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Stillbirths in Rural Hospitals in The Gambia: A Cross-Sectional Retrospective Study  [PDF]
Abdou Jammeh,Siri Vangen,Johanne Sundby
Obstetrics and Gynecology International , 2010, DOI: 10.1155/2010/186867
Abstract: Objective. We determined the stillbirth rate and associated factors among women who delivered in rural hospitals in The Gambia. Method. A cross-sectional retrospective case review of all deliveries between July and December 2008 was undertaken. Maternity records were reviewed and abstracted of the mother’s demographic characteristics, obstetric complications and foetal outcome. Main Outcome Measure: The stillbirth rate was calculated as deaths per 1000 births. Results. The hospital-based stillbirth rate was high, 156 (95% CI 138–174) per 1000 births. Of the 1,519 deliveries, there were 237 stillbirths of which 137 (57.8%) were fresh. Severe obstetric complication, birth weight <2500 g, caesarean section delivery, and referral from a peripheral health facility were highly significantly associated with higher stillbirth rates, OR = 6.68 (95% CI 3.84–11.62), 4.47 (95% CI 3.04–6.59), 4.35 (95% CI 2.46–7.69), and 3.82 (95% CI 2.24–6.51), respectively. Half (50%) of the women with stillbirths had no antenatal care OR = 4. 46(95% CI 0.84–23.43). Conclusion. We observed an unacceptably high stillbirth rate in this study. As most of the stillbirths were fresh, improved intrapartum care supported by emergency transport services and skilled personnel could positively impact on perinatal outcomes in rural hospitals in The Gambia. 1. Introduction Stillbirths and neonatal deaths remain a huge challenge in the care of pregnant women, especially in developing countries [1]. Over 3.3 million stillbirths and more than 3 million early neonatal deaths occur every year. A vast majority (98%) takes place in developing countries where stillbirths represent over half of the perinatal deaths [2]. Complications during pregnancy and child birth are known to be closely associated with high stillbirth and perinatal mortality rate [3]. Perinatal mortality and stillbirth rates are important indicators of the quality of antenatal and obstetric care in a community [4]. Despite an important indicator stillbirths are invisible in global policy and programme priorities. They are usually not captured in local data collecting systems [2, 5]. Lack of a well-defined programme agenda, coupled with the lack of data, and social invisibility, deter action and investments for stillbirth prevention and reduction [2]. Being cognizant of the distribution of stillbirths (fresh and macerated) and deaths within the immediate postpartum period may help to detect shortcomings in the quality of antenatal and obstetric care given to the pregnant woman, hence prioritize appropriate intervention programmes
Maternal age at first birth and obstetric outcome
E.P. Gharoro, A.A. Igbafe
Nigerian Journal of Clinical Practice , 2002,
Abstract: The objective of this study was to determine the effect of age on women going through their first pregnancy and delivery at extremes of reproductive life. All obstetric records of delivered mothers at the UBTH between January 1995 and December 1999 were extracted for the study. There were 2,658 primiparous birth (27.3%) out of a total of 9,735 deliveries. Teenage mothers were 156 (5.87%), while the elderly primigravidas were 117 (4.4%) and the ideal age primigravidas (Control) were 2,385 (89.73%)The average maternal age at first birth was 27.05±3.04 years. Teenagers registered for their first antenatal visit later than the elderly mothers (23 weeks vs. 18 weeks; P< 0.05). The elderly primigravidas utilized antenatal service more than the teenagers or young primigravidas; booking status (94.7%, 53.9% and 81.4% respectively), attended adequately (78.95%, 22.2% and 62.5% respectively). The caesarean section rate for the elderly and the teenage primigravidas was 52.6% and 50.0% respectively compared with 29.2% for the young (idea) mothers. The elective caesarean section rate was significantly higher for the elderly primigravida 21.05%, compared to 0.0% and 1.35% for the teenage and ideal primigravidas respectively. The incidence of low birth weight infants was significantly higher amongst the elderly primigravidas (p =0.000). The number of women having their first birth at the extremes of age is small in our community today. The caesarean section rate is high both for the teenagers and the elderly primigravidas, however their obstetric outcome is good if utilization of antenatal care is adequate and labour properly conducted. KEY WORDS: Primigravida, Age, First Birth, Pregnancy Outcome [Nig J Clinical Practice Vol.5(1) 2002: 20-24]
Increasing Low Birth Weight Rates: Deliveries in a Tertiary Hospital in Istanbul
Yasemin Akin,Serdar C?mert,Cem Turan,Orhan ünal
Iranian Journal of Pediatrics , 2010,
Abstract: Objective:Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study. Methods:Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined. Findings:Among 19,533 total births, there were 450 (23.04 per 1000) stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed (P<0.001). Very low birth weight and extremely low birth weight delivery rates were 3.14% and 1.58% respectively. Among 2073 low birth weight infants, 333 (16.06%) were stillbirths. The stillbirth delivery rate and the birth of a female infant among low birth weight deliveries were significantly higher than infants with birth weight ≥2500g (P<0.001, OR=28.37), (P<0.001) retrospectively. There was no statistical difference between low birth weight and maternal age. The rate of cesarean section among low birth weight infants was 49.4%. Conclusion:High low birth weight and stillbirth rates, as well as the increase in low birth weight deliveries over the past five years in this study are striking. For reduction of increased low birth weight rates, appropriate intervention methods should be initiated.
