Use of electrocautery for coagulation and wound complications in Caesarean sections.
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ABSTRACT:
SUBMITTER: Moreira CM
PROVIDER: S-EPMC4131101 | biostudies-other | 2014
REPOSITORIES: biostudies-other
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Project description:ObjectivesThe objective of this study is to explore the association of health financing indicators with the proportion of births by caesarean section (CS) across countries.DesignEcological cross-country study.SettingThis study examines CS proportions across 172 countries.Main outcome measuresThe primary outcome was the percentage excess of CS proportion, defined as CS proportions above the global target of 19%. We also analysed continuous CS proportions, as well as excess proportion with a more restrictive 9% global target. Multivariable linear regressions were performed to test the association of health financing factors with the percentage excess proportions of CS. The health financing factors considered were total available health system resources (as percentage of gross domestic product), total contributions from private households (out-of-pocket, compulsory and voluntary health insurance contributions) and total national income.ResultsWe estimate that in 2018 there were a total of 8.8 million unnecessary CS globally, roughly two-thirds of which occurred in upper middle-income countries. Private health financing was positively associated with percentage excess CS proportion. In models adjusted for income and total health resources as well as human resources, each 10 per cent increase in out-of-pocket expenditure was associated with a 0.7 per cent increase in excess CS proportions. A 10 per cent increase in voluntary health insurance was associated with a 4 per cent increase in excess CS proportions.ConclusionsWe have found that health system finance features are associated with CS use across countries. Further monitoring of these indicators, within countries and between countries will be needed to understand the effect of financial arrangements in the provision of CS.
| S-EPMC8149434 | biostudies-literature
Project description:(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: "caesarean section", "cesarean section", "wound complication", "wound morbidity", and "wound infection". A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64-2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85-3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.
| S-EPMC7916387 | biostudies-literature
Project description:ObjectiveFinancial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and The Cochrane Library from the first year of records through August 2016.Eligibility criteriaWe included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women.OutcomesThe prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance.ResultsEighteen articles describing 21 separate studies in 12.9?million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95%?CI 1.07 to 1.18) with no relevant heterogeneity between studies (?2=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95%?CI 1.27 to 1.44) with no relevant heterogeneity between studies (?2=0.011).ConclusionsCaesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.
| S-EPMC5629699 | biostudies-literature
Project description:BackgroundCaesarean sections (CS) are increasing worldwide. Financial incentives and related regulatory and legislative factors are important determinants of CS rates. This scoping review examines the evidence base of financial, regulatory and legislative interventions intended to reduce CS rates.MethodsWe searched MEDLINE, EMBASE, CINAHL and two trials registers in June 2019. Both experimental and observational intervention studies were eligible for inclusion. Primary outcome measures were: CS, spontaneous vaginal and instrumental birth rates. We assessed quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe identified 9057 articles and assessed 65 full-texts. We included 16 observational studies. Most of the studies were conducted in high-income countries. Three studies assessed payment methods for health workers: equalising physician fees for vaginal and caesarean delivery reduced CS rates in one study; however, little or no difference in CS rates was found in the remaining two studies. Nine studies assessed payment methods for health organisations: There was no difference in CS rates between diagnosis-related group (DRG) payment system compared to fee-for-service system in one study. However, DRG system was associated with lower odds for CS in another study. There was little or no difference in CS rates following implementation of global budget payment (GBP) system in two studies. Vaginal birth after caesarean section (VBAC) increased after implementation of a case-based payment system in one study. Caesarean section increased while VBAC rates decreased following implementation of a cap-based payment system in another study. Financial incentive for providers to promote vaginal delivery combined with free vaginal delivery policy was found to reduce CS rates in one study. Studied regulatory and legislative interventions (comprising legislatively imposed practice guidelines for physicians in one study and multi-faceted strategy which included policies to control CS on maternal request in another study) were found to reduce CS rates. The GRADE quality of evidence varied from very low to low.ConclusionsAvailable evidence on the effects of financial and regulatory strategies intended to reduce unnecessary CS is inconclusive given inconsistency in effects and low quality of the available evidence. More rigorous studies are needed.
