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1.
Birth plans—Impact on mode of delivery,obstetrical interventions,and birth experience satisfaction: A prospective cohort study 下载免费PDF全文
Yalda Afshar MD PhD Jenny Y. Mei MD Kimberly D. Gregory MD MPH Sarah J. Kilpatrick MD PhD Tania F. Esakoff MD 《分娩》2018,45(1):43-49
Objective
To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.Methods
This was a prospective cohort study of singleton pregnancies greater than 34 weeks’ gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi‐squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.Results
Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61‐2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.Conclusion
Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth‐related patient satisfaction. 相似文献2.
Tania F. Esakoff Alyson Guillet Aaron B. Caughey 《The journal of maternal-fetal & neonatal medicine》2017,30(8):890-893
Objective: Our goal was to determine whether pregnancy outcomes are worse in gestational diabetics with small for gestational age (SGA) than those without.Methods: This was a retrospective cohort study of 114 199 pregnancies with gestational diabetes mellitus (GDM) in California, 6446 of which were complicated by SGA. SGA was defined as birth weight 10th percentile. Predictors included the presence or absence of SGA. Outcomes included respiratory distress syndrome (RDS), neonatal demise (NND), intrauterine fetal demise (IUFD), hypoglycemia and jaundice. The data were also stratified by gestational age looking at 32?+?0–36?+?6 weeks and 37?+?0–41?+?6 weeks. Univariate and multivariate analyses were performed.Results: In the term 37?+?0 to 41?+?6 week GDM cohort the risk of RDS increased from 0.4% to 1.3%, the risk of neonatal demise from 0.02% to 0.09%, the risk of IUFD from 0.1% to 0.4%, the risk of hypoglycemia from 0.4% to 1.0% and the risk of jaundice from 18.0% to 23.3% (p?0.001 for all). Similar relationships were seen in the 32?+?0 to 36?+?6 week group. The findings remained significant in multivariate analyses.Conclusions: The presence of SGA in a patient with gestational diabetes is associated with significantly increased risks of adverse outcomes compared to gestational diabetics without SGA including increased risks of RDS, neonatal demise, IUFD, hypoglycemia and jaundice. 相似文献
3.
Yvonne W. Cheng G. Blake MClaughlin Tania F. Esakoff Ingrid Block-Kurbisch Aaron B. Caughey 《The journal of maternal-fetal & neonatal medicine》2013,26(12):903-908
Objective. To examine whether women with an 1-hour 50-g glucose challenge test (GCT) for gestational diabetes mellitus (GDM) between 120 and 140 mg/dL and ≥140 mg/dL are at risk of perinatal complications.Study design. A retrospective cohort study of women with singleton pregnancies screened for GDM between 1988 and 2001 with a 1-hour 50-g GCT. Values of GCT were stratified into four subgroups: <120, 120–129, 130–139, and ≥140 mg/dL. Perinatal outcomes were compared using the Chi-square test and multivariable logistic regression analysis.Results. There were 13 901 women meeting the study criteria. Compared to women with a GCT of <120 mg/dL, women with a GCT of 130–139 mg/dL and ≥140 mg/dL were more likely to have preeclampsia and operative vaginal or cesarean deliveries. Neonates born to women with a GCT of 130–139 mg/dL also had higher odds of having a 5-minute Apgar score <7 (odds ratio (OR) = 1.51, 95% confidence interval (CI) 1.01–2.29), shoulder dystocia (OR = 2.02, 95% CI 1.16–2.55), birth trauma (OR = 1.47, 95% CI 1.06–2.02), and composite morbidity (OR = 1.25, 95% CI 1.03–1.51). Women with a GCT of ≥140 mg/dL had higher odds of macrosomia (OR = 1.32, 95% CI 1.13–1.54) and shoulder dystocia (OR = 1.68, 95% CI 1.11–2.55).Conclusion. Women with GCT results of 130–139 mg/dL appear to be at increased risk for perinatal morbidity. Thus, utilizing a diagnostic test in women with a GCT above 130 mg/dL should be considered. 相似文献
4.
