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Neonatal Mortality (neonatal + mortality)
Terms modified by Neonatal Mortality Selected AbstractsNeonatal Mortality for Primary Cesarean and Vaginal Births to Low-Risk Women: Application of an "Intention-to-Treat" ModelBIRTH, Issue 1 2008Marian F. MacDorman PhD ABSTRACT: Background: The percentage of United States births delivered by cesarean section continues to increase, even for women considered to be at low risk for the procedure. The purpose of this study was to use an "intention-to-treat" methodology, as recommended by a National Institutes of Health conference, to examine neonatal mortality risk by method of delivery for low-risk women. Methods: Low-risk births were singleton, term (37,41 weeks' gestation), vertex births, with no reported medical risk factors or placenta previa and with no prior cesarean section. All U.S. live births and infant deaths for the 1999 to 2002 birth cohorts (8,026,415 births and 17,412 infant deaths) were examined. Using the intention-to-treat methodology, a "planned vaginal delivery" category was formed by combining vaginal births and cesareans with labor complications or procedures since the original intention in both cases was presumably a vaginal delivery. This group was compared with cesareans with no labor complications or procedures, which is the closest approximation to a "planned cesarean delivery" category possible, given data limitations. Multivariable logistic regression was used to model neonatal mortality as a function of delivery method, adjusting for sociodemographic and medical risk factors. Results: The unadjusted neonatal mortality rate for cesarean deliveries with no labor complications or procedures was 2.4 times that for planned vaginal deliveries. In the most conservative model, the adjusted odds ratio for neonatal mortality was 1.69 (95% CI 1.35,2.11) for cesareans with no labor complications or procedures, compared with planned vaginal deliveries. Conclusions: The finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication. (BIRTH 35:1 March 2008) [source] Neonatal Mortality for Low-Risk Women by Method of DeliveryBIRTH, Issue 1 2007Karin Källén PhD No abstract is available for this article. [source] Cesarean Section Rates and Maternal and Neonatal Mortality in Low-, Medium-, and High-Income Countries: An Ecological StudyBIRTH, Issue 4 2006Fernando Althabe MD ABSTRACT: Background: Cesarean section rates show a wide variation among countries in the world, ranging from 0.4 to 40 percent, and a continuous rise in the trend has been observed in the past 30 years. Our aim was to explore the association of cesarean section rates of different countries with their maternal and neonatal mortality and to test the hypothesis that in low-income countries, increasing cesarean section rates were associated with reductions in both outcomes, whereas in high-income countries, such association did not exist. Methods: We performed a cross-sectional multigroup ecological study using data from 119 countries from 1991 to 2003. These countries were classified into 3 categories: low-income (59 countries), medium-income (31 countries), and high-income (29 countries) countries according to an international classification. We assessed the ecological association between national cesarean section rates and maternal and neonatal mortality by fitting multiple linear regression models. Results: Median cesarean section rates were lower in low-income than in medium- and high-income countries. Seventy-six percent of the low-income countries, 16 percent of the medium-income countries, and 3 percent of high-income countries showed cesarean section rates between 0 and 10 percent. Three percent of low-income countries, 36 percent of medium-income countries, and 31 percent of high-income countries showed cesarean section rates above 20 percent. In low-income countries, a negative and statistically significant linear correlation was observed between cesarean section rates and neonatal mortality and between cesarean section rates and maternal mortality. No association was observed in medium- and high-income countries for either neonatal mortality or maternal mortality. Conclusions: No association between cesarean section rates and maternal or neonatal mortality was shown in medium- and high-income countries. Thus, it becomes relevant for future good-quality research to assess the effect of the high figures of cesarean section rates on maternal and neonatal morbidity. For low-income countries, and on confirmation by further research, making cesarean section available for high-risk pregnancies could contribute to improve maternal and neonatal outcomes, whereas a system of care with cesarean section rates below 10 percent would be unlikely to cover their needs. (BIRTH 33:4 December 2006) [source] Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998,2001 Birth CohortsBIRTH, Issue 3 2006Marian F. MacDorman PhD ABSTRACT:,Background: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37,41 weeks' gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998,2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006) [source] Influence of mode of delivery on neonatal mortality in the second twin, at and before termBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Herbst Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source] Achieving a Safety Culture in ObstetricsMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 6 2009Erin DuPree MD Abstract