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Charlene Thornton - One of the best experts on this subject based on the ideXlab platform.
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Rates of Obstetric Intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000-2008) : a linked data population-based cohort study
BMJ open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar
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rates of Obstetric Intervention and associated perinatal mortality and morbidity among low risk women giving birth in private and public hospitals in nsw 2000 2008 a linked data population based cohort study
BMJ Open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar <7 at 5 min. Neonates born in private hospitals to low-risk mothers were more likely to have a morbidity attached to the birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups. Conclusions: For low-risk women, care in a private hospital, which includes higher rates of Intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality.
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Rates of Obstetric Intervention during birth and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas
BMC pregnancy and childbirth, 2013Co-Authors: Hannah G Dahlen, Virginia Schmied, Cindy-lee Dennis, Charlene ThorntonAbstract:There are mixed reports in the literature about Obstetric Intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of Obstetric Intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas. A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=691,738). Risk profile, Obstetric Intervention rates and selected maternal and perinatal outcomes were examined. Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies
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rates of Obstetric Intervention during birth and selected maternal and perinatal outcomes for low risk women born in australia compared to those born overseas
BMC Pregnancy and Childbirth, 2013Co-Authors: Hannah G Dahlen, Virginia Schmied, Cindy-lee Dennis, Charlene ThorntonAbstract:There are mixed reports in the literature about Obstetric Intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of Obstetric Intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas. A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=691,738). Risk profile, Obstetric Intervention rates and selected maternal and perinatal outcomes were examined. Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies <10th centile (22%) and <3rd centile (8%). Lebanese women had the highest rates of stillbirth (7.2/1000). Similar trends were found in the different migrant groups when only low risk women were included. The results suggest there are significant differences in risk profiles, Obstetric Intervention rates and maternal and neonatal outcomes between Australian-born and women born overseas and these differences are seen overall and in low risk populations. The finding that Indian women (the leading migrant group to Australia) have the lowest normal birth rate and high rates of low birth weight babies is concerning, and attention needs to be focused on why there are disparities in outcomes and on effective models of care that might improve outcomes for this population.
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rates of Obstetric Intervention among low risk women giving birth in private and public hospitals in nsw a population based descriptive study
BMJ Open, 2012Co-Authors: Hannah G Dahlen, Sally Tracy, Mark Tracy, Andrew Bisits, Chris Brown, Charlene ThorntonAbstract:Objectives: To compare the risk profile of women giving birth in private and public hospitals and the rate of Obstetric Intervention during birth compared with previous published rates from a decade ago. Design: Population-based descriptive study. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000 to 2008. Main outcome measures: Risk profile of women giving birth in public and private hospitals, Intervention rates and changes in these rates over the past decade. Results: Among low-risk women rates of Obstetric Intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As Interventions were introduced during labour, the rate of Interventions in birth increased. Over the past decade these Interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no Obstetric Intervention compared to 35 per 100 women giving birth in a public hospital. Conclusions: Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.
Hannah G Dahlen - One of the best experts on this subject based on the ideXlab platform.
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Rates of Obstetric Intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000-2008) : a linked data population-based cohort study
BMJ open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar
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rates of Obstetric Intervention and associated perinatal mortality and morbidity among low risk women giving birth in private and public hospitals in nsw 2000 2008 a linked data population based cohort study
BMJ Open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar <7 at 5 min. Neonates born in private hospitals to low-risk mothers were more likely to have a morbidity attached to the birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups. Conclusions: For low-risk women, care in a private hospital, which includes higher rates of Intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality.