Yvonne W Cheng Tania F Esakoff Ingrid Block-Kurbisch Alla Ustinov Sherri Shafer Aaron B Caughey 《The journal of maternal-fetal & neonatal medicine》2006,19(11):729-734
OBJECTIVE: To determine the diagnostic value of markedly elevated 50-g glucose loading test results (>or=200 mg/dL) and associated perinatal outcomes. METHOD: This was a retrospective cohort study of 14 771 pregnancies screened for gestational diabetes mellitus (GDM) between 1988 and 2001. The positive predictive value of the 50-g oral glucose loading test (GLT) results as measured by plasma glucose value was examined. Perinatal outcomes were assessed for women with GLT results >or=200 mg/dL compared to GLT <200 mg/dL, stratified by the diagnosis of GDM. Statistical comparisons were made using the Chi-square test and Student's t-test and potential confounding factors were controlled for using multivariable logistic regression analyses. A p value <0.05 and 95% confidence intervals were used to indicate statistical significance. RESULTS: The positive predictive values for a GDM diagnosis were 62% for GLT results between 180 and 189 mg/dL, 79% for those between 200 and 209 mg/dL, and 100% for GLT results >or=230 mg/dL. Compared to women with a GLT result <200 mg/dL, among women not diagnosed with GDM but with a GLT >or=200 mg/dL the adjusted odds ratio (aOR) for cesarean delivery was 4.18 (95% confidence intervals, 1.15-15.2). These women also had higher aORs for preterm delivery <32 weeks (aOR = 8.05 (1.02-63.6)), shoulder dystocia (aOR = 15.14 (1.64-140)), and their neonates were more likely to have a 5-minute Apgar score <7 (aOR = 6.41 (1.23-33.3)). For women diagnosed with GDM and with a GLT >or=200 mg/dL, the aOR for cesarean delivery was also elevated compared to those with a GLT <200 mg/dL (aOR = 2.24 (1.19-4.21)). CONCLUSION: A GLT value of >or=200 mg/dL is not absolutely diagnostic for gestational diabetes but is associated with unfavorable perinatal outcomes. 相似文献
5.
Yvonne W Cheng G Blake McLaughlin Tania F Esakoff Ingrid Block-Kurbisch Aaron B Caughey 《The journal of maternal-fetal & neonatal medicine》2007,20(12):903-908
OBJECTIVE: To examine whether women with an 1-hour 50-g glucose challenge test (GCT) for gestational diabetes mellitus (GDM) between 120 and 140 mg/dL and >or=140 mg/dL are at risk of perinatal complications. STUDY DESIGN: A retrospective cohort study of women with singleton pregnancies screened for GDM between 1988 and 2001 with a 1-hour 50-g GCT. Values of GCT were stratified into four subgroups: <120, 120-129, 130-139, and >or=140 mg/dL. Perinatal outcomes were compared using the Chi-square test and multivariable logistic regression analysis. RESULTS: There were 13 901 women meeting the study criteria. Compared to women with a GCT of <120 mg/dL, women with a GCT of 130-139 mg/dL and >or=140 mg/dL were more likely to have preeclampsia and operative vaginal or cesarean deliveries. Neonates born to women with a GCT of 130-139 mg/dL also had higher odds of having a 5-minute Apgar score <7 (odds ratio (OR) = 1.51, 95% confidence interval (CI) 1.01-2.29), shoulder dystocia (OR = 2.02, 95% CI 1.16-2.55), birth trauma (OR = 1.47, 95% CI 1.06-2.02), and composite morbidity (OR = 1.25, 95% CI 1.03-1.51). Women with a GCT of >or=140 mg/dL had higher odds of macrosomia (OR = 1.32, 95% CI 1.13-1.54) and shoulder dystocia (OR = 1.68, 95% CI 1.11-2.55). CONCLUSION: Women with GCT results of 130-139 mg/dL appear to be at increased risk for perinatal morbidity. Thus, utilizing a diagnostic test in women with a GCT above 130 mg/dL should be considered. 相似文献
6.
Tania F. Esakoff Steve Rad Richard M. Burwick Aaron B. Caughey 《The journal of maternal-fetal & neonatal medicine》2016,29(10):1531-1535
Objective: Eclampsia is a rare yet dangerous complication of the hypertensive disorders of pregnancy. The objective was to elucidate the predictors of eclampsia in a large cohort of pregnant women with gestational hypertension or preeclampsia.Methods: This was a retrospective cohort study of 143?093 pregnancies with preeclampsia or gestational hypertension in California during 2005–2008 of which 1719 had eclampsia. Predictors included race/ethnicity, parity, chronic hypertension (CHTN), diabetes mellitus, gestational diabetes mellitus (GDM), preterm delivery <32 weeks, maternal age?≥?35, maternal age?≤?20, socioeconomic status, education, and <5 prenatal visits. Univariate and multivariate analyses were performed.Results: Factors that increased the risk of eclampsia included Black (OR 1.46 [1.19–1.80]) and Hispanic race (OR 1.56 [1.35–1.79]), nulliparity (OR 1.59 [1.42–1.77]), maternal age?≤?20 (OR 1.85 [1.61–2.11]), preterm delivery <32 weeks (OR 1.41 [1.16–1.70]), and <5 prenatal care visits (1.74 [1.46–2.07]). Factors that decreased the risk of eclampsia included CHTN (OR 0.06 [0.03–0.10]), GDM (OR 0.80 [0.67–0.96]), maternal age?≥?35 (OR 0.70 [0.59–0.82]), and college education (OR 0.83 [0.74–0.94]).Conclusions: Black and Hispanic race, nulliparity, maternal age?≤?20, preterm delivery <32 weeks, and <5 prenatal care visits increase the risk of eclampsia while CHTN, GDM, maternal age ≥?35, and college education are protective. The protective effect of CHTN is the most striking. The mechanisms are likely different and warrant further investigation. 相似文献
7.
