scholarly journals How Long is the Safest InterDelivery Interval in Women with Previous History of Cesarean Delivery?

Author(s):  
Budi I Santoso ◽  
Raymond Surya ◽  
Karina K Firdaus ◽  
Surahman Hakim

  Objective: To investigate the association between interdelivery interval and uterine rupture in women with previous CD.   Methods: The formulation question was how long is the safest interdeliveryinterval to minimalize the risk of uterine rupture. Theauthors investigated in three databases including Pubmed,Cochrane, and Embase database. Inclusion criteria wereabstract answering the clinical question, written in Englishlanguage, and full-text paper availability.   Results: One systematic review, six cohort studies, and 1 casecontrolstudy were collected to compare the inter-pregnancyinterval to the risk of uterine rupture. The author retrievedseven articles suitable to the inclusion criteria after excluding tenarticles screened by the abstract and language. Then, the authoradded one article used in the systematic review. Hence, the criticalappraisal based on Validity, Importance, and Applicability (VIA)was performed for eight articles.   Conclusion: The inter-delivery interval 18 months is the safest time to avoid uterine rupture. Prostaglandin analogue induction should be avoided and for patients with a history of past cesarean using a single-layer closure to be educated about the increased risk. Keywords: cesarean delivery, inter-delivery interval, uterine rupture,vaginal birth after cesarean delivery

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Kimya Baradaran

Background. Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods. Objective. The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Study Design. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI). Results. 4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54–25.17). Conclusion. Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Aireen Wingert ◽  
Lisa Hartling ◽  
Meghan Sebastianski ◽  
Cydney Johnson ◽  
Robin Featherstone ◽  
...  

Abstract Background To systematically review the literature on clinical interventions that influence vaginal birth after cesarean (VBAC) rates. Methods We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting VBAC, uterine rupture and uterine dehiscence rates. One reviewer extracted data and a second reviewer verified for accuracy. Meta-analysis was conducted using Mantel-Haenszel (random effects model) relative risks (VBAC rate) and risk differences (uterine rupture and dehiscence). Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). Results Twenty-nine studies (six trials and 23 cohorts) examined different clinical interventions affecting rates of vaginal deliveries among women with a prior cesarean delivery (CD). Methodological quality was good overall for the trials; however, concerns among the cohort studies regarding selection bias, comparability of groups and outcome measurement resulted in higher risk of bias. Interventions for labor induction, with or without cervical ripening, included pharmacologic (oxytocin, prostaglandins, misoprostol, mifepristone, epidural analgesia), non-pharmacologic (membrane sweep, amniotomy, balloon devices), and combined (pharmacologic and non-pharmacologic). Single studies with small sample sizes and event rates contributed to most comparisons, with no clear differences between groups on rates of VBAC, uterine rupture and uterine dehiscence. Conclusions This systematic review evaluated clinical interventions directed at increasing the rate of vaginal delivery among women with a prior CD and found low to very low certainty in the body of evidence for cervical ripening and/or labor induction techniques. There is insufficient high-quality evidence to inform optimal clinical interventions among women attempting a trial of labor after a prior CD.


Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mahmoudreza Kalantari ◽  
Shakiba Kalantari ◽  
Mahdi Mottaghi ◽  
Atena Aghaee ◽  
Salman Soltani ◽  
...  

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.


2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.


2021 ◽  
pp. 152483802110294
Author(s):  
Annie Bérubé ◽  
Jessica Turgeon ◽  
Caroline Blais ◽  
Daniel Fiset

Child maltreatment has many well-documented lasting effects on children. Among its consequences, it affects children’s recognition of emotions. More and more studies are recognizing the lasting effect that a history of maltreatment can have on emotion recognition. A systematic literature review was conducted to better understand this relationship. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used and four databases were searched, MEDLINE/PubMed, PsycINFO, EMBASE, and FRANCIS, using three cross-referenced key words: child abuse, emotion recognition, and adults. The search process identified 23 studies that met the inclusion criteria. The review highlights the wide variety of measures used to assess child maltreatment as well as the different protocols used to measure emotion recognition. The results indicate that adults with a history of childhood maltreatment show a differentiated reaction to happiness, anger, and fear. Happiness is less detected, whereas negative emotions are recognized more rapidly and at a lower intensity compared to adults not exposed to such traumatic events. Emotion recognition is also related to greater brain activation for the maltreated group. However, the results are less consistent for adults who also have a diagnosis of mental health problems. The systematic review found that maltreatment affects the perception of emotions expressed on both adult and child faces. However, more research is needed to better understand how a history of maltreatment is related to adults’ perception of children’s emotions.


2021 ◽  
Vol 20 (1) ◽  
pp. 15-20
Author(s):  
Nyoman Tyas Apsari ◽  
◽  
Kumara Tini ◽  
I Putu Eka Widyadharma ◽  
◽  
...  

Objectives. High levels of non high density lipoprotein cholesterol (non-HDL-C) are known to contribute to an increased risk of ischemic stroke. This systematic review was conducted to identify the relationship between high non-HDL-C levels and the risk of ischemic stroke. Material and methods. This systematic review using PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement guideline, with a pre-determined search strategy. The search was conducted in Pubmed Central (PMC) and Pubmed from 2009 until 2020 with inclusion criteria, patients with a diagnosis of ischemic stroke, age >18 years, with non-HDL-C levels. The title and abstract of these articles were reviewed for relevance, based on inclusion criteria. This systematic review using STROBE to evaluate the quality in individual study which consists of 22 domains. Results. In the final stage, this systematic review identifies six cohort study consisting 166.720 participants. Overall, the quality in individual studies based on STROBE is good. We reported that there are two studies report that high non-HDL-C levels can significantly increase the risk of ischemic stroke. Meanwhile, there are four studies that report there was no significant relationship between high non-HDL-C levels and the risk of ischemic stroke. Conclusions. Overall, this systematic review provides the result about relationship between high levels of nonHDL-C and the risk of ischemic stroke, there are two studies with a larger population support that high levels of non-HDL-C can increase the risk of ischemic stroke. However, further studies is needed with a large population that specifically identify the relationship between non-HDL-C levels and risk of ischemic stroke and makes a better adjustments for confounding variables.


2021 ◽  
Vol 17 ◽  
pp. 174550652110619
Author(s):  
Maleda Tefera ◽  
Nega Assefa ◽  
Kedir Teji Roba ◽  
Letta Gedefa

Background: One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.


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