Preventable maternal and neonatal mortalities still occur, despite the wonders of today's technologically advanced healthcare system. Delivering high-quality, consistent care is the goal of every provider. Yet, obstetrical practice, in which unpredictable events and high-risk situations are the norm, is particularly vulnerable to medical errors. Obstetrics departments should be striving for a climate of patient safety, one that includes a just, reporting, and learning culture. This article discusses the various components of a safety culture as well as some of the advances that are being made in the field to improve the quality of care in obstetrics. Mt Sinai J Med 76:529-538, 2009. © 2009 Mount Sinai School of Medicine [source] Differential infant and child mortality in three Dutch regions, 1812,19091ECONOMIC HISTORY REVIEW, Issue 2 2005FRANS VAN POPPEL New micro-level data have recently become available for three provinces of The Netherlands for the period 1812,1912, which allow the study of the evolution of socio-economic differentials in infant and childhood mortality. The authors found significant differences in the levels of infant mortality by social group between the three provinces, and a wide variety in the pattern of social inequality. This showed the importance of the regional environment for the level of infant mortality in the nineteenth century. Contrary to expectations, strong social differences were also observed in neonatal mortality. Being born in an urban environment did not have a strong effect on survival during the first year of birth. [source] Probabilistic risk assessment of reproductive effects of polychlorinated biphenyls on bottlenose dolphins (Tursiops truncatus) from the Southeast United States coastENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 12 2002Lori H. Schwacke Abstract High levels of polychlorinated biphenyls (PCBs) have been reported in the tissues of some species of marine mammals. The high concentrations are of concern because a growing body of experimental evidence links PCBs to deleterious effects on reproduction, endocrine homeostasis, and immune system function. Much of the recent research has focused on determining the exposure of marine mammal populations to PCBs, but very little effort has been devoted to the actual risk assessments that are needed to determine the expected impacts of the documented exposures. We describe a novel risk assessment approach that integrates measured tissue concentrations of PCBs with a surrogate dose-response relationship and leads to predictions of health risks for marine mammals as well as to the uncertainties associated with these predictions. Specifically, we use PCB tissue residue data from three populations of bottlenose dolphins (Tursiops truncatus), study the feasibility of published dose-response data from a surrogate species, and combine this information to estimate the risk of detrimental reproductive effects in female dolphins. Our risk analyses for dolphin populations near Beaufort (NC, USA), Sarasota (FL, USA), and Matagorda Bay (TX, USA) indicate a high likelihood that reproductive success, primarily in primiparous females, is being severely impaired by chronic exposure to PCBs. Excess risk of reproductive failure, measured in terms of stillbirth or neonatal mortality, for primiparous females was estimated as 60% (Beaufort), 79% (Sarasota), and 78% (Matagorda Bay). Females of higher parity, which have previously off-loaded a majority of their PCB burden, exhibit a much lower risk. [source] Hand-rearing a Potto Perodicticus potto at Franklin Park Zoo, BostonINTERNATIONAL ZOO YEARBOOK, Issue 1 2006H. D. BUCKANOFF In August 2001 a Potto Perodicticus potto was born in the Tropical Forest building of Franklin Park Zoo, Boston. The neonate was removed the following day for hand-rearing because its mother, which had a history of providing poor infant care, appeared to be neglecting it. Historically, Pottos in captivity have high rates of neonatal mortality that are frequently associated with maternal neglect. This paper gives detailed information about the methods used to hand-rear this infant successfully. Notes on infant development are presented and the health issues encountered, and medical treatments given, during the first few months are described. [source] Neonatal C-reactive protein value in prediction of Outcome of Preterm Premature Rupture of Membranes: Comparison of Singleton and Twin PregnanciesJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009Simin Taghavi Abstract Aim:, The clinical importance of preterm premature rupture of the membranes (PPROM) is its relationship to maternal and neonatal mortality and morbidity, especially in twin pregnancies. The aim of this study was to determine and compare the role of inflammatory factors as predictors of the PPROM outcome between singleton and twin pregnancies. Methods:, The medical records of 22 twins delivered between 28 and 34 weeks and complicated by PPROM were reviewed at the Al-Zahra Hospital in Tabriz, Iran. Also among singletons, 55 cases of matched gestational age were randomly selected as a control group. Three laboratory indices of neonatal white blood cell (WBC) count and C-reactive protein (CRP) in the two groups were measured immediately after delivery and the effects of two factors on neonatal outcome were assessed. Results:, In singletons, there was adverse relationship between the mean of WBC count and duration of latency (P = 0.007). Also, a