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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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 , Gravidez , Gravidez de Alto Risco , Nascimento Vaginal Após Cesárea/mortalidade , Adulto Jovem
10.
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
11.
J Matern Fetal Neonatal Med ; 32(15): 2539-2542, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29471705

RESUMO

OBJECTIVE: We aimed to compare maternal morbidity and mortality of cesarean sections (CS) in the second versus first stage of labor. STUDY DESIGN: Retrospective study of all CS at a single, university-affiliated medical center, between January 2010 and December 2014. Eligibility was limited to term, singleton pregnancies with cephalic presentation. Maternal outcomes of second-stage CS were compared to those of first-stage CS. The primary outcome was defined as estimated blood loss >1000 ml. RESULTS: Overall, 1004 women met the inclusion criteria, of which 290 (29%) had a second-stage CS and 714 (71%) had a first-stage CS. Women in the second-stage CS group had a higher nulliparity and hypertensive disorders rates and a lower rate of previous CS. Second-stage CS was associated with more than double the rate of estimated blood loss >1000 ml (9.7% versus 3.8%, p<.001), and more prone to unintentional uterine incision extension, uterine atony, hemoglobin decrease >2 g/l and antibiotic treatment for suspected endometritis. In a multivariable logistic regression model, second-stage CS was found to be independently associated with unintentional uterine incision extension (OR 6.8, 95% CI 4.1-11.2), uterine atony (OR 3.3, 95% CI 1.4-8.0) and antibiotic treatment for suspected endometritis (OR 2.6, 95% CI 1.4-5.1), but not with excessive blood loss (OR 1.5, 95% CI 0.8-2.8). Additionally, failed assisted vaginal delivery prior to second-stage CS was not associated with a higher rate of complications. CONCLUSION: Second-stage CS is associated with higher rates of adverse maternal outcomes, mainly unintentional uterine incision extension, uterine atony, and suspected endometritis.


Assuntos
Cesárea/mortalidade , Complicações Intraoperatórias/epidemiologia , Primeira Fase do Trabalho de Parto , Segunda Fase do Trabalho de Parto , Complicações Pós-Operatórias/epidemiologia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
12.
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
13.
Lancet ; 392(10155): 1349-1357, 2018 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-30322585

RESUMO

A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.


Assuntos
Cesárea/efeitos adversos , Cesárea/mortalidade , Cesárea/psicologia , Feminino , Saúde Global , Humanos , Recém-Nascido , Pobreza , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de Risco
14.
J Forensic Leg Med ; 60: 25-29, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30223232

RESUMO

BACKGROUND: Pregnancy-associated deaths are a widely recognized phenomenon, that warrants in-depth investigation. Of the 319 suspicious deaths of adult women (>20 years) autopsied during 2011-2012, in the Cairo and Giza governorates, 37 (11.7%) women were pregnant at the time of the autopsy. This paper analyzes the corresponding demographic data, autopsy findings, and toxicological screening. THE RESULTS: Reveal that the number of deaths of pregnant women were higher in 2012 than in 2011. In addition, the number of cases from Giza exceeded those from Cairo (62.2% and 37.8%, respectively). Most cases involved married women (62.2%) in the third trimester of pregnancy (67.5%). Most deaths were predominantly un-intentional (51.4%) attributed to peri-partum complications. Homicidal deaths contributed to 43% of cases, and the husband was the suspect perpetrator in 37.5% of cases. Only two cases were associated with substance abuse. CONCLUSION: the paper concludes that this analysis may inform future strategies to protect pregnant women from the hazards of violence and labor that threaten their lives.


