ABSTRACT
OBJECTIVE: To determine whether advanced paternal age is associated with increased risk for cesarean delivery. STUDY DESIGN: We used the 1990-2002 US linked live birth and infant death data files restricted to primiparous Caucasian and African-American women that delivered a singleton birth at ≥20 week's gestation (12.5 million). We examined temporal trends and risk ratios of cesarean birth in relation to paternal age before and after adjustments for known confounders. RESULTS: Among Caucasians, the cesarean delivery rates were 21.1%, 26.7% and 31.8% in fathers aged 20-29, 30-39 and ≥40 years, respectively. Among African-Americans, the corresponding rates were 24.1%, 33.2%, and 38.1%, respectively. These increased cesarean delivery rates persisted in analyses stratified by maternal age before and after adjustment for a variety of confounders. CONCLUSIONS: These findings suggest that increasing paternal age may be associated with an increased risk for cesarean delivery in primiparous women.
Subject(s)
Cesarean Section , Paternal Age , Adult , Age Distribution , Cesarean Section/statistics & numerical data , Delivery, Obstetric/statistics & numerical data , Female , Gestational Age , Humans , Infant, Newborn , Male , Maternal Age , Middle Aged , Pregnancy , Racial Groups , Risk Factors , Young AdultABSTRACT
OBJECTIVE: To determine the timing of screening for postpartum depression that optimizes access to psychiatric care. METHODS: Cross-sectional evaluation of women receiving obstetric care in a community-based medical center clinic from March to July 2006, who were screened for depression at 36 weeks gestation, delivery, and 6 weeks postpartum using the Edinburgh Postnatal Depression Scale. Positive screens generated referrals for psychiatric evaluation. The rate of positive screens for depression and psychiatric follow-up at each time point was evaluated. RESULTS: Of the 293 patients evaluated, the distribution of the first screen which occurred during the study period was 21% at 36 weeks, 31% at delivery, and 48% at 6 weeks postpartum. The incidence of a positive screen was 5% at 36 weeks, 16% at delivery and 14% at 6 weeks postpartum. Access to psychiatric care occurred in 33% at 36 weeks, 15% at 6 weeks postpartum and 100% at delivery (p = 0.001). CONCLUSION: Screening for depression in the hospital after delivery improves access to psychiatric care.
Subject(s)
Depression/diagnosis , Depression/therapy , Pregnancy Complications/psychology , Adult , Cross-Sectional Studies , Depression, Postpartum/diagnosis , Educational Status , Female , Gestational Age , Humans , Infant, Newborn , Pregnancy , Time FactorsABSTRACT
Trauma is the leading nonobstetric cause of maternal mortality. The basic tenets of trauma evaluation and resuscitation should be applied in maternal trauma. Aggressive resuscitation of the mother is the best management for the fetus. Care must be taken to keep the patient in the left lateral decubitus position to avoid compression of the inferior vena cava and resultant hypotension. Radiographic studies should be used with care. Noninvasive diagnostics should be used when available. Cardiotocographic monitoring of a viable gestation should be initiated as soon as possible in the emergency department to evaluate fetal well-being. Urgent cesarean section should be considered if fetal distress is present or if the presence of the fetus is contributing to maternal instability.
