PubMed · 13974085
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J W RITTER. 1962. Postmortem cesarean section.. https://pubmed.ncbi.nlm.nih.gov/13974085/
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We hypothesized that cord blood erythropoietin (EPO), a marker of fetal hypoxia, relates to gestational factors and not solely those associated with delivery. We investigated the association between birth weight SD score (SDS) and cord blood EPO in 290 twins (145 pairs), assessing the influence of gestational versus perinatal factors by comparing the association in those who were delivered by elective cesarean (CS) with that in other delivery modes. Blood EPO values were skewed, so geometric means are presented and log EPO values were used in statistical models. The birth size-EPO association was estimated in mixed-effects models that included terms that represented difference in log EPO and mean log EPO for each twin pair. Within-pair estimates of the association were unconfounded by maternal factors (because these were perfectly controlled). Geometric mean EPO was higher in boys versus girls (24.4 versus 17.0 IU/L; p = 0.0001) and increased with gestational age (p = 0.0003) but was similar after elective CS versus other delivery modes. The negative birth size-EPO association was stronger in infants who were delivered by elective CS than by other delivery modes [beta for log(2) EPO: -0.56 (95% CI, -0.77 to -0.36) versus -0.27 (-0.42 to -0.12), respectively; p = 0.02 for interaction). Because the association was seen after elective CS delivery, cord blood EPO must relate to factors during gestation, not just perinatal factors. There was no evidence of an association between birth weight SDS and pair mean log EPO, indicating that the association is entirely due to fetus-specific rather than pair-specific factors.
BACKGROUND: Subcutaneous and sub rectus sheath wound drains are sometimes used in women who have undergone caesarean section. The indications for using drains vary by clinician. OBJECTIVES: To compare the effects of using a wound drain with not using a wound drain at caesarean section, and of different types of drain, on maternal health and healthcare resource use. SEARCH STRATEGY: This review draws on the search strategy developed for the Cochrane Wounds Group as a whole. Electronic databases (MEDLINE, EMBASE, Cinahl and CAB Health), and the reference lists of included articles were also searched up to June 2004 SELECTION CRITERIA: Studies were included if they allocated women to groups at random and they compared any type of wound drain with no wound drainage, or with any other type of drain, in women undergoing caesarean section. DATA COLLECTION AND ANALYSIS: Trials were evaluated for appropriateness for inclusion and methodological quality without consideration of their results. This was done by two reviewers according to pre-stated eligibility criteria. MAIN RESULTS: Seven trials (1993 women) were included in the review. Meta-analysis found no difference in the risk of wound infection, other wound complications, febrile morbidity or endometritis in women who had wound drains compared with those who did not. There was some evidence that caesarean sections may be about five minutes shorter and that blood loss may be slightly lower when drains were not used. AUTHORS' CONCLUSIONS: There is no evidence in the seven small trials included to suggest that the routine use of wound drains at caesarean section confers any benefit on the women involved. These trials do not answer the question of whether wound drainage is of benefit when haemostasis is not felt to be adequate. Further large trials are justified using blinded outcome assessment to examine the role of different types of wound drain at caesarean section. Comparing the use of drains in women with different degrees of obesity and in women having first or repeat caesareans and intrapartum or prelabour caesarean sections would be of interest. Women's views and experience of drains have not been studied in these trials.
Using a statistical model and a partial equilibrium economic search model, we develop a methodology for appraising the value of consumer information about the quality of health care providers and apply it to information about physicians' predispositions to perform cesarean section deliveries. There are three primary results. First, information's value is roughly proportional to a simple statistical metric of its accuracy; the constant of proportionality can be imputed from knowledge of consumer search methods and consumer preferences. Second, the function governing the production of information from data 'inputs' can have surprising economic properties, such as economies of scale, that usefully inform the efficient production of consumer information. These properties are robust even when the value of information cannot be precisely determined. Third, information's value is enhanced by the way physicians are sorted into hospitals but greatly attenuated by the presence of other dimensions of physician heterogeneity. Under plausible assumptions, the value of information in our empirical application is small enough that it is not surprising that consumers do not utilize it when selecting a physician.