positive relationship between the means of ventilation time and WBC count in second twins was found (P = 0.034). Positive CRP was the main predictor of neonatal intensive care unit admission in both singletons (odds ratio: 4.929, P = 0.042) and first twins (odds ratio: 9.000, P = 0.005). However, positive CRP did not influence the existence of metabolic acidosis or duration of latency in either of the two groups. Conclusion:, Neonatal WBC count was a predictor for the duration of latency in singletons and for ventilation time in twins. Positive neonatal CRP was an important factor for the prediction of neonatal intensive care unit admission in both types of pregnancy; its role in twins is clearer than in singletons. [source] Dose-Dependent Effects of Prenatal Ethanol Exposure on Synaptic Plasticity and Learning in Mature OffspringALCOHOLISM, Issue 11 2002Daniel D. Savage Background We have observed profound deficits in hippocampal synaptic plasticity and one-trial learning in offspring whose mothers drank moderate quantities of ethanol during pregnancy. In the present study, we examined the question of whether lower maternal blood ethanol concentrations (BECs) could produce functional deficits in offspring. Methods Rat dams consumed either a 2%, 3%, or 5% ethanol liquid diet throughout gestation. Three other groups of dams were pair-fed a 0% ethanol liquid diet, and a seventh group consumed lab chow ad libitum. Adult offspring from each diet group were assigned either to studies of evoked [3H]-D-aspartate (D-ASP) release from hippocampal slices or spatial learning studies using the Morris Water Task. Results Consumption of the 2%, 3%, and 5% ethanol liquid diets produced mean peak maternal BECs of 7, 30 and 83 mg/dL, respectively. Consumption of these ethanol diets had no effect on offspring birthweight, litter size or neonatal mortality. Likewise, evoked D-ASP release from hippocampal slices and performance on a standard version of the Morris Water Task were not affected by prenatal ethanol exposure. By contrast, activity-dependent potentiation of evoked D-ASP release from slices and one-trial learning on a "moving platform" version of the Morris Water Task were markedly reduced in offspring whose mothers consumed the 5% ethanol liquid diet. Intermediate deficits in these two parameters were observed in offspring from the 3% ethanol diet group, whereas offspring from the 2% ethanol diet group were not statistically different than controls. Conclusions We conclude that the threshold for eliciting subtle, yet significant learning deficits in offspring prenatally exposed to ethanol is less than 30 mg/dL. This BEC is roughly equivalent to drinking 1 to 1.5 ounces of ethanol per day. [source] Incorporating nutrition into delivery care: delivery care practices that affect child nutrition and maternal healthMATERNAL & CHILD NUTRITION, Issue 4 2009Camila M. Chaparro Abstract Delayed umbilical cord clamping, early skin-to-skin contact and early initiation of exclusive breastfeeding are three simple and inexpensive delivery care practices which have the potential to improve short-term and long-term nutrition and health outcomes in mothers and infants. In preterm infants, delayed clamping prevents intraventricular haemorrhage and improves haematological status, and in full-term infants, delayed clamping improves iron status through 6 months of age. Early skin-to-skin contact, in addition to regulating neonatal temperature, improves early breastfeeding behaviours, which has important implications for long-term infant nutrition and health. Finally, early exclusive breastfeeding prevents neonatal mortality and morbidity and provides numerous health and nutritional benefits to the infant, throughout infancy and beyond, as well as to the mother. Though each practice has been the subject of controlled trials and systematic reviews, with evidence of benefit from their implementation, these practices are not common in many delivery settings, nor are their long-term effects on infant and maternal nutrition and health status adequately recognized. We discuss the immediate and long-term health and nutrition benefits of each practice, and identify the policy and programme changes needed for integration and implementation of these practices into standard delivery care. [source] Quantification of collider-stratification bias and the birthweight paradoxPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2009Brian W. Whitcomb Summary The ,birthweight paradox' describes the phenomenon whereby birthweight-specific mortality curves cross when stratified on other exposures, most notably cigarette smoking. The paradox has been noted widely in the literature and numerous explanations and corrections have been suggested. Recently, causal diagrams have been used to illustrate the possibility for collider-stratification bias in models adjusting for birthweight. When two variables share a common effect, stratification on the variable representing that effect induces a statistical relation between otherwise independent factors. This bias has been proposed to explain the birthweight paradox. Causal diagrams may illustrate sources of bias, but are limited to describing qualitative effects. In this paper, we provide causal diagrams that illustrate the birthweight paradox and use a simulation study to quantify the collider-stratification bias under a range of circumstances. Considered circumstances include exposures with and without direct effects on neonatal