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The Journal of Obstetrics and... Jul 2023To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery. (Meta-Analysis)
Meta-Analysis Review
AIM
To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery.
METHODS
A systematic review and meta-analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross-sectional, cohort, case-control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta-analysis.
RESULTS
Thirty-six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty-one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy-related factors; labor-related factors; delivery-related factors.
CONCLUSIONS
With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi-factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta-analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Oxytocics; Incidence; Cross-Sectional Studies; Delivery, Obstetric; Oxytocin; Risk Factors
PubMed: 37069822
DOI: 10.1111/jog.15654 -
Annals of Palliative Medicine Jul 2021The Plan-Do-Check-Act cycle (PDCA) (also known as the Daiming cycle) is widely used in surgical management and can standardize nursing management and improve nursing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The Plan-Do-Check-Act cycle (PDCA) (also known as the Daiming cycle) is widely used in surgical management and can standardize nursing management and improve nursing quality. This meta-analysis evaluated the application of the PDCA cycle during nursing management following gynecological surgery.
METHODS
PubMed, Web of Science, Embase, CNKI, Wanfang, and other databases were searched for studies on applying the PDCA cycle in nursing management following gynecological and obstetric surgery. Articles published between 2013 to 2020 in English and Chinese were included. The obtained data are subjected to meta-analysis using Stata16.0 analysis software. Reported outcomes included: satisfaction with care, nursing quality evaluation, and assessments using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS).
RESULTS
A total of 14 articles were included, with a total of 1,629 participants. Meta-analysis showed that satisfaction with gynecological surgery nursing using PDCA cycle management in the intervention groups was higher than in the control groups, OR =6.57 (95% CI, 4.01, 10.76), P<0.001. The perception of nursing quality was higher in the intervention groups than in the control groups, SMD =4.98 (95% CI, 3.32, 6.64, P<0.001. SAS scores of the intervention groups were lower than that of the control groups, SMD =-2.22 (95% CI, -2.80, -1.65), P<0.001. SDS scores of the intervention groups were lower than that of the control groups, SMD =-2.37 (95% CI, -3.15, -1.60), P<0.001.
DISCUSSION
The application of PDCA cycle nursing management for gynecological surgery can significantly improve patients' satisfaction with nursing, including the quality of nursing. At the same time, it can effectively reduce the anxiety and depression of surgical patients, which benefits the surgery process. Given these benefits, it has a high likelihood of being incorporated into clinical practice.
Topics: Anxiety; Female; Gynecologic Surgical Procedures; Humans; Nursing Care; Patient Satisfaction
PubMed: 34353092
DOI: 10.21037/apm-21-1590 -
Journal of Human Lactation : Official... Aug 2016Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding.... (Review)
Review
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Breast Feeding; Female; Humans; Postpartum Period; Pregnancy
PubMed: 27121239
DOI: 10.1177/0890334415623779 -
MCN. the American Journal of Maternal... 2014Triage concepts have shifted the focus of obstetric care to include obstetric triage units. The purpose of this systematic review is to examine the literature on use of... (Review)
Review
BACKGROUND
Triage concepts have shifted the focus of obstetric care to include obstetric triage units. The purpose of this systematic review is to examine the literature on use of triage concepts in obstetrics during a 15-year time frame.
METHODS
A systematic review was completed of the obstetric triage literature from 1998 to 2013 using the electronic online databases from PubMed, CINHAL, Ovid, and Cochrane Library Reviews within the English language. Reference lists of articles were reviewed to identify other pertinent publications. Both peer-reviewed and non-peer-reviewed documents were used.
INCLUSION CRITERIA
articles specifically related to obstetric triage or obstetric emergency practices in the hospital setting. Exclusion criteria included: manuscripts that focused on general, nonobstetric emergency and triage units, telephone triage, out-of-hospital practices, other clinical conditions, and references outside the time frame of 1998-2013.
RESULTS
Key categories were identified: legal issues and impact of Emergency Medical Treatment and Active Labor Act (EMTALA); liability pitfalls; risk stratification (acuity tools); clinical decision aids; utilization, patient flow, and patient satisfaction; impact on interprofessional education and advanced nursing practice; and management of selected clinical conditions. Components of a best practice model for obstetric triage are introduced.
CONCLUSION
Seven key triage categories from the literature were identified and best practices were developed for obstetric triage units from this systematic review. Both can be used to guide future practice and research within obstetric triage.