The Effect of Mother’s Hypertension and Weight and Parent’s Smoking Habit on Low Birth Weight Deliveries in Hospital, Kuala Lumpur, Malaysia
Latiffah A Latiff,Parichehr Hanachi
Journal of Family and Reproductive Health , 2010,
Abstract: Objective: Maternal factors such as age, health, diet, and environment are significantly associated with low birth weight. The objectives of this study were to determine the incidence, distribution and major risk factors of low birth weight in Hospital Kuala Lumpur."nMaterials and methods: A hospital based case–control study was done in Obstetric Ward of Maternity Hospital in Hospital Kuala Lumpur. Data was obtained using questionnaire and Performa. Out of 1021 deliveries, 330 were selected randomly as respondents that comprises of 110 cases and 220 controls. The outcome measure was low birth weight (<2500 grams)."nResults: The incidence of low birth weight was 10.8%. Among races, the highest occurrence of low birth weight was in Malay, while the highest age group was between 21 years old to 34 years old with majority of the respondent were married. Among the maternal socio-demographic factors, maternal height of less than 150 cm has a significant relationship with low birth weight. In addition, maternal weight of 45 kg and less and maternal weight gain during pregnancy of less than 10 kg were also found to be risk factors. However, none of the socio-demographic factors were significantly associated with low birth weight deliveries. Similarly, signs of premature delivery, maternal vaginal bleeding and fetal growth retardation (IUGR) had a significant association."nConclusion: The mothers that have experienced any of the risks that were identified should be monitored and effective prevention should be taken to decrease the chances of low birth weight but not forgetting to promote a health lifestyle to the mother and father as well.
Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies
Mamady Cham, Johanne Sundby, Siri Vangen
Reproductive Health , 2009, DOI: 10.1186/1742-4755-6-5
Abstract: From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge.Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs.The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.An overwhelming majority (99%) of the estimated 536,000 annual maternal deaths occur in developing countries making maternal mortality ratio (MMR) the indicator with the widest disparity between developed and developing countries [1]. To improve this situation, Millennium Development Goal 5 targets a three-quarter maternal mortality reduction by 2015 [2]. Unrestricted access to high quality emergency obstetric care (EOC) is promoted to the attainment of that goal [3]. EOC and skilled attendance at delivery are two complimentary strategies closely correlated with MMR [4-6]. Countries with low MMR, such as those in Europe and North America, have both a high proportion of births attended by skilled provider and universal access to high quality EOC [4-6]. By contrast, in many developing countries both the proportion of births attended by skilled personnel and met need for EOC a
Term birth weight and sex ratio of offspring of a nigerian obstetric population  [PDF]
Swende T. Z
International Journal of Biological and Medical Research , 2011,
Abstract: ABSTRACT BACKGROUND: Birth weight varies from one population to another and is an important variable influencing neonatal morbidity and mortality. This study was done to determine the mean birth weight, incidence of low birth weight and macrosomia, and sex ratio of live term deliveries at the Federal Medical Centre Makurdi, Nigeria. METHOD: This was a retrospective analysis of live term deliveries between January 2003 and December 2008 at the Federal Medical Centre, Makurdi, Nigeria. RESULTS: There were 9381 deliveries during the study period. The mean birth weight was 3.08 ± 0.61 Kg for all sexes. Low birth weight babies accounted for 11.16% of the study population while 6.05% of babies were macrosomic. Males weighed more than females though this was not statistically significant. The sex ratio for all deliveries was 108. CONCLUSION: The mean birth weight and incidence of low birth weight among newborns in Makurdi are similar to those reported elsewhere in Nigeria. The incidence of macrosomia at birth is however higher than earlier reports in Nigeria. The sex ratio is not only similar to those of other Nigerian studies but is comparable to findings in Caucasians.
