Pub Date : 2024-05-23DOI: 10.1016/j.xagr.2024.100356
Itamar D. Futterman MD , Hitangee Jain , Rodney A. McLaren Jr , Jonathan K. Mays MD
BACKGROUND
Intrahepatic cholestasis of pregnancy has been linked to sudden stillbirth. The suddenness of the stillbirths in these cases have led clinicians to suspect that the pathogenesis of stillbirth in women with intrahepatic cholestasis of pregnancy is not related to asphyxia but rather to an undefined etiology. One leading hypothesis relates certain bile acid metabolites to myocardial injury.
OBJECTIVE
The purpose of this study was to determine whether cord blood troponin I levels are increased in fetuses born to mothers with a diagnosis of intrahepatic cholestasis of pregnancy.
STUDY DESIGN
A prospective, case-control study was performed at a single institution between 2017 to 2019 in which 87 pregnant patients with a diagnosis of intrahepatic cholestasis of pregnancy (total bile acids ≥10 μmol/L) were enrolled as cases and 122 randomly selected pregnant patients (asymptomatic with intrapartum total bile acids <10 μmol/L) were enrolled as controls. Cord blood troponin I levels were measured at delivery in both groups using a commercially available chemiluminescent immunoassay. Values ≤0.04 ng/mL were considered negative. Values >0.04 ng/mL were considered positive. The primary outcome was the presence of elevated troponin levels in both cases and controls as a surrogate marker for cardiac status. Our secondary outcomes included neonatal intensive care unit stay, low Apgar scores, neonatal acidosis, and hypoxia indicated by cord blood pH and base excess levels at the time of birth. Chi square and t tests were performed to compare social and obstetrical variables. A P value of <.05 was considered significant. A stratification by total bile acids range of <40 μmol/L, 40 to 100 μmol/L, and >100 μmol/L was performed to assess the relationship between the different severities of intrahepatic cholestasis of pregnancy (by risk of fetal demise with those with total bile acids of >100 μmol/L considered at greatest risk) and the likelihood of a positive troponin I result. Finally, a logistic regression analysis was performed to determine if levels of ≥10 μmol/L were associated with elevated troponin levels.
RESULTS
The mean gestational age at delivery was 38.96±1.47 and 37.71±1.59 weeks of gestation in the controls and cases respectively (P<.001). The mean total bile acids values were 5.2±1.28 ng/mL and 43.2±40.62 ng/mL in the controls and cases respectively (P<.001). Cord blood troponin I was positive in 15 of 122 (12.30%) controls and in 20 of 87 (22.99%) cases. (P<.001). When further stratified by total bile acids levels of <40, 40 to 100, and >100 μmol/L, we found a positive correlation between higher total bile acids levels and a positive troponin I test (P=.002). When controlling for gestational age at delivery, maternal age, and body mass index, higher total bile acids
