Journal articles on the topic 'Cesarean section Australia'
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Slavin, Valerie, and Jennifer Fenwick. "Use of a Classification Tool to Determine Groups of Women That Contribute to the Cesarean Section Rate: Establishing a Baseline for Clinical Decision Making and Quality Improvement." International Journal of Childbirth 2, no. 2 (2012): 85–95. http://dx.doi.org/10.1891/2156-5287.2.2.85.
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OBJECTIVE:To identify the groups of women who are the largest contributors to the cesarean section rate at a maternity facility in South East Queensland, Australia. Examining the characteristics of these women will allow the development of unit-focused initiatives aimed at reducing cesarean sections in these groups of women.METHOD:A modified version of the Robson Ten Group Classification System was identified as the most appropriate tool to determine cesarean section rates in different groups of women. A prospective clinical audit was then carried out during a 6-month period in 2010 using the tool.FINDINGS:The Robson Ten Group Classification System identified that planned repeat cesarean section was the largest contributor to the cesarean rate. This was followed by women having their first baby, women having an induction, and women who have a breech presentation at term.CONCLUSIONS AND IMPLICATIONS:The Robson classification tool was useful in identifying groups of women at risk of a cesarean section. Unit-specific strategies can now be developed and implemented in an effort to lower the rate. These include increasing the vaginal birth after cesarean rate, the uptake of external cephalic version, supporting nonintervention birth environments, and implementing models of care where clinicians are skilled in facilitating normal birth. The value of using such a tool is the ability to monitor change over time as well as facilitating the comparison of data between units of a similar nature.
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Ali, Yousaf, Muhammad Waseem Khan, UbaidUllah Mumtaz, Aneel Salman, Noor Muhammad, and Muhammad Sabir. "Identification of factors influencing the rise of cesarean sections rates in Pakistan, using MCDM." International Journal of Health Care Quality Assurance 31, no. 8 (October 8, 2018): 1058–69. http://dx.doi.org/10.1108/ijhcqa-04-2018-0087.
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PurposeThe rate of cesarean sections has been rapidly increased in the last few decades in all the developing as well as developed countries. The rate of cesarean sections determined by the World Health Organization has been crossed by many countries, like Brazil, India, China, USA, Australia, etc. Similarly, this rate has also increased in Pakistan. The purpose of this paper is to explore and identify the factors that are responsible for the rising rate of cesarean sections in Pakistan.Design/methodology/approachThese factors are categorized under medical and non-medical factors. The medical factors include the obesity of mother, age of mother, weight of the baby, umbilical cord prolapse, fetal distress, abnormal presentation, dystocia and failure to progress. The non-medical factors include financial incentives of doctors, time convenience for doctors, high tolerance to surgery, patient’s preference toward cesarean section, private hospitals, public hospitals, income status of patients, rural areas, urban areas and the education of patients. To identify the critical factors, data have been collected and a multi-criteria decision-making technique, called Decision Making Trial and Evaluation Laboratory, is used.FindingsThe result shows that the medical factors that are responsible for the rise in the rate of cesarean sections are umbilical cord prolapse, age of mother and obesity of mother. On the other hand, the non-medical factors that are the reasons for the increase in cesarean sections are the large number of private hospitals and the unethical acts of the doctors in these hospitals, preference of patients, and either the unavailability of doctors or poor conditions of hospitals in rural areas.Originality/valueCesarean section is an important surgical intervention and is considered to be very essential in the cases of existing as well as potential medical problems to the mother or the baby. Cesarean section is also performed for non-medical reasons. In Pakistan, the number of private hospitals has increased and these hospitals provide good health care. However, these hospitals do not work under the rules and regulations set by the government. The doctors in private hospitals perform unnecessary cesarean sections in order to fulfill the demands of private hospital’s owners. In addition to this, it is also found that, nowadays, most women prefer to give birth through cesarean section in order to eliminate the pain of normal vaginal delivery.