mortality, as well as with and without indirect effects acting through birthweight on neonatal mortality. The results of these simulations illustrate that when the birthweight,mortality relation is subject to substantial uncontrolled confounding, the bias on estimates of effect adjusted for birthweight may be sufficient to yield opposite causal conclusions, i.e. a factor that poses increased risk appears protective. Effects on stratum-specific birthweight,mortality curves were considered to illustrate the connection between collider-stratification bias and the crossing of the curves. The simulations demonstrate the conditions necessary to give rise to empirical evidence of the paradox. [source] Do differences in maternal age, parity and multiple births explain variations in fetal and neonatal mortality rates in Europe?PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2009Results from the EURO-PERISTAT project Summary Perinatal mortality rates differ markedly between countries in Europe. If population characteristics, such as maternal age, parity or multiple births, contribute to these differences, standardised rates may be useful for international comparisons of health status and especially quality of care. This analysis used aggregated population-based data on fetal and neonatal mortality stratified by maternal age, parity and multiple birth from 12 countries participating in the EURO-PERISTAT project to explore this question. Adjusted odds ratios were computed for fetal and neonatal mortality and tested for inter-country heterogeneity; standardised mortality rates were calculated using a direct standardisation method. There were wide variations in fetal and neonatal mortality rates, from 3.3 to 7.1 and 2.0 to 6.0 per 1000 total and livebirths, respectively, and in the prevalence of mothers over 35 (7,22%), primiparae (41,50%) and multiple births (2,4%). These population characteristics had a significant association with mortality, although results were less consistent for primiparity. Odds ratios for older mothers and primiparae showed significant inter-country heterogeneity. The association between maternal age and fetal mortality declined as the prevalence of older mothers in the population increased. Standardised rates did not substantially change inter-country rankings and demographic characteristics did not explain the higher mortality observed in some countries. Our results do not support the use of mortality rates standardised for age, parity and multiple births for international comparisons of quality of care. Further research should explore why the negative effects of older maternal age decrease as delayed childbearing becomes more common and, in particular, whether this is due to changes in the social characteristics of older mothers or in health care provision. [source] Fetal growth and neonatal mortality in KoreaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2007Jae S. Hong Summary The fetal growth curve and neonatal mortality rate, based on gestational age and birthweight, are important for identifying groups of high-risk neonates and developing appropriate medical services and health-care programmes. The purpose of this study was to develop a national fetal growth curve for neonates in Korea, and examine the Korean national references for fetal growth and death according to their characteristics. Data of Korean vital statistics linked National Infant Mortality Survey conducted on births in 1999 were used in this study. The total livebirths were 621 764 in 1999, which were grouped into singletons (n = 609 643) and twins (n = 9805) for analysis. Birthweight/gestational age-specific fetal growth curves and neonatal mortality rates were based on 250 g of birthweight and weekly gestational age intervals for each characteristic of the birth. The features of high-risk neonates such as small-for-gestational-age and the limit of viability in Korea were different from those of Western countries. Difference in fetal growth and death was also detected in other characteristics of the fetus (gender and plurality of birth) besides race. The fetal growth curve of males was higher than that of females, and was higher in singleton than in twins. The neonatal mortality rate was higher in males (singleton, 2.6; twin, 23.5) than females (singleton, 2.1; twin, 15.9), and higher in twins (19.8/1000) than in singletons (2.4/1000). However, in neonates with gestational age >29 weeks and birthweight >1000 g, the neonatal mortality rate was lower in twins than in singletons. The limit of viability was gestational age 27 weeks and birthweight 1000 g, which was similar in singletons and twins regardless of gender. To improve the health of neonates in a country, it is imperative to investigate the characteristics of fetal growth and death under the particular circumstances of the country. When risk is defined for neonates account must be taken of differences in race, gender and plurality of birth, as the neonatal mortality rate varies depending on those factors. [source] Rates of caesarean section: analysis of global, regional and national estimatesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2007Ana P. Betrán Summary Rates of caesarean section are of concern in both developed and developing countries. We set out to estimate the proportion of births by caesarean section (CS) at national, regional and global levels, describe regional and subregional patterns and correlate rates with other reproductive health