Reducing maternal mortality in low- and middle-income countries

Pattern of Utilization of Antenatal Care Services and Adherence Among Females Following Up at Primary Healthcare Centers in Al-Ahsa

Background Antenatal care (ANC) is a crucial component of maternal and child health, yet disparities in utilization persist globally. This study aimed to assess the patterns of ANC service utilization and adherence among pregnant women attending primary healthcare centers (PHCCs) in Al-Ahsa, Saudi Arabia. Methodology A quantitative, cross-sectional study was conducted among 277 women attending PHCCs in Al-Ahsa. Data were collected through structured questionnaires, assessing demographic characteristics, ANC follow-up patterns, structural and personal barriers, and mental health conditions using the Depression, Anxiety, and Stress Scale. Results Significant regional variations in ANC follow-up patterns were observed, with higher proportions of pregnant women attending ANC in the Middle and Eastern regions. Prominent structural barriers included transportation challenges (structural barrier 3, 61.0%) and limited service availability (structural barrier 6, 56.0%), while personal barriers encompassed transportation problems (personal barrier 6, 36.8%) and forgetfulness regarding appointments (personal barrier 4, 19.9%). Mental health assessments revealed predominantly normal levels of depression, anxiety, and stress, with some regional variations in distress levels. Conclusions The study highlights regional disparities in ANC service utilization and adherence, influenced by structural barriers, personal barriers, and mental health conditions. Tailored interventions addressing these barriers, improving access to care, and providing targeted support are crucial for enhancing ANC service utilization and promoting maternal and child health in Al-Ahsa.

Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries

Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.

Necrotising fasciitis presenting as a blister: A case report on improving early recognition of surgical site infection following caesarean delivery

Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.