scholarly journals The impact of cesarean section on neonatal outcomes at a university based tertiary hospital in Jordan

2019 ◽  
Author(s):  
wasim khasawneh ◽  
Dawood Yusef ◽  
Jomana W Alsulaiman
Keyword(s):  
Cesarean Section ◽  
Fetal Distress ◽  
Health Care Facilities ◽  
Neonatal Outcomes ◽  
Multiple Gestation ◽  
Negative Consequences ◽  
Increased Risk ◽  
Common Diagnosis ◽  
Neonatal Icu ◽  
The Impact

Abstract Background Despite the WHO recommendation for cesarean section rates not to exceed 15% to minimize negative consequences in the mothers and neonates, there continues to be a steady rise in its rate globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and assess neonatal outcomes of cesarean section at King Abdullah University Hospital (KAUH) in Jordan.Methods A retrospective chart review of all mothers and neonates delivered by cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center.Results 2595 Cesarean deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. 60% were scheduled procedures. 72% were performed at full term gestation. The most common indication was previously scarred uterus followed by fetal distress. Rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-minute APGAR score (Adjusted OR 10). One out of six babies born at early term (37-38.6 weeks) were admitted for a median length of stay of 4 days (IQR 2, 8), the most common diagnosis was transient tachypnea of newborns and respiratory distress syndrome.Conclusion CS deliveries account for more than half the number of deliveries at our institution and one third of the delivered babies get admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

scholarly journals Lack of application of the European Work Time Directive: effects on workload, work satisfaction and burnout among Italian physicians

2017 ◽  
Vol 11 (2) ◽  
pp. 159
Author(s):  
Paola Gnerre ◽  
Domenico Montemurro ◽  
Andrea P. Rossi ◽  
Costantino Troise ◽  
Carlo Palermo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Work Conditions ◽  
Public Hospitals ◽  
Burnout Syndrome ◽  
Negative Consequences ◽  
Work Time ◽  
Increased Risk ◽  
Wide Range ◽  
The Impact

The Italian Parliament has excluded hospital physicians from the application of the European Work Time Directive (EWTD), which imposes a maximum workweek of 48 h and compulsory resting periods. This resulted in extended and excessive work time for the category. This paper is aimed at evaluating the impact of this legislation gap, by assessing the presence of excessive work-related stress and risk for burnout syndrome among Italian physicians working in public hospitals. This observational study is based on an on-line survey conducted on a sample of 1925 Italian doctors (covering a wide range of age, work experience and contractual positions) from October 2014 to February 2015. The questionnaire included 30 questions concerning their personal and professional life (<em>e.g</em>., assessment of workloads, number of uncomfortable or extra shifts, unused days-off, <em>etc</em>.). On the basis of the results, it can be inferred that the average Italian doctor working in public hospitals is under considerable stress at work with negative consequences on his health. He is exposed to high risk of suffering from sleep disorders and cardiovascular diseases (due to the lack of time for private practice and eating regular meals). Overall, his perception is that his job worsens his quality of life. This study shows the relevance of the risk of burnout among Italian physicians employed in public hospitals due to severe workload and work conditions. The resulting impact on the quality of care and the significant cost involved - both in human and economic terms - calls for significant emergency measures by the Italian health work organization. An important increase and prolonged working time is associated with a worsening of the objective cognitive performance and an increase of clinical risk, but also to an increased risk of diseases for operators and of the burnout syndrome. Our survey shows that lack of application of the EWTD has adverse effects on the quality of life and performance of Italian doctors. Failure to respond by all Italian doctors is the greatest limitation of our survey.

scholarly journals A cross sectional observational study to evaluate the maternal and fetal outcome in postdated pregnancies

2020 ◽  
Vol 10 (1) ◽  
pp. 159
Author(s):  
Ritika Narayan ◽  
Sheela S. R.
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Tertiary Care ◽  
Significant Risk ◽  
Fetal Distress ◽  
Perinatal Complications ◽  
Tertiary Care Centre ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Increased Risk

Background: Post-dated pregnancy is when the gestation is more than 40 weeks or 280 days. They last longer than the estimated date of delivery. Postdated pregnancies are associated with increased perinatal and maternal complications. These risks are greater than it was originally thought. Risks have been underestimated in the past leading to increasing number of complicated postdated pregnancies which appears to be otherwise low risk. The maternal risks are very often underappreciated resulting in increased maternal morbidity.Methods: This cross sectional observational study was done to evaluate maternal and fetal complications associated with Postdated pregnancies was carried out in the department of obstetrics and gynecology in a tertiary care centre, Sir Devraj Urs Medical College and RL Jalappa Hospital, Kolar between July 2018 and July 2019, fulfilling all the inclusion and exclusion criteria.Results: 50 out of 100 patients had full term normal deliveries where as 45% patients required cesarean section. Most common indication for cesarean section was meconium stained liquor with fetal distress (25%). 42% of the babies born needed NICU admission. Most common maternal complication seen was Postpartum Hemorrhage.Conclusions: The present study we conclude that postdated pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR. There was increased risk of obstetric complications as well like atonic PPH, oligohydramnios, obstructed labor.

