Epidemiological features of perinatal death due to obstructed labour in Addis Ababa

Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia

Introduction

Hypertensive Disorders in Pregnancy (HDP) complicate about 10% of pregnancies. It accounts to 50% of maternal death in sub-Saharan Africa and precedes 15% of perinatal deaths worldwide. In this study, we looked at the perinatal outcomes and factors associated with unfavorable perinatal outcomes among women with hypertensive disorders in pregnancy at Wolaita Sodo teaching and referral hospital, southern Ethiopia.

Methods

A hospital based retrospective cross-sectional study design was employed among women hospitalized for hypertensive disorders in pregnancy. Socio-demographic, obstetrics, clinical laboratory, pregnancy complications and outcome were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records. Bivariate and multiple logistic regressions were done to determine factors associated with unfavorable perinatal outcome. A P-value of less than 0.05 and 95% confidence interval not including 1 were considered statically significant.

Results

There were 168 (2.3%) cases of HDP of the total 7, 347 deliveries during the period of the study from January 2014-December 2016. 72.5% of mothers (72.5%) had vaginal delivery and 26.1% had Caesarean Section. This study revealed a perinatal mortality rate of 111.1 per 1000 live births. On bivariate logistic regression variables such as referral status, diastolic blood pressure, ANC use, types of HDP, fetal weight at birth, maternal complication and maternal outcome were found to be associated with unfavorable perinatal outcomes. On multiple logistic regression fetal weight at birth and maternal outcome were found to be an independent predictors of unfavorable perinatal outcome.

Conclusion

Our study shows higher perinatal mortality in a tertiary hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. However, tertiary facilities manage difficult cases which can explain the high PMR. But it is high which means there is enough room for improvement. Hence, the referral hospital and neighboring health facilities should give due emphasis for early detection and management of women with HDP.

Symphysiotomy and fetal destructive operations

Symphysiotomy and fetal destructive operations - while rarely, if ever, performed in developed countries - are an option in developing nations of the world. Problems endemic to developing countries not infrequently predispose to patients arriving at health care facilities in a moribund state with neglected labour. The health care provider then has to decide on the options available to him to deliver the mother by the safest route without incurring morbidity and mortality. Under the circumstances, the outcome for the baby will depend on factors prevalent at the time. If the fetus is alive, then the choice is between a Caesarean section and symphysiotomy, and if the fetus has died, a destructive procedure is an option to abdominal-route delivery which carries considerable risk to the mother. The following review outlines the role of symphysiotomy and fetal destructive operations and their role in modern obstetrics.

Nutrition and obstructed labor

Obstructed labor is one of the most common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Among the common causes are cephalopelvic disproportion, malpresentation, and malposition. Recognizing the causes of obstructed labor is important if the complications are to be prevented. Adequate prevention, however, can be achieved only through a multidisciplinary approach aimed in the short term at identifying high-risk cases and in the long term at improving nutrition. Early motherhood should be discouraged, and efforts are needed to improve nutrition during infancy, childhood, early adulthood, and pregnancy. Improving the access to and promoting the use of reproductive and contraceptive services will help reduce the prevalence of this complication.

Do big females have big pelves?

Previous studies have shown that maternal stature is a correlate of both pelvic size and reproductive efficiency. This study addresses the issue of body size and obstetric advantage. The relationship between pelvic size and three nonpelvic measures of body size is determined for females and males. The skeletal sample consists of blacks, whites, and Native Americans. The variables include 28 measures of the pelvis, length and head diameter of the femur, and clavicular length. The coefficient of multiple determination (CMD) is computed for each pelvic measure using multiple regression, with the three nonpelvic measures serving as the independent variables. Partial correlation coefficients are also calculated between each pelvic and nonpelvic variable, while controlling for the other two nonpelvic variables. The results show that all CMDs in females and all but one CMD in males are "low," i.e., below 33%. The sexes are nonsignificantly different in their CMDs for 22 of the 28 pelvic variables; of the six variables that are significantly different, five are of the midplane. The sexes are also broadly comparable in their partial correlations. The results are explained as follows. First, the concordance between the sexes in the relationship between pelvic size and nonpelvic measures of body size is due to their genetic similarity for homologous structures. Second, as pelvic size is at the minimum at the midplane, the sexual differences in CMDs are the result of selection with respect to obstetrics. Third, four explanations for the low CMDs are discussed: 1) lack of populationally or racially specific analysis; 2) nonlinear relationship between pelvic size and nonpelvic measures of body size; 3) combination of negative allometric selection between newborn body weight and maternal stature and weight with positive selection for maternal pelvic size; and 4) hormonally induced increase in pelvic capacity during parturition.

Characteristics of pregnant women in Mozambique--parity, child survival and socioeconomic status

As a basis for improvement of maternal health care programmes in Mozambique, 1051 pregnant women were interviewed at 10 sites in 8 of the country's 10 provinces. Two-thirds of the women lived in rural areas. The average number of previous births ranged from 2.4 to 4.7 and was significantly correlated to the proportion of children lost before 5 years of age. Child survival was significantly higher when the woman had received some education, possessed a radio, or the woman or her husband had paid employment. In the most underprivileged rural area, 56% of the children had died before the age of 5 and 35% of the pregnant women had undergone 6 childbirths or more. It is concluded that in order to improve maternal and child health it is necessary to increase socioeconomic development as well as improve maternal and child health care.

Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight

The study attempted to determine if heavy physical labour by mothers during pregnancy affected fetal growth when such mothers had calorie intakes which were below 70 per cent of WHO/FAO recommended standards. Full term infants of such mothers had a mean birth weight of 3060 +/- 355 (SD) g compared to 3270 +/- 368 SD g for the newborn of less physically active mothers on similar low calorie diets (P less than 0.01). The mothers who engaged in heavy labour had a mean pregnancy weight gain of 3.3 +/- 2.4 (SD) kg, independent of the birth weight of their offspring, compared with 5.9 +/- 3.3 kg for the less active mothers (P less than 0.001). The mothers' weight in early pregnancy had an insignificant influence on birth weights when mothers were on low calorie intakes.