scholarly journals Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophia L. Tietjen ◽  
Marie-Therese Schmitz ◽  
Andrea Heep ◽  
Andreas Kocks ◽  
Lydia Gerzen ◽  
...  
Keyword(s):  
Case Control ◽  
Higher Order ◽  
Vaginal Birth ◽  
Low Risk ◽  
Study Group ◽  
Composite Outcome ◽  
Model Of Care ◽  
Obstetric Lacerations ◽  
Mode Of Birth ◽  
Low Risk Women

Abstract Background Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. Methods A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. Results Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). Conclusion Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Model of Care and Chance of Spontaneous Vaginal Birth: A Prospective, Multicenter Matched-Pair Analysis From North Rhine-Westphalia

2021 ◽  
Author(s):  
Sophia L. Tietjen ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Andreas Kocks ◽  
Lydia Gerzen ◽  
...  
Keyword(s):  
Obstetric Care ◽  
Case Control ◽  
Vaginal Birth ◽  
Study Group ◽  
Composite Outcome ◽  
Model Of Care ◽  
Obstetric Lacerations ◽  
Mode Of Birth ◽  
Secondary Endpoints ◽  
Low Risk Women

Abstract BackgroundCompared to standard obstetric care, advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. We compared the outcome of birth planned in alongside midwifery units (AMU) in North Rhine-Westphalia (NRW) with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time.MethodsA prospective, controlled, multicenter study was conducted. Six of the seven AMUs in NRW participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for standard obstetric care at the same hospital at the same time; additionally, matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of abnormal third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-minute Apgar <7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed for the primary and all secondary endpoints.Results589 case-control pairs were recruited, corresponding to 13.6% of those assumed to be eligible; 198 cases were excluded. Final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66, 90%-CI 1.26-10.04). Superiority was also confirmed for higher-order obstetric lacerations (2.33, 90%-CI 0.04-4.81). For the composite newborn outcome non-inferiority was established (1.28, 90%-CI 1.33-3.93). Non-inferiority was not present for the composite maternal outcome (-1.56, 90%-CI -5.86-2.75). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p<0.001 for both).Transfer to standard obstetric care occurred in 51.2% of cases, with a strong association between parity and transfer (p<0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). ConclusionOur comparison between care in AMU and standard obstetric care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. Admission and transfer criteria were in place in all participating centers and strictly adhered to.

Planned Place of Birth in New Zealand: Does it Affect Mode of Birth and Intervention Rates Among Low-Risk Women?

Birth ◽  
2011 ◽  
Vol 38 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Deborah Davis ◽  
Sally Baddock ◽  
Sally Pairman ◽  
Marion Hunter ◽  
Cheryl Benn ◽  
...  
Keyword(s):  
New Zealand ◽  
Low Risk ◽  
Place Of Birth ◽  
Mode Of Birth ◽  
Low Risk Women

Cervical length ≤25 mm in low-risk women: a case control study of cerclage with rest vs rest alone

2007 ◽  
Vol 197 (3) ◽  
pp. 315.e1-315.e4 ◽  
Author(s):  
Maddalena Incerti ◽  
Alessandro Ghidini ◽  
Anna Locatelli ◽  
Sarah H. Poggi ◽  
John C. Pezzullo
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Cervical Length ◽  
Low Risk ◽  
Low Risk Women ◽  
Control Study

scholarly journals Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

2019 ◽  
Author(s):  
Waltraut Maria Merz ◽  
Laura Tascon-Padron ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Sophia L. Tietjen ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Neonatal Outcome ◽  
Obstetric Care ◽  
Models Of Care ◽  
Low Risk ◽  
Control Group ◽  
Study Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

Cervical length <25 mm in low risk women: A case-control study of cerclage vs. rest

2006 ◽  
Vol 195 (6) ◽  
pp. S59
Author(s):  
Maddalena Incerti ◽  
Alessandro Ghidini ◽  
Sarah H. Poggi ◽  
Anna Locatelli
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Cervical Length ◽  
Low Risk ◽  
Low Risk Women ◽  
Control Study

scholarly journals Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany

2020 ◽  
Author(s):  
Waltraut Maria Merz ◽  
Laura Tascon-Padron ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Sophia L. Tietjen ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Primary Outcome ◽  
Obstetric Care ◽  
Low Risk ◽  
Control Group ◽  
Study Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time. Methods We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Non-inferiority could be established for the primary outcome parameters. Epidural anesthesia and episiotomy rates were lower, and the mean duration of the second stage of labor was shorter in the study group; second-degree perineal tears were less common, higher-order obstetric lacerations occurred more frequently. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Compared to births in our consultant-led obstetric unit, the outcome of births planned in the AMU was not inferior, and intervention rates were lower. Our results support the integration of AMU as a complementary model of care for low-risk women.

scholarly journals Sepsis score performance in women at high and low risk of intraamniotic infection: a retrospective case-control study

2020 ◽  
Author(s):  
Hen Y Sela ◽  
Vered Seri ◽  
Frederic S. Zimmerman ◽  
Philip D. Levin ◽  
Arnon Smueloff ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Low Risk ◽  
Limiting Current ◽  
Secondary Outcome ◽  
Study Group ◽  
Intraamniotic Infection ◽  
Sepsis Score ◽  
Control Study ◽  
Sirs Criteria

Abstract Background: Early infection identification may improve outcomes in obstetric patients. However, obstetric vital signs and laboratory values differ from the non-pregnant, possibly limiting current sepsis score use. Thus, we evaluated sepsis score use in peripartum infection. Methods: This case-control study evaluates sepsis criteria fulfilment in preterm premature rupture of membranes (PPROM) – at high infection risk– versus in elective caesarean delivery (CD) – at low risk. The study was perfoemd at the departement of obstetrics & gynecologt at Shaare Zedek Medical Center, a 1000-bed university-affiliated acute care hospital. We inlcuded women with PPROM undergoing CD (n=453) at gestational weeks 24-36 versus those undergoing elective term CD (n=2004). The primary and secondary outcome measures were SIRS and qSOFA criteria fullfilment and availability of the score components and clinical intraamniotic infection and positive cultures rates. Results: At admission 14.8% of the study group and 4.6% of control met SIRS criteria (p=0.001), as did 12.5% and 5.5% on post-operation day (POD) 1 (p=0.001), with no significant differences on POD 0 or 2. In the study group more cultures (29.8% versus 1.9% – cervix; 27.4% versus 1.1% – placenta; 7.5% versus 1.7% – blood; p=0.001 – all differences) and more positive cultures (5.5% versus 3.0% – urine – p=0.008; 4.2% versus 0.2% – cervix – p=0.001; 7.3% versus 0.0% – placenta – p=0.001; 0.9% versus 0.1% – blood – p=0.008) were obtained. 10.6% of the study group and 0.4% of control met criteria for intraamniotic infection (p=0.001). Conclusions: Though significant difference was noted in SIRS criteria fulfilment in the study group versus control, there was considerable between-group overlap, questioning utility of SIRS in intraamniotic infection diagnosis.

Cervical Length ≤25 mm in Low-Risk Women: A Case Control Study of Cerclage with Rest vs Rest Alone

2008 ◽  
Vol 63 (2) ◽  
pp. 74-75
Author(s):  
Maddalena Incerti ◽  
Alessandro Ghidini ◽  
Anna Locatelli ◽  
Sarah H. Poggi ◽  
John C. Pezzullo
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Cervical Length ◽  
Low Risk ◽  
Low Risk Women ◽  
Control Study
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