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2. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

Author

Carroli G, Laopaiboon M, Lumbiganon P, Gülmezoglu AM, Souza JP, Fawole B, and Ruyan P

Subjects
Medicine
Abstract

Abstract Background There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Conclusions Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.

Published
2010
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3. Antenatal Dexamethasone for Early Preterm Birth in Low-resource Countries

Author

Oladapo, O.T., Vogel, J.P., Piaggio, G., Nguyen, M.H., Althabe, F., Gülmezoglu, A.M., Bahl, R., Rao, S.P.N., De Costa, A., Gupta, S., Baqui, A.H., Khanam, R., Shahidullah, M., Chowdhury, S.B., Ahmed, S., Begum, N., D Roy, A., Shahed, M.A., Jaben, I.A., Yasmin, F., Rahman, M.M., Ara, A., Khatoon, S., Ara, G., Akter, S., Akhter, N., Dey, P.R., Sabur, M.A., Azad, M.T., Choudhury, S.F., Matin, M.A., Goudar, S.S., Dhaded, S.M., Metgud, M.C., Pujar, Y.V., Somannavar, M.S., Vernekar, S.S., Herekar, V.R., Bidri, S.R., Mathapati, S.S., Patil, P.G., Patil, M.M., Gudadinni, M.R., Bijapure, H.R., Mallapur, A.A., Katageri, G.M., Chikkamath, S.B., Yelamali, B.C., Pol, R.R., Misra, S.S., Das, L., Nanda, S., Nayak, R.B., Singh, B., Qureshi, Z., Were, F., Osoti, A., Gwako, G., Laving, A., Kinuthia, J., Mohamed, H., Aliyan, N., Barassa, A., Kibaru, E., Mbuga, M., Thuranira, L., Githua, N.J., Lusweti, B., Ayede, A.I., Falade, A.G., Adesina, O.A., Agunloye, A.M., Iyiola, O.O., Sanni, W., Ejinkeonye, I.K., Idris, H.A., Okoli, C.V., Irinyenikan, T.A., Olubosede, O.A., Bello, O., Omololu, O.M., Olutekunbi, O.A., Akintan, A.L., Owa, O.O., Oluwafemi, R.O., Eniowo, I.P., Fabamwo, A.O., Disu, E.A., Agbara, J.O., Adejuyigbe, E.A., Kuti, O., Anyabolu, H.C., Awowole, I.O., Fehintola, A.O., Kuti, B.P., Isah, A.D., Olateju, E.K., Abiodun, O., Dedeke, O.F., Akinkunmi, F.B., Oyeneyin, L., Adesiyun, O., Raji, H.O., Ande, A.B.A., Okonkwo, ., I, Ariff, S., Soofi, S.B., Sheikh, L., Zulfiqar, S., Omer, S., Sikandar, R., Sheikh, S., Giordano, D., Gamerro, H., Carroli, G., Carvalho, J., Neilson, J., Molyneux, E., Yunis, K., Mugerwa, K., and Chellani, H.K.

Published
2021
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5. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., Khan K., Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., and Khan K.

Abstract

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overa

Published
2022

6. Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review

Author

Cormick, G, Moraa, H, Zahroh, RI, Allotey, J, Rocha, T, Pena-Rosas, JP, Qureshi, ZP, Hofmeyr, GJ, Mistry, H, Smits, L, Vogel, JP, Palacios, A, Gwako, GN, Abalos, E, Larbi, KK, Carroli, G, Riley, R, Snell, KIE, Thorson, A, Young, T, Betran, AP, Thangaratinam, S, Bohren, MA, Cormick, G, Moraa, H, Zahroh, RI, Allotey, J, Rocha, T, Pena-Rosas, JP, Qureshi, ZP, Hofmeyr, GJ, Mistry, H, Smits, L, Vogel, JP, Palacios, A, Gwako, GN, Abalos, E, Larbi, KK, Carroli, G, Riley, R, Snell, KIE, Thorson, A, Young, T, Betran, AP, Thangaratinam, S, and Bohren, MA

Abstract

OBJECTIVES: Daily calcium supplements are recommended for pregnant women from 20 weeks' gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia. DESIGN: Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach. DATA SOURCES: MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022. ELIGIBILITY CRITERIA: We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators. RESULTS: Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risk

Published
2023

7. Effect of High-dose Folic Acid Supplementation in Pregnancy on Preeclampsia (FACT): Double-blind, Phase III, Randomized Controlled, International, Multicenter Trial

Author

Wen, S.W., White, R.R., Rybak, N., Gaudet, L.M., Robson, S., Hague, W., Simms-Stewart, D., Carroli, G., Smith, G., Fraser, W.D., Wells, G., Davidge, S.T., Kingdom, J., Coyle, D., Fergusson, D., Corsi, D.J., Champagne, J., Sabri, E., Ramsay, T., Mol, B.W.J., Oudijk, M.A., and Walker, M.C.

Published
2019
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8. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J., Whittle, R., Snell, K. I. E., Smuk, M., Townsend, R., von Dadelszen, P., Heazell, A. E. P., Magee, L., Smith, G. C. S., Sandall, J., Thilaganathan, B., Zamora, J., Riley, R. D., Khalil, A., Thangaratinam, S., Coomarasamy, A., Kwong, A., Savitri, A. I., Salvesen, K. A., Bhattacharya, S., Uiterwaal, C. S. P. M., Staff, A. C., Andersen, L. B., Olive, E. L., Redman, C., Sletner, L., Daskalakis, G., Macleod, M., Abdollahain, M., Ramirez, J. A., Masse, J., Audibert, F., Magnus, P. M., Jenum, A. K., Baschat, A., Ohkuchi, A., Mcauliffe, F. M., West, J., Askie, L. M., Mone, F., Farrar, D., Zimmerman, P. A., Smits, L. J. M., Riddell, C., Kingdom, J. C., van de Post, J., Illanes, S. E., Holzman, C., van Kuijk, S. M. J., Carbillon, L., Villa, P. M., Eskild, A., Chappell, L., Prefumo, F., Velauthar, L., Seed, P., van Oostwaard, M., Verlohren, S., Poston, L., Ferrazzi, E., Vinter, C. A., Nagata, C., Brown, M., Vollebregt, K. C., Takeda, S., Langenveld, J., Widmer, M., Saito, S., Haavaldsen, C., Carroli, G., Olsen, J., Wolf, H., Zavaleta, N., Eisensee, I., Vergani, P., Lumbiganon, P., Makrides, M., Facchinetti, F., Sequeira, E., Gibson, R., Ferrazzani, S., Frusca, T., Norman, J. E., Figueiro, E. A., Lapaire, O., Laivuori, H., Lykke, J. A., Conde-Agudelo, A., Galindo, A., Mbah, A., Betran, A. P., Herraiz, I., Trogstad, L., Smith, G. G. S., Steegers, E. A. P., Salim, R., Huang, T., Adank, A., Zhang, J., Meschino, W. S., Browne, J. L., Allen, R. E., Costa, F. D. S., Klipstein-Grobusch Browne, K., Crowther, C. A., Jorgensen, J. S., Forest, J. -C., Rumbold, A. R., Mol, B. W., Giguere, Y., Kenny, L. C., Ganzevoort, W., Odibo, A. O., Myers, J., Yeo, S. A., Goffinet, F., Mccowan, L., Pajkrt, E., Teede, H. J., Haddad, B. G., Dekker, G., Kleinrouweler, E. C., Lecarpentier, E., Roberts, C. T., Groen, H., Skrastad, R. B., Heinonen, S., Eero, K., Anggraini, D., Souka, A., Cecatti, J. G., Monterio, I., Pillalis, A., Souza, R., Hawkins, L. A., Gabbay-Benziv, R., Crovetto, F., Figuera, F., Jorgensen, L., Dodds, J., Patel, M., Aviram, A., Papageorghiou, A., Khan, K., Clinicum, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, HUS Children and Adolescents, Lastentautien yksikkö, Children's Hospital, Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Tampere University, Obstetrics and Gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), APH - Personalized Medicine, APH - Digital Health, and Obstetrics and gynaecology

