Pub Date : 2024-02-01DOI: 10.1016/j.xagr.2024.100325
Pilar Prats PhD , M. Teresa Izquierdo MD , M. Ángeles Rodríguez PhD , Ignacio Rodríguez MSc , Alberto Rodríguez-Melcón MD , Bernat Serra MD , Gerard Albaiges MD
BACKGROUND
Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks.
OBJECTIVE
This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks.
STUDY DESIGN
We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated.
RESULTS
A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks.
CONCLUSION
The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.
{"title":"Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms","authors":"Pilar Prats PhD , M. Teresa Izquierdo MD , M. Ángeles Rodríguez PhD , Ignacio Rodríguez MSc , Alberto Rodríguez-Melcón MD , Bernat Serra MD , Gerard Albaiges MD","doi":"10.1016/j.xagr.2024.100325","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100325","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks.</p></div><div><h3>STUDY DESIGN</h3><p>We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated.</p></div><div><h3>RESULTS</h3><p>A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks.</p></div><div><h3>CONCLUSION</h3><p>The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000194/pdfft?md5=49e42e0e0fca52310fb624efaab16635&pid=1-s2.0-S2666577824000194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-19DOI: 10.1016/j.xagr.2024.100313
Miranda K. Kiefer DO , Jamie Cowen BA , Katherine A. Hinely RN , Kara M. Rood MD
BACKGROUND
Although urine drug testing can have vast legal and social ramifications, its interpretation during pregnancy and after birth remains not well understood. Fentanyl metabolism is altered by an individual's genetics, history of opioid use, and liver function. However, little is known about the clearance of fentanyl or its primary metabolite, norfentanyl, in the peripartum period.
OBJECTIVE
We sought to identify and describe cases of delayed urine norfentanyl clearance in the pregnancy and postpartum period within our institution.
STUDY DESIGN
This study described 3 cases of delayed urine norfentanyl clearance in pregnant and postpartum individuals in a colocated obstetrics, postpartum, and addiction medicine program. This program included prescriptions for medication for opioid use disorder and weekly urine drug testing with fentanyl immunoassay with reflex confirmation testing with liquid chromatography-tandem mass spectrometry for positive results with a limit of detection of 2.5 ng/mL.
RESULTS
Low levels of norfentanyl (<16.3 ng/mL) were detected in urine 294 days, 126 days, and 231 days after the last fentanyl use. Patient self-reported abstinence was supported by consistently negative urine fentanyl levels throughout the collection period, compliant weekly urine drug tests that were otherwise only positive for buprenorphine, and negative fentanyl and norfentanyl in umbilical cord toxicology.
CONCLUSION
Despite compliance in a medication for opioid use disorder program, the presence of norfentanyl in urine has significant consequences on the maternal-child dyad in the postpartum period. Caution should be used when using low levels of norfentanyl to determine an individual's abstinence, as it can lead to further discrimination against women in medication for opioid use disorder programs.
