| 1. |
- Begley, Cecily, 1954, et al.
(författare)
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Evaluation of an intervention to increase vaginal birth after caesarean section through enhanced women-centred care: The OptiBIRTH randomised trial (ISRCTN10612254)
- 2017
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Ingår i: 31th ICM Triennial Congress.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Vaginal birth after a previous caesarean (VBAC) is a safe alternative to repeat caesarean section (CS), is the preferred option of most women and may reduce overall CS rates.1 However, VBAC rates vary; e.g., rates in Germany, Ireland and Italy are considerably lower (29-36%) than those in the Netherlands, Sweden and Finland (45-55%). Purpose/Objective: To evaluate the effectiveness of an intervention to maximise VBAC rates. The OptiBIRTH Project was funded by a European Union Grant: FP7-HEALTH-2012-INNOVATION-1-HEALTH.2012.3.2-1. Agreement No:305208 Method: A cluster randomised trial was used. A sample size of 12 maternity units was required, each recruiting 120 consenting women, to detect an absolute 15% difference in successful VBACs (increase from 25% in control to 40% in intervention groups), using an ICC of 0.05, with power of >80% and an alpha of 0.05. To allow for loss to follow-up, 15 trial units were randomised across three countries with low VBAC rates (Germany, Ireland and Italy) and the trial commenced April 2014. An evidence-based intervention was introduced in all intervention sites. Control sites had usual care. Interim analysis by an independent Data Monitoring Committee at mid-point permitted continuation. Data were analysed using intention to treat. Key Findings: Recruitment closed October 2015, with the last babies born in December 2015, and data analysis will be completed in April 2016. The primary outcome, comparison of annual VBAC rates for each hospital before and after introduction of the intervention will be presented, and selected secondary outcomes for the recruited women including: mode of birth, perineal trauma, breastfeeding, uterine rupture, wound breakdown, perinatal mortality, Apgar scores, and admission to neonatal intensive care unit. Discussion: If the OptiBIRTH intervention increases VBAC rates safely, its introduction across Europe could prevent 160,000 unnecessary CSs every year, saving maternity services >€150 million annually and contributing to the normalisation of birth for thousands of women. References: 1 Cunningham et al (2010). National Institute of Health Consensus Development Conference Statement: Vaginal birth after caesarean. Obstet & Gynecol 115(6): 1279-1295. 2 EURO-PERISTAT 2008: CD006066.EURO-PERISTAT Project (2008). European Perinatal Health Report. (www.europeristat.com).
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| 2. |
- Daly, Deirdre, et al.
(författare)
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Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors.
- 2018
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 29:3, s. 353-362
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Tidskriftsartikel (refereegranskat)abstract
- While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained.We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy.Prevalence of any urinary leakagewas 34.8% before and 38.7% during pregnancy.Prevalence of UI,leaking urine at least once per month,was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5-5.6, p=0.001) and a body mass index (BMI) ≥30kg/m2 (AOR 4.2, 95% CI 1.9-9.4, p<0.001). Women aged ≥35years (AOR 2.8, 95% CI 1.4-5.9, p=0.005), women whose pre-pregnancy BMI was 25-29.99kg/m2 (AOR 2.0, 95% CI 1.2-3.5, p=0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6-4.1, p<0.005) were significantly more likely to report new-onset UI in pregnancy.Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.
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| 3. |
- Sinclair, Marlene, et al.
(författare)
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Assisting women in autonomous decision making about vaginal birth after C section (VBAC): Designing motivational Apps in OptiBIRTH cluster randomised trial (ISRCTN10612254
- 2017
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Ingår i: 31th ICM Triennial Congress 18-22 June 2017.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Optibirth is a funded FP7 research programme using a cluster randomised trial in Ireland, Germany and Italy, with 15 clusters of 94 women per cluster. The aim of OptiBIRTH is to evaluate the effectiveness of a complex intervention aimed at increased VBAC rates through enhanced women-centred care1 .The intervention consisted of motivationally enhanced, evidence-based, educational information for women and clinicians for use in face to face and online modes. Purpose/Objective: This paper reports the design process associated with creating three interrelated mobile apps, as part of a complex intervention, to enable women with a previous caesarean section to decide autonomously between a repeat caesarean section and a vaginal birth. The emphasis has been on using technology creatively and effectively maximizing optimality bearing in mind the needs of the new “Z” generation. Method: Focus groups were undertaken across six European countries to illicit women’s need for information about caesarean section and VBAC. Motivational theory underpinned the development of subsequent e-learning materials to enhance woman-led-decision-making. Ethical approval was obtained from Trinity College University, Dublin. Following analysis of focus group data, consultation with experts and exploration of technological solutions, three electronic applications were designed. Following three iterations, the Apps were reviewed for content, motivational design and functionality by Irish, German and Italian midwifery experts and translated into German and Italian. Key Findings: The following interrelated Apps were designed to provide women and health professionals with rapid access to women’s perceptions of their previous birth experience and their current decision-making-in-progress: “My birth story” uses a wordle to communicate past birth experience “My birth thoughts” enables women to communicate their current decision making “My Birth plan” generates a personalised birth plan Discussion: Discussion will focus on challenges facing midwives including, embedding the Apps into a motivationally-designed portal, staff support and training, timeline, cultural differences and translation issues
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| 4. |
- Smith, Valerie, et al.
