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1.
Rev Saude Publica ; 53: 65, 2019 Sep 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31483006

RESUMO

OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen's D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.


Assuntos
Cesárea/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Adulto Jovem
2.
Pan Afr Med J ; 33: 86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489064

RESUMO

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.


Assuntos
Histerectomia/métodos , Placenta Acreta/diagnóstico , Ultrassonografia Pré-Natal/métodos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Marrocos , Placenta Acreta/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Fatores de Risco
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 913-918, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474073

RESUMO

Objective: To analyze the correlation between elective cesarean delivery and duration of breastfeeding in Ma'anshan city from 2013 to 2014. Methods: From May 2013 to September 2014, a total of 3 474 pregnant women with the first prenatal checkup were recruited from Ma'anshan maternal and child health care hospital. Finally, 3 109 pregnant women were included after exclusion of those with terminated pregnancies, adverse birth outcomes, twin or multiple pregnancies, breech traction, breech midwifery and loss of delivery information. Demographic data of pregnant women, mode of delivery and breast feeding of children were collected through questionnaires and hospital records. Logistic regression model was used to analyze the relationship between elective cesarean delivery and duration of breastfeeding in children, with the mode of delivery as independent variable and the duration of breastfeeding as dependent variable. Results: The age of 3 109 subjects was (26.6±3.6) years old, the rate of vaginal delivery was 51.1% (1 589), and the rate of elective cesarean delivery was 46.4% (1 443), among which the rate of non-indicative elective cesarean delivery was 26.4% (820), the rate of indicative elective cesarean delivery was 20.0% (623), and the rate of emergency cesarean delivery was 2.5% (77). The proportion of breastfeeding lasting until 4, 12 and 18 months was 45.0% (1 348/2 998), 23.7% (702/2 962) and 5.2% (154/2 944), respectively. After adjusting the confounding factors, compared with vaginal delivery, the OR (95%CI) values of breastfeeding for 4 months in indicative elective cesarean delivery and non-indicative elective cesarean delivery women were 0.870(0.714-1.059), 0.795(0.665-0.949), and the OR (95%CI) values of breastfeeding for 12 months were 0.772(0.611-0.975), 0.755(0.610-0.934), respectively. Conclusion: Elective cesarean delivery may result in shorter duration of breastfeeding in children.


Assuntos
Aleitamento Materno , Cesárea , Adulto , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Criança , China , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Gravidez , Gestantes , Fatores de Tempo , Adulto Jovem
4.
Zhonghua Fu Chan Ke Za Zhi ; 54(9): 582-587, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550773

RESUMO

Objective: To explore the effect of induced labor on delivery outcome of pregnant women undergoing vaginal trial of labor after cesarean section. Methods: Totally, 173 pregnant women undergoing vaginal trial of labor after cesarean from April 1st, 2016 to October 31st, 2017 were involved. According to whether or not induced labor, pregnant women were divided into induced labor group (n=47) and natural labor group (n=126). The two groups of the general situation, the situation of delivery and delivery outcome were compared. Further more, the induced labor group were divided into cesarean section patients (n=20) and vaginal delivery patients (n=27) based on pregnancy outcomes, induction situation and delivery situation were analyzed. Results: (1) The gestational weeks was 39.2±1.1 in induced labor group, 38.7±1.0 in natural labor group. The 1-minute Apgar score was 9.98±0.15 in induced labor group, and 9.87±0.60 in natural labor group. The neonatal weight was (3 497±426) g in induced labor group, and (3 288±350) g in natural labor group. The thickness of lower uterine segment at 36-39 weeks of pregnancy was (2.4±0.6) mm in induced labor group, (2.1±0.6) mm in natural labor group. There were obviously differences in the gestational week, the 1-minute Apgar score, the neonatal weight and the thickness of lower uterine segment at 36-39 weeks of pregnancy between the two groups (all P<0.05). There were no significant differences in 5-minute Apgar score, the interval between previous cesarean delivery, postpartum hemorrhage, fetal distress, and intrauterine infection, secondary uterine inertia, placental abruption and uterine ruption between the two groups (all P>0.05). (2) In induced labor group, the cervical score of cesarean section patients was 3.8±1.7, while the cervical score of vaginal delivery patients was 5.2±1.7. The induced labor days of cesarean section patients was (1.6±0.9) days, while the induced labor days of vaginal delivery patients was (1.2±0.4) days. There were obviously differences in the cervical score and the induced labor days among the two subgroup patients (all P<0.05). There were no significiant differences in Apgar score, neonatal weight, the thickness of lower uterine segment at 36-39 gestational weeks and the interval times of previous cesarean delivery between the two subgroup patients (P>0.05). Conclusion: Induction of labor does not reduce neonatal Apgar score, and does not increase the incidence of postpartum complications, and eliminats the increase of cesarean section rate caused by increased gestational weeks and fetal enlargement, and increases the vaginal delivery rate of pregnant women undergoing vaginal trail of labor after cesarean section.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/métodos , Resultado da Gravidez/epidemiologia , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto , China/epidemiologia , Parto Obstétrico/métodos , Feminino , Humanos , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto , Avaliação de Resultados (Cuidados de Saúde) , Hemorragia Pós-Parto/epidemiologia , Gravidez
5.
Pan Afr Med J ; 33: 66, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448028