背景妊娠肝内胆汁淤积症与突发性死胎有关。这些病例中死胎的突然性使临床医生怀疑妊娠肝内胆汁淤积症妇女死胎的发病机制与窒息无关，而是与未确定的病因有关。本研究旨在确定诊断为妊娠期肝内胆汁淤积症的母亲所生胎儿的脐带血肌钙蛋白 I 水平是否升高。研究设计2017年至2019年期间，在一家机构进行了一项前瞻性病例对照研究，将87名确诊为妊娠期肝内胆汁淤积症（总胆汁酸≥10 μmol/L）的孕妇作为病例，将122名随机选择的孕妇（无症状，产前总胆汁酸为<10 μmol/L）作为对照。使用市售化学发光免疫测定法测定两组孕妇分娩时的脐带血肌钙蛋白 I 水平。≤0.04纳克/毫升为阴性。0.04纳克/毫升为阳性。主要结果是病例和对照组的肌钙蛋白水平升高，以此作为心脏状况的替代指标。次要结果包括新生儿重症监护室住院时间、低Apgar评分、新生儿酸中毒以及出生时脐带血pH值和碱过量水平显示的缺氧。对社会变量和产科变量进行了卡方检验和 t 检验。P 值为 <.05为显著。按照总胆汁酸范围（40 μmol/L、40 至 100 μmol/L、100 μmol/L）进行分层，以评估不同严重程度的妊娠肝内胆汁淤积症（按照胎儿死亡风险，总胆汁酸为 100 μmol/L者风险最大）与肌钙蛋白 I 阳性结果的可能性之间的关系。最后，进行了逻辑回归分析，以确定总胆汁酸水平≥10 μmol/L 是否与肌钙蛋白水平升高有关。 结果对照组和病例的平均分娩胎龄分别为（38.96±1.47）周和（37.71±1.59）周（P<.001）。对照组和病例的总胆汁酸平均值分别为 5.2±1.28 纳克/毫升和 43.2±40.62 纳克/毫升（P< .001）。在 122 例对照组和 87 例病例中，分别有 15 例（12.30%）和 20 例（22.99%）脐带血肌钙蛋白 I 呈阳性。(P<.001）。当按总胆汁酸水平为 40、40 至 100 和 100 μmol/L 进一步分层时，我们发现总胆汁酸水平较高与肌钙蛋白 I 检测呈阳性之间存在正相关（P=.002）。结论与无妊娠肝内胆汁淤积症的患者相比，妊娠肝内胆汁淤积症患者更容易出现肌钙蛋白 I 升高。按总胆汁酸水平分层时，总胆汁酸水平越高，肌钙蛋白 I 水平越容易呈阳性。此外，随着总胆汁酸水平的升高，肌钙蛋白 I 水平呈阳性的可能性也增大。虽然我们的队列中没有死胎，但我们的研究结果表明，婴儿出生时脐带血中肌钙蛋白 I 水平升高，表明心脏损伤与总胆汁酸水平过高之间存在潜在关系。
{"title":"Cord blood troponin I levels: biomarker evidence of fetal cardiac injury in intrahepatic cholestasis of pregnancy","authors":"Itamar D. Futterman MD , Hitangee Jain , Rodney A. McLaren Jr , Jonathan K. Mays MD","doi":"10.1016/j.xagr.2024.100356","DOIUrl":"10.1016/j.xagr.2024.100356","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Intrahepatic cholestasis of pregnancy has been linked to sudden stillbirth. The suddenness of the stillbirths in these cases have led clinicians to suspect that the pathogenesis of stillbirth in women with intrahepatic cholestasis of pregnancy is not related to asphyxia but rather to an undefined etiology. One leading hypothesis relates certain bile acid metabolites to myocardial injury.</p></div><div><h3>OBJECTIVE</h3><p>The purpose of this study was to determine whether cord blood troponin I levels are increased in fetuses born to mothers with a diagnosis of intrahepatic cholestasis of pregnancy.</p></div><div><h3>STUDY DESIGN</h3><p>A prospective, case-control study was performed at a single institution between 2017 to 2019 in which 87 pregnant patients with a diagnosis of intrahepatic cholestasis of pregnancy (total bile acids ≥10 μmol/L) were enrolled as cases and 122 randomly selected pregnant patients (asymptomatic with intrapartum total bile acids <10 μmol/L) were enrolled as controls. Cord blood troponin I levels were measured at delivery in both groups using a commercially available chemiluminescent immunoassay. Values ≤0.04 ng/mL were considered negative. Values >0.04 ng/mL were considered positive. The primary outcome was the presence of elevated troponin levels in both cases and controls as a surrogate marker for cardiac status. Our secondary outcomes included neonatal intensive care unit stay, low Apgar scores, neonatal acidosis, and hypoxia indicated by cord blood pH and base excess levels at the time of birth. Chi square and <em>t</em> tests were performed to compare social and obstetrical variables. A <em>P</em> value of <.05 was considered significant. A stratification by total bile acids range of <40 μmol/L, 40 to 100 μmol/L, and >100 μmol/L was performed to assess the relationship between the different severities of intrahepatic cholestasis of pregnancy (by risk of fetal demise with those with total bile acids of >100 μmol/L considered at greatest risk) and the likelihood of a positive troponin I result. Finally, a logistic regression analysis was performed to determine if levels of ≥10 μmol/L were associated with elevated troponin levels.