The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Abstract Background There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. Methods We used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. Results Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. Conclusions The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

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Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

Scientific Reports ◽

10.1038/s41598-021-92037-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yanxia Xie ◽

Xiaodong Wang ◽

Yi Mu ◽

Zheng Liu ◽

Yanping Wang ◽

...

Keyword(s):

Adolescent Pregnancy ◽

Gestational Age ◽

Rural Areas ◽

Reference Group ◽

Perinatal Outcomes ◽

Severe Anaemia ◽

Adverse Outcomes ◽

Near Miss ◽

Adolescent Women ◽

Adolescent Pregnancies

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

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Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v3i1.31918 ◽

2020 ◽

Vol 3 (1) ◽

pp. 234-238

Author(s):

Deepak Raj Kafle ◽

Prem Raj Pageni

Keyword(s):

Retrospective Study ◽

Vaginal Delivery ◽

Apgar Score ◽

Genital Tract ◽

Neonatal Morbidity ◽

Regional Hospital ◽

Assisted Vaginal Delivery ◽

Second Stage ◽

Vaginal Deliveries ◽

Western Regional

Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage. Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program. Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute. Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.

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Near miss: determinants of maternal near miss and perinatal outcomes: a prospective case control study from a tertiary care center of India

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1902497 ◽

2021 ◽

pp. 1-8

Author(s):

Neha Agarwal ◽

Vanita Jain ◽

Rashmi Bagga ◽

Pooja Sikka ◽

Seema Chopra ◽

...

Keyword(s):

Case Control Study ◽

Care Center ◽

Tertiary Care ◽

Perinatal Outcomes ◽

Case Control ◽

Near Miss ◽

Maternal Near Miss ◽

Tertiary Care Center ◽

Control Study ◽

Prospective Case Control Study

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Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery

Anesthesiology ◽

10.1097/aln.0000000000003589 ◽

2020 ◽

Vol 134 (1) ◽

pp. 52-60

Author(s):

Alexander J. Butwick ◽

Cynthia A. Wong ◽

Henry C. Lee ◽

Yair J. Blumenfeld ◽

Nan Guo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Relative Risk ◽

Vaginal Delivery ◽

Neonatal Intensive Care ◽

Neonatal Morbidity ◽

Assisted Ventilation ◽

Adjusted Relative Risk ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery

Background Up to 84% of women who undergo operative vaginal delivery receive neuraxial analgesia. However, little is known about the association between neuraxial analgesia and neonatal morbidity in women who undergo operative vaginal delivery. The authors hypothesized that neuraxial analgesia is associated with a reduced risk of neonatal morbidity among women undergoing operative vaginal delivery. Methods Using United States birth certificate data, the study identified women with singleton pregnancies who underwent operative vaginal (forceps- or vacuum-assisted delivery) in 2017. The authors examined the relationships between neuraxial labor analgesia and neonatal morbidity, the latter defined by any of the following: 5-min Apgar score less than 7, immediate assisted ventilation, assisted ventilation greater than 6 h, neonatal intensive care unit admission, neonatal transfer to a different facility within 24 h of delivery, and neonatal seizure or serious neurologic dysfunction. The authors accounted for sociodemographic and obstetric factors as potential confounders in their analysis. Results The study cohort comprised 106,845 women who underwent operative vaginal delivery, of whom 92,518 (86.6%) received neuraxial analgesia. The proportion of neonates with morbidity was higher in the neuraxial analgesia group than the nonneuraxial group (10,409 of 92,518 [11.3%] vs. 1,271 of 14,327 [8.9%], respectively; P < 0.001). The unadjusted relative risk was 1.27 (95% CI, 1.20 to 1.34; P < 0.001); after accounting for confounders using a multivariable model, the adjusted relative risk was 1.19 (95% CI, 1.12 to 1.26; P < 0.001). In a post hoc analysis, after excluding neonatal intensive care unit admission and neonatal transfer from the composite outcome, the effect of neuraxial analgesia on neonatal morbidity was not statistically significant (adjusted relative risk, 1.07; 95% CI, 1.00 to 1.16; P = 0.054). Conclusions In this population-based cross-sectional study, a neonatal benefit of neuraxial analgesia for operative vaginal delivery was not observed. Confounding by indication may explain the observed association between neuraxial analgesia and neonatal morbidity, however this dataset was not designed to evaluate such considerations. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Patient-requested Neuraxial Analgesia for Labor

