scholarly journals Timing of Delivery and Adverse Outcomes in Term Singleton Repeat Cesarean Deliveries

2014 ◽  
Vol 34 (2) ◽  
pp. 86
Author(s):  
G. Chiossi ◽  
Y. Lai ◽  
M.B. Landon ◽  
C.Y. Spong ◽  
D.J. Rouse ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Cesarean Deliveries

scholarly journals POS0719 ADVERSE OUTCOMES AND REHOSPITALIZATION AFTER DELIVERY AMONG WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS OR RHEUMATOID ARTHRITIS AND THEIR INFANTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 609.1-609
Author(s):  
J. Sabo ◽  
N. Singh ◽  
D. A. Crane ◽  
D. R. Doody ◽  
M. A. Schiff ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Hospital Discharge ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Lupus Erythematosus ◽  
Adverse Outcomes ◽  
Systemic Lupus ◽  
Cesarean Deliveries

Background:Women with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have greater risk of adverse obstetric and birth outcomes than women without these conditions. Infant outcomes are less well-studied. It is unknown whether re-hospitalization after delivery occurs more often for affected mothers and their infants.Objectives:We compared obstetric outcomes among women with and without RA or SLE, and birth outcomes among their infants. Maternal and infant rehospitalizations <2 years of delivery were also compared.Methods:This population-based cohort study used linked birth-hospital discharge data from Washington State for 1987-2014. International Classification of Disease 9th revision (ICD9) codes identified all women with RA (ICD9 714.X, 725.X) and SLE (ICD9 710, 710.0, 710.1) in the hospital discharge record at delivery, and a 10:1 comparison group of women without these codes. Analyses were restricted to singleton live births (1,223 RA; 1,354 SLE). Poisson regression with robust standard errors estimated relative risks (RR) and 95% confidence intervals (CI) for selected outcomes, accounting for delivery year, maternal age, and parity.Results:Many adverse outcomes were more common among RA and SLE cases than among comparison women. Preeclampsia occurred more often during pregnancies of women with RA (RR 1.42, 95% CI 1.17-1.71) or SLE (RR 2.33, 95% CI 2.01-2.70), as did preterm rupture of membranes (PROM, RR 2.85, 95% CI 2.20-3.72 for RA; RR 3.28, 95% CI 2.54-4.23 for SLE). Cesarean deliveries were more common among nulliparous women in both groups (RR 1.32, 95% CI 1.18-1.48 for both conditions). Infants of women with RA or SLE were more likely to weigh <2500 g (RR 2.08, 95% CI 1.72-2.52 for RA; RR 4.88, 95% CI 4.27-5.58 for SLE), be small for gestational age (RR 1.25, 95% CI 1.07-2.50; RR 2.30; 2.04-2.59, respectively), delivered at <32 weeks gestation (RR 1.83, 95% CI 1.13-2.97; RR 5.13, 95% CI 3.75-7.01, respectively), and require neonatal intensive care unit admission (NICU, RR 1.89, 95% CI 1.56-2.30; RR 2.71, 95% CI 2.25-3.28, respectively). Infants of women with SLE were more likely to have a malformation (RR 1.46, 95% CI 1.21-1.75) or die within 2 years (RR 2.11, 95% CI 1.21-3.67). Rehospitalization levels among both women with RA (RR 2.22; 1.62-3.04) and SLE (RR 2.78, 95% CI 2.15-3.59) were greatest <6 months of delivery and declined over time. Infants of women with SLE had increased rehospitalization <6 months (RR 1.64, 95% CI 1.36-1.98).Conclusion:Consistent with prior literature, we found women with RA or SLE experienced many adverse outcomes. In our data, these included preeclampsia, PROM, and cesarean deliveries, with increased risks more notable among women with SLE. Infants of women with either condition were more likely to weigh <2500g, be <32 weeks gestation, small for gestational age, and require NICU admission than infants of comparison women. Only infants of women with SLE had increased malformations. Maternal rehospitalization after delivery was more common in both groups; most marked at <6 months. Infant rehospitalizations were increased in both cohorts to a lesser extent. Close follow-up during this time period is crucial to minimize adverse outcomes.Disclosure of Interests:Julianna Sabo: None declared, Namrata Singh: None declared, Deborah A. Crane: None declared, David R. Doody: None declared, Melissa A. Schiff: None declared, Beth A. Mueller Shareholder of: Household owns shares in AstraZeneca

