Haim A. Abenhaim

Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United States

OBJECTIVE Amniotic fluid embolism (AFE) is a condition occurring during delivery that can lead to severe maternal morbidity and mortality. Given the rarity of its occurrence, current estimates and predictors of the incidence and outcomes are often difficult to obtain. STUDY DESIGN We conducted a population-based cohort study on 3 million birth records in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2003 to estimate the incidence and case fatality of AFEs. Logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (CIs) of demographic and obstetrical determinants of AFEs and fatal AFEs. RESULTS The overall incidence of AFE was 7.7 per 100,000 births (95% CI 6.7 to 8.7), with a case fatality rate of 21.6% (95% CI 15.5 to 27.6%). AFE was associated with maternal age greater than 35 (OR 2.2, 95% CI 1.5 to 2.1), placenta previa (OR 30.4, 95% CI 15.4 to 60.1), and cesarean delivery (OR 5.7, 95% CI 3.7 to 8.7). Although AFEs were not significantly associated with induction of labor (OR 1.5, 95% CI 0.9 to 2.3), they were associated with preeclampsia, abruptio placentae, and the use of forceps. Among women with an AFE, common demographic or obstetrical determinants were not predictive of maternal mortality. CONCLUSION AFE is a rare but serious condition that is associated with advanced maternal age, placental pathologies, and cesarean deliveries. Further research on the treatment of this condition is necessary.

Effect of Fear of Litigation on Obstetric Care: A Nationwide Analysis on Obstetric Practice

The aim of our study was to investigate the influence of malpractice premiums paid by obstetricians on obstetric care across the United States. We conducted a retrospective cross-sectional population-based study using patient-level data obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample on every woman who delivered in 2006. Mode of delivery was compared with the average state medical liability insurance premium paid by obstetricians (Medical Liability Monitor and the National Association of Insurance Commissioners) using a generalized estimating equation to calculate crude and adjusted odds ratios. Our cohort included 890,266 women who delivered across 37 states in 2006. Average state malpractice premium of over

A Cluster-Randomized Trial to Reduce Cesarean Delivery Rates in Quebec

100,000 was associated with higher incidences of total cesarean deliveries (odds ratio [OR] 1.17, 95% confidence interval [CI]: 1.02, 1.35); lower incidences of vaginal births after cesarean deliveries (OR 0.60, 95% CI: 0.37, 0.98); and lower rates of instrumental deliveries (OR 0.72, 95% CI: 0.63, 0.83) compared with when the average state malpractice premium was less than

Socioeconomic and Racial Predictors of Undergoing Laparoscopic Hysterectomy for Selected Benign Diseases: Analysis of 341 487 Hysterectomies

50,000. Fear of litigation appears to have a marked effect on obstetric practice, particularly total cesarean delivery, vaginal birth after cesarean, and instrumental delivery, when malpractice premiums rise above

Drospirenone-containing oral contraceptive pills and the risk of venous and arterial thrombosis: a systematic review

100,000 per annum.

The effect of smoking cessation counselling in pregnant women: a meta‐analysis of randomised controlled trials

BACKGROUND In Canada, cesarean delivery rates have increased substantially over the past decade. Effective, safe strategies are needed to reduce these rates. METHODS We conducted a cluster-randomized, controlled trial of a multifaceted 1.5-year intervention at 32 hospitals in Quebec. The intervention involved audits of indications for cesarean delivery, provision of feedback to health professionals, and implementation of best practices. The primary outcome was the cesarean delivery rate in the 1-year postintervention period. RESULTS Among the 184,952 participants, 53,086 women delivered in the year before the intervention and 52,265 women delivered in the year following the intervention. There was a significant but small reduction in the rate of cesarean delivery from the preintervention period to the postintervention period in the intervention group as compared with the control group (change, 22.5% to 21.8% in the intervention group and 23.2% to 23.5% in the control group; odds ratio for incremental change over time, adjusted for hospital and patient characteristics, 0.90; 95% confidence interval [CI], 0.80 to 0.99; P=0.04; adjusted risk difference, -1.8%; 95% CI, -3.8 to -0.2). The cesarean delivery rate was significantly reduced among women with low-risk pregnancies (adjusted risk difference, -1.7%; 95% CI, -3.0 to -0.3; P=0.03) but not among those with high-risk pregnancies (P=0.35; P = 0.03 for interaction). The intervention group also had a reduction in major neonatal morbidity as compared with the control group (adjusted risk difference, -0.7%; 95% CI, -1.3 to -0.1; P=0.03) and a smaller increase in minor neonatal morbidity (adjusted risk difference, -1.7%; 95% CI, -2.6 to -0.9; P<0.001). Changes in minor and major maternal morbidity did not differ significantly between the groups. CONCLUSIONS Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies. (Funded by the Canadian Institutes of Health Research; QUARISMA Current Controlled Trials number, ISRCTN95086407.).

Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy

STUDY OBJECTIVE Socioeconomic status and race are important determinants of health care access in the United States. The purpose of our study was to evaluate whether these factors influence use of laparoscopic hysterectomy for management of benign gynecologic diseases. DESIGN Retrospective cohort study (Canadian Task Force classification II-3). SETTING Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 1998 to 2002. PATIENTS All records of women with primary discharge diagnosis of uterine leiomyomas or menorrhagia who underwent hysterectomy (laparoscopy or abdominal) were included in the study. INTERVENTIONS Race (Caucasian, African-American, Hispanic, or other), median household income (<

Higher Caesarean Section Rates in Women With Higher Body Mass Index: Are We Managing Labour Differently?

25000,

Maternal Marital Status and the Risk of Stillbirth and Infant Death: A Population-Based Cohort Study on 40 Million Births in the United States

25000-

Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births

34999,