scholarly journals The Generalizability of Patients’ Preferences and Concerns regarding Anesthesia Care for Cesarean Delivery: A Prospective Survey

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Aaron J. Smith ◽  
Jaime Daly ◽  
David E. Arnolds ◽  
Barbara M. Scavone ◽  
Brendan Carvalho
Keyword(s):  
African American ◽  
Cesarean Delivery ◽  
Women Of Color ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Anesthesia Care ◽  
Demographic Groups ◽  
Obstetric Population ◽  
Anesthetic Outcomes ◽  
Two Populations

Background. False assumptions regarding the generalizability of patients’ expectations and preferences across different demographic groups may contribute in part to the increased prevalence of negative peripartum outcomes seen among women of color. The intention of this study was to determine preferences and concerns regarding anesthesia care during cesarean delivery in a largely African-American population and to compare them to those obtained in a prior study conducted in a demographically distinct population. Methods. Women presenting for scheduled cesarean delivery or induction of labor completed a preoperative survey requesting demographic information and the opportunity to rank ten common potential anesthetic outcomes in relation to each other from most to least desirable. Participants were also asked about their biggest fear concerning their anesthetic and their preferences and expectations regarding degree of wakefulness, pain, and other adverse events. Those who underwent cesarean delivery were administered a briefer postoperative survey. We tabulated preference rankings and then compared demographic and outcome data to that obtained in a previous study with a demographically dissimilar population. Results. A total of 73 women completed the preoperative survey, and 64 took the postoperative survey. Pain during and after cesarean delivery was ranked as least desirable outcomes and fear of paralysis was respondents’ principal concern with neuraxial anesthesia. Postoperative concerns were similar to preoperative concerns and did not correlate with the frequency with which specific adverse outcomes occurred. These results were consistent with those from the previous study despite the women in this study being more likely to be younger, unmarried, African-American, and less educated than those in the previous investigation. Conclusions. Patient preference rankings and concerns were remarkably similar to those previously demonstrated despite a number of demographic differences between the two populations, suggesting generalizability of these preferences to a broader obstetric population.

scholarly journals Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shilei Bi ◽  
Lizi Zhang ◽  
Jingsi Chen ◽  
Minshan Huang ◽  
Lijun Huang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Cesarean Delivery ◽  
Maternal Age ◽  
Reference Group ◽  
Multivariate Logistic Regression Analysis ◽  
Advanced Maternal Age ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Singleton Pregnancies

Abstract Background To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. Methods This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis. Results The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years). Conclusions Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.

scholarly journals Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery

2018 ◽  
Vol 08 (04) ◽  
pp. e349-e354 ◽  
Author(s):  
Rodney McLaren ◽  
Fouad Atallah ◽  
Nelli Fisher ◽  
Howard Minkoff
Keyword(s):  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
External Cephalic Version ◽  
Multivariable Logistic Regression Analysis ◽  
Success Rates ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes ◽  
Previous Cesarean

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

scholarly journals Interim-analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry

2021 ◽  
Author(s):  
Julius J Schmidt ◽  
Dan Nicolae Borchina ◽  
Mariet van´t Klooster ◽  
Khalida Bulhan-Soki ◽  
Reuben Okioma ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Sofa Score ◽  
Cox Regression ◽  
Treatment Time ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Icu Patients ◽  
Icu Admission ◽  
Late Initiation ◽  
Bacterial Superinfection