Subjects
Calibration (statistics), Perinatal Death, Overfitting, Cohort Studies, Fetal Development, 0302 clinical medicine, Discriminative model, 3123 Gynaecology and paediatrics, Models, Pregnancy, GROWTH RESTRICTION, Statistics, Medicine, Prenatal, 030212 general & internal medicine, Ultrasonography, RISK, 030219 obstetrics & reproductive medicine, PRETERM, Radiological and Ultrasound Technology, LOW-DOSE ASPIRIN, DIAGNOSIS TRIPOD, Obstetrics and Gynecology, General Medicine, Statistical, Stillbirth, Prognosis, Pregnancy Complication, external validation, individual participant data, intrauterine death, prediction model, stillbirth, Female, Humans, Infant, Newborn, Models, Statistical, Pregnancy Complications, Regression Analysis, Risk Assessment, Ultrasonography, Prenatal, 3. Good health, PREECLAMPSIA, Meta-analysis, Human, Cohort study, Prognosi, MEDLINE, Regression Analysi, WEEKS GESTATION, 03 medical and health sciences, VELOCIMETRY, Radiology, Nuclear Medicine and imaging, RECURRENCE, business.industry, Infant, Newborn, R1, HYPERTENSIVE DISORDERS, Reproductive Medicine, Sample size determination, Cohort Studie, RG, business, RA, Predictive modelling
Abstract

Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Published
2022
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9. Clinical practice patterns on the use of magnesium sulphate for treatment of pre‐eclampsia and eclampsia: a multi‐country survey

Author

Long, Q, Oladapo, OT, Leathersich, S, Vogel, JP, Carroli, G, Lumbiganon, P, Qureshi, Z, Gülmezoglu, AM, Mustafa, Lais, Carroli, Guillermo, Cecatti, José, Wolomby‐Molondo, Jean‐José, Roy, Malabika, Sing, Shalini, Mori, Rintaro, Nagata, Chie, Qureshi, Zahida, Panozo, Eduardo, Nafiou, Idi, Fawole, Bukola, Mazhar, Batool, Bataglia, Vicente, Zavaleta, Nelly, Jayaratne, Kapila, and Mugerwa, Kidza

Published
2017
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10. WHO Statement on Caesarean Section Rates

Author

Betran, A P, Torloni, M R, Zhang, J J, Gülmezoglu, A M, Aleem, H A, Althabe, F, Bergholt, T, de Bernis, L, Carroli, G, Deneux-Tharaux, C, Devlieger, R, Debonnet, S, Duan, T, Hanson, C, Hofmeyr, J, Pérez, Gonzalez R, de Jonge, A, Khan, K, Lansky, S, Lazdane, G, Lumbiganon, P, Mackeen, D, Mahaini, R, Manyame, S, Mathai, M, Mikolajczyk, R, Mori, R, De Mucio, B, Oladapo, O T, Ortiz-Panozo, E, Ouedraogo, L, Parker, C, Robson, M, Serruya, S, Souza, J P, Spong, C Y, Stanton, C, Stanton, M E, Sullivan, E A, Temmerman, M, Tita, A, Tunçalp, Ö, Velebil, P, Vogel, J P, Weber, M, Wojdyla, D, Ye, J, Yunis, K, Zamora, J, and Zongo, A

Published
2016
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12. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

Author

Souza, J P, Betran, A P, Dumont, A, de Mucio, B, Gibbs Pickens, C M, Deneux-Tharaux, C, Ortiz-Panozo, E, Sullivan, E, Ota, E, Togoobaatar, G, Carroli, G, Knight, H, Zhang, J, Cecatti, J G, Vogel, J P, Jayaratne, K, Leal, M C, Gissler, M, Morisaki, N, Lack, N, Oladapo, O T, Tunçalp, Ö, Lumbiganon, P, Mori, R, Quintana, S, Costa Passos, A D, Marcolin, A C, Zongo, A, Blondel, B, Hernández, B, Hogue, C J, Prunet, C, Landman, C, Ochir, C, Cuesta, C, Pileggi-Castro, C, Walker, D, Alves, D, Abalos, E, Moises, E CD, Vieira, E M, Duarte, G, Perdona, G, Gurol-Urganci, I, Takahiko, K, Moscovici, L, Campodonico, L, Oliveira-Ciabati, L, Laopaiboon, M, Danansuriya, M, Nakamura-Pereira, M, Costa, M L, Torloni, M R, Kramer, M R, Borges, P, Olkhanud, P B, Pérez-Cuevas, R, Agampodi, S B, Mittal, S, Serruya, S, Bataglia, V, Li, Z, Temmerman, M, and Gülmezoglu, A M

Published
2016
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14. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications ( <scp>IPPIC</scp> ) Network database: individual participant data meta‐analysis

Author

Allotey, J, Whittle, R, Snell, KIE, Smuk, M, Townsend, R, Dadelszen, P, Heazell, AEP, Magee, L, Smith, GCS, Sandall, J, Thilaganathan, B, Zamora, J, Riley, RD, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, AI, Salvesen, KÅ, Bhattacharya, S, Uiterwaal, CSPM, Staff, AC, Andersen, LB, Olive, EL, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramírez, JA, Massé, J, Audibert, F, Magnus, PM, Jenum, AK, Baschat, A, Ohkuchi, A, McAuliffe, FM, West, J, Askie, LM, Mone, F, Farrar, D, Zimmerman, PA, Smits, LJM, Riddell, C, Kingdom, JC, Post, J, Illanes, SE, Holzman, C, Kuijk, SMJ, Carbillon, L, Villa, PM, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, CA, Nagata, C, Brown, M, Vollebregt, KC, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, JE, Figueiró‐Filho, EA, Lapaire, O, Laivuori, H, Lykke, JA, Conde‐Agudelo, A, Galindo, A, Mbah, A, Betran, AP, Herraiz, I, Trogstad, L, Smith, GGS, Steegers, EAP, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, WS, Browne, JL, Allen, RE, Costa, F Da Silva, Klipstein‐Grobusch, K, Crowther, CA, Jørgensen, JS, Forest, J‐C, Rumbold, AR, Mol, BW, Giguère, Y, Kenny, LC, Ganzevoort, W, Odibo, AO, Myers, J, Yeo, SA, Goffinet, F, McCowan, L, Pajkrt, E, Teede, HJ, Haddad, BG, Dekker, G, Kleinrouweler, EC, LeCarpentier, É, Roberts, CT, Groen, H, Skråstad, RB, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, JG, Monterio, I, Pillalis, A, Souza, R, Hawkins, LA, Gabbay‐Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, and Khan, K

Abstract

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at risk can guide decisions on closer surveillance or timing of birth to prevent fetal death.Prognostic models have been developed to predict the risk of stillbirth, but none have yet been externally validated. We externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: We searched Medline, EMBASE, DH-DATA and AMED databases from inception to December 2020 to identify stillbirth prediction models. We included studies that developed or updated prediction models for stillbirth for use at any time during pregnancy. IPD from cohorts within the International Prediction of Pregnancy Complication (IPPIC) Network were used to externally validate the identified prediction models whose individual variables were available in the IPD. We assessed the risk of bias of the models and IPD using PROBAST, and reported discriminative performance using the C-statistic, and calibration performance using calibration plots, calibration slopeand calibration-in-the-large. We estimated performance measures separately in each study, and then summarised across studies using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: We identified 17 studies reporting the development of 40 prognostic models for stillbirth. None of the models were previously externally validated, and only a fifth (20%, 8/40) reported the full model equation. We were able to validate three of these models using the IPD from 19 cohort studies (491,201 pregnant women) within the IPPIC Network database. Based on evaluating their development studies, all three models had an overall high risk of bias according to PROBAST. In our IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65; summary calibration slopes of 0.40to 0.88, and generally with observed risks predictions that were too extreme compared to observed risks; and little to no clinical utility as assessed by net benefit. However, there remained uncertainty in performance for some models due to small available sample sizes. Conclusion: The three validated models generally showed poor and uncertain predictive performancein new data, with limited evidence to support their clinical application. Findings suggest methodological shortcomings in their development including overfitting of models. Further research is needed to further validate these and other models, identify stronger prognostic factors, and to develop more robust prediction models