Assuntos
Causas de Morte , Gestantes , Aborto Criminoso/mortalidade , Adulto , Asfixia/mortalidade , Queimaduras/mortalidade , Cesárea/mortalidade , Egito/epidemiologia , Feminino , Homicídio/estatística & dados numéricos , Humanos , Hemorragia Pós-Operatória/mortalidade , Gravidez , Embolia Pulmonar/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adulto Jovem
15.
Eur J Obstet Gynecol Reprod Biol ; 229: 148-152, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30195138

RESUMO

OBJECTIVES: Maternal mortality is rare in high-resource settings. This hampers studies of the association between maternal mortality and mode of birth, although this topic remains of importance, given the changing patterns in mode of birth with increasing cesarean section rates in most countries. Purpose of this study was to examine incidence of cesarean section-related maternal mortality in the Netherlands and association of surgery with the chain of morbid events leading to death. STUDY DESIGN: We performed a retrospective cohort study using the Confidential Enquiry into Maternal Deaths, including all 2,684,946 maternities in the Netherlands between January 1st, 1999, and December 31st, 2013, registered in the Dutch Perinatal Registry. All available medical records of cases reported to the Dutch Maternal Mortality and Severe Morbidity Audit Committee were assessed by two researchers, and one or two additional experts in case of contradicting opinions, based on a set of pre-identified clinical criteria. Main outcome measures were (1) incidence and relative risk of maternal death following cesarean section and vaginal birth and (2) incidence of death directly related to cesarean section and death in which cesarean section was one of the contributing factors. RESULTS: Risk of death after cesarean section was 21.9 per 100.000 cesarean sections (86/393,443) versus 3.8 deaths per 100.000 vaginal births (88/2,291,503): Relative Risk (RR) 5.7 (95% Confidence Interval [CI] 4.2-7.7). Death directly related to complications of cesarean section occurred in 8/86 women: 2 per 100,000 cesarean sections. With addition of 43 women in which cesarean section did not initiate, but contributed to the chain of events leading to mortality, risk of death increased to 13 per 100,000 cesarean sections (51/393,443; RR 3.4; 95%CI 2.4-4.8). At the start of cesarean section, pre-existing morbidity was present in 70/86 women (81.4%). CONCLUSIONS: Compared to vaginal birth, maternal mortality after cesarean section was three times higher following exclusion of deaths that had no association with surgery. In approximately one in ten deaths after cesarean section, surgery did in fact initiate the chain of morbid events.


Assuntos
Cesárea/mortalidade , Adulto , Causas de Morte , Feminino , Humanos , Mortalidade Materna , Países Baixos/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
16.
JAMA Pediatr ; 172(10): 949-957, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30105352

RESUMO

Importance: Preterm and postterm deliveries have declined since 2005 in the United States, but the association between these changes and neonatal mortality remains unknown. Objective: To estimate changes in the gestational age distribution among spontaneous and clinician-initiated deliveries between 2006 and 2013 and associated changes in neonatal mortality. Design, Setting, and Participants: A retrospective cohort analysis was conducted of 22 million singleton live births without major malformations in the United States from 2006 to 2013. Data analysis was performed from August to October 2017. Main Outcomes and Measures: Changes in gestational age distribution among spontaneous and clinician-initiated deliveries at extremely preterm (20-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), term (39-40), late term (41 weeks), and postterm (42-44 weeks) gestations and changes in neonatal mortality rates at less than 28 days between 2006 and 2013. These changes were estimated from log-linear Poisson regression models with robust variance, adjusted for confounders. Results: Among 22 million births, 12 493 531 (56.7%) were spontaneous and 9 557 815 (43.3%) were clinician-initiated deliveries. Among spontaneous deliveries, the proportion of births at 20 to 27, 28 to 31, 32 to 33, 34 to 36, and 37 to 38 weeks declined. Among clinician-initiated deliveries, the proportion of births at 34 to 36 and 37 to 38 weeks declined and the proportion at 39 to 40 weeks increased. Among spontaneous deliveries, overall neonatal mortality rates declined from 1.8 to 1.3 per 1000 live births, mainly at 20 to 27 weeks (adjusted annual decline, 1%; 95% CI, -2% to -1%) and 28 to 31 weeks (adjusted annual decline, 6%; 95% CI, -8% to -5%). Among clinician-initiated deliveries, overall mortality rates remained unchanged (2.1 to 2.2 per 1000 live births). However, mortality rates declined (0.6 to 0.5 per 1000 live births) at 39 to 40 weeks by 1% (95% CI, -3% to -0.4%) annually, adjusted for confounders. Conclusions and Relevance: In the United States, there was a decline in spontaneous deliveries associated with an overall decline in neonatal mortality. Although clinician-initiated deliveries increased at 39 to 40 weeks, neonatal mortality at that gestation declined.


