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BJOG : An International Journal of... Apr 2014Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery... (Review)
Review
OBJECTIVES
Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines.
DESIGN
Systematic review.
SETTING
Women's magazines printed from 1989 to 2009 with the largest national distribution.
SAMPLE
Articles with any information on CS.
METHODS
Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study.
MAIN OUTCOME MEASURES
Accuracy, comprehensiveness and sources of information.
RESULTS
Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles.
CONCLUSIONS
The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery.
Topics: Cesarean Section; Female; Humans; Length of Stay; Medicine in Literature; Pain, Postoperative; Periodicals as Topic; Pregnancy; Recovery of Function; Spain; Stress, Psychological; Uterine Rupture
PubMed: 24467797
DOI: 10.1111/1471-0528.12513 -
Fertility and Sterility Dec 2013To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and... (Meta-Analysis)
Meta-Analysis Review
Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis.
OBJECTIVE
To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and cleavage-stage embryos generated through IVF.
DESIGN
Systematic review.
SETTING
University hospital.
PATIENT(S)
Singleton pregnancies resulting from ET at the blastocyst stage versus those at the cleavage stage.
INTERVENTION(S)
Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980-2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1.
MAIN OUTCOME MEASURE(S)
Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa.
RESULT(S)
In vitro fertilization pregnancies occurring as a result of ET at the blastocyst stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22-1.31) and very preterm delivery (RR 1.22; 95% CI 1.10-1.35) in comparison with those resulting from the transfer of cleavage-stage embryos. The risk of growth restriction was lower in babies conceived through blastocyst transfer (RR 0.82; 95% CI 0.77-0.88).
CONCLUSION(S)
Data from observational studies show that ET at the blastocyst stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the blastocyst stage compared with the cleavage stage.
Topics: Blastocyst; Cleavage Stage, Ovum; Comorbidity; Embryo Transfer; Female; Fertilization in Vitro; Humans; Incidence; Infant, Low Birth Weight; Infertility, Female; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Survival Rate; Treatment Outcome
PubMed: 24083875
DOI: 10.1016/j.fertnstert.2013.08.044 -
Tropical Medicine & International... Jun 2013(i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
(i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity.
METHODS
Systematic review of the literature and random-effects meta-analysis. Potential sources of heterogeneity were investigated using meta-regression.
RESULTS
The overall prevalence of placenta praevia was 5.2 per 1000 pregnancies (95% CI: 4.5-5.9). However, there was evidence of regional variation (P = 0.0001); prevalence was highest among Asian studies (12.2 per 1000 pregnancies; 95% CI: 9.5-15.2) and lower among studies from Europe (3.6 per 1000 pregnancies; 95% CI: 2.8-4.6), North America (2.9 per 1000 pregnancies; 95% CI: 2.3-3.5) and Sub-Saharan Africa (2.7 per 1000 pregnancies; 95% CI: 0.3-11.0). The prevalence of major placenta praevia was 4.3 per 1000 pregnancies (95% CI: 3.3-5.4).
CONCLUSION
The prevalence of placenta praevia is low at around 5 per 1000 pregnancies. There is some evidence suggestive of regional variation in its prevalence, but it is not possible to determine from existing data whether this is due to true ethnic differences or other unknown factor(s).
Topics: Africa South of the Sahara; Asia; Europe; Female; Humans; Maternal Welfare; North America; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Prevalence; Regression Analysis; Reproductive Health
PubMed: 23551357
DOI: 10.1111/tmi.12100 -
The Cochrane Database of Systematic... Mar 2012Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of... (Review)
Review
BACKGROUND
Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and a greater risk of stillbirth and neonatal morbidity. The differences in neonatal physiology following vaginal and caesarean births are thought to have implications for the infant, with caesarean section potentially increasing the risk of compromised health in both the short and the long term. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics.
OBJECTIVES
To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012) and reference lists of relevant studies.
SELECTION CRITERIA
All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section.
DATA COLLECTION AND ANALYSIS
We identified no studies that met the inclusion criteria.
MAIN RESULTS
There were no included trials.
AUTHORS' CONCLUSIONS
There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth.
Topics: Cesarean Section; Female; Humans; Pregnancy; Term Birth
PubMed: 22419296
DOI: 10.1002/14651858.CD004660.pub3 -
Fertility and Sterility Feb 2012To determine whether elective single embryo transfer (eSET) lowers the risk of poor perinatal outcomes associated with IVF, when [1] compared with double embryo transfer... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether elective single embryo transfer (eSET) lowers the risk of poor perinatal outcomes associated with IVF, when [1] compared with double embryo transfer (DET) or multiple embryo transfer (MET), and separately, [2] compared with spontaneous conceptions.
DESIGN
Systematic review and meta-analysis.
SETTING
Centers for reproductive care.
PATIENT(S)
Infertility patients.
