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Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway.

https://arctichealth.org/en/permalink/ahliterature309107
Source
BMC Pregnancy Childbirth. 2019 Sep 09; 19(1):330
Publication Type
Journal Article
Date
Sep-09-2019
Author
Solveig Bjellmo
Sissel Hjelle
Lone Krebs
Elisabeth Magnussen
Torstein Vik
Author Affiliation
Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway. solveigbjellmo@gmail.com.
Source
BMC Pregnancy Childbirth. 2019 Sep 09; 19(1):330
Date
Sep-09-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Breech Presentation
Case-Control Studies
Cesarean Section - methods - statistics & numerical data
Delivery, Obstetric - methods - standards - statistics & numerical data
Female
Guideline Adherence
Humans
Infant, Newborn
Needs Assessment
Norway - epidemiology
Obstetric Labor Complications - diagnosis - etiology - mortality - surgery
Perinatal Death - prevention & control
Perinatal mortality
Practice Guidelines as Topic
Pregnancy
Pregnancy Outcome - epidemiology
Prenatal Care - methods - standards
Quality Improvement
Abstract
In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable.
Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries.
Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p?=?0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head.
All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.
PubMed ID
31500581 View in PubMed
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Are health expectations of term breech infants unrealistically high?

https://arctichealth.org/en/permalink/ahliterature181703
Source
Acta Obstet Gynecol Scand. 2004 Feb;83(2):180-6
Publication Type
Article
Date
Feb-2004
Author
Veli-Matti Ulander
Mika Gissler
Mika Nuutila
Olavi Ylikorkala
Author Affiliation
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, and STAKES National Research and Development Center for Welfare and Health, Helsinki, Finland.
Source
Acta Obstet Gynecol Scand. 2004 Feb;83(2):180-6
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Apgar score
Breech Presentation
Cesarean Section
Child Development
Cohort Studies
Delivery, Obstetric - methods
Female
Finland - epidemiology
Follow-Up Studies
Humans
Infant Welfare
Infant, Newborn
Pregnancy
Registries - statistics & numerical data
Retrospective Studies
Time Factors
Abstract
The aim of this study was to compare the effect of fetal presentation and mode of delivery on infant outcome in a nation-wide study.
In a retrospective observational cohort study, we compared, with the help of Finnish Medical Birth Register and other nation-wide registers, the short-term and long-term outcome of infants born by breech vaginal (n = 1270) or by vertex vaginal delivery (n = 128,683) or through planned cesarean section (CS) in breech (n = 1640) or vertex (n = 4997); the pregnancies were otherwise entirely normal.
One perinatal death occurred in the breech vaginal group and 23 deaths in the vertex vaginal group (p = 0.112), but none in either CS group. Breech vaginal delivery was associated with increased risk of Apgar scores 6 or less at age 1 min (OR 7.65, CI 6.41-9.12) and at age 5 min (OR 6.42, CI 4.36-9.45) as compared with vertex vaginal delivery. These odd ratios were also elevated (OR 4.59, CI 3.48-7.08 and OR 7.58, CI 3.09-18.66, respectively) when compared with breech planned CS. Yet the risk for birth trauma of infants in the breech vaginal group was smaller (OR 0.70, CI 0.51-0.96) than that in the vertex vaginal group but this risk was smallest in the planned CS groups. A number of other neonatal complications occurred equally commonly in each group. Breech infants born vaginally needed fewer admissions (OR 0.58, 0.47-0.72) to out-patient departments and the cumulative incidence of long-term morbidity in the breech vaginal group was smaller (OR 0.47, CI 0.28-0.80) to the age of 7 years than that in the breech planned CS. The maturity for starting school and school performance during the first two school years showed no dependence on mode of delivery.
Apart from Apgar suppression, elective vaginal delivery of a full-term breech fetus in highly selected pregnancies does not cause additional neonatal hazards as compared with full-term vertex deliveries. The immediate outcome was best for breech or vertex infants born through elective CSs.
PubMed ID
14756737 View in PubMed
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Are intrapartum and neonatal deaths in breech delivery at term potentially avoidable?--a blinded controlled audit.