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Rates of Obstetric Intervention during birth and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas
BMC pregnancy and childbirth, 2013Co-Authors: Hannah G Dahlen, Virginia Schmied, Cindy-lee Dennis, Charlene ThorntonAbstract:There are mixed reports in the literature about Obstetric Intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of Obstetric Intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas. A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=691,738). Risk profile, Obstetric Intervention rates and selected maternal and perinatal outcomes were examined. Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies
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rates of Obstetric Intervention during birth and selected maternal and perinatal outcomes for low risk women born in australia compared to those born overseas
BMC Pregnancy and Childbirth, 2013Co-Authors: Hannah G Dahlen, Virginia Schmied, Cindy-lee Dennis, Charlene ThorntonAbstract:There are mixed reports in the literature about Obstetric Intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of Obstetric Intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas. A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000–2008 (n=691,738). Risk profile, Obstetric Intervention rates and selected maternal and perinatal outcomes were examined. Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies <10th centile (22%) and <3rd centile (8%). Lebanese women had the highest rates of stillbirth (7.2/1000). Similar trends were found in the different migrant groups when only low risk women were included. The results suggest there are significant differences in risk profiles, Obstetric Intervention rates and maternal and neonatal outcomes between Australian-born and women born overseas and these differences are seen overall and in low risk populations. The finding that Indian women (the leading migrant group to Australia) have the lowest normal birth rate and high rates of low birth weight babies is concerning, and attention needs to be focused on why there are disparities in outcomes and on effective models of care that might improve outcomes for this population.
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rates of Obstetric Intervention among low risk women giving birth in private and public hospitals in nsw a population based descriptive study
BMJ Open, 2012Co-Authors: Hannah G Dahlen, Sally Tracy, Mark Tracy, Andrew Bisits, Chris Brown, Charlene ThorntonAbstract:Objectives: To compare the risk profile of women giving birth in private and public hospitals and the rate of Obstetric Intervention during birth compared with previous published rates from a decade ago. Design: Population-based descriptive study. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000 to 2008. Main outcome measures: Risk profile of women giving birth in public and private hospitals, Intervention rates and changes in these rates over the past decade. Results: Among low-risk women rates of Obstetric Intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As Interventions were introduced during labour, the rate of Interventions in birth increased. Over the past decade these Interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no Obstetric Intervention compared to 35 per 100 women giving birth in a public hospital. Conclusions: Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.
K.s. Joseph - One of the best experts on this subject based on the ideXlab platform.
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Trends in Obstetric Intervention and Pregnancy Outcomes of Canadian Women With Diabetes in Pregnancy From 2004 to 2015.
Journal of the Endocrine Society, 2017Co-Authors: Amy Metcalfe, Yasser Sabr, Jennifer A. Hutcheon, Lois E. Donovan, Janet Lyons, Jason Burrows, K.s. JosephAbstract:Context Multiple consensus statements decree that women with diabetes mellitus should have comparable birth outcomes to women without diabetes mellitus; however, there is a scarcity of contemporary population-based studies on this issue. Objective To examine temporal trends in Obstetric Interventions and perinatal outcomes in a population-based cohort of women with type 1, type 2, or gestational diabetes mellitus compared with a control population. Design Cross-sectional study. Setting National hospitalization data (Canada except Quebec) from 2004 to 2015. Patients Pregnant women with type 1 (n = 7362), type 2 (n = 11,028), and gestational diabetes mellitus (n = 149,780) and women without diabetes mellitus (n = 2,688,231). Main Outcome Measures Rates of Obstetric Intervention, maternal morbidity, and neonatal morbidity/mortality. Results A consistent relationship was generally observed between diabetes mellitus subtype and Obstetric outcomes, with women with type 1 diabetes mellitus having the highest rate of Intervention and the highest rates of adverse perinatal outcomes followed by women with type 2 diabetes mellitus and women with gestational diabetes mellitus. Rates of severe preeclampsia were 1.2% among women without diabetes mellitus, 2.1% among women with gestational diabetes mellitus, 4.2% among women with type 2 diabetes mellitus, and 7.5% among women with type 1 diabetes mellitus (P < 0.001). The rate of neonatal morbidity ranged from 8.7% in women without diabetes mellitus to 11.0%, 17.4%, and 24.1% in women with gestational, type 2, and type 1 diabetes mellitus, respectively (P < 0.001). Conclusions In a contemporary Obstetric population, women with diabetes mellitus remain at increased risk of adverse pregnancy outcomes compared with women without diabetes mellitus.