Published
2021

16. Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial

Author

Dumont, A, Betran, AP, Kabore, C, de Loenzien, M, Lumbiganon, P, Bohren, MA, Mac, QNH, Opiyo, N, Carroli, G, Annerstedt, KS, Ridde, V, Escuriet, R, Robson, M, Hansen, C, Dumont, A, Betran, AP, Kabore, C, de Loenzien, M, Lumbiganon, P, Bohren, MA, Mac, QNH, Opiyo, N, Carroli, G, Annerstedt, KS, Ridde, V, Escuriet, R, Robson, M, and Hansen, C

Abstract

Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while impro

Published
2020

17. Maternal Characteristics and Causes Associated With Refractory Postpartum Hemorrhage After Vaginal Birth: A Secondary Analysis of the WHO CHAMPION Trial Data

Author

Widmer, M., primary, Piaggio, G., additional, Hofmeyr, G.J., additional, Carroli, G., additional, Coomarasamy, A., additional, Gallos, I., additional, Goudar, S., additional, Gulmezoglu, A.M., additional, Lin, S.L., additional, Lumbiganon, P., additional, Mugerwa, K., additional, Owa, O., additional, Qureshi, Z., additional, and Althabea, F., additional

Published
2021
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18. Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data

Author

Widmer, M, primary, Piaggio, G, additional, Hofmeyr, GJ, additional, Carroli, G, additional, Coomarasamy, A, additional, Gallos, I, additional, Goudar, S, additional, Gülmezoglu, AM, additional, Lin, SL, additional, Lumbiganon, P, additional, Mugerwa, K, additional, Owa, O, additional, Qureshi, Z, additional, and Althabe, F, additional

Published
2020
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23. The World Health Organization ACTION-I (Antenatal CorTicosteroids for Improving Outcomes in preterm Newborns) Trial: a multi-country, multi-centre, two-arm, parallel, double-blind, placebo-controlled, individually randomized trial of antenatal corticosteroids for women at risk of imminent birth in the early preterm period in hospitals in low-resource countries

Author

Bahl, R, Gulmezoglu, AM, My, HN, Oladapo, OT, Piaggio, G, Vogel, JP, Baqui, AH, Chowdhury, SB, Shahidullah, M, Goudar, S, Dhaded, SM, Mallapur, AA, Bidri, S, Misra, S, Kinuthia, J, Qureshi, Z, Were, F, Ayede, AI, Fawole, B, Adesina, OA, Adejuyigbe, EA, Kuti, O, Ariff, S, Sheikh, L, Soofi, S, Neilson, J, Althabe, F, Chellani, H, Molyneux, E, Mugerwa, K, Yunis, K, Campodonico, L, Carroli, G, Gamerro, H, Giordano, D, Patterson, J, Khanam, R, Harrison, M, Mannan, MA, Nasrin, B, Ahmed, S, Begum, N, Sultana, S, Khatoon, S, Ara, A, Chowdhury, MA, Dey, PR, Bhowmik, DK, Sabur, MA, Azad, MT, Ara, G, Akter, S, Bari, S, Rahman, MM, Yasmin, F, Matin, MA, Choudhury, SF, Goudar, SS, Metgud, MC, Pujar, YV, Somannavar, MS, Vernekar, SS, Herekar, V, Machakanur, VL, Andola, SS, Katageri, GM, Math, S, Yelamali, BC, Pol, R, Ramdurg, U, Bidri, SR, Mathpati, S, Patil, P, Lakhkar, BB, Patil, MM, Gudadinni, MR, Misra, SS, Padhi, M, Das, LB, Das, L, Nanda, SS, Pradhan, MJ, Mohanty, GSG, Nayak, RS, Singh, BS, Osoti, A, Gwako, G, Laving, A, Mohamed, H, Nassir, F, Mohamed, N, Barassa, A, Ogindo, J, Gwer, B, Salome, W, Ochieng, G, Githua, NJ, Lusweti, B, Okunlola, MA, Falade, AG, Ashubu, OF, Busari, O, Sanni, W, Ebedi, A, Kate, EI, Violet, O, Idris, HA, Sallau, FA, Viola, OC, Osaretin, EL, Irinyenikan, TA, Olubosede, OA, Omololu, OM, Runsewe, O, Imam, Z, Akintan, AL, Owa, OO, Oluwafemi, OR, Eniowo, IP, Fabamwo, A, Disu, E, Awowole, IO, Adeyemi, AB, Fehintola, AO, Anyabolu, HC, Kuti, BP, Famurewa, OC, Ande, ABA, Okonkwo, I, Peter, AA, Olugbenga, M, Adesiyun, O, Isah, AD, Kudirat, OE, Abiodun, O, Dedeke, OF, Oyeneyin, L, Akinkunmi, FB, Soofi, SB, Najimi, N, Ali, M, Anwar, J, Zulfiqar, S, Sikander, R, Rani, S, Sheikh, S, Memon, S, Bahl, R, Gulmezoglu, AM, My, HN, Oladapo, OT, Piaggio, G, Vogel, JP, Baqui, AH, Chowdhury, SB, Shahidullah, M, Goudar, S, Dhaded, SM, Mallapur, AA, Bidri, S, Misra, S, Kinuthia, J, Qureshi, Z, Were, F, Ayede, AI, Fawole, B, Adesina, OA, Adejuyigbe, EA, Kuti, O, Ariff, S, Sheikh, L, Soofi, S, Neilson, J, Althabe, F, Chellani, H, Molyneux, E, Mugerwa, K, Yunis, K, Campodonico, L, Carroli, G, Gamerro, H, Giordano, D, Patterson, J, Khanam, R, Harrison, M, Mannan, MA, Nasrin, B, Ahmed, S, Begum, N, Sultana, S, Khatoon, S, Ara, A, Chowdhury, MA, Dey, PR, Bhowmik, DK, Sabur, MA, Azad, MT, Ara, G, Akter, S, Bari, S, Rahman, MM, Yasmin, F, Matin, MA, Choudhury, SF, Goudar, SS, Metgud, MC, Pujar, YV, Somannavar, MS, Vernekar, SS, Herekar, V, Machakanur, VL, Andola, SS, Katageri, GM, Math, S, Yelamali, BC, Pol, R, Ramdurg, U, Bidri, SR, Mathpati, S, Patil, P, Lakhkar, BB, Patil, MM, Gudadinni, MR, Misra, SS, Padhi, M, Das, LB, Das, L, Nanda, SS, Pradhan, MJ, Mohanty, GSG, Nayak, RS, Singh, BS, Osoti, A, Gwako, G, Laving, A, Mohamed, H, Nassir, F, Mohamed, N, Barassa, A, Ogindo, J, Gwer, B, Salome, W, Ochieng, G, Githua, NJ, Lusweti, B, Okunlola, MA, Falade, AG, Ashubu, OF, Busari, O, Sanni, W, Ebedi, A, Kate, EI, Violet, O, Idris, HA, Sallau, FA, Viola, OC, Osaretin, EL, Irinyenikan, TA, Olubosede, OA, Omololu, OM, Runsewe, O, Imam, Z, Akintan, AL, Owa, OO, Oluwafemi, OR, Eniowo, IP, Fabamwo, A, Disu, E, Awowole, IO, Adeyemi, AB, Fehintola, AO, Anyabolu, HC, Kuti, BP, Famurewa, OC, Ande, ABA, Okonkwo, I, Peter, AA, Olugbenga, M, Adesiyun, O, Isah, AD, Kudirat, OE, Abiodun, O, Dedeke, OF, Oyeneyin, L, Akinkunmi, FB, Soofi, SB, Najimi, N, Ali, M, Anwar, J, Zulfiqar, S, Sikander, R, Rani, S, Sheikh, S, and Memon, S

Abstract

BACKGROUND: Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. METHODS/DESIGN: The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up).