RESUMO

Introduction: Unattended pregnancies are characterized by significant morbidity maternal and morbidity and mortality fetal. This study aims to determine the frequency of unattended pregnancies, to describe the socio-demographic profile and to assess the maternal and fetal outcomes during childbirth among women who did not attend antenatal care (ANC) in the city of Lubumbashi. Methods: It was an analytical cross-sectional study of maternal pregnancy from December 2013 to May 2014 in 10 maternity hospitals in Lubumbashi. Women who did not receive ANC were compared to women who had followed them (ANC≥4). Maternal socio-demographic parameters, maternal and perinatal morbidity and mortality were analyzed. Results: We found that the frequency of no pregnancy monitoring was 21.23% and the mean number of antenatal visits was 2.6 ± 1.9. An analysis of the relationship between ANC and socio-demographic characteristics of women who were delivered shows that the lack of follow-up was 2.29 times higher for adolescent girls than for adult women (OR=2.29 [1.54-3.41]), 4 times higher for women living alone than for women living in unions (OR=4.00 [2.05-7.79]) and 4.08 times higher for women with low levels of education (illiterate or primary) than among those with a high level of education (OR=4.08 [3.08-5.40]). Compared to those who followed them well, we did not find that women who did not attend ANC had a high risk of obstetric emergency (OR = 1.90 [1.26-2.95]), rupture of membranes fetal admission (OR=1.31 [1.02-1.68]), fetal mal presentation (OR=1.89 [1.03-3.44]), caesarean delivery (OR=1.78 [1.21-2.63]), eclampsia (OR=3.00 [1.09-8.70]), uterine rupture (OR=4.76 [1.00-47.19]) and anemia (OR=2.33 [1.06-5.13]). Rates of preterm birth (OR = 1.93 [1.33-2.80]), post-maturity (OR=1.47 [1.00-2.30]), low birth weight (OR=2.33 [1.56-3.46]), neonatal depression (OR=3.89 [2.52-6.02]), neonatal transfer (OR=1.60 [1.11-2.32]) and perinatal mortality (OR=2.70 [1.59-4.57]) were significantly higher in neonates from women with prenatal consultations than in those with well followed. Conclusion: Our study shows that the lack of follow-up of ANC is associated with high maternal morbidity and high perinatal morbidity and mortality in our environment.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Cesárea/estatística & dados numéricos , Estudos Transversais , República Democrática do Congo/epidemiologia , Escolaridade , Feminino , Maternidades , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Adulto Jovem
6.
Anaesthesia ; 74(11): 1439-1455, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31429919