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The association between temporal changes in the use of Obstetrical Intervention and small- for-gestational age live births
BMC pregnancy and childbirth, 2015Co-Authors: Amy Metcalfe, Sarka Lisonkova, K.s. JosephAbstract:The literature attributes secular declines in small-for-gestational age (SGA) live births to changes in maternal smoking and other maternal characteristics. However, there are reasons to believe that the observed reductions in SGA may be a consequence of early delivery following Obstetric Intervention. We examined temporal trends in Obstetrical Intervention and SGA among singleton live births in the United States from 1990 to 2010. The modified Kitagawa decomposition, based on the fetuses-at-risk approach, was used to assess the relative contribution of changes in the gestational age distribution and gestational age-specific SGA to overall changes in SGA. Reductions in SGA rates due to a left shift in the gestational age distribution were assumed to primarily reflect increased Obstetrical Intervention, whereas decreases in overall SGA due to decreases in gestational-age-specific SGA rates were assumed to reflect declines in risk factors. Temporal trends in SGA followed a non-linear pattern, with substantial declines from 10.1 % in 1990–92 to 8.9 % in 2002–04, followed by a small increase to 9.1 % in 2008–10. Rates of maternal smoking steadily decreased throughout the same time period and changes in SGA rates were more consistent with changes in the gestational age distribution. The modified Kitagawa decomposition analysis also attributed the initial decline in SGA rates to changes in the gestational age distribution. Complex temporal pattern in SGA rates cannot be explained by the linear pattern of changes in factors like maternal smoking. Changes in the gestational age distribution are more consistent with the observed secular trends in SGA rates.
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The influence of Obstetric Intervention on trends in twin stillbirths: United States, 1989-99.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine the Federation of Asia and , 2004Co-Authors: Cande V. Ananth, K.s. Joseph, Wendy L. KinzlerAbstract:Objective: Although twin stillbirth rates have declined substantially over the past two decades, the contribution of changes in Obstetric Interventions to reducing twin stillbirths has not been quantified.Methods: We carried out a retrospective cohort study of twin live births and stillbirths in the United States between 1989 and 1999 (n = 1 102 212). Changes in the rate of stillbirth ( ⩾ 22 weeks) before and after adjustment for changes in labor induction, Cesarean delivery and sociodemographic factors were estimated through ecological logistic regression analysis. This analysis was based on aggregating data by each state within the United States.Results: Between 1989 and 1999, rates of labor induction and Cesarean delivery among twin live births increased by 138% (from 5.8% to 13.8%) and 15% (from 48.3% to 55.6%), respectively. These changes were accompanied by a 43% decline in the stillbirth rate between 1989 and 1999 (from 24.4 to 13.9 per 1000 fetuses at risk). After excluding births weighing
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Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and Obstetric Intervention.
American journal of obstetrics and gynecology, 2004Co-Authors: Cande V. Ananth, K.s. Joseph, John C. SmulianAbstract:Abstract Objective We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. Study design We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. Results The frequency of live born twins who weighed Conclusion Increases in preterm birth because of Obstetric Intervention among twins have not led to increases in twin neonatal mortality rates in the United States.
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Obstetric Intervention, stillbirth, and preterm birth.
Seminars in perinatology, 2002Co-Authors: K.s. Joseph, Kitaw Demissie, Michael S. KramerAbstract:Despite widespread recognition that preventing preterm birth is the most important perinatal challenge facing industrialized countries, preterm birth has increased steadily in recent years. This article examines the relation between trends in preterm birth, preterm labor induction/cesarean delivery, stillbirth, and infant mortality. The recent rise in preterm birth in the United States and Canada has been mainly due to increases in mild preterm birth (34-36 weeks). Live births at 34 to 36 weeks' gestation have increased largely as a consequence of increases in preterm induction and preterm cesarean delivery among women at high risk for adverse pregnancy outcomes. Increased Obstetric Intervention at 34 to 36 weeks' gestation appears to have led to larger-than-expected temporal declines in stillbirth rates at this gestation. Infant mortality rates have declined overall and also among live births at 34 to 36 weeks' gestation. Obstetric Intervention at preterm gestation, when indicated, can prevent stillbirth and reduce infant morbidity and mortality despite the increasing rates of preterm delivery.
