scholarly journals Compliance with venous thromboembolism guideline after delivery at Maternity Teaching Hospital, Erbil city, Iraq

2021 ◽  
Vol 25 (3) ◽  
pp. 675-685
Author(s):  
Parween Nawkhas ◽  
Shahla Alalaf
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Teaching Hospital ◽  
Odds Ratio ◽  
Post Partum ◽  
Wrong Decision ◽  
Emergency Cesarean

Background and objective: Venous thromboembolism is a leading cause of maternal morbidity and mortality. Few published articles have evaluated obstetricians' compliance with thromboprophylaxis guidelines, especially after vaginal delivery. This study aimed to assess obstetricians’ adherence to postpartum thromboprophylaxis guidelines and correlate adherence with the risk factors for venous thromboembolism after vaginal and cesarean delivery. Methods: A cross-sectional study involving 981 women delivered at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, was conducted. Obstetricians' compliance with the thromboprophylaxis guideline regarding dose, duration, and indications were recorded. We assessed the risk factors for thromboembolism using the 2015 Royal College of Obstetricians and Gynecologists guideline. Results: Medical thromboprophylaxis was required but not given to 93.2% of the women who delivered vaginally compared with 6.7% of the women who delivered by cesarean section. Women who delivered vaginally had a higher rate of age ˃ 36 years, parity of 3 and more, varicose vein, and current infection (P <0.001). The rates of preeclampsia, preterm labor, and prolonged labor were highest in the emergency cesarean section group (P <0.001). Factors associated with making a wrong decision were having no preeclampsia (odds ratio=15.4; 95% confidence interval=3.4–68.6), post-partum hemorrhage (odds ratio=15.3; 95% confidence interval=2.0–114.2), and vaginal delivery (odds ratio=250.2; 95% confidence interval=110.6–566.0). Conclusion: Obstetricians' compliance with postpartum thromboprophylaxis in the hospital was low, especially after vaginal delivery. Keywords: Thromboprophylaxis; Postpartum; Compliance; Venous thromboembolism; Guideline.

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

2020 ◽  
pp. 000486742095428
Author(s):  
Lei Sun ◽  
Su Wang ◽  
Xi-Qian Li
Keyword(s):  
Postpartum Depression ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Spontaneous Vaginal Delivery ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation

2017 ◽  
Vol 28 (2) ◽  
pp. 234-242 ◽  
Author(s):  
Christie M. Atchison ◽  
Ernest Amankwah ◽  
Jean Wilhelm ◽  
Shilpa Arlikar ◽  
Brian R. Branchford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Critically Ill ◽  
Odds Ratio ◽  
Cardiothoracic Surgery ◽  
Critically Ill Children ◽  
Cardiovascular Intensive Care

AbstractBackgroundPaediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.ObjectiveThe aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.MethodsWe conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.ResultsAmong 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.ConclusionMajor infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

scholarly journals Prediction of emergency cesarean section by measurable maternal and fetal characteristics

2020 ◽  
Vol 68 (3) ◽  
pp. 799-806 ◽  
Author(s):  
Ping Guan ◽  
Fei Tang ◽  
Guoqiang Sun ◽  
Wei Ren
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Amniotic Fluid ◽  
Vaginal Delivery ◽  
Scoring System ◽  
Normal Vaginal Delivery ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Risk Scoring ◽  
Risk Scoring System

ObjectiveTo analyze the maternal and fetal factors affecting emergency cesarean section (EmCS) and establish a risk scoring system to quantitatively predict the risk of EmCS.DesignA total of 10,295 pregnant women were enrolled in this study. The influence of maternal and fetal factors on the risk of EmCS was analyzed.Results991 (9.63%) cases of failed vaginal delivery received EmCS. The two main causes of EmCS were fetal distress (67.21%) and abnormal fetal position (14.93%). There were significant differences in 17 maternal and fetal factors between the normal vaginal delivery (NVD) and EmCS groups (p<0.05 for all). Univariate and multivariate regression analyses showed that nine maternal and infant factors were independent risk factors (p<0.05 for all). The major factors were abnormal quantity of amniotic fluid (OR 6.867, 95% CI 4.442 to 10.618), nulliparous (OR 4.336, 95% CI 3.074 to 6.115), induction of labor (OR 5.300, 95% CI 4.514 to 6.224) and abnormal characters of amniotic fluid (OR 3.126, 95% CI 2.708 to 3.608). A risk scoring system (six grades) was established based on those factors which showed high discriminative power. The rate of EmCS was 1.30%, 2.57%, 5.83%, 13.94%, 21.75% and 39.71% in grades 1, 2, 3, 4, 5 and 6, respectively. The area under the curve of the risk scoring system was 0.787, indicating that the regression model of the risk factors had a good predictive ability.ConclusionAn effective risk scoring system has been developed to quantitatively assess the risk of EmCS based on measurable maternal and fetal factors. The system is simple, easy to operate and has good repeatability in clinical practice.