Anesthesiology ◽

10.1097/01.anes.0000265165.06760.c2 ◽

2007 ◽

Vol 106 (5) ◽

pp. 1035-1045 ◽

Cited By ~ 47

Author(s):

Massimo Marucci ◽

Gilda Cinnella ◽

Gaetano Perchiazzi ◽

Nicola Brienza ◽

Tommaso Fiore ◽

...

Keyword(s):

Confidence Interval ◽

Vaginal Delivery ◽

Odds Ratio ◽

Meta Analysis ◽

Quality Criteria ◽

Control Group ◽

Neuraxial Analgesia ◽

Nulliparous Women ◽

Vaginal Deliveries ◽

Increased Risk

A systematic review, including a meta-analysis, on the timing effects of neuraxial analgesia (NA) on cesarean and instrumental vaginal deliveries in nulliparous women was conducted. Of 20 articles identified, 9 met the inclusion quality criteria (3,320 participants). Cesarean delivery (odds ratio, 1.00; 95% confidence interval, 0.82-1.23) and instrumental vaginal delivery (odds ratio, 1.00; 95% confidence interval, 0.83-1.21) rates were similar in the early NA and control groups. Neonates of women with early NA had a higher umbilical artery pH and received less naloxone. In the early NA group, fewer women were not compliant with assigned treatment and crossed over to the control group. Women receiving early NA for pain relief are not at increased risk of operative delivery, whereas those receiving early parenteral opioid and late epidural analgesia present a higher risk of instrumental vaginal delivery for nonreassuring fetal status, worse indices of neonatal wellness, and a lower quality of maternal analgesia.

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Maternal near-miss and the risk of adverse perinatal outcomes: a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-1983-y ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Ewnetu Firdawek Liyew ◽

Alemayehu Worku Yalew ◽

Mesganaw Fantahun Afework ◽

Birgitta Essén

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Addis Ababa ◽

Perinatal Outcomes ◽

Public Hospitals ◽

Near Miss ◽

Maternal Near Miss ◽

Adverse Perinatal Outcomes

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Characteristics and Adverse Outcomes of Chinese Adolescent Pregnancy Between 2012 and 2019: An Observational Study of 438 Health Facilities

10.21203/rs.3.rs-253568/v1 ◽

2021 ◽

Author(s):

Yanxia Xie ◽

Xiaodong Wang ◽

Yi Mu ◽

Zheng Liu ◽

Yanping Wang ◽

...

Keyword(s):

Adolescent Pregnancy ◽

Gestational Age ◽

Rural Areas ◽

Reference Group ◽

Perinatal Outcomes ◽

Severe Anaemia ◽

Adverse Outcomes ◽

Near Miss ◽

Adolescent Women ◽

Adolescent Fertility

Abstract We aimed to describes characteristic of adolescent pregnancy, determines its effect on adverse maternal and perinatal outcomes and explores whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. 2,366,559 women aged 10-24 years who had singleton pregnancies between 2012 and 2019 from 438 hospitals were included in the study. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effect. Women aged 20-24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 despite common-law marriage in rural areas have improved. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57~2.23), severe anaemia (aOR 1.18, 95% CI 1.09~1.28), maternal near miss (aOR 1.24, 95% CI 1.12~1.37), and small-for-gestational-age (aOR 1.30, 95% CI 1.28~1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent fertility and to avoid adverse fertility outcomes among adolescent women in China at a time when adolescent fertility is rebounding.