Abstract Background The Seraph®100 Microbind Affinity Blood Filter® is a hemoperfusion device that is licensed for the reduction of pathogens, including several viruses, in the blood. It received Emergency Use Authorization (EUA) for the treatment of severe coronavirus disease 2019 (COVID-19) by the FDA. Several studies have shown that the blood viral load of SARS-CoV-2 correlates with adverse outcomes and removal of the nucleocapsid of the SARS-CoV-2 virus by the Seraph®100 has been recently demonstrated. The aim of this registry was to evaluate safety and efficacy of Seraph®100 treatment for COVID-19 patients. Methods Twelve hospitals from six countries representing two continents documented patient and treatment characteristics as well as outcome parameters without reimbursement. Additionally, mortality and safety results of the device were reported. One hundred-and-two treatment sessions in 82 patients were documented in the registry. Four patients were excluded from mortality analysis due to incomplete outcome data, which were available in the other 78 patients. Results Overall, a 30-day mortality rate of 46.2% in the 78 patients with complete follow up was reported. Median treatment time was 5.00 [4.00–13.42] h. and 43.1% of the treatments were performed as hemoperfusion only. Adverse events of the Seraph®100 treatment were reported in 8.8% of the 102 treatments and represented premature end of treatment due to circuit failure. Patients that died were treated later in their ICU stay and onset of COVID symptoms. They also had higher ferritin levels. Multivariate Cox regression revealed that delayed Seraph®100 treatment after ICU admission (&gt;60 hours) as well as bacterial superinfection were associated with mortality. While average predicted mortality rate according to SOFA score in ICU patients was 56.7% the observed mortality was 50.7%. In non-ICU patients 4C-Score average predicted a mortality rate of 38.0% while the observed mortality rate was 11.1% Conclusions The treatment of COVID-19 patients with Seraph®100 is well tolerated and the circuit failure rate was lower than previously reported for KRT in COVID-19 patients. Mortality corelated with late initiation of Seraph treatment after ICU admission and bacterial superinfection infection. Compared to predicted mortality according to 4C-Score and SOFA Score, mortality of Seraph®100 treated patients reported in the registry was lower.

scholarly journals Bacterial genotypic and patient risk factors for adverse outcomes in Escherichia coli bloodstream infections: a prospective molecular-epidemiological study

2021 ◽  
Author(s):  
Elita Jauneikaite ◽  
Kate Honeyford ◽  
Oliver Blandy ◽  
Mia Mosavie ◽  
Max Pearson ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Length Of Stay ◽  
Single Agent ◽  
Bloodstream Infections ◽  
Outcome Data ◽  
Sequence Type ◽  
Adverse Outcomes ◽  
Beta Lactam ◽  
E Coli ◽  
Sequence Types

Background Escherichia coli bloodstream infections have increased rapidly in the UK, for reasons that are unclear. The relevance of highly fit, or multi-drug resistant lineages such as ST131 to overall E. coli disease burden remains to be fully determined. We set out to characterise the prevalence of E. coli multi-locus sequence types (MLST) and determine if these were associated with adverse outcomes in an urban population of E. coli bacteraemia patients. Methods We undertook whole genome sequencing of E. coli blood isolates from all patients with diagnosed E. coli bacteraemia in north-west London from July 2015 to August 2016 and assigned multi-locus sequence types to all isolates. Isolate sequence types were linked to routinely collected antimicrobial susceptibility, patient demographic, and clinical outcome data to explore relationships between the E. coli sequence types, patient factors, and outcomes. Findings A total of 551 E. coli genomes were available for analysis. More than half of these cases were caused by four E. coli sequence types: ST131 (21%), ST73 (15%), ST69 (9%) and ST95 (8%). E. coli genotype ST131-C2 was associated with non-susceptibility to quinolones and third-generation cephalosporins, and also to amoxicillin, augmentin, gentamicin and trimethoprim. An association between the ST131-C2 lineage and longer length-of-stay was detected, although multivariable regression modelling did not demonstrate an association between E. coli sequence type and mortality. However, a number of unexpected associations were identified, including gentamicin non-susceptibility, ethnicity, and sex that might influence mortality and length-of-stay, requiring further research. Interpretation Although E. coli sequence type was associated with antimicrobial non-susceptibility patterns and length-of-stay, we did not find that E. coli sequence type was associated with increased mortality. Where ST131 is prevalent, caution is required when pairing beta-lactam agents with gentamicin or using single agent aminoglycosides.