{"title":"Prolonged detection of urine norfentanyl in individuals enrolled in a medication for opioid use disorder in pregnancy and postpartum program: a case series","authors":"Miranda K. Kiefer DO , Jamie Cowen BA , Katherine A. Hinely RN , Kara M. Rood MD","doi":"10.1016/j.xagr.2024.100313","DOIUrl":"10.1016/j.xagr.2024.100313","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Although urine drug testing can have vast legal and social ramifications, its interpretation during pregnancy and after birth remains not well understood. Fentanyl metabolism is altered by an individual's genetics, history of opioid use, and liver function. However, little is known about the clearance of fentanyl or its primary metabolite, norfentanyl, in the peripartum period.</p></div><div><h3>OBJECTIVE</h3><p>We sought to identify and describe cases of delayed urine norfentanyl clearance in the pregnancy and postpartum period within our institution.</p></div><div><h3>STUDY DESIGN</h3><p>This study described 3 cases of delayed urine norfentanyl clearance in pregnant and postpartum individuals in a colocated obstetrics, postpartum, and addiction medicine program. This program included prescriptions for medication for opioid use disorder and weekly urine drug testing with fentanyl immunoassay with reflex confirmation testing with liquid chromatography-tandem mass spectrometry for positive results with a limit of detection of 2.5 ng/mL.</p></div><div><h3>RESULTS</h3><p>Low levels of norfentanyl (<16.3 ng/mL) were detected in urine 294 days, 126 days, and 231 days after the last fentanyl use. Patient self-reported abstinence was supported by consistently negative urine fentanyl levels throughout the collection period, compliant weekly urine drug tests that were otherwise only positive for buprenorphine, and negative fentanyl and norfentanyl in umbilical cord toxicology.</p></div><div><h3>CONCLUSION</h3><p>Despite compliance in a medication for opioid use disorder program, the presence of norfentanyl in urine has significant consequences on the maternal-child dyad in the postpartum period. Caution should be used when using low levels of norfentanyl to determine an individual's abstinence, as it can lead to further discrimination against women in medication for opioid use disorder programs.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000078/pdfft?md5=a62d68b1fa5b04653d18c510723c0656&pid=1-s2.0-S2666577824000078-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-15DOI: 10.1016/j.xagr.2023.100294
Cecille A. Tapia-Santiago MD, MHA, Dalanda Diallo MD
Rupture of a gravid uterus is a known complication of a cesarean hysterotomy. Uterine rupture of a nongravid uterus is usually caused by trauma, instrumentation, a pelvic mass, infection, or malignancy. Spontaneous rupture of a nongravid uterus is a rare event with only 4 cases reported in the English literature since 2011.
This was the case of a healthy 52-year-old woman with a remote history of 2 cesarean deliveries and an endometrial ablation. The patient presented with severe right lower-quadrant pain. The hospital evaluation revealed a hemoperitoneum, a 5 cm endometrial complex or mass, and layering of blood product along the cesarean delivery scar. Exploration confirmed a spontaneous rupture of the previous hysterotomy. The patient was treated successfully with a total abdominal hysterectomy. Pathology report confirmed the uterine wall defect.
Uterine rupture in the non-gravid uterus is a rare event. Presentation may be atypical but consistent with the diagnosis. Spontaneous uterine rupture should be considered in the nongravid patient with abdominal pain and a hemoperitoneum of unclear origin.
{"title":"Spontaneous rupture of a nongravid uterus: a case report","authors":"Cecille A. Tapia-Santiago MD, MHA, Dalanda Diallo MD","doi":"10.1016/j.xagr.2023.100294","DOIUrl":"10.1016/j.xagr.2023.100294","url":null,"abstract":"<div><p>Rupture of a gravid uterus is a known complication of a cesarean hysterotomy. Uterine rupture of a nongravid uterus is usually caused by trauma, instrumentation, a pelvic mass, infection, or malignancy. Spontaneous rupture of a nongravid uterus is a rare event with only 4 cases reported in the English literature since 2011.</p><p>This was the case of a healthy 52-year-old woman with a remote history of 2 cesarean deliveries and an endometrial ablation. The patient presented with severe right lower-quadrant pain. The hospital evaluation revealed a hemoperitoneum, a 5 cm endometrial complex or mass, and layering of blood product along the cesarean delivery scar. Exploration confirmed a spontaneous rupture of the previous hysterotomy. The patient was treated successfully with a total abdominal hysterectomy. Pathology report confirmed the uterine wall defect.</p><p>Uterine rupture in the non-gravid uterus is a rare event. Presentation may be atypical but consistent with the diagnosis. Spontaneous uterine rupture should be considered in the nongravid patient with abdominal pain and a hemoperitoneum of unclear origin.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001363/pdfft?md5=9e5cb0ff78b614c862588df1cb72a82b&pid=1-s2.0-S2666577823001363-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139538077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Several studies show that gestational age estimation during the third trimester of pregnancy using fetal transcerebellar diameter is superior to that measured using fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length). However, the conclusion of the studies stemmed from findings of correlation and regression statistical tests, which are not the recommended statistical analysis methods for comparing the values of 1 variable as measured by 2 different methods.