</p></div><div><h3>RESULTS</h3><p>The mean gestational age at delivery was 38.96±1.47 and 37.71±1.59 weeks of gestation in the controls and cases respectively (<em>P</em><.001). The mean total bile acids values were 5.2±1.28 ng/mL and 43.2±40.62 ng/mL in the controls and cases respectively (<em>P</em><.001). Cord blood troponin I was positive in 15 of 122 (12.30%) controls and in 20 of 87 (22.99%) cases. (<em>P</em><.001). When further stratified by total bile acids levels of <40, 40 to 100, and >100 μmol/L, we found a positive correlation between higher total bile acids levels and a positive troponin I test (<em>P</em>=.002). When controlling for gestational age at delivery, maternal age, and body mass index, higher total bile acids","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100356"},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000509/pdfft?md5=84c36ab84a6e9e37e033fab1bbe041cc&pid=1-s2.0-S2666577824000509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133167","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 : 2024-05-21DOI: 10.1016/j.xagr.2024.100358
LeAnn A. Louis MD, MPH , Adu Appiah-Kubi MBChB, FGCS , Ruth Owusu-Antwi MBChB, MSc, FGCP , Thomas O. Konney MD, FWACS, FGCS , Cheryl A. Moyer PhD, MPH , Emma R. Lawrence MD, MS
Background
Rates of maternal mortality are highest in low-resource settings. Family members are often involved in the critical periods surrounding a maternal death, including transportation to health centers and financial and emotional support during hospital admissions. Maternal death has devastating impacts on surviving family members, which are often overlooked and understudied.
Objective
Our study aimed to explore the hospital experiences of family members surrounding a maternal death, and to define their access to and need for institutional and psychosocial support.
Study Design
This mixed methods cross-sectional study was conducted at an urban tertiary hospital in Ghana. Maternal mortalities from June 2019 to December 2020 were identified using death certificates. Participants, defined as husbands or other heads of households in families affected by maternal mortality, were purposively recruited. An interview guide was developed using grounded theory. In-person semi‐structured interviews were conducted in English or Twi to explore impacts of maternal mortality on family members, with a focus on hospital experiences. Surveys were administered on types of and needs for institutional support. Interviews were audio recorded, translated, transcribed, coded with an iteratively-developed codebook, and thematically analyzed. Survey data was descriptively analyzed.
Results
Fifty-one participants included 26 husbands of the deceased woman, 5 parents, 12 siblings, and 8 second-degree relatives. Interviews revealed an overall negative hospital experience for surviving family members, who expressed substantial dissatisfaction and distress. Four themes regarding the hospital experience emerged from the interviews: 1) poor communication from healthcare workers and hospital personnel, which contributed to 2) limited understanding of the patient's clinical status, hospital course, and cause of death; 3) maternal death perceived as avoidable; and 4) maternal death perceived as unexpected and shocking. Survey data revealed that only 10% of participants were provided psychosocial support following the maternal death event, yet 93.3% of those who did not receive support desired this resource.
Conclusion
The hospital experience was overall negative for family members and a lack of effective communication emerged as the root cause of this negative perception. Strategies to improve communication between healthcare providers and families are essential. In addition, there is an unmet need for formal mental health resources for families who experience a maternal death.
