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Perinatal morbidity and early neonatal mortality in twin pregnancies  [PDF]
Corinna Peter, Paul Wenzlaff, Jan Kruempelmann, Gerhard Alzen, Eva Bueltmann, Susanne E. Gruessner
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.31017

Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p < 0.01), decreased gestational ages (p < 0.01), increased rates of mechanical ventilation (p < 0.05) and higher early neonatal mortality rates (p < 0.05). Additional risk factors for perinatal morbidity and adverse early neonatal outcome were prematurity (<36 completed weeks of gestation), severe intertwin birth weight discordance >25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age >36 completed weeks was accompanied by a decrease of early neonatal complications (p < 0.05). Pregnancies conceived by IVF/ ICSI didn’t differ from the overall study cohort regarding the investigated risk factors. Conclusions: Twin pregnancies complicated by prematurity, AIS and severe intertwin birth weight discordance are associated with higher perinatal morbidity and adverse early neonatal outcome. In addition, MC twins are jeopardized by an increased early neonatal mortality and therefore represent considerable challenges to both obstetricians and neonatologists. Based on our results, we recommend such twin pregnancies to be monitored and delivered at tertiary perinatal care centres to minimize perinatal morbidity and adverse early neonatal outcomes.

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States  [PDF]
Valerie E. Whiteman,Jason L. Salemi,Mulubrhan F. Mogos,Mary Ashley Cain,Muktar H. Aliyu,Hamisu M. Salihu
Journal of Pregnancy , 2014, DOI: 10.1155/2014/906723
Abstract: Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067), compared to $4,084 (95% CI: $4,002–$4,166) for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs. 1. Introduction Opioid pain medications are among the most prescribed drugs in the United States (US) [1]. In the past few decades, recent trends in increases in narcotic abuse overshadow successes in improved awareness and management of pain. Clinicians, administrators, and policymakers now face the consequential task of preventing opioid drug misuse and addiction without compromising their effective and appropriate use in the treatment of pain. Opioid dependence in pregnancy complicates the clinical management of an already vulnerable group of patients. Dependence increases the risk of poor maternal and perinatal outcomes [2–11]. Women of reproductive age who use and abuse opioid drugs, both prescription and illegal, are more likely to have a lower socioeconomic status, family instability, receive inadequate prenatal care, and suffer from alcohol, tobacco, and illicit drug use [12, 13]. In addition to the risks associated with opioid dependence, these comorbid conditions further increase the risk of adverse perinatal outcomes [3, 14]. Increasing at an alarming rate, opioid use in pregnancy underwent an estimated 3-4-fold increase between 2000 and 2009 [15, 16]. The 2011 National
Women’s Experience with Socio-Economic Factors Associated with Perinatal Morbidity and Mortality in Lusaka and Mumbwa Districts of Zambia  [PDF]
Maimbolwa Connie Margaret, Mukwato Katowa Patricia, Muleya Mutinta, Kwaleyela Concepta, Kalusopa Mwiinga Victoria, Emmanuel Musenge, Jon Oyvind Odland, Babil Stray-Pedersen
Health (Health) , 2019, DOI: 10.4236/health.2019.116061
Abstract: Background: More than half a million women and four million infants are reported to die every year due to complications related to pregnancy and child bearing. The efforts to improve quality maternity care have been on the World Health Organization member countries’ agenda. Zambia has been striving to reduce maternal mortality by ensuring universal access to maternal and child health care services. Our study aimed to explore women’s experience with socio-economic factors associated with perinatal morbidity and mortality in Lusaka and Mumbwa districts, Zambia. Methodology: This hermeneutic phenomenological study was conducted at four health facilities in Mumbwa and Lusaka Districts of Zambia. A purposeful sample of 45 consenting women organized in four groups was selected. Each group comprised of 11 to 12 women. The focus group discussion guide was used to direct the discussion and the Olympus Digital Voice Recorder WS-852 (Olympus Corporation, Shinjuku, Tokyo, Japan) was used to record the discussions. The audio data was manually transcribed and verbatim transcript analyzed using ATLAS.ti 8.0 qualitative data software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) to ascertain patterns of relationships between themes and quotations. Results: Money, husbands and family support, adequate health care resources, and good nurses attitude simplify the burden of pregnancy, delivery and child rearing for the health care providers, mothers and society. Conclusion: Having money and all the necessary resources during pregnancy simplifies the burden of pregnancy, delivery and child rearing for the health care providers, mothers and society. Women are still ignorant and believe in myths and need information on the dangers of depending on herbs and God in preparation for labor and care of the new born, but also seek help from qualified medical personnel when labor starts. Nurse’s attitude needs to change to ensure a reduction in women and newborn mortalities. Nurses were mentioned as the cause of mortality among women and newborn. Recommendations: There’s a need for training of nurses and other health care workers on self-awareness of attitudes. Women should be empowered with resources that facilitate labor and delivery. Midwives and health care providers should take responsibility for evaluating and correcting the beliefs and traditional practices of the community. Training should be planned for raising awareness in order to support beneficial practices and prevent