OBJECTIVE
This study aimed to compare the accuracy of gestational age estimation using transcerebellar diameter to that using fetal biometry during the third trimester of pregnancy using Bland-Altman statistical analysis.
STUDY DESIGN
This was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester of pregnancy (28–41 weeks of gestation) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on the Open Data Kit. The primary outcome of our study was the mean bias of gestational age estimation (error in estimating gestational age) using transcerebellar diameter and composite fetal biometry (composite gestational age). Data were analyzed using Stata (version 15; StataCorp, College Station, TX). Simple descriptive analysis, Bland-Altman analysis, and the Kendall τa discordance measurement were performed as appropriate. The mean bias (error) and limits of agreement were used to present the significance of the finding.
RESULTS
A total of 104 pregnant women in the third trimester were included in the study. The mean error (bias) when transcerebellar diameter was used to estimate the gestational age was 0.65 weeks vs a bias of 1.1 weeks using composite biometry, compared with the gold standard method from crown-lump length (in both cases). The calculated estimated limit of agreement was narrower in the case of transcerebellar diameter than in the case of composite fetal biometry (−3.56 to 2.25 vs −4.73 to 2.53). The Kendall τa discordance measurement revealed that gestational age estimations using composite biometry and crown-lump length were 51% to 70%, respectively, more likely to agree than disagree and that gestational age estimations using transcerebellar diameter and crown-lump length were 62% to 77%, respectively, more likely to agree than to disagree (P≤.001).
CONCLUSION
Gestational age estimation using transcerebellar diameter is more accurate than gestational age estimation using composite gestational age (biparietal diameter, head circumference, femur diaphysis length, and abdominal circumference). Transcerebellar diameter should be used to date third-trimester pregnancies with unknown gestational age (unknown last norma
背景多项研究显示，在妊娠三个月时，使用胎儿经小脑直径估计胎龄优于使用胎儿生物测量（双顶径、头围、腹围和股骨干骺端长度）估计胎龄。本研究旨在使用布兰德-阿尔特曼（Bland-Altman）统计分析方法，比较在妊娠三个月内使用小脑横径和胎儿生物测量法估计胎龄的准确性。研究设计这是一项横断面研究，研究对象是2020年11月1日至2021年2月28日期间在圣保罗医院千禧医学院（埃塞俄比亚）接受常规产前护理随访的怀孕三个月（孕28-41周）的孕妇。数据采用开放数据工具包上的结构化问卷进行前瞻性收集。我们研究的主要结果是使用经小脑直径和复合胎儿生物测量（复合胎龄）估算胎龄的平均偏差（估算胎龄的误差）。数据使用 Stata（版本 15；StataCorp，德克萨斯州 College Station）进行分析。根据情况进行了简单描述性分析、Bland-Altman 分析和 Kendall τa 不一致性测量。结果共有 104 名怀孕三个月的孕妇参与了研究。与根据胎冠-胎块长度的金标准方法（两种情况）相比，使用经小脑直径估计胎龄的平均误差（偏差）为 0.65 周，而使用复合生物测量法的偏差为 1.1 周。经小脑直径法计算的估计一致限（-3.56-2.25 vs -4.73-2.53）比综合胎儿生物测量法要窄（-3.56-2.25 vs -4.73-2.53）。Kendall τa不一致性测量显示，使用复合胎儿生物测量和胎冠-胎块长度估计胎龄时，同意的可能性分别为51%至70%，而不同意的可能性较高；使用经小脑直径和胎冠-胎块长度估计胎龄时，同意的可能性分别为62%至77%，而不同意的可能性较高（P≤.001）。结论与使用复合胎龄（双顶径、头围、股骨干骺端长度和腹围）估计胎龄相比，使用经小脑直径估计胎龄更准确。对于胎龄未知的第三孕期孕妇（末次正常月经时间未知且无早期超声波里程碑），应使用横小脑直径来确定胎龄。
{"title":"Utilization of third-trimester fetal transcerebellar diameter measurement for gestational age estimation: a comparative study using Bland-Altman analysis","authors":"Delayehu Bekele MD, MPH , Wondimu Gudu MD, MPH , Mekitie Wondafrash MD, PhD , Abdulfetah Abdulkadir Abdosh MD , Abraham Fessehaye Sium MD","doi":"10.1016/j.xagr.2024.100307","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100307","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Several studies show that gestational age estimation during the third trimester of pregnancy using fetal transcerebellar diameter is superior to that measured using fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length). However, the conclusion of the studies stemmed from findings of correlation and regression statistical tests, which are not the recommended statistical analysis methods for comparing the values of 1 variable as measured by 2 different methods.