-
The Journal of Obstetrics and... Aug 2021Postpartum hemorrhage (PPH) has remained the leading cause of maternal mortality. While anemia is a leading contributor to maternal morbidity, molecular, cellular and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Postpartum hemorrhage (PPH) has remained the leading cause of maternal mortality. While anemia is a leading contributor to maternal morbidity, molecular, cellular and anemia-induced hypoxia, clinical studies of the relationship between prenatal-anemia and PPH have reported conflicting results. Therefore, our objective was to investigate the outcomes of studies on the relationships between prenatal anemia and PPH-related mortality.
MATERIALS AND METHODS
Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, and the Cochrane Central Register of Controlled Trials) were searched for studies published before August 2019. Keywords included "anemia," "hemoglobin," "postpartum hemorrhage," and "postpartum bleeding." Only studies involving the association between anemia and PPH were included in the meta-analysis. Our primary analysis used random effects models to synthesize odds-ratios (ORs) extracted from the studies. Heterogeneity was formally assessed with the Higgins' I statistics, and explored using meta-regression and subgroup analysis.
RESULTS
We found 13 eligible studies investigating the relationship between prenatal anemia and PPH. Our findings suggest that severe prenatal anemia increases PPH risk (OR = 3.54; 95% CI: 1.20, 10.4, p-value = 0.020). There was no statistical association with mild (OR = 0.60; 95% CI: 0.31, 1.17, p-value = 0.130), or moderate anemia (OR = 2.09; 95% CI: 0.40, 11.1, p-value = 0.390) and the risk of PPH.
CONCLUSION
Severe prenatal anemia is an important predictive factor of adverse outcomes, warranting intensive management during pregnancy. PROSPERO Registration Number: CRD42020149184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149184.
Topics: Anemia; Female; Humans; Maternal Mortality; Oxytocics; Postpartum Hemorrhage; Postpartum Period; Pregnancy
PubMed: 34002432
DOI: 10.1111/jog.14834 -
Obstetrics and Gynecology Feb 2021To identify and quantify risk factors for atonic postpartum hemorrhage. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify and quantify risk factors for atonic postpartum hemorrhage.
DATA SOURCES
PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location. Studies included randomized trials, prospective or retrospective cohort studies, and case-control studies of pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor.
METHODS OF STUDY SELECTION
Title, abstract, and full-text screening were performed using the Raayan web application. Of 1,239 records screened, 27 studies were included in this review. Adjusted or unadjusted odds ratios (ORs), relative risks, or rate ratios were recorded or calculated. For each risk factor, a qualitative synthesis of low and moderate risk of bias studies classifies the risk factor as definite, likely, unclear, or not a risk factor. For risk factors with sufficiently homogeneous definitions and reference ranges, a quantitative meta-analysis of low and moderate risk of bias studies was implemented to estimate a combined OR.
TABULATION, INTEGRATION, AND RESULTS
Forty-seven potential risk factors for atonic postpartum hemorrhage were identified in this review, of which 15 were judged definite or likely risk factors. The remaining 32 assessed risk factors showed no association with atonic postpartum hemorrhage or had conflicting or unclear evidence.
CONCLUSION
A substantial proportion of postpartum hemorrhage occurs in the absence of recognized risk factors. Many risk factors for atonic hemorrhage included in current risk-assessment tools were confirmed, with the greatest risk conferred by prior postpartum hemorrhage of any etiology, placenta previa, placental abruption, uterine rupture, and multiple gestation. Novel risk factors not currently included in risk-assessment tools included hypertension, diabetes, and ethnicity. Obesity and magnesium were not associated with atonic postpartum hemorrhage in this review.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020157521.
Topics: Female; Humans; Postpartum Hemorrhage; Pregnancy; Risk Factors; Uterine Inertia
PubMed: 33417319
DOI: 10.1097/AOG.0000000000004228 -
Psychoneuroendocrinology Oct 2020Postpartum depression (PPD) is a significant mental health concern, especially for women in vulnerable populations. Oxytocin (OT), a hormone essential for a variety of...