scholarly journals Adverse maternal outcomes associated with Cesarean deliveries and their determinants: hospital based cross sectional, mixed- methods study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mulugeta Meles Dibabi ◽  
Alemu Tamiso Debiso ◽  
Kaleb Mayisso Rodamo
Keyword(s):  
Mixed Methods ◽  
Sample Size ◽  
Adverse Outcomes ◽  
Healthcare Personnel ◽  
Sufficient Evidence ◽  
Medical Illness ◽  
Cross Sectional ◽  
Content Type ◽  
Cesarean Deliveries ◽  
Set Up

PurposeThe purpose of this study was to examine adverse outcomes associated with cesarean deliveries and to assess potential confounding factors.Design/methodology/approachA hospital-based cross-sectional study was conducted from September 1−30, 2019 using mixed methods of data collection. Multistage sampling was used to draw the eligible study participants. The sample size was calculated using the single population proportion formula. A systematic random sampling technique was used to draw the sample size. 180 original medical records were excluded because of having missed information, leaving 1,618 women as the study population. We used the questionnaire adapted from the Ethiopian Demographic and Health Survey to collect quantitative data and analyzed using SPSS version 22, while thematic analysis for qualitative measures was used to generate themes regarding associated perspectives of participants from a community.FindingsMore than 383 women delivered by cesarean section. 20% of the mothers with the mean age at birth of 26.1 ± 4.8 experienced adverse outcomes. Adjusted odds ratio (AOR) was used to measure the association of determinants and was 2.95 (95% CI 1.19–7.29) for nonuse of antenatal care, 3.18 (95% CI 1.43–6.94) for nonuse of prophylaxis, 4.28 (95% CI 1.58−11.61) for history of medical illness and 7.09 (95% CI 1.19−45.59) for use of substandard operation set up compared with their counterparts.Research limitations/implicationsStrengths of the study include the finding of the study are reliably reported in mixed study methods examining hospital-based institutional and personal risk factors and exploring the whole community's perspectives. However, the important limitations of the study indicate that the study poses a number of challenges related to studying design, therefore there was not sufficient evidence of causality to draw conclusions from the findings. In addition, the study was conducted at a single hospital so that it is not convenient to generalize the findings of the study for setting different in social and economic status.Originality/valueBased on the findings, attention has been drawn to healthcare personnel to provide training and consultation services for pregnant women and for health care administration to ensure standard set up for operation.

Temporal Trends in Anesthesia-related Adverse Events in Cesarean Deliveries, New York State, 2003–2012

2015 ◽  
Vol 123 (5) ◽  
pp. 1013-1023 ◽  
Author(s):  
Jean Guglielminotti ◽  
Cynthia A. Wong ◽  
Ruth Landau ◽  
Guohua Li
Keyword(s):  
New York ◽  
Adverse Events ◽  
Perioperative Complications ◽  
Statistical Significance ◽  
New York State ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Adverse Outcomes ◽  
Perioperative Morbidity ◽  
Cesarean Deliveries

