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Biomedical subjects

E Wollast

Publications and source records attributed to E Wollast.

At least 19 recordsLinked to original sources
PubMed2000

Anemia during pregnancy and birth outcome: a meta-analysis.

To determine the relationship between maternal anemia [hemoglobin (Hgb) < 10-11 g/dL] and various birth outcomes, a meta-analysis was conducted based on published literature identified by MEDLINE and manual search from 1966 through 1999. Odds ratios (OR) from selected studies were pooled according to the gestational age at anemia diagnosis. The meta-analysis shows that maternal anemia during early pregnancy was associated with slightly increased preterm birth [pooled adjusted OR (aOR): 1.32, 95% confidence interval (CI): 1.01-1.74], and nonstatistically significant increased low birth weight [pooled aOR: 1.39 (0.70-2.74)], and was not associated with fetal growth restriction [pooled aOR: 1.01 (0.73-1.38)]. However, there was a nonstatistically significant inverse relationship between anemia during late pregnancy and preterm birth [pooled aOR: 0.92 (0.54-1.84)] and low birth weight [pooled aOR: 0.80 (0.64-1.00)]. Anemia was not statistically significantly associated with hypertensive disorders of pregnancy regardless of stage of pregnancy [pooled OR: 0.80 (0.53-1.20)]. The relationship between anemia and perinatal mortality was inconclusive. A few studies indicated that severe maternal anemia (Hgb < 8-8.5 g/dL) was associated with increased risk of poor outcomes. We conclude that early pregnancy anemia is associated with slightly increased risk of preterm birth. The trend toward an inverse association of anemia determined during late pregnancy with preterm birth and low birth weight may reflect the benefit of plasma volume expansion.

Adult↗
PubMed1997

Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis.

OBJECTIVE: To evaluate the safety and effectiveness of a policy of trial of labour for women with a previous caesarean section, delivering in hospitals in sub-Saharan Africa. DESIGN: A meta-analysis of 17 published reports. SETTING: Hospitals located in sub-Saharan Africa. MAIN OUTCOME MEASURES: The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical conditions were computed using an approach equivalent to a random effects model. RESULTS: The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI 63-75%). Maternal mortality among all women with a previous caesarean section was 1.9/1000 (95% CI 0-4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95% CI 1.0-3.2). Criteria used to select women for a trial of labour appeared to have a limited impact on the probability of vaginal delivery. CONCLUSIONS: In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.

Africa South of the Sahara↗
PubMed1995

IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies.

Because of inconsistent findings among case-control studies on the relationship between IUD use and the risk of ectopic pregnancy, a meta-analysis of published literature was conducted. From 1977 through 1994, 19 publications regarding 16 studies of ectopic pregnancy and IUD use were found by MEDLINE and manual search. The odds ratio (ORs) of ectopic pregnancy with current and past IUD use in each study were pooled. A quality score system was developed to assess each study. Funnel plot was used to assess potential publication biases. For current IUD use, when cases were compared to pregnant controls, there was an increased risk of ectopic pregnancy (pooled OR: 10.63, 95% confidence interval (CI): 7.66-14.74); when cases were compared to non-pregnant controls, there was no risk of ectopic pregnancy (pooled OR: 1.06, 95% CI: 0.91-1.24). Past IUD use could mildly increase the risk of ectopic pregnancy (pooled OR: 1.40, 95% CI: 1.23-1.59). Selecting pregnant or non-pregnant women as controls, however, did not affect the OR estimates of past IUD use. Current IUD use does not increase the risk of the ectopic pregnancy. However, a pregnancy with an IUD in situ is more often an ectopic one than a pregnancy with no IUD. Past IUD use could mildly elevate the risk of ectopic pregnancy.

Adolescent↗
PubMed1995

Oxytocics in developing countries.

