/library/oar/handle/123456789/413 2025-11-13T10:03:05Z /library/oar/handle/123456789/139175 Title: European Board and College of Obstetrics and Gynaecology position statement on maternal mortality surveillance in Europe Authors: Kallianidis, Athanasios F.; Velebil, Petr; Alexander, Sophie; Kristufkova, Alexandra; Savona-Ventura, Charles; Mahmood, Tahir; Mukhopadhyay, Sambit Abstract: Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place. 2024-01-01T00:00:00Z /library/oar/handle/123456789/130249 Title: Robson ten group classification system for Caesarean sections across Europe : a systematic review and meta-analysis Authors: El Radaf, Viktoria; Campos, Leticia Nunes; Savona-Ventura, Charles; Mahmood, Tahir; Zaigham, Mehreen Abstract: The aim of this systemic review and meta-analysis was to examine the differences in caesarean section rates across European regions and at a country level by utilizing the Robson classification system. The study has compared caesarean rates across European regions using the Robson classification to identify the drivers of caesarean section use. This review shows significant variations in caesarean section rates across European regions, ranging from 16.9 % in Northern Europe to 43.6 % in Southern Europe. There was a higher contribution of previous CS (Robson Group 5), ranging from 51.2 to 95.0 % of CS in this group to overall rates, particularly in Southern Europe (95.0 %), raises concerns about the “domino effect” of primary caesareans. This finding emphasises the critical importance of strategies to reduce primary CS rates. Background: Caesarean section (CS) rates exhibit considerable global variation, reflecting diverse medical practices, cultural attitudes, and healthcare policies. While some regions maintain relatively low rates, others report significantly higher incidences of the procedure. Analysing these differences is crucial for understanding and developing targeted healthcare strategies and ensuring optimal maternal and neonatal outcomes. This review examines differences in CS rates in Europe according to the Robson 10 group classification. Methods: We identified articles between January 2000 to June 2023 using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library. There was no restriction on patient population, except for birth in a country of the European region. We excluded all studies that were conference proceedings and studies reported in a language other than English and Swedish. Findings: The search generated a total of 1024 studies, out of which 44 were included, encompassing 6,641,615 births. The majority were from Northern (38 %) and Western Europe (33.5 %). CS rates varied markedly across Europe, ranging from 16.9 % in Northern region to 43.6 % in Southern Europe. The highest contribution to CS rates came from Robson Group 5 (previous CS), with contributions ranging from 51.2 % in Northern to 95.0 % in Southern Europe. The mode of birth for Robson Group 6 (nulliparous, breech) was predominately by CS (88.8 % in Northern to 92.5 % in Central-Eastern Europe). Interpretation: CS rates continue to vary widely across Europe, with the highest rates in Southern and the lowest in Northern Europe. Previous CS and breech presentation were prominent drivers of CS rates. Region-specific strategies are needed to address these diverse factors to minimise accelerating CS rates across Europe. 2024-01-01T00:00:00Z /library/oar/handle/123456789/119487 Title: Anaemia in pregnancy : its prevalence and maternal and neonatal outcomes in Malta Abstract: Aim: Anaemia in pregnancy has been associated with adverse maternal and perinatal outcomes. This study aims to determine the prevalence of anaemia in Maltese pregnant women at three specific stages in pregnancy; at booking appointment (first hospital consultation), at 34-36 weeks of gestation (third trimester) and at delivery. In addition, the factors associated with maternal anaemia, including socio-demographic factors and BMI will be analysed. Finally, the association between maternal anaemia at booking, at the third trimester and at delivery and maternal and neonatal outcomes will also be examined. Method: An observational longitudinal prospective study was carried out, whereby all the pregnant women who had their booking appointment at Mater Dei Hospital from the 1st of July, 2021 till the 8th of August, 2021 were asked to participate. During this period, 432 patients had their booking appointment. 46 patients did not agree to participate, whilst 75 patients met the exclusion criteria (multiple pregnancies, developement of medical disorders of pregnancy and pregnancy losses). Inclusion criteria included willingness to participate and planned delivery at Mater Dei Hospital. The final sample consisted of 311 participants. At booking appointment, a complete blood count (CBC) was taken and data including socio-demographic data and BMI was obtained. These women were followed up at 34-36 weeks of pregnancy whereby CBC was repeated. Another CBC was taken at delivery. The WHO criteria were used to classify patients who were anaemic; a haemoglobin concentration less than 11.0 g/dl was diagnostic of anaemia. At delivery, maternal and fetal outcomes were assessed, including need for transfusion, postpartum haemorrhage, length of hospital stay, ITU admission, postpartum sepsis, maternal and neonatal mortality, type of delivery, gestation at delivery, birth weight and Apgar score. This data was obtained from medical records. The IBM SPSS software (Version 23) was used to analyse the data. The Chi-square test (χ2) was used to examine relationships whereby a p-value of less than 0.05 (95% confidence) indicated a statistical significance between associations. Results: The prevalence of anaemia was found to be 11% at booking, 21% during the third trimester and 29% at delivery. Maternal anaemia was significantly associated with nationality (p-value less than 0.001, 0.011 and 0.004, at