Public and social environment changes and caesarean section delivery choice in Japan

Yuda, Michio

doi:10.1186/s13104-018-3746-2

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…The pregnant women included in the present study all had CHD and an older average age at delivery compared with previous studies; 7,12 60% were primiparous, 8% had a NYHA classification of II, and 15% had complex CHD. Based on a nationwide study using the national database of health insurance claims (18.5%) 21 and the Survey of Medical Institutions (Iryo Shisetsu Chosa) from 1999 to 2014 (17.6%), 22 the rate of cesarean section among women with CHD in our study was higher than among the general population (35.0% vs. 18.5%/17.6% (national database of health insurance claims/Survey of Medical Institutions)). Among the study population, women with moderate or complex CHD experienced more CV events (arrhythmia and heart failure) during gestation than women with simple CHD.…”

Section: Discussionmentioning

confidence: 74%

Peripartum Management of Pregnant Women With Congenital Heart Disease

Yamasaki

Sawatari

Konagai

et al. 2019

Circ J

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Background:The average maternal age at delivery, and thus the associated maternal risk are increasing including in women with congenital heart disease (CHD). A comprehensive management approach is therefore required for pregnant women with CHD. The present study aimed to investigate the factors determining peripartum safety in women with CHD. Methods and Results:We retrospectively collected multicenter data for 217 pregnant women with CHD (age at delivery: 31.4±5.6 years; NYHA classifications I and II: 88.9% and 7.4%, respectively). CHD severity was classified according to the American College of Cardiology/American Heart Association guidelines as simple (n=116), moderate complexity (n=69), or great complexity (n=32). Cardiovascular (CV) events (heart failure: n=24, arrhythmia: n=9) occurred in 30 women during the peripartum period. Moderate or great complexity CHD was associated with more CV events during gestation than simple CHD. CV events occurred earlier in women with moderate or great complexity compared with simple CHD. Number of deliveries (multiparity), NYHA functional class, and severity of CHD were predictors of CV events. Conclusions:This study identified not only the severity of CHD according to the ACC/AHA and NYHA classifications, but also the number of deliveries, as important predictive factors of CV events in women with CHD. This information should be made available to women with CHD and medical personnel to promote safe deliveries.

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Section: Discussionmentioning

confidence: 74%

Peripartum Management of Pregnant Women With Congenital Heart Disease

Yamasaki

Sawatari

Konagai

et al. 2019

Circ J

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“…Cesarean sections can be a life-saving procedure when medically indicated, but they are increasing worldwide [ 8 ], and Japan is no exception [ 34 ]. In particular, the number of procedures performed at the request of the mother is increasing [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Cesarean section and parenting stress: Results from the Japan Environment and Children’s Study

et al. 2023

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Background: Accumulating evidence suggests a long-term health risk of cesarean section for the mother and child, but few studies have examined the link between cesarean section and parenting stress. Here, we examined this association by exploiting a large dataset. Methods: Participants were 65,235 mothers participating in the Japan Environment and Children's Study, an ongoing nationwide birth cohort. Outcome variables were parenting stress assessed as total score and subscale scores (representing the difficult child, parental distress, and spouse factors) on the Japanese 19-item version of the Parenting Stress IndexShort Form (J-PSI-SF). Exposures were the mode of delivery, the timing of J-PSI-SF assessment (1.5, 2.5, and 3.5 years postpartum), and the interaction between them. Multivariate regression analysis was used to calculate adjusted β coefficients and standard error of the means (SEMs).Results: The J-PSI-SF total score was higher in the cesarean section group than in the vaginal delivery group (adjusted β = 0.24, SEM = 0.09). This increase was primarily due to higher scores for the difficult child factor (adjusted β = 0.18, SEM = 0.05) and not to higher scores for the parental distress or spouse factor.Conclusions: Cesarean section was associated with higher parenting stress, especially in relation to the difficult child factor. Our results highlight the importance of paying particular attention to the mental health of both mother and child in the case of cesarean section.

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“…[ 75 ] Usually in countries where plural democracy predominates, such as America, Oceania and Europe, the legal system tends to favor the practice of defensive medicine. [ 23 , 76 ] However, defensive medicine is also causing concerns in many other regions of the world, [ 21 , 34 , 77 , 78 ] including countries with different political regimes than plural democracies. The Islamic Republic of Iran, for example, in addition to having a high rate of CS, [ 79 ] also has a high frequency of DM, [ 80 ] and obstetric litigation in this country reduces the tendency of doctors to perform vaginal deliveries.…”

Section: Discussionmentioning

confidence: 99%

Defensive medicine and cesarean sections in Brazil

2021

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Brazil has a high rate of cesarean sections (CS) that cannot be solely justified by women's clinical conditions; thus, other causes, for example, CS on maternal request and physicians’ fear of litigation as possible influencing factors, cannot be overlooked. This study aimed to identify through a survey whether Brazilian gynecologists and obstetricians (GOs) perform defensive CS. In this cross-sectional, descriptive study, a questionnaire was administered. The target population comprised of GOs who were members of premier Brazilian professional associations of gynecology and obstetrics. A total of 403 GOs participated in the survey using an obstetrics questionnaire about litigation and defensive medicine (DM). Statistical analyses were performed on pairs of variables to determine the risk factors of performing CS due to concerns of complications during vaginal delivery and to avoid lawsuits. The mean age of the GOs was 47.7 years who were mostly female (58.3%) and having worked professionally in both public and private sectors (71.7%). Of all participants, 80.6% had been sued or knew an obstetrician who had been sued. The obstetricians who had been sued or who knew a colleague that had been sued exhibited a significantly higher likelihood of performing defensive CS than physicians who had not been sued or did not know physicians who had been sued. The perception of a higher risk of lawsuits against obstetricians influenced the practice of DM and led to a more than six-fold increase in CSs in specialists with this perception compared to specialists who did not believe the presence of an increased risk of litigation in obstetrics existed. The majority of Brazilian GOs perform defensive CS. It is important to consider DM as one of the causes of high CS rates in Brazil and include it in the development of public policies to reduce these CS rates.

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Public and social environment changes and caesarean section delivery choice in Japan

Cited by 8 publications

References 17 publications

Peripartum Management of Pregnant Women With Congenital Heart Disease

Peripartum Management of Pregnant Women With Congenital Heart Disease

Cesarean section and parenting stress: Results from the Japan Environment and Children’s Study

Defensive medicine and cesarean sections in Brazil

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