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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh. PLoS One 2024; 19:e0287622. [PMID: 39037995 PMCID: PMC11262631 DOI: 10.1371/journal.pone.0287622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United Stated of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
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Al-Nuaimi AMA. Role of hematological indices in predicting preeclampsia and its severity: retrospective case-control study. Medicine (Baltimore) 2024; 103:e38557. [PMID: 38905404 PMCID: PMC11192010 DOI: 10.1097/md.0000000000038557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024] Open
Abstract
Preeclampsia (PE) is a serious condition that threatens pregnancy with severe sequelae on both the mother and infant. Early detection of PE will lead to favorable outcomes, and using readily available markers like hematological indices is an attractive choice. Examine the diagnostic utility of hematological indices in pregnant women to predict preeclampsia and its severity. In a retrospective case-control study that included 252 women, all had their complete blood picture evaluated during their first and third trimesters as part of their outpatient antenatal care during their pregnancy. They were also divided into 3 groups: healthy pregnant women (control), non-severe PE, and severe PE, each involving 84 women. The changes in platelet to lymphocyte ratio (PLR) between 1st and 3rd trimesters showed an excellent ability to differentiate between severe PE and control (area under the curve = 0.954, cutoff ≤ -5.45%) and a good ability to differentiate between severe PE and non-severe PE (area under the curve = 0.841, cutoff ≤ -7.89%). Neutrophil to lymphocyte ratio showed a good to excellent ability to differentiate between severe PE and non-severe PE compared to control in the first and third trimesters and the percentage change between them. Changes in neutrophil to lymphocyte ratio and PLR strongly predict preeclampsia and its severity since they offer more predictive values than measuring NLP and PLR at different stages of pregnancy individually.
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Mendis L, Palaniswami M, Keenan E, Brownfoot F. Rapid detection of fetal compromise using input length invariant deep learning on fetal heart rate signals. Sci Rep 2024; 14:12615. [PMID: 38824217 PMCID: PMC11144251 DOI: 10.1038/s41598-024-63108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
Standard clinical practice to assess fetal well-being during labour utilises monitoring of the fetal heart rate (FHR) using cardiotocography. However, visual evaluation of FHR signals can result in subjective interpretations leading to inter and intra-observer disagreement. Therefore, recent studies have proposed deep-learning-based methods to interpret FHR signals and detect fetal compromise. These methods have typically focused on evaluating fixed-length FHR segments at the conclusion of labour, leaving little time for clinicians to intervene. In this study, we propose a novel FHR evaluation method using an input length invariant deep learning model (FHR-LINet) to progressively evaluate FHR as labour progresses and achieve rapid detection of fetal compromise. Using our FHR-LINet model, we obtained approximately 25% reduction in the time taken to detect fetal compromise compared to the state-of-the-art multimodal convolutional neural network while achieving 27.5%, 45.0%, 56.5% and 65.0% mean true positive rate at 5%, 10%, 15% and 20% false positive rate respectively. A diagnostic system based on our approach could potentially enable earlier intervention for fetal compromise and improve clinical outcomes.
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Affiliation(s)
- Lochana Mendis
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia.
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Emerson Keenan
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, 3084, VIC, Australia
| | - Fiona Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, 3084, VIC, Australia
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Jung S, Chi H, Eom YJ, Subramanian S, Kim R. Multilevel analysis of determinants in postnatal care utilisation among mother-newborn pairs in India, 2019-21. J Glob Health 2024; 14:04085. [PMID: 38721673 PMCID: PMC11079700 DOI: 10.7189/jogh.14.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India. Methods Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories. Results Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories. Conclusions Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.
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Affiliation(s)
- Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Boo YY, Bora AK, Chhabra S, Choudhury SS, Deka G, Kakoty S, Kumar P, Mahanta P, Minz B, Rani A, Rao S, Roy I, Solomi V C, Verma A, Zahir F, Deka R, Kurinczuk JJ, Nair M. Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study. Int J Gynaecol Obstet 2024; 165:462-473. [PMID: 38234106 DOI: 10.1002/ijgo.15367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to investigate the incidence of and risk factors for stillbirth in an Indian population. METHODS We conducted a secondary data analysis of a hospital-based cohort from the Maternal and Perinatal Health Research collaboration, India (MaatHRI), including pregnant women who gave birth between October 2018-September 2023. Data from 9823 singleton pregnancies recruited from 13 hospitals across six Indian states were included. Univariable and multivariable Poisson regression analysis were performed to examine the relationship between stillbirth and potential risk factors. Model prediction was assessed using the area under the receiver-operating characteristic (AUROC) curve. RESULTS There were 216 stillbirths (48 antepartum and 168 intrapartum) in the study population, representing an overall stillbirth rate of 22.0 per 1000 total births (95% confidence interval [CI]: 19.2-25.1). Modifiable risk factors for stillbirth were: receiving less than four antenatal check-ups (adjusted relative risk [aRR]: 1.75, 95% CI: 1.25-2.47), not taking any iron and folic acid supplementation during pregnancy (aRR: 7.23, 95% CI: 2.12-45.33) and having severe anemia in the third trimester (aRR: 3.37, 95% CI: 1.97-6.11). Having pregnancy/fetal complications such as hypertensive disorders of pregnancy (aRR: 1.59, 95% CI: 1.03-2.36), preterm birth (aRR: 4.41, 95% CI: 3.21-6.08) and birth weight below the 10th percentile for gestational age (aRR: 1.35, 95% CI: 1.02-1.79) were also associated with an increased risk of stillbirth. Identified risk factors explained 78.2% (95% CI: 75.0%-81.4%) of the risk of stillbirth in the population. CONCLUSION Addressing potentially modifiable antenatal factors could reduce the risk of stillbirths in India.
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Affiliation(s)
- Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amrit K Bora
- Sonapur District Hospital, Guwahati, Assam, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Gitanjali Deka
- Tezpur Medical College and Hospital, Tezpur, Assam, India
| | - Swapna Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Bina Minz
- Sewa Bhawan Hospital Society, Basna, Chhattisgarh, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sereesha Rao
- Silchar Medical College and Hospital, Silchar, Assam, India
| | - Indrani Roy
- Nazareth Hospital, Shillong, Meghalaya, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ashok Verma
- Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Farzana Zahir
- Assam Medical College (AMC), Dibrugarh, Assam, India
| | - Rupanjali Deka
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mooberry M, Voss N, Wendt L, Kenne KA, Jackson JB, Rysavy MB. Predictors of Postpartum Hemorrhage and Associated Outcomes at a Midwest Academic Medical Center. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:358-366. [PMID: 39035139 PMCID: PMC11257117 DOI: 10.1089/whr.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 07/23/2024]
Abstract
Background Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality around the world, with rates increasing in the United States. The objective of this study was to determine predictors of, and outcomes associated with, PPH at a Midwest academic health center. Methods Demographic and clinical data were obtained from the electronic medical record on all consecutive delivering patients between May 1, 2020, and April 30, 2021. Associations between PPH and perinatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons. Results Of the 2497 delivering patients during the study period, 437 (18%) experienced PPH. Chronic hypertension, gestational hypertension, and preeclampsia with and without severe features were all associated with increased odds of PPH (odds rations [ORs], respectively, 1.61 (95% CI:1.13-2.24, p = 0.006), 1.62 (95% CI 1.18-2.21, p = 0.003), 1.81 (95% CI 1.14-2.80, p ≤ 0.001), and 1.92 (95% CI 1.29-2.82, p = 0.009). There were also increased odds of PPH with type I diabetes: 2.83 (95% CI 1.45-5.30, p = 0.001), type II diabetes: 2.14 (95% CI 1.15-3.82, p = 0.012), twin delivery: 3.20 (95% CI 2.11-4.81, p ≤ 0.001), cesarean delivery: 5.66 (95% CI 4.53-7.09, p ≤ 0.001), and assisted vaginal delivery: 3.12 (95% CI1.95-4.88, p ≤ 0.001). Infants of mothers with PPH had high odds of NICU admission (CI = 1.34-2.07, p < 0.001) and hypoxic ischemic encephalopathy (CI = 1.64-7.14, p < 0.001). Conclusion Our findings confirm previous literature that preexisting and pregnancy-related hypertension, diabetes mellitus, multiple gestation, cesarean delivery, and assisted vaginal delivery are important predictors of PPH. In addition, we found that neonates of mothers with PPH had more adverse outcomes. These results may help to inform clinical care as rates of PPH continue to rise in the United States.
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Affiliation(s)
- Megan Mooberry
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Natalie Voss
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Kimberly A. Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | | | - Mary B. Rysavy
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Bonell A, Part C, Okomo U, Cole R, Hajat S, Kovats S, Sferruzzi-Perri AN, Hirst JE. An expert review of environmental heat exposure and stillbirth in the face of climate change: Clinical implications and priority issues. BJOG 2024; 131:623-631. [PMID: 37501633 DOI: 10.1111/1471-0528.17622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
Exposure to extreme heat in pregnancy increases the risk of stillbirth. Progress in reducing stillbirth rates has stalled, and populations are increasingly exposed to high temperatures and climate events that may further undermine health strategies. This narrative review summarises the current clinical and epidemiological evidence of the impact of maternal heat exposure on stillbirth risk. Out of 20 studies, 19 found an association between heat and stillbirth risk. Recent studies based in low- to middle-income countries and tropical settings add to the existing literature to demonstrate that all populations are at risk. Additionally, both short-term heat exposure and whole-pregnancy heat exposure increase the risk of stillbirth. A definitive threshold of effect has not been identified, as most studies define exposure as above the 90th centile of the usual temperature for that population. Therefore, the association between heat and stillbirth has been found with exposures from as low as >12.64°C up to >46.4°C. The pathophysiological pathways by which maternal heat exposure may lead to stillbirth, based on human and animal studies, include both placental and embryonic or fetal impacts. Although evidence gaps remain and further research is needed to characterise these mechanistic pathways in more detail, preliminary evidence suggests epigenetic changes, alteration in imprinted genes, congenital abnormalities, reduction in placental blood flow, size and function all play a part. Finally, we explore this topic from a public health perspective; we discuss and evaluate the current public health guidance on minimising the risk of extreme heat in the community. There is limited pregnancy-specific guidance within heatwave planning, and no evidence-based interventions have been established to prevent poor pregnancy outcomes. We highlight priority research questions to move forward in the field and specifically note the urgent need for evidence-based interventions that are sustainable.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Part
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Uduak Okomo
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rebecca Cole
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sari Kovats
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Imperial College London, London, UK
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Zhu D, Barabadi M, McDonald C, Kusuma G, Inocencio IM, Lim R. Implications of maternal-fetal health on perinatal stem cell banking. Gene Ther 2024; 31:65-73. [PMID: 37880336 PMCID: PMC10940157 DOI: 10.1038/s41434-023-00426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
Cell based therapies are being assessed for their therapeutic potential across a variety of diseases. Gestational tissues are attractive sources for cell therapy. The large number of births worldwide ensures sufficient access to gestational tissues, however, limited information has been reported around the impact of birth trends, delivery methods and pregnancy conditions on perinatal stem cell banking. This review describes the current state of banking of gestational tissues and their derived perinatal stem cells, discusses why the changes in birth trends and delivery methods could affect gestational tissue banking practices, and further explores how common pregnancy complications can potentially influence perinatal stem cell banking.