RESUMO

We performed a systematic review using 'consensus-based standards for the selection of health measurement instruments' (COSMIN) criteria to identify and evaluate the quality of patient-reported outcome measures (PROM) instruments that have been utilised to assess functional recovery following caesarean section, and determine the optimal instrument for use in this setting. A literature search was performed using five databases. Studies were included if a psychometrically validated instrument was used to assess functional recovery following caesarean section. The COSMIN appraisal checklist was utilised to: assess the quality of included studies reporting PROMs; determine psychometric quality of instruments; and identify the most promising instruments for use after caesarean section. We identified 13 PROMs used to assess the quality of recovery after caesarean section in 20 studies that included 9214 patients. All PROMs contained between two and seven domains. Five out of the 13 PROMs were specific to postpartum recovery. Only two of these PROM instruments were specifically designed for use after caesarean section (Obstetric Quality of Recovery-11 and Recovery from Caesarean Section Scale). We found very few adequate measures of functional recovery following caesarean section. Overall, the Obstetric Quality of Recovery-11 achieved the highest COSMIN standards for any PROM. Future development of PROMs for use after caesarean section should include multiple domains, and undergo validation as outlined by the COSMIN criteria.


Assuntos
Cesárea/estatística & dados numéricos , Lista de Checagem/métodos , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Consenso , Feminino , Humanos , Gravidez , Psicometria , Inquéritos e Questionários
7.
BMC Public Health ; 19(1): 1080, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399068

RESUMO

BACKGROUND: The increasing trend of Caesarean section (CS) in childbirth has become a global public health challenge. Previous studies have proposed financial intervention strategies for reducing CS rates by limiting caesarean delivery on maternal request (CDMR). This study synthesizes such strategies while evaluating their effectiveness. METHODS: The sources of data for this study are Cochrane Library, PubMed, EMBASE, and CINAHL. The publication period included in this study is from January 1991 to November 2018. The financial intervention strategies are divide into two categories: healthcare provider interventions and patient interventions. Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was employed to assess the risk of bias of included studies. The outcome of each study was evaluated with Grades of Recommendation, Assessment, Development and Evaluation (GRADE) through the GRADEpro Guideline Development Tool software. RESULTS: Nine studies were included in this systematic review: five with high certainty evidence (HCE), three with moderate certainty evidence (MCE), and one with low certainty evidence (LCE). Of the nine studies, seven are centered on the effect of provider-side interventions. Three of the HCE studies found that the diagnosis-related group payment system, risk-adjusted capitation, and equalizing fee for both facilities and physicians were effective intervention strategies. One HCE and one MCE study showed that only equalizing facility fees between vaginal and CS deliveries in healthcare service settings had no significant effect on reducing the CS rate. The MCE study showed that case payment had a negative effect on reducing the CS rates. One LCE study revealed that the effect of a global budget system was uncertain, and one HCE and one MCE study focused on combining both provider and patient-side interventions. However, equalizing fees for vaginal and CS deliveries and a co-payment policy for CDMRs failed to reduce the CS rate. CONCLUSIONS: The effectiveness of risk-adjusted payment methods appears promising and should be the subject of further research. Financial interventions should consider stakeholders' characteristics, especially the personal interests of doctors. Finally, high-quality randomized control trials and comparative studies on different financial intervention methods are needed to confirm or refute previous studies' outcomes.


Assuntos
Cesárea/economia , Cesárea/estatística & dados numéricos , Ensaios Clínicos Controlados como Assunto , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Acta Clin Croat ; 58(1): 37-41, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363323

RESUMO

Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.


Assuntos
Peso ao Nascer , Diabetes Gestacional/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Ganho de Peso
9.
Zhonghua Fu Chan Ke Za Zhi ; 54(8): 512-515, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31461806

RESUMO

Objective: To investigate the ratio of transfer cesarean section after trial of labor and maternal-fetal outcomes based on Robson classifications. Methods: The delivery data by cesarean section in Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2009 to December 31st, 2015 (gestational age ≥28 weeks and newborn birth weight >1 000 g) were retrospectively collected. The ratio of transfer cesarean section after trial of labor and maternal-fetal adverse outcomes were analyzed by weighted adverse outcome score in different Robson classifications. Results: (1) The highest ratio of transfer cesarean section after trial of labor was classification 9 (all abnormal lies, including previous cesarean section and breech were excluded) reached 47.31% (431/911) , followed by classification 2 (nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation who had labour induced) accounted for 44.90%(409/911). (2)The tops of weighted adverse outcome score of transfer cesarean section after trial of labor were classification 10 (single cephalic pregnancy at <37 weeks gestation, including women with previous cesarean delivery) 24.55, classification 5 (single cephalic pregnancy multiparous women, with at least one previous cesarean delivery, ≥37weeks gestation) 3.64. Conclusion: Carefully evaluating the delivery mode and emphasizing the intrapartum management in nulliparous women with a single cephalic pregnancy, at ≥37 weeks gestation who had labour induced and trial of labor after cesarean section is essential to reduce the risk of adverse outcomes in transfer cesarean section after trial of labor.