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to compare the accuracy of gestational age estimation using transcerebellar diameter to that using fetal biometry during the third trimester of pregnancy using Bland-Altman statistical analysis.</p></div><div><h3>STUDY DESIGN</h3><p>This was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester of pregnancy (28–41 weeks of gestation) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on the Open Data Kit. The primary outcome of our study was the mean bias of gestational age estimation (error in estimating gestational age) using transcerebellar diameter and composite fetal biometry (composite gestational age). Data were analyzed using Stata (version 15; StataCorp, College Station, TX). Simple descriptive analysis, Bland-Altman analysis, and the Kendall τa discordance measurement were performed as appropriate. The mean bias (error) and limits of agreement were used to present the significance of the finding.</p></div><div><h3>RESULTS</h3><p>A total of 104 pregnant women in the third trimester were included in the study. The mean error (bias) when transcerebellar diameter was used to estimate the gestational age was 0.65 weeks vs a bias of 1.1 weeks using composite biometry, compared with the gold standard method from crown-lump length (in both cases). The calculated estimated limit of agreement was narrower in the case of transcerebellar diameter than in the case of composite fetal biometry (−3.56 to 2.25 vs −4.73 to 2.53). The Kendall τa discordance measurement revealed that gestational age estimations using composite biometry and crown-lump length were 51% to 70%, respectively, more likely to agree than disagree and that gestational age estimations using transcerebellar diameter and crown-lump length were 62% to 77%, respectively, more likely to agree than to disagree (<em>P</em>≤.001).</p></div><div><h3>CONCLUSION</h3><p>Gestational age estimation using transcerebellar diameter is more accurate than gestational age estimation using composite gestational age (biparietal diameter, head circumference, femur diaphysis length, and abdominal circumference). Transcerebellar diameter should be used to date third-trimester pregnancies with unknown gestational age (unknown last norma","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000017/pdfft?md5=f49c8e6485c206fdf577df381d52b12e&pid=1-s2.0-S2666577824000017-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139548779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-11DOI: 10.1016/j.xagr.2024.100310
Genevieve R. Mazza MD , Ariane C. Youssefzadeh MD , Laurel S. Aberle MD , Zachary S. Anderson MD , Rachel S. Mandelbaum MD , Joseph G. Ouzounian MD, MBA , Kazuhide Matsushima MD , Koji Matsuo MD, PhD
BACKGROUND
Gallstone disease in pregnancy is one of the most common indications for nonobstetrical surgery during pregnancy. National-level data on contemporary surgical practice and outcomes are limited.
OBJECTIVE
This study aimed to assess the clinical characteristics and outcomes of patients undergoing cholecystectomy during pregnancy.
STUDY DESIGN
This cross-sectional study examined the Healthcare Cost and Utilization Project's 2 nationwide databases in the United States: the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample. The study population included 18,630 patients who had cholecystectomy during pregnancy from January 2016 to December 2020. The exposure was gestational age, grouped sequentially into the following 5 groups: first trimester (<14 weeks), early second trimester (14–20 weeks), late second trimester (21–27 weeks), early third trimester (28–36 weeks), and late third trimester (≥37 weeks). The main outcomes were clinical demographics, medical comorbidities, surgical information, and pregnancy characteristics and outcomes, assessed by gestational age.