Published
2019

25. The epidemiology of syphilis in pregnancy

Author

Lumbiganon, P, Piaggio, G, Villar, J, Pinol, A, Bakketeig, L, Bergsjo, P, Al-Mazrou, Y, Ba'aqeel, H, Belizán, J M, Farnot, U, Carroli, G, and Berendes, H

Published
2002

27. WHO Statement on Caesarean Section Rates

Author

Betran, AP, Torloni, MR, Zhang, JJ, Gülmezoglu, AM, Aleem, HA, Althabe, F, Bergholt, T, de Bernis, L, Carroli, G, Deneux‐Tharaux, C, Devlieger, R, Debonnet, S, Duan, T, Hanson, C, Hofmeyr, J, Gonzalez Pérez, R, de Jonge, A, Khan, K, Lansky, S, Lazdane, G, Lumbiganon, P, Mackeen, D, Mahaini, R, Manyame, S, Mathai, M, Mikolajczyk, R, Mori, R, De Mucio, B, Oladapo, OT, Ortiz‐Panozo, E, Ouedraogo, L, Parker, C, Robson, M, Serruya, S, Souza, JP, Spong, CY, Stanton, C, Stanton, ME, Sullivan, EA, Temmerman, M, Tita, A, Tunçalp, Ӧ, Velebil, P, Vogel, JP, Weber, M, Wojdyla, D, Ye, J, Yunis, K, Zamora, J, and Zongo, A

Subjects
Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Consensus Development Conferences as Topic, Population, MEDLINE, Scientific literature, Appropriate technology, Global Health, World Health Organization, 03 medical and health sciences, 0302 clinical medicine, Case mix index, Pregnancy, Commentaries, Health care, Global health, medicine, Humans, Caesarean section, 030212 general & internal medicine, education, Obstetrics & Reproductive Medicine, 11 Medical and Health Sciences, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Cesarean Section, Obstetrics and Gynecology, medicine.disease, MONITORAMENTO, Commentary, Female, Medical emergency, business
Abstract

In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10–15%’.1 Over the years, this quote has become ubiquitous in scientific literature, being interpreted as the ideal CS rate. Although this reference range was intended for ‘populations’, which are defined by geopolitical boundaries, in many instances it has been mistakenly used as the measurement for healthcare facilities regardless of their complexity or other characteristics. In addition to the case mix of the obstetric population served, the use of CS at healthcare facilities is also affected by factors such as their capacity to handle cases, availability of resource and the clinical management protocols used locally.

Published
2015

29. <scp>WHO</scp> Statement on Caesarean Section Rates

Author

Betran, AP, Torloni, MR, Zhang, JJ, Gülmezoglu, AM, Aleem, HA, Althabe, F, Bergholt, T, Bernis, L, Carroli, G, Deneux‐Tharaux, C, Devlieger, R, Debonnet, S, Duan, T, Hanson, C, Hofmeyr, J, Gonzalez Pérez, R, Jonge, A, Khan, K, Lansky, S, Lazdane, G, Lumbiganon, P, Mackeen, D, Mahaini, R, Manyame, S, Mathai, M, Mikolajczyk, R, Mori, R, De Mucio, B, Oladapo, OT, Ortiz‐Panozo, E, Ouedraogo, L, Parker, C, Robson, M, Serruya, S, Souza, JP, Spong, CY, Stanton, C, Stanton, ME, Sullivan, EA, Temmerman, M, Tita, A, Tunçalp, Ӧ, Velebil, P, Vogel, JP, Weber, M, Wojdyla, D, Ye, J, Yunis, K, Zamora, J, and Zongo, A

Published
2015

30. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years

Author

Duley, L, Farrell, B, Armstrong, N, Spark, P, Roberts, B, Smyth, R, Tivnan, M, Laws, A, Corfield, N, Salter, A, Thorn, L, Altman, D, Yu, L-M, Abalos, E, Carroli, B, Dellepiane, L, Duarte, M, Fernandez, H, Giordano, D, Clarke, M, Gray, A, Hey, E, Neilson, J, Simon, J, Collins, R, Karaoglou, A, Lilford, R, Moodley, J, Robson, S, Roberts, I, Rubin, P, Thornton, J, Twaddle, S, Villar, J, Walker, I, Watkins, C, Doyle, L, Bimbashi, A, Demalia, E, Gliozheni, O, Shpata, A, Karolinski, A, Lamas, M, Pesaresi, M, Wainer, V, Barbato, W, Paciocco, M, Bertin, M, Boiza, E, Castaldi, J, Partida, Y, Arias, C, Farri, M, Kerz, G, Aguirre, J, de Sagastizabal, M, Falcone, R, Morales, E, Carroli, G, Krupitzky, S, Lopez, S, Palermo, M, Varela, DM, Delprato, H, Camusso, H, Curioni, M, Ludmer, E, Brandi, R, Martin, R, Mesas, W, Taralli, R, Lezaola, M, Morosini, M, Andina, E, Bernal, L, Estiu, M, Ulens, E, de Speranza, BO, Peyrano, A, Damiano, M, Saumench, C, Horn, J, Pritchard, M, Smith-Orr, V, Wilson, M, Lawrence, A, Watson, D, Crowther, C, Paynter, J, Mannan, M, Shahidullah, M, Shamsuddin, L, Santos, CB, Freire, S, Melo, E, Cobo, E, Jaramillo, M, Cardozo, C, Fandino, N, Gaitan, H, Montano, L, Lozano, J, Rojas, M, Garcia, AB, Ramirez, AF, Miras, RG, Sampera, S, Farnot, U, Gomez, E, Rojas, G, Valdes, R, El-Kreem, HA, Al-Hussaini, T, Hammad, E, Danso, K, Kwapong, E, Ofosu-Barko, F, Jasper, MP, Peedicayil, A, Regi, A, Sharma, R, Chauhan, A, Raut, V, Udani, R, Batra, S, Muthal-Rathore, A, Ramji, S, Zutshi, V, Balakrishnan, S, Eapen, E, Koshy, G, Ambardar, B, Vadakkepat, P, Vaidya, D, Lema, V, Rijken, Y, Tadesse, E, Dada, O, Sofekun, A, Ohiaeri, C, Runsewe-Abiodun, T, Adewole, I, Adeyemo, A, Brown, B, Oladokun, R, Adewale, O, Inimgba, N, John, C, Ogu, R, Ekele, B, Isah, A, Onankpa, B, Jamelle, R, Junejo, D, Faiz, N, Gul, F, Sherin, A, Bangash, K, Mahmud, G, Masud, K, Tasneem, N, Gassama, S, Soyei, A, Agarwal, P, Rajadurai, V, Pirani, N, Delport, S, Macdonald, P, Mokhondo, R, Pattinson, R, Zondo, M, Adhikari, M, Mnguni, N, Carstens, M, Kirsten, G, Steyn, W, van Zyl, J, Helwig, A, Jacobson, S-L, Panosche, R, Hammond, E, Masanganise, L, and Colla, MTF-US

