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1.
Br J Anaesth ; 125(6): 895-911, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33121750

RESUMO

BACKGROUND: Current guidelines for perioperative management of coronavirus disease 19 (COVID-19) are mainly based on extrapolated evidence or expert opinion. We aimed to systematically investigate how COVID-19 affects perioperative management and clinical outcomes, to develop evidence-based guidelines. METHODS: First, we conducted a rapid literature review in EMBASE, MEDLINE, PubMed, Scopus, and Web of Science (January 1 to July 1, 2020), using a predefined protocol. Second, we performed a retrospective cohort analysis of 166 women undergoing Caesarean section at Tongji Hospital, Wuhan during the COVID-19 pandemic. Demographic, imaging, laboratory, and clinical data were obtained from electronic medical records. RESULTS: The review identified 26 studies, mainly case reports/series. One large cohort reported greater mortality in elective surgery patients diagnosed after, rather than before surgery. Higher 30 day mortality was associated with emergency surgery, major surgery, poorer preoperative condition and surgery for malignancy. Regional anaesthesia was favoured in most studies and personal protective equipment (PPE) was generally used by healthcare workers (HCWs), but its use was poorly described for patients. In the retrospective cohort study, duration of surgery, oxygen therapy and hospital stay were longer in suspected or confirmed patients than negative patients, but there were no differences in neonatal outcomes. None of the 262 participating HCWs was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when using level 3 PPE perioperatively. CONCLUSIONS: When COVID-19 is suspected, testing should be considered before non-urgent surgery. Until further evidence is available, HCWs should use level 3 PPE perioperatively for suspected or confirmed patients, but research is needed on its timing and specifications. Further research must examine longer-term outcomes. CLINICAL TRIAL REGISTRATION: CRD42020182891 (PROSPERO).


Assuntos
Infecções por Coronavirus/terapia , Assistência Perioperatória/métodos , Pneumonia Viral/terapia , Adulto , Anestesia por Condução , Cesárea/métodos , Cesárea/mortalidade , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Oxigenoterapia , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
2.
Vet Rec ; 186(13): 416, 2020 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-31582573

RESUMO

BACKGROUND: With the increasing popularity of planned caesarean section, the need for knowledge regarding this surgery has become increasingly important. The reported death and survival rates for caesarean sections vary widely. Another important aspect is the fertility rate in subsequent oestrous after caesarean section. The aim of this study was to investigate the mortality and survival rate of bitches during caesarean section. Additionally, the fertility of bitches after caesarean sections was determined. METHODS: Caesarean sections which were performed in the years 1997-2009 at two university clinics were evaluated retrospectively. A distinction was made between bitches in which a conservative caesarean section was performed and bitches with a caesarean section followed by an ovariohysterectomy. RESULTS: A total of 482 caesarean sections were included in the study. The overall mortality rate was 3.11 per cent, with 2.59 per cent during or after a conservative caesarean section and 4.19 per cent during or after caesarean section with ovariohysterectomy. The reason for ovariohysterectomy was the owner's preference in 63 bitches (47.01 per cent); in 71 (52.98 per cent) bitches, ovariohysterectomy was performed due to a medical indication. The fertility rate after caesarean section was 100 per cent. CONCLUSION: The results show a high mortality rate during and after caesarean section. On the other hand, caesarean section does not seem to have a big impact on further fertility. Further studies are needed to investigate possible reduction of litter sizes and the suitability of caesarean section in subsequent pregnancies.


Assuntos
Coeficiente de Natalidade/tendências , Cesárea/mortalidade , Cesárea/veterinária , Animais , Cães , Feminino , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida/tendências
3.
Ann Ist Super Sanita ; 55(4): 363-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850864

RESUMO

OBJECTIVE: To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries. METHODS: All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death. FINDINGS: A total of 106 maternal deaths among 1 455 545 live births have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes. CONCLUSIONS: A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for preventing avoidable maternal deaths.