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Affiliation(s)
- Dandan Zhu
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia
| | - Mehri Barabadi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia.
| | - Courtney McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia
| | - Gina Kusuma
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia
| | - Ishmael Miguel Inocencio
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Monash, VIC, Australia
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Halomoan Harahap T, Mansouri S, Salim Abdullah O, Uinarni H, Askar S, Jabbar TL, Hussien Alawadi A, Yaseen Hassan A. An artificial intelligence approach to predict infants' health status at birth. Int J Med Inform 2024; 183:105338. [PMID: 38211423 DOI: 10.1016/j.ijmedinf.2024.105338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Machine learning could be used for prognosis/diagnosis of maternal and neonates' diseases by analyzing the data sets and profiles obtained from a pregnant mother. PURPOSE We aimed to develop a prediction model based on machine learning algorithms to determine important maternal characteristics and neonates' anthropometric profiles as the predictors of neonates' health status. METHODS This study was conducted among 1280 pregnant women referred to healthcare centers to receive antenatal care. We evaluated several machine learning methods, including support vector machine (SVM), Ensemble, K-Nearest Neighbor (KNN), Naïve Bayes (NB), and Decision tree classifiers, to predict newborn health state. RESULTS The minimum redundancy-maximum relevance (MRMR) algorithm revealed that variables, including head circumference of neonates, pregnancy intention, and drug consumption history during pregnancy, were top-scored features for classifying normal and unhealthy infants. Among the different classification methods, the SVM classifier had the best performance. The average values of accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) in the test group were 75%, 75%, 76%, 76%, and 65%, respectively, for SVM model. CONCLUSION Machine learning methods can efficiently forecast the neonate's health status among pregnant women. This study proposed a new approach toward the integration of maternal data and neonate profiles to facilitate the prediction of neonates' health status.
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Affiliation(s)
- Tua Halomoan Harahap
- Education of Mathematics, Universitas Muhammadiyah Sumatera Utara, Medan, Indonesia.
| | - Sofiene Mansouri
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; University of Tunis El Manar, Higher Institute of Medical Technologies of Tunis, Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia.
| | - Omar Salim Abdullah
- Ministry of Education, Baqubah, Iraq; Bilad Alrafidain University College, Baquhah, Iraq.
| | - Herlina Uinarni
- Department of Anatomy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Indonesia; Radiology Department of Pantai Indah Kapuk Hospital Jakarta, Indonesia.
| | - Shavan Askar
- Erbil Polytechnic University, Erbil Technical Engineering College, Information System Engineering Department, Erbil, Iraq.
| | - Thaer L Jabbar
- College of Pharmacy, Al- Ayen University, Thi-Qar, Iraq.
| | - Ahmed Hussien Alawadi
- Medical Laboratory Technique College, The Islamic University, Najaf, Iraq.; Medical Laboratory Technique College, The Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq; Medical Laboratory Technique College, The Islamic University of Babylon, Babylon, Iraq.
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10
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Zhang QQ, Di XM, Cao X, Nie Y, Shuai W, Li J, Zhang H. Analysis of pharmacodynamic components, targets and synergistic action mechanism of Fuyuan Shenghua granule for the treatment of medical-induced incomplete abortion based on network pharmacology. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117118. [PMID: 37659757 DOI: 10.1016/j.jep.2023.117118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Fuyuan Shenghua Granule (FYSHG) is a traditional Chinese medicine preparation widely used in our hospital for the treatment of incomplete postpartum uterine repair. However, its pharmacological action, main components, and synergistic mechanism are still unclear. AIM OF THE STUDY The study aims to verify the pharmacological action, identify the main components and explore the synergistic mechanisms of FYSHG for the treatment of medical-induced incomplete abortion. MATERIALS AND METHODS The ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was employed to identify the main components of FYSHG after extraction with water and methanol. A medical-induced incomplete abortion rat model was established, and the uterine status was evaluated by morphological and H&E staining analysis. The KEGG enrichment analysis and network pharmacology analysis were used to screen the potential synergistic mechanisms of FYSHG. Hemorheological analysis was employed to analyze the blood viscosity and coagulation of FYSHG-treated rats. The ELISA was used to measure the concentration of E2, progesterone, RCG, IL-1, IL-6, and TNF. The Western blot analysis was employed to measure the protein expression of p38 and NF-κB signaling pathways. RESULTS A total 106 of components of FYSHG were identified and characterized rapidly by UHPLC-Q-TOF/MS technology. Intragastric administration of FYSHG could play a role in promoting uterine involution in rats with medical-induced incomplete abortion. The analysis of its components and targets by network pharmacology showed that the synergetic effect of FYSHG on anti-uterine involution mainly focused on anti-inflammatory, anticoagulant, and hormone regulation. ELISA and Western blot analysis showed that FYSHG mainly inhibited the protein expression of p38 and NF-κB signaling pathways. CONCLUSIONS Our study suggested that FYSHG suppressed the p38 and NF-κB signaling pathway to alleviate inflammation, regulate coagulant function, and correct hormone level, which might contribute to the treatment of medical-induced incomplete abortion.
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Affiliation(s)
- Qi-Qiang Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xue-Mei Di
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China; Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiang Cao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yonghong Nie
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wen Shuai
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jun Li
- Department of Obstetrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, 250011, China.
| | - Hai Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China; Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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11
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Levaillant M, Garabédian C, Legendre G, Soula J, Hamel JF, Vallet B, Lamer A. In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study. Int J Gynaecol Obstet 2024; 164:210-218. [PMID: 37485702 DOI: 10.1002/ijgo.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. METHODS All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). RESULTS Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. CONCLUSIONS Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high-level, high-volume maternity throughout the territory; this suggests closing down high-volume units and improving low-volume ones to maintain coherent mapping.
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Affiliation(s)
- Mathieu Levaillant
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
| | | | - Guillaume Legendre
- Faculté de Santé, Département de Médecine, CHU d'Angers, Angers, France
- Service de Gynécologie-Obstétrique, CHU d'Angers, Angers, France
| | - Julien Soula
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Jean-François Hamel
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
- UMR_S1085, University of Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Benoît Vallet
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Antoine Lamer
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- F2RSM Psy - Fédération Régionale de Recherche en Psychiatrie et Santé Mentale Hauts-de-France, Lille, France
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12
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Colomar M, de Mucio B, Sosa C, Gomez R, Mainero L, Souza RT, Costa ML, Luz AG, Sousa MH, Cruz CM, Chevez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Serruya SJ, Cecatti JG. Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network. Glob Health Action 2023; 16:2269736. [PMID: 37886828 PMCID: PMC10795600 DOI: 10.1080/16549716.2023.2269736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.
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Affiliation(s)
- Mercedes Colomar
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Bremen de Mucio
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Rodolfo Gomez
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Luis Mainero
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria H. Sousa
- Department of Statistics, Jundiaí School of Medicine - HU/FMJ, Jundiaí, Brazil
| | - Carmen M. Cruz
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Luz M. Chevez
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Rita Lopez
- Department of Obstetrics, Hospital Berta Calderon Roque, Managua, Nicaragua
| | - Gema Carrillo
- Department of Obstetrics, Hospital España, Chinandega, Nicaragua
| | - Ulises Rizo
- Department of Obstetrics, Hospital España, Chinandega, Nicaragua
| | - Erika E. Saint Hillaire
- Department of Obstetrics, Hospital San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - William E. Arriaga
- Department of Obstetrics, Hospital Regional de Ocidente, Quetzaltenango, Guatemala
| | - Rosa M. Guadalupe
- Department of Obstetrics, Hospital Regional de Ocidente, Quetzaltenango, Guatemala
| | | | - Freddy Gonzalez
- Department of Obstetrics, Hospital Roberto Suazo Cordova, La Paz, Honduras
| | - Rigoberto Castro
- Department of Obstetrics, Hospital Roberto Suazo Cordova, La Paz, Honduras
| | - Allan Stefan
- Department of Obstetrics, Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | - Amanda Moreno
- Department of Obstetrics, Hospital Boliviano Japones, La Paz, Bolivia
| | - Suzanne J. Serruya
- Department of Research, Latin American Center for Perinatology (CLP-PAHO), Montevideo, Uruguay
| | - José G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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13
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Kalter HD, Koffi AK, Perin J, Kamwe MA, Black RE. Maternal interventions to decrease stillbirths and neonatal mortality in Tanzania: evidence from the 2017-18 cross-sectional Tanzania verbal and social autopsy study. BMC Pregnancy Childbirth 2023; 23:849. [PMID: 38082404 PMCID: PMC10714492 DOI: 10.1186/s12884-023-06099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Reduction of Tanzania's neonatal mortality rate has lagged behind that for all under-fives, and perinatal mortality has remained stagnant over the past two decades. We conducted a national verbal and social autopsy (VASA) study to estimate the causes and social determinants of stillbirths and neonatal deaths with the aim of identifying relevant health care and social interventions. METHODS A VASA interview was conducted of all stillbirths and neonatal deaths in the prior 5 years identified by the 2015-16 Tanzania Demographic and Health Survey. We evaluated associations of maternal complications with antepartum and intrapartum stillbirth and leading causes of neonatal death; conducted descriptive analyses of antenatal (ANC) and delivery care and mothers' careseeking for complications; and developed logistic regression models to examine factors associated with delivery place and mode. RESULTS There were 204 stillbirths, with 185 able to be classified as antepartum (88 [47.5%]) or intrapartum (97 [52.5%]), and 228 neonatal deaths. Women with an intrapartum stillbirth were 6.5% (adjusted odds ratio (aOR) = 1.065, 95% confidence interval (CI) 1.002, 1.132) more likely to have a C-section for every additional hour before delivery after reaching the birth attendant. Antepartum hemorrhage (APH), maternal anemia, and premature rupture of membranes (PROM) were significantly positively associated with early neonatal mortality due to preterm delivery, intrapartum-related events and serious infection, respectively. While half to two-thirds of mothers made four or more ANC visits (ANC4+), a third or fewer received quality ANC (Q-ANC). Women with a complication were more likely to deliver at hospital only if they received Q-ANC (neonates: aOR = 4.5, 95% CI 1.6, 12.3) or ANC4+ (stillbirths: aOR = 11.8, 95% CI 3.6, 38.0). Nevertheless, urban residence was the strongest predictor of hospital delivery. CONCLUSIONS While Q-ANC and ANC4 + boosted hospital delivery among women with a complication, attendance was low and the quality of care is critical. Quality improvement efforts in urban and rural areas should focus on early detection and management of APH, maternal anemia, PROM, and prolonged labor, and on newborn resuscitation.