Assuntos
Cesárea/classificação , Cesárea/estatística & dados numéricos , Parto Obstétrico/classificação , Parto Obstétrico/estatística & dados numéricos , Prova de Trabalho de Parto , Adulto , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Apresentação no Trabalho de Parto , Parto , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
10.
Pan Afr Med J ; 32: 160, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303929

RESUMO

Introduction: Vaginismus is a severe dysfunction and a problem which can interfere with woman's and couple's sex life. It may influence the obstetric outcome. This study aims to determine if the clinical features of vaginismus can impact childbirth experience. Methods: We conducted a retrospective multicenter study involving patients affected by primary vaginismus, having given birth to their first child (who had reached term), between 2005 and 2015. Results: Out of 19 patients included in the study, 9 had prolonged pregnancies, 14 had spontaneous labor (including 8 at term), 3 had cesarean section before going into labor and 2 had labor induction. Among the 16 women who experienced labor, 4 had cesarean section, 5 had vaginal delivery with the help of forceps and 7 had spontaneous vaginal delivery. Among the 12 women who had vaginal delivery, 9 underwent episiotomy, 7 had spontaneous perineal tear alone or in combination with episiotomy. No 3rd and 4th degree perineal injury or intact perineum were found. The average birth weight for babies was 3380 g ± 332 (2870 g-3970g, 47th percentile). Conclusion: The rates of labour dystocia and perineal morbidity were significantly high. These data were comparable to most of the data in the literature. It is likely that the psychological and behavioral aspects of vaginismus (fear-avoidance and anxiety-inducing mechanism) have favoured prolonged pregnancies, cesarean sections, mechanical dystocias and perineal injuries. Additional studies are necessary to better identify vaginismus and its obstetrical implications.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez , Gravidez Prolongada/epidemiologia , Vaginismo/complicações , Adulto , Cesárea/estatística & dados numéricos , Distocia/epidemiologia , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Períneo/lesões , Gravidez , Estudos Retrospectivos , Adulto Jovem
11.
BJOG ; 126 Suppl 4: 21-26, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257695

RESUMO

OBJECTIVE: To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN: Retrospective study. SETTING: Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE: Women who gave birth between 2000 and 2018. METHODS: Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES: Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS: Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. CONCLUSION: In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. TWEETABLE ABSTRACT: Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.


Assuntos
Asfixia Neonatal/epidemiologia , Cesárea/estatística & dados numéricos , Mortalidade Perinatal , Cuidado Pré-Natal/normas , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Asfixia Neonatal/prevenção & controle , Cardiotocografia/métodos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Período Periparto , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
13.
Ceska Gynekol ; 84(3): 201-207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324110

RESUMO

OBJECTIVE: To compare the performance of obstetrical interventions and maternal and perinatal outcomes between vaginal and cesarean delivery routes in pregnant women at normal risk. Type of article: Original article. Desing: Cross-sectional study with 421 participants admitted for spontaneous or induced labor with full-term singleton gestations and fetuses weighing between 2,500 and 4,499 g. SETTING: Maternal Fetal-Medicine Service, Assis Chateaubriand Maternity, Federal University of Ceará (UFC), Fortaleza-CE, Brazil. METHODS: The instrument of data collection was divided into socio-demographic, clinical, and obstetric characteristics; data of labor and delivery; maternal morbidity; maternal outcome and perinatal outcomes. Pearsons chi-square test and Fishers exact test were used to verify associations between the groups. RESULTS: The mean age was 22.8 ± 6.0 (vaginal) and 22.9 ± 4.9 (cesarean section). Overall, 44.5% of vaginal deliveries and 85.5% of cesarean sections were monitored electronically (p < 0.001). Immediate skin-to-skin contact (84.1%) and first-hour breastfeeding (80.4%) were more frequent in vaginal deliveries compared with cesarean deliveries (27% vs. 61.0%, p < 0.001). The prevalence of puerperal infections was 1.2% (vaginal) and 5.0% (cesarean section) with a p value of 0.02; 40% of cesarean-delivered newborns and 9.7% of vaginally-delivered newborns were referred to the neonatal intensive care unit (p < 0.001). CONCLUSION: The cesarean section was associated with a lower frequency of useful practices, a higher frequency of harmful practices, worse neonatal outcomes, and a higher rate of postpartum infections.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Brasil/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Gravidez , Resultado da Gravidez , Infecção Puerperal/epidemiologia
14.
BJOG ; 126(10): 1213-1222, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31188526