{"title":"“Nobody gave me information”: Hospital experiences of Ghanaian families after maternal mortalities","authors":"LeAnn A. Louis MD, MPH , Adu Appiah-Kubi MBChB, FGCS , Ruth Owusu-Antwi MBChB, MSc, FGCP , Thomas O. Konney MD, FWACS, FGCS , Cheryl A. Moyer PhD, MPH , Emma R. Lawrence MD, MS","doi":"10.1016/j.xagr.2024.100358","DOIUrl":"10.1016/j.xagr.2024.100358","url":null,"abstract":"<div><h3>Background</h3><p>Rates of maternal mortality are highest in low-resource settings. Family members are often involved in the critical periods surrounding a maternal death, including transportation to health centers and financial and emotional support during hospital admissions. Maternal death has devastating impacts on surviving family members, which are often overlooked and understudied.</p></div><div><h3>Objective</h3><p>Our study aimed to explore the hospital experiences of family members surrounding a maternal death, and to define their access to and need for institutional and psychosocial support.</p></div><div><h3>Study Design</h3><p>This mixed methods cross-sectional study was conducted at an urban tertiary hospital in Ghana. Maternal mortalities from June 2019 to December 2020 were identified using death certificates. Participants, defined as husbands or other heads of households in families affected by maternal mortality, were purposively recruited. An interview guide was developed using grounded theory. In-person semi‐structured interviews were conducted in English or Twi to explore impacts of maternal mortality on family members, with a focus on hospital experiences. Surveys were administered on types of and needs for institutional support. Interviews were audio recorded, translated, transcribed, coded with an iteratively-developed codebook, and thematically analyzed. Survey data was descriptively analyzed.</p></div><div><h3>Results</h3><p>Fifty-one participants included 26 husbands of the deceased woman, 5 parents, 12 siblings, and 8 second-degree relatives. Interviews revealed an overall negative hospital experience for surviving family members, who expressed substantial dissatisfaction and distress. Four themes regarding the hospital experience emerged from the interviews: 1) poor communication from healthcare workers and hospital personnel, which contributed to 2) limited understanding of the patient's clinical status, hospital course, and cause of death; 3) maternal death perceived as avoidable; and 4) maternal death perceived as unexpected and shocking. Survey data revealed that only 10% of participants were provided psychosocial support following the maternal death event, yet 93.3% of those who did not receive support desired this resource.</p></div><div><h3>Conclusion</h3><p>The hospital experience was overall negative for family members and a lack of effective communication emerged as the root cause of this negative perception. Strategies to improve communication between healthcare providers and families are essential. In addition, there is an unmet need for formal mental health resources for families who experience a maternal death.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000522/pdfft?md5=3d13def12550710e6e97862b8804379a&pid=1-s2.0-S2666577824000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140103","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 : 2024-05-21DOI: 10.1016/j.xagr.2024.100357
Kathleen C. Minor MD , Katherine Bianco MD , Jonathan A. Mayo MPH , Gillian Abir MBChB , Amy E. Judy MD , Henry C. Lee MD , Stephanie A. Leonard PhD , Stephany Ayotte BScN , Laura C. Hedli MS , Kristen Schaffer MPH , Lillian Sie MPH , Kay Daniels MD
Background
Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events.
Objective
To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals.
Study design
The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point.
Results
Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23–16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79–20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly great
{"title":"Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US","authors":"Kathleen C. Minor MD , Katherine Bianco MD , Jonathan A. Mayo MPH , Gillian Abir MBChB , Amy E. Judy MD , Henry C. Lee MD , Stephanie A. Leonard PhD , Stephany Ayotte BScN , Laura C. Hedli MS , Kristen Schaffer MPH , Lillian Sie MPH , Kay Daniels MD","doi":"10.1016/j.xagr.2024.100357","DOIUrl":"10.1016/j.xagr.2024.100357","url":null,"abstract":"<div><h3>Background</h3><p>Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events.</p></div><div><h3>Objective</h3><p>To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals.</p></div><div><h3>Study design</h3><p>The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point.</p></div><div><h3>Results</h3><p>Direct simulation training participants (<em>n</em>=22) and students of the train-the-trainer instructors (<em>n</em>=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, <em>P-</em>value<em>=</em>.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23–16.40], <em>P-</em>value<.01; confidence score mean difference 13.64 [95% CI 6.79–20.48], <em>P-</em>value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly great","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100357"},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000510/pdfft?md5=58189d6e7a09a2ace085a8bf1cd787b5&pid=1-s2.0-S2666577824000510-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133994","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100349
Qiyu Zhong MD , Shuhang Qin MD , Huiling Lai MD , Shuzhong Yao MD , Shuqin Chen MD
BACKGROUND
The increasing global prevalence of cesarean scar endometriosis necessitates a thorough understanding of the risk factors for postoperative recurrence, as this is crucial for developing preventive strategies and informed decision-making.