indicators. We analysed nationally representative data available from surveys or vital registration systems on the proportion of births by CS. We used local non-parametric regression techniques to correlate CS with maternal mortality ratio, infant and neonatal mortality rates, and the proportion of births attended by skilled health personnel. Although very unevenly distributed, 15% of births worldwide occur by CS. Latin America and the Caribbean show the highest rate (29.2%), and Africa shows the lowest (3.5%). In developed countries, the proportion of caesarean births is 21.1% whereas in least developed countries only 2% of deliveries are by CS. The analysis suggests a strong inverse association between CS rates and maternal, infant and neonatal mortality in countries with high mortality levels. There is some suggestion of a direct positive association at lower levels of mortality. CS levels may respond primarily to economic determinants. [source] Innovation, Technological Conditions and New Firm Survival,THE ECONOMIC RECORD, Issue 267 2008PAUL H. JENSEN High neonatal mortality is one of the most salient ,facts' about firm performance in the industrial organisation literature. We model firm survival and examine the relative influence of firm, industry and macroeconomic factors on survival for new vis-ŕ-vis incumbent firms in Australia. In particular, we focus on how the intensity of innovation in each industry relates to firm survival. Our results imply that while new firms thrive in risky and innovative industries, they are also more susceptible to business cycle effects such as changes in the rate of growth of industry profits and the availability of equity finance. [source] Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada, 2003,2006: A Retrospective Cohort StudyBIRTH, Issue 3 2009Eileen K. Hutton PhD ABSTRACT: Background: Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006.Methods: The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth.Results: The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68,1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births.Conclusions: Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births. [source] Neonatal Mortality for Primary Cesarean and Vaginal Births to Low-Risk Women: Application of an "Intention-to-Treat" ModelBIRTH, Issue 1 2008Marian F. MacDorman PhD ABSTRACT: Background: The percentage of United States births delivered by cesarean section continues to increase, even for women considered to be at low risk for the procedure. The purpose of this study was to use an "intention-to-treat" methodology, as recommended by a National Institutes of Health conference, to examine neonatal mortality risk by method of delivery for low-risk women. Methods: Low-risk births were singleton, term (37,41 weeks' gestation), vertex births, with no reported medical risk factors or placenta previa and with no prior cesarean section. All U.S. live births and infant deaths for the 1999 to 2002 birth cohorts (8,026,415 births and 17,412 infant deaths) were examined. Using the intention-to-treat methodology, a "planned vaginal delivery" category was formed by combining vaginal births and cesareans with labor complications or procedures since the original intention in both cases was presumably a vaginal delivery. This group was compared with cesareans with no labor complications or procedures, which is the closest approximation to a "planned cesarean delivery" category possible, given data limitations. Multivariable logistic regression was used to model neonatal mortality as a function of delivery method, adjusting for sociodemographic and medical risk factors. Results: The unadjusted neonatal mortality rate for cesarean deliveries with no labor complications or procedures was 2.4 times that for planned vaginal deliveries. In the most conservative model, the adjusted odds ratio for neonatal mortality was 1.69 (95% CI 1.35,2.11) for cesareans with no labor complications or procedures, compared with planned vaginal deliveries. Conclusions: The finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication. (BIRTH 35:1 March 2008) [source] Evidence-Based Strategies for Reducing Cesarean Section Rates: A Meta-AnalysisBIRTH, Issue 1 2007Nils Chaillet PhD ABSTRACT: Background: Canada's cesarean section rate reached an all-time high of 22.5 percent of in-hospital deliveries in 2002 and was associated with potential maternal and neonatal complications. Clinical practice guidelines represent an appropriate mean for reducing cesarean section rates. The challenge now lies in implementing these guidelines. Objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rate and to assess the impact of this reduction on maternal and perinatal mortality and morbidity. Methods: The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and expert suggestions. Studies involving rigorous evaluation of a strategy for reducing overall cesarean section rates were identified. Randomized controlled trials, controlled before-and-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organisation of Care Group criteria. Results: Among the 10 included studies, a significant reduction of cesarean section rate was found by random meta-analysis (pooled RR = 0.81 [0.75, 0.87]). No evidence of publication bias was identified. Audit and feedback (pooled RR = 0.87 [0.81, 0.93]), quality improvement (pooled RR = 0.74 [0.70, 0.77]), and multifaceted strategies (pooled RR=0.73 [0.68, 0.79]) were effective for reducing the