Peripartum antidepressant use is associated with an increased risk of postpartum hemorrhage

Dissertação de mestrado em Treino Desportivo para Crianças e Jovens, apresentada à Faculdade de Ciências do Desporto e Educação Física da Universidade de CoimbraEste estudo teve como objetivo avaliar os fatores determinantes do rendimento e da contribuição metabólica numa competição de 1000m em Kayak ergómetro, em jovens atletas praticantes de canoagem na variante “regatas em linha”. A amostra foi constituída por 12 atletas jovens de canoagem com experiencia desportiva. Verificou-se também a associação dos parâmetros morfológicos e maturacionais com a performance num teste máximo de 1000m e em segmentos de 250m desses 1000m. Este estudo ganha pertinência pela determinação da associação da intensidade relativa, identificada com os parâmetros ventilatórios, com o resultado de uma prova critério – 1000m em kayak ergómetro, em jovens praticantes. Metodologia: O desenho do estudo consistiu num levantamento de dados antropométricos da amostra, após este levantamento foi realizado um protocolo progressivo e após 48 horas foi realizado um teste máximo de 1000 metros. Dados da amostra: idade decimal 16,0 ± 1,1; massa corporal (kg) 63,8 ± 7,2; estatura (centímetros) 174,9 ± 7,2; estatura matura predita (Khamis-Roche) 100,1 ± 5,7; prática semanal (horas) 10,5 ± 2,4; com experiencia desportiva (anos) 2,7 ± 0,7. Utilizámos: adipômetro, estadiómetros, Bod Pod, Balança, estação meteorológica, analisador de gases, kayak ergómetro, ciclo ergómetro e analisador de lactato portátil. Resultados: No protocolo incremental alcançaram um valor de VO2 max abs (L.min-1) 3,4 ± 0,6; sendo o Lv1 (58,8 ± 11,8%) e o Lv2 (88 ± 14,7%), e um valor de potência 138,5 ± 24,5 watt. O teste máximo de 1000m teve duração de 292,25 ± 15 segundos, uma percentagem da VAM 97,0 ± 2,8, uma percentagem VO2 max de 90,0 ± 6,5 e uma percentagem da PAM de 96,3. Conseguindo um modelo preditivo. Discussão: Verificámos a existência de correlação entre as seguintes variáveis e a performance no teste máximo: idade, PAM, Cadência, VO2 max abs, VAM, VLv1, VLv2 e FC Lv1. O que é uma novidade pois na literatura sobre esta temática apenas são apresentados com frequência o VO2 max abs, a idade, cadência e a VAM. Estes novos indicadores necessitam de maior aprofundamento para perceber numa amostra com um N maior a sua resposta e dessa forma perceber a sua importância como preditores. Conclusão: A realização do protocolo progressivo pode ser preditor de um teste máximo de 1000m, contribuindo também para o planeamento de treino para a preparação de competições desta distância. Além disso os limiares ventilatórios são uma das novas tendências da prescrição do treino. iii ABSTRACT Coelho, AB (2015). Predictive value of a progressive protocol on a Kayak ergometer for the 1,000 metre race in Kayak ergometer. Master's Thesis on Children and Teenage Sport Training - Faculty of Sport Sciences and Physical Education, University of Coimbra. Introduction: The aim of this study was to evaluate the determinants of efficiency and metabolic contribution in a 1,000 metre race in Kayak ergometer in young athletes practicing canoeing in the variant flat water. The sample contained 12 young canoeing athletes with competitive sporting experience. The association of morphological and maturation parameters with the performance of a maximum 1,000 metre test and 250 metre segments within the 1,000 metres was verified. This study gains relevance from the determination of the association of relative intensity , identified with the ventilation parameters, with the result of a test criterion – 1,000 metre kayak ergometer in young sportsmen. Methodology: The study consisted of a survey of the anthropometric data of sample. After this survey a progressive protocol was conducted and after 48 hours a maximal test of 1,000 metres at full speed was performed. Sample data: decimal age 16.0 ± 1.1; body mass (kg) 63.8 ± 7.2; height (centímetros) 174.9 ± 7.2; predicted mature height (Khamis-Roche) 100.1 ± 5.7; weekly practice (hours) 10.5 ± 2.4; with sports experience (years) 2.7 ± 0.7. We used: adipometer, stadiometers, Bod Pod, weighing scale, weather station, gas analyzer, kayak ergometer, ergometer cycle and portable lactate analyzer. Results: In the incremental protocol they reached a value of VO2 max abs (L.min-1) 3.4 ± 0.6; being VT1 (58.8 ± 11.8%) and VT2 (88 ± 14.7%), and a power value of 138.5 ± 24.5 watts. The maximum 1,000 m test race lasted 292.25 ± 15 seconds, a 97.0 ± 2.8 MAV percentage, a 90.0 ± 6.5 maximum VO2 percentage and a 96.3 MAP percentage. A predictive model was reached. Discussion: We found a correlation between the following variables and the maximum performance in the test: age, MAP, Cadence, VO2 max abs, MAV, VVT1, VVT2 and HR VT1. This is new because in the literature on this subject only VO2 max abs, age, cadence and MAV are presented frequently. These new indicators need to be deeper clarified to understand in a sample with a higher N their answer and, thus, understand its importance as predictors. Conclusion: The performance of the progressive protocol can be a predictor of a maximum 1000m test, also contributing to the training plan for the preparation of competitions of this distance. In addition, the ventilatory thresholds are one of the new trends in the training prescription