Topics: Education, Nursing, Continuing; Emergency Service, Hospital; Female; Humans; Liability, Legal; Obstetric Nursing; Patient Discharge; Patient Transfer; Pregnancy; Triage; United States
PubMed: 24905040
DOI: 10.1097/NMC.0000000000000069 -
International Journal of Nursing Studies Sep 2023Perineal lacerations could lead to substantial morbidities for women. A reliable prediction model for perineal lacerations has the potential to guide the prevention....
BACKGROUND
Perineal lacerations could lead to substantial morbidities for women. A reliable prediction model for perineal lacerations has the potential to guide the prevention. Although several prediction models have been developed to estimate the risk of perineal lacerations, especially third- and fourth-degree perineal lacerations, the evidence about the model quality and clinical applicability is scarce.
OBJECTIVES
To systematically review and critically appraise the existing prediction models for perineal lacerations.
METHODS
Seven databases (PubMed, Embase, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SinoMed, China National Knowledge Infrastructure, and Wanfang Data) were systematically searched from inception to July 2022. Studies that developed prediction models for perineal lacerations or performed external validation of existing models were considered eligible to include in the systematic review. Two reviewers independently conducted data extraction according to the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies. The risk of bias and the applicability of the included models were assessed with the Prediction Model Risk of Bias Assessment Tool. A narrative synthesis was performed to summarize the characteristics, risk of bias, and performance of existing models.
RESULTS
Of 4345 retrieved studies, 14 studies with 22 prediction models for perineal lacerations were included. The included models mainly aimed to estimate the risk of third- and fourth-degree perineal lacerations. The top five predictors used were operative vaginal birth (72.7 %), parity/previous vaginal birth (63.6 %), race/ethnicity (59.1 %), maternal age (50.0 %), and episiotomy (40.1 %). Internal and external validation was performed in 12 (54.5 %) and seven (31.8 %) models, respectively. 13 studies (92.9 %) assessed model discrimination, with the c-index ranging from 0.636 to 0.830. Seven studies (50.0 %) evaluated the model calibration using the Hosmer-Lemeshow test, Brier score, or calibration curve. The results indicated that most of the models had fairly good calibration. All the included models were at higher risk of bias mainly due to unclear or inappropriate methods for handling missing data and continuous predictors, external validation, and model performance evaluation. Six models (27.3 %) showed low concerns about applicability.
CONCLUSIONS
The existing models for perineal lacerations were poorly validated and evaluated, among which only two have the potential for clinical use: one for women undergoing vaginal birth after cesarean delivery, and the other one for all women undergoing vaginal birth. Future studies should focus on robust external validation of existing models and the development of novel models for second-degree perineal laceration.
PROSPERO REGISTRATION NUMBER
CRD42022349786.
TWEETABLE ABSTRACT
The existing models for perineal lacerations during childbirth need external validation and updating. Tools are needed for second-degree perineal laceration.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Episiotomy; Lacerations; Parity; Perineum; Risk Factors
PubMed: 37423201
DOI: 10.1016/j.ijnurstu.2023.104546 -
International Journal of Medical... Feb 2020Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and...
BACKGROUND
Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and prevention of intercurrences, providing local intervention before hospitalization.
OBJECTIVE
This paper aims to identify advances, contributions and limitations of obstetric telemonitoring using mobile technologies.
METHODS
A systematic review was performed on the Pubmed, Medline, LILACS, Cochrane, Scielo, Embase, ACM Surveys, and IEEE databases, from 2008 to 2018. PRISMA and CASP were used to analyze methodological rigour.
RESULTS
26 papers were included. The majority of the studies related to pregnant women, prenatal care, high-risk pregnancies and homecare. Only 2 articles related to postpartum and none related to delivery. Among the technological resources, the articles presented smartphone applications, which interact with external telemonitoring devices (such as electrodes attached to the body and thermometers) or request information about maternal and / or fetal health status. Based on those devices, decision-making by health professionals is more reliable, since data is obtained by digital devices that have a greater accuracy. The variety of studies is enormous and achieve promising results. However, there are still important gaps to be addressed. Many studies only cover isolated aspects of maternal health, e.g. blood pressure, which somehow limits clinical decision-making. All authors have described concerns about usability, but not all of them had actually performed usability tests. Interventions through obstetric telemonitoring can be applied to a wide range of domains, at various levels of healthcare complexity. There are still few investments in studies in developing countries, where maternal and fetal morbidity and mortality are higher.