Assuntos
Mortalidade Materna , Vigilância da População , Aborto Induzido/mortalidade , Adulto , Causas de Morte , Cesárea/mortalidade , Atestado de Óbito , Emergências , Emigrantes e Imigrantes , Feminino , Humanos , Incidência , Itália/epidemiologia , Registro Médico Coordenado , Vigilância da População/métodos , Gravidez , Complicações na Gravidez/mortalidade , Estudos Prospectivos , Transtornos Puerperais/mortalidade , Técnicas de Reprodução Assistida/mortalidade
4.
Rev. cuba. anestesiol. reanim ; 18(3): e505, sept.-dic. 2019.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093115

RESUMO

Introducción: El paro cardiaco en gestantes y la cesárea perimorten son infrecuentes. Estas constituyen catástrofes médicas que precisan atención inmediata. Realizar este proceder según normas adecuadas brinda mejores opciones a la madre y el feto. Cuba presta especial atención al binomio materno fetal, para ello emplea grandes recursos humanos y tecnológicos. Objetivo: Actualizar la información acerca de cesárea perimorten. Métodos: Se realizó una revisión en bases de datos que permitiese encontrar descripciones epidemiológicas, informes de casos, series de casos, comunicaciones personales, y estudios en diferentes contextos sanitarios, los cuales sirvieran de evidencia científica del tema. Resultados: El paro cardiaco en embarazadas es un evento infrecuente, la realización de una cesárea perimorten con tiempo reducido (4-5 min) resultó una opción efectiva. El trabajo del equipo multidisciplinario basado en protocolos tiene una función que beneficia tanto a la madre como al feto. Actualmente se recomienda el concepto de histerotomía resucitadora que refleja la optimización de los esfuerzos realizados en la reanimación. La muerte materna por anestesia es una emergencia médica que requiere especial atención. Existen asociaciones médicas que preconizan las escalas de cuidados precoces en gestantes graves, con un entrenamiento actualizado y con estrategias novedosas para obtener mejores resultados. Conclusiones: El estudio del paro cardiaco en gestantes, la cesárea perimorten y la muerte materna relacionada con la anestesia son importantes. La creación de grupos multidisciplinarios y grupos bien entrenados son la mejor opción en estas circunstancias. Se recomienda incrementar el estudio y entrenamiento para ofrecer las mejores opciones al binomio materno-fetal(AU)


Introduction: Cardiac arrest in pregnant women and perimortem cesarean section are rare. These are medical catastrophes that require immediate attention. Performing this procedure according to adequate standards provides better options for both the mother and the fetus. Cuba pays special attention to the maternal-fetal binomial, for which large amounts of human and technological resources are used. Objective: To update the information about perimortem cesarean section. Methods: A database review was carried out to find epidemiological descriptions, case reports, case series, personal communications, and studies in different health contexts, which would serve as scientific evidence on the subject. Results: Cardiac arrest in pregnant women is a rare event; the performance of a perimortem cesarean section with reduced time (4-5 min) was an effective option. The work of the multidisciplinary team based on protocols has a function that benefits both the mother and the fetus. Currently, the concept of resuscitative hysterotomy is recommended, which reflects the optimization of the resuscitation efforts. Maternal death by anesthesia is a medical emergency that requires special attention. There are medical associations that advocate the scales of early care in pregnant women, with updated training and innovative strategies to obtain better outcomes. Conclusions: The study of cardiac arrest in pregnant women, perimortem caesarean section and anesthesia-related maternal death are important. The creation of multidisciplinary groups and well-trained groups are the best option in these circumstances. It is recommended to increase the study and training to offer the best options to the maternal-fetal binomial(AU)


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez/prevenção & controle , Cesárea/mortalidade , Histerotomia/métodos , Parada Cardíaca/complicações , Anestesia Obstétrica/mortalidade , Complicações na Gravidez/mortalidade
5.
BMJ Open ; 9(10): e027235, 2019 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-31615793

RESUMO

OBJECTIVE: To examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016. DESIGN: Secondary analysis of Ethiopian Demographic and Health Surveys. SETTING: All administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016. PARTICIPANTS: Women aged 15-49 years with a live birth during the 5 years preceding the survey. MAIN OUTCOME MEASURES: We analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the 'Three Delays Model' to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia. RESULTS: The adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths. CONCLUSIONS: A naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.