RESULTS
Cholecystectomy was most common in the early second trimester (32.1%), followed by the first trimester (25.2%), late second trimester (23.1%), early third trimester (12.4%), and late third trimester (7.2%). Patients in the first-trimester group were more likely to be aged ≥35 years, to smoke, and to have acute cholecystitis, severe hyperemesis gravidarum including metabolic disturbance, pregestational diabetes, multifetal gestation, and sepsis/shock (P<.001). Patients in the early-third-trimester group were more likely to be obese and have gestational diabetes, Charlson Comorbidity Index of ≥1, premature rupture of membranes, and intrauterine growth restriction, whereas those in the late-third-trimester group were more likely to have gallstone pancreatitis, biliary colic, chorioamnionitis, gestational hypertension, preeclampsia, and severe maternal morbidity including sepsis (P<.001). At the cohort level, a laparoscopic approach was used in most cholecystectomy procedures (97.5%), and bile duct injury was uncommon (<0.1%). Delivery during the admission occurred in 0.3%, 0%, 0.6%, 17.8%, and 60.6% in the 5 gestational age groups, respectively (P<.001). Among the cases that had delivery in the early- and late-third-trimester groups, the delivery event preceded cholecystectomy in 61.4% and 86.2%, respectively, whereas both delivery and cholecystectomy occurred on the same day in 34.3% and 13.8%, respectively.
CONCLUSION
This nationwide analysis suggests that clinical and pregnancy characteristics and outcomes of patients undergoing cholecystectomy differ by pregnancy stage with a bimodal distribution. Although patients in the first and third trimesters have distinct medical conditions, more clinically
{"title":"Pregnant patients undergoing cholecystectomy: nationwide assessment of clinical characteristics and outcomes","authors":"Genevieve R. Mazza MD , Ariane C. Youssefzadeh MD , Laurel S. Aberle MD , Zachary S. Anderson MD , Rachel S. Mandelbaum MD , Joseph G. Ouzounian MD, MBA , Kazuhide Matsushima MD , Koji Matsuo MD, PhD","doi":"10.1016/j.xagr.2024.100310","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100310","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Gallstone disease in pregnancy is one of the most common indications for nonobstetrical surgery during pregnancy. National-level data on contemporary surgical practice and outcomes are limited.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the clinical characteristics and outcomes of patients undergoing cholecystectomy during pregnancy.</p></div><div><h3>STUDY DESIGN</h3><p>This cross-sectional study examined the Healthcare Cost and Utilization Project's 2 nationwide databases in the United States: the National Inpatient Sample and the Nationwide Ambulatory Surgery Sample. The study population included 18,630 patients who had cholecystectomy during pregnancy from January 2016 to December 2020. The exposure was gestational age, grouped sequentially into the following 5 groups: first trimester (<14 weeks), early second trimester (14–20 weeks), late second trimester (21–27 weeks), early third trimester (28–36 weeks), and late third trimester (≥37 weeks). The main outcomes were clinical demographics, medical comorbidities, surgical information, and pregnancy characteristics and outcomes, assessed by gestational age.</p></div><div><h3>RESULTS</h3><p>Cholecystectomy was most common in the early second trimester (32.1%), followed by the first trimester (25.2%), late second trimester (23.1%), early third trimester (12.4%), and late third trimester (7.2%). Patients in the first-trimester group were more likely to be aged ≥35 years, to smoke, and to have acute cholecystitis, severe hyperemesis gravidarum including metabolic disturbance, pregestational diabetes, multifetal gestation, and sepsis/shock (<em>P</em><.001). Patients in the early-third-trimester group were more likely to be obese and have gestational diabetes, Charlson Comorbidity Index of ≥1, premature rupture of membranes, and intrauterine growth restriction, whereas those in the late-third-trimester group were more likely to have gallstone pancreatitis, biliary colic, chorioamnionitis, gestational hypertension, preeclampsia, and severe maternal morbidity including sepsis (<em>P</em><.001). At the cohort level, a laparoscopic approach was used in most cholecystectomy procedures (97.5%), and bile duct injury was uncommon (<0.1%). Delivery during the admission occurred in 0.3%, 0%, 0.6%, 17.8%, and 60.6% in the 5 gestational age groups, respectively (<em>P</em><.001). Among the cases that had delivery in the early- and late-third-trimester groups, the delivery event preceded cholecystectomy in 61.4% and 86.2%, respectively, whereas both delivery and cholecystectomy occurred on the same day in 34.3% and 13.8%, respectively.