scholarly journals The Impact of COVID-19 on Risky Behaviors and Health Changes in African-American Smokers Who Are Eligible for LDCT Screening

2021 ◽  
Vol 9 ◽  
Author(s):  
Tung-Sung Tseng ◽  
Mirandy Li ◽  
Yu-Hsiang Kao ◽  
Lei-Shih Chen ◽  
Hui-Yi Lin
Keyword(s):  
African American ◽  
Risky Behaviors ◽  
Adverse Outcomes ◽  
Health Changes ◽  
The Us ◽  
The Mean ◽  
Vegetables And Fruits ◽  
Control And Management ◽  
Low Dose Computed Tomography ◽  
The Impact

The COVID-19 pandemic has disrupted much of day-to-day life in the US and around the world. Smokers have a higher risk of adverse outcomes due to COVID-19. This study investigated the impact of COVID-19 on risky behaviors and health changes in lower income African-American smokers eligible for Low dose computed tomography (LDCT) screening, who may be more adversely impacted by the COVID-19 pandemic. A total of 22 African-American daily smokers who were eligible for LDCT screening participated in this study. The mean age of participants was 61.2 years old (SD = 4.7), 77.3% of the smokers were female, all participants had an income below $20,000, and 63.6% were on Medicaid. Descriptive statistics were used to provide summary information on demographics, COVID-19, and health status. Results showed that participants increased cigarette smoking, spent more time on screens, increased sugary drink consumption, consumed more vegetables and fruits, and engaged in more gardening activities during the COVID-19 pandemic. However, participants also decreased physical activity time and slept less during the pandemic. In general, more than one-third of participants gained more body weight and reported increased stress and anxiety. Our results suggest that African-American smokers who qualify for LDCT screening should be encouraged to consider strategies not only for smoking cessation, but also risky behavior control and management.

Anesthesia Care Handovers and Risk of Adverse Outcomes

JAMA ◽  
2018 ◽  
Vol 319 (21) ◽  
pp. 2235 ◽  
Author(s):  
Vikas N. O'Reilly-Shah ◽  
Grant C. Lynde ◽  
Craig S. Jabaley
Keyword(s):  
Adverse Outcomes ◽  
Anesthesia Care

Duration of Spontaneous Active Labor and Perinatal Outcomes Using Contemporary Labor Curves

2018 ◽  
Vol 35 (12) ◽  
pp. 1186-1191 ◽  
Author(s):  
Kara Hoppe ◽  
Melissa Schiff ◽  
Thomas Benedetti ◽  
Shani Delaney
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Inclusion Criteria ◽  
Labor Duration ◽  
Estimated Blood Loss ◽  
Active Labor

Objective Evaluate the association between spontaneous active labor duration utilizing contemporary labor curves and risk of adverse outcomes. Materials and Methods This is a retrospective cohort study from January 2012 to January 2015. Subjects were nulliparous, 18 to 44 years, with a cephalic, singleton ≥37 weeks in spontaneous labor. Subjects were placed into three subgroups, defined by active labor duration from 6 to 10 cm as less than the median, the median-95th, and >95th percentile based on contemporary labor curves published by Zhang et al. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, estimated blood loss, Apgar score < 7 at 5 minutes, and neonatal intensive care unit admission using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Results Six-hundred forty two women met the inclusion criteria. Compared with women whose active labor was less than the median, the risk of cesarean was higher in the median-95th percentile ([adjusted OR, aOR] 3.1, 95% CI 1.8–5.5) and the >95th percentile ([aOR] 6.8, 95% CI 3.9–11.7) subgroups. There was an increased odds of chorioamnionitis in the median-95th percentile subgroup ([aOR] 2.5, 95% CI 1.1–5.9). Conclusion Chorioamnionitis and cesarean delivery increased significantly as labor duration exceeded the median. This study provides a better understanding regarding the potential risk of cesarean and chorioamnionitis using contemporary labor curves.

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