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Affiliation(s)
- Henry D Kalter
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Alain K Koffi
- Department of International Health, Health Systems, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jamie Perin
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mlemba A Kamwe
- National Bureau of Statistics, Dodoma, United Republic of Tanzania
| | - Robert E Black
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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14
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Wu X, Li Q, Cai J, Huang H, Ma S, Tan H. Longitudinal change of gut microbiota in hypertensive disorders in pregnancy: a nested case-control and Mendelian randomization study. Sci Rep 2023; 13:16986. [PMID: 37813882 PMCID: PMC10562506 DOI: 10.1038/s41598-023-43780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
Mounting evidence has shown that gut microbiota (GM) is related to hypertensive disorders in pregnancy (HDP), however, most studies only focused on one time point in pregnancy. In this study, we conducted a nested case-control study utilizing a follow-up cohort, resulting in the collection of 47 HDP patients and 30 healthy controls. The GM profiles were explored using 16S rRNA sequencing at three time points during pregnancy. The diversity analysis of GM showed no significant difference between HDP patients and controls, however, we found 21 differential GM during pregnancy. Trend analysis showed that there are statistical differences in the relative abundance of Thermomonas, Xanthomonas, and Phenylobacteriumat during pregnancy in the gestational hypertension group, and of Xanthomonas, Polycyclovorans, and Phenylobacterium in the control group. The correlation study found that six genera of GM are related to blood pressure. Furthermore, the MR analysis identified the causal relationship between Methanobrevibacter and pre-eclampsia (PE). This study first explored the longitudinal change of GM in HDP patients during pregnancy, found the differential GM, and detected the causal association. Our findings may promote the prevention and treatment of HDP from the perspective of GM and provide valuable insights into the pathogenesis of HDP.
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Affiliation(s)
- Xinrui Wu
- School of Medicine, Jishou University, Jishou, China
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Qi Li
- Xiangxi Center for Disease Control and Prevention, Jishou, China
| | - Jiawang Cai
- School of Medicine, Jishou University, Jishou, China
| | | | - Shujuan Ma
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.
| | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China.
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15
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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Self-reported diabetes or hypertension diagnoses and antenatal care among child-bearing women in rural Bangladesh: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002175. [PMID: 37708098 PMCID: PMC10501644 DOI: 10.1371/journal.pgph.0002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
Health care systems in low- and middle-income countries may not meet the needs of pregnant women where the burden of diabetes and hypertension is rapidly increasing. We asked recently pregnant women about ever having been screened for or diagnosed with hypertension or diabetes and their ANC-seeking experiences in a cross-sectional survey. We used chi-squared tests and logistic regression to test the associations between self-reported coverage of hypertension and diabetes screening, diagnoses, and elements of ANC by age, wealth, educational attainment, and gravidity. Among 4,692 respondents, for hypertension, 97% reported having been screened and 10% of screened women reported a diagnosis. Women 30-39 years of age (aOR 3.02, 95% CI 2.00, 4.56) or in the top wealth quintile (aOR 1.70, 95% CI 1.18, 2.44) were more likely to be diagnosed with hypertension compared to reference groups. Any hypertension diagnosis was associated with reporting four or more antenatal care contacts (44% vs. 35%, p < 0.01), blood pressure measurements (85% vs. 79%, p < 0.01), and urine tests (71% vs. 61%, p < 0.01) conducted during ANC visits. For diabetes, 46% of respondents reported having been screened and 3% of screened women reported a diagnosis. Women 30-39 years of age were more likely to be diagnosed with diabetes (aOR 8.19, 95% CI 1.74, 38.48) compared to the reference group. Any diabetes diagnosis was associated with reporting four or more ANC contacts (48% vs. 36%, p = 0.04) and having blood testing during pregnancy (83% vs. 66%, p < 0.01). However, the frequency and quality of ANC was below the national guidelines among all groups. Focused efforts to ensure that women receive the recommended number of ANC contacts, coupled with improved compliance with ANC guidelines, would improve awareness of hypertension and diabetes among women in Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy L. Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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16
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Wu X, Li Q, Lin D, Cai J, Huang H, Tan H. Gut microbiota and hypertensive disorders in pregnancy: evidence from the Mendelian randomization study. Aging (Albany NY) 2023; 15:9105-9127. [PMID: 37698537 PMCID: PMC10522390 DOI: 10.18632/aging.205019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Recent studies have shown that gut microbiota (GM) is related to hypertensive disorders in pregnancy (HDP). However, the causal relationship needs to be treated with caution due to confounding factors and reverse causation. METHODS We obtained genetic variants from genome-wide association studies including GM (N = 18,340) in MiBioGen Consortium as well as HDP (7,686 cases/115,893 controls) and specific subtypes in FinnGen Consortium. Then, Inverse variance weighted, maximum likelihood, weighted median, MR-Egger, and MR.RAPS methods were applied to examine the causal association. Reverse Mendelian randomization (RMR) and multivariable MR were performed to confirm the causal direction and adjust the potential confounders, respectively. Furthermore, sensitivity analyses including Cochran's Q statistics, MR-Egger intercept, MR-PRESSO global test, and the leave-one-out analysis were conducted to detect the potential heterogeneity and horizontal pleiotropy. RESULTS The present study found causalities between eight gut microbial genera and HDP. The HDP-associated gut microbial genera identified by MR analyses varied in different subtypes. Specifically, our study found causal associations of LachnospiraceaeUCG010, Olsenella, RuminococcaceaeUCG009, Ruminococcus2, Anaerotruncus, Bifidobacterium, and Intestinibacter with GH, of Eubacterium (ruminantium group), Eubacterium (ventriosum group), Methanobrevibacter, RuminococcaceaeUCG002, and Tyzzerella3 with PE, and of Dorea and RuminococcaceaeUCG010 with eclampsia, respectively. CONCLUSIONS This study first applied the MR approach to detect the causal relationships between GM and specific HDP subtypes. Our findings may promote the prevention and treatment of HDP targeted on GM and provide valuable insights to understand the mechanism of HDP in different subtypes from the perspective of GM.
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Affiliation(s)
- Xinrui Wu
- School of Medicine, Jishou University, Jishou, China
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Qi Li
- Xiangxi Center for Disease Control and Prevention, Jishou, China
| | - Dihui Lin
- School of Medicine, Jishou University, Jishou, China
| | - Jiawang Cai
- School of Medicine, Jishou University, Jishou, China
| | | | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China
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Mendis L, Palaniswami M, Brownfoot F, Keenan E. Computerised Cardiotocography Analysis for the Automated Detection of Fetal Compromise during Labour: A Review. Bioengineering (Basel) 2023; 10:1007. [PMID: 37760109 PMCID: PMC10525263 DOI: 10.3390/bioengineering10091007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The measurement and analysis of fetal heart rate (FHR) and uterine contraction (UC) patterns, known as cardiotocography (CTG), is a key technology for detecting fetal compromise during labour. This technology is commonly used by clinicians to make decisions on the mode of delivery to minimise adverse outcomes. A range of computerised CTG analysis techniques have been proposed to overcome the limitations of manual clinician interpretation. While these automated techniques can potentially improve patient outcomes, their adoption into clinical practice remains limited. This review provides an overview of current FHR and UC monitoring technologies, public and private CTG datasets, pre-processing steps, and classification algorithms used in automated approaches for fetal compromise detection. It aims to highlight challenges inhibiting the translation of automated CTG analysis methods from research to clinical application and provide recommendations to overcome them.
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Affiliation(s)
- Lochana Mendis
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
| | - Fiona Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, VIC 3084, Australia;
| | - Emerson Keenan
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, VIC 3084, Australia;
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18
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Öcal E, Toprak V, Akalin SA, Aşir F, Deveci E. Investigation of Beclin 1 and TNF-α expressions in preeclampsia placentas: Immunohistochemical study. Medicine (Baltimore) 2023; 102:e34757. [PMID: 37603530 PMCID: PMC10443776 DOI: 10.1097/md.0000000000034757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Preeclampsia is a pregnancy complication Aim of this study was to investigate expression of Beclin1 and tumor necrosis factor (TNF)-α in normotensive and preeclamptic placentas of pregnant women patients. METHODS Twenty normotensive and 20 preeclamptic patients placentas were dissected for paraffin- wax processing. Placental samples were embedded in parafin blocks. Sections were stained with Hematoxylin-Eosin staining and TNF-α and Beclin1 immunostaining. RESULTS In control group, root and floating villi were normal in histological perspectives, syncytial node number was low, vessels were normal with connective tissue. No hemorrhage was observed in the intervillous area. In preeclampsia group, decidual cell degeneration and fibrinoid accumulation increased. Vascular dilatation and congestion with mononuclear cell infiltration were observed. Beclin1 reaction was generally negative in control group. In preeclampsia group, Beclin1 reaction was increased in decidual cells, syncytial nodes and bridges and in chorionic villi and in some Hoffbauer cells. In control group, TNF-α expression was mainly negative but only in some decidual cells. In preeclampsia, TNF-α reaction was observed in degenerated decidua cells, in leukocytes and in villi. CONCLUSION In preeclampsia placentas, degenerated decidua cells and inflammation increased. It was thought that Beclin1 and TNF-α signals could be used as a marker in affecting the fetal structure of blood flow in preeclamptic placentas.
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Affiliation(s)
- Ece Öcal
- Divison of Perinatology, Antalya Research and Education Hospital, Antalya, Turkey
| | - Veysel Toprak
- Department of Gynecology and Obstetrics, Eyyübiye Education and Research Hospital, Şanliurfa, Turkey
| | - Senem Alkan Akalin
- Divison of Gynecology and Obstetrics, Private Medical Practice, Diyarbakir, Turkey
| | - Firat Aşir
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Engin Deveci
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Kalter HD, Setel PW, Deviany PE, Nugraheni SA, Sumarmi S, Weaver EH, Latief K, Rianty T, Nandiaty F, Anggondowati T, Achadi EL. Modified Pathway to Survival highlights importance of rapid access to quality institutional delivery care to decrease neonatal mortality in Serang and Jember districts, Java, Indonesia. J Glob Health 2023; 13:04020. [PMID: 37054399 PMCID: PMC10101726 DOI: 10.7189/jogh.13.04020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 3.4-12.5) and twice (OR = 2.0; 95% CI = 1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean = 0.3 vs 3.6 days; P < 0.001) and death came sooner (3.5 vs 5.3 days; P = 0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median = 3.3 vs 1.3 hours; P = 0.01). Conclusions Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications.
