Persistence of anxiety symptoms after elective caesarean delivery.
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ABSTRACT:
SUBMITTER: Janssen AB
PROVIDER: S-EPMC6127961 | biostudies-literature | 2018 Sep
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe OptiBIRTH study incorporates a multicentre cluster randomised trial in 15 hospital sites across three European countries. The trial was designed to test a complex intervention aimed at improving vaginal birth after caesarean section (VBAC) rates through increasing women's involvement in their care. Prior to developing a robust standardised model to conduct the health economic analysis, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in four European countries.MethodsA decision-analytic model was developed to estimate the costs and the health effects, measured using Quality Adjusted Life Years (QALYs), of VBAC compared with ERCD. A cost-effectiveness analysis for the period from confirmation of pregnancy to 6 weeks postpartum was performed for short-term consequences and during lifetime for long-term consequences, based on a hypothetical cohort of 100,000 pregnant women in each of four different countries; Belgium, Germany, Ireland and Italy. A societal perspective was adopted. Where possible, transition probabilities, costs and health effects were adapted from national data obtained from the respective countries. Country-specific thresholds were used to determine the cost-effectiveness of VBAC compared to ERCD. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions.ResultsWithin a 6-week time horizon, VBAC resulted in a reduction in costs, ranging from €3,334,052 (Germany) to €66,162,379 (Ireland), and gains in QALYs ranging from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country. Compared to ERCD, VBAC is the dominant strategy in all four countries. Applying a lifetime horizon, VBAC is dominant compared to ERCD in all countries except for Germany (probabilistic analysis, ICER: €8609/QALY). In conclusion, compared to ERCD, VBAC remains cost-effective when using a lifetime time.ConclusionsIn all four countries, VBAC was cost-effective compared to ERCD for low-risk women. This is important for health service managers, economists and policy makers concerned with maximising health benefits within limited and constrained resources.
| S-EPMC5896042 | biostudies-literature
Project description:BackgroundElective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.MethodsUsing a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.ResultsMaternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€ 1,835.06 versus € 4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.ConclusionsClinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.
| S-EPMC3590223 | biostudies-literature
Project description:To compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery.We conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool.Four hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed.For elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up.Chinese Clinical Trial Registry ChiCTR-TRC-11001853.
| S-EPMC4492889 | biostudies-literature
Project description:ObjectivesThis study aimed to determine if low dose intravenous ketamine is effective in reducing opioid use and pain after non-elective caesarean delivery.DesignProspective, randomised, double-blind.SettingTertiary hospital, Bisheshwar Prasad Koirala Institute of Health Sciences, Dharan, Nepal PARTICIPANTS: 80 patients undergoing non-elective caesarean section with spinal anaesthesia.InterventionsPatients were allocated in 1:1 ratio to receive either intravenous ketamine 0.25 mg/kg or normal saline before the skin incision.Primary and secondary outcome measuresThe primary outcome was the total amount of morphine equivalents needed up to postoperative 24 hours. Secondary outcome measures were postoperative pain scores, time to the first perception of pain, maternal adverse effects (nausea, vomiting, hypotension, shivering, diplopia, nystagmus, hallucination) and neonatal Apgar score at 1 and 5 min, neonatal respiratory depression and neonatal intensive-care referral.ResultsThe median (range) cumulative morphine consumption during the first 24 hours of surgery was 0 (0-4.67) mg in ketamine group and 1 (0-6) mg in saline group (p=0.003). The median (range) time to the first perception of pain was 6 (1-12) hours and 2 (0.5-6) hours in ketamine and saline group, respectively (p<0.001). A significant reduction in postoperative pain scores was observed only at 2 hours and 6 hours in the ketamine group compared with placebo group (p<0.05). Maternal adverse effects and neonatal outcomes were comparable between the two groups.ConclusionsIntravenous administration of low dose ketamine before surgical incision significantly reduced the opioid requirement in the first 24 hours in patients undergoing non-elective caesarean delivery.Trial registration numberNCT03450499.
