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The increasing prevalence of cesarean deliveries remains a challenge in modern obstetrics. In 2012 and 2014, updated recommendations for reducing cesarean deliveries among first-time mothers were introduced by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists. Recent study was a cluster randomized controlled trial conducted in 26 Canadian hospitals to assess whether the adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates in nulliparous women.

Study Design and Outcomes

The study included 13 control sites and 13 intervention sites. The primary outcome was the rate of cesarean delivery, and secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety.

Analysis and Findings

The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. The study found no evidence of a decrease in the rate of cesarean delivery associated with the intervention. However, a slight increase in the rate of spontaneous vaginal delivery was observed in the intervention group, with no differences in adverse maternal or neonatal outcomes.

Site-Specific Variation and Compliance

The researchers observed site-specific variation in the effectiveness of the guidelines on the cesarean delivery rate. They noted that compliance with the guidelines at the intervention sites was low (31%), which may account for the null results. However, compliance was higher at sites with a reduction in cesarean delivery and an increase in spontaneous vaginal delivery.

Conclusion and Implications

The study contributes important information to the challenge of reducing cesarean delivery rates. While the intervention did not result in a statistically significant reduction in cesarean deliveries, the safety data and the slight increase in spontaneous vaginal births suggest that this approach deserves further study, particularly in settings where compliance with the guidelines can be improved.

Key Points

Here are the 6 key points from the research paper:

1. This was a cluster randomized controlled trial conducted in 26 Canadian hospitals to assess whether the adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates in nulliparous women.

2. The primary outcome was the rate of cesarean delivery, and secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety.

3. The study found no evidence of a decrease in the rate of cesarean delivery associated with the intervention, but did observe a slight increase in the rate of spontaneous vaginal delivery in the intervention group, with no differences in adverse maternal or neonatal outcomes.

4. The researchers observed site-specific variation in the effectiveness of the guidelines on the cesarean delivery rate, and noted that compliance with the guidelines at the intervention sites was low (31%), which may account for the null results. However, compliance was higher at sites with a reduction in cesarean delivery and an increase in spontaneous vaginal delivery.

5. The study contributes important information to the challenge of reducing cesarean delivery rates, and suggests that this approach deserves further study, particularly in settings where compliance with the guidelines can be improved.

6. While the intervention did not result in a statistically significant reduction in cesarean deliveries, the safety data and the slight increase in spontaneous vaginal births indicate that this approach warrants additional investigation.

Reference –

Wood S, Skiffington J, Brant R, Crawford S, Hicks M, Mohammad K, Mrklas KJ, Tang S, Metcalfe A; REDUCED Trial Team. The REDUCED trial: a cluster randomized trial for REDucing the utilization of CEsarean delivery for dystocia. Am J Obstet Gynecol. 2023 May;228(5S):S1095-S1103. doi: 10.1016/j.ajog.2022.10.038. Epub 2023 Mar 16. PMID: 37164490.

A new study published in the journal of Human Reproduction showed that women confirmed to have premature ovarian insufficiency (POI) have an elevated frequency of certain particular autoimmune disorders. 1% of women have spontaneous premature ovarian insufficiency, which is characterized as the loss of ovarian function before the age of 40. The autoimmune processes affecting the ovaries that cause POI might appear alone. Autoimmunity has been proposed as a key player in the pathophysiology of POI. The proportion of POI patients with an autoimmune etiology has been estimated to be between 4% and 50%. Thus, this study by Savukoski and colleagues was to investigate any potential link between severe autoimmune illnesses and early ovarian insufficiency, both before and after the diagnosis of POI.

This community-based registry investigation included both case-control and cohort analysis, where 3972 women with spontaneous POI diagnoses between 1988 and 2017 were involved, along with 15,708 female population controls. Diagnoses of autoimmune diseases were assessed from childhood till the end of 2017. The Finnish Social Insurance Institution’s reimbursement registry data was used to identify women with POI based on their eligibility for hormone replacement treatment (HRT). For every POI instance, 4 female population controls who were matched based on age and place of residence were looked for in order to create a reference cohort. Women who had had a bilateral oophorectomy or a history of malignancy were not eligible. Diagnoses for severe autoimmune disorders from 1970 to 2017 were retrieved from the Hospital Discharge Registry.

When compared to population controls, the frequency of at least one serious autoimmune illness in women with POI was 5.6%, with an OR of 2.6. The women with POI had higher rates of several specific autoimmune diseases like hyperthyroidism, inflammatory bowel diseases, Addison’s disease, systemic lupus erythematosus, vasculitis, sarcoidosis, rheumatoid arthritis, and polyglandular autoimmune diseases prior to the index date.

Also, there was no difference in the prevalence of diabetes type 1 and ankylosing spondylitis between the POI and the reference cohort. Following a diagnosis of post-traumatic inflammation (POI), the odds ratio (SIR) for receiving a new diagnostic of a severe autoimmune illness was 2.8 during the first three years following the diagnosis, and it progressively dropped to 1.3 after 12 years.

Overall, this study gives new evidence at the population level on the relationship between severe autoimmune illnesses and POI. Overall, women with POI have a more than 2-fold higher frequency of serious autoimmune disorders, and this prevalence persists for more than a decade following diagnosis when compared to female population controls.

Reference:

Savukoski, S. M., Silvén, H., Pesonen, P., Pukkala, E., Gissler, M., Suvanto, E., Ollila, M.-M., & Niinimäki, M. (2024). Excess of severe autoimmune diseases in women with premature ovarian insufficiency: a population-based study. In Human Reproduction. Oxford University Press (OUP). https://doi.org/10.1093/humrep/deae213

Andhra Pradesh- Dr NTR University of Health Sciences (Dr NTRUHS) is inviting online application forms from eligible candidates for admission to MD and MS (Ayurveda) courses under competent authority quota seats for the academic year 2024-25 in the colleges affiliated with the University. On this, Dr NTRUHS has released a notification detailing the eligibility, registration and tuition fee, documents, and other details.