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Ontario Health Technology Assessment... 2015In 2007, caesarean deliveries comprised 28% of all hospital deliveries in Ontario. Provincial caesarean delivery rates increased with maternal age and varied by Local... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In 2007, caesarean deliveries comprised 28% of all hospital deliveries in Ontario. Provincial caesarean delivery rates increased with maternal age and varied by Local Health Integration Network. However, the accepted rate of caesarean delivery in a low-risk maternal population remains unclear.
OBJECTIVES
To review the literature to assess factors that affect the likelihood of experiencing a caesarean delivery, and to examine Ontario caesarean delivery rates to determine whether there is rate variation across the province.
DATA SOURCES
Data sources included publications from OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, as well as data from the Canadian Institute for Health Information Discharge Abstracts Database and the Better Outcomes and Registry Network.
REVIEW METHODS
A mixed-methods approach was used, which included a systematic review of the literature to delineate factors associated with the likelihood of caesarean delivery and an analysis of administrative and clinical data on hospital deliveries in Ontario to determine provincial caesarean delivery rates, variation in rates, and reasons for variation.
RESULTS
Fourteen systematic reviews assessed 14 factors affecting the likelihood of caesarean delivery; 7 factors were associated with an increased likelihood of caesarean delivery, and 2 factors were associated with a decreased likelihood. Five factors had no influence. One factor provided moderate-quality evidence supporting elective induction policies in low-risk women. The overall Ontario caesarean delivery rate in a very-low-risk population was 17%, but varied significantly across Ontario hospitals.
LIMITATIONS
The literature review included a 5-year period and used only systematic reviews. The determination of Robson class for women is based on care received in hospital only, and the low-risk population may have included data from women with obstetrical conditions that warranted a caesarean delivery.
CONCLUSIONS
There is moderate-quality evidence that-compared with expectant management-an induction policy is associated with a decrease in caesarean delivery rates in low-risk women. There is significant caesarean delivery rate variation among Ontario hospitals.
Topics: Adult; Cesarean Section; Evidence-Based Medicine; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Obstetrics; Obstetrics and Gynecology Department, Hospital; Ontario; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Unnecessary Procedures; Young Adult
PubMed: 26366243
DOI: No ID Found -
Midwifery Sep 2014to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment... (Review)
Review
OBJECTIVES
to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in the first and second stages of labour, and to identify any positive health-focussed outcomes used.
DESIGN
eight relevant citation databases were searched up to January 2013 for all randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in labour. Trials of active management of labour or partogram action lines were excluded. 1918 citations were identified. Two reviewers reviewed all citations and extracted data. Twenty-six individual trials and five systematic reviews were included. Primary and secondary outcome measures were documented and analysed using frequency distributions.
FINDINGS
most frequent primary outcomes were caesarean section (n=15, 46%), length of labour (n=14, 42%), measurements of uterine activity (n=13, 39%) and mode of vaginal birth (n=9, 27%). Maternal satisfaction was identified a priori by one review and included as a secondary outcome by three papers. No further positive health-focussed outcomes were identified.
KEY CONCLUSIONS
outcomes used to measure the effectiveness of oxytocin for treatment of delay in labour are heterogeneous and tend to focus on adverse events.
IMPLICATIONS FOR PRACTICE
it is recommended that, in future randomised trials of oxytocin use for delay in labour, some women-centred and health-focussed outcome measures should be used, which may instil a more salutogenic culture in childbirth.
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 25017174
DOI: 10.1016/j.midw.2014.06.005 -
BMC Health Services Research Jun 2023Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these... (Meta-Analysis)
Meta-Analysis
The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis.
BACKGROUND
Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries.
OBJECTIVE
The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries.
METHODS
Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles.
RESULTS
The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73).
CONCLUSIONS
The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.
Topics: Pregnancy; Humans; Female; Postnatal Care; Developing Countries; Parturition; Postpartum Period; Telemedicine
PubMed: 37296420
DOI: 10.1186/s12913-023-09581-7 -
International Journal of Reproductive... Nov 2023Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between... (Review)
Review
Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between ART and maternal outcomes. In this systematic review, the electronic databases, including PubMed, MEDLINE, Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, Magiran, Irandoc, and Scientific Information Database were searched for maternal outcomes reported from 2010-2021. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality of studies. A total of 3362 studies were identified by searching the databases. After screening abstracts and full-text reviews, 19 studies assessing the singleton pregnancy-related complications of in vitro fertilization/intracytoplasmic sperm injection were included in the study. The results demonstrated that singleton pregnancies conceived through ART had higher risks of pregnancy-related complications and adverse maternal outcomes, such as vaginal bleeding, cesarean section, hypertension induced by pregnancy, pre-eclampsia, placenta previa, and premature membrane rupture than those conceived naturally. In conclusion, an increased risk of adverse obstetric outcomes was observed in singleton pregnancies conceived by ART. Therefore, obstetricians should consider these pregnancies as high-risk cases and should pay special attention to their pregnancy process.