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Affiliation(s)
- Henry D Kalter
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Poppy E Deviany
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Sri A Nugraheni
- Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Sri Sumarmi
- Faculty of Public Health, Airlangga University, Surabaya, Indonesia
| | - Emily H Weaver
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tika Rianty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Fitri Nandiaty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Trisari Anggondowati
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Endang L Achadi
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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Wu L, Yin WJ, Yu LJ, Wang YH, Jiang XM, Zhang Y, Tao FB, Tao RX, Zhu P. Prenatal Exposure to Air Pollution and Pre-Labor Rupture of Membranes in a Prospective Cohort Study: The Role of Maternal Hemoglobin and Iron Supplementation. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47013. [PMID: 37074185 PMCID: PMC10116877 DOI: 10.1289/ehp11134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Exposure to air pollution in prenatal period is associated with prelabor rupture of membranes (PROM). However, the sensitive exposure time windows and the possible biological mechanisms underlying this association remain unclear. OBJECTIVE We aimed to identify the sensitive time windows of exposure to air pollution for PROM risk. Further, we examined whether maternal hemoglobin levels mediate the association between exposure to air pollution and PROM, as well as investigated the potential effect of iron supplementation on this association. METHOD From 2015 to 2021, 6,824 mother-newborn pairs were enrolled in the study from three hospitals in Hefei, China. We obtained air pollutant data [particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), PM with aerodynamic diameter ≤10μm (PM10), sulfur dioxide (SO2), and carbon monoxide (CO)] from the Hefei City Ecology and Environment Bureau. Information on maternal hemoglobin levels, gestational anemia, iron supplementation, and PROM was obtained from medical records. Logistic regression models with distributed lags were used to identify the sensitive time window for the effect of prenatal exposure to air pollutant on PROM. Mediation analysis estimated the mediated effect of maternal hemoglobin in the third trimester, linking prenatal air pollution with PROM. Stratified analysis was used to investigate the potential effect of iron supplementation on PROM risk. RESULTS We found significant association between prenatal exposure to air pollution and increased PROM risk after adjusting for confounders, and the critical exposure windows of PM2.5, PM10, SO2 and CO were the 21th to 24th weeks of pregnancy. Every 10-μg/m3 increase in PM2.5 and PM10, 5-μg/m3 increase in SO2, and 0.1-mg/m3 increase in CO was associated with low maternal hemoglobin levels [-0.94g/L (95% confidence interval (CI): -1.15, -0.73), -1.31g/L (95% CI: -1.55, -1.07), -2.96g/L (95% CI: -3.32, -2.61), and -1.11g/L (95% CI: -1.31, -0.92), respectively] in the third trimester. The proportion of the association between air pollution and PROM risk mediated by hemoglobin levels was 20.61% [average mediation effect (95% CI): 0.02 (0.01, 0.05); average direct effect (95%): 0.08 (0.02, 0.14)]. The PROM risk associated with exposure to low-medium air pollution could be attenuated by maternal iron supplementation in women with gestational anemia. CONCLUSIONS Prenatal exposure to air pollution, especially in the 21st to 24th weeks of pregnancy, is associated with PROM risk, which is partly mediated by maternal hemoglobin levels. Iron supplementation in anemia pregnancies may have protective effects against PROM risk associated with exposure to low-medium air pollution. https://doi.org/10.1289/EHP11134.
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Affiliation(s)
- Lin Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Wan-jun Yin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Li-jun Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Yu-hong Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Xiao-min Jiang
- Department of Obstetrics and Gynecology, Anhui Women and Child Health Care Hospital, Hefei, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang-biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
| | - Rui-xue Tao
- Department of Gynecology and Obstetrics, Hefei First People’s Hospital, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenic, Anhui Medical University, Hefei, China
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Olubodun T, Rahman SA, Odukoya OO, Okafor IP, Balogun MR. Determinants of health facility delivery among young mothers aged 15 - 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey. BMC Pregnancy Childbirth 2023; 23:185. [PMID: 36932391 PMCID: PMC10024451 DOI: 10.1186/s12884-023-05492-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.
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Affiliation(s)
- Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Center, Abeokuta, Ogun State, Nigeria.
| | - Semiu Adebayo Rahman
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ifeoma P Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
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22
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Torre Monmany N, Astete JA, Ramaiah D, Suchitra J, Krauel X, Fillol M, Balasubbaiah Y, Alarcón A, Bassat Q. Extended Perinatal Mortality Audit in a Rural Hospital in India. Am J Perinatol 2023; 40:375-386. [PMID: 33902133 DOI: 10.1055/s-0041-1727220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. STUDY DESIGN Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." RESULTS The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. CONCLUSION This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. KEY POINTS · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..
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Affiliation(s)
- Núria Torre Monmany
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatric Emergency Transport, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joaquín Américo Astete
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatrics, Pediatria dels pirineus, la Seu d'Urgell, Spain
| | - Dasarath Ramaiah
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Jyothi Suchitra
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Xavier Krauel
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Manolo Fillol
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Gynecology, Hospital de la plana, Castellón, Spain
| | - Yadamala Balasubbaiah
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Ana Alarcón
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Icrea, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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23
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Ahmed AT, Farah AE, Ali HN, Ibrahim MO. Determinants of early neonatal mortality (hospital based retrospective cohort study in Somali region of Ethiopia). Sci Rep 2023; 13:1114. [PMID: 36670231 PMCID: PMC9859816 DOI: 10.1038/s41598-023-28357-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Early neonatal mortality occurs when a newborn dies within the first seven days of life. Despite interventions, neonatal mortality remains public health problem over time in Ethiopia (33 per 1000 live births). Determinants varies on level of neonatal mortality. The study's goal was to determine magnitude of early newborn death, as well as its determinants and causes in Newborn Intensive Care Unit of Referral hospital in Ethiopia's Somali region. Health facility based retrospective study review was conducted between May 2019 to May 2021 in Shiek Hassan Yabare Referral Hospital of Jigjiga University of Ethiopia. All neonates admitted at neonatal intensive care unit (NICU) with complete data and get registered using the new NICU registration book from May 2019 to May 2021 were included. Kobo toolkit was used for data collection and analyzed in SPSS 20. The magnitude of early neonatal mortality rate was defined as death between 0 and 7 days. Logistic regression model was used to estimate maternal and neonatal characteristics as a determinant variables on neonatal mortality. The statistical significance was considered at P-value < 0.05. The magnitude of early neonatal mortality rate of Ethiopia's Somali region is estimated to be 130 per 1000 live births-that is say 130 newborn couldn't celebrate their seventh day in every 1000 live births. Hypothermia, prematurity, maternal death at birth and shorter length of stay in NICU were increasing the chance of neonatal mortality at early stage while neonatal resuscitation had shown protective effect against neonatal mortality. Similarly birth asphyxia, preterm, sepsis, and congenital abnormalities were major causes of admission and death in the NICU. The magnitude of early neonatal mortality is considerable and most of the determinants are preventable. Enhancing quality of intra-partum and NICU care including infection prevention, managing hypothermia and neonatal resuscitation as per the national standard within the first golden hour is key.
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Affiliation(s)
- Ahmed Tahir Ahmed
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia. .,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia.
| | | | - Hussein Nooh Ali
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia.,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Muse Obsiye Ibrahim
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia.,Pediatric and child health Specialty Department, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reprod Health 2023; 20:7. [PMID: 36609381 PMCID: PMC9817240 DOI: 10.1186/s12978-022-01546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications. METHODS We used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15-49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section). RESULTS 16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0-100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p < 0.001), but lower supportive care scores, and about the same scores for dignity and respect and for the overall PCMC. 18 out of 31 experience of care indicators showed statistically significant differences by complications, but the magnitudes of the differences were generally small, and the direction of the associations were inconsistent. In general, women who delivered by c-section reported better experiences. CONCLUSIONS There is insufficient evidence based on our analysis to suggest that women with obstetric complications report consistently better or worse experiences of care than women without. Women with complications appear to experience better care on some indicators and worse care on others. More studies are needed to understand the relationship between obstetric complications and women's experience of care and to explore why women who deliver by c-section may report better experience of care.
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Debrah AF, Adebusoye FT, Shah MH, Awuah WA, Tenkorang PO, Bharadwaj HR, Wellington J, Ghosh S, Abiy L, Fernandes C, Abdul-Rahman T, Lychko V, Volodymyrivna BT, Mykolayivna NI. Neurological disorders in pregnant women in low- and middle-income countries-Management gaps, impacts, and future prospects: A review perspective. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231210265. [PMID: 37955275 PMCID: PMC10644749 DOI: 10.1177/17455057231210265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023]
Abstract
Neurological disorders during pregnancy are a substantial threat to women's health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | | | | | - Jack Wellington
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Lydia Abiy
- Donetsk National Medical University, Kropyvnytskyi, Ukraine
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26
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Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021. S Afr Med J 2022; 113:17-23. [PMID: 36537548 DOI: 10.7196/samj.2022.v113i1.16619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. OBJECTIVES To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021. METHODS Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. RESULTS While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. CONCLUSIONS The COVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets.
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Cetin K, Worku D, Demtse A, Melberg A, Miljeteig I. "Death audit is a fight" - provider perspectives on the ethics of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Ethiopia. BMC Health Serv Res 2022; 22:1214. [PMID: 36175949 PMCID: PMC9524002 DOI: 10.1186/s12913-022-08568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and neonatal health are regarded as important indicators of health in most countries. Death auditing through, for example, the Maternal and Perinatal Death Surveillance and Response (MPDSR) is viewed as key to preventing maternal and newborn mortality. However, little is known about the implications of implementing perinatal auditing for healthcare professionals in low-income contexts. This study aimed to explore the ethical and practical consequences clinicians experience concerning MPDSR reporting practices in Ethiopia. METHODS: Qualitative semi-structured in-depth individual interviews were conducted with 16 healthcare workers across professions at selected facilities in Ethiopia. The interview questions were related to clinicians' experiences with, and perceptions of, death auditing. Their strategies for coping with newborn losses and the related reporting practices were also explored. The material was analyzed following systematic text condensation, and the NVivo11 software was used for organizing and coding the data material. RESULTS Participants experienced fear of punishment and blame in relation to the perinatal death auditing process. They found that auditing did not contribute to reducing perinatal deaths and that their motivation to stick to the obligation was negatively affected by this. Performing audits without available resources to provide optimal care or support in the current system was perceived as unfair. Some hid information or misreported information in order to avoid accusations of misconduct when they felt they were not to blame for the baby's death. Coping strategies such as engaging in exceedingly larger work efforts, overtreating patients, or avoiding complicated medical cases were described. CONCLUSIONS Experiencing perinatal death and death reporting constitutes a double burden for the involved healthcare workers. The preventability of perinatal death is perceived as context-dependent, and both clinicians and the healthcare system would benefit from a safe and blame-free reporting environment. To support these healthcare workers in a challenging clinical reality, guidelines and action plans that are specific to the Ethiopian context are needed.