https://arctichealth.org/en/permalink/ahliterature58496
Source
J Perinat Med. 2002;30(3):220-4
Publication Type
Article
Date
2002
Author
Lone Krebs
Jens Langhoff-Roos
Birgit Bødker
Author Affiliation
Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. lone.krebs@dadlnet.dk
Source
J Perinat Med. 2002;30(3):220-4
Date
2002
Language
English
Publication Type
Article
Keywords
Abruptio Placentae - complications
Breech Presentation
Case-Control Studies
Cesarean Section
Delivery, Obstetric - methods
Female
Fetal Growth Retardation - complications
Humans
Infant mortality
Infant, Newborn
Medical Audit
Obstetric Labor Complications
Pre-Eclampsia - complications
Pregnancy
Prenatal Care
Questionnaires
Research Support, Non-U.S. Gov't
Risk factors
Time Factors
Abstract
The aim of the study was to investigate whether deaths in term breech deliveries could have been avoided with improved care during pregnancy and delivery. All cases of intrapartum/early neonatal death of nonmalformed infants in breech presentation delivered at term in Denmark in the period 1982-92 were studied. For each of the 12 deaths two controls matched by presentation and planned mode of delivery were selected. Eleven obstetricians assessed the care through narratives that ended when the infant was delivered to umbilicus and stated if the infant died, and whether the "possible death" was potentially avoidable. The majority thought that 42% of cases and 9% of the controls had died. Antenatal and intrapartum care was suboptimal respectively in 17% and 25% of cases and 4% and 26% of controls. The assumed death was found to have been potentially avoidable in 58% of cases and 17% of controls. Care in pregnancies with IUGR, pre-eclampsia, placental abruption, post-maturity, the time from decision to performance of cesarean section, and compliance between patient and professionals were more often criticized in cases than in controls. Controlled audit seemed to be a valuable tool for quality improvement and for validation of litigation activities. In conclusion, infant death at term breech delivery was to a large extent potentially avoidable. However, even in controls, suboptimal care was not uncommon.
PubMed ID
12122903 View in PubMed
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[Are more caesarean sections of any advantage?]

https://arctichealth.org/en/permalink/ahliterature82684
Source
Laeknabladid. 2006 Mar;92(3):185-7
Publication Type
Article
Date
Mar-2006
Author
Geirsson Reynir Tómas
Source
Laeknabladid. 2006 Mar;92(3):185-7
Date
Mar-2006
Language
Icelandic
Publication Type
Article
Keywords
Breech Presentation
Cesarean Section
Cesarean Section, Repeat
Female
Humans
Pregnancy
PubMed ID
16520490 View in PubMed
Less detail

[A retrospective study of breech deliveries at Kongsberg Hospital, 1965-1974]

https://arctichealth.org/en/permalink/ahliterature60771
Source
Tidsskr Nor Laegeforen. 1977 Oct 10;97(28):1438-42
Publication Type
Article
Date
Oct-10-1977

Association of Perinatal Risk Factors With Obsessive-Compulsive Disorder: A Population-Based Birth Cohort, Sibling Control Study.

