RESUMO
Aim: To examine the association between opioid use disorder (OUD) and maternal outcomes following cesarean delivery. Methods: Retrospective analysis of over 2.4 million discharge records for in-patient cesarean delivery across five states from 2007 to 2014. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS) and 30- and 90-day readmission rates. Results: OUD patients were 148% more likely than non-OUD patients to die during hospitalization (adjusted odds ratios [aOR]: 2.48, 95% CI: 1.20, 5.10; p < 0.05). OUD was associated with increased odds of 30-day readmission (aOR: 1.46, 95% CI: 1.30, 1.65; p < 0.001) and 90-day readmission (aOR: 1.70, 95% CI: 1.55, 1.88; p < 0.001); LOS was not significantly different. Conclusion: OUD predicts increased in-patient mortality and odds of 30- and 90-day readmission following cesarean delivery.
Assuntos
Analgésicos Opioides/administração & dosagem , Cesárea/efeitos adversos , Hospitalização/estatística & dados numéricos , Mortalidade Materna , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Alta do Paciente , Readmissão do Paciente , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To develop a model that uses cervical effacement, fetal station, and parity to predict progress during the first stage of labor. STUDY DESIGN: This was a secondary analysis of a cohort of 1,128 parturients delivering after 34 weeks. Timed cervical exams from each patient were fit with a biexponential model. Methods for consideration of fetal station, cervical effacement and parity were developed and validated. RESULTS: The biexponential model fit the data in an unbiased manner with a median absolute prediction error of 1.1 cm. Although nulliparous women had slower active labor, they did not differ from multiparous women in their rate of latent labor or the cervical dilation at which they transitioned to active labor. In addition, nulliparous women began laboring with a more effaced cervix (45 vs. 31%) and lower fetal station (-2.8 vs. -3.2). CONCLUSION: We validated a biexponential model for labor progress using a large mixed parity cohort. We demonstrated that parity and initial fetal station add important clinical information that can be used to make a labor model more accurate. As such, parity and fetal station can be utilized in such structural models to predict normal labor progress and potentially identify abnormalities in labor progress.