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Affiliation(s)
- Kaya Cetin
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway.
| | - Dawit Worku
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Demtse
- Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Melberg
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ingrid Miljeteig
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Muluneh AG, Asratie MH, Gebremariam T, Adu A, Enyew MM, Cherkos EA, Melkamu S, Berta M, Mamo W, Kassahun D, Tsega NT, Kebede AA, Asmamaw DB, Kassa GM, Mihret MS. Lifetime adverse pregnancy outcomes and associated factors among antenatal care booked women in Central Gondar zone and Gondar city administration, Northwest Ethiopia. Front Public Health 2022; 10:966055. [PMID: 36033730 PMCID: PMC9399634 DOI: 10.3389/fpubh.2022.966055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background In developing countries, adverse pregnancy outcomes are major public health issues. It is one of the leading causes of neonatal morbidity and mortality worldwide. Despite the fact that ending prenatal mortality and morbidity is one of the third Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of lifetime adverse pregnancy outcomes among antenatal care (ANC) booked women in Northwest Ethiopia. Methods An institutional-based cross-sectional study design was conducted in Northwest Ethiopia, between March 2021 and June 2021. A multi-stage stratified random sampling technique was employed to recruit participants. An interviewer-administered and checklist questionnaire were used to collect the data. The data were entered into Epi-data version 4.6 software and exported to Stata version 16 for analysis. The binary logistic regression model was fitted to identify an association between associated factors and the outcome variable. Variables with a p-value of < 0.05 in the multivariable logistic regression model were declared as statistically significant. Results In this study, the lifetime prevalence of adverse pregnancy outcome among study participants was 14.53% (95%CI: 11.61, 18.04). Road access to the health facilities (AOR = 2.62; 95% CI: 1.14, 6.02) and husband-supported pregnancy (AOR = 2.63; 95 CI: 1.46, 4.72) were significantly associated with adverse pregnancy outcomes. Conclusions More than one in 10 reproductive age women had adverse pregnancy outcome throughout their life. Road access to health facilities and husband-supported pregnancy were statistically significant factors for adverse events in pregnancy. Therefore, it is better to give more attention to expanding infrastructure like road accessibility and increasing husband-supported pregnancy to reduce adverse pregnancy outcomes.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tesfamichael Gebremariam
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aynalem Adu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihretu Molla Enyew
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Endeshaw Admasu Cherkos
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Senetsehuf Melkamu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martha Berta
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Worku Mamo
- North Gondar Zonal Health Department, Carter Center Zonal Project Coordinator, Gondar, Ethiopia
| | - Dawit Kassahun
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,*Correspondence: Desale Bihonegn Asmamaw
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Lupariello F, Di Vella G, Botta G. Stillbirth diagnosis and classification: comparison of ReCoDe and ICD-PM systems. J Perinat Med 2022; 50:713-721. [PMID: 35607751 DOI: 10.1515/jpm-2022-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The identification of causes of stillbirth (SB) can be a challenge due to several different classification systems of SB causes. In the scientific literature there is a continuous emergence of SB classification systems, not allowing uniform data collection and comparisons between populations from different geographical areas. For these reasons, this study compared two of the most used SB classifications, aiming to identify which of them should be preferable. METHODS A total of 191 SBs were retrospectively classified by a panel composed by three experienced-physicians throughout the ReCoDe and ICD-PM systems to evaluate which classification minimizes unclassified/unspecified cases. In addition, intra and inter-rater agreements were calculated. RESULTS ReCoDe defined: the 23.6% of cases as unexplained, placental insufficiency in the 14.1%, lethal congenital anomalies in the 12%, infection in the 9.4%, abruptio in the 7.3%, and chorioamnionitis in the 7.3%. ICD-PM defined: the 20.9% of cases as unspecified, antepartum hypoxia in the 44%, congenital malformations, deformations, and chromosomal abnormalities in the 11.5%, and infection in the 11.5%. For ReCoDe, inter-rater was agreement of 0.58; intra-rater agreements were 0.78 and 0.79. For ICD-PM, inter-rater agreement was 0.54; intra-rater agreements were of 0.76 and 0.71. CONCLUSIONS There is no significant difference between ReCoDe and ICD-PM classifications in minimizing unexplained/unspecified cases. Inter and intra-rater agreements were largely suboptimal for both ReCoDe and ICD-PM due to their lack of specific guidelines which can facilitate the interpretation. Thus, the authors suggest correctives strategies: the implementation of specific guidelines and illustrative case reports to easily solve interpretation issues.
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Affiliation(s)
- Francesco Lupariello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giancarlo Di Vella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale, "Università degli Studi di Torino" Torino, Italy
| | - Giovanni Botta
- Dipartimento di Scienze Mediche - Anatomia Patologica, Unità Materno Fetal, "Università degli Studi di Torino" Torino, Italy
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Haghighi M, Oladbaniadam K, Mohaddesi H, Rasuli J. Individual counseling in mothers bereaved by pregnancy loss: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:209. [PMID: 36003258 PMCID: PMC9393948 DOI: 10.4103/jehp.jehp_1765_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The loss of a pregnancy can result in grief, guilt, self-doubt, anxiety, and post-traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent pregnancies. The current study was designed to assess the impact of individual counseling on stress, anxiety, and depression in mothers with pregnancy loss. MATERIALS AND METHODS The study commenced 100 women who experienced pregnancy loss (in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The intervention group received four individual counseling sessions (weekly sessions with a duration of 1 h) based on Warden's principles. The control group received routine care. The Depression Anxiety Stress Scale (DASS-42) was filled out at baseline, the pre- and post-intervention. Analyses were performed using the Chi-square, paired, or individual t-tests, when necessary. P value < 0.05 was considered significant. RESULTS There were no significant differences regarding socio-demographic characteristics and clinical features between groups at baseline. Intra-group analysis showed that all outcome measures in the intervention group were significantly improved. According to inter-groups analysis, a significant association was found between pre-test and post-test in the intervention group (P < 0.05). CONCLUSION Results of this study can clarify the psychological effects of pregnancy loss in these mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these women and include them in the healthcare system.
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Affiliation(s)
| | - Khatereh Oladbaniadam
- M.Sc. Student of Counselling in Midwifery, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamideh Mohaddesi
- Department of Midwifery, Maternal and Childhood Obesity Research Center, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Rasuli
- Department of Epidemiology and Biostatistics, School of Medicine, University of Medical Sciences, Urmia, Iran
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Javeed A, Ali L, Mohammed Seid A, Ali A, Khan D, Imrana Y. A Clinical Decision Support System (CDSS) for Unbiased Prediction of Caesarean Section Based on Features Extraction and Optimized Classification. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1901735. [PMID: 35707186 PMCID: PMC9192258 DOI: 10.1155/2022/1901735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/16/2022] [Indexed: 12/14/2022]
Abstract
Nowadays, caesarean section (CS) is given preference over vaginal birth and this trend is rapidly rising around the globe, although CS has serious complications such as pregnancy scar, scar dehiscence, and morbidly adherent placenta. Thus, CS should only be performed when it is absolutely necessary for mother and fetus. To avoid unnecessary CS, researchers have developed different machine-learning- (ML-) based clinical decision support systems (CDSS) for CS prediction using electronic health record of the pregnant women. However, previously proposed methods suffer from the problems of poor accuracy and biasedness in ML. To overcome these problems, we have designed a novel CDSS where random oversampling example (ROSE) technique has been used to eliminate the problem of minority classes in the dataset. Furthermore, principal component analysis has been employed for feature extraction from the dataset while, for classification purpose, random forest (RF) model is deployed. We have fine-tuned the hyperparameter of RF using a grid search algorithm for optimal classification performance. Thus, the newly proposed system is named ROSE-PCA-RF and it is trained and tested using an online CS dataset available on the UCI repository. In the first experiment, conventional RF model is trained and tested on the dataset while in the second experiment, the proposed model is tested. The proposed ROSE-PCA-RF model improved the performance of traditional RF by 4.5% with reduced time complexity, while only using two extracted features through the PCA. Moreover, the proposed model has obtained 96.29% accuracy on training data while improving the accuracy of 97.12% on testing data.
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Affiliation(s)
- Ashir Javeed
- Aging Research Center, Karolinska Institute, Solna, Sweden
| | - Liaqat Ali
- Department of Electrical Engineering, University of Science and Technology Bannu, Bannu, Pakistan
| | - Abegaz Mohammed Seid
- Information & Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Arif Ali
- Department of Computer Science, University of Science and Technology Bannu, Bannu, Pakistan
| | - Dilpazir Khan
- Department of Computer Science, University of Science and Technology Bannu, Bannu, Pakistan
| | - Yakubu Imrana
- School of Engineering, University for Development Studies, Tamale, Ghana
- School of Computer Science and Engineering, University of Electronic Science and Technology of China (UESTC), Chengdu, China
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Okafor O, Roos N, Abdosh AA, Adesina O, Alaoui Z, Romero WA, Assarag B, Aworinde O, de Bernis L, Castro R, Chrifi H, Day LT, Demissew R, Aceituno MGF, Gadama L, Gashawbeza B, Keke SG, Govule P, Gwako G, Jayaratne K, Komboigo EB, Lara B, Madziyire MG, Mathai M, Moulki R, Moutaouadia I, Munjanja S, Fletes CAO, Ortiz EI, Ouedraogo HG, Qureshi Z, Recidoro ZD, Senanayake H, Soma-Pillay P, Tin KN, Sedami P, Worku D, Bonet M. International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions. BMC Pregnancy Childbirth 2022; 22:431. [PMID: 35606709 PMCID: PMC9128080 DOI: 10.1186/s12884-022-04731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
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Affiliation(s)
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | | | - Olubukola Adesina
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - Zaynab Alaoui
- Regional Directorate of Health, Settat region Casablanca, Morocco
| | - William Arriaga Romero
- Department of the Gynecology and Obstetrics, Hospital Regional de Occidente, Quetzaltenango, Guatemala
| | | | - Olufemi Aworinde
- Department of Obstetrics and Gynecology, Bowen University, Iwo, Nigeria
| | - Luc de Bernis
- Independent Consultant in International Maternal and Perinatal Health, 47300, Bias, France
| | | | | | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Rahel Demissew
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Zomba, Malawi
| | - Biruck Gashawbeza
- Department of Obstetrics and Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Philip Govule
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - George Gwako
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | | | | | - Bredy Lara
- Ministry of Health of Honduras, Tegucigalpa, Honduras
| | - Mugove Gerald Madziyire
- Clinical Trials Research Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Matthews Mathai
- Independent Consultant in International Maternal and Perinatal Health, St John's, Newfoundland and Labrador, Canada
| | | | | | - Stephen Munjanja
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Edgar Ivan Ortiz
- Department of Obstetrics and Gynecology, University of Valle, Cali, Colombia
| | - Henri Gautier Ouedraogo
- National Center for Scientific and Technological Research: Ouagadougou, Center, Ouagadougou, Burkina Faso
| | - Zahida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Zenaida Dy Recidoro
- Department of Health, Disease Prevention and Control Bureau, Manila, Philippines
| | - Hemantha Senanayake
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Khaing Nwe Tin
- Department of Public Health, Maternal and Reproductive Health Division, Ministry of Health and Sports, Naypyitaw, Myanmar
| | | | - Dawit Worku
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 27 CH-1211, Geneva, Switzerland.