OBJECTIVE
To obtain insight into the clinical risk factors for postoperative recurrence of cesarean scar endometriosis following open lesion resection.
STUDY DESIGN
The cohort for this study comprised 272 women, including 26 patients with postoperative recurrence and 246 without recurrence. Various parameters, including baseline characteristics, preoperative, intraoperative, and postoperative conditions, and follow-up information, were analyzed. A comparison of these parameters was made between patients with and without postoperative recurrence. Time-to-recurrence analyses were conducted using Cox's univariate and multivariate proportional hazard analyses, the Kaplan-Meier method, and the log-rank test.
RESULTS
The results revealed significant differences between patients with and without postoperative recurrence in terms of visual analog scale for abdominal pain (P=.008), method of surgery (P<.001), and incision length (P=.002). The Cox proportional hazard model identified the visual analog scale for abdominal pain ≥4 as a significant risk factor for postoperative recurrence (hazard ratio, 3.72 [95% confidence interval, 1.65–8.43]; P=.002). In addition, patients who received removal of scar, excision of mass, and exploration underneath the scar (named as integrated excision) had a lower risk of recurrence than those who received local excision of mass (hazard ratio, 0.14 [95% confidence interval, 0.04–0.48]; P=.002). Furthermore, older patients (aged ≥35 years) were found to have a lower risk of postoperative recurrence than those <35 years (hazard ratio, 0.35 [95% confidence interval, 0.12–1.04]; P=.058). In addition, the depth of involvement was identified as a meaningful factor in postoperative recurrence for patients with local excision of mass, as determined by the log-rank test (P=.018).
CONCLUSION
The study highlights that the visual analog scale for abdominal pain ≥4 is a risk factor for the recurrence of cesarean scar endometriosis after open lesion resection. Furthermore, the surgical method of integrated excision was identified as a protective factor.
{"title":"Risk factors for postoperative recurrence of cesarean scar endometriosis","authors":"Qiyu Zhong MD , Shuhang Qin MD , Huiling Lai MD , Shuzhong Yao MD , Shuqin Chen MD","doi":"10.1016/j.xagr.2024.100349","DOIUrl":"10.1016/j.xagr.2024.100349","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The increasing global prevalence of cesarean scar endometriosis necessitates a thorough understanding of the risk factors for postoperative recurrence, as this is crucial for developing preventive strategies and informed decision-making.</p></div><div><h3>OBJECTIVE</h3><p>To obtain insight into the clinical risk factors for postoperative recurrence of cesarean scar endometriosis following open lesion resection.</p></div><div><h3>STUDY DESIGN</h3><p>The cohort for this study comprised 272 women, including 26 patients with postoperative recurrence and 246 without recurrence. Various parameters, including baseline characteristics, preoperative, intraoperative, and postoperative conditions, and follow-up information, were analyzed. A comparison of these parameters was made between patients with and without postoperative recurrence. Time-to-recurrence analyses were conducted using Cox's univariate and multivariate proportional hazard analyses, the Kaplan-Meier method, and the log-rank test.</p></div><div><h3>RESULTS</h3><p>The results revealed significant differences between patients with and without postoperative recurrence in terms of visual analog scale for abdominal pain (<em>P</em>=.008), method of surgery (<em>P</em><.001), and incision length (<em>P</em>=.002). The Cox proportional hazard model identified the visual analog scale for abdominal pain ≥4 as a significant risk factor for postoperative recurrence (hazard ratio, 3.72 [95% confidence interval, 1.65–8.43]; <em>P</em>=.002). In addition, patients who received removal of scar, excision of mass, and exploration underneath the scar (named as integrated excision) had a lower risk of recurrence than those who received local excision of mass (hazard ratio, 0.14 [95% confidence interval, 0.04–0.48]; <em>P</em>=.002). Furthermore, older patients (aged ≥35 years) were found to have a lower risk of postoperative recurrence than those <35 years (hazard ratio, 0.35 [95% confidence interval, 0.12–1.04]; <em>P</em>=.058). In addition, the depth of involvement was identified as a meaningful factor in postoperative recurrence for patients with local excision of mass, as determined by the log-rank test (<em>P</em>=.018).