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Sullivan, Elizabeth A., Michael G. Chapman, Yueping A. Wang, and G. David Adamson. "Population-Based Study of Cesarean Section After In Vitro Fertilization in Australia." Birth 37, no. 3 (September 2, 2010): 184–91. http://dx.doi.org/10.1111/j.1523-536x.2010.00405.x.
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Friedman, N. Deborah, Ann L. Bull, Philip L. Russo, Lyle Gurrin, and Michael Richards. "Performance of the National Nosocomial Infections Surveillance Risk Index in Predicting Surgical Site Infection in Australia." Infection Control & Hospital Epidemiology 28, no. 1 (January 2007): 55–59. http://dx.doi.org/10.1086/509848.
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Background.The Victorian Hospital Acquired Infection Surveillance System (VICNISS) hospital-acquired infection surveillance system was established in 2002 in Victoria, Australia, and collates surgical site infection (SSI) surveillance data from public hospitals in Australia.Objective.To evaluate the association between the US National Nosocomial Infections Surveillance (NNIS) system's risk index and SSI rates for 7 surgical procedures.Methods.SSI surveillance was performed with NNIS definitions and methods for surgical procedures performed between November 2002 and September 2004. Correlations were assessed using the Goodman-Kruskal γ statistic.Results.Data were submitted for the following numbers of procedures: appendectomy, 545; coronary artery bypass graft (CABG), 4,632; cholecystectomy, 1,001; colon surgery, 623; cesarean section, 4,857; hip arthroplasty, 3,825; and knee arthroplasty, 2,416. NNIS risk index and increasing SSI rate were moderately well correlated for appendectomy (γ = 0.55), colon surgery (γ = 0.48), and cesarean section (γ = 0.42). A fairly positive correlation was found for cholecystectomy (γ = 0.17), hip arthroplasty (γ = 0.2), and knee arthroplasty (γ = 0.16). However, for CABG surgery, a poor association was found (γ = 0.02).Conclusions.The NNIS risk index was positively correlated with an increasing SSI rate for all 7 procedures; the strongest correlation was found for appendectomy, cesarean section, and colon surgery, and the poorest correlation was found for CABG surgery. We believe that risk stratification with the NNIS risk index is appropriate for comparison of data for most procedures and superior to use of no risk adjustment. However, for some procedures, particularly CABG, further studies of alternative risk indexes are needed to better stratify patients.
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Read, A. W., W. J. Prendiville, V. P. Dawes, and F. J. Stanley. "Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia." American Journal of Public Health 84, no. 1 (January 1994): 37–42. http://dx.doi.org/10.2105/ajph.84.1.37.
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Read, Anne W., Walter J. Prendiville, Vivienne P. Dawes, and Fiona J. Stanley. "Cesarean Section and Operative Vaginal Delivery in Low-Risk Primiparous Women, Western Australia." Obstetrical & Gynecological Survey 49, no. 11 (November 1994): 751–52. http://dx.doi.org/10.1097/00006254-199411000-00011.
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Dodd, Jodie, and Caroline A. Crowther. "Vaginal Birth After Cesarean Section: A Survey of Practice in Australia and New Zealand." Obstetrical & Gynecological Survey 59, no. 1 (January 2004): 19–21. http://dx.doi.org/10.1097/01.ogx.0000102783.03796.8f.
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Robson, Stephen J., Woo Syong Tan, Adebayo Adeyemi, and Keith B. G. Dear. "Estimating the Rate of Cesarean Section by Maternal Request: Anonymous Survey of Obstetricians in Australia." Birth 36, no. 3 (September 2009): 208–12. http://dx.doi.org/10.1111/j.1523-536x.2009.00331.x.
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Godden, Brodie, Yvonne Hauck, Tasmin Hardwick, and Sara Bayes. "Women’s Perceptions of Contributory Factors for Successful Vaginal Birth After Cesarean." International Journal of Childbirth 2, no. 2 (2012): 96–106. http://dx.doi.org/10.1891/2156-5287.2.2.96.