Subjects
Pediatrics, medicine.medical_specialty, Randomization, pre-eclampsia, magnesium sulphate, Population, Maternal Medicine, Placebo, law.invention, Longterm follow-up, Magnesium Sulfate, Randomized controlled trial, Interquartile range, law, Pregnancy, Risk Factors, Medicine, Humans, Maternal Health Services, education, Child, education.field_of_study, Eclampsia, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, Patient Acceptance of Health Care, medicine.disease, randomised trial, Clinical trial, Maternal Mortality, Relative risk, Anticonvulsants, Female, business, Follow-Up Studies
Abstract

Objective: The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia. Design: Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998-2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre-eclampsia. Setting: Follow up after discharge from hospital at 125 centres in 19 countries across five continents. Population: A total of 7927 women were randomised at the follow-up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where

Published
2006

31. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

Author

Souza, JP, Betran, AP, Dumont, A, de Mucio, B, Pickens, CMG, Deneux-Tharaux, C, Ortiz-Panozo, E, Sullivan, E, Ota, E, Togoobaatar, G, Carroli, G, Knight, H, Zhang, J, Cecatti, JG, Vogel, JP, Jayaratne, K, Leal, MC, Gissler, M, Morisaki, N, Lack, N, Oladapo, OT, Tuncalp, O, Lumbiganon, P, Mori, R, Quintana, S, Passos, ADC, Marcolin, AC, Zongo, A, Blondel, B, Hernandez, B, Hogue, CJ, Prunet, C, Landman, C, Ochir, C, Cuesta, C, Pileggi-Castro, C, Walker, D, Alves, D, Abalos, E, Moises, ECD, Vieira, EM, Duarte, G, Perdona, G, Gurol-Urganci, I, Takahiko, K, Moscovici, L, Campodonico, L, Oliveira-Ciabati, L, Laopaiboon, M, Danansuriya, M, Nakamura-Pereira, M, Costa, ML, Torloni, MR, Kramer, MR, Borges, P, Olkhanud, PB, Perez-Cuevas, R, Agampodi, SB, Mittal, S, Serruya, S, Bataglia, V, Li, Z, Temmerman, M, Guelmezoglu, AM, Souza, JP, Betran, AP, Dumont, A, de Mucio, B, Pickens, CMG, Deneux-Tharaux, C, Ortiz-Panozo, E, Sullivan, E, Ota, E, Togoobaatar, G, Carroli, G, Knight, H, Zhang, J, Cecatti, JG, Vogel, JP, Jayaratne, K, Leal, MC, Gissler, M, Morisaki, N, Lack, N, Oladapo, OT, Tuncalp, O, Lumbiganon, P, Mori, R, Quintana, S, Passos, ADC, Marcolin, AC, Zongo, A, Blondel, B, Hernandez, B, Hogue, CJ, Prunet, C, Landman, C, Ochir, C, Cuesta, C, Pileggi-Castro, C, Walker, D, Alves, D, Abalos, E, Moises, ECD, Vieira, EM, Duarte, G, Perdona, G, Gurol-Urganci, I, Takahiko, K, Moscovici, L, Campodonico, L, Oliveira-Ciabati, L, Laopaiboon, M, Danansuriya, M, Nakamura-Pereira, M, Costa, ML, Torloni, MR, Kramer, MR, Borges, P, Olkhanud, PB, Perez-Cuevas, R, Agampodi, SB, Mittal, S, Serruya, S, Bataglia, V, Li, Z, Temmerman, M, and Guelmezoglu, AM

Abstract

OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

Published
2016

35. A global reference for caesarean section rates (C‐Model): a multicountry cross‐sectional study

Author

Souza, JP, primary, Betran, AP, additional, Dumont, A, additional, de Mucio, B, additional, Gibbs Pickens, CM, additional, Deneux‐Tharaux, C, additional, Ortiz‐Panozo, E, additional, Sullivan, E, additional, Ota, E, additional, Togoobaatar, G, additional, Carroli, G, additional, Knight, H, additional, Zhang, J, additional, Cecatti, JG, additional, Vogel, JP, additional, Jayaratne, K, additional, Leal, MC, additional, Gissler, M, additional, Morisaki, N, additional, Lack, N, additional, Oladapo, OT, additional, Tunçalp, Ö, additional, Lumbiganon, P, additional, Mori, R, additional, Quintana, S, additional, Costa Passos, AD, additional, Marcolin, AC, additional, Zongo, A, additional, Blondel, B, additional, Hernández, B, additional, Hogue, CJ, additional, Prunet, C, additional, Landman, C, additional, Ochir, C, additional, Cuesta, C, additional, Pileggi‐Castro, C, additional, Walker, D, additional, Alves, D, additional, Abalos, E, additional, Moises, ECD, additional, Vieira, EM, additional, Duarte, G, additional, Perdona, G, additional, Gurol‐Urganci, I, additional, Takahiko, K, additional, Moscovici, L, additional, Campodonico, L, additional, Oliveira‐Ciabati, L, additional, Laopaiboon, M, additional, Danansuriya, M, additional, Nakamura‐Pereira, M, additional, Costa, ML, additional, Torloni, MR, additional, Kramer, MR, additional, Borges, P, additional, Olkhanud, PB, additional, Pérez‐Cuevas, R, additional, Agampodi, SB, additional, Mittal, S, additional, Serruya, S, additional, Bataglia, V, additional, Li, Z, additional, Temmerman, M, additional, and Gülmezoglu, AM, additional

Published
2015
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37. Outcomes of non-vertex second twins, following vertex vaginal delivery of first twin: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health

Author

Vogel, JP, Holloway, E, Cuesta, C, Carroli, G, Souza, JP, Barrett, J, Vogel, JP, Holloway, E, Cuesta, C, Carroli, G, Souza, JP, and Barrett, J

Abstract

BACKGROUND: Mode of delivery remains a topic of debate in vertex/non-vertex twin pregnancies. We used the WHO Global Survey dataset to determine the risk of adverse maternal/perinatal outcomes associated with presentation of the second twin, following vaginal delivery of a vertex first twin. METHODS: We analysed a derived dataset of twin pregnancies ≥ 32 weeks gestation where the first twin was vertex and delivered vaginally. Maternal, delivery and neonatal characteristics and adverse outcomes were reported by presentation of the second twin. Logistic regression models (adjusted for maternal and perinatal confounders, mode of delivery and region) were developed to determine odds of adverse outcomes associated with presentation. RESULTS: 1,424 twin pregnancies were included, 25.9% of these had a non-vertex second twin and Caesarean was more common in non-vertex presentations (6.2% vs 0.9%, p < 0.001). While the odds of Apgar < 7 at 5 minutes were higher in non-vertex presenting second twins (16.0% vs 11.4%, AOR 1.42 95% CI 1.01-2.00), the odds of maternal ICU admission (4.6% vs 1.7%, AOR 1.30, 95% CI 0.88-1.94), blood transfusion (6.0% vs 3.4%, AOR 1.23, 95% CI 0.67-2.25), stillbirth (7.6% vs 4.7%, AOR 1.15, 95% CI 0.72-1.73), early neonatal death (3.8% vs 2.1%, AOR 1.68, 95% CI 0.96-2.94), and NICU admission (26.6% vs 23.2%, AOR 0.93, 95% CI 0.62-1.39) were not. CONCLUSION: After a vaginal delivery of a vertex first twin, non-vertex presentation of the second twin is associated with increased odds of Apgar <7 at 5 minutes, but not of other maternal/perinatal outcomes. Presentation of the second twin is not as important a consideration in planning twin vaginal birth as previously considered.