Linkage of four administrative datasets to examine blood transfusion in pregnancy

Currently collected hospital data records fact of transfusion, but lacks detail on quantity of blood transfused, and timing of transfusions. A number of administrative datasets collect information on blood transfusion including quantity and timing. Linkage of multiple datasources has the potential to give increase the depth of information available for researchers. This study aims to describe the linkage of four administrative datasets to identify transfusions among women giving birth in NSW and to describe the population represented by this linked data. Hospital, birth, blood issue and blood pack databases were linked to identify women receiving red blood cell transfusions in NSW between July 2006 and December 2010. Characteristics of the linked data population are compared with the population of all women giving birth, and births in public hospitals. Between July 2006-December 2010 there were 425,036 births in NSW hospitals, including 235,796 in a population with additional blood issue data available, of which, 4642(2%) received a transfusion. Hospitals supplying blood issue data were more likely to be larger urban or tertiary hospitals, and had a higher risk population than the state overall and public hospitals generally. Linkage of multiple data sources provides additional detail compared with hospital data alone, providing a wealth of data for researchers. The population identified through linkage differs from the overall birthing population, and to a lesser extent from women birthing in public hospitals. In some cases this may affect generalisability of research findings, but in other cases may be beneficial

Ascertaining severe perineal trauma and associated risk factors by comparing birth data with multiple sources

Objectives Population data are often used to monitor severe perineal trauma trends and association of risk factors. Within NSW, two different datasets can be used; the Perinatal Data Collection (‘birth’ data), or a linked dataset combining birth data with the Admitted Patient Hospital Data Collection (‘hospital’ data). Severe perineal trauma can be ascertained by birth data alone, or by hospital ICD-10-AM diagnosis and procedure coding in the linked dataset. The aim of this study is to compare rates and risk factors for severe perineal trauma using birth data alone, with those using linked data. Methods The study population consisted of all vaginal births in NSW 2001-2011. As perineal injury coding in birth data was revised in 2006, data were analysed separately for 2 ‘earlier data’ and ‘more recent data’. Rates of severe perineal injury over time were compared in birth data alone, and in linked data. Kappa and agreement statistics were calculated. Risk factor distributions (primiparity, instrumental birth, birthweight≥4kg, Asian country of birth and episiotomy) were compared between women with severe perineal trauma identified by birth data alone, and identified by linked data. Multivariable logistic regression was used to calculate the adjusted odds ratios of severe perineal trauma. Results Among 697,202 vaginal births, 2.1% were identified with severe perineal trauma by birth data alone, and 2.6% by linked data. The rate discrepancy was higher among earlier data (1.7% for birth data, 2.4% for linked data). Kappa for earlier data was 0.78 (95% CI 0.78, 0.79), and 0.89 (95% CI 0.89, 0.89) for more recent data. With the exception of episiotomy, differences in risk factor distributions were small, with similar adjusted odds ratios. Adjusted odds ratio of severe perineal trauma for episiotomy was higher (1.34 95% CI 1.27, 1.41) using linked data compared with birth data (1.03 95% CI 0.97, 1.09). Conclusions While discrepancies in ascertainment of severe perineal trauma improved after revision of birth data coding in 2006, higher ascertainment by linked data was still evident for recent data. There were also higher risk estimates of severe perineal trauma with episiotomy by linked data than by birth data.Australian Research Council; Dr Albert S McKern Research Scholarshi

Outcomes of gallstone disease during pregnancy: a population based data linkage study