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BACKGROUND:In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service was launched at King Edward Memorial Hospital (KEMH) in Perth, Western Australia. Midwives from the NBAC service provide antenatal care, evidence-based information about birth choices, tailored birth preparation classes, and assistance with developing birth plans to pregnant women who have had a previous cesarean birth.OBJECTIVE:To determine the contributory factors that women who were cared for by the NBAC service and experienced a vaginal birth after cesarean (VBAC) perceived to be associated with achieving their desired mode of birth.METHODS:A qualitative descriptive approach was used for this study in which semistructured interviews were conducted with 13 participant women who have achieved a VBAC and were analyzed using a modified “constant comparison” technique.FINDINGS:Two key themes reflecting personal and professional factors comprising eight subthemes emerged from analysis of interview data.CONCLUSIONS:These findings offer a unique perspective on the phenomenon of achieving a VBAC and provide maternity care practitioners and policy makers around the world with valuable insights into how the care environment might be enhanced for women who would prefer a vaginal birth after their previous cesarean section.
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Sandy-Hodgetts, Kylie, Richard Parsons, Richard Norman, Mark W. Fear, Fiona M. Wood, and Scott W. White. "Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial—the CYGNUS protocol." BMJ Open 10, no. 10 (October 2020): e035727. http://dx.doi.org/10.1136/bmjopen-2019-035727.
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IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
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Morris, Sara, Sadie Geraghty, and Deborah Sundin. "Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study." JMIR Research Protocols 10, no. 2 (February 23, 2021): e23514. http://dx.doi.org/10.2196/23514.
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Background The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID) DERR1-10.2196/23514
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Vajda, Frank John Emery, Terence John O'Brien, Janet Elizabeth Graham, Alison Anne Hitchcock, Raphael John Paul Kuhn, Cecilie Margaret Lander, and Mervyn John Eadie. "Cesarean section in Australian women with epilepsy." Epilepsy & Behavior 89 (December 2018): 126–29. http://dx.doi.org/10.1016/j.yebeh.2018.10.008.
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Miller, Jessica E., Raphael Goldacre, Hannah C. Moore, Justin Zeltzer, Marian Knight, Carole Morris, Sian Nowell, et al. "Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries." PLOS Medicine 17, no. 11 (November 19, 2020): e1003429. http://dx.doi.org/10.1371/journal.pmed.1003429.
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Background The proportion of births via cesarean section (CS) varies worldwide and in many countries exceeds WHO-recommended rates. Long-term health outcomes for children born by CS are poorly understood, but limited data suggest that CS is associated with increased infection-related hospitalisation. We investigated the relationship between mode of birth and childhood infection-related hospitalisation in high-income countries with varying CS rates. Methods and findings We conducted a multicountry population-based cohort study of all recorded singleton live births from January 1, 1996 to December 31, 2015 using record-linked birth and hospitalisation data from Denmark, Scotland, England, and Australia (New South Wales and Western Australia). Birth years within the date range varied by site, but data were available from at least 2001 to 2010 for each site. Mode of birth was categorised as vaginal or CS (emergency/elective). Infection-related hospitalisations (overall and by clinical type) occurring after the birth-related discharge date were identified in children until 5 years of age by primary/secondary International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Analysis used Cox regression models, adjusting for maternal factors, birth parameters, and socioeconomic status, with results pooled using meta-analysis. In total, 7,174,787 live recorded births were included. Of these, 1,681,966 (23%, range by jurisdiction 17%–29%) were by CS, of which 727,755 (43%, range 38%–57%) were elective. A total of 1,502,537 offspring (21%) had at least 1 infection-related hospitalisation. Compared to vaginally born children, risk of infection was greater among CS-born children (hazard ratio (HR) from random effects model, HR 1.10, 95% confidence interval (CI) 1.09–1.12, p < 0.001). The risk was higher following both elective (HR 1.13, 95% CI 1.12–1.13, p < 0.001) and emergency CS (HR 1.09, 95% CI 1.06–1.12, p < 0.001). Increased risks persisted to 5 years and were highest for respiratory, gastrointestinal, and viral infections. Findings were comparable in prespecified subanalyses of children born to mothers at low obstetric risk and unchanged in sensitivity analyses. Limitations include site-specific and longitudinal variations in clinical practice and in the definition and availability of some data. Data on postnatal factors were not available. Conclusions In this study, we observed a consistent association between birth by CS and infection-related hospitalisation in early childhood. Notwithstanding the limitations of observational data, the associations may reflect differences in early microbial exposure by mode of birth, which should be investigated by mechanistic studies. If our findings are confirmed, they could inform efforts to reduce elective CS rates that are not clinically indicated.