Andrew Bisits - One of the best experts on this subject based on the ideXlab platform.
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Persistent Occiput Posterior position - OUTcomes following manual rotation (POP-OUT): study protocol for a randomised controlled trial
Trials, 2015Co-Authors: Hala Phipps, Andrew Bisits, Sabrina Kuah, Joh Pardey, J Ludlow, Felicity Park, David Kowalski, Jon A Hyett, Bradley De VriesAbstract:Background Occiput posterior position is the most common malpresentation in labour, contributes to about 18% of emergency caesarean sections and is associated with a high risk of assisted delivery. Caesarean section is now a major contributing factor to maternal mortality and morbidity following childbirth in developed countries. Obstetric Intervention by forceps and ventouse delivery is associated with complications to the maternal genital tract and to the neonate, respectively. There is level 2 evidence that prophylactic manual rotation reduces the caesarean section rate and assisted vaginal delivery. But there has been no adequately powered randomised controlled trial. This is a protocol for a double-blinded, multicentre, randomised controlled clinical trial to define whether this Intervention decreases the operative delivery (caesarean section, forceps or vacuum delivery) rate. Methods/Design Eligible participants will be (greater than or equal to) 37 weeks’ with a singleton pregnancy and a cephalic presentation in the occiput posterior position on transabdominal ultrasound early in the second stage of labour. Based on a background risk of operative delivery of 68%, then for a reduction to 50%, an alpha value of 0.05 and a beta value of 0.2, 254 participants will need to be enrolled. This study has been approved by the Ethics Review Committee (RPAH Zone) of the Sydney Local Health District, Sydney, Australia, and protocol number X110410. Participants with written consent will be randomised to either prophylactic manual rotation or a sham procedure. The primary outcome will be operative delivery (defined as vacuum, forceps and/or caesarean section deliveries). Secondary outcomes will be caesarean section, significant maternal mortality/morbidity and significant perinatal mortality/morbidity. Analysis will be by intention-to-treat. Primary and secondary outcomes will be compared using a chi-squared test. A logistic regression for the primary outcome will be undertaken to account for potential confounders. The results of the trial will be presented at one or more medical conferences. The trial will be submitted to peer review journals for consideration for publication. There will be potential to incorporate the results into professional guidelines for Obstetricians and midwives. Trial registration The Australian New Zealand Clinical Trials Registry ACTRN12612001312831 . Trial registered 12 December 2012.
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Rates of Obstetric Intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000-2008) : a linked data population-based cohort study
BMJ open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar
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rates of Obstetric Intervention and associated perinatal mortality and morbidity among low risk women giving birth in private and public hospitals in nsw 2000 2008 a linked data population based cohort study
BMJ Open, 2014Co-Authors: Hannah G Dahlen, Andrew Bisits, Chris Brown, Sally K. Tracy, Mark A Tracy, Charlene ThorntonAbstract:Objectives: To examine the rates of Obstetric Intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000–2008). Design: Linked data population-based retrospective cohort study involving five data sets. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000–2008. Main outcome measures: Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private Obstetric units. Results: Rates of Obstetric Intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar <7 at 5 min. Neonates born in private hospitals to low-risk mothers were more likely to have a morbidity attached to the birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups. Conclusions: For low-risk women, care in a private hospital, which includes higher rates of Intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality.