Abstract Background Cesarean delivery (CD) is associated with significantly increased risks of anesthesia-related adverse events (ARAEs) and nonanesthetic perioperative morbidity compared with vaginal delivery. Temporal trends in these adverse outcomes remain unknown despite efforts to improve maternal safety. This study examines temporal trends in ARAEs and nonanesthetic perioperative complications in CDs in New York hospitals. Methods Data are from the State Inpatient Database for New York, 2003–2012. ARAEs, including minor and major ARAEs, and nonanesthetic perioperative complications were identified through International Classification of Diseases, Ninth Revision, Clinical Modification codes. Statistical significance in time trends was assessed using the Cochran–Armitage test and multivariable logistic regression. Results Of the 785,854 CDs studied, 5,715 (730 per 100,000; 95% CI, 710 to 750) had at least one ARAE and 7,040 had at least one perioperative complication (890 per 100,000; 95% CI, 870 to 920). The overall annual rate of ARAEs decreased from 890 per 100,000 in 2003 to 660 in 2012 (25% decrease; 95% CI, 16 to 34; P &lt; 0.0001). The rate of minor ARAEs decreased 23% (95% CI, 13 to 32) and of major ARAEs decreased 43% (95% CI, 23 to 63). No decrease was observed in the rate of ARAEs for CDs performed under general anesthesia. The rate of nonanesthetic complications increased 47% (95% CI, 31 to 63; P &lt; 0.0001). Conclusions Anesthesia-related outcomes in cesarean deliveries appear to have improved significantly across hospitals in New York in the past decade. Perioperative nonanesthetic complications remain a serious healthcare issue.

Maternal Morbidity with Repeated Cesarean Deliveries

2021 ◽  
Author(s):  
Rebecca Klahr ◽  
Kevin Cheung ◽  
Emily S. Markovic ◽  
Mackenzie Naert ◽  
Andrei Rebarber ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Adverse Outcomes ◽  
Wound Complications ◽  
Chi Square ◽  
Maternal Fetal Medicine ◽  
Cesarean Deliveries ◽  
Key Points ◽  
The Absolute ◽  
Uterine Dehiscence

Objective This study aimed to estimate the association between adverse maternal outcomes and the number of repeated cesarean deliveries (CDs) in a single obstetrical practice. Study Design Retrospective cohort study of all CDs between 2005 and 2020 in a single maternal fetal medicine practice. We used electronic records to get baseline characteristics and pregnancy/surgical outcomes based on the number of prior CDs. We performed two subgroup analyses for women with and without placenta previa. Chi-square for trend and one-way analysis of variance (ANOVA) were used. Results A total of 3,582 women underwent CD and met inclusion criteria. Of these women, 1,852 (51.7%) underwent their first cesarean, 950 (26.5%) their second, 382 (10.7%) their third, 191 (5.3%) their fourth, 117 (3.3%) their fifth, and 84 (2.3%) their sixth or higher CDs. The incidence of adverse outcomes (placenta accreta, uterine window, uterine rupture, hysterectomy, blood transfusion, cystotomy, bowel injury, need for a ventilator postpartum, intensive care unit admission, wound complications, thrombosis, reoperation, and maternal death) increased with additional CDs. However, the absolute rates remained low. In women without a placenta previa, the likelihood of adverse outcome did not differ across groups. In women with a placenta previa, adverse outcomes increased with increasing CDs. However, the incidence of placenta previa did not increase with increasing CDs (<5% in each group). The incidence of a uterine dehiscence increased significantly with additional CDs: first, 0.2%; second, 2.0%; third, 6.6%; fourth, 10.3%; fifth, 5.8%; and sixth or higher, 10.4% (p < 0.001). Conclusion Maternal morbidity increases with CDs, but the absolute risks remain low. For women without placenta previa, increasing CDs is not associated with maternal morbidity. For women with placenta previa, risks are highest, but the incidence of placenta previa does not increase with successive CDs. The likelihood of uterine dehiscence increases significantly with increasing CDs which should be considered when deciding about timing of delivery in this population. Key Points

scholarly journals Timing of Delivery and Adverse Outcomes in Term Singleton Repeat Cesarean Deliveries