CONCLUSION
The area of obstetrical telemonitoring has a great potential for contributing with better gestational outcomes, early detection of complications, prevention of intercurrences, providing local intervention even before hospitalization. Development of obstetric telemonitoring systems wich collect complete obstetric parameter integrated with the periods of childbirth and postpartum is recommended.
Topics: Female; Home Care Services; Hospitalization; Humans; Monitoring, Physiologic; Obstetrics; Pregnancy; Pregnancy Outcome; Telemedicine
PubMed: 31816495
DOI: 10.1016/j.ijmedinf.2019.104004 -
BMC Women's Health Feb 2023Obstetric fistula continues to affect the social and mental wellbeing of women living in Nigeria giving rise to poor maternal health outcome. While the World Health...
BACKGROUND
Obstetric fistula continues to affect the social and mental wellbeing of women living in Nigeria giving rise to poor maternal health outcome. While the World Health Organisation (WHO) has recommended the introduction of psycho-social interventions in the management of obstetric fistula women, psycho-social support for women living with obstetric fistula in Nigeria, are limited. This systematic review aimed to synthesise the psycho-social impact of obstetric fistula on women living in Nigeria as well as the available psycho-social support for these affected women.
METHODS
Following a keyword strategy, Medline, CINAHL, Google scholar, ScienceDirect, Cochrane library, PsychINFO, AMED, British Nursing database, Pubmed central, TRIP database, UK Pubmed central, socINDEX, Annual reviews, ISI Web of Science, Academic search complete, Credo reference, Sage premier and Scopus databases were searched alongside hand searching of articles. The inclusion criteria were set as articles published between 2000 and 2020, on the psychosocial consequences of obstetric fistula in Nigeria. The Critical Appraisal Skills Program (CASP) tool was used to appraise the quality of the included studies. The data was extracted and then analysed using narrative synthesis.
RESULTS
620 relevant citations were identified, and 8 studies were included. Women with obstetric fistula, living in Nigeria were found to be ostracised, abandoned by families and friends, stigmatised and discriminated against, which led to depression, loneliness, loss of self-esteem, self-worth and identity. Psycho-social interventions for women who experienced obstetric fistula are not widely available.
CONCLUSION
There is a need for the introduction of more rehabilitation and reintegration programs across the country. The psychosocial effect of obstetric fistula is significant and should be considered when developing interventions. Further, more research is needed to evaluate the sustainability of psychosocial interventions in Nigeria.
Topics: Pregnancy; Female; Humans; Nigeria; Social Change; Social Support; Family; Fistula
PubMed: 36841757
DOI: 10.1186/s12905-023-02220-7 -
BMC Pregnancy and Childbirth Oct 2016Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy.
METHODS
An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared.
RESULTS
The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities.
DISCUSSION
Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis.
CONCLUSIONS
It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction.
Topics: Bipolar Disorder; Case-Control Studies; Delivery, Obstetric; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Infant, Small for Gestational Age; Parturition; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 27793111
DOI: 10.1186/s12884-016-1127-1 -
Systematic Reviews Feb 2019According to the 2015 World Health Organization report, globally, an estimated 10.7 million mothers died from 1990 to 2015 due to obstetric complications. This report... (Meta-Analysis)
Meta-Analysis
BACKGROUND
According to the 2015 World Health Organization report, globally, an estimated 10.7 million mothers died from 1990 to 2015 due to obstetric complications. This report showed that almost all global maternal deaths (99%) occurred in developing countries and two thirds of these deaths took place in sub-Saharan Africa where the majority of women lack knowledge about obstetric danger signs. In Ethiopia, in several research reports, it has been indicated that women have poor knowledge about obstetric danger signs. Although several studies have been conducted to assess women's knowledge of obstetric danger signs, to date, no systematic review has been conducted in Ethiopia. Therefore, this review is aimed at synthesising the existing literature about women's knowledge of obstetric danger signs.
METHODS
We systematically searched for articles from MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, Scopus, Google Scholar and Maternity and Infant Care databases. A combination of search terms including 'knowledge' or 'awareness' or 'information' and 'pregnancy danger signs' or 'obstetric danger signs' or 'obstetric warning signs' and 'Ethiopia' was used to locate appropriate articles. Two reviewers conducted article screening and data abstraction independently. Observational studies published in English and conducted in Ethiopia to date were assessed for quality using the adapted Newcastle Ottawa Scale for cross-sectional studies. The PRISMA checklist was used to present the findings of this systematic review.