https://arctichealth.org/en/permalink/ahliterature282263
Source
JAMA Psychiatry. 2016 Nov 01;73(11):1135-1144
Publication Type
Article
Date
Nov-01-2016
Author
Gustaf Brander
Mina Rydell
Ralf Kuja-Halkola
Lorena Fernández de la Cruz
Paul Lichtenstein
Eva Serlachius
Christian Rück
Catarina Almqvist
Brian M D'Onofrio
Henrik Larsson
David Mataix-Cols
Source
JAMA Psychiatry. 2016 Nov 01;73(11):1135-1144
Date
Nov-01-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Apgar score
Birth weight
Breech Presentation
Case-Control Studies
Cesarean Section
Cohort Studies
Epigenesis, Genetic
Female
Gene-Environment Interaction
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases - epidemiology - genetics
Male
Obsessive-Compulsive Disorder - epidemiology - etiology - genetics
Perinatal care
Pregnancy
Prenatal Exposure Delayed Effects
Retrospective Studies
Risk factors
Siblings
Sweden
Tobacco Smoke Pollution - adverse effects
Young Adult
Abstract
Perinatal complications may increase the risk of obsessive-compulsive disorder (OCD). Previous reports were based on small, retrospective, specialist clinic-based studies that were unable to rigorously control for unmeasured environmental and genetic confounding.
To prospectively investigate a wide range of potential perinatal risk factors for OCD, controlling for unmeasured factors shared between siblings in the analyses.
This population-based birth cohort study included all 2?421?284 children from singleton births in Sweden from January 1, 1973, to December 31, 1996, who were followed up through December 31, 2013. From the 1?403?651 families in the cohort, differentially exposed siblings from the 743?885 families with siblings were evaluated; of these, 11?592 families included clusters of full siblings that were discordant for OCD. Analysis of the data was conducted from January, 26, 2015, to September, 5, 2016.
Perinatal data were collected from the Swedish Medical Birth Register and included maternal smoking during pregnancy, labor presentation, obstetric delivery, gestational age (for preterm birth), birth weight, birth weight in relation to gestational age, 5-minute Apgar score, and head circumference.
Previously validated OCD codes (International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, code F42) in the Swedish National Patient Register.
Of 2?421?284 individuals included in the cohort, 17?305 persons were diagnosed with OCD. Of these, 7111 were men (41.1%). The mean (SD) age of individuals at first diagnosis of OCD was 23.4 (6.5) years. An increased risk for OCD remained after controlling for shared familial confounders and measured covariates (including sex, year of birth, maternal and paternal age at birth, and parity), for smoking 10 or more cigarettes per day during pregnancy (hazard ratio [HR], 1.27; 95% CI, 1.02-1.58), breech presentation (HR, 1.35; 95% CI, 1.06-1.71), delivery by cesarean section (HR, 1.17; 95% CI, 1.01-1.34), preterm birth (HR, 1.24; 95% CI, 1.07-1.43), birth weight 1501 to 2500 g (HR, 1.30; 95% CI, 1.05-1.62) and 2501 to 3500 g (HR, 1.08; 95% CI, 1.01-1.16), being large for gestational age (HR, 1.23; 95% CI, 1.05-1.45), and Apgar distress scores at 5 minutes (HR, 1.50; 95% CI, 1.07-2.09). Gestational age and birth weight followed inverse dose-response associations, whereby an increasingly higher risk for OCD was noted in children with a shorter gestational age and lower birth weight. We also observed a dose-response association between the number of perinatal events and increased OCD risk, with HRs ranging from 1.11 (95% CI, 1.07-1.15) for 1 event to 1.51 (95% CI, 1.18-1.94) for 5 or more events.
A range of perinatal risk factors is associated with a higher risk for OCD independent of shared familial confounders, suggesting that perinatal risk factors may be in the causal pathway to OCD.
PubMed ID
27706475 View in PubMed
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Attitudes among Toronto obstetricians towards vaginal breech delivery.

https://arctichealth.org/en/permalink/ahliterature133979
Source
J Obstet Gynaecol Can. 2011 May;33(5):437-42
Publication Type
Article
Date
May-2011
Author
Karthika Devarajan
P Gareth Seaward
Dan Farine
Author Affiliation
Department of Obstetrics and Gynaecology, University of Toronto, Ontario.
Source
J Obstet Gynaecol Can. 2011 May;33(5):437-42
Date
May-2011
Language
English
Publication Type
Article
Keywords
Breech Presentation
Delivery, Obstetric - standards
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Hospitals, Teaching
Humans
Obstetrics - standards
Ontario
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications
Questionnaires
Abstract
The recent SOGC guidelines allow for selective vaginal delivery of breech presentations, following an eight-year period during which vaginal breech delivery was discouraged based on the results of the Term Breech Trial (TBT). We sought to determine the effect of publication of this guideline on the acceptance of vaginal breech delivery by obstetricians and to correlate obstetricians' attitudes with actual practice.
A survey was sent to all obstetricians practising in five teaching hospitals in Toronto exploring their attitudes towards, and comfort with, vaginal breech delivery in various clinical situations. We correlated these with their graduation year in relation to the publication of the TBT. We also reviewed the obstetrical database of the largest teaching hospital in Toronto to see if these attitudes correlated with actual practice.
The vaginal breech delivery rate, which was declining prior to publication of the TBT, plummeted after it. Our survey found that most practitioners (50% to 80%) would be willing to provide vaginal breech delivery in defined conditions, with more experienced obstetricians being more comfortable with offering vaginal breech delivery. However, despite these attitudes, the vaginal breech delivery rate during the period surveyed was only 3% (6/195).
In the eight years between publication of the TBT and the new guidelines, very few vaginal breech deliveries were performed. Our survey indicates that most obstetricians have accepted the new guidelines; however, it seems that actual practice is lagging behind. The recent SOGC guidelines seem to have changed attitudes, but without changes in training and practical support, it seems unlikely that the trend for very few vaginal breech deliveries to be performed will be reversed.
PubMed ID
21639962 View in PubMed
Less detail