</p></div><div><h3>CONCLUSION</h3><p>This nationwide analysis suggests that clinical and pregnancy characteristics and outcomes of patients undergoing cholecystectomy differ by pregnancy stage with a bimodal distribution. Although patients in the first and third trimesters have distinct medical conditions, more clinically","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000042/pdfft?md5=f9dd06fadfd9c98b49a984aacc2c4cd2&pid=1-s2.0-S2666577824000042-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139505334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-10DOI: 10.1016/j.xagr.2023.100291
Shigeki Matsubara MD, PhD
{"title":"Letter to the editor regarding placenta accreta spectrum: treatment consensus in a resource-limited setting: classification and registration of surgeries are necessary","authors":"Shigeki Matsubara MD, PhD","doi":"10.1016/j.xagr.2023.100291","DOIUrl":"10.1016/j.xagr.2023.100291","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001338/pdfft?md5=0221107b9e6256284e607e528330ce7e&pid=1-s2.0-S2666577823001338-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.1016/j.xagr.2023.100303
E. Kathleen Adams PhD , Michael R. Kramer PhD , Peter J. Joski MSPH , Marissa Coloske MPH, MA , Anne L. Dunlop MD, MPH
BACKGROUND
Studies find that delivery hospital explains a significant portion of the Black-White gap in severe maternal morbidity. No such studies have focused on the US Southeast, where racial disparities are widest, and few have examined the relative contribution of hospital, residential, and maternal factors.
OBJECTIVE
This study aimed to estimate the portion of Georgia's Black-White gap in severe maternal morbidity during delivery through 42 days postpartum explained by hospital, residential, and maternal factors.
STUDY DESIGN
Using linked Georgia hospital discharge, birth, and fetal death records for 2016 through 2020, we identified 413,124 deliveries to non-Hispanic White (229,357; 56%) or Black (183,767; 44%) individuals. We linked hospital data from the American Hospital Association and Center for Medicare and Medicaid Services, and area data from the Area Resource File and American Community Survey. We identified severe maternal morbidity indicator conditions during delivery or subsequent hospitalizations through 42 days postpartum. Using race-specific logistic models followed by a decomposition technique, we estimated the portion of the Black-White severe maternal morbidity gap explained by the following: (1) sociodemographic factors (age, education, marital status, and nativity), (2) medical conditions (diabetes mellitus, gestational diabetes, chronic hypertension, gestational hypertension or preeclampsia, and smoking), (3) obstetrical factors (singleton or multiple, and birth order); (4) access to care (no or third trimester care, and payer), (5) hospital factors that are time-varying (delivery volume, deliveries per full-time equivalent nurse, doctor communication, patient safety, and adverse event composite score) or measured time-invariant characteristics (ownership, profit status, religious affiliation, teaching status, and perinatal level), and (6) residential factors (county urban/rural classification, percent uninsured women of reproductive age, obstetrician-gynecologists per women of reproductive age, number of federally-qualified and community health centers, medically-underserved area [yes/no], and census tract neighborhood deprivation index). We estimated models with and without hospital fixed-effects, which account for unobserved time-invariant hospital characteristics such as within-hospital care processes or unmeasured hospital-specific factors.