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Multiple Pregnancy: Epidemiology and Association with Maternal and Perinatal Morbidity

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1668117 ◽

2018 ◽

Vol 40 (09) ◽

pp. 554-562 ◽

Cited By ~ 8

Author(s):

Danielly Santana ◽

Fernanda Surita ◽

José Cecatti

Keyword(s):

Twin Pregnancy ◽

Multiple Pregnancy ◽

Perinatal Outcomes ◽

Rare Condition ◽

Vital Statistics ◽

Near Miss ◽

Maternal Near Miss ◽

Perinatal Morbidity ◽

Perinatal Complications ◽

Multicenter Studies

AbstractTwin pregnancy accounts for 2 to 4% of total births, with a prevalence ranging from 0.9 to 2.4% in Brazil. It is associated with worse maternal and perinatal outcomes. Many conditions, such as severe maternal morbidity (SMM) (potentially life-threatening conditions and maternal near-miss) and neonatal near-miss (NNM) still have not been properly investigated in the literature. The difficulty in determining the conditions associated with twin pregnancy probably lies in its relatively low occurrence and the need for larger population studies. The use of the whole population and of databases from large multicenter studies, therefore, may provide unprecedented results. Since it is a rare condition, it is more easily evaluated using vital statistics from birth e-registries. Therefore, we have performed a literature review to identify the characteristics of twin pregnancy in Brazil and worldwide. Twin pregnancy has consistently been associated with SMM, maternal near-miss (MNM) and perinatal morbidity, with still worse results for the second twin, possibly due to some characteristics of the delivery, including safety and availability of appropriate obstetric care to women at a high risk of perinatal complications.

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PREVALENCE OF NEAR MISS AND MATERNAL DEATHS AND ITS MATERNAL AND PERINATAL OUTCOMES: A RETROSPECTIVE STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i8.41893 ◽

2021 ◽

pp. 62-65

Author(s):

ANITA MADAN ◽

PALLAVI SHARMA ◽

JAGDEEP KAUR ◽

ANISHA PURI

Keyword(s):

Cesarean Section ◽

Maternal Mortality ◽

Maternal Mortality Ratio ◽

Perinatal Outcomes ◽

Near Miss ◽

Maternal Near Miss ◽

Maternal Deaths ◽

Emergency Cesarean ◽

Tertiary Teaching ◽

Mortality Ratio

Objectives: The objective of the study was to determine maternal mortality ratio (MMR), maternal near miss incidence ratio (MNM IR), MNM to mortality ratio (MNM: MD), and mortality index (MI) and to know the prevalence, demographic distribution, causes and feto-maternal outcome of maternal near miss and maternal deaths. Methods: A retrospective review of near miss and maternal mortality over a period of 20 months in a tertiary teaching hospital in Punjab. Results: MMR was 998 MNM IR was 24.20/1000 live births. Maternal near miss mortality ratio was 2.4:1. MI was 29.21%. The most common cause of maternal mortality was hypertension, which was seen in 14 (53.84%) women. Among near miss cases, the most common complication noted was hemorrhage, seen in 40 (63.49%) cases. Among maternal deaths, 7 (26.92%) women delivered vaginally, 6 (23.07%) women underwent emergency cesarean section. Among near miss cases, 20 (31.74%) women delivered vaginally, 13 (20.63%) women underwent cesarean section while 7 (11.11%) had cesarean hysterectomy. Laparotomy for ruptured ectopic pregnancy was done in 6 (9.52%) women, 7 (11.11%) women had dilatation and evacuation, 3 (4.76%) had exploration of Uterovaginal canal. Preterm birth has seen in 8 (12.69%) in maternal deaths and 23(36.50%) in maternal near miss. Intrauterine fetal demise occurred in 4 (6.34%) in maternal deaths and 2 (4.87%) in near miss. Conclusion: The review of near miss cases is important to identify response of health care system to medical emergencies and provides opportunities to improve the quality of service.

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