| S-EPMC7457477 | biostudies-literature
Project description:ObjectiveTo investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo.DesignCross-sectional survey.SettingFive largest public hospitals in Kosovo.Participants859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo.Outcome measuresThe prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital.ResultsWomen with personal monthly income had increased odds for caesarean (OR 1.55, 95%?CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95%?CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95%?CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95%?CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95%?CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95%?CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95%?CI 0.24 to 0.90).ConclusionsWe found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
| S-EPMC6500236 | biostudies-literature
Project description:PurposeTo investigate the occurrence of heat-related complications from radiofrequency and electrocautery devices in patients undergoing arthroscopic surgery.MethodsA systematic review was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting complications after arthroscopy using electrosurgery devices were included. Only English- and Dutch-language articles were included. Basic science/nonclinical studies/human cadaveric studies and animal studies were excluded. Article selection was performed by 2 separate reviewers. Interobserver agreement of the selection procedure was determined by Cohen's kappa. All included articles were critically appraised using an adapted version of the ROBINS-I tool.ResultsTwenty-five studies were included in this systematic review. A total of 309 cases of heat-related complications were identified. Chondrolysis was present in 45 cases and dermal burns in 15 cases. Axillary nerve injuries were reported in 197 cases of arthroscopic adhesive capsulitis release. However, it was unclear whether these injuries were directly related to the overheating of the arthroscopic fluid. No one specific risk factor for thermal complications was identified, but related factors included the leakage of the arthroscopy fluid, use of a thermal device continuously for a long period of time, proximity of the thermal device to the tissue, intra-articular local anesthetic injection or the use of intra-articular pain pumps, and certain surgical procedures, such as thermal capsulorrhaphy, capsular release, and synovectomy.ConclusionsThe most common heat-related complications in arthroscopy are dermal burns and chondrolysis. Risk factors include leakage of arthroscopy fluid, use of a thermal device, intra-articular anesthetics/pain pumps, and performing specific surgical procedures.Level of evidenceSystematic review of level III-IV studies.
| S-EPMC8129439 | biostudies-literature
Project description:Human amniotic fluid cells (AFCs) are immune-privileged with low immunogenicity and anti-inflammatory properties. Furthermore, they are high proliferative and have a broad differentiation potential, making them amenable for cell replacement therapies. Amniotic fluid (AF) is routinely obtained via amniocentesis. It contains heterogeneous populations of foetal-derived differentiated and undifferentiated progenitor cells including mesenchymal stem cells (MSCs). AF-derived mesenchymal stem cells (AF-MSCs) can self-renew and have a high proliferation and differentiation potential. In this study, we isolated AFCs from AF obtained during Caesarean sections (C-sections) and characterized them. The AFCs showed typical MSCs characteristics in relation to morphology, in vitro differentiation potential, cell surface marker expression and secreted factors. Subpopulations of AF-MSCs expressed several pluripotency-associated markers such as stage specific embryonic antigen 4 (SSEA4), c-Kit, TRA-1-60 and TRA-1-81, making them reprogrammable to induced pluripotent stem cells (iPSCs) without the use of ectopic gene expression. Additionally, they express the mesenchymal marker - Vimentin and multipotency-associated stem cell marker - CD133. Furthermore, the transcriptome and secretome analyses showed significant overlap with bone marrow-derived MSCs. C-section-derived AFMSCs can be routinely obtained without any risk to the foetus. Patient-specific AF-MSCs can be used for personalized cell therapies and disease modelling.
2018-01-12 | GSE100448 | GEO
Project description:INTRODUCTION: Uterine scar dehiscence can complicate caesarean section with complications like post partum hemorrhage, endomyometritis, localized/generalized peritonitis, and sepsis. PRESENTATION OF CASE: Our patient had abdominal wound infection after LSCS surgery and features of sepsis. The wound infection was actually the presentation of a uterine scar dehiscence and localized peritonitis. DISCUSSION: Incidence of uterine scar dehiscence is around 0.6%. Presentation can be post partum hemorrhage, endomyometritis, and generalized/localized peritonitis. Peritonitis caused by uterine incisional necrosis must be dealt surgically. A high index of suspicion with appropriate investigations can highlight such problems for early treatment and cure with least morbidity especially related to further pregnancies. CONCLUSION: Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy.
| S-EPMC4392185 | biostudies-other
Project description:BackgroundCaesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time.MethodsWe analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates.ResultsThe overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively.ConclusionThe 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care.
| S-EPMC2779175 | biostudies-literature
Project description:ObjectiveTo measure the likelihood of delivery by caesarean section (C-section) for publicly insured births as compared with privately insured births, across all hospitals and within private hospitals.DesignRepeated cross-sectional analysis.SettingThe universe of hospital births in 15 regions of Chile.Participants2?405?082 singleton births between 2001 and 2014.Outcome measuresC-section rates by type of hospital and type of insurance; contribution to overall C-section rates of subgroups by type of insurance and type of hospital; adjusted OR of privately insured births delivered by C-section compared with publicly insured births, across all hospitals and within private hospitals; percentage of discharges related to maternal morbidity and mortality across groups; length of stay after delivery.ResultsAn increasing percentage of publicly insured births occur in private facilities each year. Approximately three out of four publicly insured births in private hospitals are delivered by C-section. The adjusted odd of C-section delivery in a private maternity unit is lower for those privately insured than for those with public insurance: OR 0.6, 95% CI 0.56 to 0.64. There is no evidence that these women would have been more likely to have a C-section out of medical necessity.ConclusionsWe find an association between high C-section rates and publicly insured women delivering at private institutions in Chile, and show that this group is driving the overall high and growing rates. There is a need for a more informed surveillance on the part of the public insurance system of its private providers' C-section practices.
| S-EPMC6500210 | biostudies-literature