(författare)
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Salutogenically focused outcomes in systematic reviews of intrapartum interventions:A systematic review of systematic reviews
- 2014
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 30:4
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Forskningsöversikt (refereegranskat)abstract
- Introduction: research on intrapartum interventions in maternity care has focused traditionally on the identification of risk factors' and on the reduction of adverse outcomes with less attention given to the measurement off actors that contribute to well-being and positive health outcomes.We conducted a systematic review of reviews to determine the type and number of salutogenically-focused reported outcomes in current maternity care intrapartum intervention-based research.For the conduct of this review,we interpreted salutogenic outcomes as tho se relating to optimum and/or positive maternal and neonatal health and well-being. Objectives: to identify salutogenically-focused outcomes reported in systematic reviews of randomised trials of intrapartum interventions. Review methods: we searched Issue 9(September 2011 of the Cochrane Database of Systematic Reviews for allreviews of intrapartum interventions published by the Cochrane Pregnancy and Childbirth Group using the group filter “hm-preg”. Systematic reviews of randomised trials ofi ntrapartum interventions were eligible for inclusion.We excluded protocols for systematic reviews and systematic reviews that had been withdrawn. Outcome data were extracted independently from each included review by at least two review authors.Unique lists of salutogenically and non-salutogenically focused outcomes wereestablished. Results: 16 salutogenically-focused outcome categories were identified in 102 included reviews. Maternal satisfaction and breastfeeding were reported most frequently. 49non-salutogenically-focusedoutcome categories were identified in the102 included reviews. Measures of neonatal morbidity were reported most frequently. Conclusion: there is an absence of salutogenically focused outcomes reported in intrapartum intervention- based research. We recommend the development of a core outcome dataset of salutogenically-focused outcomes for intrapartumresearch.
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| 5. |
- Smith, Valerie, et al.
(författare)
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Salutogenically focused outcomes in systematic reviews of intrapartum interventions: A systematic review of systematic reviews
- 2014
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Ingår i: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Salutogenesis explores health systematically in terms of movement along the health continuum, thereby eliminating a distinct dichotomy of being in a state of health or being in a state of disease. Currently there is little understanding of what constitutes salutogenically focused outcomes in maternity care. In evaluating current maternity care intrapartum intervention-based research, a systematic review of reviews, to determine the type and number of salutogenically-focused reported outcomes, was performed. Aim: To present the findings of this systematic review of systematic reviews. Methodology: Systematic reviews of randomsied trials of intrapartum interventions were eligible for inclusion. Protocols for systematic reviews and systematic reviews that had been withdrawn were excluded. Issue 9, 2011 of the Cochrane Database of Systematic Reviews was searched for all reviews published by the Cochrane Pregnancy and Childbirth Group using the group filter “hm-preg”. At least two review authors independently reviewed each review for inclusion and extracted the data using a purposively designed data extraction form. Any disagreements were resolved through within pair discussions or deferral to the team for consensus. Unique lists of salutogenically-focused and non-salutogenically-focused outcome categories were identified. Ethical approval: Not applicable. Findings: A total of 102 reviews were included. 135 salutogenically-focused outcomes were identified and collapsed into 16 outcome categories. Examples include maternal satisfaction, spontaneous vaginal birth, maternal parenting confidence and breastfeeding. 1632 non-salutogenically-focused outcomes, collapsed into 49 outcome categories, were identified. Examples include preterm birth, instrumental birth and neonatal death. Conclusion: The findings of this review support the hypothesis that the effectiveness of intrapartum interventions is measured against adverse outcomes rather than increases in measures of health and wellbeing. Given the relative absence of salutogenically-focused reported outcomes identified in this systematic review of reviews, the development of a core dataset of salutogenic outcomes for reporting in maternity care research, is recommended.
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