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Gåre Kymre I, Paal P, Vaismoradi M. A Systematic Review and Meta-Analysis of the Risk of Stillbirth, Perinatal and Neonatal Mortality in Immigrant Women. Int J Public Health 2022; 67:1604479. [PMID: 35664648 PMCID: PMC9156626 DOI: 10.3389/ijph.2022.1604479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to investigate the risk of stillbirth, perinatal and neonatal mortality in immigrant women compared to native-origin women in host countries. Methods: A systematic literature review and meta-analysis was conducted. Relevant studies were identified using a thorough literature search and their quality was appraised. The analysis of heterogeneous data was carried out using the random effects model and publication bias was assessed using the Harbord-test. Also, the pooled odds ratio of events was calculated through the DerSimonian and Laird, and inverse variance methods. Results: In the search process 45 studies were retrieved consisting of 8,419,435 immigrant women and 40,113,869 native-origin women. The risk of stillbirth (Pooled OR = 1.35, 95% CI = 1.22–1.50), perinatal mortality (Pooled OR = 1.50, 95% CI = 1.35–1.68), and neonatal mortality (Pooled OR = 1.09, 95% CI = 1.00–1.19) in the immigrant women were significantly higher than the native-origin women in host countries. According to the sensitivity analyses, all results were highly consistent with the main data analysis results. Conclusion: The immigrant women compared to the native-origin women had the higher risks of stillbirth, perinatal and neonatal mortality. Healthcare providers and policy makers should improve the provision of maternal and neonatal healthcare for the immigrant population.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani,
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Moawad EMI, Tammam ASF, Mosaad MM, Sayed HME, Atef A. Evaluating the predictive value of fetal Doppler indices and neonatal outcome in late-onset preeclampsia with severe features: a cross-sectional study in a resource-limited setting. BMC Pregnancy Childbirth 2022; 22:377. [PMID: 35501758 PMCID: PMC9063060 DOI: 10.1186/s12884-022-04704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). Methods A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured. Results All UA indices were significantly higher in the case group compared to the controls (p < 0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p < 0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79, 72.8 and 73.3%, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52, 87 and 57%, respectively. Conclusion In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.
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Affiliation(s)
| | - Amr Samir Fouad Tammam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maha Mohamed Mosaad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Adel Atef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
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Lazo-Vega L, Toledo-Jaldin L, Badner A, Barriga-Vera JL, Castro-Monrroy M, Euser AG, Larrea-Alvarado A, Lawrence I, Mérida C, Mizutani R, Pérez Y, Rocabado S, Vargas M, Vasan V, Julian CG, Moore LG. ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:100194. [PMID: 35719175 PMCID: PMC9205446 DOI: 10.1016/j.lana.2022.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Methods Medical records for all HDP discharge diagnoses (n = 734) and twice as many controls (n = 1647) were reviewed for one year at the three largest delivery sites. For the 690 cases and 1548 controls meeting inclusion criteria (singleton, 18-45 maternal age, local residence), health history, blood pressures, symptoms, lab tests, HDP diagnoses (i.e., gestational hypertension [GH]; preeclampsia [PE]; haemolysis, low platelets, high liver enzymes [HELLP] syndrome, eclampsia), and adverse outcomes were recorded. Bolivian diagnoses were compared to ACOG guidelines using accuracy analysis and associated with adverse outcomes by logistic regression. Findings Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Interpretation Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. Funding NIH TW010797, HD088590, HL138181, UL1 TR002535.
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Affiliation(s)
- Litzi Lazo-Vega
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | - Abraham Badner
- Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia
| | | | | | - Anna G. Euser
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
| | | | - Ian Lawrence
- University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Carola Mérida
- Universidad Major de San Andrés, Escuela de Medicina, La Paz, Bolivia
| | | | | | - Sebastian Rocabado
- Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia
| | | | - Vikram Vasan
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Colleen G. Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Lorna G. Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, MS 8913, 12700 E 19th Avenue, Aurora, CO 80045, USA
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Cirillo F, Costa P, Romano M, Negri L, Morenghi E, Albani E, Setti PEL. Is the lack of prior exposure to sperm antigens associated with worse neonatal and maternal outcomes? A 10 years single-center experience comparing ICSI-TESE pregnancies to ICSI pregnancies. Andrology 2022; 10:931-943. [PMID: 35485252 DOI: 10.1111/andr.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nowadays pathogenesis of preeclampsia is still unknown. Among the different etiological hypotheses, some authors proposed that it might be due to an abnormal immunologic response to foreign fetal antigen derived from the father's sperm. Indeed, the fetus is considered a semi allograft, being one half paternally derived in its antigenicity, and the first pathogenic insult of preeclampsia may be an abnormal maternal immune response towards this semi-allogenic implant. In the context of Artificial Reproductive Techniques, it has been shown that the use of donor and surgically retrieved spermatozoa (e.g. Testicular Sperm Extraction) increases the risk of preeclampsia, confirming the protective effect of sperm exposure on maternal complications. OBJECTIVE Determining whether the lack of exposure to sperm antigens is associated with worse maternal and neonatal outcomes in pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia. MATERIAL AND METHODS This is a single-center case-control retrospective study, focusing on all first pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia at Humanitas Fertility Center between January 1st, 2010 and December 31st, 2019. Controls included patients that achieved their first pregnancy with intracytoplasmic sperm injection and ejaculated sperm, for a diagnosis other than azoospermia, in the same time period. Cases were matched with controls in a 1:2 ratio, considering female age, female BMI and year of controlled ovarian stimulation. The primary outcome measure was the delivery rate, defined as the number of deliveries divided by the total number of clinical pregnancies. Secondary outcome measures focused on maternal and neonatal complications, such as miscarriage rate, rate of main obstetric complications, prematurity rate and rate of congenital malformations. RESULTS By analyzing overall 113 pregnancies among cases and 214 pregnancies among controls, this study showed that the delivery rate was higher in controls with respect to cases (92.06% vs 84.07%, p = 0.026); among deliveries, live births were respectively 98.95% and 100%, while only one stillbirth occurred in cases. The first trimester miscarriage rate was higher in the cases than controls (13.27% vs 6.07%, p = 0.027), while no difference was found among rate of second trimester miscarriages, therapeutic abortions and ectopic pregnancies. There was no difference regarding the rate of maternal complications, including gestational hypertension, preeclampsia, HELLP syndrome, gestational diabetes, placenta previa, placental abruption and premature rupture of the membranes. Considering neonatal complications, it was shown that twins belonging to controls had a higher prematurity rate with respect to cases (65.79% vs 50.00%) but without a statistical relevance. Lastly, the rate of congenital malformations did not differ among the two groups. DISCUSSION This study showed that, once couples diagnosed with obstructive azoospermia achieve a pregnancy, they have a much higher risk of miscarriage in the first trimester in respect to non-azoospermic patients. Moreover, controls had a higher delivery rate in respect to cases; however, when the fetal status at birth was compared, no difference was found between live births and stillbirths. CONCLUSIONS Differently from the findings in the literature, no association with preeclampsia was found. This might be related to a collider bias/left truncation bias: since azoospermic patients are at higher risk of early termination of pregnancy, it results that they do not have the possibility to develop preeclampsia and other adverse outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Federico Cirillo
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paola Costa
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Massimo Romano
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Luciano Negri
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elena Albani
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
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Bain LE, Aboagye RG, Dowou RK, Kongnyuy EJ, Memiah P, Amu H. Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data. BMC Public Health 2022; 22:647. [PMID: 35379198 PMCID: PMC8981812 DOI: 10.1186/s12889-022-13037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Maternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys. METHODS This was a cross-sectional study of 43,786 young women aged 15-24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05. RESULTS The prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80-2.29), SBA (95% CI = 4.67-7.20), and PNC (95% CI = 1.08-1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78-0.88; SBA: aOR = 0.82, 95% CI = 0.75-0.88; PNC: aOR = 0.88, 95% CI = 0.83-0.94). CONCLUSION While SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.
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Affiliation(s)
- Luchuo Engelbert Bain
- College of Social Science, Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore Maryland, USA
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
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Basta M, Hanif K, Zafar S, Khabazeh A, Amin F, Sharif Khan S, Ghaffar U, Mohammed Saeed Muthanna F, Wali S. Impact of Hypertensive Disorders of Pregnancy on Stillbirth and Other Perinatal Outcomes: A Multi-Center Retrospective Study. Cureus 2022; 14:e22788. [PMID: 35399480 PMCID: PMC8986463 DOI: 10.7759/cureus.22788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/16/2022] Open
Abstract
Objective: The aim of the study is to assess the impact of hypertensive disorders of pregnancy on stillbirths and other perinatal outcomes among women in Karachi, Pakistan. Methodology: This was a retrospective cohort study conducted at two tertiary care hospitals, Aga Khan Hospital (AKU) and Liaquat National Hospital (LNH) in Karachi, Pakistan. The primary outcome variable of this study was stillbirth. Other outcomes assessed in this study included preterm birth, low birth weight, and early neonatal death. Results: Data of a total of 840 women were included in this study; 280 (33.33%) women had hypertensive disorders of pregnancy and 560 (66.67%) were normotensive. Among women who had hypertensive disorders of pregnancy, the adjusted odds ratio (AOR) of having a stillbirth was two times more than that for normotensive women (AOR=2.62, 95% CI=1.46-4.40), four times for low birth weight (AOR=4.23, 95% CI=2.88-6.20), five times for early neonatal death (AOR=5.03, 95% CI=2.40-10.50) and six times for pre-term birth (AOR=5.16, 95% CI=3.42-7.79). Conclusion: The current study found that incidence of stillbirth, low birth weight, pre-term birth, and neonatal mortality is higher in mothers with hypertensive disorders of pregnancy than normotensive mothers.