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Bayes, Sara, Jennifer Fenwick, and Yvonne Hauck. "Becoming Redundant: Australian Women’s Experiences of Pregnancy After Being Unexpectedly Scheduled for a Medically Necessary Term Elective Cesarean Section." International Journal of Childbirth 2, no. 2 (2012): 73–84. http://dx.doi.org/10.1891/2156-5287.2.2.73.
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PURPOSE: There is now a comprehensive body of evidence reporting the effects of emergency cesarean section on women’s emotional well-being. How women respond to becoming in need of a medically necessary elective cesarean section, however, has not previously been reported. This article describes and explains how a cohort of Australian women experienced the remainder of the antenatal period following the discovery during pregnancy of a medical reason to book a term elective cesarean section.DESIGN: Grounded theory methodology was used for this study.FINDINGS: Seven categories emerged from data analysis to represent the women’s responses to becoming in need of a medically necessary term elective cesarean section. Four categories describe women’s actions and interactions as they dealt with their lost expectations and their perceived “displacement” from their baby’s birth. The other three categories represent the factors that mediated, or caused, women’s responses.MAIN CONCLUSIONS: This study provides new knowledge about how women experience and respond to an unwanted and unforeseen change in their childbearing journey. The sense of disappointment and loss that is likely to arise for women who must “change track” must be anticipated, recognized, acknowledged, and when possible, forestalled by maternity care professionals.
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Vajda, F. J. E., T. J. O'Brien, J. E. Graham, A. A. Hitchcock, P. Perucca, R. Kuhn, C. M. Lander, and M. J. Eadie. "Neurological factors and Cesarean section in Australian women with epilepsy." Epilepsy & Behavior 132 (July 2022): 108740. http://dx.doi.org/10.1016/j.yebeh.2022.108740.
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Rahmawati, Sitti, Mark A. Graber, Mohammad Hakimi, Ali Ghufron Multi, Indra Bastian, and Nurulhuda Rahman. "Cost Comparison of Emergency Cesarean Section in Indonesia: The impact of Australian Model of Diagnosis-related Groups as a Payment System for Patient Care in Hospitals." Open Access Macedonian Journal of Medical Sciences 9, E (March 8, 2021): 216–23. http://dx.doi.org/10.3889/oamjms.2021.5831.
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BACKGROUND: The cesarean section in Indonesia was higher, still worrying for women and babies’ health with pregnancy complications. It will have psychological effects such as trauma and stress during labor and its consequences on labor cost. AIM: This study’s purpose was to determine the cost of cesarean delivery as a diagnosis of transition-related groups and the Australian-diagnosis-related groups (AR-DRGs) model’s impact. METHODS: The research method is descriptive qualitative study. The 42 samples are pregnant women and that selected by purposive sampling. The data are collected from a secondary data source of medical record installations, observations, interview interviews, and focus group discussion with health professionals, nurses, doctors, and midwives. Data analysis is based on the activity-based costing system method. It includes cost treatment per disease diagnosis, cesarean section AR-DRG 370 method as a payment method for hospital treatment. RESULTS: Determinants of cost differences in cesarean section surgery are based on AR-DRG 370 related to diabetes and eclampsia (complications and comorbidities) with relatively high-cost rates of O01A DRGs of US$ 2639 due to high-risk pregnancy complications. Complications of mild pregnancy (DRGO01D) with different categories of uterine rupture and sepsis have a low-cost average at the total cost of US$ 1251. Payment ability of an average of 42 respondents shows the costs category of DRGs O01A-DRGs O01D US$ 7088 or US$ 169, per patient and length of stay 4–6 days. CONCLUSIONS: The impact of Australia’s AR-DRGs model of transition DRG prospective payment shows that the health system can improve the quality of professional services in hospitals and control costs, and labor costs are cheaply profitable for hospitals. The results are accurate and experienced to be applied in Indonesian hospitals.
