Attributable factors for the rising caesarean delivery rate over three decades: an observational cohort study

Objective: Caesarean delivery rates continue to rise globally the reasons for which are poorly understood. We aimed to characterize attributable factors for increasing caesarean delivery rates over a 30-year period within our health network. Design: Observational cohort study. Setting: Two hospitals (large tertiary referral hospital and metropolitan hospital) in Sydney, Australia, across two time periods: 1989-1999 and 2009-2016, between which the caesarean delivery rate increased from 19% to 30%. Participants: All women who had a caesarean delivery after 24 weeks gestation Methods: Data were analysed using multiple imputation and robust Poisson regression to estimate the changes in the caesarean delivery rate attributable to maternal and clinical factors. Main outcome measures: Caesarean delivery. Results: Fifty-six percent of the increase in the rate of caesarean delivery was attributed to changes in the distribution of maternal factors including maternal age, body mass index, parity and history of previous caesarean delivery. When changes in the obstetric management of multiple gestation, malpresentation and preterm singleton birth were considered, 66% of the increase in caesarean rate was explained. When pre-labour caesarean deliveries for maternal choice, suspected fetal compromise, previous pregnancy issues and suspected large fetus were excluded, 78% of the increase was explained. Conclusions: Most of the steep rise in the caesarean delivery rate from 19% to 30% is attributable to changes in maternal demographic and clinical factors.

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Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study

The Lancet Global Health ◽

10.1016/s2214-109x(19)30036-1 ◽

2019 ◽

Vol 7 (4) ◽

pp. e513-e522 ◽

Cited By ~ 37

Author(s):

David Bishop ◽

Robert A Dyer ◽

Salome Maswime ◽

Reitze N Rodseth ◽

Dominique van Dyk ◽

...

Keyword(s):

Cohort Study ◽

Surgical Outcomes ◽

Caesarean Delivery ◽

Observational Cohort Study ◽

Neonatal Outcomes ◽

Prospective Observational Cohort Study ◽

Observational Cohort ◽

Maternal And Neonatal Outcomes ◽

Outcomes Study

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Staphylococcus aureus Carriage Status in Patients with Hidradenitis Suppurativa: An Observational Cohort Study in a Tertiary Referral Hospital in Athens, Greece

Dermatology ◽

10.1159/000504537 ◽

2019 ◽

Vol 236 (1) ◽

pp. 31-36 ◽

Cited By ~ 4

Author(s):

Alexander Katoulis ◽

Vasiliki Koumaki ◽

Ourania Efthymiou ◽

Dimitra Koumaki ◽

Evangelia Dimitroulia ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Hidradenitis Suppurativa ◽

Observational Cohort Study ◽

Referral Hospital ◽

Stage Iii ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Observational Cohort ◽

The Mean

Background: Hidradenitis suppurativa (HS) is a chronic, recurrent, auto-inflammatory disease that affects the pilosebaceous unit in apocrine gland-bearing areas. Bacteria are thought to play a role in the development and progression of disease. In addition, antibiotics are frequently used as first-line management for HS. We sought to determine the carriage status of Staphylococcus aureus and its resistance to antibiotics among patients with HS in a tertiary referral hospital in Athens, Greece. Methods: In this observational cohort study, 68 consecutive patients attending the HS clinic of “Attikon” General University Hospital in Athens, Greece, during a 9-month period were enrolled. All patients had not received any antibiotic therapy for any reason during the previous 3 months before enrollment. Nasal and oropharyngeal samplingwere obtained, and specimens were tested for the presence of S. aureus.Antibiotic susceptibility testing was performed using the VITEK 2 system. Standard statistical tests, descriptive statistics tests, and χ2 and Pearson correlation tests were performed, using IBM SPSS Statistics 25.The level of significance was set at a pvalue <0.05. Results: Sixty-eight patients with HS were studied. There were 44 females (64.7%) and 24 males (35.3%). The mean age was 36.63 ± 13.0 (IQR = 21), and the mean age at onset of disease was 23.90 ± 11.53 (IQR = 14). The mean duration of disease was 12.74 ± 10.20 years (IQR = 15). Fifteen (22.1%) of the patients were Hurley stage I, 22 (32.4%) were Hurley stage II, and 31 (45.6%) were Hurley stage III. S. aureus carriage was detected in 17 patients (25%). Six of them (35.3%) had MRSA strains. There was an increased prevalence of S. aureus colonization (p = 0.058) and MRSA (p = 0.101) in Hurley stage III patients, but this result was not statistically significant. Conclusions: We found a 25% prevalence of S. aureus colonization (17/68 patients) and a 35.3% prevalence of MRSA (6/17) among our HS patients. There was an increased prevalence of S. aureusand MRSA positivity in HS patients with Hurley stage III. Further studies are needed to clarify the possible clinical significance of S. aureus carriage in the disease development and progression as well as in the treatment outcome.

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