cesarean section rate. However, quality improvement based on active management of labor showed mixed effects. Design of studies showed a higher effect for noncontrolled studies than for controlled studies (pooled RR = 0.76 [0.72, 0.81] vs 0.92 [0.88, 0.96]). Studies including an identification of barriers to change were more effective than other interventions for reducing the cesarean section rate (pooled RR = 0.74 [0.71, 0.78] vs 0.88 [0.82, 0.94]). Among included studies, no significant differences were found for perinatal and neonatal mortality and perinatal and maternal morbidity with respect to the mode of delivery. Only 1 study showed a significant reduction of neonatal and perinatal mortality (p < 0.001). Conclusions: The cesarean section rate can be safely reduced by interventions that involve health workers in analyzing and modifying their practice. Our results suggest that multifaceted strategies, based on audit and detailed feedback, are advised to improve clinical practice and effectively reduce cesarean section rates. Moreover, these findings support the assumption that identification of barriers to change is a major key to success. (BIRTH 34:1 March 2007) [source] Cesarean Section Rates and Maternal and Neonatal Mortality in Low-, Medium-, and High-Income Countries: An Ecological StudyBIRTH, Issue 4 2006Fernando Althabe MD ABSTRACT: Background: Cesarean section rates show a wide variation among countries in the world, ranging from 0.4 to 40 percent, and a continuous rise in the trend has been observed in the past 30 years. Our aim was to explore the association of cesarean section rates of different countries with their maternal and neonatal mortality and to test the hypothesis that in low-income countries, increasing cesarean section rates were associated with reductions in both outcomes, whereas in high-income countries, such association did not exist. Methods: We performed a cross-sectional multigroup ecological study using data from 119 countries from 1991 to 2003. These countries were classified into 3 categories: low-income (59 countries), medium-income (31 countries), and high-income (29 countries) countries according to an international classification. We assessed the ecological association between national cesarean section rates and maternal and neonatal mortality by fitting multiple linear regression models. Results: Median cesarean section rates were lower in low-income than in medium- and high-income countries. Seventy-six percent of the low-income countries, 16 percent of the medium-income countries, and 3 percent of high-income countries showed cesarean section rates between 0 and 10 percent. Three percent of low-income countries, 36 percent of medium-income countries, and 31 percent of high-income countries showed cesarean section rates above 20 percent. In low-income countries, a negative and statistically significant linear correlation was observed between cesarean section rates and neonatal mortality and between cesarean section rates and maternal mortality. No association was observed in medium- and high-income countries for either neonatal mortality or maternal mortality. Conclusions: No association between cesarean section rates and maternal or neonatal mortality was shown in medium- and high-income countries. Thus, it becomes relevant for future good-quality research to assess the effect of the high figures of cesarean section rates on maternal and neonatal morbidity. For low-income countries, and on confirmation by further research, making cesarean section available for high-risk pregnancies could contribute to improve maternal and neonatal outcomes, whereas a system of care with cesarean section rates below 10 percent would be unlikely to cover their needs. (BIRTH 33:4 December 2006) [source] Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998,2001 Birth CohortsBIRTH, Issue 3 2006Marian F. MacDorman PhD ABSTRACT:,Background: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37,41 weeks' gestation) women with no indicated medical risks or complications. Methods: National linked birth and infant death data for the 1998,2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. Results: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. Conclusions: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication. (BIRTH 33:3 September 2006) [source] Influence of mode of delivery on neonatal mortality in the second twin, at and before termBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Herbst Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source] Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008MP Amelink-Verburg Objective, To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design, Descriptive study. Setting, Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001,03). Population, Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods, Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures, Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results, In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001). On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions, Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. [source] Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in SwedenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2007M Kaczmarczyk Objective, Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery. Design, Population-based cohort study. Setting, Sweden. Population, A total of 300 200 Swedish women delivering two single consecutive births