Published
2014

38. Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exercise

Author

Souza, JP, Widmer, M, Guelmezoglu, AM, Lawrie, TA, Adejuyigbe, EA, Carroli, G, Crowther, C, Currie, SM, Dowswell, T, Hofmeyr, J, Lavender, T, Lawn, J, Mader, S, Martinez, FE, Mugerwa, K, Qureshi, Z, Silvestre, MA, Soltani, H, Torloni, MR, Tsigas, EZ, Vowles, Z, Ouedraogo, L, Serruya, S, Al-Raiby, J, Awin, N, Obara, H, Mathai, M, Bahl, R, Martines, J, Ganatra, B, Phillips, SJ, Johnson, BR, Vogel, JP, Oladapo, OT, Temmerman, M, Souza, JP, Widmer, M, Guelmezoglu, AM, Lawrie, TA, Adejuyigbe, EA, Carroli, G, Crowther, C, Currie, SM, Dowswell, T, Hofmeyr, J, Lavender, T, Lawn, J, Mader, S, Martinez, FE, Mugerwa, K, Qureshi, Z, Silvestre, MA, Soltani, H, Torloni, MR, Tsigas, EZ, Vowles, Z, Ouedraogo, L, Serruya, S, Al-Raiby, J, Awin, N, Obara, H, Mathai, M, Bahl, R, Martines, J, Ganatra, B, Phillips, SJ, Johnson, BR, Vogel, JP, Oladapo, OT, and Temmerman, M

Abstract

BACKGROUND: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. METHODS: We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international stakeholders constituting a large reference group, and consolidated into a final list of research questions by a technical working group. Questions on this list were then scored by the reference working group according to five independent and equally weighted criteria. Normalized research priority scores (NRPS) were calculated, and research priority questions were ranked accordingly. RESULTS: A list of 190 priority research questions for improving maternal and perinatal health was scored by 140 stakeholders. Most priority research questions (89%) were concerned with the evaluation of implementation and delivery of existing interventions, with research subthemes frequently concerned with training and/or awareness interventions (11%), and access to interventions and/or services (14%). Twenty-one questions (11%) involved the discovery of new interventions or technologies. CONCLUSIONS: Key research priorities in maternal and perinatal health were identified. The resulting ranked list of research questions provides a valuable resource for health research investors, researchers and other stakeholders. We are hopeful that this exercise will inform the post-2015 Development Agenda and assist donors, research-policy decision makers and researchers to invest in research that will ultimately make the most sig

Published
2014

39. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months

Author

Duley, L, Farrell, B, Armstrong, N, Spark, P, Roberts, B, Smyth, R, Tivnan, M, Laws, A, Corfield, N, Salter, A, Thorn, L, Altman, D, Yu, L-M, Abalos, E, Carroli, B, Dellepiane, L, Duarte, M, Fernandez, H, Giordano, D, Clarke, M, Gray, A, Hey, E, Neilson, J, Simon, J, Doyle, L, Kelly, T, Squires, J, Collins, R, Karaoglou, A, Lilford, R, Moodley, J, Robson, S, Roberts, I, Rubin, P, Thornton, J, Twaddle, S, Villar, J, Walker, I, Watkins, C, Bimbashi, A, Demalia, E, Gliozheni, O, Shpata, A, Karolinski, A, Lamas, M, Pesaresi, M, Wainer, V, Barbato, W, Paciocco, M, Bertin, M, Boiza, E, Castaldi, J, Partida, Y, Farri, M, Kerz, G, Aguirre, J, de Sagastiza, M, Falcone, R, Morales, E, Carroli, G, Krupitzky, S, Lopez, S, Palermo, M, Varela, DM, Delprato, H, Camusso, H, Curioni, M, Ludmer, E, Brandi, R, Martin, R, Mesas, W, Taralli, R, Lezaola, M, Morosini, M, Andina, E, Bernal, L, Estiu, M, Ulens, E, de Speranza, BO, Peyrano, A, Damiano, M, Saumench, C, Horn, J, Pritchard, M, Smith-Orr, V, Wilson, M, Lawrence, A, Watson, D, Crowther, C, Paynter, J, Mannan, M, Shahidullah, M, Shamsuddin, L, Barros Santos, C, Freire, S, Melo, E, Cobo, E, Jaramillo, M, Cardozo, C, Fandino, N, Gaitan, H, Montano, L, Lozano, J, Rojas, M, Breto Garcia, A, Fuentes Ramirez, A, Garcia Miras, R, Sampera, S, Farnot, U, Gomez, E, Rojas, G, Valdez, R, El-Kreem, HA, Al-Hussaini, T, Hammad, E, Danso, K, Kwapong, E, Ofosu-Barko, F, Jasper, MP, Peedicayil, A, Regi, A, Sharma, R, Chauhan, A, Raut, V, Udani, R, Batra, S, Muthal-Rathore, A, Ramji, S, Zutshi, V, Balakrishnan, S, Eapen, E, Koshy, G, Ambardar, B, Vadakkepat, P, Vaidya, D, Lema, V, Rijken, Y, Tadesse, E, Dada, O, Sofekun, A, Ohiaeri, C, Runsewe-Abiodun, T, Adewole, I, Adeyemo, A, Brown, B, Oladokun, R, Adewale, O, Inimgba, N, John, C, Ogu, R, Ekele, B, Isah, A, Onankpa, B, Jamelle, R, Junejo, D, Faiz, NR, Gul, F, Sherin, A, Bangash, K, Mahmud, G, Masud, K, Tasneem, N, Gassama, S, Soyei, A, Agarwal, P, Rajadurai, V, Hani, C, Pirani, N, Delport, S, Macdonald, P, Mokhondo, R, Pattinson, R, Zondo, M, Adhikari, M, Mnguni, N, Carstens, M, Kirsten, G, Steyn, W, van Zyl, J, Helwig, A, Jacobson, S-L, Panosche, R, Hammond, E, Masanganise, L, and Collabor, MTFS

Subjects
Pediatrics, medicine.medical_specialty, pre-eclampsia, magnesium sulphate, Maternal Medicine, Placebo, Preeclampsia, law.invention, Longterm follow-up, Disability Evaluation, Magnesium Sulfate, Randomized controlled trial, law, Pregnancy, medicine, Humans, reproductive and urinary physiology, Cause of death, Eclampsia, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, Infant, medicine.disease, randomised trial, female genital diseases and pregnancy complications, Disabled Children, Clinical trial, In utero, Prenatal Exposure Delayed Effects, Sensation Disorders, Anticonvulsants, Female, Nervous System Diseases, business
Abstract

Objective To assess the long-term effects of in utero exposure to magnesium sulphate for children whose mothers had pre-eclampsia. Design Assessment at 18 months of age for children whose mothers were recruited to the Magpie Trial (recruitment 1998–2001 ISRCTN 86938761), which compared magnesium sulphate with placebo. Setting Follow-up of children born at 125 centres in 19 countries across five continents. Population A total of 6922 children were born to women randomised before delivery at follow-up centres. Of these, 2271 were not included for logistic reasons and 168 were excluded (101 at a centre where

Published
2007

40. Moving Beyond Essential Interventions for Reduction of Maternal Mortality (the WHO Multicountry Survey on Maternal and Newborn Health)