RESULTS
From the 215 articles initially screened by abstracts and titles, 12 studies fulfilled the inclusion criteria. All the studies reported women's knowledge of obstetric danger signs during pregnancy, ten articles reported on the level of knowledge during delivery and eight studies reported on the level of knowledge of danger signs during the postpartum period. The pooled random effect meta-analysis level of women's knowledge about obstetric danger signs during pregnancy, delivery and postpartum was 48%, 43% and 32%, respectively. Maternal age, education, income, health service use, distance from facility and women's autonomy were reported in several studies as determinants of women's knowledge of obstetric danger signs.
CONCLUSIONS
Women's knowledge about obstetric danger signs in Ethiopia was very poor, which could hamper access to obstetric care when women encounter obstetric complications. Counselling services during antenatal care and community-based health information dissemination about obstetric danger signs should be strengthened.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017077000.
Topics: Diagnostic Self Evaluation; Educational Status; Ethiopia; Female; Health Knowledge, Attitudes, Practice; Health Services; Humans; Income; Maternal Age; Obstetric Labor Complications; Personal Autonomy; Postpartum Period; Pregnancy; Symptom Assessment
PubMed: 30803443
DOI: 10.1186/s13643-019-0979-7 -
International Journal of Nursing Studies Aug 2021The World Health Organization has emphasized the critical role of prenatal care in achieving the Millennium Development Goals to reduce child and maternal mortality. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The World Health Organization has emphasized the critical role of prenatal care in achieving the Millennium Development Goals to reduce child and maternal mortality. The CenteringPregnancy program is a widely recognized model of prenatal care. Several countries have attempted to implement the program in prenatal care practice; however, its effectiveness on maternal and birth outcomes has not been systematically evaluated and analyzed.
OBJECTIVES
To determine the effect of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depression.
DESIGN
This study evaluated and analyzed randomized controlled trials by comparing the CenteringPregnancy program with o0bstetric led prenatal care. Maternal and birth outcomes of interest included low birthweight, preterm birth, and postpartum depressive symptoms.
DATA SOURCES
Embase, PubMed, CINAHL, Web of Science, and The Cochrane Library were utilized in this systematic review. Additionally, a supplemental Google Scholar search was performed to capture all relevant articles.
METHODS
All data were extracted independently by two trained researchers, who evaluated the quality of the study by examining the risk of bias. The biases of selection, allocation, measurement, reporting, and loss of follow-up were assessed using the Cochrane risk of bias for these included randomized controlled trials. A meta-analysis of eligible randomized controlled trials was conducted using Review Manager. Heterogeneity of studies was assessed using the I statistic.
RESULTS
Out of 591 articles reviewed, seven randomized controlled trials were included in this study. Findings showed that the CenteringPregnancy program was not associated with lower rates of preterm birth (0.88 [0.71-1.07], p = 0.20, I = 0%), low birth weight (0.87 [0.68-1.12], p =0.29, I = 0%), or 12-month postpartum depressive symptoms (0.07 [-0.12-0.26], p =0.46, I = 69%). However, the CenteringPregnancy program was associated with reduced rates of 6-month postpartum depressive symptoms (0.49 [0.40-0.59], p < 0.01, I = 40%).
CONCLUSIONS
Existing evidence suggests that the CenteringPregnancy program and obstetric led care have similar effects on reducing the rates of preterm birth and low birth weight but different effects on postpartum depressive symptoms. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms. PROSPERO Registration number: CRD42020171831. Tweetable abstract: We conducted a systematic review and meta-analysis of randomized controlled trials to determine the effects of the CenteringPregnancy program on improving maternal and birth outcomes, including low birth weight, preterm birth, and postpartum depressive symptoms. Seven randomized controlled trials were included in this study. The findings suggested that the CenteringPregnancy program and obstetric led care had similar effects in reducing the rates of preterm birth and low birth weight. More studies are needed to examine the effect of the CenteringPregnancy program on the improvement of postpartum depressive symptoms.
Topics: Child; Female; Humans; Infant, Newborn; Parturition; Postpartum Period; Pregnancy; Premature Birth; Prenatal Care; Randomized Controlled Trials as Topic
PubMed: 34098451
DOI: 10.1016/j.ijnurstu.2021.103981