Risk Factors at Birth for Permanent Obstetric Brachial Plexus Injury and Associated Osseous Deformities  [PDF]
Rahul K. Nath,Nirupama Kumar,Meera B. Avila,Devin K. Nath,Sonya E. Melcher,Mitchell G. Eichhorn,Chandra Somasundaram
ISRN Pediatrics , 2012, DOI: 10.5402/2012/307039
Abstract: Purpose. To examine the most prevalent risk factors found in patients with permanent obstetric brachial plexus injury (OBPI) to identify better predictors of injury. Methods. A population-based study was performed on 241 OBPI patients who underwent surgical treatment at the Texas Nerve and Paralysis Institute. Results. Shoulder dystocia (97%) was the most prevalent risk factor. We found that 80% of the patients in this study were not macrosomic, and 43% weighed less than 4000?g at birth. The rate of instrument use was 41% , which is 4-fold higher than the 10% predicted for all vaginal deliveries in the United States. Posterior subluxation and glenoid version measurements in children with no finger movement at birth indicated a less severe shoulder deformity in comparison with those with finger movement. Conclusions. The average birth weight in this study was indistinguishable from the average birth weight reported for all brachial plexus injuries. Higher birth weight does not, therefore, affect the prognosis of brachial plexus injury. We found forceps/vacuum delivery to be an independent risk factor for OBPI, regardless of birth weight. Permanently injured patients with finger movement at birth develop more severe bony deformities of the shoulder than patients without finger movement. 1. Introduction The incidence of obstetric brachial plexus injury (OBPI) is about 1.51 [1] per 1000 live births in the United States and reports vary from 0.38 [2] to 5.8 [3] per 1000 live births. Many of these injuries are transient; however, most of the OBPI patients never recover full function and develop permanent injuries [2, 4, 5]. In reports conducted by pediatricians and specialists, with follow-up times greater than 3 years, the reported proportion of injuries that remain permanent varies from 50 to 90% [6–8]. Risk factors for injury include shoulder dystocia, macrosomia (defined as birth weight greater than 4500?g [9–12]) instrument-assisted delivery, and downward traction of the fetal head [1, 7, 8]. Yet in a database search of over 11 million births, it was found that most children with neonatal brachial plexus palsy did not have known risk factors [1]. In obstetrics, presentation of shoulder dystocia is often emergent because the reported risk factors for its occurrence are not good predictors of it [13, 14]. Therefore we seek to examine the most prevalent risk factors found in a population of patients with permanent OBPI that necessitated surgical treatment to attempt to identify better predictors of injury and to elucidate the pathophysiology of OBPI.
Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India
Singh,Amarjit; Mavalankar,Dileep V; Bhat,Ramesh; Desai,Ajesh; Patel,SR; Singh,Prabal V; Singh,Neelu;
Bulletin of the World Health Organization , 2009, DOI: 10.1590/S0042-96862009001200017
Abstract: problem: india has the world's largest number of maternal deaths estimated at 117 000 per year. past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level. approach: we have documented an innovative public-private partnership scheme between the government of gujarat, in india, and private obstetricians practising in rural areas to provide delivery care to poor women. local setting: in april 2007, the majority of poor women delivered their babies at home without skilled care. relevant changes: more than 800 obstetricians joined the scheme and more than 176 000 poor women delivered in private facilities. we estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between april and october 2007. the programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor. lessons learned: at least in some areas of india, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.
Anaesthetic and Obstetric challenges of morbid obesity in caesarean deliveries-a study in South-eastern Nigeria
UV Okafor, ER Efetie, O Nwoke, O Okezie, U Umeh
African Health Sciences , 2012,
Abstract: Background: Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. Objective: To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. Methods: The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35kg/m2). Results: There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3kg/m2 (SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths. Conclusion: The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.
Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates- A birth register-based study in Finland
Sari R?is?nen, Katri Vehvil?inen-Julkunen, Mika Gissler, Seppo Heinonen
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-345
Abstract: The aim of the study was to assess risks of OASIS among five university teaching hospitals and 14 non-university central hospitals with more than 1,000 deliveries annually during 1997-2007 in Finland. Women with singleton vaginal deliveries divided into two populations consisting of all 168,637 women from five university hospitals and all 255,660 women from non-university hospitals, respectively, derived from population-based register. Primiparous and multiparous women with OASIS (n = 2,448) were compared in terms of possible risk factors to primiparous and multiparous women without OASIS, respectively, using stepwise logistic regression analysis. The occurrences of OASIS varied from 0.7% to 2.1% in primiparous and from 0.1% to 0.3% in multiparous women among the university hospitals. Three-fold inter-hospital differences in OASIS rates did not significantly change after adjustment for patient mix or the use of interventions. In non-university hospitals OASIS rates varied from 0.2% to 1.4% in primiparous and from 0.02% to 0.4% in multiparous women, and the results remained virtually unchanged after adjustment for known risks.Up to 3.2-fold inter-hospital differences in OASIS risk demonstrates significant differences in the quality of Finnish obstetric care.Birth injuries have been chosen one of the 21 indicators for patient safety in Organisation for Economic Cooperation and Development (OECD) countries [1], and one of 36 quality indicators in Nordic countries [2]. Obstetric anal sphincter injury (OASIS) is a serious complication of delivery, which frequently results in faecal incontinence despite primary repair and has serious implications for women's health [3-5]. The occurrence of OASIS varies widely between countries, and might be consequently preventable. For instance, in Finland and Sweden rates of 1% and 4% have been reported [6] respectively. To date, studies on the relationship between OASIS rates and standards of obstetric care have focused primarily on ho
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