Assuntos
Cesárea/mortalidade , Morte Perinatal/etiologia , Adolescente , Adulto , Fatores Etários , Cesárea/estatística & dados numéricos , Estudos de Coortes , Intervalos de Confiança , Países em Desenvolvimento , Etiópia , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Retrospectivos , Medição de Risco , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana
6.
Arch Gynecol Obstet ; 300(5): 1245-1252, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31576451

RESUMO

PURPOSE: Information regarding the use of barbed suture in gynecologic surgery is limited. Our aim was to compare maternal morbidity following caesarean deliveries performed with barbed compared with non-barbed suture for uterine closure. METHODS: A historical cohort study from a single tertiary institution. The study group composed of all women that underwent term, uncomplicated singleton caesarean deliveries, where uterine closure was performed with ETHICON's Stratafix®, a polydioxanone barbed suture, compared with caesarean deliveries where uterine closure was performed with ETHICON's VICRYL®, a Polyglactin 910 non-barbed suture. The primary outcomes were the rate of maternal morbidity including the rate of red packed cells transfusion and a composite of infectious morbidity. Operation duration was also evaluated. An analysis restricted to elective caesarean deliveries was performed comparing the suture types. RESULTS: Three thousand and sixty patients were included in the study; 1337 in the study group and 1723 in the control group. There was no significant difference in the rate of the primary outcomes (red packed cells transfusion: 2.5% in the barbed suture vs. 2.1% in the non-barbed suture groups; p = 0.47; composite maternal morbidity: 3.8% vs. 4.8%, respectively; p = 0.18). Barbed suture was associated with reduced risk of postoperative ileus compared with the non-barbed suture (0.3% vs. 1.0%, respectively; p = 0.02) and a longer operation time (31 vs. 29 min, respectively; p < 0.001). In the analysis restricted to elective caesarean deliveries only the duration of operation remained significantly different between the groups. CONCLUSIONS: The rate of short term maternal morbidities among patients undergoing uterine closure with barbed suture during caesarean delivery is similar to the non-barbed suture.


Assuntos
Cesárea/mortalidade , Complicações Pós-Operatórias/mortalidade , Técnicas de Sutura/efeitos adversos , Útero/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Retrospectivos
7.
Birth Defects Res ; 111(19): 1543-1550, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31642615

RESUMO

BACKGROUND: It is hypothesized that cesarean delivery may reduce mortality among infants with spina bifida (e.g., by reducing trauma to the open lesion); however, few studies have assessed this relationship. METHODS: We used the Texas Birth Defects Registry to identify neonates with spina bifida born between 1999 and 2014. The mode of delivery (main exposure) was abstracted from each subject's birth certificate. The vital status (main outcome) was determined based on the presence or absence of a death certificate. When a death certificate was present, survival time was calculated by subtracting the date of birth from the date of death. We then conducted multivariable Cox proportional hazards regression to estimate the adjusted hazard ratio between cesarean delivery and death prior to 29 days. We adjusted for maternal race/ethnicity, maternal education, gestational age/birthweight, and breech presentation. This analysis was repeated for death prior to 365 days. RESULTS: We analyzed 1,983 nonsyndromic, liveborn neonates with spina bifida, and 68% of these neonates were delivered by cesarean. After adjusting for potential confounders, the adjusted hazard ratio [aHR] for death prior to 29 days was 0.77 (95% confidence interval [CI] 0.49, 1.21) and the aHR for death prior to 365 days was 0.93 (95% CI 0.63, 1.38) comparing infants delivered by cesarean to those delivered vaginally. CONCLUSIONS: Despite a lack of strong prior epidemiologic evidence, cesarean rates for neonates with spina bifida were high. Further investigations of the relationship between mode of delivery and infant outcomes, including mortality, complications, and long-term prognosis, are warranted.


Assuntos
Cesárea/mortalidade , Parto Obstétrico/mortalidade , Disrafismo Espinal/mortalidade , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Nascimento Vivo , Masculino , Parto , Gravidez , Modelos de Riscos Proporcionais , Texas/epidemiologia
8.
PLoS Med ; 16(7): e1002846, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31283770

RESUMO

BACKGROUND: The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS AND FINDINGS: This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. CONCLUSIONS: Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.