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Walker, Ruth, Deborah Turnbull, and Chris Wilkinson. "Increasing Cesarean Section Rates: Exploring the Role of Culture in an Australian Community." Birth 31, no. 2 (June 2004): 117–24. http://dx.doi.org/10.1111/j.0730-7659.2004.00289.x.
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Kelly, Georgina, Yvonne L. Hauck, Sara Bayes, and Tasmin Hardwick. "Women’s Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC)." International Journal of Childbirth 3, no. 2 (2013): 106–16. http://dx.doi.org/10.1891/2156-5287.3.2.106.
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BACKGROUND:With cesarean rates around the world escalating, concern is growing around why women wanting a vaginal birth after cesarean (VBAC) are not achieving their goal.AIM:To gain an understanding of women’s perceptions of factors they felt contributed to not achieving a VBAC.SETTING AND PARTICIPANTS:Fifteen women were interviewed following a nonelective repeat cesarean section (NERCS). They had attended a Western Australian midwifery-led service, next birth after cesarean (NBAC), and labored but were not successful in achieving a VBAC because of reasons around delayed progress. Interview transcripts were analyzed using Colaizzi’s method of thematic analysis.FINDINGS:Five themes emerged: “Tentative commitment with lingering doubts,” “My body failed me,” “Compromised by a longer than tolerable labor,” “Unable to effectively self-advocate in a climate of power struggling and poor support,” and “The inflexibility of hospital processes.” The final theme included two subthemes: “Restrictive policies” on labor and use of the cardiotocography, “The CTG.”CONCLUSIONS:When labor did not progress as envisaged and hospital processes adversely affected how women were supported, women’s doubts around being able to achieve a VBAC were reinforced with a NERCS. Maternity services need to ensure clinical practice reflects best evidence while assuring staff are supportive of women’s choice.
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Dekker, G. A., A. Chan, C. G. Luke, K. Priest, M. Riley, J. Halliday, J. F. King, et al. "Risk of Uterine Rupture in Australian Women Attempting Vaginal Birth After 1 Prior Cesarean Section." Obstetric Anesthesia Digest 31, no. 4 (December 2011): 220. http://dx.doi.org/10.1097/01.aoa.0000406671.94411.87.
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Gratwohl, Alois, Helen Baldomero, Mahmoud Aljurf, Marcelo C. Pasquini, Luis Fernando Bouzas, Ayami Yoshimi, Jeffrey Szer, et al. "Hematopoietic Stem Cell Transplantation: a Global Perspective From the Worldwide Network of Blood and Marrow Transplantation." Blood 114, no. 22 (November 20, 2009): 809. http://dx.doi.org/10.1182/blood.v114.22.809.809.