Assuntos
Cesárea/mortalidade , Parto Obstétrico/mortalidade , Nascimento Vivo/epidemiologia , Nascimento Prematuro/mortalidade , Natimorto/epidemiologia , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
17.
Afr Health Sci ; 18(1): 157-165, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29977269

RESUMO

Background: Caesarean section is a very important procedure to decrease maternal and perinatal morbidity and mortality. Anecdotal evidence suggests that more than half of all caesarean sections done in The Gambia are done at the Edward Francis Small Teaching Hospital. Objective: The aim of the study was to determine the caesarean section rate at the Edward Francis Small teaching Hospital. The study also aimed to determine the socio-demographic factors associated with caesarean section and maternal and fetal outcomes of caesarean section at the hospital. Method: A retrospective review of all caesarean sections carried out at the Edward Francis Small Teaching Hospital from 1st January 2014 to 31st December 2014 was done. Data was extracted from patients' record. Descriptive statistics was done using Epi Info 7 statistical software. Results: The Caesarean section rate in the hospital is 24.0%. The commonest indications for caesarean section were previous caesarean section (20.6%) and cephalopelvic disproportion (20.2%). There were 21 maternal deaths (1.8%) and 71 fresh stillbirths (6.0%) in the study population. Conclusion: About a quarter of all deliveries in the hospital were caesarean sections most of which were done as emergencies. The commonest indications for caesarean section were cephalopelvic disproportion and previous caesarean section.


Assuntos
Cesárea/estatística & dados numéricos , Tratamento de Emergência , Hospitais de Ensino/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adulto , Apresentação Pélvica , Desproporção Cefalopélvica , Cesárea/mortalidade , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Sofrimento Fetal , Macrossomia Fetal , Gâmbia/epidemiologia , Humanos , Lactente , Mortalidade Infantil , Prole de Múltiplos Nascimentos , Placenta Prévia , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores Socioeconômicos , Natimorto/epidemiologia
18.
Midwifery ; 59: 88-93, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29421643

RESUMO

BACKGROUND: it is critically important to explore a possible relationship between cesarean section and maternal mortality in Latin America, where the highest cesarean section rates in the world are found. Our aim was to conduct a systematic literature review on the relationship between maternal death and caesarean section in Latin America. METHODS: we undertook a systematic review through six electronic databases. Studies that reported any association analysis between maternal mortality and the mode of delivery in Latin America were included. Papers that fulfilled the inclusion criteria were then read fully, and a quality assessment was conducted with the PROMPT tool. RESULTS: seven articles were identified for final analysis, all of which were observational studies. Most of the studies were retrospective (6) and one was prospective. Of the retrospective studies, 3 were case control and 3 were cross-sectional. Most of the publications on this topic suggest that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth (odds ratio ranging from 1.6 to 7.08). However, it is evident that there is a lack of studies with this subject, especially those that take into account the differences in risk between women delivered by cesarean section or by vaginal birth. CONCLUSIONS: most of the articles showed that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth. However, it is clear that there is a limited number of studies published on this issue. Additional studies with a better methodological design should be conducted.


Assuntos
Cesárea/mortalidade , Mortalidade Materna/tendências , Complicações na Gravidez/epidemiologia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , América Latina/epidemiologia , Morte Materna/etiologia , Gravidez
19.
Am J Infect Control ; 46(4): 375-378, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29174657