Assuntos
Cesárea/tendências , Educação em Saúde/tendências , Assistência Perinatal/tendências , Padrões de Prática Médica/tendências , Adulto , Fortalecimento Institucional/tendências , Cesárea/efeitos adversos , Cesárea/mortalidade , China , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Capacitação em Serviço/tendências , Mortalidade Materna/tendências , Educação de Pacientes como Assunto/tendências , Mortalidade Perinatal/tendências , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
BMC Public Health ; 19(1): 811, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234805

RESUMO

BACKGROUND: The perinatal mortality rate (PMR) in Nigeria rose by approximately 5% from 39 to 41 deaths per 1000 total births between 2008 and 2013, indicating a reversal in earlier gains. This study sought to identify factors associated with increased PMR. METHODS: Nationally representative data including 31,121 pregnancies of 7 months or longer obtained from the 2013 Nigeria Demographic and Health Survey were used to investigate the community-, socio-economic-, proximate- and environmental-level factors related to perinatal mortality (PM). Generalized linear latent and mixed models with the logit link and binomial family that adjusted for clustering and sampling weights was employed for the analyses. RESULTS: Babies born to obese women (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.13-1.89) and babies whose mothers perceived their body size after birth to be smaller than the average size (aOR = 1.92, 95% CI: 1.61-2.30) showed greater odds of PM. Babies delivered through caesarean section were more likely to die (aOR = 2.85, 95% CI: 2.02-4.02) than those born through vaginal delivery. Other factors that significantly increased PM included age of the women (≥40 years), living in rural areas, gender (being male) and a fourth or higher birth order with a birth interval ≤ 2 years. CONCLUSIONS: Newborn and maternal care interventions are needed, especially for rural communities, that aim at counselling women that are obese. Promoting well-timed caesarean delivery, Kangaroo mother care of small-for-gestational-age babies, child spacing, timely referral for ailing babies and adequate medical check-up for older pregnant women may substantially reduce PM in Nigeria.


Assuntos
Parto Obstétrico/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Complicações na Gravidez/mortalidade , Adulto , Intervalo entre Nascimentos , Cesárea/mortalidade , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Serviços de Saúde Materna , Mães/estatística & dados numéricos , Nigéria , Obesidade/mortalidade , Razão de Chances , Gravidez , Adulto Jovem
10.
J Am Coll Cardiol ; 73(17): 2181-2191, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31047006

RESUMO

BACKGROUND: Pregnant women with congenital heart defects (CHDs) may be at increased risk for adverse events during delivery. OBJECTIVES: This study sought to compare comorbidities and adverse cardiovascular, obstetric, and fetal events during delivery between pregnant women with and without CHDs in the United States. METHODS: Comorbidities and adverse delivery events in women with and without CHDs were compared in 22,881,691 deliveries identified in the 2008 to 2013 National Inpatient Sample using multivariable logistic regression. Among those with CHDs, associations by CHD severity and presence of pulmonary hypertension (PH) were examined. RESULTS: There were 17,729 deliveries to women with CHDs (77.5 of 100,000 deliveries). These women had longer lengths of stay and higher total charges than women without CHDs. They had greater odds of comorbidities, including PH (adjusted odds ratio [aOR]: 193.8; 95% confidence interval [CI]: 157.7 to 238.0), congestive heart failure (aOR: 49.1; 95% CI: 37.4 to 64.3), and coronary artery disease (aOR: 31.7; 95% CI: 21.4 to 47.0). Greater odds of adverse events were observed, including heart failure (aOR: 22.6; 95% CI: 20.5 to 37.3), arrhythmias (aOR: 12.4; 95% CI: 11.0 to 14.0), thromboembolic events (aOR: 2.4; 95% CI: 2.0 to 2.9), pre-eclampsia (aOR: 1.5; 95% CI: 1.3 to 1.7), and placenta previa (aOR: 1.5; 95% CI: 1.2 to 1.8). Cesarean section, induction, and operative vaginal delivery were more common, whereas fetal distress was less common. Among adverse events in women with CHDs, PH was associated with heart failure, hypertension in pregnancy, pre-eclampsia, and pre-term delivery; there were no differences in most adverse events by CHD severity. CONCLUSIONS: Pregnant women with CHDs were more likely to have comorbidities and experience adverse events during delivery. These women require additional monitoring and care.