| S-EPMC8246353 | biostudies-literature
Project description:Trial of labour is a safe option for most women after one previous caesarean delivery. However, the proportion of women attempting trial of labour after previous caesarean delivery (TOLAC) has been declining in many countries. In addition, women with prior caesarean delivery appear to know little regarding their mode of delivery and healthcare providers' recommendations. The doctors' preferences exert a strong influence on patient's decision whether or not to pursue TOLAC. In Kenya, it is unclear whether women who opt for trial of labour after caesarean delivery (TOLAC) or elective repeat caesarean delivery (ERCD) do that based on clear understanding of risks and benefits of both modes of delivery. This study aimed at determining whether patients with one previous caesarean delivery make an informed decision on preferred mode of delivery following their interactions with doctors.A cross-sectional descriptive study was carried out on 202 pregnant women with one previous caesarean delivery at Kenyatta National Hospital (KNH) antenatal clinic. Data was collected from both the patients' records and women were interviewed using a structured questionnaire.Out of 202 women with mean age of 30.2 years 136 (67.2%) chose Elective Repeat Caesarean Delivery (ERCD), while 66 (32.8%) opted for TOLAC. Only 61/202 (30.6%; 95% C.I: 24.4 to 37.6%) made informed decisions. Few women (65: 32.2%) knew that the chance of successful TOLAC was high (60-80%) and 97 (48%) were not aware of the chances for a successful TOLAC. More than half of the women (109: 53.9%) were unaware of the risk of uterine rupture after one previous delivery and only few patients (64: 31.7%) knew that the risk of uterine rupture in TOLAC is low (< 1%). The majority of the women (112: 55.4%) did not know that the indications for previous caesarean delivery are an important factor in determining the chance of a successful Vaginal Birth after Caesarean Delivery (VBAC). For 47(23.3%) of the women, there was no documented indication for the previous caesarean delivery. The women's mode of delivery was significantly associated with the preference of the counseling doctor (p < 0.001) and their qualification (p = 0.020). Only 23 (11.4%) women signed the consent form for ERCD while none of the women for TOLAC signed any consent form.There was an overall lack of information on both modes of delivery while doctor's preferences affected women's decisions. Only just under one third of the women made an informed decision. There is a need to develop clear standard protocols and checklists for information to be disseminated to doctors and all patients with previous caesarean deliveries in subsequent pregnancies in Kenya.
| S-EPMC5558758 | biostudies-other
Project description:ObjectiveTo assess the relationship between the timing of antepartum elective caesarean delivery (CD) at term and perinatal outcomes in a Chinese population.MethodsWe conducted a retrospective cohort study of mode of delivery at a large obstetric centre in Shanghai, China between 2007 and 2014. Eligibility criteria included: term nulliparous women with a singleton gestation undergoing antepartum elective CD.ResultsThere were 19 939 women delivered by antepartum CD without indications, with 5.9% performed at 37-37 6/7 weeks, 36.2% at 38-38 6/7 weeks, 38.4% at 39-39 6/7 weeks, 15.4% at 40-40 6/7 weeks, 4.0% at ≥41 weeks. As compared with births at 39-39 6/7 weeks, births at 37 weeks were associated with an increased odds of neonatal respiratory disease (adjusted odds ratian(aOR): 4.82; 95% CI 3.35 to 6.94), neonatal infection (aOR: 3.68; 95% CI 1.80 to 7.52), hypoglycaemia (aOR: 3.85; 95%CI 2.29 to 6.48), hyperbilirubinaemia (aOR: 3.50; 95%CI 2.12 to 5.68), neonatal intensive care admission (aOR: 3.73; 95% CI 2.84 to 4.89) and prolonged hospitalisation (aOR: 7.51; 95% CI 5.10 to 11.07). Births at 38 weeks, 40 weeks or ≥41 weeks were also associated with an increased odds of neonatal respiratory disease with corresponding aORs (95% CI) of 2.26 (1.71 to 3.00), 1.97 (1.33 to 2.94) and 2.91 (1.80 to 4.70), respectively.ConclusionFor women undergoing elective CD, neonatal outcome data suggest that delivery at 39-39 6/7 complete weeks is optimal timing in a Chinese population.
| S-EPMC5623362 | biostudies-literature
Project description:Permanent nerve damage caused by anesthesia is a rare but critical issue, and the mechanism of it remains unclear. Large-scale analysis of changes in noncoding RNA such as circRNA and microRNA in anesthesia-related nerve damage may provide insight into the mechanism of anesthesia-induced nerve injury.