RESUMO

BACKGROUND: Serious unintended outcomes (SUOs) associated with cesarean section (CS), defined in this study as sepsis, endometritis, or wound disruption, occurring during the admission to deliver an infant by CS, or on readmission for wound disruption, are not routinely measured in a manner that continuously evaluates their impact on women's health. METHODS: The Texas Healthcare Information Collection Public Use Data File was used to investigate trends in the diagnosis of SUOs over a 5-year period from January 1, 2010-December 31, 2014. RESULTS: CS-associated SUOs affected 9.24 women for every 1,000 CSs. During the study period, a large decrease in the rate of SUOs occurred (R2 = 0.60). This was potentially influenced by a large decrease in the rate of endometritis (R2 = 0.41). Decreases in the diagnosis of and readmission for CS wound disruption were not as large (R2 = 0.06 and R2 = 0.03, respectively). A large increase in CS-associated sepsis (R2 = .32) was identified. Administrative coded data used to identify SUOs in this study may have utility for the identification of serious unintended outcomes associated with CS at the population level. CONCLUSIONS: Increases in length of stay and utilization of critical care were noted among women affected by CS-associated SUOs. Additional study is needed to determine factors that increase the likelihood of the development of SUO and to evaluate the preventability of these events.


Assuntos
Cesárea/efeitos adversos , Endometrite/etiologia , Sepse/etiologia , Infecção da Ferida Cirúrgica/etiologia , Cesárea/mortalidade , Endometrite/epidemiologia , Feminino , Humanos , Estudos Retrospectivos , Sepse/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/patologia
20.
Eur J Obstet Gynecol Reprod Biol ; 221: 97-104, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29277048

RESUMO

OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after planned caesarean delivery (CD) versus planned vaginal delivery (VD). STUDY DESIGN: A nationwide cohort study on women pregnant with twins and the first child in cephalic position, who delivered between 32 + 0-41 + 0 weeks between 2000 and 2012 in the Netherlands, using multivariate logistic regression analysis to compare neonatal morbidity and mortality according to planned delivery mode, and looking at subgroups 32 + 0-36 + 6 and 37 + 0-41 + 0 weeks. RESULTS: We included 21,107 women, of whom 1384 (6.6%) had a planned CD. Of the 19,723 women (93.4%) who had a planned VD, 19.7% delivered by intrapartum CD. We found no significant differences in 'any mortality' (aOR planned CD vs. planned VD 1.34 (95% CI 0.63-2.60)), the outcome 'Apgar score (AS) < 4 or death within 28 days' (aOR 1.28 (95% CI 0.77-2.11) or asphyxia-related morbidity (aOR 0.57 (95% CI 0.32-1.03)). After planned CD more prematurity-related morbidity (aOR 1.55 (95% CI 1.21-1.98)), other morbidity (aOR 1.50 (95% CI 1.26-1.78)) and 'any morbidity or mortality' (aOR 1.41 (95% CI 1.20-1.66) was noted. Trauma-associated morbidity was absent after planned CD and occurred 45 times (0.2%) after planned VD. Before 36 + 6 weeks, planned CD resulted in more perinatal mortality (aOR 2.10 (95% CI 0.92-4.76)), while asphyxia-related morbidity did not differ (aOR 0.80 (95% CI 0.41-1.54). Planned CD resulted in more 'any morbidity or mortality' (aOR 1.52 (95% CI 1.25-1.84)), 'AS < 4 or death within 28 days' (aOR 1.77 (95% CI 1.02-3.09)), prematurity-related morbidity (aOR 1.73 (95% CI 1.34-2.23)), and 'other morbidity' (aOR 1.56 (95% CI 1.28-1.90)). After 37 weeks, no significance differences in mortality, 'any morbidity or mortality <28 days' (aOR 0.96 (95% CI 1 (0.67-1.38)), or 'AS < 4 or death within 28 days' (aOR 0.41 (95% CI (0.10-1.70)) were found. There was less asphyxia-related morbidity after planned CD (aOR 0.24 (95% CI 0.06-1.002)). CONCLUSION: Planned VD results in comparable neonatal outcomes as planned CD for twin pregnancy with the first twin in cephalic position, even with a low intrapartum CD rate of 19.7%. At term, a planned CD may result in less asphyxia- and trauma-related outcomes.


Assuntos
Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Resultado da Gravidez , Gravidez de Gêmeos , Adulto , Cesárea/mortalidade , Estudos de Coortes , Parto Obstétrico/métodos , Parto Obstétrico/mortalidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Países Baixos , Parto , Mortalidade Perinatal , Gravidez , Gêmeos , Adulto Jovem
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