between 1983 and 2001. Methods, Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI. Main outcome measure, Uterine rupture and neonatal mortality in the second pregnancy. Results, Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73,57.00). Induction of labour, high (,4000 g) birthweight, postterm (,42 weeks) births, high (,35 years) maternal age, and short (,164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60,132.08). Conclusion, The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics. [source] Pregnancy-induced hypertension and infant mortality: roles of birthweight centiles and gestational ageBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2007XK Chen Objective, To assess the effect of pregnancy-induced hypertension (PIH) on infant mortality in different birthweight centiles (small for gestational age [SGA], appropriate for gestational age [AGA], and large for gestational age [LGA]) and gestational ages (early preterm, late preterm, and full term). Design, Retrospective cohort study. Setting, Linked birth and infant death data set of USA between 1995 and 2000. Population, A total of 17 464 560 eligible liveborn singleton births delivered after 20th gestational week. Methods, Multivariate logistic regression models were applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders stratified by birthweight centiles and gestational age. Main outcome measure, Infant death (0,364 days) and its three components: early neonatal death (0,6 days), late neonatal death (7,27 days), and postneonatal death (28,364 days). Results, PIH was associated with decreased risks of infant mortality, early neonatal mortality, and late neonatal mortality in both preterm and term SGA births, and PIH was associated with lower postneonatal mortality in preterm SGA births. PIH was associated with decreased risks of infant mortality, early neonatal mortality, late neonatal mortality and postneonatal mortality in preterm AGA births. Decreased risk of infant mortality and early neonatal mortality was associated with PIH in early preterm LGA births. Conclusions, The association between PIH and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIH is associated with a decreased risk of infant mortality in SGA births, preterm AGA births, and early preterm LGA births. [source] Expectant management of early onset, severe pre-eclampsia: perinatal outcomeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000D. R. Hall Consultant Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia. Design Prospective case series extending over a five-year period. Setting Tertiary referral centre. Population All women (n= 340) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable. Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward. Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications. Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (, 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. [source] Comparative trends in cause-specific fetal and neonatal mortality in twin and singleton births in the North of England, 1982,1994BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2000Public Health), Svetlana V. Glinianaia Research Associate (Epidemiology Objective To examine trends in cause- and birthweight-specific fetal and neonatal mortality rates in twins and singletons. Design Descriptive analysis based on a regional register. Setting The Northern Health Region of England, 1982,1994. Sample Two hundred and thirty-six fetal and 356 neonatal twin deaths; 2687 fetal and 2301 neonatal singleton deaths from a population of 10,734 twins and 505,477 singletons. Main outcome measures Fetal and neonatal autopsy rates, cause- and birthweight-specific fetal and neonatal mortality rates in twins and singletons. Results The extended perinatal mortality (including stillbirths and neonatal deaths) rate (EPMR) was 55.2 per 1000 in 1982,1994 in twins compared with 9.9 per 1000 in singletons. The relative risk for twin compared with singleton deaths was 5.6 (95% CI 5.1-6.1) being highest for immaturity (12.9, 95% CI 11.1,15.0). A significant decrease in the EPMR occurred in both twins and singletons in 1988,1994 compared with 1982,1987. The EPMR decreased mainly due to a reduction of deaths from antepartum asphyxia in twins and intrapartum asphyxia and trauma in singletons, as well as a reduction in congenital malformations in both groups. In both twins and singletons, birthweight-specific mortality rates improved between 1982,1987 and 1988,1994. Conclusion The higher relative risk for twin deaths remained stable due to a similar decrease in the EPMR for both twins and singletons. The cause-specific relative risk in twins declined for antepartum asphyxia. The mortality rate resulting from lethal congenital malformations decreased in twins and singletons mainly due to earlier detection and subsequent termination of pregnancy. [source] Perinatal services and outcomes in Quang Ninh province, VietnamACTA PAEDIATRICA, Issue 10 2010Nguyen T Nga Abstract Aim:, We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Methods:, Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Results:, Three quarters of pregnant women had ,3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. Conclusion:, A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality. [source] Hospital volume and neonatal mortality among very low birth weight infantsACTA PAEDIATRICA, Issue 4 2009Helmut Hummler No abstract is available for this article. [source] | ||||||||||||||||