RESUMO

OBJECTIVE: Studies on pregnancy outcomes in psoriatic arthritis (PsA) are scarce and typically of small size. Available studies have reported conflicting results. The aim of this study was to describe maternal and infant pregnancy outcomes among women with PsA compared with women without PsA. DESIGN: Nationwide cohort study. SETTING: Nationwide Swedish registers. POPULATION: A total of 41 485 singleton pregnancies in 1997-2014, of which 541 pregnancies were identified with PsA exposure and 40 944 pregnancies were unexposed. METHODS: By linkage of national health and population register data, we obtained information on individual pregnancies and compared outcomes among pregnancies with PsA and non-PsA pregnancies. Relative risks were estimated by odds ratios (ORs) with 95% CIs using a generalised linear regression model with generalised estimating equations. Adjustments were made for maternal factors and calendar year of birth. MAIN OUTCOME MEASURES: Maternal and infant pregnancy outcomes. RESULTS: Pregnancies to women with PsA had increased risks of preterm birth (adjusted OR 1.63; 95% CI 1.17-2.28), elective and emergency caesarean deliveries (adjusted OR 1.47; 95% CI 1.10-1.97 and adjusted OR 1.43; 95% CI 1.08-1.88, respectively) compared with non-PsA pregnancies. No increased risks were observed for pre-eclampsia, stillbirth or other infant outcomes apart from preterm birth. CONCLUSION: The majority of women with PsA have uneventful pregnancies with respect to adverse outcomes. In the present study, we found increased risks of preterm birth and caesarean delivery compared with non-PsA pregnancies. TWEETABLE ABSTRACT: Women with psoriatic arthritis have uneventful pregnancies but are at increased risk of preterm birth and caesarean delivery.


Assuntos
Artrite Psoriásica/fisiopatologia , Cesárea/estatística & dados numéricos , Obesidade/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Adolescente , Adulto , Artrite Psoriásica/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Recém-Nascido , Masculino , Obesidade/fisiopatologia , Razão de Chances , Paridade , Gravidez , Resultado da Gravidez , Suécia/epidemiologia , Adulto Jovem
15.
BMC Public Health ; 19(1): 671, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151395

RESUMO

BACKGROUND: Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. METHODS: In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen (modified) was used to assess fear and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 (69%) women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. RESULTS: Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 (95% CI;1.10-4.73)]. CONCLUSIONS: Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not.


Assuntos
Violência Doméstica/estatística & dados numéricos , Resultado da Gravidez , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Nepal/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Adulto Jovem
16.
Int J Gynaecol Obstet ; 146(3): 289-295, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172522

RESUMO

OBJECTIVE: To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. METHODS: A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. RESULTS: Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. CONCLUSION: The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. CHINESE CLINICAL TRIALS REGISTRY: ChiCTR-OOC-16008467.


Assuntos
Histerectomia/efeitos adversos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Hemorragia Uterina/cirurgia , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , China , Cicatriz/complicações , Cicatriz/cirurgia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
17.
Rev Saude Publica ; 53: 51, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166379

RESUMO

OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Anestesia Epidural , Anestesia Geral , Raquianestesia , Brasil , Estudos de Coortes , Estudos Transversais , Prescrições de Medicamentos/classificação , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
18.
Rev. méd. Urug ; 35(2): 113-116, jun. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-999563