RESULTS
There was 1.8 times the rate of severe maternal morbidity per 100 discharges among non-Hispanic Black (3.15) than among White (1.73) individuals, with an explained proportion of 30.4% in models without and 49.8% in models with hospital fixed-effects. In the latter, hospital fixed-effects explained the largest portion of the Black-White severe maternal morbidity gap (15.1%) followed by access to care (14.9%) and sociodemographic factors (14.4%), with residential factors being protect
{"title":"Examination of the Black-White racial disparity in severe maternal morbidity among Georgia deliveries, 2016 to 2020","authors":"E. Kathleen Adams PhD , Michael R. Kramer PhD , Peter J. Joski MSPH , Marissa Coloske MPH, MA , Anne L. Dunlop MD, MPH","doi":"10.1016/j.xagr.2023.100303","DOIUrl":"10.1016/j.xagr.2023.100303","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Studies find that delivery hospital explains a significant portion of the Black-White gap in severe maternal morbidity. No such studies have focused on the US Southeast, where racial disparities are widest, and few have examined the relative contribution of hospital, residential, and maternal factors.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to estimate the portion of Georgia's Black-White gap in severe maternal morbidity during delivery through 42 days postpartum explained by hospital, residential, and maternal factors.</p></div><div><h3>STUDY DESIGN</h3><p>Using linked Georgia hospital discharge, birth, and fetal death records for 2016 through 2020, we identified 413,124 deliveries to non-Hispanic White (229,357; 56%) or Black (183,767; 44%) individuals. We linked hospital data from the American Hospital Association and Center for Medicare and Medicaid Services, and area data from the Area Resource File and American Community Survey. We identified severe maternal morbidity indicator conditions during delivery or subsequent hospitalizations through 42 days postpartum. Using race-specific logistic models followed by a decomposition technique, we estimated the portion of the Black-White severe maternal morbidity gap explained by the following: (1) sociodemographic factors (age, education, marital status, and nativity), (2) medical conditions (diabetes mellitus, gestational diabetes, chronic hypertension, gestational hypertension or preeclampsia, and smoking), (3) obstetrical factors (singleton or multiple, and birth order); (4) access to care (no or third trimester care, and payer), (5) hospital factors that are time-varying (delivery volume, deliveries per full-time equivalent nurse, doctor communication, patient safety, and adverse event composite score) or measured time-invariant characteristics (ownership, profit status, religious affiliation, teaching status, and perinatal level), and (6) residential factors (county urban/rural classification, percent uninsured women of reproductive age, obstetrician-gynecologists per women of reproductive age, number of federally-qualified and community health centers, medically-underserved area [yes/no], and census tract neighborhood deprivation index). We estimated models with and without hospital fixed-effects, which account for unobserved time-invariant hospital characteristics such as within-hospital care processes or unmeasured hospital-specific factors.</p></div><div><h3>RESULTS</h3><p>There was 1.8 times the rate of severe maternal morbidity per 100 discharges among non-Hispanic Black (3.15) than among White (1.73) individuals, with an explained proportion of 30.4% in models without and 49.8% in models with hospital fixed-effects. In the latter, hospital fixed-effects explained the largest portion of the Black-White severe maternal morbidity gap (15.1%) followed by access to care (14.9%) and sociodemographic factors (14.4%), with residential factors being protect","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001454/pdfft?md5=2d76a8f9044832685d7cc357250c5cdb&pid=1-s2.0-S2666577823001454-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated.
OBJECTIVE
This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents.
STUDY DESIGN
A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses.