Assuntos
Parto Obstétrico/efeitos adversos , Cardiopatias Congênitas/epidemiologia , Mortalidade Hospitalar , Mortalidade Materna , Complicações na Gravidez/epidemiologia , Gravidez de Alto Risco , Adolescente , Adulto , Cesárea/mortalidade , Cesárea/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Parto Obstétrico/métodos , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Tempo de Internação , Modelos Logísticos , Saúde Materna , Análise Multivariada , Placenta Prévia/diagnóstico , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
11.
Paediatr Perinat Epidemiol ; 33(3): 204-212, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31087678

RESUMO

BACKGROUND: Mode of delivery is hypothesised to influence clinical outcomes among neonates with gastroschisis. Results from previous studies of neonatal mortality have been mixed; however, most studies have been small, clinical cohorts and have not adjusted for potential confounders. OBJECTIVES: To evaluate whether caesarean delivery is associated with mortality among neonates with gastroschisis. METHODS: We studied liveborn, nonsyndromic neonates with gastroschisis delivered during 1999-2014 using data from the Texas Birth Defect Registry. Using multivariable Cox proportional hazards regression, we separately assessed the relationship between caesarean and death during two different time periods, prior to 29 days (<29 days) and prior to 365 days (<365 days) after delivery, adjusting for potential confounders. We also updated a recent meta-analysis on this relationship, combining our estimates with those from the literature. RESULTS: Among 2925 neonates with gastroschisis, 63% were delivered by caesarean. No associations were observed between caesarean delivery and death <29 days (adjusted hazard ratio [aHR] 1.00, 95% confidence interval [CI] 0.63, 1.61) or <365 days after delivery (aHR 0.99, 95% CI 0.70, 1.41). The results were similar among those with additional malformations and among those without additional malformations. When we combined our estimate with prior estimates from the literature, results were similar (combined risk ratio [RR] 1.00, 95% CI 0.84, 1.19). CONCLUSIONS: Although caesarean rates among neonates with gastroschisis were high, our results suggest that mode of delivery is not associated with mortality among these individuals. However, data on morbidity outcomes (eg intestinal damage, infection) were not available in this study.


Assuntos
Cesárea/estatística & dados numéricos , Gastrosquise/mortalidade , Adolescente , Adulto , Cesárea/mortalidade , Estudos de Coortes , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Texas/epidemiologia , Adulto Jovem
12.
Semin Perinatol ; 43(5): 260-266, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30979600

RESUMO

Cesarean birth (CB) rates are rising, globally. The global burden of CB is having a mixed effect on pregnancy outcomes and requires significant clinical and economic resources. The context of CB care in low- and middle-income countries is further complicated by barriers to facility-based care itself, followed by issues with quality and delivery of care in these resource-limited settings. The objective of this commentary is to propose an original, new, flexible, comprehensive care model for delivering SAFE cesarean delivery care in very low-resource settings. This model, the SAFEmodel for cesarean delivery care in low- and middle-income countries, developed by the authors, does not assume the current care model is working. It does not assume that even traditional hospital settings are what is needed to solve the problem of delivering high-quality, easily accessible CB care in the most remote and geographically isolated communities. The novel model promotes a decentralized care program that brings emergency obstetric care to women instead of the converse through four concepts: the care should be cloSe (community-based), it should be very dedicated to Action (transfer of care), it should be Focused on and highly specific to labor and delivery (cesarean birth center), and finally, it should be committed to high-quality care through iterative Evidence-based quality improvement programming and data collection.


Assuntos
Cesárea , Assistência à Saúde/normas , Serviços de Saúde Materna/normas , Qualidade da Assistência à Saúde/normas , Adulto , Cesárea/mortalidade , Países em Desenvolvimento , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Segurança do Paciente , Projetos Piloto , Gravidez , Resultado da Gravidez
13.
JAMA Netw Open ; 2(3): e190526, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901040