Steve Rad S. Beauchamp C. Morales J. Mirocha T. F. Esakoff 《The journal of maternal-fetal & neonatal medicine》2018,31(23):3089-3094
Purpose: The purpose of this study is to determine if using abdominal circumference percentile (AC) to define fetal growth restriction (FGR) improves ultrasound at ≥36 weeks as a screening test for small for gestational age (SGA).Materials and methods: All non-anomalous singletons undergoing ultrasound at a single center at ≥36 weeks during 12/2008–5/2014 were included. FGR was defined as (estimated fetal weight) estimated fetal weight (EFW) and/or abdominal circumference (AC)?10 for gestational age (GA). The primary outcome was SGA (birthweight ≤10th percentile for GA). Data were stratified by maternal race/ethnicity and BMI. Sensitivity, specificity, false-positive rate (FPR), positive- and negative-predictive values (positive-predictive value (PPV), negative-predictive value (NPV)), and areas under the receiver-operating characteristic (ROC) curve (AUC were calculated.Results: There were 1594 ultrasounds. Median (IQR) ultrasound GA was 37.3 (36.6–38.0), days to delivery 10.6 (5.0–18.4), and delivery GA 39.29 (38.6–39.9). EFW <10 had the following characteristics: sensitivity 50.6%, FPR 2.0%, PPV 83.8%, and AUC 0.743. Using AC <10, these were 64.0, 2.9, 81.3, and 0.806, respectively. Using AC or EFW <10, these were 67.5, 3.3, 80.3, and 0.821, respectively; this criterion has the largest AUC (p?.008). This finding persisted when stratified by maternal race/ethnicity and BMI.Conclusions: AC <10 is more sensitive and has a similar PPV compared with EFW <10 for SGA. Using AC <10 or EFW <10 has the best balance of sensitivity and specificity as a screening test and has a low FPR. AC may be a reasonable alternative criterion to EFW for FGR diagnosis. 相似文献
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9.
Kathryn J. Sharma Tania F. Esakoff Alyson Guillet Richard M. Burwick Aaron B. Caughey 《The journal of maternal-fetal & neonatal medicine》2017,30(19):2342-2345
Objective: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone.Methods: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD).Results: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p?0.001), higher CD rate (66.5% versus 55.0%, p?0.001), and higher likelihood of a CD for FHR abnormalities (21.7% versus 10.0%, p?0.001). SGA infants were more likely to experience adverse neonatal outcomes including RDS (10.1% versus 4.9%, p?0.001), jaundice (59.8% versus 39.2%, p?0.001), hypoglycemia (8.9% versus 3.9%, p?0.001), asphyxia (0.6% versus 0.2%, p?=?0.015), and IUFD (1.5% versus 0.3%, p?0.001).Conclusions: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates. 相似文献
10.
Yvonne W. Cheng Tania F. Esakoff Ingrid Block-Kurbisch Alla Ustinov Sherri Shafer Aaron B. Caughey 《The journal of maternal-fetal & neonatal medicine》2013,26(11):729-734
Objective.?To determine the diagnostic value of markedly elevated 50-g glucose loading test results (≥200 mg/dL) and associated perinatal outcomes.Method.?This was a retrospective cohort study of 14 771 pregnancies screened for gestational diabetes mellitus (GDM) between 1988 and 2001. The positive predictive value of the 50-g oral glucose loading test (GLT) results as measured by plasma glucose value was examined. Perinatal outcomes were assessed for women with GLT results ≥200 mg/dL compared to GLT <200 mg/dL, stratified by the diagnosis of GDM. Statistical comparisons were made using the Chi-square test and Student's t-test and potential confounding factors were controlled for using multivariable logistic regression analyses. A p value <0.05 and 95% confidence intervals were used to indicate statistical significance.Results.?The positive predictive values for a GDM diagnosis were 62% for GLT results between 180 and 189 mg/dL, 79% for those between 200 and 209 mg/dL, and 100% for GLT results ≥230 mg/dL. Compared to women with a GLT result <200 mg/dL, among women not diagnosed with GDM but with a GLT ≥200 mg/dL the adjusted odds ratio (aOR) for cesarean delivery was 4.18 (95% confidence intervals, 1.15–15.2). These women also had higher aORs for preterm delivery <32 weeks (aOR = 8.05 (1.02–63.6)), shoulder dystocia (aOR = 15.14 (1.64–140)), and their neonates were more likely to have a 5-minute Apgar score <7 (aOR = 6.41 (1.23–33.3)). For women diagnosed with GDM and with a GLT ≥200 mg/dL, the aOR for cesarean delivery was also elevated compared to those with a GLT <200 mg/dL (aOR = 2.24 (1.19–4.21)).Conclusion.?A GLT value of ≥200 mg/dL is not absolutely diagnostic for gestational diabetes but is associated with unfavorable perinatal outcomes. 相似文献