PubMed: 38292514
DOI: 10.18502/ijrm.v21i11.14651 -
PloS One 2024Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We...
BACKGROUND
Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We performed a systematic review to identify, summarize and discuss studies on inflammatory biomarkers described in relation to PND.
METHOD
Inclusion criteria defined the selection of observational studies written in English, French, Spanish or Portuguese, that evaluate analytical levels of inflammatory molecules (protein levels) in biological fluids in women, with a diagnosis of depression using ICD/DSM diagnostic criteria or depressive symptoms assessed by standardized psychometric instruments, during pregnancy and/or postpartum. Case reports, experimental studies, reviews, qualitative analysis, meta-analysis, gray literature or replicated data were excluded. Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale. Data extraction included study design; number of subjects; obstetric information; tools and timepoints of depression and inflammatory markers assessment.
RESULTS
56 studies (sample size for cross-sectional and case-control studies ranging from 10 to 469; sample size for longitudinal studies ranging from 26 to 467), where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and postpartum period were included in this systematic review. Overall, the findings of our systematic review lend support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms. The associations were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-α among depressed.
DISCUSSION
In summary, our systematic review findings provide evidence supporting the hypothesis that several inflammatory markers may correlate with peripartum depressive symptoms. However, our work also highlighted notable differences in the timing of biological sampling for inflammatory markers and in the methodologies used to assess depression during the perinatal period. Additionally, variations were observed in how inflammatory biomarkers and depression were approached, including their classification as exposure or outcome variables, and the timing of assessments. It is essential for future research to investigate the influence of biological fluids and the timing of assessments for both inflammatory biomarkers and depression to gain a deeper understanding of their association. This comprehensive exploration is pivotal for elucidating the intricate relationship between inflammation and perinatal depression.
Topics: Humans; Female; Pregnancy; Biomarkers; Pregnancy Complications; Depression; Inflammation; Depression, Postpartum
PubMed: 38820411
DOI: 10.1371/journal.pone.0280612 -
BMC Pregnancy and Childbirth Jan 2017The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way... (Review)
Review
BACKGROUND
The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use.
METHODS
This review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis.
RESULTS
The evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators.
CONCLUSIONS
This first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.
Topics: Female; Fetal Monitoring; Humans; Labor, Obstetric; Obstetric Labor Complications; Pregnancy; Uterine Monitoring
PubMed: 28086823
DOI: 10.1186/s12884-016-1213-4 -
Annals of Palliative Medicine Dec 2021The timing of urinary catheter removal after gynecological and obstetric surgery remains controversial. This meta-analysis investigated the optimal timing of urinary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The timing of urinary catheter removal after gynecological and obstetric surgery remains controversial. This meta-analysis investigated the optimal timing of urinary catheter removal.
METHODS
The PubMed, Ovid Medline, Cochrane, and Embase databases were searched for literatures published between 2010 and 2021 relating to randomized controlled studies examining the timing of catheter removal. The modified Joanna Briggs Institute (JBI) scoring criteria was used to assess the quality of the literatures. After extracting the literature data, the Revman 5.3 software was used for analysis and to obtain the statistical forest plots.
RESULTS
A total of 345 literatures were screened and 11 literatures were finally included. Meta-analysis showed that there was no statistical difference in the occurrence of urinary tract infection (UTI) rate between extubation at 6 hours and immediately after surgery [odds ratio (OR) =1.66; 95% confidence interval (CI): 0.58 to 4.81; P=0.35], but the urinary retention rate was significantly lower in patients who were extubated at 6 hours post-surgery compared to immediately after surgery (OR =0.06; 95% CI: 0.01 to 0.36; P=0.002). In patients who were extubated at 12 hours post-operation, the rate of UTI was significantly higher than immediate extubation post-operation (OR =2.32; 95% CI: 1.31 to 4.10; P=0.004), while the probability of urinary retention was significantly lower than extubated immediate (OR =0.18; 95% CI: 0.04 to 0.83; P=0.03). Similarly, in patients who were extubated at 24 hours post-operation, the UTI rate was significantly higher than that patients who were immediately extubated (OR =4.51; 95% CI: 2.02 to 10.09; P=0.0002) and the urinary retention rate was significantly lower than extubated immediately (OR =0.06; 95% CI: 0.01 to 0.32; P=0.001). The UTI rate of patients who were extubated 48 hours after surgery was not significantly different from that of patients extubated 24 hours after surgery (OR =1.62; 95% CI: 0.76 to 3.45; P=0.21) and the incidence of urinary retention was not significantly different (OR =0.28; 95% CI: 0.07 to 1.18; P=0.08).