INTERVENTION(S)
MEDLINE, Embase, and bibliographies were searched for the period 1978-2011. Two reviewers independently assessed titles, abstracts, and full studies, extracted data, and assessed quality. Dichotomous data were pooled using relative risks and continuous data with mean differences using a random effects model. Randomized controlled trials (RCTs), case-control studies, and cohort studies that examined any of the primary or secondary outcomes in singleton, twin, or multiple-order infants conceived by eSET as compared with [1] those conceived by DET or MET or [2] spontaneously conceived singleton gestations were included.
MAIN OUTCOME MEASURE(S)
Primary outcomes were preterm birth (PTB, <37 weeks' gestation) and low birth weight (LBW, <2,500 g).
RESULT(S)
Sixteen studies were included (eight RCTs, eight cohort studies). Compared with DET-conceived infants, eSET-conceived singletons were less likely to be born either preterm (RCT-based relative risk [RR] 0.37, 95% confidence interval [CI] 0.25-0.55) or with LBW (RCT-based RR 0.25, 95% CI 0.15-0.45; cohort study RR 0.51, 95% CI 0.29-0.91). However, compared with spontaneously conceived singletons, eSET gestations had higher risks of PTB (RR 2.13, 95% CI 1.26-3.61), placenta previa (RR 6.02, 95% CI 2.79-13.01), gestational diabetes (RR 1.69, 95% CI 1.19-2.42), and ectopic pregnancy (RR 6.40, 95% CI 4.38-9.35).
CONCLUSION(S)
Elective single embryo transfer is associated with decreased risks of PTB and LBW compared with DET but higher risks of PTB compared with spontaneously conceived singletons.
Topics: Female; Fertilization in Vitro; Gestational Age; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infertility; Pregnancy; Pregnancy Outcome; Premature Birth; Risk Assessment; Risk Factors; Single Embryo Transfer; Treatment Outcome
PubMed: 22177461
DOI: 10.1016/j.fertnstert.2011.11.033 -
NIH Consensus and State-of-the-science...To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
PARTICIPANTS
A non-DHHS, nonadvocate 18-member panel representing the fields of obstetrics and gynecology, preventive medicine, biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.
EVIDENCE
Presentations by experts and a systematic review of the literature prepared by the RTI International-University of North Carolina Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
CONFERENCE PROCESS
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.
CONCLUSIONS
The incidence of cesarean delivery without medical or obstetric indications is increasing in the United States, and a component of this increase is cesarean delivery on maternal request. Given the tools available, the magnitude of this component is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles. Given that the risks of placenta previa and accreta rise with each cesarean delivery, cesarean delivery on maternal request is not recommended for women desiring several children. Cesarean delivery on maternal request should not be performed prior to 39 weeks of gestation or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Maternal request for cesarean delivery should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women. NIH or another appropriate Federal agency should establish and maintain a Web site to provide up-to-date information on the benefits and risks of all modes of delivery.
Topics: Cesarean Section; Decision Making; Ethics, Clinical; Female; Humans; Mothers; Needs Assessment; Outcome Assessment, Health Care; Practice Guidelines as Topic; Pregnancy; United States
PubMed: 17308552
DOI: No ID Found -
The Cochrane Database of Systematic... 2000Because placenta praevia is implanted unusually low in the uterus, it may cause major, and/or repeated, antepartum haemorrhage. The traditional policy of care of women... (Review)
Review
BACKGROUND
Because placenta praevia is implanted unusually low in the uterus, it may cause major, and/or repeated, antepartum haemorrhage. The traditional policy of care of women with symptomatic placenta praevia includes prolonged stay in hospital and delivery by caesarean section.
OBJECTIVES
To assess the impact of any clinical intervention applied specifically because of a perceived likelihood that a pregnant woman might have placenta praevia.
SEARCH STRATEGY
A comprehensive electronic search was performed to identify relevant literature. Searched databases included the Trials Register maintained by the Cochrane Pregnancy and Childbirth Group, and the Cochrane Controlled Clinical Trials Register.
SELECTION CRITERIA
Any controlled clinical trial that has assessed the impact of an intervention in women diagnosed as having, or being likely to have, placenta praevia.
DATA COLLECTION AND ANALYSIS
Data were extracted from the three identified trial reports, unblinded, by the author without consideration of results.
MAIN RESULTS
Two comparisons could be made - home versus hospitalisation and cervical cerclage versus no cerclage. Both were associated with reduced lengths of stay in hospital antenatally. Otherwise, there was little evidence of any clear advantage or disadvantage to a policy of home versus hospital care. Cervical cerclage may reduce the risk of delivery before 34 weeks, or the birth of a baby weighing less than 2 kg or having a low 5 minute Apgar score. In general, these possible benefits were more evident in the trial of lesser methodological quality.
REVIEWER'S CONCLUSIONS
There are insufficient data from trials to recommend any change in clinical practice. Available data should, however, should encourage further work to address the safety of more conservative policies of hospitalisation for women with suspected placenta praevia, and the possible value of insertion of a cervical suture.
Topics: Female; Humans; Placenta Previa; Pregnancy
PubMed: 10796278
DOI: 10.1002/14651858.CD001998