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      A History of Abuse and Operative Delivery – Results from a European Multi-Country Cohort Study

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          The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.


          The Bidens study, a cohort study in six European countries ( Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations.


          Among 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05–2.19).


          Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.

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          Most cited references 24

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          Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

          Background There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Conclusions Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
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            Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health.

            To conduct a population-based assessment of associations of intimate partner violence in the year prior to and during pregnancy with maternal and neonatal morbidity. Data from women giving birth in 26 U.S. states and participating in the 2000 to 2003 Pregnancy Risk Assessment Monitoring System (n = 118,579) were analyzed. Women reporting intimate partner violence in the year prior to pregnancy were at increased risk for high blood pressure or edema (adjusted odds ratio 1.37-1.40), vaginal bleeding (adjusted odds ratio 1.54-1.66), severe nausea, vomiting or dehydration (adjusted odds ratio 1.48-1.63), kidney infection or urinary tract infection (adjusted odds ratio 1.43-1.55), hospital visits related to such morbidity (adjusted odds ratio 1.45-1.48), and delivery preterm (adjusted odds ratio 1.37), of a low-birthweight infant (adjusted odds ratio 1.17), and an infant requiring intensive care unit care (adjusted odds ratio 1.31-1.33) compared with those not reporting intimate partner violence. Women reporting intimate partner violence during but not prior to pregnancy experienced higher rates of a subset of these concerns. Women experiencing intimate partner violence both prior to and during pregnancy are at risk for multiple poor maternal and infant health outcomes, suggesting prenatal risks to children from mothers' abusive partners.
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              Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth.

               M Zar,  B Wijma,  K Wijma (1998)
              Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) was developed. This paper presents the theoretical background of the W-DEQ together with a documentation of the first psychometric studies. Examination of construct validity indicates that it seems to be possible to penetrate a psychological construct related to fear of childbirth by means of the W-DEQ, both before and after delivery, in nulliparous as well as in parous women. The questionnaire measures the construct more clearly in parous than in nulliparous women. Internal consistency reliability and split-half reliability of the W-DEQ of > or = 0.87 are good for a new research instrument. More research is on its way to make the W-DEQ suitable even for measurements in applied settings.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                31 January 2014
                : 9
                : 1
                [1 ]Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
                [2 ]Department of Obstetrics and Gynaecology, St.Olav's University Hospital, Trondheim, Norway
                [3 ]Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
                [4 ]Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden
                [5 ]John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
                [6 ]Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
                [7 ]Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
                [8 ]Directorate of Health, Reykjavik, Iceland
                [9 ]Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
                [10 ]Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
                [11 ]Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
                [12 ]Malmö University, Faculty of Health and Society, Malmö, Sweden
                [13 ]Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland
                Baylor College of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: BS JC MT. Performed the experiments: AMS H. Kristjansdottir AMW M. Lukasse M. Laanpere ASVP H. Karro AT MT ELR BS TS. Analyzed the data: Mirjam L. Contributed reagents/materials/analysis tools: AMS H. Kristjansdottir AMW M. Lukasse M. Laanpere ASVP H. Karro AT MT ELR BS TS JC. Wrote the paper: BS M. Lukasse ELR TS H. Karro. Commented on drafts and approved the final manuscript: AMS H. Kristjansdottir AMW M. Lukasse M. Laanpere ASVP H. Karro AT MT ELR BS TS JC. Developed the questionnaire: BS M. Lukasse ELR JC H. Karro H. Kristjansdottir M. Laanpere AMS AT MT ASVP AMW TS. Finalized the research protocol: BS M. Lukasse ELR JC H. Karro H. Kristjansdottir M. Laanpere AMS AT MT ASVP AMW TS. Collected data: AMS AMW M. Lukasse M. Laanpere ASVP.


                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 10
                The Bidens study was supported by the Daphne II Program, European Commission for Freedom, Security, and Justice, Brussels, Belgium (Grant no. JLS/2006/DAP-1/242/W30-CE-0120887/00-87). Mirjam Lukasse received a postdoctoral fellowship from the Norwegian Research Council, Grant no. 204292. The funders had no role in study design, data collection and analysis, decision to publish, or presentation of the manuscript.
                Research Article
                Non-Clinical Medicine
                Socioeconomic Aspects of Health
                Obstetrics and Gynecology
                Pregnancy Complications
                Labor and Delivery
                Public Health
                Socioeconomic Aspects of Health
                Women's Health
                Rape and Sexual Assault
                Social and Behavioral Sciences
                Crime and Criminology
                Domestic Violence



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