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Abstract Abstract 809 Hematopoietic stem cell transplantation (HSCT) has become the standard of care for many patients with defined congenital or acquired disorders of the hematopoietic system. It has seen rapid expansion over the last two decades. HSCT is frequently considered as high cost and highly specialized medicine restricted to countries with abundant resources. This view needs to be changed; HSCT might represent the most cost effective therapy in certain situations. In an attempt to obtain a global overview, the WBMT, has collected information from 1,350 transplant centers in 71 reporting countries over all continents on the numbers of HSCT by indication and donor type for 2006. Data were analyzed by four regions, based on the WHO classification (www.who.org): America (North, Central and South America), Asia (South East Asia and Western Pacific, including Australia and New Zealand), Europe and EMRO/Africa (Eastern Mediterranean region and Africa). Main indications were compared within and between regions. Transplant rates (number of HSCT per 10 million inhabitants) were computed and compared with several macro-economic health care indicators by single and multiple linear regression analyzes. They included gross national income per capita (GNI/capita), total health care expenditures, governmental health care expenditures, adult, infant and maternal mortality rate, hospital beds, cesarean section rates and human developmental index (http://hdr.undp.org). There were a total of 51,421 first HSCT, 22,163 allogeneic (43%), 29,258 autologous (57%). Main indications were leukemias 17,553 (34%; 89% allogeneic), lymphomas 27,778 (54%; 87% autologous), solid tumors 2,954 (6%; 95% autologous) and non-malignant disorders 2,771 (5%; 93% allogeneic). There were significant differences between and within regions: autologous HSCT was the preferred type of HSCT in America (58%) and Europe (61%), allogeneic HSCT in Asia (57%) and in EMRO Africa (65%). The proportion of unrelated donors was highest in Asia (49%); it was negligible in EMRO/Africa (6%). Leukemia was the main indication for allogeneic HSCT globally (71%). Non-malignant/congenital diseases represented about 10% of all HSCT globally; with almost 40% activity reported in EMRO/Africa. A minimum income as measured by GNI per capita and a minimum size as measured by its population or size were the primary prerequisites for performing HSCT in an individual country. No transplants were performed in countries with less than 300 000 inhabitants, less than 960 km2 of size and less than 680 US$ GNI per capita. All macro-economic factors has a significant positive or negative (mortality ratios) association with transplant rates (p<0.05; t-test) but with variable explanatory content: Governmental Health Care Expenditures (r2= 77.33), Gross National Income per Capita (r2= 74.04), team density (r2= 76.28) and, Human Developmental Index (r2= 74.36) explained best transplant rates. Weak explanations were found with, adult (r2= 49.03), infant (r2= 66.31) and maternal mortality rate (r2= 63.21), hospital beds (r2= 32.04) or, caesarean section rates (r2= 30.56). If all factors are combined in regression analyzes explanatory content reaches r2 = 84.24 but the significance of human development index is lost due to multicolinearity. In conclusion, this first global overview on HSCT activity demonstrates that HSCT is an accepted therapy world-wide today, with different needs and priorities in different countries. Transplant activity is concentrated in countries with higher health care expenditures, highest GNI/capita and high team density; hence, governmental support, access to a transplant center, disease prevalence and availability of resources are the key factors related to regional transplant activity. These data provide a solid basis for up-to-date health care counseling and targeted interventions and support the establishment of comprehensive regional registries. Disclosures: Gratwohl: AMGEN: Research Funding; Bristo Myers Squibb: Research Funding; Roche: Research Funding; Novartis: Research Funding; Pfizer: Research Funding.
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Fenwick, Jennifer, Yvonne Hauck, Virginia Schmeid, Satvinder Dhaliwal, and Janice Butt. "Association Between Mode of Birth and Self-Reported Maternal Physical and Psychological Health Problems at 10 Weeks Postpartum." International Journal of Childbirth 2, no. 2 (2012): 115–25. http://dx.doi.org/10.1891/2156-5287.2.2.115.
