How can we treat it in the UK?

Costa, Amanda J Da

doi:10.1136/bmj.c933

Cited by 9 publications

(3 citation statements)

References 1 publication

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“…Smoking in pregnancy has serious long-term health implications for women and their babies [15]; it increases the woman's risk of spontaneous abortions, placental abruption, cardiovascular and pulmonary disease. Adverse foetal outcomes associated with smoking in pregnancy include; preterm delivery, sudden infant death syndrome and low birth weight [1,8,14,16,17]. We found women who were at risk of PP were more likely to use alcohol, cannabis or amphetamines and were more likely to have a history of poly-substance use.…”

Section: Discussionmentioning

confidence: 90%

“…5% of all pregnancies [7,8]. PP is an obstetric emergency when there is bleeding and it is often associated with increased perinatal and maternal mortality and morbidity [5,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Controlling for all confounding factors such as number of ante natal visits, amount of AOD use as this is self-reported, multiple gestation, history of imprisonment, family violence and abruption cannot be done with this sample as it is not large enough to allow clear inferences. Placenta abruption has been associated with cocaine and amphetamine use [6,8,20], AOD use and smoking can be associated with foetal growth restriction and poor maternal diet, however women with AOD histories are socially disadvantaged when compared to a group who have no history of AOD use. Opioid replacement programmes have been suggested to improve overall outcomes but within the WANDAS population it is suggested that engagement in Ante natal care for women with AOD use will improve overall outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Are Women with Alcohol and Other Drug Use at Increased Risk of Placenta Praevia (PP)?

O’Connor¹,

McLaurin²,

Hamilton³

2016

J Addict Res Ther

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Objective: To correlate the incidence of Low Lying placenta with maternal alcohol and other drug use (AOD) among pregnant women attending the Women and Newborn Drug and Alcohol Service (WANDAS), a specialist obstetric Drug and Alcohol Service situated at Women and Newborn Health Service King Edward Memorial Hospital (KEMH). Methods:A retrospective audit was undertaken of 751 maternal records compromising of the women attending Women and Newborn Drug and Alcohol Service (WANDAS) from 2010 to 2014. All women were scanned at approximately 20 weeks and again between 32 to 34 weeks gestation. The incidence of, low lying placenta, placenta praevia and maternal drug use was analysed. The maternal outcomes including mode of delivery, foetal outcome and maternal complications were compared with the general obstetric population at KEMH. In order to determine if maternal AOD use increased the risk of placentation issues. Conclusion:Maternal AOD use increases the risk of placenta praevia and other maternal and neonatal comorbidities.

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Section: Discussionmentioning

confidence: 90%

“…5% of all pregnancies [7,8]. PP is an obstetric emergency when there is bleeding and it is often associated with increased perinatal and maternal mortality and morbidity [5,[9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Are Women with Alcohol and Other Drug Use at Increased Risk of Placenta Praevia (PP)?

O’Connor¹,

McLaurin²,

Hamilton³

2016

J Addict Res Ther

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Determining population based mortality risk in the Department of Veterans Affairs

Stefos

Lehner²,

Render³

et al. 2011

Health Care Manag Sci

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We develop a patient level hierarchical regression model using administrative claims data to assess mortality outcomes for a national VA population. This model, which complements more traditional process driven performance measures, includes demographic variables and disease specific measures of risk classified by Diagnostic Cost Groups (DCGs). Results indicate some ability to discriminate survivors and non-survivors with an area under the Receiver Operating Characteristic Curve (C-statistic) of .86. Observed to expected mortality ranges from .86 to 1.12 across predicted mortality deciles while Risk Standardized Mortality Rates (RSMRs) range from .76 to 1.29 across 145 VA hospitals. Further research is necessary to understand mortality variation which persists even after adjusting for case mix differences. Future work is also necessary to examine the role of personal behaviors on patient outcomes and the potential impact on population survival rates from changes in treatment policy and infrastructure investment.

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What is the value of hospital mortality indicators, and are there ways to do better?

Barker

Mengersen

Morton

2012

Aust. Health Review

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Monitoring hospital performance using patient safety indicators is one of the key components of healthcare reform in Australia. Mortality indicators, including the hospital standardised mortality ratio and deaths in low mortality diagnosis reference groups have been included in the core national hospital-based outcome indicator set recommended for local generation and review and public reporting. Although the face validity of mortality indicators such as these is high, an increasing number of studies have demonstrated that there are concerns regarding their internal, construct and criterion validity. Use of indicators with poor validity has the consequence of potentially incorrectly classifying hospitals as performance outliers and expenditure of limited hospital staff time on activities which may provide no gain to hospital quality and safety and may in fact cause damage to morale. This paper reviews the limitations of current approaches to monitoring hospital quality and safety performance using mortality indicators. It is argued that there are better approaches to improving performance than monitoring with mortality indicators generated from hospital administrative data. These approaches include use of epidemiologically sound, clinically relevant data from clinical-quality registries, better systems of audit, evidence-based bundles, checklists, simulators and application of the science of complex systems.

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How can we treat it in the UK?

Cited by 9 publications

References 1 publication

Are Women with Alcohol and Other Drug Use at Increased Risk of Placenta Praevia (PP)?

Are Women with Alcohol and Other Drug Use at Increased Risk of Placenta Praevia (PP)?

Determining population based mortality risk in the Department of Veterans Affairs

What is the value of hospital mortality indicators, and are there ways to do better?

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