Pregnancy outcomes among women with peptic ulcer disease

2020 ◽  
Vol 48 (3) ◽  
pp. 209-216
Author(s):  
Charlotte Rosen ◽  
Nicholas Czuzoj-Shulman ◽  
Daniel S. Mishkin ◽  
Haim Arie Abenhaim
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
The United States ◽  
Neonatal Outcomes ◽  
Intrauterine Fetal Death ◽  
Ulcer Disease ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
The Impact ◽  
In Pregnancy

AbstractBackgroundLittle is known about the impact of peptic ulcer disease (PUD) on pregnancy. Our objective was to evaluate the effect of PUD on pregnancy and newborn outcomes.MethodsA retrospective cohort study was carried out using the Healthcare Cost and Utilization Project (HCUP)-National Inpatient Sample (NIS) from the United States. The cohort consisted of all births that took place from 1999 to 2015. PUD was classified on the basis of the International Classification of Diseases-Ninth Revision (ICD-9) coding. Multivariate logistic regression was used to evaluate the adjusted effect of PUD on maternal and neonatal outcomes.ResultsOf the 13,792,544 births in this cohort, 1005 were to women with PUD (7/100,000 births). Between 1999 and 2015, prevalence of PUD in pregnancy increased from 4/100,000 to 11/100,000, respectively. Women with PUD were more commonly older and more likely to have comorbid illnesses. Women with PUD were at greater risk of preeclampsia [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.67–2.66], preterm premature rupture of membranes (PPROM; OR 2.16, 95% CI 1.30–3.59), cesarean delivery (OR 1.60, 95% CI 1.40–1.82), venous thromboembolism (OR 3.77, 95% CI 2.08–6.85) and maternal death (OR 24.50, 95% CI 10.12–59.32). Births to women with PUD were at increased risk of intrauterine growth restriction (IUGR; OR 1.54, 95% CI 1.11–2.14), preterm birth (OR 1.84, 95% CI 1.54–2.21), intrauterine fetal death (OR 2.18, 95% CI 1.35–3.52) and congenital anomalies (OR 2.69, 95% CI 1.59–4.56).ConclusionThe prevalence of PUD in pregnancy has risen over the last several years. PUD in pregnancy should be considered a high-risk condition associated with important adverse maternal and neonatal outcomes.

scholarly journals Main Fetal Predictors of Adverse Neonatal Outcomes in Pregnancies with Gestational Diabetes Mellitus

2020 ◽  
Vol 9 (8) ◽  
pp. 2409
Author(s):  
Maria-Christina Antoniou ◽  
Leah Gilbert ◽  
Justine Gross ◽  
Jean-Benoît Rossel ◽  
Céline Julie Fischer Fumeaux ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Cesarean Section ◽  
Gestational Diabetes Mellitus ◽  
Neonatal Outcomes ◽  
Abdominal Circumference ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Adverse Neonatal Outcomes ◽  
The Impact

The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. These associations were independent of maternal anthropometric and metabolic predictors, with the exception of cesarean section. FWC was the most significant predictor for NWC, LGA and SGA, while FACC was the most significant predictor for prematurity and FACC > 90% for emergency cesarean section. In women with GDM, third-trimester fetal anthropometric parameters have an important role in predicting adverse neonatal outcomes beyond the impact of maternal predictors.

scholarly journals Impact of Excess Weight Gain on Risk of Postpartum Infection in Class III Obesity

2020 ◽  
Vol 10 (03) ◽  
pp. e213-e216
Author(s):  
Courtney J. Mitchell ◽  
LaMani Adkins ◽  
Ann Tucker ◽  
Haywood Brown ◽  
Anne Siegel ◽  
...  
Keyword(s):  
Weight Gain ◽  
Wound Infection ◽  
Multiple Gestation ◽  
Institute Of Medicine ◽  
Class Iii ◽  
Infectious Morbidity ◽  
Increased Risk ◽  
Significant Difference ◽  
Class Iii Obesity ◽  
The Impact

Abstract Objective To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity. Methods This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, and delivery characteristics of women exceeding IOM guidelines (GT20) with those who did not (LT20). Regression models were used to estimate adjusted odds of outcomes. Results Of 374 women, 144 (39%) gained GT20 and 230 (62%) gained LT20. Primiparous, nonsmokers more likely gained GT20 (p < 0.05). No significant difference in other demographics. Among women who gained GT20, 10.4% had postpartum infectious morbidity compared with 3.0% in LT20 (p < 0.01). Wound infection is more common in the GT20 group (7.6 vs. 2%, p = 0.02). After adjustment, women who gained GT20 had threefold higher odds of postpartum infectious morbidity (adjusted odds ratio: 3.17, 95% confidence interval: 1.17, 8.60). Conclusion Women with class III obesity who gain more than the IOM recommends are at increased risk for postpartum infectious morbidity.