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AIM:To determine the association between mode of birth and physical and psychological health problems reported at 10 weeks postpartum.METHODS:A cross-sectional, self-report survey was completed by 2,699 Western Australian women at 10 weeks postpartum. Information on birth mode and physical and psychological health was sought. Descriptive statistics and frequency distributions were performed to describe the sample. Logistic regression was used to determine the association between mode of birth and the reported number of physical health problems (two or more and three or more) and two psychological health problems.RESULTS:The occurrence of physical health problems for all women were incontinence (11.5%), no bowel control (2.6%), backache (41%), heavy bleeding (14.1%), and excessive fatigue or tiredness (35.7%). A significant association was found between all cesarean sections (elective and emergency) and the number of physical health problems compared to spontaneous vaginal births. Women who had an emergency cesarean were most likely (OR= 3.15, CI = 2.40–4.13,p< 0.0005) to report two or more physical problems, whereas women who had an elective cesarean were more likely (OR= 2.75, CI = 2.08–3.63,p< 0.0005) to report three or more physical problems.Nearly 15% of women reported being unhappy for more than a few days. This was highest in women having an emergency cesarean (16.4%) and lowest in women giving birth spontaneously (13.5%). Some 6.4% of women stated they were constantly reliving negative thoughts of birth and/or labor. Women who had an emergency cesarean were more likely (OR= 3.10, CI = 1.96–4.89,p< 0.0005) to choose this item and they were also more likely (OR= 2.04, CI = 1.01–4.13,p< 0.047) to experience both psychological health items.CONCLUSION:Women’s reports of health problems within the first 10 weeks postpartum are concerning and warrant ongoing attention. The prevalence of health problems was higher in women who had experienced a cesarean. This information on morbidity postbirth is essential for women and their care providers in making informed decisions around available birth options.
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Perram, Jacinta, Stephanie Anderson, Stephen Matthews, Melly Gou, and P. Joy Ho. "Assisted Reproductive Technology Required to Achieve High Conception Rates, Despite a Low Incidence of Hypogonadotrophic Hypogonadism in Thalassemia and Sickle Cell Disease Patients." Blood 138, Supplement 1 (November 5, 2021): 4989. http://dx.doi.org/10.1182/blood-2021-147102.
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Abstract Background Early and effective iron chelation has improved life expectancy and decreased disease complications for people with transfusion dependent thalassemia (TDT) and Sickle Cell Disease (SCD). Fertility challenges and pregnancy complications have historically limited reproductive options in this group, however improved disease management has made subfertility a chronic disease complication requiring attention. Despite this, there are very few reports on rates of conception and pregnancy outcomes in this population. Methods A 20 year retrospective analysis (1997 - 2017) was performed to evaluate fertility outcomes in women with TDT and SCD at an Australian referral centre. Patients with TDT and SCD who tried to conceive during the study period were included. Use of assisted reproductive technologies (ART), as well as pregnancy outcomes and neonatal and maternal complications were assessed. Results Eleven women with TDT and 3 with SCD tried to conceive during the study period. Median age at conception was 28 years (range 21-35). A total of 28 pregnancies and 25 live births were reported, including 2 spontaneous early pregnancy losses, a termination for anencephaly and a reduction of triplets. There was 1 multiple gestation in the cohort. At least 1 live birth occurred in 13 of the 14 women (93%). Spontaneous conception was reported in 9 women, of whom 8 had at least one resulting live birth, with a total of 15 live births from spontaneous conception. Of 5 women who were unable to conceive spontaneously, four had a diagnosis of hypogonadotrophic hypogonadism (HH) - two conceived following ovarian stimulation (OS), one required in vitro fertilization (IVF), and one did not pursue IVF following unsuccessful OS. The cause of subfertility was unknown in one patient, who conceived with IVF following failed OS. Three women who had an initial spontaneous conception required assisted reproductive technology (ART) for subsequent pregnancies, with no cause for subfertility identified. Mean ferritin at conception was 2911 mmol/L (range 164 to 8697mmol/L), and there was no association between ferritin at conception and need for ART. A trend was observed between increasing age and use of ART. Nine of the thirteen (69%) women who achieved pregnancy underwent Cesarean section for their first delivery. Prematurity (birth prior to 37 