</p></div><div><h3>CONCLUSION</h3><p>The study highlights that the visual analog scale for abdominal pain ≥4 is a risk factor for the recurrence of cesarean scar endometriosis after open lesion resection. Furthermore, the surgical method of integrated excision was identified as a protective factor.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000431/pdfft?md5=45e9eec732ac6514e8eed99a775bf9d7&pid=1-s2.0-S2666577824000431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778457","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100340
Eleza Valente DO , Morgan Zueger DO , Daniel Donato MD
Myomatous erythrocytosis syndrome is a rare phenomenon of secondary polycythemia evolving from uterine leiomyoma. Although the underlying pathology is still unknown, patients have an increased risk of venous thrombosis. A 44-year-old GO (gravida zero) presented with an incidental finding of secondary polycythemia, and a diagnosis of myomatous erythrocytosis syndrome was made because of her large uterine fibroids. She was placed on therapeutic anticoagulation after developing pulmonary embolisms and a dural sinus venous thrombosis. Subsequently, she underwent uterine artery embolization, which resulted in a substantial decrease in her erythropoietin (8.1 mU/mL) along with hemoglobin (15.1 g/dL) and hematocrit (4 5g/dL). Myomatous erythrocytosis syndrome can cause venous thrombosis, leading to neurologic complications. In patients with increased risk for surgery, uterine artery embolization is an effective option for treatment.
子宫肌瘤性红细胞增多症综合征是一种罕见的由子宫肌瘤演变而来的继发性多血症现象。虽然潜在的病理机制尚不清楚，但患者静脉血栓形成的风险会增加。一名 44 岁的 GO 患者（孕酮为 0）偶然发现继发性多血症，因其子宫肌瘤较大，被诊断为肌瘤性红细胞增多症综合征。在出现肺栓塞和硬膜窦静脉血栓后，她接受了抗凝治疗。随后，她接受了子宫动脉栓塞术，这导致她的促红细胞生成素（8.1 mU/mL）、血红蛋白（15.1 g/dL）和血细胞比容（4.5 g/dL）大幅下降。肌红细胞增多症综合征可引起静脉血栓，导致神经系统并发症。对于手术风险增加的患者，子宫动脉栓塞是一种有效的治疗方法。
{"title":"A rare case of venous sinus thrombosis and pulmonary embolisms secondary to myomatous erythrocytosis syndrome","authors":"Eleza Valente DO , Morgan Zueger DO , Daniel Donato MD","doi":"10.1016/j.xagr.2024.100340","DOIUrl":"10.1016/j.xagr.2024.100340","url":null,"abstract":"<div><p>Myomatous erythrocytosis syndrome is a rare phenomenon of secondary polycythemia evolving from uterine leiomyoma. Although the underlying pathology is still unknown, patients have an increased risk of venous thrombosis. A 44-year-old GO (gravida zero) presented with an incidental finding of secondary polycythemia, and a diagnosis of myomatous erythrocytosis syndrome was made because of her large uterine fibroids. She was placed on therapeutic anticoagulation after developing pulmonary embolisms and a dural sinus venous thrombosis. Subsequently, she underwent uterine artery embolization, which resulted in a substantial decrease in her erythropoietin (8.1 mU/mL) along with hemoglobin (15.1 g/dL) and hematocrit (4 5g/dL). Myomatous erythrocytosis syndrome can cause venous thrombosis, leading to neurologic complications. In patients with increased risk for surgery, uterine artery embolization is an effective option for treatment.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100340"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000340/pdfft?md5=33ce4d5781f3876e66a03bc801a2b9ee&pid=1-s2.0-S2666577824000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275308","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100355
Greg J. Marchand MD, FACS, FICS, FACOG , Hollie Ulibarri BS , Amanda Arroyo BS , Madison Blanco BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Ali Azadi MD, FACOG, FPMRS
Objective
As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.