2013 ◽  
Vol 121 (3) ◽  
pp. 561-569 ◽  
Author(s):  
Giuseppe Chiossi ◽  
Yinglei Lai ◽  
Mark B. Landon ◽  
Catherine Y. Spong ◽  
Dwight J. Rouse ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Cesarean Deliveries

The Association Between Number of Repeat Cesarean Deliveries and Adverse Outcomes among Low‐Risk Pregnancies

2022 ◽  
Author(s):  
Sami Backley ◽  
Han‐Yang Chen ◽  
Baha M. Sibai ◽  
Suneet P. Chauhan ◽  
Michal Fishel Bartal
Keyword(s):  
Adverse Outcomes ◽  
Low Risk ◽  
Cesarean Deliveries

scholarly journals The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes

2018 ◽  
Vol 08 (03) ◽  
pp. e146-e157 ◽  
Author(s):  
Dotun Ogunyemi ◽  
Andrew Jovanovski ◽  
James Liu ◽  
Perry Friedman ◽  
Nathaniel Sugiyama ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychotropic Drugs ◽  
Postpartum Hemorrhage ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Anxiety And Depression ◽  
Cesarean Deliveries ◽  
Adverse Neonatal Outcomes ◽  
Neonatal Adaptation ◽  
Anxiety Depression

Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.

scholarly journals Changes in adverse maternal, pregnancy, and delivery outcomes among U.S. delivery hospitalizations during the COVID-19 Pandemic, 2019-2020

2021 ◽  
Author(s):  
Regina M. Simeone ◽  
Karrie F. Downing ◽  
Bailey Wallace ◽  
Romeo R. Galang ◽  
Carla L. DeSisto ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Preterm Births ◽  
Population Level ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Healthcare Database ◽  
Cesarean Deliveries ◽  
Delivery Outcomes ◽  
Pregnancy And Delivery ◽  
Hospital Deaths

Abstract Background Early reports suggested changes in select pregnancy outcomes during the coronavirus disease 2019 (COVID-19) pandemic. The population-level impact of the pandemic on pregnancy and delivery outcomes is not well understood. Objective To assess whether pregnancies that ended during the pandemic were at increased or decreased risk of selected adverse outcomes compared to the previous year. Methods Data from a cohort of delivery hospitalizations occurring during April-December of 2019 and 2020 in the Premier Healthcare Database were analyzed. Prevalence of select adverse outcomes were examined. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using Poisson regression with robust standard errors. Results We identified 663,620 deliveries occurring April-December of 2019 and 614,093 deliveries occurring April-December of 2020. We observed an increase in in-hospital death from 2019 to 2020 (n=33; 5 per 100,000 vs. n=53; 9 per 100,000, aPR: 1.68, CI: 1.09, 2.59), which was no longer statistically significant after excluding deliveries with a COVID-19 diagnosis (aPR: 1.25, CI: 0.78, 2.00). Intensive care unit admission decreased from 2019 to 2020 (n=10,964; 1.7% vs. n=9,480; 1.5%, aPR: 0.90, CI: 0.87, 0.92). Preterm birth decreased from 2019 to 2020 (n=61,101; 9.2% vs. n=56,158; 9.1%, aPR: 0.96, CI: 0.95, 0.97). The prevalence of cesarean deliveries was similar in 2019 and 2020 (30.9% vs 31.6%, respectively), but there were some differences in cesarean delivery characteristics (e.g., an increase in cesarean deliveries due to conduct of labor [n=2,553; 1.2% vs. n=2,642; 1.4%, aPR: 1.11, CI: 1.05, 1.17]) from 2019 to 2020. Conclusions In 2020 compared to 2019, in-hospital deaths among pregnant women increased and there was a small decrease in prevalence of preterm births. The full impact of the COVID-19 pandemic on maternal and pregnancy outcomes remains to be understood. However, it appears that most outcomes investigated experienced minimal change from 2019 to 2020.

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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