scholarly journals Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0245977
Author(s):  
Melaku Desta ◽  
Getachew Mullu Kassa ◽  
Temesgen Getaneh ◽  
Yewbmirt Sharew ◽  
Addisu Alehegn Alemu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Maternal Mortality ◽  
Uterine Rupture ◽  
Maternal Morbidity ◽  
Perinatal Death ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Mortality And Morbidity ◽  
Prolonged Duration ◽  
Duration Of Operation

Background Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger’s test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). Results The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). Conclusions The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.

scholarly journals The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2035
Author(s):  
Tesfaye S. Mengistu ◽  
Jessica M. Turner ◽  
Christopher Flatley ◽  
Jane Fox ◽  
Sailesh Kumar
Keyword(s):  
Systematic Review ◽  
Maternal Morbidity ◽  
Perinatal Death ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Obstetric Hemorrhage ◽  
Hypertensive Disorders ◽  
Adverse Perinatal Outcomes ◽  
Nicu Admission ◽  
The Impact

While there is clear evidence that severe maternal morbidity (SMM) contributes significantly to poor maternal health outcomes, limited data exist on its impact on perinatal outcomes. We undertook a systematic review and meta-analysis to ascertain the association between SMM and adverse perinatal outcomes in high-income countries (HICs). We searched for full-text publications in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus databases. Studies that reported data on the association of SMM and adverse perinatal outcomes, either as a composite or individual outcome, were included. Two authors independently assessed study eligibility, extracted data, and performed quality assessment using the Newcastle–Ottawa Scale. We used random-effects modelling to calculate odds ratios (ORs) with 95% confidence intervals. We also assessed the risk of publication bias and statistical heterogeneity using funnel plots and Higgins I2, respectively. We defined sub-groups of SMM as hemorrhagic disorders, hypertensive disorders, cardiovascular disorders, hepatic disorders, renal disorders, and thromboembolic disorders. Adverse perinatal outcome was defined as preterm birth (before 37 weeks gestation), small for gestational age (SGA) (birth weight (BW) < 10th centile for gestation), low birthweight (LBW) (BW < 2.5 kg), Apgar score < 7 at 5 min, neonatal intensive care unit (NICU) admission, stillbirth and perinatal death (stillbirth and neonatal deaths up to 28 days). A total of 35 studies consisting of 38,909,426 women were included in the final analysis. SMMs associated with obstetric hemorrhage (OR 3.42, 95% CI: 2.55–4.58), severe hypertensive disorders (OR 6.79, 95% CI: 6.06–7.60), hepatic (OR 3.19, 95% CI: 2.46–4.13) and thromboembolic disorders (OR 2.40, 95% CI: 1.67–3.46) were significantly associated with preterm birth. SMMs from hypertensive disorders (OR 2.86, 95% CI: 2.51–3.25) or thromboembolic disorders (OR 1.48, 95% CI: 1.09–1.99) were associated with greater odds of having SGA infant. Women with severe hemorrhage had increased odds of LBW infant (OR 2.31, 95% CI: 1.57–3.40). SMMs from obstetric hemorrhage (OR 4.16, 95% CI: 2.54–6.81) or hypertensive disorders (OR 4.61, 95% CI: 1.17–18.20) were associated with an increased odds of low 5-min Apgar score and NICU admission (Severe obstetric hemorrhage: OR 3.34, 95% CI: 2.26–4.94 and hypertensive disorders: OR 3.63, 95% CI: 2.63–5.02, respectively). Overall, women with SMM were 4 times more likely to experience stillbirth (OR 3.98, 95% CI: 3.12–7.60) compared to those without SMM with cardiovascular disease (OR 15.2, 95% CI: 1.29–180.60) and thromboembolic disorders (OR 9.43, 95% CI: 4.38–20.29) conferring greatest risk of this complication. The odds of neonatal death were significantly higher in women with SMM (OR 3.98, 95% CI: 2.44–6.47), with those experiencing hemorrhagic (OR 7.33, 95% CI: 3.06–17.53) and hypertensive complications (OR 3.0, 95% CI: 1.78–5.07) at highest risk. Overall, SMM was also associated with higher odds of perinatal death (OR 4.74, 95% CI: 2.47–9.12) mainly driven by the increased risk in women experiencing severe obstetric hemorrhage (OR 6.18, 95% CI: 2.55–14.96). Our results highlight the importance of mitigating the impact of SMM not only to improve maternal health but also to ameliorate its consequences on perinatal outcomes.