OBJECTIVES: A prospective multicenter study of obstetric practices was conducted in three developing countries (Benin, Congo and Senegal) to analyze oxytocic use during labor. One of the objectives was to assess the possible negative effects of the treatment regimens instituted during the labor monitoring phase. METHODS: Four health districts participated in the study. All women who gave birth in one of the participating health facilities over a 6-month period in Benin and Congo, and over a 3-month period in Senegal, were recruited. The number of deliveries studied in each district varied from 457 to 1048. For each case a partogram was used to assess the progress of labor and the onset of dysfunctional labor. Information was collected on the risk factors for dysfunctional labor, stillbirths and resuscitation of the neonate. RESULTS: Each of the four collaborating centers used oxytocics preferentially to treat dysfunctional labor, but even in normal labor (i.e. with a normal partogram) oxytocics were used in 4.4-21.5% of cases. In normal labor the incidence of neonatal resuscitation was higher in cases with than in those without oxytocic use: the relative risks (R.R.) varied from 1.9 to 5.6; the odds ratios varied from 2.4 to 7.0, and both were statistically significant in the four settings. In addition the stillbirth rate was always higher, though not significantly, when oxytocics were used in normal labor (R.R. 1.2-2.2). When the data of the four centers were pooled, the global relative risk for stillbirths was 1.9, and the 95% confidence interval was 1.1-3.4. Logistic regression analysis was carried out for five confounding factors (primiparity, a previous complicated delivery, presence of meconium, ruptured membranes and educational level) to adjust the odds ratio for the risk of neonatal resuscitation when oxytocics were used in normal labor. Except in the case of Abomey in Benin, where the variable 'presence of meconium' decreased the odds ratio from 6.4 to 3.4, the adjusted odds ratios remained similar to their non-adjusted values. In cases of non-dysfunctional labor, nurses and midwives used oxytocics more often than lesser trained health personnel (R.R. 4.0 [3.2-5.1]). CONCLUSION: Our results show that an obstetric treatment which is safe when used in certain well-defined indications, may have significant negative effects when used in situations where the same technical quality of care cannot be guaranteed.

Developing Countries↗
PubMed1993

[Ignorance and misconceptions in the use of contraceptive methods].

Good knowledge of the available contraceptive methods ensures better acceptability, continuity and satisfaction, and lower failure rates of these methods. This paper describes an inquiry on the contraceptive knowledge in 114 women attending three Brussels family planning clinics. Misconceptions, beliefs in false rumors, and considerable insufficiencies in knowledge were detected. In order to increase patient's ability to correctly use birth control methods, so as to lower unwanted pregnancy rate, efforts should be made by health practitioners as well as by mass media and teaching institutions.

Adolescent↗
PubMed1992

[Estimate of seroprevalence of HIV infection in Belgium using the back calculation method].

An estimation of HIV seroprevalence in Belgium in June 1990 was made by the "back calculation method". The theoretical calculation of the number of virus carriers gave a range of values from 5,750 to 16,800 carriers. The upper part of this range seems to be more consistent with data from epidemiologic monitoring (range of values from 8,900 to 16,800 carriers). HIV prevalence rate in Belgium in June 1990 would is estimated between 0.9/1000 and 1.7/1000. The detection rate of the infection among HIV positives individuals should be at least 34%.

Belgium↗
PubMed1989

Perinatal geography of Belgium.

The use of routinely collected perinatal data allows calculation of health indicators at regional levels. It helps the health managers in making decisions and provides etiological clues for epidemiology. The information is more easily assimilated with the use of maps. In Belgium, the rates of perinatal mortality, low-birthweight and preterm births vary widely between the districts. Southern districts maintain the highest rates of low-birthweight and preterm births. Even though these two factors account for most perinatal mortality cases, within 20 years, a disproportion of perinatal mortality rates between the north and the south of the country was progressively inversed to the disadvantage of the north. Advances in perinatology of some major services of the southern part may explain a good deal of this change. Discrepancies between low-birthweight and preterm rates in some districts may be explained by biomedical characteristics of ethnic groups concentrated in these areas.

Belgium↗
PubMed1989

Organization of prenatal care in Belgium.