Postpartum depression (PPD) is a significant mental health concern, especially for women in vulnerable populations. Oxytocin (OT), a hormone essential for a variety of maternal tasks, including labor, lactation, and infant bonding, has also been hypothesized to have a role in postpartum depression. Women are routinely given synthetic oxytocin to induce or augment labor and to prevent postpartum hemorrhage. The aim of this study was to review the quality and reliability of literature that examines potential relationships between OT and PPD to determine if there is sufficient data to reliably assess the strength of these relationships. We conducted a literature search in December of 2018 using five databases (PubMed, Web of Science, Embase, PsycInfo, and CINAHL). Eligible studies were identified, selected, and appraised using the Newcastle-Ottawa quality assessment scale and Cochrane Collaboration's tool for assessing risk of bias, as appropriate. Sixteen studies were included in the analysis and broken into two categories: correlations of endogenous OT with PPD and administration of synthetic OT with PPD. Depressive symptoms were largely measured using the Edinburgh Postnatal Depression Scale. OT levels were predominately measured in plasma, though there were differences in laboratory methodology and control of confounders (primarily breast feeding). Of the twelve studies focused on endogenous oxytocin, eight studies suggested an inverse relationship between plasma OT levels and depressive symptoms. We are not able to draw any conclusions regarding the relationship between intravenous synthetic oxytocin and postpartum depression based on current evidence due to the heterogeneity and small number of studies (n = 4). Considering limitations of the current literature and the current clinical prevalence of synthetic OT administration, we strongly recommend that rigorous studies examining the effects of synthetic OT exposure on PPD should be performed as well as continued work in defining the relationship between endogenous OT and PPD.
Topics: Adult; Anxiety; Breast Feeding; Depression; Depression, Postpartum; Female; Humans; Infant; Lactation; Mothers; Oxytocin; Postpartum Period; Pregnancy; Reproducibility of Results
PubMed: 32683141
DOI: 10.1016/j.psyneuen.2020.104793 -
Brazilian Journal of Physical Therapy 2021Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period.
OBJECTIVE
To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum.
METHODS
Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI).
RESULTS
Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA.
CONCLUSION
There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum.
Topics: Diastasis, Muscle; Exercise Therapy; Female; Humans; Pelvic Floor; Postpartum Period; Randomized Controlled Trials as Topic; Rectus Abdominis
PubMed: 34391661
DOI: 10.1016/j.bjpt.2021.06.006 -
Midwifery Nov 2021The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns.... (Review)
Review
BACKGROUND
The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns. Anxiety must therefore be reduced using different strategies.
OBJECTIVE
To determine published non-pharmacological interventions to reduce anxiety during pregnancy, childbirth and postpartum.
METHODS
A systematic peer-review of experimental and quasi-experimental studies was conducted using the PubMed, Scopus, Web of Science (WOS), and CINAHL databases. The quality of the studies was assessed using the Spanish version of the PEDro scale. Two researchers participated independently in the data selection and extraction process.
FINDINGS
587 articles were identified, of which 21 met the eligibility criteria. In eleven studies the intervention was performed during pregnancy, in three of them during labour, in four of them during the postpartum period, and in three of them during pregnancy and postpartum. During pregnancy, the most effective interventions were behavioural activation, cognitive behavioural therapy, yoga, music therapy, and relaxation; during childbirth: aromatherapy; during pregnancy and postpartum: antenatal training, massage by partners, and self-guided book reading with professional telephone assistance.
CONCLUSION AND IMPLICATIONS
The most effective interventions to reduce anxiety were performed either during pregnancy or during the postpartum period, not during labour. Most of the interventions were performed on the women, with few of them being performed on both partners. Non-pharmacological interventions may be applied by nurses and midwives to reduce anxiety during pregnancy, labour and postpartum.
Topics: Anxiety; Anxiety Disorders; Female; Humans; Infant, Newborn; Labor, Obstetric; Parturition; Postpartum Period; Pregnancy
PubMed: 34464836
DOI: 10.1016/j.midw.2021.103126 -
The Cochrane Database of Systematic... May 2020About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017.
OBJECTIVES
To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies.
SELECTION CRITERIA
We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment).
DATA COLLECTION AND ANALYSIS
We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE.
MAIN RESULTS
We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it.
AUTHORS' CONCLUSIONS
This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.
Topics: Exercise Therapy; Fecal Incontinence; Female; Humans; Pelvic Floor; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Puerperal Disorders; Randomized Controlled Trials as Topic; Urinary Incontinence
PubMed: 32378735
DOI: 10.1002/14651858.CD007471.pub4 -
European Journal of Obstetrics,... Dec 2021To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major... (Meta-Analysis)
Meta-Analysis Review
To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.
Topics: Exercise; Exercise Therapy; Female; Humans; Postpartum Period; Pregnancy; Urinary Incontinence
PubMed: 34839247
DOI: 10.1016/j.ejogrb.2021.11.005 -
Computational and Mathematical Methods... 2022Evidences which prove relation between breastfeeding women and risk of breast cancer have been limited. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidences which prove relation between breastfeeding women and risk of breast cancer have been limited.
OBJECTIVE
A meta-analysis was carried out on the basis of published literature from clinical trials and studies among different parts of the world.
