Continuous intrapartum support to reduce primary cesarean in Mexico

2020 ◽  
Author(s):  
Luz Maria Cardona-Torres ◽  
Rafael Leyva-Jimenez
Keyword(s):  
Risk Reduction ◽  
Cesarean Delivery ◽  
Absolute Risk ◽  
Obstetric Care ◽  
Absolute Risk Reduction ◽  
Delivery Rate ◽  
Control Group ◽  
Study Group ◽  
Cesarean Deliveries ◽  
Cesarean Delivery Rate

Abstract Background Cesarean deliveries are effective in saving maternal and infant lives, but only when they are necessary for medical reasons. In Mexico, the average cesarean delivery rate in 2015 was reported at 45%, the high incidence of cesarean deliveries is considered a problem of public health in the country, our purpose was to reduce the cesarean delivery rate for primary cesarean, in nulliparous women, term, singleton, vertex presentation and under 40 years through continuous intrapartum support provided by a professional nurse. Methods This was a historical control study, in a health institution in Mexico, in the period de July-December 2018. The control group received the usual obstetric care, without continuous intrapartum support. The study group received the usual obstetric care plus continuous intrapartum support, it was obtained the cesarean delivery rate, estimating the risk ratio, the absolute risk reduction and odds ratio, in addition, a binomial logistic regression model was carried out and was adjusted with possible covariates. Results In the study group the cesarean delivery rate was 1.7% (1 of 60) significantly lower than in the control group (29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% - 40%), also the hours of labor were significantly lower (p < 0.001) in the study group (median = 6.7 hours, 95% CI: 6.0-8.1), than in the control group (median = 13.4 hours, 95% CI: 10.7 - 16.1) and no significant covariates were found. Keywords: Cesarean delivery rate, Continuous intrapartum support, labor

scholarly journals Continuous intrapartum support to reduce primary cesarean

2019 ◽  
Author(s):  
Luz Maria Cardona-Torres ◽  
Rafael Leyva-Jimenez
Keyword(s):  
Cesarean Delivery ◽  
Group Versus ◽  
Active Phase ◽  
World Health ◽  
Delivery Rate ◽  
Control Group ◽  
Study Group ◽  
Professional Nurse ◽  
Average Percentage ◽  
Cesarean Delivery Rate

Abstract Background The average percentage of births by cesarean section worldwide in 2014 was 18.6% (range: 1.4% to 56.4%), and in Latin America and the Caribbean 40.5% [range: 5.5% - 55.6%]. In Mexico, the cesarean delivery rate remained above 40% in the period from 2008 to 2015, and without signs of decreasing, the World Health Organization recommends up to 15% maximum. The objective of the study was to decrease the rate of deliveries by cesarean, through continuous intrapartum support during the active phase until birth.Methods Experimental study, open label, carried out in a public health institution in Mexico, during July-December 2018, with a study population of N = 115 women in labor (nulliparous, term, singleton, vertex) and under 40 years old, was formed a control group (n = 55) who received routine maternity care and a study group (n = 60), who received continuous intrapartum support during the active phase until birth by a professional nurse with a university degree.Results In the study group, the cesarean delivery rate was 1.7% (1 of 60), significantly lower than that of the control group, which was 29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% to 40%), also, the hours of labour were significantly lower with a median of 6.7 hours in the study group versus a median of 13.4 hours in the control group,Conclusion Continuous intrapartum support provided by a professional nurse in the active phase helps to reduce the rate of cesarean deliveries, as well as to reduce the time of labour in women (nulliparous, term, singleton, vertex) under 40 years of age.

scholarly journals The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates

2018 ◽  
Vol 27 (6) ◽  
pp. 555-561 ◽  
Author(s):  
Michael F.E. Diejomaoh ◽  
Waleed Al-Jassar ◽  
Zainab Bello ◽  
Kavitha Karunakaran ◽  
Asiya Mohammed
Keyword(s):  
Cesarean Delivery ◽  
Maternity Hospital ◽  
Delivery Rate ◽  
Cesarean Deliveries ◽  
Fetal Birth Weight ◽  
Gestational Age At Delivery ◽  
Group A ◽  
Cesarean Delivery Rate ◽  
Group B ◽  
Repeat Cesarean Delivery

