, p=0.007), whereas a T-score <−2.5 and hyperoxaluria were associated with symptoms (odds ratio=2.59, p=0.037; odds ratio=0.45, p=0.01; respectively). Conclusion: These results revealed that low T-scores might cause symptoms in patients with urolithiasis, suggesting the importance of BMD examination for high-risk Japanese patients with urolithiasis having hypocitraturia.

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Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery

Anesthesiology ◽

10.1097/aln.0000000000002534 ◽

2019 ◽

Vol 130 (2) ◽

pp. 237-246 ◽

Cited By ~ 7

Author(s):

Benjamin T. Cobb ◽

Meghan B. Lane-Fall ◽

Richard C. Month ◽

Onyi C. Onuoha ◽

Sindhu K. Srinivas ◽

...

Keyword(s):

General Anesthesia ◽

Cesarean Delivery ◽

Subgroup Analysis ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Medical Center ◽

Academic Medical Center ◽

Obstetric Anesthesia ◽

Epidural Block ◽

Cesarean Deliveries

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Manuscript Tells Us That Is NewBackgroundGuidelines for obstetric anesthesia recommend neuraxial anesthesia (i.e., spinal or epidural block) for cesarean delivery in most patients. Little is known about the association of anesthesiologist specialization in obstetric anesthesia with a patient’s likelihood of receiving general anesthesia. The authors conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by generalist versus obstetric-specialized anesthesiologists.MethodsThe authors studied patients undergoing cesarean delivery for live singleton pregnancies from 2013 through 2017 at one academic medical center. Data were extracted from the electronic medical record. The authors estimated the association of anesthesiologist specialization in obstetric anesthesia with the odds of receiving general anesthesia for cesarean delivery.ResultsOf the cesarean deliveries in our sample, 2,649 of 4,052 (65.4%) were performed by obstetric-specialized anesthesiologists, and 1,403 of 4,052 (34.6%) by generalists. Use of general anesthesia differed for patients treated by specialists and generalists (7.3% vs. 12.1%; P < 0.001). After adjustment, the odds of receiving general anesthesia were lower among patients treated by obstetric-specialized anesthesiologists among all patients (adjusted odds ratio, 0.71; 95% CI, 0.55 to 0.92; P = 0.011), and in a subgroup analysis restricted to urgent or emergent cesarean deliveries (adjusted odds ratio, 0.75; 95% CI, 0.56 to 0.99; P = 0.049). There was no association between provider specialization and the odds of receiving general anesthesia in a subgroup analysis restricted to evening or weekend deliveries (adjusted odds ratio, 0.76; 95% CI, 0.56 to 1.03; P = 0.085).ConclusionsTreatment by an obstetric anesthesiologist was associated with lower odds of receiving general anesthesia for cesarean delivery; however, this finding did not persist in a subgroup analysis restricted to evening and weekend deliveries.

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The assumption of self_ responsibility for health behaviour change in patients with hypertension from poor socio-economic areas

South African Journal of Physiotherapy ◽

10.4102/sajp.v58i3.216 ◽

2002 ◽

Vol 58 (3) ◽

Author(s):

A. V. Stewart ◽

C. J. Eales ◽

K. A. Davies

Keyword(s):

Health Care ◽

Regression Analysis ◽

Behaviour Change ◽

Health Behaviour ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cardiovascular Complications ◽

Health Care Practitioner ◽

Behaviour Modification ◽

Health Behaviour Change

Patients with hypertension need to convert their knowledgeabout the disease and its management into meaningful action to be able to change their health behaviour. By doing this they are able to reduce the risk of the cardiovascular complications that are associated with hypertension If they can change their health behaviour it can be said that they have taken responsibility for their health. In this study a group of patients with hypertension who assumed responsibility for health behaviour change during a health behaviour modification programme was identified and compared to a group who did not. There were significant differences between the group that assumed responsibility for health behaviour change and the group that did not. The group that assumed responsibility:• had the support of a health care practitioner and a family member (p<0,000); • were employed (p=0.03); • were not anxious or depressed (p=0.07); • experienced their usual sex-lives (p=0.03); • did not have symptoms of heart pounding present (p=0.03). The adjusted odds ratio obtained from a logistic regression analysis showed a seven- times more likelihood ofpatients becoming responsible for their health if they were supported by their families and a health-care practitioner

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Prevalence and Antimicrobial Resistance of Mycoplasma genitalium Infection Among Women Living With Human Immunodeficiency Virus in South Africa: A Prospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz045 ◽

2019 ◽

Vol 69 (5) ◽

pp. 873-876 ◽

Cited By ~ 2

Author(s):

Jason J Ong ◽

Mahlape Precious Magooa ◽

Admire Chikandiwa ◽

Helen Kelly ◽

Marie-Noelle Didelot ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Mycoplasma Genitalium ◽

Cd4 Counts ◽

Immunodeficiency Virus ◽

Hiv 1

Abstract This prospective cohort study of 622 women living with human immunodeficiency virus (HIV) from Johannesburg (2012) detected Mycoplasma genitalium in 7.4% (95% confidence interval [CI]: 5.5–9.7, 46/622), with detection more likely with lower CD4 counts(adjusted odds ratio [AOR] 1.02 per 10 cells/μL decrease, 95% CI: 1.00–1.03) and higher plasma HIV-1 RNA (AOR 1.15 per log copies/mL increase, 95% CI: 1.03–1.27). No mutations for macrolide/quinolone resistance was detected.