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rates of Obstetric Intervention among low risk women giving birth in private and public hospitals in nsw a population based descriptive study
BMJ Open, 2012Co-Authors: Hannah G Dahlen, Sally Tracy, Mark Tracy, Andrew Bisits, Chris Brown, Charlene ThorntonAbstract:Objectives: To compare the risk profile of women giving birth in private and public hospitals and the rate of Obstetric Intervention during birth compared with previous published rates from a decade ago. Design: Population-based descriptive study. Setting: New South Wales, Australia. Participants: 691 738 women giving birth to a singleton baby during the period 2000 to 2008. Main outcome measures: Risk profile of women giving birth in public and private hospitals, Intervention rates and changes in these rates over the past decade. Results: Among low-risk women rates of Obstetric Intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As Interventions were introduced during labour, the rate of Interventions in birth increased. Over the past decade these Interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no Obstetric Intervention compared to 35 per 100 women giving birth in a public hospital. Conclusions: Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.
Cande V. Ananth - One of the best experts on this subject based on the ideXlab platform.
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Characteristics of childbearing women, Obstetrical Interventions and preterm delivery: a comparison of the US and France.
Maternal and child health journal, 2014Co-Authors: Jennifer Zeitlin, Béatrice Blondel, Cande V. AnanthAbstract:Preterm delivery rates have remained consistently higher in the US than France, but the reasons for this excess remain poorly understood. We examined if differences in socio-demographic risk factors or more liberal use of Obstetrical Interventions contributed to higher rates in the US. Data on singleton live births in 1995, 1998 and 2003 from US birth certificates and the French National Perinatal Survey were used to analyze preterm delivery rate by maternal characteristics (age, parity, marital status, education, race (US)/nationality (France), prenatal care and smoking). We distinguished between preterm deliveries with a cesarean or a labor induction and those without these Interventions. Unadjusted and adjusted risk ratios (RR) for the US compared to France were estimated using log-binomial regression. Preterm delivery rates were 7.9 % in the US and 4.7 % in France (risk ratio [RR] = 1.7, 95 % confidence interval [CI] 1.6–1.8). The US had more teen mothers and late entry to prenatal care, but fewer women smoked, although adjustment for these and other confounders did not reduce RR (1.8, 95 % CI 1.7–1.9). Preterm delivery rates associated with labor induction or cesarean were 3.3 % in the US and 2.1 % in France (RR 1.6, 95 % CI 1.5–1.7); the corresponding rates for preterm delivery without these Interventions were 4.5 and 2.5 % (RR 1.8, 95 % CI 1.7–1.9), respectively. Key socio-demographic risk factors and more Obstetric Intervention do not explain higher US preterm delivery rates. Avenues for future research include the impact of universal access to health services (universal health insurance?) on health care quality and the association between more generous social policies, stress and the risks of preterm delivery.
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The influence of Obstetric Intervention on trends in twin stillbirths: United States, 1989-99.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine the Federation of Asia and , 2004Co-Authors: Cande V. Ananth, K.s. Joseph, Wendy L. KinzlerAbstract:Objective: Although twin stillbirth rates have declined substantially over the past two decades, the contribution of changes in Obstetric Interventions to reducing twin stillbirths has not been quantified.Methods: We carried out a retrospective cohort study of twin live births and stillbirths in the United States between 1989 and 1999 (n = 1 102 212). Changes in the rate of stillbirth ( ⩾ 22 weeks) before and after adjustment for changes in labor induction, Cesarean delivery and sociodemographic factors were estimated through ecological logistic regression analysis. This analysis was based on aggregating data by each state within the United States.Results: Between 1989 and 1999, rates of labor induction and Cesarean delivery among twin live births increased by 138% (from 5.8% to 13.8%) and 15% (from 48.3% to 55.6%), respectively. These changes were accompanied by a 43% decline in the stillbirth rate between 1989 and 1999 (from 24.4 to 13.9 per 1000 fetuses at risk). After excluding births weighing
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Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and Obstetric Intervention.
American journal of obstetrics and gynecology, 2004Co-Authors: Cande V. Ananth, K.s. Joseph, John C. SmulianAbstract:Abstract Objective We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. Study design We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. Results The frequency of live born twins who weighed Conclusion Increases in preterm birth because of Obstetric Intervention among twins have not led to increases in twin neonatal mortality rates in the United States.