RESUMO

Importance: The World Health Organization recommends that rates of cesarean delivery range from 10% to 15%. India has the largest annual number of births in the world and needs updates of existing estimates. Objective: To provide a new set of estimates of the rates of cesarean delivery and to map regional and socioeconomic disparities within these rates in India. Design, Setting, and Participants: Cross-sectional study primarily based on cross-sectional figures drawn from the fourth round of the National Family and Health Survey conducted from January 20, 2015, through December 4, 2016, by the Indian Institute for Population Sciences in Mumbai. The survey interviewed 699 686 girls and women aged 15 to 49 years and collected information on their last 3 pregnancies since January 2010 (259 627 births). The study population was statistically representative of India's 36 states and Union territories and its 640 districts. The survey also included information on the socioeconomic status of households. The research is based on data tabulations and mapping and on spatial and regression analyses of microdata. Socioeconomic inequalities in access to cesarean deliveries were assessed using the Gini coefficient. Data were analyzed from August to October 2018. Main Outcomes and Measures: Rate of cesarean deliveries by regional and socioeconomic characteristics. Results: The cesarean birth rate computed for 699 686 Indian girls and women aged 15 to 49 years (mean [SD] age, 26.8 [5.0] years) was 17.2% (95% CI, 17.1%-17.3%) in 2010 to 2016, which corresponds to an estimated 4.38 million cesarean deliveries per year during the period (95% CI, 4.34-4.41 million) in India. Cesarean birth rates vary widely within the country, with a range of 5.8% (95% CI, 5.1%-6.5%) to 40.1% (95% CI, 38.4%-41.8%) across states and 4.4% (95% CI, 4.3%-4.6%) to 35.9% (35.4%-36.4%) across socioeconomic quintiles. The rate significantly increased from 9.2% (95% CI, 9.1%-9.3%) in 2004 to 2008. According to the recommended 10% to 15% benchmark of cesarean birth rates by the WHO, the estimated deficit of cesarean births in India is 0.5 million per year, whereas the estimated excess of cesarean births is 1.8 million. The overall Gini coefficient of inequality in access to cesarean deliveries is 46.4. Conclusions and Relevance: The rate of cesarean births is increasing in India and has already crossed the World Health Organization threshold of 15%. More research is needed to understand the factors behind the rapid rise of cesarean deliveries among affluent groups and in more developed regions.


Assuntos
Cesárea/mortalidade , Cesárea/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Gravidez/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
14.
Lancet Glob Health ; 7(4): e513-e522, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30879511

RESUMO

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.


Assuntos
Cesárea/efeitos adversos , Cesárea/mortalidade , Mortalidade Infantil , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez , Resultado do Tratamento , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Mortalidade Materna , Gravidez , Estudos Prospectivos , Fatores de Risco , África do Sul/epidemiologia
15.
Vet Med Sci ; 5(3): 336-344, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30839178

RESUMO

In human medicine, there is a recommended decision to delivery interval (DDI), which allows for the optimization of protocols and systematic review of hospital success. In veterinary medicine, no such guideline has been established or investigated. The purpose of this study was to investigate the relationship between the interval from the decision to perform a caesarean section and the delivery of the neonates and fetal mortality at the time of surgery. One hundred and fifty canine caesarean sections were evaluated retrospectively. Caesarean cases were dichotomized to those that had at least one perinatal death and cases where all puppies survived. Factors that increased the likelihood of at least one perinatal death at caesarean section were: cases that presented as an emergency caesarean section, the dam presenting with a fetus in the vaginal canal, the dam not having a history of previous caesareans sections, and being multiparous. Even though there was no association of DDI with likelihood of having perinatal death, timing related factors that increased the likelihood of having at least one perinatal death at caesarean section were: cases where total anaesthesia time was longer than 2 h; time from induction to start of surgery was longer than 45 min and surgical time longer than 75 min. In conclusion, time is a factor in the success of canine caesarean sections and further research is needed to better define the optimal decision to delivery time in canine caesarean sections in order to optimize fetal survival and hospital protocol success rates.


Assuntos
Cesárea/veterinária , Tomada de Decisões , Mortalidade Fetal , Medicina Veterinária/estatística & dados numéricos , Animais , Cesárea/mortalidade , Cães , Humanos , Estudos Retrospectivos
16.
BMC Health Serv Res ; 19(1): 133, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808367

RESUMO

BACKGROUND: The state of São Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality in the state of São Paulo, Brazil. METHODS: In this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted "p" at 5%. RESULTS: The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates. CONCLUSIONS: It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population.