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Nonjudicious Dispensing of Antibiotics by Drug Stores in Pratumthani, Thailand

Infection Control and Hospital Epidemiology ◽

10.1086/587496 ◽

2008 ◽

Vol 29 (6) ◽

pp. 572-575 ◽

Cited By ~ 34

Author(s):

Anucha Apisarnthanarak ◽

Jeeraluk Tunpornchai ◽

Korakot Tanawitt ◽

Linda M. Mundy

Keyword(s):

Multivariate Analysis ◽

Confidence Interval ◽

Antibiotic Therapy ◽

Odds Ratio ◽

Adjusted Odds Ratio

Mock patient presentations of 6 common syndromic ailments to drug stores in Pratumthani, Thailand, were conducted. Appropriate dispensing of antibiotic therapy for all 6 presentations occurred at 56 (20%) of 280 drug stores. By multivariate analysis, drug stores' proximity to a hospital was associated with appropriate dispensing of antibiotics (adjusted odds ratio, 34 [95% confidence interval, 15–83]; P < .001).

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Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes

American Journal of Perinatology Reports ◽

10.1055/s-0038-1649486 ◽

2018 ◽

Vol 08 (02) ◽

pp. e89-e94 ◽

Cited By ~ 1

Author(s):

Tetsuya Kawakita ◽

Chun-Chih Huang ◽

Helain Landy

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

Cervical Dilation ◽

Cord Prolapse ◽

Umbilical Cord Prolapse ◽

Singleton Pregnancies

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

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Pancreatic and gut hormones as predictors of new-onset prediabetes after non-necrotising acute pancreatitis: a prospective longitudinal cohort study

Endocrine Connections ◽

10.1530/ec-21-0229 ◽

2021 ◽

Author(s):

Sakina H Bharmal ◽

Wandia Kimita ◽

Juyeon Ko ◽

Maxim S Petrov

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Gut Hormones ◽

Study Groups ◽

Prospective Longitudinal ◽

Prospective Longitudinal Cohort ◽

New Onset

Objective: Early identification of individuals at a high risk for metabolic derangements after an attack of acute pancreatitis (AP) is critical with a view to tertiary preventing of this disease. The aim was to investigate whether fasting pancreatic and gut hormones at baseline were predictive of future risk of new-onset prediabetes after acute pancreatitis (NOPAP) in individuals with non-necrotising AP. Methods: This was a prospective longitudinal cohort study that included 69 consecutive non-diabetic participants with AP, of whom 55% (n=38) had normoglycaemia both at baseline and during follow-up, 25% (n=17) had prediabetes both at baseline and during follow-up, and 20% (n=14) were normoglycaemic at baseline but developed NOPAP during follow-up. The associations between the study groups and circulating fasting levels of pancreatic and gut hormones (insulin, C-peptide, glucose-dependent insulinotropic peptide, glucagon-like peptide-1, pancreatic polypeptide, and peptide YY) were studied using multinomial regression in both unadjusted and adjusted analyses. Results: Elevated plasma insulin and glucagon at baseline were significantly associated with NOPAP (adjusted odds ratio 1.99, 95% confidence interval 1.01 to 3.92; and adjusted odds ratio 3.44, 95% confidence interval 1.06 to 11.19, respectively). The same hormones had no significant association with antecedent prediabetes in AP. The other studied hormones were not significantly associated with the study groups. Conclusions: Normoglycaemic AP individuals with elevated fasting levels of insulin and glucagon at baseline constitute a high-risk group for future NOPAP.

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Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

10.21203/rs.3.rs-19505/v2 ◽

2020 ◽

Author(s):

Beatrice Ekman ◽

Prajwal Paudel ◽

Omkar Basnet ◽

KC Ashish ◽

J. Wrammert

Keyword(s):

Cohort Study ◽

Antimicrobial Resistance ◽

Low Income ◽

Neonatal Sepsis ◽

Early Onset ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

World Health Organisation ◽

World Health ◽

Adherence To Guidelines

Abstract Background Neonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors. Methods This cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 hours of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied. Results 1,564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines. Conclusion Adherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance.

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