OBJECTIVE: To compare the differences in operative time and surgical outcomes between salpingectomy and standard tubal interruption at the time of cesarean delivery. DATA SOURCES: PubMed, Medline, Google Scholar, Cochrane, and ClinicalTrials.gov were searched from inception until July 2019 for articles reporting outcomes for women undergoing salpingectomy during cesarean delivery compared with women undergoing standard sterilization methods. METHODS OF STUDY SELECTION: Studies were selected if they included the main outcome of operative time or additional outcomes, which included infection, transfusion, readmission, change in hematocrit, and estimated blood loss. The Newcastle-Ottawa Quality Assessment scale or Cochrane Handbook were used to assess quality of cohort and randomized controlled trials (RCTs), respectively. A random-effects model was employed to calculate pooled relative risk or weighted mean difference for each outcome with their 95% CI. Heterogeneity was assessed using the I2 statistic, and L'Abbé plots were inspected visually to assess for homogeneity. TABULATION, INTEGRATION, AND RESULTS: We identified 11 studies comprising 320,443 women undergoing total salpingectomy or standard sterilization methods at the time of cesarean delivery. Three RCTs and eight retrospective cohort studies were investigated separately by meta-analysis. When compared with standard sterilization methods, total operative time for patients receiving salpingectomy was significantly longer (6.3 minutes, 95% CI 3.5–9.1, seven studies, 7,303 patients) for cohort studies. With the three RCTs of 163 patients, total operative time was not significantly increased in women receiving salpingectomy (8.1 minutes, 95% CI −4.4 to 20.7). The salpingectomy group did not have an increased risk of wound infection, transfusion, readmission, reoperation, internal organ damage, blood loss, change in hemoglobin, or length of stay when compared with standard sterilization methods. CONCLUSION: Salpingectomy at the time of cesarean delivery was associated with a small increase in operative time; however, it was not associated with an increased rate of surgical complications. This option should be considered for patients desiring sterilization during cesarean delivery. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019145247.
INTRODUCTION: Low food access has been associated with an increased risk of obesity and cardiovascular disease, but little is known if food access increases the likelihood of adverse pregnancy outcomes. We aimed to determine if living in an area of low food access is associated with an increased prevalence of preterm birth in Florida. METHODS: We linked, at the census tract level, data on food access from the United States Department of Agriculture (USDA) Food Access Research Atlas to pregnancy outcome data from the Florida Community Health Assessment Research Tool Set. We defined a census tract as “low access to healthy food” if the tract was both low income and a significant number (≥500) or proportion (33%) of the population lives more than 1 mile (urban areas) or 10 miles (rural areas) from the nearest supermarket. Prevalence ratios and 95% confidence intervals were calculated using modified Poisson regression models. RESULTS: We analyzed 2,368,114 births in the state of Florida from 2008-2018 with nonmissing gestational age and food access designation. The preterm birth rate was 10.9% and 10.1% in areas with and without low food access, respectively. We calculated a prevalence ratio of 1.04 (95% CI 1.03–1.05) for the association between preterm birth and low food access after adjustment for maternal race/ethnicity. CONCLUSION: Living in an area of low food access was associated with a slight increase in prevalence of preterm birth in Florida. Food access and other measures of neighborhood deprivation may play a role in the risk of adverse perinatal outcomes.
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