Assuntos
Mortalidade Materna , Atenção Primária à Saúde , Adulto , Brasil/epidemiologia , Cesárea/mortalidade , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Mortalidade Materna/tendências , Modelos Estatísticos , Análise Multivariada , Gravidez
17.
Eur J Obstet Gynecol Reprod Biol ; 234: 96-102, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30682601

RESUMO

OBJECTIVE: Caesarean section (CS) may reduce mortality and morbidity for very preterm breech infants, but evidence is inconclusive. We evaluated neonatal outcomes for singleton breech infants by mode of delivery in a European cohort. STUDY DESIGN: Data come from the EPICE population-based cohort of very preterm births in 19 regions in 11 European countries (7770 live births). The study population was singleton spontaneous-onset breech births at 24-31 weeks gestational age (GA) without antenatal medical complications requiring caesarean delivery (N = 572). Mixed-effects regression models adjusting for maternal and pregnancy covariates and propensity score matching was used to examine the effect of (1) CS and (2) a unit policy of systematic CS for breech presentation by GA. The primary outcome was a composite of in-hospital mortality, intraventricular haemorrhage grades III & IV or cystic periventricular leukomalacia. Secondary outcomes were each component separately, five minute Apgar score below seven and mortality within six hours of delivery. RESULTS: 64.4% of infants were delivered by CS with a range across regions from 41% to 100%; these infants had higher GA and were more likely to be small for gestational age, receive antenatal steroids, and have mothers who were hospitalised for more than one day before delivery compared to those delivered vaginally. CS was associated with lower risks of all outcomes in mixed-effects adjusted models (odds ratio (OR) for the composite outcome: 0.50, 95% confidence interval (CI): 0.30-0.81), but not in propensity score matched models (OR: 0.72, 95% CI: 0.41; 1.29). A systematic CS policy was associated with lower mortality and morbidity in unadjusted, but not adjusted models (OR for composite outcome: 0.76, 95% CI: 0.44; 1.28). 35% of births 24-25 weeks were delivered by CS and protective effects were consistently stronger, but not statistically significant. CONCLUSIONS: Point estimates indicated protective effects of caesarean delivery for very preterm breech infants in conventional statistical models. However, analyses using propensity scores and based on unit policies did not confirm statistically significant associations. Prospective large-scale studies are needed to establish best practice and could be implemented in European regions where vaginal delivery remains an option.


Assuntos
Apresentação Pélvica/mortalidade , Cesárea/mortalidade , Mortalidade Perinatal , Adulto , Estudos de Coortes , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Gravidez
18.
J Matern Fetal Neonatal Med ; 32(2): 265-270, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28889774

RESUMO

INTRODUCTION: The routine to deliver almost all term breech cases by elective cesarean section (CS) has continued to be debated due to the risk of maternal and neonatal complications. The aims of the study were (1) to investigate if mode of delivery impacts on the risk of morbidity and mortality among term infants in breech presentation and (2) to compare the rates of severe neonatal complications and mortality in relation to presentation and mode of delivery. METHODS: This population-based cohort study used data from the Swedish Medical Birth Register. All women (and their newborn infants) with singleton pregnancies who gave birth at term to an infant in breech (n = 27,357) or cephalic presentation (n = 837,494) between 2001 and 2012 were included. Births with vacuum extraction and induced labors were excluded, as well as antepartum stillbirths, births with infants diagnosed with congenital malformations and multiple births. RESULTS: On one hand, the rates of neonatal complications and mortality were higher among infants born in vaginal breech compared to the vaginal cephalic group. On the other hand, after CS, the rates of all neonatal complications under study and neonatal mortality were lower among infants in breech presentation than in those in cephalic presentation. After adjustment for confounders, infants delivered in vaginal breech had 23.8 times higher odds AOR (ratio) for brachial plexus injury, 13.3 times higher odds ratio for Apgar score <7 at 5 min, 6.7 times higher odds of intracranial hemorrhage (ICH), or convulsions and 7.6 higher odds ratio for perinatal mortality than those delivered by elective CS. CONCLUSIONS: Despite a probable selection of women who before-hand were considered at low risk and, therefore, could be recommended vaginal breech delivery, infants delivered in vaginal breech faced substantially increased risks of severe neonatal complications compared with infants in breech presentations delivered by elective CS. Key message Vaginal breech delivery is associated with increased risk for severe neonatal complications.