RESULTS
Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=−0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, −17.3; 95% confidence interval, −22.4 to −12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls w
{"title":"Menstrual symptoms and subjective well-being among postmenarchal adolescents","authors":"Pietro Gambadauro MD, MSc (Med Ed), PhD , Gergö Hadlaczky MSc, PhD , Danuta Wasserman MD, PhD , Vladimir Carli MD, PhD","doi":"10.1016/j.xagr.2023.100304","DOIUrl":"10.1016/j.xagr.2023.100304","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents.</p></div><div><h3>STUDY DESIGN</h3><p>A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses.</p></div><div><h3>RESULTS</h3><p>Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (<em>P</em><.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=−0.0201; <em>P</em>=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, −17.3; 95% confidence interval, −22.4 to −12.3). Analysis of variance showed significant associations (<em>P</em><.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls w","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001466/pdfft?md5=f31ba4cf96c1bd7e565ab24df7d1f127&pid=1-s2.0-S2666577823001466-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-13DOI: 10.1016/j.xagr.2023.100298
Diana M. Tordoff PhD, MPH , Heidi Moseson PhD, MPH , Sachiko Ragosta , Jen Hastings MD , Annesa Flentje PhD , Matthew R. Capriotti PhD , Micah E. Lubensky PhD , Mitchell R. Lunn MD, MAS , Juno Obedin-Maliver MD, MPH, MAS
BACKGROUND
Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.
OBJECTIVE
This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.
STUDY DESIGN
This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.
RESULTS
Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.
CONCLUSION
Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.
{"title":"Family building and pregnancy experiences of cisgender sexual minority women","authors":"Diana M. Tordoff PhD, MPH , Heidi Moseson PhD, MPH , Sachiko Ragosta , Jen Hastings MD , Annesa Flentje PhD , Matthew R. Capriotti PhD , Micah E. Lubensky PhD , Mitchell R. Lunn MD, MAS , Juno Obedin-Maliver MD, MPH, MAS","doi":"10.1016/j.xagr.2023.100298","DOIUrl":"10.1016/j.xagr.2023.100298","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.</p></div><div><h3>STUDY DESIGN</h3><p>This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.</p></div><div><h3>RESULTS</h3><p>Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.</p></div><div><h3>CONCLUSION</h3><p>Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001405/pdfft?md5=79d446d32ca42ceefacc14c7b54886e3&pid=1-s2.0-S2666577823001405-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood.
OBJECTIVE
This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery.
STUDY DESIGN
This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth <37.0 weeks. Maternal vital signs and fetal heart rate tracings for the 1 hour before and 1 hour after epidural analgesia was administered were reviewed. The occurrence of maternal hypotension, defined as a continuous variable and dichotomized into a decrease in maternal systolic blood pressure to <90 mm Hg or a drop in systolic blood pressure by >20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses).
RESULTS
A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (P=.03), the duration of labor after epidural (P<.001), and worsening fetal heart rate category within 60 minutes of epidural administration (P=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery.
CONCLUSION
Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.
{"title":"Side effects from epidural analgesia in laboring women and risk of cesarean delivery","authors":"Alessandro Ghidini MD , Kelly Vanasche BSN , Alyssa Cacace BS , Marietta Cacace BSN , Simona Fumagalli RM , Anna Locatelli MD","doi":"10.1016/j.xagr.2023.100297","DOIUrl":"10.1016/j.xagr.2023.100297","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery.</p></div><div><h3>STUDY DESIGN</h3><p>This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth <37.0 weeks. Maternal vital signs and fetal heart rate tracings for the 1 hour before and 1 hour after epidural analgesia was administered were reviewed. The occurrence of maternal hypotension, defined as a continuous variable and dichotomized into a decrease in maternal systolic blood pressure to <90 mm Hg or a drop in systolic blood pressure by >20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses).</p></div><div><h3>RESULTS</h3><p>A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (<em>P</em>=.03), the duration of labor after epidural (<em>P</em><.001), and worsening fetal heart rate category within 60 minutes of epidural administration (<em>P</em>=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery.</p></div><div><h3>CONCLUSION</h3><p>Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001399/pdfft?md5=101d318c92ae44130be47a3292d23b84&pid=1-s2.0-S2666577823001399-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139024772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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