Author

Souza, J.P., primary, Gülmezoglu, A.M., additional, Vogel, J., additional, Carroli, G., additional, Lumbiganon, P., additional, Qureshi, Z., additional, Costa, M.J., additional, Fawole, B., additional, Mugerwa, Y., additional, Nafiou, I., additional, Neves, I., additional, Wolomby-Molondo, J.J., additional, Bang, H.T., additional, Cheang, K., additional, Chuyun, K., additional, Jayaratne, K., additional, Jayathilaka, C.A., additional, Mazhar, S.B., additional, Mori, R., additional, Mustafa, M.L., additional, Pathak, L.R., additional, Perera, D., additional, Rathavy, T., additional, Recidoro, Z., additional, Roy, M., additional, Ruyan, P., additional, Shrestha, N., additional, Taneepanichsku, S., additional, Tien, N.V., additional, Ganchimeg, T., additional, Wehbe, M., additional, Yadamsuren, B., additional, Yan, W., additional, Yunis, K., additional, Bataglia, V., additional, Cecatti, J.G., additional, Hernandez-Prado, B., additional, Nardin, J.M., additional, Narváez, A., additional, Ortiz-Panozo, E., additional, Pérez-Cuevas, R., additional, Valladares, E., additional, Zavaleta, N., additional, Armson, A., additional, Crowther, C., additional, Hogue, C., additional, Lindmark, G., additional, Mittal, S., additional, Pattinson, R., additional, Stanton, M.E., additional, Campodonico, L., additional, Cuesta, C., additional, Giordano, D., additional, Intarut, N., additional, Laopaiboon, M., additional, Bahl, R., additional, Martines, J., additional, Mathai, M., additional, Merialdi, M., additional, and Say, L., additional

Published
2014
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41. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial

Author

Vogel, JP, Abu Habib, N, Souza, JP, Guelmezoglu, AM, Dowswell, T, Carroli, G, Baaqeel, HS, Lumbiganon, P, Piaggio, G, Oladapo, OT, Vogel, JP, Abu Habib, N, Souza, JP, Guelmezoglu, AM, Dowswell, T, Carroli, G, Baaqeel, HS, Lumbiganon, P, Piaggio, G, and Oladapo, OT

Abstract

BACKGROUND: In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality. METHODS: Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age. RESULTS: 12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups. CONCLUSION: It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is

Published
2013

43. Prophylactic use of oxytocin in the third stage of labour

Author

Elbourne, DR, Prendiville, WJ, Carroli, G, Wood, J, and McDonald, S

Abstract

BACKGROUND: Many maternal deaths across the world result from complications of the third stage of labour (when the placenta is delivered). OBJECTIVES: To examine the effect of oxytocin given prophylactically in the third stage of labour on maternal and neonatal outcomes. SEARCH STRATEGY: Relevant trials were identified in the Cochrane Collaboration Controlled Trials Register and the Pregnancy and Childbirth Review Group's Specialised Register of Controlled Trials. Date of last search: May 2001. SELECTION CRITERIA: All acceptably randomised or quasi-randomised controlled trials including pregnant women anticipating a vaginal delivery where oxytocin was given prophylactically for the third stage of labour. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies for relevance and methodological quality, and extracted data. Analysis was by intention to treat. Subgroup analyses were based on extent of selection bias, oxytocin in the context of active or expectant management of the third stage, and timing of administration. Results are presented as relative risks, and weighted mean difference, both with 95% confidence intervals using a fixed effects model. MAIN RESULTS: In seven trials involving over 3000 women in hospital and/or developed country settings, prophylactic oxytocin showed benefits (reduced blood loss (relative risk (RR) for blood loss > 500 ml 0.50; 95% confidence interval (CI) 0.43, 0.59) and need for therapeutic oxytocics (RR 0.50; 95% CI 0.39, 0.64).) compared to no uterotonics, although there was a non-significant trend towards more manual removal of the placenta (RR 1.17; 95% CI 0.79, 1.73) which was most marked in the expectant management subgroup, and blood transfusions (RR 1.30; 95% CI 0.50, 3.39) in the trials with more manual removals of the placenta). In six trials involving over 2800 women, there was little evidence of differential effects for oxytocin versus ergot alkaloids, except ergot alkaloids are associated with more manual removals of the placenta (RR 0.57; 95% CI 0.41, 0.79), and with the suggestion of more raised blood pressure (RR 0.53; 95% CI 0.19, 1.58) than with oxytocin. In five trials involving over 2800 women, there was little evidence of a synergistic effects of adding oxytocin to ergometrine versus ergometrine alone. For all other outcomes in the comparisons either there are no data or the number of adverse events is very small, and so definite conclusions cannot be drawn. REVIEWER'S CONCLUSIONS: There are strong suggestions of benefit for oxytocin in terms of postpartum haemorrhage, and the need for therapeutic oxytocics, but without sufficient information about other outcomes and side-effects it is difficult to be confident about the trade-offs for these benefits, especially if the risk of manual removal of the placenta may be increased. There seems little evidence in favour of ergot alkaloids alone compared to either oxytocin alone, or to Syntometrine, but the data are sparse. More trials are needed in domiciliary deliveries in developing countries, which shoulder most of the burden of third stage complications.