Assuntos
Apresentação Pélvica/epidemiologia , Mortalidade Infantil , Doenças do Recém-Nascido/epidemiologia , Adolescente , Adulto , Apresentação Pélvica/mortalidade , Cesárea/mortalidade , Cesárea/estatística & dados numéricos , Estudos de Coortes , Parto Obstétrico/mortalidade , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Pessoa de Meia-Idade , Morbidade , Gravidez , Suécia/epidemiologia , Vácuo-Extração/efeitos adversos , Vácuo-Extração/métodos , Vácuo-Extração/mortalidade , Vácuo-Extração/estatística & dados numéricos , Adulto Jovem
19.
Acta Obstet Gynecol Scand ; 98(1): 117-126, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30192982

RESUMO

INTRODUCTION: Trial of labor (TOLAC) is an option in most preganancies after a cesarean section The objective of the study was to compare perinatal outcome in TOLAC and non-TOLAC deliveries in a population with high TOLAC rates. MATERIAL AND METHODS: This was a cohort study based on population data from the Medical Birth Registry of Norway. We included term, cephalic, single, second deliveries, 1989-2009, after a first cesarean section (n = 43 422). TOLAC, TOLAC failure, non-TOLAC deliveries, and after high-risk and low-risk pregnancies (no risk/any risk), were compared with respect to offspring mortality, 5-minute Apgar score Apgar < 7 and < 4, transfer to a neonatal intensive care unit, and neonatal respiratory distress syndrome. RESULTS: Statistically significant differences were observed (P <0.05). In the low-risk group the offspring mortality was 2.3/1000 in TOLAC compared with 0.9/1000 in non-TOLAC. In the high-risk group, the offspring mortality was 3.7/1000 in TOLAC compared with 0.9/1000 in non-TOLAC, and the 5-minute Apgar score < 4 was 3.1/1000 in TOLAC compared with 0.9/1000 in non-TOLAC. In both risk groups, TOLAC delivery had a higher rate of 5-minute Apgar score < 7. In the low-risk group, non-TOLAC deliveries had a higher rate of neonatal respiratory distress syndrome than TOLAC deliveries. CONCLUSIONS: We observed higher risk of offspring mortality and lower 5-minute Apgar score in TOLAC than in non-TOLAC. Possible causes and preventive measures should be explored.


Assuntos
Recesariana/mortalidade , Cesárea/mortalidade , Mortalidade Infantil , Resultado da Gravidez/epidemiologia , Prova de Trabalho de Parto , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Noruega , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Gravidez de Alto Risco , Nascimento Vaginal Após Cesárea/mortalidade , Adulto Jovem
20.
J Matern Fetal Neonatal Med ; 32(22): 3771-3777, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29807452

RESUMO

Objective: In women with a triplet pregnancy, there is debate on the preferred mode of delivery. We performed a nationwide cohort study to assess the impact of mode of delivery on perinatal outcome in women with a triplet pregnancy. Methods: Nationwide cohort study on women with a triplet pregnancy who delivered between 26 + 0 and 40 + 0 weeks of gestation in the years 1999-2008. We compared perinatal outcomes according to the intended mode of delivery and the actual mode of delivery. Outcome measures were perinatal mortality and neonatal morbidity. Perinatal outcomes were analyzed taking into account the dependency between the children of the same triplet pregnancy ("any mortality" and "any morbidity") and were also analyzed separately per child. Results: We identified 386 women with a triplet pregnancy in the study period. Mean gestational age at delivery was 33.1 weeks (SD 2.5 weeks; range 26.0-40.0 weeks). Perinatal mortality was 2.3% for women with a planned caesarean section and 2.4% in women with a planned vaginal delivery (aOR 0.37; 95% confidence interval (CI) 0.09-1.5) and neonatal morbidity was 26.0% versus 36.0%, (aOR 0.88; 95% CI 0.51-1.4) respectively. In the subgroup analyses according to gestational age and in the analysis of perinatal outcomes per child separately, there were also no large differences in perinatal outcomes. The same applied for perinatal outcomes according to the actual mode of delivery. Conclusion: In this large cohort study among women with a triplet pregnancy, caesarean delivery is not associated with reduced perinatal mortality and morbidity.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Gravidez de Trigêmeos/estatística & dados numéricos , Adulto , Cesárea/mortalidade , Cesárea/estatística & dados numéricos , Parto Obstétrico/mortalidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/mortalidade , Morbidade , Países Baixos/epidemiologia , Mortalidade Perinatal , Gravidez , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/mortalidade , Estudos Retrospectivos
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