2022-08-02 | GSE135297 | GEO
Project description:BackgroundThe rate of caesarean delivery has increased markedly both globally and within India. However, there is considerable variation within countries. No previous studies have examined the relative importance of multiple geographic levels in shaping the distribution of caesarean delivery and to what extent they can be explained by individual-level risk factors.ObjectivesTo describe geographic variation in caesarean delivery and quantify the contribution of individual-level risk factors to the variation in India.MethodsWe conducted four-level logistic regression analysis to partition total variation in caesarean delivery to three geographic levels (states, districts and communities) and quantify the extent to which variance at each level was explained by a set of 20 sociodemographic, medical and institutional risk factors. Stratified analyses were conducted by the type of delivery facility (public/private).ResultsOverall prevalence of caesarean delivery was 19.3% in India in 2016. Most geographic variation was attributable to states (44%), followed by communities (32%), and lastly districts (24%). Adjustment for all risk factors explained 44%, 52% and 46% of variance for states, districts and communities, respectively. The proportion explained by individual risk factors was larger in public facilities than in private facilities at all three levels. A substantial proportion of between-population variation still existed even after clustering of individual risk factors was comprehensively adjusted for.ConclusionsDiverse contextual factors driving high or low rate of caesarean delivery at each geographic level should be explored in future studies so that tailored intervention can be implemented to reduce the overall variation in caesarean delivery.
| S-EPMC9292746 | biostudies-literature
Project description:Prospective epidemiological studies found that generalized anxiety disorder (GAD) can impair immune function and increase risk for cardiovascular disease or events. Mechanisms underlying the physiological reververations of anxiety, however, are still elusive. Hence, we aimed to investigate molecular processes mediating effects of anxiety on physical health using blood gene expression profiles of 546 community participants. Of these, 179 met the status of controls and 157 cases of anxiety.
2014-12-01 | GSE61672 | GEO
Project description:Background:Though emerging evidence indicates caesarean section (CS) brings about late initiation of breastfeeding, early cessation of breastfeeding, and a higher risk of developing obesity, little is documented on the association between CS birth and stunted growth. This study assessed caesarean section delivery and the risk of poor postnatal childhood growth. Methods:A retrospective cohort study design was used to collect the requisite data on a sample of 528 mothers having children between the ages of 6 to 24 months. An interviewer-administered questionnaire was used to collect the data. Results:After controlling for potential confounding factors, linear growth as measured by height-for-age Z-score (HAZ) was significantly higher by 0.121 standard units in children born through normal vaginal delivery, compared to their counterparts born through caesarean section (beta coefficients (?)?=?0.121, p=0.002). The mode of delivery also had a statistically significant impact on infant feeding practices. Whereas 70.4% of babies delivered via vagina initiated breastfeeding within one hour of delivery, only 52.7% of babies born through CS did the same. Vaginally delivered babies were 2.1 times more likely to initiate breastfeeding within one hour of delivery ((Crude odds ratio (COR)?=?2.13, p < 0.001). Compared to CS babies, vaginally delivered babies were 3.2 times more likely not to have been fed with prelacteal feeds such as water and sugar solutions. Vagina delivered babies were 1.8 times more likely to receive adequate neonatal feeding than their counterparts who were delivered through CS (COR?=?1.76, p=0.003). Conclusions:This study has found an association between CS delivery and stunting, an adverse outcome that clinicians and patients should weigh when considering in particular elective CS that seeks to avoid the pain associated with a vaginal birth.
| S-EPMC7211263 | biostudies-literature