Investigation of the association of Apgar score with maternal socio-economic and biological factors: an analysis of German perinatal statistics

PURPOSE: To examine the relationship of 5-min Apgar score with maternal socio-economic and biological factors. METHODS: We analyzed data from 465,964 singleton pregnancies (37–41 weeks’ gestation) from the German perinatal statistics of 1998–2000. Using a logistic regression model we analyzed the incidence of low (0–6) 5-min Apgar scores in relation to these maternal factors: body mass index (BMI), age, previous live births, country of origin, occupation, single mother status, working during pregnancy, and smoking. RESULTS: A low Apgar score was more common in overweight [adjusted odds ratio (OR) 1.24; 95% confidence interval (CI) 1.10–1.40; P < 0.001] and obese [OR 1.92 (95% CI 1.67–2.20); P < 0.001] compared to normal weight women. A low Apgar score was also more common for women aged >35 years compared to those aged 20–35 years [OR 1.35 (95% CI 1.16–1.58); P < 0.001]. Furthermore, odds of a low Apgar score were higher for women with no previous live births compared to those with one or more previous live births [OR 1.52 (95% CI 1.37–1.70); P < 0.001]. Socio-economic factors did not convincingly influence Apgar scores. CONCLUSIONS: There was an influence of the biological maternal factors age, BMI, and parity on the 5-min Apgar score. There was no convincing effect of socio-economic factors on Apgar score in our study population. Possible reasons for this are discussed

Resultados perinatais em gestações tardias

O objetivo do estudo foi comparar resultados perinatais de mulheres com idade igual ou superior a 35 anos com os de mulheres entre 20 e 34 anos. O estudo é retrospectivo e foi realizado a partir da consulta às fichas obstétricas de 1.255 puérperas que tiveram partos no único hospital de Sarandi-PR, no período de janeiro de 2007 a dezembro de 2008. As variáveis analisadas foram: estado civil, escolaridade, idade gestacional, tipo de parto, peso ao nascer, índice de Apgar no 1º e 5º minutos e óbitos fetais. Na regressão logística, a idade materna avançada esteve associada significativamente à cesariana (OR 1,23, IC 95% 0,19-0,44) e a um índice de Apgar menor que 7 no 5º minuto de vida (OR 5,78, IC 95% 0,74-2,76). Esses resultados evidenciam os riscos de complicações em gestantes com idade igual ou superior a 35 anos e a necessidade de que o aconselhamento às mulheres que pretendam postergar a gestação seja realizado

Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

Elizabeth BS Driscoll,1 Ana Hosseinzadeh Maleki,2 Leila Jahromi,3 Brittany Nelson Hermecz,4 Lauren E Nelson,5 Imelda L Vetter,6 Spencer Evenhuis,2 Lee Ann Riesenberg2 1Department of Anesthesiology, University of Tennessee, Knoxville, TN, 2Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, 3Department of Biology, Georgia State University, Atlanta, GA, 4Department of Diagnostic Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, 5University of South Alabama College of Medicine, Mobile, 6School of Health Professions, Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. Keywords: compartment syndrome, patient-controlled analgesia, regional anesthesia, peripheral nerve bloc