METHODS
Studies were analyzed and extracted using PRISMA flowchart. RevMan 5.4.1 was used for analyzing the extracted data. Included studies were fully cited texts with complete information about studies, trails conducted for risk of breast cancer, and breastfeeding correlations.
RESULTS
Menarche age, family history, lactation duration, and menopausal status have a strong effect on the risks of breast cancer. Family history studies concluded that for 95% CI, the risk ratio was 2.66 (2.00, 3.52).
CONCLUSION
Findings have suggested that family history and lactation duration affect the risks of breast cancer.
Topics: Adolescent; Adult; Breast Feeding; Breast Neoplasms; Child; Computational Biology; Female; Humans; Lactation; Menarche; Menopause; Middle Aged; Odds Ratio; Pregnancy; Risk Factors; Young Adult
PubMed: 35126640
DOI: 10.1155/2022/8500910 -
Archivos Espanoles de Urologia Feb 2023Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma... (Review)
Review
BACKGROUND
Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma during childbirth. Physiotherapy is currently presented as one of the conservative options for the treatment of urinary incontinence at this stage, so this review aims to go over scientific literature to assess the effect of physiotherapy on postpartum urinary incontinence.
MATERIAL AND METHODS
In February 2022, a bibliographic search was carried out in PubMed, Scopus, Medline, PeDRO and Sport Discuss databases. Studies published within the last 10 years and randomized clinical trials that used physiotherapy techniques for the treatment of postpartum urinary incontinence were identified, but those articles that differ from the objective of the work and those that were duplicated in the databases were excluded.
RESULTS
Out of the 51 articles identified, 8 were finally included that fit the criteria and the subject of the study. Regarding the intervention, we have found that all the articles refer to pelvic floor muscle training. In addition to urinary incontinence, these studies evaluated other variables such as strength, resistance, quality of life and sexual function, obtaining significant results in 6 out of all the studies consulted.
CONCLUSIONS
Pelvic floor muscle training is beneficial for the treatment of urinary incontinence in the postpartum period, then supervised and controlled exercise combined with a home training routine is recommended. It is not clear whether the benefits are maintained over time.
Topics: Pregnancy; Female; Humans; Quality of Life; Exercise Therapy; Pelvic Floor; Urinary Incontinence; Postpartum Period; Physical Therapy Modalities
PubMed: 36914417
DOI: 10.56434/j.arch.esp.urol.20237601.2 -
Obstetrics and Gynecology Jun 2021To estimate the risk of maternal and neonatal sepsis associated with chorioamnionitis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the risk of maternal and neonatal sepsis associated with chorioamnionitis.
DATA SOURCES
PubMed, BIOSIS, and ClinicalTrials.gov databases were systematically searched for full-text articles in English from inception until May 11, 2020.
METHODS OF STUDY SELECTION
We screened 1,251 studies. Randomized controlled trials, case-control, or cohort studies quantifying a relationship between chorioamnionitis and sepsis in mothers (postpartum) or neonates born at greater than 22 weeks of gestation were eligible. Studies were grouped for meta-analyses according to exposures of histologic or clinical chorioamnionitis and outcomes of maternal or neonatal sepsis.
TABULATION, INTEGRATION, AND RESULTS
One hundred three studies were included, and 55 met criteria for meta-analysis (39 studies of preterm neonates, 10 studies of general populations of preterm and term neonates, and six studies of late preterm and term neonates). Study details and quantitative data were abstracted. Random-effects models were used to generate pooled odds ratios (ORs); most studies only reported unadjusted results. Histologic chorioamnionitis was associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 4.42 [95% CI 2.68-7.29] and 5.88 [95% CI 3.68-9.41], respectively). Clinical chorioamnionitis was also associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 6.82 [95% CI 4.93-9.45] and 3.90 [95% CI 2.74-5.55], respectively). Additionally, histologic and clinical chorioamnionitis were each associated with higher odds of late-onset sepsis in preterm neonates. Confirmed sepsis incidence was 7% (early-onset) and 22% (late-onset) for histologic and 6% (early-onset) and 26% (late-onset) for clinical chorioamnionitis-exposed neonates. Three studies evaluated chorioamnionitis and maternal sepsis and were inconclusive.
CONCLUSION
Both histologic and clinical chorioamnionitis were associated with early- and late-onset sepsis in neonates. Overall, our findings support current guidelines for preventative neonatal care. There was insufficient evidence to determine the association between chorioamnionitis and maternal sepsis.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020156812.
Topics: Chorioamnionitis; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Neonatal Sepsis; Postpartum Period; Pregnancy; Premature Birth; Sepsis; Term Birth; Time Factors
PubMed: 33957655
DOI: 10.1097/AOG.0000000000004377