Hematoma retroplacentario: su repercusión en la morbi-mortalidad perinatal Retroplacental hematoma: Its repercussion in perinatal morbidity and mortality  [cached]
Armando Avellaneda González,Jesús Hernández Cabrera,Carmen Ulloa Gómez,Marla Deulofeu Jiménez
Revista Cubana de Obstetricia y Ginecolog?-a , 1997,
Abstract: Se realiza un estudio descriptivo en el Hospital Docente Ginecoobstétrico de Matanzas, en el período comprendido de enero de 1985 hasta diciembre de 1991, de los casos clasificados como hematoma retroplacentario. Se habilitó un registro estadístico para la recolección de los datos primarios que permitió el estudio: de un total de 24 902 partos ocurridos hubo 82 hematomas retroplacentarios, con 87 productos (por 5 embarazos gemelares), que arrojó una incidencia de 0,33 %. Se utilizaron los métodos estadísticos del porcentaje; la prueba del x2 donde # 0,01 a 0,05 y el hallazgo de medias aritméticas, que permitieron el estudio de variables mediante tablas estadísticas. Se demostró la influencia de la entidad en los indicadores de mortalidad perinatal del centro, donde el hematoma retroplacentario en su forma clínica grave fue la causa de las mayores complicaciones encontradas. También se reporta su efecto en la mortalidad, en el indicador de bajo peso y en el índice de apgar bajo. A descriptive study was performed at the Obstetric and Gynecological Teaching Hospital of Matanzas during the period of January, 1985 to December, 1991 of all cases classified as having retroplacental hematoma. A statistical registry was used for the collection of primary data which allowed to perform the study. From a total number of 24 902 deliveries, there were 82 retroplacental hematomas with 87 products (per 5 twin pregnancies) which yields an incidence of 0.33 %. Statistical percentage methods were used, as well as the x2 test where 0.01 to 0.05, and the finding of arithmetic mean which allowed the study of variables by means of statistical tables. The influence of this entity in the indicators of perinatal mortality of this center was demonstrated, where retroplacental hematoma in its more severe clinical form was found to be the main cause of the most frequent and severe complications. Its effect on mortality, low birth weight, and on the index of low Apgar score is also reported.
Enfermedad hipertensiva gravídica: algunas consideraciones sobre su influencia en los indicadores de morbimortalidad perinatal Some considerations of the impact of hypertension in pregnancy on perinatal mortality and morbidity indicators  [cached]
Mediala Rodríguez Pino,José Luis Homma Castro,Jesús Hernández Cabrera,Teresa Crespo Hernández
Revista Cubana de Obstetricia y Ginecolog?-a , 1999,
Abstract: Se exponen los resultados del a o 1996 en el hospital general de Colón "Mario Mu oz Monroy", de las pacientes ingresadas y clasificadas como hipertensas que alcanzaron un total de 227 pacientes, de un total de 2 457 gestantes no hipertensas y que arrojó una incidencia de 9,2 % de hipertensión. Se comparó con un grupo control constituido por un muestreo aleatorio homogeneizado y sin enfermedades asociadas, y se creó una base de datos, que permitió obtener resultados estadísticos al ser procesados en una computadora IBM del Sectorial de Salud de Colón, compatible con el paquete EPINFO-5, que halló el método de porcentajes, medias aritméticas y el método paramétrico del X2 para percentil prefijado donde a £ 0,05. Las variables analizadas permitieron demostrar por su significación estadística la influencia negativa de la hipertensión gravídica en los indicadores de morbimortalidad perinatal. The results of a study of 227 patients who had been classified as hypertensive and admitted to "Mario Mu oz Monroy" general hospital in Colon municipality during 1996 are set forth in this paper. The total number of non-hypertensive pregnant women cared for was 2 457, so the incidence rate of hypertension was set at 9.2 %. This case group was compared to a control group composed by a homogeneous randomized sample without associated diseases, and a database was created which allowed to obtain statistical results by data processing in an EPINFO-5 package compatible IBM computer from the health department of Colon and to find out the percentage method, the arithmetic means a £ 0,05 and the X2 parametric test for a preset percentile where. Due to their statistical significance, the analyzed variables proved the negative influence of hypertension in pregnancy on perinatal morbidity and mortality rates.