Data sources
We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023.
Study eligibility criteria
We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications.
Study appraisal and synthesis methods
We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.
Results
We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=−44.70 [−99.97, 10.57]; P=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=−0.16 [−1.62, 1.30]; P=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications.
Conclusion
vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.
{"title":"Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery hysterectomy versus vaginal hysterectomy for benign indications","authors":"Greg J. Marchand MD, FACS, FICS, FACOG , Hollie Ulibarri BS , Amanda Arroyo BS , Madison Blanco BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Ali Azadi MD, FACOG, FPMRS","doi":"10.1016/j.xagr.2024.100355","DOIUrl":"10.1016/j.xagr.2024.100355","url":null,"abstract":"<div><h3>Objective</h3><p>As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.</p></div><div><h3>Data sources</h3><p>We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023.</p></div><div><h3>Study eligibility criteria</h3><p>We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications.</p></div><div><h3>Study appraisal and synthesis methods</h3><p>We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.</p></div><div><h3>Results</h3><p>We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=−44.70 [−99.97, 10.57]; <em>P</em>=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=−0.16 [−1.62, 1.30]; <em>P</em>=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications.</p></div><div><h3>Conclusion</h3><p>vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100355"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000492/pdfft?md5=cf7c03d25a26f726059121737c1a7fe5&pid=1-s2.0-S2666577824000492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027491","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100353
Xiaotong Dong MD , Shengrui Zhao MM , Peng Liu MM , Qian Yu MD , Lei Yan MD
We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.
{"title":"Congenital interruption between the ampulla and fimbria of the fallopian tube: case report","authors":"Xiaotong Dong MD , Shengrui Zhao MM , Peng Liu MM , Qian Yu MD , Lei Yan MD","doi":"10.1016/j.xagr.2024.100353","DOIUrl":"10.1016/j.xagr.2024.100353","url":null,"abstract":"<div><p>We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100353"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000479/pdfft?md5=0cb0aa25760a7886ec6accf2e2230977&pid=1-s2.0-S2666577824000479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052177","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}
Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar.
OBJECTIVE
This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery.
STUDY DESIGN
This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele.
RESULTS
Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m2), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele.
CONCLUSION
Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.
{"title":"Investigating the risk factors for isthmocele development after cesarean delivery","authors":"Masoud Saadat Fakhr MD , Mahya Mozafari MD , Kiana Rezvanfar MD , Zahra Amini MD , Koosha Amiri MD , Reza Shah Hosseini MD , Hengame Sarnaz MD , Poorya Gholami MD , Zohreh Lavasani MD","doi":"10.1016/j.xagr.2023.100299","DOIUrl":"10.1016/j.xagr.2023.100299","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery.</p></div><div><h3>STUDY DESIGN</h3><p>This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele.</p></div><div><h3>RESULTS</h3><p>Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m<sup>2</sup>), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele.</p></div><div><h3>CONCLUSION</h3><p>Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100299"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001417/pdfft?md5=80e5235a11e8795072c4c928c992199d&pid=1-s2.0-S2666577823001417-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139024962","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100339
Vo Anh Vinh Trang MD , Thao-Ngan Nguyen Pham MD , Bao Huy Le MD , Thien Tan Tri Tai Truyen MD , Hoang Kim Tu Trinh MD, PhD , Kieu-Minh Le MSc , Huu Doan Pham MD , Ngoc Minh Tam Nguyen MD , Quoc Kha Tran , Phuc Cam Hoang Nguyen MD, PhD , Vinh Hung Tran MD, PhD
Spontaneous idiopathic vulvar edema during the second trimester is a rare condition. The approach to managing this condition involves relieving symptoms, identifying underlying causes, and implementing appropriate treatment. Managing such cases during pregnancy is challenging because of concerns for potential adverse fetal outcomes. Conservative management expects the condition to be relieved spontaneously postpartum, whereas invasive treatment offers a more rapid resolution. Treatment choices are controversial because each method has its pros and cons and influences the delivery process to a certain extent. Surgical drainage becomes a viable option when patients are not responsive to medications. We report a case of spontaneous massive vulvar edema in a 22-year-old primigravida in her 23rd week of pregnancy. After ruling out other notable causes of vulvar edema, we decided to intervene using an invasive procedure because she complained of progressive symptoms and discomfort. Subsequently, the edema subsided postprocedure, and the patient experienced successful labor with no complications. This report aims to alert clinicians that drainage attempts should be considered in pregnant patients with worsening symptoms.
