Obstetric outcomes after instituting a dedicated External Cephalic Version clinic in a large tertiary centre: a 3-year prospective cohort study

Objective. To examine the association between adverse childhood experiences (ACE), prenatal common mental disorders (PCMDs) and delivery and neonatal outcomes. Also, to examine the overall effect of ACE and individual ACE subcategories on PCMD diagnosis and obstetric outcomes. Design. Prospective cohort study from pregnancy to birth. Setting. The study was based on an Icelandic cohort study and supplemented with maternal childbirth records from three hospitals in Iceland. Sample. Women recruited in the cohort study who had accessible childbirth records and singleton births (N = 522). Methods. Bayesian SEM was used to test pathways between ACE, PCMD and delivery and neonatal outcomes with probit regression models. Main outcome measures. ACE was assessed with a semi-structured interview. PCMD was diagnosed with the MINI+. Delivery outcomes were defined as pain management during labor and mode of delivery. Neonatal outcomes were defined as small for gestational age (SGA), preterm delivery (PD), Apgar score, fetal distress, and newborn intensive care unit (NICU) admissions. Results. Women having experienced ACE were at increased risk of PCMD [β=.538, p < .001, CI: .195-1.154] and PD [β=.768, p < .05, CI: .279 - 1.007)]. An indirect association was found between ACE and increased risk of non-spontaneous delivery [β=.054, p < .05, CI: .004 - .152], mediated by PCMD. Identical findings were observed for individual ACE subcategories. Conclusion. The negative impact of ACE on non-spontaneous delivery is mediated by the impact of ACE on PCMD diagnosis suggesting that interventions aimed at decreasing PCMD may reduce the risk of non-spontaneous delivery.

Download Full-text

Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study

Frontline Gastroenterology ◽

10.1136/flgastro-2017-100847 ◽

2017 ◽

Vol 9 (3) ◽

pp. 192-199 ◽

Cited By ~ 2

Author(s):

Hey-Long Ching ◽

Federica Branchi ◽

David S Sanders ◽

David Turnbull ◽

Reena Sidhu

Keyword(s):

Cohort Study ◽

Elderly Patients ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Diagnostic Yield ◽

Young Patients ◽

The Elderly ◽

Double Balloon Enteroscopy ◽

Tertiary Centre ◽

American Society

ObjectiveEvaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort.DesignProspective cohort studySettingAll patients undergoing DBE over a 30-month period were recruited at our tertiary centre.Patients215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly.InterventionsPatients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl).Main outcome measuresPatient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared.ResultsCardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn’s disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17).ConclusionCompared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.

Download Full-text