DISCUSSION
The optimal time for removal of the urinary catheter is 6 hours after gynecological and obstetric surgery.
Topics: Airway Extubation; Catheters, Indwelling; Female; Humans; Obstetric Surgical Procedures; Pregnancy; Time Factors; Urinary Catheters
PubMed: 35016455
DOI: 10.21037/apm-21-3290 -
Florence Nightingale Hemsirelik Dergisi Oct 2019The aim of this study was to review interventional studies conducted by nurses about elderly people with urinary incontinence in nursing homes and to match the results... (Review)
Review
AIM
The aim of this study was to review interventional studies conducted by nurses about elderly people with urinary incontinence in nursing homes and to match the results to standardized nursing terminology using the Nursing Interventions Classification and the Nursing Outcomes Classification Linkages to the NANDA-I diagnoses guidelines.
METHOD
A systematic review of quantitative intervention studies was conducted using the PRISMA statement as a guide. The interventional research in English was scanned using the MEDLINE and CINAHL databases from January 2005 to May 2015. Fourteen studies that had at least one nurse researcher were conducted in nursing homes, excluding surgical and pharmacological interventions. The Nursing Outcome Classification and Nursing Intervention Classification Linkages to NANDA-I diagnoses and the Clinical Conditions Part II-U List were used as a guide to select North American Nursing Diagnosis Association International nursing diagnoses, Nursing Outcome Classification Scales, and Nursing Interventions from the data.
RESULTS
We found the frequency of use of various NANDA-I diagnoses, Nursing Interventions, and Nursing Outcomes based on the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses and the Clinical Conditions List for incontinence.
CONCLUSION
Using the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses guide may provide new nursing perspectives on non-standardized research. In future studies, this may allow a comparison of data worldwide, enabling nurses to use the results in evidence-based practices.
PubMed: 34267982
DOI: 10.26650/FNJN386150 -
BJOG : An International Journal of... Oct 2015Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes.
OBJECTIVES
Systematic review to assess risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) over the last 20 years.
SEARCH STRATEGY
Electronic literature search of Medline, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and Embase to find recent studies.
SELECTION CRITERIA
Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series.
DATA COLLECTION AND ANALYSIS
Primary analysis calculated absolute risks and 95% confidence intervals (CI) for pregnancy outcomes using a random effects model. The Freeman-Tukey transformation was utilised in secondary analysis due to the large number of individual study outcomes with zero events.
MAIN RESULTS
Eleven studies capturing 499 pregnancies among women with heart valve prostheses, including 256 mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2), for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100 pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI 1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5).
CONCLUSIONS
Women with heart valve prostheses experienced higher rates of adverse outcomes than expected in a general obstetric population; however, lower than previously reported. Women with bioprostheses had significantly fewer thromboembolic events compared to women with mechanical valves. Women should be counselled pre-pregnancy about risk of maternal death and pregnancy loss. Vigilant surveillance by a multidisciplinary team throughout the perinatal period remains warranted for these women and their infants.
TWEETABLE ABSTRACT
Metaanalysis suggests improvement in #pregnancy outcomes among women with #heartvalveprostheses.
Topics: Bioprosthesis; Female; Fetal Death; Fetal Mortality; Heart Valve Prosthesis; Humans; Infant, Newborn; Maternal Mortality; Perinatal Mortality; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Thromboembolism
PubMed: 26119028
DOI: 10.1111/1471-0528.13491 -
International Journal of Environmental... Mar 2023(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual... (Review)
Review
(1) Background: Sexual function can be affected up to and beyond 18 months postpartum, with some studies suggesting that spontaneous vaginal birth results in less sexual dysfunction. This review examined the impact of mode of birth on sexual function in the medium- (≥6 months and <12 months postpartum) and longer-term (≥12 months postpartum). (2) Methods: Literature published after January 2000 were identified in PubMed, Embase and CINAHL. Studies that compared at least two modes of birth and used valid sexual function measures were included. Systematic reviews, unpublished articles, protocols and articles not written in English were excluded. Quality was assessed using the Newcastle Ottawa Scale. (3) Results: In the medium-term, assisted vaginal birth and vaginal birth with episiotomy were associated with worse sexual function, compared to caesarean section. In the longer-term, assisted vaginal birth was associated with worse sexual function, compared with spontaneous vaginal birth and caesarean section; and planned caesarean section was associated with worse sexual function in several domains, compared to spontaneous vaginal birth. (4) Conclusions: Sexual function, in the medium- and longer-term, can be affected by mode of birth. Women should be encouraged to seek support should their sexual function be affected after birth.
Topics: Female; Humans; Pregnancy; Cesarean Section; Delivery, Obstetric; Episiotomy; Parturition; Postpartum Period
PubMed: 37047868
DOI: 10.3390/ijerph20075252