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Affiliation(s)
- Marina Basta
- School of Medicine, St. George's University, True Blue, GRD
| | - Kiran Hanif
- Medicine, Ayub Medical College, Abbottabad, PAK
| | - Sana Zafar
- Biological Sciences, Victoria University of Wellington, School of Biological Sciences, Wellington, NZL
| | | | - Faiqa Amin
- Medicine, Quaid e Azam Medical College, Bahawalpur, PAK
| | | | - Umar Ghaffar
- Internal Medicine, Nishtar Medical University and Hospital, Multan, PAK
| | | | - Sher Wali
- Research, Aga Khan University, Karachi, PAK
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Bremner L, Gill C, Seed PT, Conti-Ramsden F, Webster L, Fleminger J, Chappell LC, Shennan A, Bramham K. Rule-in and rule-out of pre-eclampsia using DELFIA Xpress PlGF 1-2-3 and sFlt-1: PlGF ratio. Pregnancy Hypertens 2022; 27:96-102. [PMID: 34979346 DOI: 10.1016/j.preghy.2021.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to explore and validate thresholds for Placental growth factor (PlGF) and soluble fms-like tyrosine-kinase 1 (s-Flt-1) (as s-Flt-1: PlGF ratio), to rule-in and rule-out disease in women with suspected pre-eclampsia, using DELFIA® Xpress PlGF1-2-3 and sFlt-1 assays. STUDY DESIGN 369 samples from women with suspected or confirmed pre-eclampsia were analysed from a prospective cohort study. MAIN OUTCOME MEASURES Serum PlGF and sFlt-1: PlGF were quantified using DELFIA® Xpress PlGF1-2-3 and DELFIA® Xpress sFlt-1 tests. Performances were evaluated at established and exploratory thresholds. Low PlGF concentration and sFlt-1: PlGF AUROC were compared. RESULTS PlGF 1-2-3 concentration thresholds were confirmed to have high performance for rule-in (<50 pg/ml) and rule-out (≥150 pg/ml) pre-eclampsia within seven days (20-33+6 Weeks <50 pg/ml: Negative predictive value (NPV) 90.7% (95% CI 83.9, 95.3); ≥150 pg/ml: NPV 94.8% (95% CI 88.4, 98.3)) and 28 days (20-33+6 Weeks <50 pg/ml: Negative predictive value (NPV) 83.9% (95% CI 76.0, 90.0); ≥150 pg/ml: NPV 92.8% (95% CI 85.7, 97.0)). Optimal sFlt-1: PlGF thresholds for rule-in were ≥ 70 before 34 weeks and ≥ 90 after 34 weeks, and <50 to rule-out pre-eclampsia. Low PlGF alone had comparable performance to sFlt-1: PlGF, but test performance for both was reduced in women with Kidney Disease. CONCLUSIONS DELFIA® Xpress PlGF1-2-3 and sFlt-1 assays for pre-eclampsia rule-in and rule-out have comparable performance to other established assays, and could be an alternative for clinical use. Performance was not enhanced by use of sFlt-1: PlGF ratio, suggesting that PlGF alone could provide a cheaper alternative to dual biomarker testing.
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Affiliation(s)
- Laura Bremner
- Department of Women and Children's Health, King's College London, London
| | - Carolyn Gill
- Department of Women and Children's Health, King's College London, London
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London
| | | | - Louise Webster
- Department of Women and Children's Health, King's College London, London
| | - Jessica Fleminger
- Department of Women and Children's Health, King's College London, London
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London; Guy's and St. Thomas' NHS Foundation Trust, London
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London
| | - Kate Bramham
- Department of Women and Children's Health, King's College London, London; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London.
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Beyene T, Chojenta C, Smith R, Loxton D. The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia. BMC Pediatr 2022; 22:6. [PMID: 34980034 PMCID: PMC8721979 DOI: 10.1186/s12887-021-03058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia. Methods Three years (2014–2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association. Result The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths. Conclusion Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03058-4.
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Affiliation(s)
- Tesfalidet Beyene
- Priority Research Center for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Catherine Chojenta
- Centre for Women's Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Roger Smith
- The Mothers and Babies Research Centre at the Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Tesfay N, Legesse F, Kebede M, Woldeyohannes F. Determinants of stillbirth among reviewed perinatal deaths in Ethiopia. Front Pediatr 2022; 10:1030981. [PMID: 36518781 PMCID: PMC9743177 DOI: 10.3389/fped.2022.1030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deaths. METHOD The national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis. RESULT Among reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth. CONCLUSION The study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Frehiwot Legesse
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Mandefro Kebede
- Center of Public Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Shiferaw K, Mengistie B, Gobena T, Dheresa M, Seme A. Adequacy and timeliness of antenatal care visits among Ethiopian women: a community-based panel study. BMJ Open 2021; 11:e053357. [PMID: 34949623 PMCID: PMC8704979 DOI: 10.1136/bmjopen-2021-053357] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The purposes of the study are; (A) to identify whether Ethiopian women's antenatal care (ANC) visits are adequate and timely and (B) to explore factors that determine these. DESIGN Panel study design. SETTING Ethiopia. PARTICIPANTS A total of 2855 women nested within 217 enumeration areas. PRIMARY OUTCOME MEASURES Adequacy and timeliness of ANC visits. RESULTS Of all the 2855 respondents, 65% had made an ANC visit once, while 26.8% initiated ANC visits in a timely way and 43.3% attended adequate ANC visits. Rural residence (adjusted OR (AOR)=0.55, 95% CI: 0.36 to 0.84), attending higher level of education (AOR=2.64, 95% CI: 1.47 to 4.77), being multipara (AOR=0.53, 95% CI: 0.32 to 0.89) and encouragement by partners to attend clinic for ANC (AOR=1.98, 95% CI: 1.14 to 3.44) were significantly associated with timeliness of ANC visit. Similarly, residing in rural areas (AOR=0.20, 95% CI: 0.12 to 0.35), attending higher level of education (AOR=2.96, 95% CI: 1.38 to 6.15), encouragement by partners to attend clinic for ANC (AOR=2.11, 95% CI: 1.31 to 3.40) and timeliness of ANC visit (AOR=4.59, 95% CI: 2.93 to 7.21) were significantly associated with adequacy of ANC visits. CONCLUSIONS A quarter of the pregnant women started ANC visits during the first trimester and nearly half attended adequate ANC visits with wider disparities across regions of their origin and their background characteristics. Concerted efforts on tailored interventions for rural residents, female education and partner involvement are recommended for early and adequate ANC visit(s).
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Environmental Health Science, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
- Public Health, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Dagdeviren G, Uysal NS, Dilbaz K, Celen S, Caglar AT. Application of the international classification of diseases-perinatal mortality (ICD-PM) system to stillbirths: A single center experience in a middle income country. J Gynecol Obstet Hum Reprod 2021; 51:102285. [PMID: 34890860 DOI: 10.1016/j.jogoh.2021.102285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study is intended to investigate the causes of stillbirth and its relationship with maternal conditions using the International Classification of Diseases-Perinatal Mortality (ICD-PM) system. MATERIAL AND METHODS All early and late fetal deaths between 2015 and 2020 were analyzed. Time of death, fetal causes, and the maternal conditions involved were identified using the ICD-PM classification system. RESULTS During the study period, out of 74,102 births a total of 475 stillbirths were recorded (6.4 per 1000 births), of which 83.6% of the cases were antepartum and 11.8% were intrapartum fetal deaths, and the time of death could not be determined in 4.6% of the cases. Fetal developmental disorder was the most common cause of antepartum fetal death (24.2%). Intrapartum deaths were mostly due to extremely low birth weight (44.6%). The most common maternal conditions involved were complications of placenta, cord, and membranes (19.8%). CONCLUSION The applicability of the ICD-PM classification system for stillbirths is easy. It was observed that fetal deaths mostly occurred in the antepartum period and the cause of death could not be identified in over half of these antepartum fetal deaths. In over half of the stillbirths, there is at least one maternal condition involved. The most common maternal conditions involved are complications of placenta, cord, and membranes. The most common maternal medical problem is hypertensive diseases of pregnancy.
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Affiliation(s)
- Gulsah Dagdeviren
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Nihal Sahin Uysal
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Kubra Dilbaz
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sevki Celen
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ali Turhan Caglar
- Department of Perinatology, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Bezerra IMP, Ramos JLS, Pianissola MC, Adami F, da Rocha JBF, Ribeiro MAL, de Castro MR, Bezerra JDF, Smiderle FRN, Sousa LVDA, Siqueira CE, de Abreu LC. Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11671. [PMID: 34770185 PMCID: PMC8583128 DOI: 10.3390/ijerph182111671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.
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Affiliation(s)
- Italla Maria Pinheiro Bezerra
- Departamento de Pós-Graduação em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - José Lucas Souza Ramos
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Micael Colodetti Pianissola
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | - Fernando Adami
- Laboratório de Epidemiologia do Centro Universitário ABC (FMABC), Santo André 09060590, Brazil;
| | - João Batista Francalino da Rocha
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Mariane Albuquerque Lima Ribeiro
- Ciências da Saúde no Centro Universitário ABC (FMABC), Santo André 09060870, Brazil; (J.B.F.d.R.); (M.A.L.R.)