Augmenting health care failure modes and effects analysis with simulation.

https://arctichealth.org/en/permalink/ahliterature257816
Source
Simul Healthc. 2014 Feb;9(1):48-55
Publication Type
Article
Date
Feb-2014
Author
Ditte S Nielsen
Peter Dieckmann
Marlene Mohr
Anja U Mitchell
Doris Østergaard
Author Affiliation
From the Danish Institute for Medical Simulation (D.S.N., P.D., M.M., D.O.), and Department of Anesthesia (A.U.M.), Herlev Hospital, Capital Region of Denmark, Copenhagen University, Copenhagen. Denmark.
Source
Simul Healthc. 2014 Feb;9(1):48-55
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Breech Presentation - therapy
Denmark
Female
Group Processes
Humans
Medical Errors - prevention & control
Patient care team
Patient Safety
Patient Simulation
Pregnancy
Risk Assessment - methods
Abstract
This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process by brainstorming, followed by simulation. Two means of adding simulation were investigated as follows: just simulating the process and interrupting the simulation between substeps of the process. By adding simulation to a traditional HFMEA, both multidisciplinary teams identified additional data that were relevant for deeper analysis. The study indicates that simulation has a role in HFMEA. Both ways of using simulation seemed feasible, and our results are not conclusive in selecting one over the other.
PubMed ID
24492339 View in PubMed
Less detail

Breech at term--mode of delivery? A register-based study.

https://arctichealth.org/en/permalink/ahliterature59261
Source
Acta Obstet Gynecol Scand. 1995 Oct;74(9):702-6
Publication Type
Article
Date
Oct-1995
Author
L. Krebs
J. Langhoff-Roos
T. Weber
Author Affiliation
University of Copenhagen, Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark.
Source
Acta Obstet Gynecol Scand. 1995 Oct;74(9):702-6
Date
Oct-1995
Language
English
Publication Type
Article
Keywords
Apgar score
Birth weight
Breech Presentation
Cesarean Section
Decision Making
Delivery, Obstetric - methods
Denmark - epidemiology
Female
Humans
Infant mortality
Infant, Newborn
Male
Parity
Pregnancy
Pregnancy outcome
Registries
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND. The present study was designed to determine neonatal mortality and morbidity in non-malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other. METHODS. Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply that vaginal delivery is associated with increased mortality and morbidity. However, validation of data and additional information from the medical records are needed before a recommendation of whether selection of parturients, structure of perinatal care or professional skills need to be improved, or all singleton term infants in breech presentation should be delivered by cesarean section.
PubMed ID
7572104 View in PubMed
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Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team.

https://arctichealth.org/en/permalink/ahliterature58314
Source
Acta Obstet Gynecol Scand. 2004 Feb;83(2):126-30
Publication Type
Article
Date
Feb-2004
Author
Lise Lund Håheim
Susanne Albrechtsen
Lillian Nordbø Berge
Per E Børdahl
Thore Egeland
Tore Henriksen
Pål ØIan
Author Affiliation
Norwegian Center for Health Technology Assessment, Oslo, Norway. lise.l.haheim@sintef.no
Source
Acta Obstet Gynecol Scand. 2004 Feb;83(2):126-30
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Breech Presentation
Cesarean Section - statistics & numerical data
Cohort Studies
Delivery, Obstetric - methods - statistics & numerical data
Female
Humans
Infant mortality
Infant, Newborn
Maternal mortality
Norway - epidemiology
Outcome and Process Assessment (Health Care)
Pregnancy
Randomized Controlled Trials
Registries - statistics & numerical data
Notes
Comment In: Acta Obstet Gynecol Scand. 2004 Feb;83(2):121-314756725
Comment In: Acta Obstet Gynecol Scand. 2005 Jun;84(6):608; author reply 60915901278
PubMed ID
14756727 View in PubMed
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114 records – page 1 of 12.