scholarly journals Impact of severe maternal morbidity on adverse perinatal outcomes in high-income countries: systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027100 ◽  
Author(s):  
Tesfaye S Mengistu ◽  
Jessica Turner ◽  
Christopher Flatley ◽  
Jane Fox ◽  
Sailesh Kumar
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Maternal Morbidity ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
High Income ◽  
Severe Maternal Morbidity ◽  
Low Middle Income Countries ◽  
Adverse Perinatal Outcomes ◽  
Meta Analyses

IntroductionSevere maternal morbidity (SMM) includes conditions that are on a continuum of maternal morbidity to maternal death. Rates of SMM are increasing both in high-income countries (HICs) as well as in low/middle-income countries (LMICs). There is evidence that analysis of SMM trends and detailed investigation of factors implicated in these cases may reflect the standard of maternal healthcare both in HICs and LMICs. SMM is also associated with poorer perinatal outcomes. The aim of this protocol is to describe the proposed methodology for the synthesis and analyses of the data describing the relationship between SMM and adverse perinatal outcomes in a systematic review and meta-analysis.MethodsThis systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews (PROSPERO). Original peer-reviewed epidemiologic/clinical studies of observational (cross-sectional, cohort, case-control) and randomised controlled trial studies conducted in high-income countries will be included. An electronic search of PubMed, Embase, CINAHL and Scopus databases will be performed without restricting publication date/year. Two authors will independently screen the titles, review abstracts and perform data extraction. Where possible, meta-analyses will be done to calculate pooled estimates.Ethics and disseminationAs this is a protocol for systematic review and meta-analysis of published data, ethics review and approval are not required. The findings will be published in peer-reviewed journals and disseminated at scientific conferences.PROSPERO registration numberCRD42019130933.

Comparison of Perinatal Outcomes of Pregnant Women with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Pengming Sun ◽  
Hangjing Gao ◽  
Xiqi Huang ◽  
Huanrui Zheng ◽  
Hongning Cai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Meta Analysis ◽  
Perinatal Outcomes

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Influenza-associated disease burden in mainland China: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jing Li ◽  
Yinzi Chen ◽  
Xiling Wang ◽  
Hongjie Yu
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Fixed Effects ◽  
Disease Burden ◽  
Outpatient Visit ◽  
Meta Analysis ◽  
Age Groups ◽  
Mainland China ◽  
Mortality And Morbidity ◽  
All Cause Mortality

AbstractInfluenza causes substantial morbidity and mortality. Many original studies have been carried out to estimate disease burden of influenza in mainland China, while the full disease burden has not yet been systematically reviewed. We did a systematic review and meta-analysis to assess the burden of influenza-associated mortality, hospitalization, and outpatient visit in mainland China. We searched 3 English and 4 Chinese databases with studies published from 2005 to 2019. Studies reporting population-based rates of mortality, hospitalization, or outpatient visit attributed to seasonal influenza were included in the analysis. Fixed-effects or random-effects model was used to calculate pooled estimates of influenza-associated mortality depending on the degree of heterogeneity. Meta-regression was applied to explore the sources of heterogeneity. Publication bias was assessed by funnel plots and Egger’s test. We identified 30 studies eligible for inclusion with 17, 8, 5 studies reporting mortality, hospitalization, and outpatient visit associated with influenza, respectively. The pooled influenza-associated all-cause mortality rates were 14.33 and 122.79 per 100,000 persons for all ages and ≥ 65 years age groups, respectively. Studies were highly heterogeneous in aspects of age group, cause of death, statistical model, geographic location, and study period, and these factors could explain 60.14% of the heterogeneity in influenza-associated mortality. No significant publication bias existed in estimates of influenza-associated all-cause mortality. Children aged < 5 years were observed with the highest rates of influenza-associated hospitalizations and ILI outpatient visits. People aged ≥ 65 years and < 5 years contribute mostly to mortality and morbidity burden due to influenza, which calls for targeted vaccination policy for older adults and younger children in mainland China.

scholarly journals 329 Perinatal outcomes of pregnancies with iatrogenic chorioamniotic separation following fetal interventions: systematic review and meta-analysis

2021 ◽  
Vol 224 (2) ◽  
pp. S216
Author(s):  
Ahmed A. Nassr ◽  
Hessami Kamran ◽  
Sherif Shazly ◽  
Nazlisadat Meshinchiasl ◽  
Romain Corroenne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Perinatal Outcomes
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