RESUMO

Antecedentes: en Uruguay, el Ministerio de Salud ha seleccionado la disminución de las cesáreas innecesarias como uno de los objetivos sanitarios nacionales por considerarlo un problema de salud pública. Objetivos: analizar las tasas de cesáreas por sector asistencial: público versus privado y Montevideo versus interior, usando la clasificación de Robson como insumo para su disminución. Material y método: estudio descriptivo de corte transversal que categoriza cada nacimiento ocurrido en Uruguay en 2017 en uno de los diez grupos de Robson, según el sector de asistencia y el lugar geográfico donde ocurrió, informando el tamaño relativo, la tasa de cesáreas y las contribuciones absolutas y relativas hechas por cada grupo a la tasa global de cesáreas. Resultados: la tasa de cesáreas en 2017 fue de 44%. Los grupos que más contribuyeron a la tasa global de cesáreas (70% de las cesáreas practicadas en el país) fueron: mujeres con una o más cesáreas previas, cesáreas electivas o inducciones fallidas en nulíparas y el grupo de nulíparas de término con inicio espontáneo. Luego de ajustar por las variables pronósticas, la probabilidad de terminar en cesáreas en el sector privado fue 18% mayor que en el sector público, sin mostrar diferencias en los resultados perinatales. Las tasas de cesáreas por grupos de Robson en Montevideo y en el interior se muestran muy similares. Conclusiones: fomentar el parto vaginal después de una cesáreas, evitar cesáreas electivas e inducciones innecesarias y disminuir la primera cesáreas son las medidas propuestas para bajar las tasas de cesáreas innecesarias. Guías clínicas basadas en la mejor evidencia científica que sistematicen estas intervenciones ayudarán a implementar los cambios.


Background: in Uruguay, the Ministry of Public Health has set the reduction of unnecessary C-sections as one of the "National Health Goals", as it considers this a public health issue. Objectives: to analyse the C-section rates by health sector: the private sector versus the public sector and Montevideo versus the rest of the country, using the Robson classification and an input to be used to reduce the rate. Method: transversal descriptive study that categorizes every birth in Uruguay during 2017 according to the Robson criterion in one of the 10 groups, depending on the healthcare center and the geographical place of birth, reporting the relative size, the C-section rate and the absolute and relative contributions of each group to the global CS rate. Results: in 2017 the CS rare was 44%. The groups that contributed the most to the global CS rate (70% of the CS in the country) were the following: women with previous CS, elective CS or failed induced labor in nulliparous women and the term nulliparous women with spontaneous initiation of labor group. After adjusting the prognostic variables, the possibility of ending up in CS in the private sector was 18% higher than in the public sector, without there being any differences in terms of the perinatal results. CS rates by Robson group in Montevideo and the rest of the country are very similar. Conclusions: vaginal birth must be encouraged after a CS, elective CS and unnecessary induction of labor must be avoided, and the number of first CS needs to be reduced. These are the measures proposed to reduce the unnecessary CS rates. Clinical guidelines based on the best scientific evidence that systematize these interventions will contribute to the implementation of changes.


Antecedentes: o Ministério da Saúde do Uruguai (MS) definiu como um dos "Objetivos sanitários nacionais" a redução do número de cesáreas (CS) necessárias por considerar que este é um problema de saúde pública. Objetivos: analisar as taxas de CS por setor assistencial: público vs privado e geográfico: Montevideo vs Interior usando a classificação de Robson, como insumo para sua redução. Material e métodos: estudo descritivo transversal que classifica cada nascimento ocorrido no Uruguai em 2017, em um dos 10 grupos de Robson de acordo com o setor de assistência e o lugar onde aconteceu, informando tamanho relativo, taxa de CS e as contribuições absolutas e relativas de cada grupo à taxa global de CS. Resultados: a taxa de CS em 2017, foi de 44%. Os grupos que mais contribuíram para a taxa global de CS (70% das CSs realizadas no país) foram: as cesareadas previas, as cesáreas eletivas ou induções falidas em nulíparas e o grupo de nulíparas a termo com início espontâneo. Depois de ajustar pelas variáveis prognósticas, a probabilidade de terminar em CS no setor privado foi 18% maior que no setor público, sem diferenças nos resultados perinatais. As taxas de CS por grupos de Robson em Montevideo e no Interior foram similares. Conclusões: fomentar o parto vaginal depois de uma CS, evitar CS eletivas e induções desnecessárias e diminuir a quantidade de primeira CS, são las medidas propostas para reduzir as taxas de cesáreas desnecessárias. Pautas clínicas baseadas na melhor evidência científica que sistematizem estas intervenções ajudarão a implementar as mudanças propostas.


