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Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study
OBJECTIVE: Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855201/ https://www.ncbi.nlm.nih.gov/pubmed/29500215 http://dx.doi.org/10.1136/bmjopen-2017-020578 |
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author | Wen, Qi Muraca, Giulia M Ting, Joseph Coad, Sarah Lim, Kenneth I Lisonkova, Sarka |
author_facet | Wen, Qi Muraca, Giulia M Ting, Joseph Coad, Sarah Lim, Kenneth I Lisonkova, Sarka |
author_sort | Wen, Qi |
collection | PubMed |
description | OBJECTIVE: Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN: A retrospective observational study. SETTINGS AND PARTICIPANTS: All hospital singleton live births in Washington State, USA, 2004–2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS: Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION: While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery. |
format | Online Article Text |
id | pubmed-5855201 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58552012018-03-19 Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study Wen, Qi Muraca, Giulia M Ting, Joseph Coad, Sarah Lim, Kenneth I Lisonkova, Sarka BMJ Open Obstetrics and Gynaecology OBJECTIVE: Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN: A retrospective observational study. SETTINGS AND PARTICIPANTS: All hospital singleton live births in Washington State, USA, 2004–2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS: Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION: While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery. BMJ Publishing Group 2018-03-02 /pmc/articles/PMC5855201/ /pubmed/29500215 http://dx.doi.org/10.1136/bmjopen-2017-020578 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Obstetrics and Gynaecology Wen, Qi Muraca, Giulia M Ting, Joseph Coad, Sarah Lim, Kenneth I Lisonkova, Sarka Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title | Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title_full | Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title_fullStr | Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title_full_unstemmed | Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title_short | Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
title_sort | temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study |
topic | Obstetrics and Gynaecology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855201/ https://www.ncbi.nlm.nih.gov/pubmed/29500215 http://dx.doi.org/10.1136/bmjopen-2017-020578 |
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