scholarly journals Association of Chorioamnionitis With Failed Conversion of Epidural Labor Analgesia to Cesarean Delivery Anesthesia: a Retrospective Cohort Study

2020 ◽  
Author(s):  
Yumi Katakura ◽  
Yusuke Nagamine ◽  
Takahisa Goto ◽  
Hiroyuki Sumikura
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Labor Analgesia ◽  
University Hospital ◽  
Emergency Cesarean

Abstract Background: This study examined the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.Methods: This retrospective cohort study, conducted in a single-center university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of the study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.Results: Among the 180 parturients, it was found that 58 parturients (43.9%) fulfilled the criteria of chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than that in the chorioamnionitis (-) group (46.6 % [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval 1.7-8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval 1.6-8.4). Conclusions: Chorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.

scholarly journals Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Felicitas Schulz ◽  
Ekkehart Jenetzky ◽  
Nadine Zwink ◽  
Charlotte Bendixen ◽  
Florian Kipfmueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Environmental Risk ◽  
Odds Ratio ◽  
Alcohol Intake ◽  
Case Control Study ◽  
Case Control ◽  
Parental Risk Factors ◽  
Healthy Control ◽  
Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

scholarly journals Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mabel Aoun ◽  
Rabab Khalil ◽  
Walid Mahfoud ◽  
Haytham Fatfat ◽  
Line Bou Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
National Study ◽  
Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

Subclinical atherosclerosis in children and adolescents with congenital heart disease

2020 ◽  
pp. 1-8
Author(s):  
Silvia M. Cardoso ◽  
Michele Honicky ◽  
Yara M. F. Moreno ◽  
Luiz R. A. de Lima ◽  
Matheus A. Pacheco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Congenital Heart ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.

Incidence of Venous Thromboembolism in Families with Inherited Thrombophilia

1999 ◽  
Vol 81 (02) ◽  
pp. 198-202 ◽  
Author(s):  
Paolo Simioni ◽  
Bernd-Jan Sanson ◽  
Daniela Tormene ◽  
Philip Friederich ◽  
Bruno Girolami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Oral Contraceptive ◽  
Contraceptive Use ◽  
Post Partum ◽  
Family Members ◽  
Factor V Leiden ◽  
Factor V ◽  
Relative Risks ◽  
Oral Contraceptive Use

SummaryThe risk of spontaneous or risk-period related venous thromboembolism in family members of symptomatic carriers of antithrombin (AT), protein C (PC) or protein S (PS) defects, as well as of the Factor V Leiden mutation is still undefined. We performed a retrospective cohort study in family members (n = 793) of unselected patients with a documented venous thromboembolism and one of these deficiencies to make an estimate of this risk. The annual incidences of total and spontaneous venous thromboembolic events in carriers of AT, PC or PS defects (n = 181) were 1.01% and 0.40%, respectively, as compared to 0.10% and 0.04% in non-carriers, respectively (relative risks both 10.6). In carriers of Factor V Leiden (n = 224), the annual incidences of total and spontaneous venous thromboembolism were 0.28% and 0.11%, respectively, as compared to 0.09% and 0.04% in non-carriers, respectively (relative risks 2.8 and 2.5). Additional risk factors (immobilisation, surgery and trauma; oral contraceptive use; and pregnancy/ post-partum) increased the risk of thrombosis in carriers of AT, PC and PS defects as compared to non-carriers (relative risks 8.3, 6.4 and 8.2, respectively). Oral contraceptive use and pregnancy/ post-partum period increased the risk of thrombosis in carriers of Factor V Leiden to 3.3-fold and 4.2-fold, respectively, whereas other risk factors had only a minor effect.These data lend some support to the practice of screening family members of symptomatic carriers of a AT, PC and PS deficiency. For family members of symptomatic carriers of Factor V Leiden, screening does not seem to be justified except for women in fertile age.

scholarly journals Adverse Maternal and Fetal Outcome in Patients with Eclampsia

2019 ◽  
Vol 16 (41) ◽  
pp. 425-427
Author(s):  
Tarun Pradhan ◽  
Pappu Rijal ◽  
Rubina Rai ◽  
Rabindra Dev Bhatta ◽  
Baburam Dixit Thapa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Maternal Mortality ◽  
Magnesium Sulphate ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Adverse Outcomes ◽  
Time Interval ◽  
Maternal Condition ◽  
Emergency Cesarean

Background: Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. Methods: All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. Results: Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusions: Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes. Keywords: Eclampsia; maternal mortality; risk factors.

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