Assuntos
Amniocentese , Parto Obstétrico , Testes Genéticos , Hemofilia A/genética , Diagnóstico Pré-Natal , Feminino , Humanos , GravidezRESUMO
OBJECTIVE: To examine the association between intended mode of delivery and severe postpartum haemorrhage. DESIGN: A retrospective cohort study. SETTING: Material from a nationwide study in Denmark. POPULATION: Danish women giving birth in 2001-08. METHODS: We compared use of red blood cell transfusion by intended mode of delivery in the total population (n = 382 266), in low-risk nulliparous women (n = 147 132) and in women with a previous caesarean delivery (n = 25 156). MAIN OUTCOME MEASURE: Red blood cell transfusion within 7 days of delivery. RESULTS: In the total population the crude transfusion rates for women with planned caesarean delivery and intended vaginal delivery were 2.24 and 1.75%. After adjustment for maternal age, body mass index, birthweight, smoking, parity, number of infants and previous caesarean delivery, the risk of red blood cell transfusion was significantly lower in women with planned caesarean delivery compared with intended vaginal delivery (odds ratio 0.82; 95% CI 0.73-0.92; P < 0.01). In low-risk nulliparous women and in women with a previous caesarean delivery the transfusion rates were lower for planned caesarean delivery compared with intended vaginal delivery before and after adjustment. CONCLUSION: Compared with intended vaginal delivery, planned caesarean delivery was associated with a reduced risk of severe postpartum haemorrhage indicated by use of red blood cell transfusion.
Assuntos
Parto Obstétrico/efeitos adversos , Hemorragia Pós-Parto/etiologia , Adolescente , Adulto , Peso ao Nascer , Índice de Massa Corporal , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Dinamarca/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Idade Materna , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: To determine whether the combined intervention of 50 000 IU vitamin A administered together with Bacille Calmette-Guerin (BCG) vaccination at birth was associated with adverse events, in particular bulging fontanels and adverse reactions to BCG. SUBJECTS/METHODS: From an ongoing trial, 2145 infants randomized to 50 000 IU vitamin A or placebo with BCG vaccination were recruited. Adverse events were monitored in two different ways: (A) daily clinical examinations by a medical doctor during the first 3 days post supplementation; (B) weekly interviews by a trained assistant during the first month post supplementation. RESULTS: In part A, 1271 infants were enrolled, in part B 2078. Vitamin A supplementation (VAS) was associated with a relative risk (RR) of bulging fontanels of 1.16 (95% confidence interval (CI)=0.82-1.65). The rate of health care contacts and various symptoms during the first month were comparable between the groups. VAS was associated with larger peak local reactions to BCG vaccination in boys, but not in girls (P-value for test of interaction between VAS and sex=0.02). CONCLUSION: 50 000 IU vitamin A with BCG was not associated with adverse events. The observed sex-differential effect of VAS on local reaction to BCG is in line with other observations of sex-differential effects of VAS.