Background Gallstone disease is a leading indication for non-obstetric abdominal surgery during pregnancy. There are limited whole population data on maternal and neonatal outcomes. This population-based study aims to describe the outcomes of gallstone disease during pregnancy in an Australian setting. Methods Linked hospital, birth and mortality data for all women with singleton pregnancies in New South Wales, Australia, 2001-2012 were analysed. Exposure of interest was gallstone disease (acute biliary pancreatitis, gallstones with/without cholecystitis). Outcomes including preterm birth (spontaneous and planned), readmission, morbidity and mortality (maternal and neonatal) were compared between pregnancies with and without gallstone disease and within disease subtypes. Adjusted risk ratios (aRRs) and 99% confidence intervals were estimated using modified Poisson regression and adjusted for maternal and pregnancy factors. Results Among 1,064,089 pregnancies, 1882 (0.18%) had gallstone disease. Of these, 239 (12.7%) had an antepartum cholecystectomy and 1643 (87.3%) were managed conservatively. Of those managed conservatively, 319 (19.0%) had a postpartum cholecystectomy. Gallstone disease was associated with increased risk of preterm birth (aRR 1.3, 99% CI 1.1, 1.6) particularly planned preterm birth (aRR 1.6, 99% CI 1.2, 2.1), maternal morbidity (aRR 1.6, 99% CI 1.1, 2.3), maternal readmission (aRR 4.7, 99% CI 4.2, 5.3), and neonatal morbidity (aRR 1.4, 99% CI 1.1, 1.7). Surgery was associated with decreased risk of maternal readmission (aRR 0.4, 99% CI 0.2, 0.7). Conclusions Gallstone disease during pregnancy was associated with adverse maternal and neonatal outcomes. Most women with gallstone disease during pregnancy are managed conservatively. Surgical management was associated with decreased risk of readmission.NHMRC, AR

Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes

Study Objectives: To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Methods: Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth in hospital from 2002 to 2012 (N=636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Results: Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.68; 95% CI 1.40 – 2.07), planned delivery (1.15; 1.07 – 1.23), preterm birth (1.50; 1.21 – 1.84), 5-minute Apgar <7 (1.60; 1.07 – 2.38), admission to neonatal intensive care/special care nursery (1.26; 1.11 – 1.44), large-for-gestational-age infants (1.27; 1.04 – 1.55) but not with gestational diabetes (1.09; 0.82 – 1.46), caesarean section (1.06; 0.96 – 1.17), perinatal death (1.73; 0.92 – 3.25), or small-for-gestational-age infants (0.81; 0.61 – 1.08). Conclusions: Sleep apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history.NHMRC, AR

Haemoglobin changes during pregnancy: a retrospective cohort study of consecutive pregnancies

NHMR

Are women birthing in New South Wales hospitals satisfied with their care?

Abstract Background Surveys of satisfaction with maternity care among Australian women have been conducted using overnight inpatient surveys and dedicated maternity surveys in a number of Australian states and territories, however to date no information on satisfaction with maternity care has been published for women birthing in New South Wales. The aim of this study was to investigate the effects of pregnancy and birth characteristics, hospital location and type of care provision on patient satisfaction with hospital care at the time of birth. Results Analysis of responses from 5,367 obstetric patients completing overnight patient surveys between 2007 and 2011 revealed three quarters of women were satisfied with care provided in hospital. Compared with women who had previously given birth, first-time mothers were more likely to recommend their birth hospital to friends and family (60.5% versus 56.4%; P<0.05), less likely to have experienced differing messages from staff (44.8% vs 59.4%; P<0.001), and less likely to feel they had received sufficient information about feeding (58.8% vs 65.0%; P<0.001) and caring for their babies (52.4% vs 65.2%; P<0.001). Women having a caesarean birth were more likely to have a negative experience of differing messages from doctors and nurses than women giving birth vaginally (52.7% vs 44.3%; P<0.001). While metropolitan women were more likely to rate their birth hospital positively (76.0% vs. 71.3%; P<0.05) than their rural counterparts, rural women tended to rate the care they received (68.1% vs. 63.4%; P<0.05), and doctors (70.7% vs 61.1%; P<0.05) and nurses (73.5% vs. 66.9%; P<0.001) more highly than metropolitan women. Conclusions The overall picture of maternity care satisfaction in New South Wales is a positive one, with three quarters of women satisfied with care. The differences in care ratings among some subgroups of women (for instance, by parity and rurality) may assist in targeting allocation of resources to improve maternity satisfaction. Further resources could be dedicated to ensuring consistency and amount of information provided, particularly to first-time mothers.Australian Research Council Future Fellowship (#FT120100069)