Objective: The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution. Subjects and Methods: All cesarean deliveries at the Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified. A comparative study was undertaken on patients having their first and second cesarean deliveries. The social and clinical characteristics of these patients were extracted from our records and the antenatal, intrapartum, and postpartum course of the pregnancies and their outcomes documented. Results: During the study period, 10,586 deliveries were recorded, including 3,676 cesarean deliveries, i.e., a cesarean delivery rate of 34.7%. 840 of these patients were undergoing their first cesarean delivery (group A) and 607 patients were undergoing their second (group B); 484 patients from group A and 341 patients from group B with complete records were analyzed. Mean age (30.89 ± 4.93 vs. 29.94 ± 5.56 years, p = 0.008), parity (1.49 ± 1.22 vs. 0.98 ± 1.60, p < 0.0001), gestational age at delivery (38.12 ± 2.61 vs. 37.66 ± 3.11 weeks, p = 0.02), and fetal birth weight (3,211.60 ± 691.51 vs. 2,829.73 ± 863.26 g, p < 0.001) were significantly higher in group B than in group A. 53.2% of the patients in group B requested repeat cesarean delivery, their second cesarean. The rate of maternal morbidity was low. Conclusions: The incidence of repeat cesarean delivery in group B is high, and its reduction should contribute to a lowering of the overall cesarean delivery rate.

Reduction in the Cesarean Delivery Rate After Obstetric Care Consensus Guideline Implementation

2016 ◽  
Vol 128 (1) ◽  
pp. 145-152 ◽  
Author(s):  
Jonas G. Wilson-Leedy ◽  
Alexis J. DiSilvestro ◽  
John T. Repke ◽  
Jaimey M. Pauli
Keyword(s):  
Cesarean Delivery ◽  
Guideline Implementation ◽  
Obstetric Care ◽  
Delivery Rate ◽  
Consensus Guideline ◽  
Cesarean Delivery Rate

scholarly journals The Danish Model for Improvement of Diabetes Care in General Practice: Impact of Automated Collection and Feedback of Patient Data

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Henrik Schroll ◽  
René dePont Christensen ◽  
Janus Laust Thomsen ◽  
Morten Andersen ◽  
Søren Friborg ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Of Care ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Data Capture ◽  
Lipid Lowering ◽  
Control Group ◽  
Electronic Data

Background. Sentinel Data Capture is an IT program designed to collect data automatically from GPs’ electronic health record system. Data include ICPC diagnoses, National Health Service disbursement codes, laboratory analysis, and prescribed drugs. Quality feedback reports are generated individually for each practice on the basis of the accumulated data and are available online only for the specific practice. Objective. To describe the development of the quality of care concerning drug prescriptions for diabetes patients listed with GPs using the Data Capture module. Methods. In a cohort study, among 8320 registered patients with diabetes, we analyzed the change in the proportion of medication for uncontrolled cases of diabetes. Results. From 2009 to 2010, there was an absolute risk reduction of 1.35% (0.89–1.81: ) in proportion of persons not in antidiabetic medication despite an HbA1c above 7.0. Similarly, there was a 4.51% (3.42–5.61: ) absolute risk reduction in patients not in antihypertensive treatment despite systolic blood pressure above 130 mm Hg and 4.73% (3.56–5.90: ) absolute risk reduction in patients with total cholesterol level above 4.5 mmol/L and not receiving lipid-lowering treatment. Conclusions. Structured collection of electronic data from general practice and feedback with reports on quality of care for diabetes patient seems to give a significant reduction in proportion of patients with no medical treatment over one year for participating GPs. Due to lack of a control group, we are, however, not able to say if the drop in the proportion of uncontrolled cases is a result of participation in collection of electronic data and feedback alone.

Contribution of Excess Weight Gain During Pregnancy and Macrosomia to the Cesarean Delivery Rate, 1990–2000

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_1) ◽  
pp. 1181-1185
Author(s):  
Julia C. Rhodes ◽  
Kenneth C. Schoendorf ◽  
Jennifer D. Parker
Keyword(s):  
Weight Gain ◽  
Cesarean Delivery ◽  
Absolute Risk ◽  
Birth Certificate ◽  
Excess Weight ◽  
Excess Weight Gain ◽  
Cesarean Deliveries ◽  
Cesarean Delivery Rate ◽  
Current Guidelines ◽  
Weight Gain During Pregnancy