Published
2001

44. The Magpie Trial:: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia.: Outcome for women at 2 years

Author

Duley, L, Farrell, B, Armstrong, N, Spark, P, Roberts, B, Smyth, R, Tivnan, M, Laws, A, Corfield, N, Salter, A, Thorn, L, Altman, D, Yu, L-M, Abalos, E, Carroli, B, Dellepiane, L, Duarte, M, Fernandez, H, Giordano, D, Clarke, M, Gray, A, Hey, E, Neilson, J, Simon, J, Collins, R, Karaoglou, A, Lilford, R, Moodley, J, Robson, S, Roberts, I, Rubin, P, Thornton, J, Twaddle, S, Villar, J, Walker, I, Watkins, C, Doyle, L, Bimbashi, A, Demalia, E, Gliozheni, O, Shpata, A, Karolinski, A, Lamas, M, Pesaresi, M, Wainer, V, Barbato, W, Paciocco, M, Bertin, M, Boiza, E, Castaldi, J, Partida, Y, Arias, C, Farri, M, Kerz, G, Aguirre, J, de Sagastizabal, M, Falcone, R, Morales, E, Carroli, G, Krupitzky, S, Lopez, S, Palermo, M, Varela, DM, Delprato, H, Camusso, H, Curioni, M, Ludmer, E, Brandi, R, Martin, R, Mesas, W, Taralli, R, Lezaola, M, Morosini, M, Andina, E, Bernal, L, Estiu, M, Ulens, E, de Speranza, BO, Peyrano, A, Damiano, M, Saumench, C, Horn, J, Pritchard, M, Smith-Orr, V, Wilson, M, Lawrence, A, Watson, D, Crowther, C, Paynter, J, Ashrafunnessa, Mannan, M, Shahidullah, M, Shamsuddin, L, Santos, CB, Freire, S, Melo, E, Cobo, E, Jaramillo, M, Cardozo, C, Fandino, N, Gaitan, H, Montano, L, Lozano, J, Rojas, M, Garcia, AB, Ramirez, AF, Miras, RG, Sampera, S, Farnot, U, Gomez, E, Rojas, G, Valdes, R, El-Kreem, HA, Al-Hussaini, T, Hammad, E, Danso, K, Kwapong, E, Ofosu-Barko, F, Jasper, MP, Peedicayil, A, Regi, A, Sharma, R, Chauhan, A, Raut, V, Udani, R, Batra, S, Muthal-Rathore, A, Ramji, S, Zutshi, V, Balakrishnan, S, Eapen, E, Koshy, G, Ambardar, B, Vadakkepat, P, Vaidya, D, Lema, V, Rijken, Y, Tadesse, E, Dada, O, Sofekun, A, Ohiaeri, C, Runsewe-Abiodun, T, Adewole, I, Adeyemo, A, Brown, B, Oladokun, R, Adewale, O, Inimgba, N, John, C, Ogu, R, Ekele, B, Isah, A, Onankpa, B, Jamelle, R, Junejo, D, Faiz, N, Gul, F, Sherin, A, Bangash, K, Mahmud, G, Masud, K, Tasneem, N, Gassama, S, Soyei, A, Agarwal, P, Rajadurai, V, Pirani, N, Delport, S, Macdonald, P, Mokhondo, R, Pattinson, R, Zondo, M, Adhikari, M, Mnguni, N, Carstens, M, Kirsten, G, Steyn, W, van Zyl, J, Helwig, A, Jacobson, S-L, Panosche, R, Hammond, E, Masanganise, L, Duley, L, Farrell, B, Armstrong, N, Spark, P, Roberts, B, Smyth, R, Tivnan, M, Laws, A, Corfield, N, Salter, A, Thorn, L, Altman, D, Yu, L-M, Abalos, E, Carroli, B, Dellepiane, L, Duarte, M, Fernandez, H, Giordano, D, Clarke, M, Gray, A, Hey, E, Neilson, J, Simon, J, Collins, R, Karaoglou, A, Lilford, R, Moodley, J, Robson, S, Roberts, I, Rubin, P, Thornton, J, Twaddle, S, Villar, J, Walker, I, Watkins, C, Doyle, L, Bimbashi, A, Demalia, E, Gliozheni, O, Shpata, A, Karolinski, A, Lamas, M, Pesaresi, M, Wainer, V, Barbato, W, Paciocco, M, Bertin, M, Boiza, E, Castaldi, J, Partida, Y, Arias, C, Farri, M, Kerz, G, Aguirre, J, de Sagastizabal, M, Falcone, R, Morales, E, Carroli, G, Krupitzky, S, Lopez, S, Palermo, M, Varela, DM, Delprato, H, Camusso, H, Curioni, M, Ludmer, E, Brandi, R, Martin, R, Mesas, W, Taralli, R, Lezaola, M, Morosini, M, Andina, E, Bernal, L, Estiu, M, Ulens, E, de Speranza, BO, Peyrano, A, Damiano, M, Saumench, C, Horn, J, Pritchard, M, Smith-Orr, V, Wilson, M, Lawrence, A, Watson, D, Crowther, C, Paynter, J, Ashrafunnessa, Mannan, M, Shahidullah, M, Shamsuddin, L, Santos, CB, Freire, S, Melo, E, Cobo, E, Jaramillo, M, Cardozo, C, Fandino, N, Gaitan, H, Montano, L, Lozano, J, Rojas, M, Garcia, AB, Ramirez, AF, Miras, RG, Sampera, S, Farnot, U, Gomez, E, Rojas, G, Valdes, R, El-Kreem, HA, Al-Hussaini, T, Hammad, E, Danso, K, Kwapong, E, Ofosu-Barko, F, Jasper, MP, Peedicayil, A, Regi, A, Sharma, R, Chauhan, A, Raut, V, Udani, R, Batra, S, Muthal-Rathore, A, Ramji, S, Zutshi, V, Balakrishnan, S, Eapen, E, Koshy, G, Ambardar, B, Vadakkepat, P, Vaidya, D, Lema, V, Rijken, Y, Tadesse, E, Dada, O, Sofekun, A, Ohiaeri, C, Runsewe-Abiodun, T, Adewole, I, Adeyemo, A, Brown, B, Oladokun, R, Adewale, O, Inimgba, N, John, C, Ogu, R, Ekele, B, Isah, A, Onankpa, B, Jamelle, R, Junejo, D, Faiz, N, Gul, F, Sherin, A, Bangash, K, Mahmud, G, Masud, K, Tasneem, N, Gassama, S, Soyei, A, Agarwal, P, Rajadurai, V, Pirani, N, Delport, S, Macdonald, P, Mokhondo, R, Pattinson, R, Zondo, M, Adhikari, M, Mnguni, N, Carstens, M, Kirsten, G, Steyn, W, van Zyl, J, Helwig, A, Jacobson, S-L, Panosche, R, Hammond, E, and Masanganise, L

Abstract

OBJECTIVE: The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia. DESIGN: Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998-2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre-eclampsia. SETTING: Follow up after discharge from hospital at 125 centres in 19 countries across five continents. POPULATION: A total of 7927 women were randomised at the follow-up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced. METHODS: Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed. Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources. RESULTS: Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). CONCLUSIONS: The reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.

Published
2007

45. WHO systematic review of randomised controlled trials of routine antenatal care.

Author

Carroli G, Villar J, Piaggio G, Khan-Neelofur D, Gülmezoglu M, Mugford M, Lumbiganon P, Farnot U, Bersgjø P, WHO Antenatal Care Trial Research Group, Carroli, G, Villar, J, Piaggio, G, Khan-Neelofur, D, Gülmezoglu, M, Mugford, M, Lumbiganon, P, Farnot, U, and Bersgjø, P

Abstract

Background: There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was that a model with a lower number of antenatal visits, with or without goal-oriented components, would be as effective as the standard antenatal-care model in terms of clinical outcomes, perceived satisfaction, and costs.Methods: The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were pre-eclampsia, urinary-tract infection, postpartum anaemia, maternal mortality, low birthweight, and perinatal mortality. We also selected measures of women's satisfaction with care and cost-effectiveness. This review drew on the search strategy developed for the Cochrane Pregnancy and Childbirth Group of the Cochrane Collaboration.Findings: Seven eligible randomised controlled trials were identified. 57418 women participated in these studies: 30799 in the new-model groups (29870 with outcome data) and 26619 in the standard-model groups (25821 with outcome data). There was no clinically differential effect of the reduced number of antenatal visits when the results were pooled for pre-eclampsia (typical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal statistical equivalence to be attained. Some dissatisfaction with care, particularly among women in more developed countries, was observed with the new model. The cost of the new model was equal to or less than that of the standard model.Interpretation: A model with a reduced number of antenatal visits, with or without goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved. [ABSTRACT FROM AUTHOR]

Published
2001
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48. Misoprostol as an Adjunct to Standard Uterotonics for Treatment of Postpartum Hemorrhage

Author

Widmer, M., primary, Blum, J., additional, Hofmeyr, G.J., additional, Carroli, G., additional, Abdel-Aleem, H., additional, Lumbiganon, P., additional, Nguyen, T.N., additional, Wojdyla, D., additional, Thinkhamrop, J., additional, Singata, M., additional, Mignini, L.E., additional, Abdel-Aleem, M.A., additional, Tran, S.T., additional, and Winikoff, B., additional

Published
2011
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49. Method of Delivery and Pregnancy Outcomes in Asia

Author

Lumbiganon, P., primary, Laopaiboon, M., additional, Gülmezoglu, A.M., additional, Souza, J.P., additional, Taneepanichskul, S., additional, Ruyan, P., additional, Attygalle, D.E., additional, Shrestha, N., additional, Mori, R., additional, Nguyen, D.H., additional, Hoang, T.B., additional, Rathavy, T., additional, Chuyun, K., additional, Cheang, K., additional, Festin, M., additional, Udomprasertgul, V., additional, Germar, M.J., additional, Yanqiu, G., additional, Roy, M., additional, Carroli, G., additional, Ba-Thike, K., additional, Filatova, E., additional, and Villar, J., additional

Published
2011
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50. Womens' opinions on antenatal care in developing countries: results of astudy in Cuba, Thailand, Saudi Arabia and Argentina.

Author

Nigenda, G, Langer, A, Kuchaisit, C, Romero, M, Rojas, G, Al-Osimy, M, Villar, J, Garcia, J, Al-Mazrou, Y, Ba'aqeel, H, Carroli, G, Farnot, U, Lumbiganon, P, Belizan, J, Bergsjo, P, Bakketeig, L, Lindmark, G, Nigenda, G, Langer, A, Kuchaisit, C, Romero, M, Rojas, G, Al-Osimy, M, Villar, J, Garcia, J, Al-Mazrou, Y, Ba'aqeel, H, Carroli, G, Farnot, U, Lumbiganon, P, Belizan, J, Bergsjo, P, Bakketeig, L, and Lindmark, G

Published
2003

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