Intensive Insulin Therapy Has No Effect on Mortality and Morbidity in Cardiac Surgery Patients: A Meta-Analysis  [PDF]
Kedar P. Kulkarni, Ronald S. Chamberlain
International Journal of Clinical Medicine (IJCM) , 2016, DOI: 10.4236/ijcm.2016.78057
Abstract: Introduction: Optimal glycemic control in cardiac surgery patients remains a laudable but confusing practice. Existing studies have primarily employed two maintenance strategies using either intensive insulin therapy (IIT) (maintain glucose < 120 mg/dl) or conventional insulin therapy (CIT) (<200 mg/dl) with conflicting outcomes. This meta-analysis evaluates the impact of IIT and CIT in regards to the incidence of mortality, length of stay (LOS), intensive care unit (ICU) LOS, atrial fibrillation (AF), and infections. Methods: A comprehensive literature search in PubMed, Google Scholar and the Cochrane Central Registry of Controlled Trials was completed between 1966 and 2016. Keywords searched were “insulin”, “bypass”, “coronary”, “CABG”, “glucose”, “artery”, “intensive”, “cardiac”, and “surgery”. Eligible studies were randomized control trials (RCTs) comparing IIT (BGL 80-120 mg/dL) and CIT (BGL < 200 mg/dL). Primary outcomes were mortality, ICU LOS, and hospital LOS. Results: 8 RCTs were included in this study. IIT strategies did not significantly affect overall mortality (RR = 0.905, 95% CI = 0.604 to 1.356; p = 0.628), ICU LOS (MD = -0.073 days, 95% CI = -0.324 to 0.178; p = 0.568), or hospital LOS (MD = 0.269, 95% CI = -2.158 to 2.696; p = 0.828). No difference in AF rates (RR = 0.887, 95% CI = 0.681 to 1.155; p = 0.375) or deep sternal infection (RR = 0.985, 95% CI = 0.357 to 2.720; p = 0.977) were observed. Conclusion: IIT targeting blood sugar levels of 80 - 120 mg/dl have no effect on perioperative outcomes in cardiac surgery patients. IIT is associated with similar mortality, ICU LOS, hospital LOS, AF rates, and deep sternal infection rates compared to more liberal glycemic strategies. IIT should not replace CIT as the standard of care in cardiac surgery patients.
Alcohol consumption and the risk of morbidity and mortality for different stroke types - a systematic review and meta-analysis
Jayadeep Patra, Benjamin Taylor, Hyacinth Irving, Michael Roerecke, Dolly Baliunas, Satya Mohapatra, Jürgen Rehm
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-258
Abstract: Using Medical Subject Headings (alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke), a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science databases between 1980 to June 2009 was performed followed by manual searches of bibliographies of key retrieved articles. From twenty-six observational studies (cohort or case-control) with ischemic or hemorrhagic strokes the relative risk or odds ratios or hazard ratios of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and life time abstention (manually estimated where data for current abstainers were given) was used as the reference group. Two reviewers independently extracted the information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, risk estimates and key criteria of study quality using a standardized protocol.The dose-response relationship for hemorrhagic stroke had monotonically increasing risk for increasing consumption, whereas ischemic stroke showed a curvilinear relationship, with a protective effect of alcohol for low to moderate consumption, and increased risk for higher exposure. For more than 3 drinks on average/day, in general women had higher risks than men, and the risks for mortality were higher compared to the risks for morbidity.These results indicate that heavy alcohol consumption increases the relative risk of any stroke while light or moderate alcohol consumption may be protective against ischemic stroke. Preventive measures that should be initiated are discussed.Stroke is an international health problem with high associated human and economic costs. Among adults, it is the second-leading cause of death worldwide, and ranks fourth in overall disease burden. Recent trend analysis showed that stroke incidence and associated deaths appears
Impact of extended lymphadenectomy on morbidity, mortality, recurrence and 5-year survival after gastrectomy for cancer: meta-analysis of randomized clinical trials
Lustosa, Suzana Angélica Silva;Saconato, Humberto;Atallah, álvaro Nagib;Lopes Filho, Gaspar de Jesus;Matos, Delcio;
Acta Cirurgica Brasileira , 2008, DOI: 10.1590/S0102-86502008000600009
Abstract: purpose: to compare morbidity, mortality, recurrence and 5-year survival between d1 and d2 or d3 for treatment of gastric cancer. methods: systematic review and meta-analysis of rcts. metaview in revman 4.2.8 for analysis; statistical heterogeneity by cochran's q test (p<0.1) and i2 test (p>50%). estimates of effect were calculated using random effects model. results: d2 or d3 was associated with higher in-hospital mortality, with rr = 2.13, p=0.0004, 95% ci, 1.40 to 3.25, i2=0%, p=0.63; overall morbidity showed higher incidence in d2 or d3, rr = 1.98, p<0.00001, 95% ci, 1.64 to 2.38, i2 = 33.9%, p=0.20; operating time showed longer duration in d2 or d3, weighted mean difference of 1.05, p<0.00001, 95% ci, 0.71 to 1.38, i2 = 78.7%, p=0.03, with significant statistical heterogeneity; reoperation showed higher rate in d2 or d3, with rr = 2.33, p<0.0001, 95% ci, 1.58 to 3.44, i2 = 0%, p=0.99; hospital stay showed longer duration in the d2 or d3, with weighted mean difference of 4.72, p<0.00001, 95% ci, 3.80 to 5.65, i2 = 89.9%, p<0.00001; recurrence was analyzed showed lower rate in d2 or d3, with rr = 0.89, p=0.02, 95% ci, 0.80 to 0.98, i2 = 71.0%, p = 0.03, with significant statistical heterogeneity; mortality with recurrent disease showed higher incidence in d1, with rr = 0.88, p=0.04, 95% ci, 0.78 to 0.99, i2 =51.8%, p=0.10; 5-year survival showed no significant difference, with rr = 1.05, p=0.40, 95% ci, 0.93 to 1.19, i2 = 49.1% and p=0.12. conclusions: d2 or d3 lymphadenectomy procedure is followed by higher overall morbidity and higher in-hospital mortality; d2 or d3 lymphadenectomy shows lower incidence of recurrence and lower mortality with recurrent disease, when analysed altogether with statistical heterogeneity; d2 or d3 lymphadenectomy has no significant impact on 5-year survival.