ANALYSIS OF URGENCY, GESTATIONAL AGE AND CONTRIBUTING FACTORS FOR INCREASING CAESAREAN SECTION RATES

2021 ◽  
pp. 20-24
Author(s):  
Ashraf M Ali ◽  
Sonal Garg ◽  
Papa Dasari
Keyword(s):  
Health Care ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Gestational Age ◽  
Fetal Distress ◽  
Health Care Facilities ◽  
South Indian Population ◽  
Common Indication ◽  
Medical Disorders ◽  
Associated Conditions

Background: Over the past few decades, the indications for Caesarean delivery have broadened thus increasing the rate of caesarean section beyond the set level of WHO. The indications vary in different health care facilities. It is essential to determine the factors responsible for increasing caesarean section rates. To Objectives: nd out the cesarean section rate based on urgency as per RCOG and gestational age as per the categorization of pregnancy by ACOG in a tertiary health care facility catering to large South Indian population. It also aimed to determine the associated conditions contributing for caesarean section. Retrospective analysis of women who underwent caesar Methods: ean section from Jan-2017 to June 2017. Data was analyzed with respect to gestational age, Urgency of caesarean section, maternal fetal indications, clinical characteristics and associated conditions. Neonatal outcomes measured were gestational age, birth weight and NICU admissions. Data was expressed as proportions and percentages. The CS Results: rate was 24.5% among7, 346 deliveries and 81% were emergency CS. Preterm Caesarean sections were done in 18% and term 81.5%. Category II CS were the commonest (49%) followed by Category I (32%). Scarred uterus was the most common indication (85%) for elective caesarean section and fetal distress was most common indication (55.7%) for emergency caesarean sections. The associated factors were prior Caesarean section (32%), Medical disorders in 21% and 2.4% prolonged infertility and ART conceptions. Obstetric conditions including mal presentation were responsible in 19%. On the whole fetal indications accounted for 62%. Conclusion: Fetal indications, especially fetal distress is the most common reason for caesarean section which may have contributed for increased rate of caesarean section. Hence following strict criteria for diagnosis of fetal distress and adopting policies for intrauterine resuscitation prior to decision making for cesarean section would contribute to reduction of CS rate at tertiary health care centers.

The impact of parity and maternal obesity on the fetal outcomes of a non-selected Lower Saxony population

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Lars Brodowski ◽  
Niels Rochow ◽  
Efrah I. Yousuf ◽  
Fabian Kohls ◽  
Constantin S. von Kaisenberg ◽  
...  
Keyword(s):  
Maternal Obesity ◽  
Fetal Distress ◽  
Maternal Body Mass Index ◽  
Obese Women ◽  
Lower Saxony ◽  
Fetal Outcomes ◽  
Increased Risk ◽  
Longitudinal Position ◽  
The Impact ◽  
Maternal Bmi

Abstract Objectives Maternal obesity during pregnancy is associated with adverse intrauterine events and fetal outcomes and may increase the risk of obesity and metabolic disease development in offspring. Higher parity, regardless of socioeconomic status, is associated with increased maternal body mass index (BMI). In this study, we examined the relationship between parity, maternal obesity, and fetal outcomes in a large sample of mother-neonate pairs from Lower Saxony, Germany. Methods This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony’s statewide quality assurance initiative. 448,963 cases were included. Newborn outcomes were assessed in relation to maternal BMI and parity. Results Maternal obesity was associated with an increased risk of placental insufficiency, chorioamnionitis, and fetal distress while giving birth. This effect was present across all parity groups. Fetal presentation did not differ between BMI groups, except for the increased risk of high longitudinal position and shoulder dystocia in obese women. Maternal obesity was also associated with an increased risk of premature birth, low arterial cord blood pH and low 5-min APGAR scores. Conclusions Maternal obesity increases the risk of adverse neonatal outcomes. There is a positive correlation between parity and increased maternal BMI. Weight-dependent fetal risk factors increase with parity, while parity-dependent outcomes occur less frequently in multipara. Prevention and intervention programs for women planning to become pregnant can be promising measures to reduce pregnancy and birth complications.

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