booking, third trimester and delivery, respectively) and nulliparity (p-value 0.022, 0.022 and 0.018, at booking, third trimester and delivery, respectively). Increasing gravidity was found to decrease risk of anaemia at booking (p-value 0.014) and at the third trimester (p-value 0.007), but not at delivery. Those women with higher level of education were found to be less likely to be anaemic at booking (p-value 0.001), whilst those women who were employed were found to be more likely to be anaemic at booking (p-value 0.024). Married women were more likely to be anaemic at the third trimester when compared to their single counterparts (p-value 0.049). Booking at first trimester was linked with decreased rates of maternal anaemia (p-value less than 0.001). Short pregnancy interval of less than 2 years increased risk anaemia, whilst longer intervals decreased likelihood of developing maternal anaemia (p-value 0.006). No statistical significance was found between age and BMI and anaemia in pregnancy. Significant associations between anaemia at the third trimester and the need for blood transfusion (p-value 0.001), as well as anaemia at delivery and increased length of hospital stay were found (p-value 0.006). Likelihood of anaemia decreased in women who had a vaginal delivery and increased in those who had elective caesarean section (p-value 0.005). No significant relationships were found between maternal anaemia and postpartum haemorrhage, gestation at delivery, birth weight of newborns and APGAR score. Conclusion: This study showed that in Malta anaemia in pregnancy is a public health problem. The development of local policies and guidelines for the detection, screening, treatment and prevention of anaemia in pregnant women is crucial Description: M.Sc.(Melit.) 2023-01-01T00:00:00Z /library/oar/handle/123456789/107282 Title: The role of biochemical markers and genetic susceptibility in the pathogenesis of hormone dependent malignancies Abstract: Introduction: Multiple studies have associated the global increase of postmenopausal breast and endometrial cancer with the worldwide increase in obesity and the metabolic syndrome. The Maltese population has also been repeatedly shown to have markedly increased obesity, metabolic syndrome and insulin resistance, with increasing trends of breast and endometrial cancers. Aims: To evaluate which markers - metabolic/hormonal and genetic markers related to the metabolic syndrome – are associated with increased risk of breast and/or endometrial cancer. Also, it aims to compare the performance of polygenic risk scores relative to anthropometric/clinical predictors in classifying cancer from control patients. Method: A random sample of three study populations was recruited: Study Group 1- Patients with a history of endometrial carcinoma; Study Group 2 - Patients with a history of breast carcinoma; and Study Group 3: A control group including women with histologically confirmed absence of endometrial carcinoma (after hysterectomy) and no history of breast carcinoma. All the patients recruited were postmenopausal patients of Maltese ethnicity. Each subject was interviewed and anthropometric data measured. Blood was collected for biochemical and hormonal tests. The risk factors were associated with breast/endometrial cancer risk and logistic regression was done. DNA was extracted from whole blood and genetic profiling by LP-WGS was then carried out. Association of genetic risk scores of single nucleotide polymorphisms known to be association with diabetes mellitus type II and insulin resistance were determined by logistic regression. Results: 300 patients have been recruited - 132 patients were diagnosed with breast cancer, 90 patients with endometrial cancer (four patients had both endometrial and breast cancer) and 82 patients controls. The study observed a positive association between early menarche, nulliparity and high BMI with both breast (p=0.02, p=0.049, and p=0.04 respectively] and endometrial cancer risk (p=0.01, p=0.017, p<0.01) respectively. Family history of breast cancer and high SHBG level were also found to be associated with increased breast cancer risk (p=0.009 and p=0.02 respectively) while a positive association between history of hypertension (p<0.01), diabetes mellitus type 2 (p<0.01), presence of the metabolic syndrome (p<0.01), family history of hypertension (p=0.007), high serum triglycerides (p<0.01), HbA1C (p<0.01), HOMA-IR (p=0.01) were found with endometrial cancer. History of breastfeeding was observed to be negatively associated with both breast (p<0.01) and endometrial cancer risk (p<0.01). Serum FSH and LH levels were also found to be negatively associated with breast cancer (p<0.01 and p<0.01 respectively) while serum SHBG and progesterone showed a negative association with endometrial cancer (p=0.01 and p=0.01 respectively). The logistic regression models showed that that BMI was the best predictor of breast and endometrial cancers - for every 1 kg/m2 increase in BMI, the odds of having breast cancer increased by 3.9% (OR=1.039) while the odds of having endometrial cancer increased by 8.4% (OR=1084). Genetic profiling showed that a greater number of alleles from genetic risk scores with loci for diabetes mellitus type 2 and insulin resistance were significantly present in the breast and endometrial cancer cohorts. After adjustment for age, fasting insulin, fasting glucose, WHR and serum triglycerides level, quintile 5 of GRS 1 was found to have an OR for cancer risk (breast/endometrial) of 21.738 (p<0.01). Conclusion: This study gave better understanding on the risk significance of various factors related to breast and endometrial carcinogenesis in the Maltese population. By determining risk factors, women can be risk-stratified and individualised intervention/s can be implemented according to their risk for developing breast/endometrial cancer. Description: Ph.D.(Melit.) 2022-01-01T00:00:00Z