- Centro de Ciências da Saúde e do Desporto (CCSD), Universidade Federal do Acre (UFAC), Rio Branco 69920900, Brazil
| | - Magda Ribeiro de Castro
- Departamento de Enfermagem da Universidade Federal do Espírito Santo (UFES), Vitória 29075910, Brazil;
| | - Juliana da Fonsêca Bezerra
- Departamento de Enfermagem Materno Infantil (DEMI) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941901, Brazil;
| | - Fabiana Rosa Neves Smiderle
- Departamento de Enfermagem, Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória 29027502, Brazil; (J.L.S.R.); (M.C.P.); (F.R.N.S.)
| | | | - Carlos Eduardo Siqueira
- Environment and Public Health, School for the Environment, Transnational Brazilian Project, The Mauricio Gastón Institute for Latino Community Development and Public Policy, UMass Boston, Boston, MA 02125, USA;
| | - Luiz Carlos de Abreu
- Departamento de Educação Integrada em Saúde na Universidade Federal do Espírito Santo (UFES), Vitória 29027502, Brazil;
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Baguiya A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, Jayaratne K, Ribeiro-do-Valle CC, Budianu MA, Souza JP, Kouanda S. Perinatal outcomes among births to women with infection during pregnancy. Arch Dis Child 2021; 106:946-953. [PMID: 34475107 PMCID: PMC8461398 DOI: 10.1136/archdischild-2021-321865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC). DESIGN We conducted a 1-week inception hospital-based cohort study. SETTING The study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017. PATIENTS We included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up. MAIN OUTCOME MEASURES Perinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death). RESULTS 1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother's infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death. CONCLUSIONS Overall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
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Affiliation(s)
- Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, SP, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ala Curteanu
- Department of Perinatology, Mother and Child Institute, Chisinau, Moldova
| | - Meile Minkauskiene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kapila Jayaratne
- Maternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Colombo, Sri Lanka
| | | | - Mihaela-Alexandra Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Mureș, Romania
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Séni Kouanda
- Ecole docotorale ED2ST, Saint Thomas d'Aquin University (USTA), Ouagadougou, Burkina Faso,Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Worke MD, Mekonnen AT, Limenh SK. Incidence and determinants of neonatal mortality in the first three days of delivery in northwestern Ethiopia: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:647. [PMID: 34556077 PMCID: PMC8461935 DOI: 10.1186/s12884-021-04122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Addressing sustainable development goals to reduce neonatal mortality remains a global challenge, and it is a concern in Ethiopia. As a result, the goal of this study was to assess the incidence and determinants of neonatal mortality in the first 3 days among babies delivered in the referral hospitals of the Amhara National Regional State. Methods A hospital-based prospective cohort study was conducted among 810 neonates in the first 3 days of delivery between March 1 and August 30, 2018. The neonates were followed up from the time of admission to 72 h. Interviewer-administered questionnaires and medical record reviews were conducted for data collection. Data were entered into Epi-data manager version 4.4 and analysed using STATA™ version 16.0. The neonate’s survival time was calculated using the Cox-Proportional hazards model. Results The overall incidence of neonatal mortality in this study was 151/1000 births. Neonatal mortality was significantly higher among neonates whose mothers came between 17 and 28 weeks of gestation for the first visit; among those whose mothers labour was not monitored with a partograph, mothers experienced postpartum haemorrhage and developed a fistula first 24 h, and experienced obstructed labour. However, 39% were less risky among neonates whose mothers were directly admitted and whose mothers had visited health facilities in less than 1-h, both. Conclusions This study revealed that approximately 1 in 7 neonates died within the first 3 days of life. The determinants were the timing of the first antenatal visit, quality of labour monitoring, maternal complications, and delay in seeking care. Thus, scaling up evidence-based interventions and harmonising efforts to improve antenatal care quality, promote institutional deliveries, provide optimal essential and emergency obstetric care, and ensure immediate postnatal care may improve neonatal survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04122-8.
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Kwon C, Naser AM, Eilerts H, Reniers G, Argeseanu Cunningham S. Pregnancy Surveillance Methods within Health and Demographic Surveillance Systems. Gates Open Res 2021; 5:144. [PMID: 35382350 PMCID: PMC8960731 DOI: 10.12688/gatesopenres.13332.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Pregnancy identification and follow-up surveillance can enhance the reporting of pregnancy outcomes, including stillbirths and perinatal and early postnatal mortality. This paper reviews pregnancy surveillance methods used in Health and Demographic Surveillance Systems (HDSSs) in low- and middle-income countries. Methods: We searched articles containing information about pregnancy identification methods used in HDSSs published between January 2002 and October 2019 using PubMed and Google Scholar. A total of 37 articles were included through literature review and 22 additional articles were identified via manual search of references. We reviewed the gray literature, including websites, online reports, data collection instruments, and HDSS protocols from the Child Health and Mortality Prevention Study (CHAMPS) Network and the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH). In total, we reviewed information from 52 HDSSs described in 67 sources. Results: Substantial variability exists in pregnancy surveillance approaches across the 52 HDSSs, and surveillance methods are not always clearly documented. 42% of HDSSs applied restrictions based on residency duration to identify who should be included in surveillance. Most commonly, eligible individuals resided in the demographic surveillance area (DSA) for at least three months. 44% of the HDSSs restricted eligibility for pregnancy surveillance based on a woman's age, with most only monitoring women 15-49 years. 10% had eligibility criteria based on marital status, while 11% explicitly included unmarried women in pregnancy surveillance. 38% allowed proxy respondents to answer questions about a woman's pregnancy status in her absence. 20% of HDSSs supplemented pregnancy surveillance with investigations by community health workers or key informants and by linking HDSS data with data from antenatal clinics. Conclusions: Methodological guidelines for conducting pregnancy surveillance should be clearly documented and meticulously implemented, as they can have implications for data quality and accurately informing maternal and child health programs.
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Affiliation(s)
- Christie Kwon
- Global Health Institute, Emory University, Atlanta, GA, 30322-4201, USA
| | - Abu Mohd Naser
- Global Health Institute, Emory University, Atlanta, GA, 30322-4201, USA
| | - Hallie Eilerts
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Georges Reniers
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Johnson AR, Sunny S, Nikitha R, Thimmaiah S, Rao SPN. A Case-Control Study on the Predictors of Neonatal Near-Miss: Implications for Public Health Policy and Practice. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.3.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city.Methods: This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro’s pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI).Results: Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02).Conclusion: The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.
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Aliyi AA, Deyessa N, Dilnessie MY. Effect of maternal near miss on neonatal mortality in selected hospitals: Prospective cohort study, Southeast Ethiopia. SAGE Open Med 2021; 9:20503121211042219. [PMID: 34484789 PMCID: PMC8411626 DOI: 10.1177/20503121211042219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess effect of maternal near miss on neonatal mortality. METHODS Prospective cohort study was conducted on 384 pregnant women who came for delivery to purposely selected hospitals. The cohort was made up of 128 exposed (near miss) mothers and 256 non-exposed (non-near-miss) mothers. Women who came for delivery were only included. Those who came for services other than delivery such as abortion care, women who developed life-threatening condition not related to delivery, and those who come from no phone network area were excluded. A purposive sampling technique was used by including all mothers with near miss consecutively until the required sample size was obtained. Two non-near-miss mothers were selected using lottery for every near-miss mother. Survival analysis was done for both groups using Cox regression to look for effect of maternal near miss on neonatal mortality. Verbal informed consent from study participants was obtained. RESULTS A total of 354 (118 with near miss and 236 without near miss) women completed the follow-up time, yielding response rate of 92.2%. Of all, 55 (15.5%) of them have previous history of abortion, 44 (12.4%) were admitted to the intensive care unit during delivery, and 22 (6.2%) have history of past delivery of still birth. Severe preeclampsia with intensive care unit admission and severe anemia with transfusion of greater than 2 units of blood were common complications leading to maternal near miss. There were 17 (48 per 1000 live birth) neonatal death at the end of the study, of which 15 occurred among mothers with near miss. Monthly income (adjusted hazard ratio = 998, 95% confidence interval = 0.996-0.999), fetal presentation (adjusted hazard ratio = 6.48, 95% confidence interval = 1.84-22.73), APGAR score (adjusted hazard ratio = 0.746, 95% confidence interval = 0.620-0.898), and being near miss mother (adjusted hazard ratio = 8.40, 95% confidence interval = 1.638-43.118) were significantly affecting neonatal mortality. CONCLUSION Maternal near miss and other fetal and general maternal characteristics have effect on occurrence of neonatal mortality. Therefore, due attention should be given to these factors for improvement of neonatal survival.
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Affiliation(s)
- Ahmednur Adem Aliyi
- Department of Public Health, College of
Medicine and Health Sciences, Madda Walabu University, Goba, Ethiopia
| | - Negussie Deyessa
- Department of Preventive Medicine,
School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mengistu Yilma Dilnessie
- Department of Preventive Medicine,
School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Jaleta DD, Gebremedhin T, Jebena MG. Perinatal outcomes of women with hypertensive disorders of pregnancy in Jimma Medical Center, southwest Ethiopia: Retrospective cohort study. PLoS One 2021; 16:e0256520. [PMID: 34411170 PMCID: PMC8375998 DOI: 10.1371/journal.pone.0256520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) increases adverse perinatal outcomes in women with the disorder. About 16% of all still births and 10% of early neonatal deaths are accounted by HDP. In Ethiopia, HDP complicates about 6% of all pregnancies. Hence, the objective of this study was to determine the risk of adverse perinatal outcomes among women with HDP in Jimma Medical Center, southwest Ethiopia. METHODS A retrospective cohort study was conducted on a total of 777 women who gave birth from June 2017 to March 2020 at Jimma Medical Center, southwest Ethiopia. Women with HDP and normotensive women who gave birth at or after 28 weeks of gestation were enrolled as exposed and unexposed respectively. Simple random sampling technique was used to select study participants. Data were reviewed using structured data collection performa that was prepared after reviewing relevant literatures. Data were entered to Epi-Data then exported to STATA version 13 for analysis. The adverse perinatal outcomes risk were examined using log binomial and modified Poisson regression model with robust standard errors. RESULTS In this study, the overall incidence of adverse perinatal outcome was higher among women with hypertensive disorders of pregnancy (HDP) than normotensive women (64.1% versus 32.8%). After adjusting for confounders, women with HDP were at higher risk of babies with low birth weight (adjusted RR = 2.88 (2.2, 3.75)), preterm birth(aRR = 2.31(1.7, 3.14)), fifth minute low Apgar score (aRR = 2.6(1.53, 4.42)), admission to neonatal intensive care unit (aRR = 1.77(1.32, 2.37), stillbirth (aRR = 2.02(1.11, 3.01)), and perinatal mortality (aRR = 3.88(1.97, 7.66)) than normotensive women. CONCLUSION Women with hypertensive disorder of pregnancy were at higher risk of adverse perinatal outcomes than normotensive women who gave birth at Jimma Medical Center, southwest Ethiopia. Therefore, health care providers should strengthen prevention, early diagnosis and prompt management of HDP in order to reduce adverse perinatal outcomes.
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Affiliation(s)
- Debela Dereje Jaleta
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Tadesse Gebremedhin
- Faculty of Public Health, Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mulusew Gerbaba Jebena
- Faculty of Public Health, Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
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