{"title":"When intervention becomes imperative: a case report of spontaneous vulvar edema during pregnancy","authors":"Vo Anh Vinh Trang MD , Thao-Ngan Nguyen Pham MD , Bao Huy Le MD , Thien Tan Tri Tai Truyen MD , Hoang Kim Tu Trinh MD, PhD , Kieu-Minh Le MSc , Huu Doan Pham MD , Ngoc Minh Tam Nguyen MD , Quoc Kha Tran , Phuc Cam Hoang Nguyen MD, PhD , Vinh Hung Tran MD, PhD","doi":"10.1016/j.xagr.2024.100339","DOIUrl":"10.1016/j.xagr.2024.100339","url":null,"abstract":"<div><p>Spontaneous idiopathic vulvar edema during the second trimester is a rare condition. The approach to managing this condition involves relieving symptoms, identifying underlying causes, and implementing appropriate treatment. Managing such cases during pregnancy is challenging because of concerns for potential adverse fetal outcomes. Conservative management expects the condition to be relieved spontaneously postpartum, whereas invasive treatment offers a more rapid resolution. Treatment choices are controversial because each method has its pros and cons and influences the delivery process to a certain extent. Surgical drainage becomes a viable option when patients are not responsive to medications. We report a case of spontaneous massive vulvar edema in a 22-year-old primigravida in her 23rd week of pregnancy. After ruling out other notable causes of vulvar edema, we decided to intervene using an invasive procedure because she complained of progressive symptoms and discomfort. Subsequently, the edema subsided postprocedure, and the patient experienced successful labor with no complications. This report aims to alert clinicians that drainage attempts should be considered in pregnant patients with worsening symptoms.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100339"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000339/pdfft?md5=287db7c847c3651849d31b536361b49e&pid=1-s2.0-S2666577824000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273097","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 : 2024-05-01DOI: 10.1016/j.xagr.2024.100351
Erin C. Nacev MD, MPH , Ann C. Martinez Acevedo MPH , Menolly Kaufman PhD, MPH , Megan F. Fuerst MD, MPH , Jacquelyn M. Knapp MD , Maria I. Rodriguez MD, MPH
BACKGROUND
Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.
OBJECTIVE
We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.
STUDY DESIGN
We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.
RESULTS
Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P<.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059–1.059], P<.001). We found a significant interaction between maternal race and rurality (P<.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188–1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843–1.252]).
CONCLUSION
We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection
{"title":"Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders","authors":"Erin C. Nacev MD, MPH , Ann C. Martinez Acevedo MPH , Menolly Kaufman PhD, MPH , Megan F. Fuerst MD, MPH , Jacquelyn M. Knapp MD , Maria I. Rodriguez MD, MPH","doi":"10.1016/j.xagr.2024.100351","DOIUrl":"10.1016/j.xagr.2024.100351","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.</p></div><div><h3>OBJECTIVE</h3><p>We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.</p></div><div><h3>STUDY DESIGN</h3><p>We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.</p></div><div><h3>RESULTS</h3><p>Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; <em>P</em><.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059–1.059], <em>P</em><.001). We found a significant interaction between maternal race and rurality (<em>P</em><.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188–1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843–1.252]).</p></div><div><h3>CONCLUSION</h3><p>We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100351"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000455/pdfft?md5=a5e936d8c8d02c15a291c55c40428394&pid=1-s2.0-S2666577824000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783836","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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