BackgroundThe aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Costs were assessed by taking into account maternal origin and delivery type.MethodsWe performed a cross-sectional study of all deliveries in a teaching hospital to mothers living in its catchment area between October 2006 and September 2007. A process cost analysis based on a full cost accounting system was performed. The main information sources were the primary care program for sexual and reproductive health, and hospital care and costs records. Partial and total costs were compared according to maternal origin and delivery type. A regression model was fit to explain the total cost of the childbirth process as a function of maternal age and origin, prenatal care, delivery type, maternal and neonatal severity, and multiple delivery.ResultsThe average cost of childbirth was 4,328€, with an average of 18.28 contacts between the mother or the newborn and the healthcare facilities. The delivery itself accounted for more than 75% of the overall cost: maternal admission accounted for 57% and neonatal admission for 20%. Prenatal care represented 18% of the overall cost and 75% of overall acts. The average overall cost was 5,815€ for cesarean sections, 4,064€ for vaginal instrumented deliveries and 3,682€ for vaginal non-instrumented deliveries (p < 0.001). The regression model explained 45.5% of the cost variability. The incremental cost of a delivery through cesarean section was 955€ (an increase of 31.9%) compared with an increase of 193€ (6.4%) for an instrumented vaginal delivery. The incremental cost of admitting the newborn to hospital ranged from 420€ (14.0%) to 1,951€ (65.2%) depending on the newborn's severity. Age, origin and prenatal care were not statistically significant or economically relevant.ConclusionsNeither immigration nor prenatal care were associated with a substantial difference in costs. The most important predictors of cost were delivery type and neonatal severity. Given the impact of cesarean sections on the overall cost of childbirth, attempts should be made to take into account its higher cost in the decision of performing a cesarean section.
Asymmetric hydrogenation plays an important role in organic synthesis, but that of the challenging substrates such as N‐unprotected imines, enamines, and N‐heteroaromatic compounds (1H‐indoles, 1H‐pyrroles, pyridines, quinolines, and quinoxalines) has only received increased attention in the past three years. Considering the interaction modes of a Brønsted acid with a Lewis base, Brønsted acids may be used as the ideal activators of CN bonds. This Minireview summarizes the recent advances in transition‐metal‐catalyzed, Brønsted acid activated asymmetric hydrogenation of these challenging substrates, thus offering a promising substrate activation strategy for transformations involving CN bonds.
Group prenatal care support has been studied in order to increase maternal and neonatal benefits, such as breastfeeding initiation rates, in front of standard care. In our area, especially in some high risk sub-groups, it could be an important intervention to improve individual care.The aim of the pilot initiative is to compare the effect of group prenatal care support versus only standard individual care on breastfeeding initiation rates and other perinatal outcomes. A retrospective cohort study was made analyzing all deliveries at Hospital del Mar in Barcelona during 1 year. All pregnant women were compared depending on whether they had received the group prenatal care support by midwifes or only standard care. 1383 women gave birth at Hospital del Mar in Barcelona in 2015. 207 received group prenatal care support (15% of total). In group prenatal care there significantly were more nulliparous and native women. Breastfeeding initiation rate was higher in group prenatal care women (94.2% vs. 86.7%, p=0.01). Other outcomes like cesarean section rates, prematurity and low birth weight rates also improved in group prenatal care support in front of standard care.Our study suggests that group prenatal care support improves breastfeeding initiation rates and some other maternal and perinatal outcomes.
Transfusion and Perforation: Perforation of colon occurred in four neonates after exchange transfusion for haemolytic disease, and was thought to be the result of disturbances in the portal circulation. All recovered after laparotomy and antibiotics (p. 345). Six further cases are reported, the pathological findings resembling acute necrotizing enterocolitis (p. 349). Leader at p. 340. Prognosis in Nephrotic Syndrome: A study of 400 nephrotics suggests that in children aged 1 to 5 years differential protein clearance tests can obviate renal biopsy (p. 352). Leader at p. 343. Folate Siatus in Pregnancy: Report confirms previous findings that 300 "g. folic acid daily is a suitable supplement (p. 356). Myocardial Infarction: Oxygen therapy probably worth while since tissue oxygenation appears to be improved by it, despite reduction it causes in cardiac output (p. 360). Ventricular Dysrhythmias: Occurred after recovery from infarction in 11 out of 142 patients, and proved fatal in seven (p. 364). Vasodilator in Infarction: Controlled trial did not show any benefit from treatment with dipyridamole (p. 366). Case Reports: Oedema of legs from bladder distension (p. 369). Bandaging causing sternal depression with associated cardiac arrhythmia (p. 369). Schizophrenia: Coping with patient in the home environment (p. 371). Audiometry: Diagnostic tests described in Medicine Today article (p. 373). Surgical Training: Proposals for revision of diploma and better supervision of postgraduate training (p. 379).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.