Assuntos
Humanos , Cesárea/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Prevalência , Parto
19.
Ceska Gynekol ; 84(2): 129-139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238683

RESUMO

OBJECTIVE: Analysis of maternal morbidity and mortality in Slovak Republic in the years 2007-2015. DESIGN: Prospective epidemiological perinatological nation-wide. SETTINGS: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. METHODS: The analysis of selected maternal morbidity and mortality data prospective collected in the years 2007-2015. RESULTS: Cesarean section rate progressively increased from 24.1% in the year 2007 up to 30.8% in the year 2013 and up to year 2015 decreased to 30.2%. Vacuum-extraction frequency was 1.3% in the year 2007 and to the year 2015 increased up to 1.6%. Forceps frequency was the same in the year 2007 and 2015: 0.6%. In the years 2008-2015 frequency of perineal tears 3th and 4th degree increased from 0.44% to 0.68% and frequency of episiotomies decreased from 74.7% to 57.2%. In the years 2012-2015 incidence of total severe acute maternal morbidity per 1,000 births was 5.85, peripartum hysterectomy 0.78, severe postpartum bleeding 2.03, transport to anaesthesiology department/intensive care unit 1.26, eclampsia 0.2, HELLP syndrome 0.6, abnormal placental invasion 0.38, uterine rupture 0.45, severe sepsis in pregnancy and puerperium 0.14 and frequency of nonfatal amniotic fluid embolism was 2/100,000 maternities. Total maternal mortality ratio in this period was 11.5 and pregnancy-related deaths ratio 9.9 per 100,000 live births. CONCLUSION: The highest cesarean section rate in Slovakia, 30.8 %, was in the year 2013, but in the next years slowly decreased. Frequency of episiotomies decreased in followed period too. Incidence of severe acute maternal morbidity was 5.85 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union and not corresponding with good level of perinatal mortality. Improving of cesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic.


Assuntos
Cesárea/estatística & dados numéricos , Eclampsia/epidemiologia , Histerectomia/estatística & dados numéricos , Mortalidade Materna , Ruptura Uterina/epidemiologia , Adulto , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Incidência , Morbidade , Mortalidade Perinatal , Períneo/lesões , Período Pós-Parto , Gravidez , Estudos Prospectivos , Eslováquia/epidemiologia , Vácuo-Extração/estatística & dados numéricos
20.
Pan Afr Med J ; 32: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223385

RESUMO

Introduction: This study was aimed at evaluating effect of Gestational diabetes mellitus (GDM) and maternal characteristics on pregnancy outcome. GDM has several risk factors including; advanced maternal age, ethnic background, obesity and family history of diabetes mellitus. These pregnancy complications are associated with fetal morbidity and mortality and may lead to macrosomia and shoulder dystocia. Others are stillbirth, miscarriages, preterm and small for gestational age babies. Methods: This was a retrospective case-case control study which compared maternal characteristics and pregnancy outcome among pregnant women with and without GDM. Diagnosis of GDM was done in accordance with the American Diabetes Association (ADA) criteria. Weight and height were determined and Body mass index (BMI) calculated. Pregnancy outcome was determined at the end of pregnancy and information on maternal characteristics obtained using questionnaire and patient folders. Results: Those who developed GDM were significantly older (OR= 1.772; 95% CI =1.432-2.192; P<0.0001) and had higher BMI (OR=1.637; 95% CI=1.004-1.289; P=0.044) than those who did not. A significant number of those who developed GDM also had stillbirths OR= 5.188; 95% CI=1.093-24.613; p=0.038) and cesarean deliveries (OR=14.362; 95% CI=3.661-56.335; p= 0.001). Conclusion: Women who develop GDM are more likely to deliver stillborn or macrosmic babies and may require surgical intervention in order to have normal deliveries.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Macrossomia Fetal/epidemiologia , Gana/epidemiologia , Humanos , Idade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco , Natimorto/epidemiologia
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