Prenatal care in Belgium is characterized by regional variations between the Flemish- and French-speaking communities. Generally, care in the former area is provided by a general practitioner or a gynecologist/obstetrician in private practice, and in the latter by a gynecologist/obstetrician on a private or public basis. The level of use of prenatal care observed is, on average, high, but variations do exist according to the socioeconomic and cultural characteristics of the families and the health care services which they frequent.

Belgium↗
PubMed1989

[Follow-up of a cohort of premature infants: identification of factors associated with hospital death].

A cohort of premature babies (i.e. under 2.000 g and/or less than 32 weeks of gestation) born in Brussels in 1987, was followed-up during and after their stay at the neonatal unit. Among the 181 babies, 27 hospital deaths were recorded (a rate of 14.9%). Some of the variables significantly associated with hospital deaths (p less than 0.005) are well known, i.e.: birthweight, gestational age, respiratory distress, intraventricular hemorrhage. The strength of the link is measured by the relative risk (RR). For each factor with a significant RR, the positive predictive value (PPV) was also calculated. Not surprisingly, respiratory distress and intraventricular hemorrhage have the highest RR and PPV. More interesting, however, is the relatively high RR of Apgar score at five minutes (the value of which is determined at an early stage). Furthermore, the positive predictive value reaches a level of 35% and may therefore be used for the early detection of babies with a high risk of hospital death.

Birth Weight↗
PubMed1989

A versatile approach to health system evaluation.

Although problems in the relationships between different levels of health care systems in developing countries have a significant influence on efficiency, they have not been clearly defined. In the present article a simple method is described for assessing certain aspects of these problems. It is shown that data collected in a hospital can be used not only to highlight inadequate management of patients at the community level, but also to identify deficiencies at the community/hospital interface. The method is inexpensive and easy to understand, and could easily be adapted for every interface in a system and for all stages of health service development.

Chad↗
PubMed1987

[Avoidable mortality in Belgium].

The concept of avoidable mortality leads to an attempt at using specific mortality rates as output measures of health services. The analysis covered 43 Belgian districts between the years 1974 and 1978. Two Belgian areas were compared along a dimension defined by two axes of a correspondence factor analysis: Flanders which is associated with low SMR of avoidable mortality and Wallonia which has high rates. The persistence of high mortality in Wallonia was confirmed. Factorial scores for each district were used as indexes for geographical heterogeneity. Variations in these indices, including patient consultation rates and technical medical procedures, remained even after adjustment for socio-economic differences.

Adolescent↗
PubMed1987

[Episiotomy and prevention of complete and complicated tears. A study in 3 European countries].

The rates of third-degree tears in deliveries with and without episiotomy were compared in five samples: three French samples, a Belgian one and a Dutch one. Those samples corresponded to 48,430 single vaginal deliveries. The rates of episiotomy ranged from 29.3% to 54.2%. The results demonstrate that the risk of third-degree tears in vertex uncomplicated deliveries without episiotomy is low, and that in numerous cases third-degree tears are not prevented by an episiotomy. When uncomplicated deliveries of primipara were considered, results from four of the five samples showed that third-degree tears were not significantly more frequent in deliveries without episiotomy.

Belgium↗
PubMed1986

[Evaluation of prenatal care in Belgium and comparison between public and private medical sectors].

The Belgian health system imposes no regulations regarding antenatal care. A special study was carried out by questionnaire in a sample of 32 maternity units representative of the French-speaking region to determine the coverage rate achieved by the health system. The study also compared the private and public sectors for rate of use, socioeconomic profile of users and regularity of antenatal care. Overall results show that despite the generosity of the system, a utilization rate of 98.8%, and a coverage rate of 84%, are reached. Public and private sector attendance is comparable but their respective populations are different. Regularity of antenatal care varies considerably between the two sectors. The public sector performs better in this regard, especially when it is endowed with medico-public health teams. The results suggest that the regularity of antenatal care is a better indicator of the quality of services than of their accessibility.

Belgium↗