Preventive Home Visits for Mortality, Morbidity, and Institutionalization in Older Adults: A Systematic Review and Meta-Analysis  [PDF]
Evan Mayo-Wilson, Sean Grant, Jennifer Burton, Amanda Parsons, Kristen Underhill, Paul Montgomery
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0089257
Abstract: Background Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. Methods and Findings Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Data Extraction and Synthesis: Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures: Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. Results Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [?0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = ?0.06 [?0.11 to ?0.01]) and physical functioning (SMD = ?0.10 [?0.17 to ?0.03]) respectively, but these may not be clinically important. Conclusions Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.
Repercusión de la enfermedad hipertensiva gravídica en los indicadores de morbimortalidad perinatal y materno 1986-1993 Impact of the gravidic hypertensive disease on perinatal and maernal morbidity-mortality indicators 1986-1993  [cached]
Jesús Hernández Cabrera,Carmen Ulloa Gómez,Venelio Martín Ojeda,Jesús Castellanos Castillo
Revista Cubana de Obstetricia y Ginecolog?-a , 1996,
Abstract: Realizamos un estudio prospectivo descriptivo en el Hospital Docente Ginecoobstétrico de Matanzas, durante el período de tiempo comprendido de 1986 a 1993 a toda paciente clasificada como hipertensa, acorde con los criterios de clasificación del Colegio Americano de Obstetricia y Ginecología [muestra constituída por 1092 pacientes, con 1 127 partos (33 gemelares y un trillizo) de un total de 28 555 partos]. Los datos fueron extraídos de las historias clínicas de las referidas pacientes, de las actas del Comité de Mortalidad Infantil del Centro y los protocolos de necropsias, así como datos estadísticos del Centro, que permitieron su vaciamiento en una base de datos de FOXBASE, permitiendo el procesamiento estadístico diferencial por el sistema Statqraph, por método de cálculo de porcentajes; medias aritméticas; y prueba de Chi cuadrado para independencia de niveles de significación con percentil prefijado. Para la clasificación del peso fetal se utilizó la tabla de Usher. Las diferentes variables estudiadas demostraron la incidencia negativa que la entidad tiene para con los indicadores generales y particulares de morbimortalidad perinatal y materna, siendo los más representativos en la preeclampsia grave y las crónicas III en la mayoría de los aspectos estudiados. En cuanto a la mortalidad materna ocurrió una letalidad de 0,6 % y una morbilidad de 2,5 x 10 000. The authors performed a prospective, descriptive study at the Matanzas Gyneco-Obstetric Educational Hospital, from 1986 to 1993, to each patient classified as hypertensive, according with the classification criteria of the American Association of Obstetrics and Gynecology (sample made up with 1 092 patients with 1 127 deliveries [33 twin births and one birth of triplets] from a total of 28 555 deliveries). Data were taken from the case histories of the said patients, from the acts of the Infantile Mortality Comittee of the Center, and from the protocols of the necropsies, as well as from statistical data from the Center which allowed emptying them in a FOXBASE data base, allowing the differential statistical proceeding by the Statgraph system, by the percentage estimation method; arithmetic means; Chi-square test for independence of significance levels with predetermined percentile. The Usher's Table was used in classifying the fetal weight. The different variables studied demonstrated the negative incidence that the entity has over the general and the particular indicators of perinatal and maternal morbidity and mortality, being the most representative in serious pre-eclampsia and the III chron
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