Objective. After declining for many years, cesarean delivery rates recently increased. To explore whether this increase is associated with excess weight gain during pregnancy, resulting in macrosomic infants who require cesarean delivery, we examined trends in excess weight gain, macrosomia, and cesarean delivery. Methods. Analysis of 1990–2000 US Natality Files of birth certificate data were restricted to first birth, singleton infants of 37 to 42 weeks’ gestation to avoid confounding by repeat cesarean delivery, complications of multigestational pregnancy, and preterm and postterm birth. Excess weight gain was defined according to current guidelines (41+ lb) and macrosomia as birth weight &gt;4000 g. Results. From 1990–2000, excess weight gain rose steadily from 18.6% to 24.2%. There was a 19.3% decline in macrosomic infants among women who gained excess weight compared with an 11.9% decline among women who gained 15–40 lb, although the absolute risk remained substantially greater among women who gained excess weight (eg, 14.2% vs 7.2%, in 2000). From 1990–1997, cesarean delivery declined by 20.2% among women who gained excess weight compared with 15.7% among women who gained 15 to 40 lb. After 1997, cesarean delivery increased in all weight gain categories, and absolute risks in 2000 were 25.8% for women who gained excess weight compared with 21.6% for women who gained 15–40 lb. Overall, women who gained excess weight accounted for 24.1% of cesarean deliveries in 1990 and 28.1% in 2000. Conclusions. Excess weight gain and macrosomia do not seem to be the primary factors that contribute to the recent increase in cesarean delivery because cesarean delivery rates have increased in all weight gain categories and macrosomia rates have decreased steadily from 1990–2000. Nonetheless, women who gain excess weight account for a growing proportion of cesarean deliveries because their relative numbers have grown.

scholarly journals Effectiveness of Metformin in the Prevention of Gestational Diabetes Mellitus in Obese Pregnant Women

2018 ◽  
Vol 40 (04) ◽  
pp. 180-187 ◽  
Author(s):  
Willian Sales ◽  
Iramar Nascimento ◽  
Guilherme Dienstmann ◽  
Matheus Souza ◽  
Grazielle Silva ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Control Group ◽  
Significant Difference ◽  
The Absolute

Objective To assess the effectiveness of metformin in the incidence of gestational diabetes mellitus (GDM) in obese pregnant women attending a public maternity hospital in Joinville, Santa Catarina, Brazil. Methods Randomized clinical trial including obese pregnant women with a body mass index (BMI) ≥ 30 kg/m2, divided into two groups (control and metformin). Both groups received guidance regarding diet and physical exercise. The participants were assessed at two moments, the first at enrollment (gestational age ≤ 20) and the second at gestational weeks 24–28. The outcomes assessed were BMI and gestational diabetes mellitus (GDM) diagnosis. The data distribution was assessed with the Friedman test. For all the analytical models, the p-values were considered significant when lower than 0.05. The absolute risk reduction was also estimated. Results Overall, 164 pregnant women were assessed and further divided into 82 participants per group. No significant difference was observed in BMI variation between the control and metformin groups (0.9 ± 1.2 versus 1.0 ± 0.9, respectively, p = 0.63). Gestational diabetes mellitus was diagnosed in 15.9% (n = 13) of the patients allocated to the metformin group and 19.5% (n = 16) of those in the control group (p = 0.683). The absolute risk reduction was 3.6 (95% confidence interval 8.0–15.32) in the group treated with metformin, which was not significant. Conclusion Metformin was not effective in reducing BMI and preventing GDM in obese pregnant women.

Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

2021 ◽  
pp. 1-6
Author(s):  
A S Khatiwada ◽  
A S Harris
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Clinical Trials ◽  
Total Thyroidectomy ◽  
Risk Reduction ◽  
Operative Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Vitamin D Supplementation ◽  
Absolute Reduction

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rehab Abdelhamid Aboshama ◽  
Ahmed Mohamed Abdelhakim ◽  
Mohammad Abrar Shareef ◽  
Abdulhadi A. AlAmodi ◽  
Mohammad Sunoqrot ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Low Dose ◽  
Delivery Rate ◽  
Cochrane Library ◽  
High Dose ◽  
Safety And Efficacy ◽  
Labor Duration ◽  
Uterine Hyperstimulation ◽  
Cesarean Delivery Rate ◽  
Labor Augmentation

AbstractObjectivesTo compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation.MethodsWe searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion.ResultsEight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=−1.02 h, 95% CI [−1.77, −0.27], p=0.008).ConclusionsWe found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.

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