weeks' gestation) occurred in 5 (20%) of live births. Intrauterine growth restriction (IUGR) evidenced by birth weight <10 th centile for gestational age at birth was observed in 7 of 25 births (28%). This included one very low birth weight neonate delivered following induction for suspected IUGR. Respiratory distress syndrome occurred in two neonates in the setting of prematurity (delivered at 31 and 33 weeks gestation), both from women with TDT. Post partum hemorrhage (PPH) occurred after four deliveries in three women with TDT. There were no neonatal or maternal deaths. Conclusions Our data is the first analysis of fertility and pregnancy outcomes in Australian patients with TDT or SCD. Publications in this area are limited, and primarily report on pregnancy outcomes without capturing failure to conceive. Our findings are encouraging, with high conception rates achieved, with the use of ART where needed. Ferritin level did not predict difficulty with spontaneous conception and few of the women (29%) had HH, despite many having significant hyperferritinemia. Overall, 48% of live births resulted from ART, despite 58% of these patients not having a diagnosis of HH. This indicates that pituitary iron deposition with resultant HH alone does not adequately explain subfertility in this population. Our data also highlight the importance of affordable ART access for this patient population despite the clinical gains achieved with effective chelation therapy. Pregnancies were largely uncomplicated with excellent maternal and foetal outcomes. A high rate of IUGR was observed, supporting classification of pregnancy in this population as high risk. Rates of Cesarean section for first delivery were more than double the Australian average, likely in part due to high IUGR rates. Neonatal complications and PPH occurred at general population rates. Guidelines around pregnancy management in this population abound, however large prospective studies are needed to identify those at risk of sub- and infertility, even in the era of effective chelation. Disclosures No relevant conflicts of interest to declare.
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Eden, Aimee R., Sara Gill, Karleen Gribble, Elien Rouw, and Jacqueline H. Wolf. "The Journal of Human Lactation: A Reflective Discussion." Journal of Human Lactation 35, no. 4 (August 22, 2019): 655–60. http://dx.doi.org/10.1177/0890334419870798.
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Research about lactation and breastfeeding has exploded since the Journal of Human Lactation ( JHL) began publishing in 1985. To discuss the 3-decade-long role of the Journal in promoting, supporting, and disseminating lactation research, editors convened a multidisciplinary group of lactation researchers and providers which comprised three senior researchers and one clinical practitioner, all of whom have a long history of lactation advocacy. Their discussion took place on July 1, 2019. Dr Aimee Eden is a medical anthropologist who leads the qualitative research efforts in a small research department. Her dissertation research focused on the maternal and child healthcare workforce, and the professionalization of breastfeeding support. She served on the Board of Directors of the International Board of Lactation Examiners (2010–2016) and currently serves on the board of the Monetary Investment for Lactation Consultant Certification. Dr Karleen Gribble has been conducting research for 15 years about infant and young child feeding in emergencies, long-term breastfeeding, milk sharing, early childhood trauma, adoption, and fostering. She is an Australian Breastfeeding Association community educator and breastfeeding counselor and a member of the Infant and Young Child Feeding in Emergencies Core Group. Elien Rouw is a practicing physician in Germany specialized in healthy infant care, with a long-standing specialization in breastfeeding medicine. She serves on the Board of Directors of the Academy of Breastfeeding Medicine, is a member of the German National Breastfeeding Committee and their delegate to the World Alliance for Breastfeeding Action. Dr Jackie Wolf is an historian of medicine, whose research focuses on the history of childbirth and breastfeeding practices in the United States and how those practices have shaped women’s and children’s health, as well as public health, over time. Her latest book, published by Johns Hopkins University Press and funded by a 3 year grant from the National Institutes of Health, is Cesarean Section: An American History of Risk, Technology, and Consequence. Dr Sara Gill moderated the discussion. She was a member of the Board of Directors of the International Lactation Consultant Association for 5 years, and has been an Associate Editor of the Journal of Human Lactation for the past 4 years. Her research has focused on breastfeeding among vulnerable populations. (Participants’ comments are noted as AE = Aimee Eden; SG = Sara Gill; KG = Karleen Gribble; ER = Elien Rouw; JW = Jacqueline Wolf).