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Gazeley U, Ochieng MC, Wanje O, Koech Etyang A, Mwashigadi G, Barreh N, Kombo AM, Bakari M, Maitha G, Silverio SA, Temmerman M, Magee L, von Dadelszen P, Filippi V. Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: a grounded theory of recovery trajectories beyond 42 days. BMJ Glob Health 2024; 9:e014821. [PMID: 38925665 PMCID: PMC11202725 DOI: 10.1136/bmjgh-2023-014821] [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: 12/12/2023] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION The burden of severe maternal morbidity is highest in sub-Saharan Africa, and its relative contribution to maternal (ill) health may increase as maternal mortality continues to fall. Women's perspective of their long-term recovery following severe morbidity beyond the standard 42-day postpartum period remains largely unexplored. METHODS This woman-centred, grounded theory study was nested within the Pregnancy Care Integrating Translational Science Everywhere (PRECISE) study in Kilifi, Kenya. Purposive and theoretical sampling was used to recruit 20 women who experienced either a maternal near-miss event (n=11), potentially life-threatening condition (n=6) or no severe morbidity (n=3). Women were purposively selected between 6 and 36 months post partum at the time of interview to compare recovery trajectories. Using a constant comparative approach of line-by-line open codes, focused codes, super-categories and themes, we developed testable hypotheses of women's postpartum recovery trajectories after severe maternal morbidity. RESULTS Grounded in women's accounts of their lived experience, we identify three phases of recovery following severe maternal morbidity: 'loss', 'transition' and 'adaptation to a new normal'. These themes are supported by multiple, overlapping super-categories: loss of understanding of own health, functioning and autonomy; transition in women's identity and relationships; and adaptation to a new physical, psychosocial and economic state. This recovery process is multidimensional, potentially cyclical and extends far beyond the standard 42-day postpartum period. CONCLUSION Women's complex needs following severe maternal morbidity require a reconceptualisation of postpartum recovery as extending far beyond the standard 42-day postpartum period. Women's accounts expose major deficiencies in the provision of postpartum and mental healthcare. Improved postpartum care provision at the primary healthcare level, with reach extended through community health workers, is essential to identify and treat chronic mental or physical health problems following severe maternal morbidity.
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Affiliation(s)
- Ursula Gazeley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Onesmus Wanje
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Angela Koech Etyang
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Grace Mwashigadi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Nathan Barreh
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Alice Mnyazi Kombo
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Mwanajuma Bakari
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Grace Maitha
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Sergio A Silverio
- Department of Women and Children's Health, King's College London, London, UK
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Laura Magee
- Department of Women and Children's Health, King's College London, London, UK
- Institute of Women and Children's Health, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, London, UK
- Institute of Women and Children's Health, King's College London, London, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Gazeley U, Polizzi A, Romero-Prieto JE, Aburto JM, Reniers G, Filippi V. Lifetime risk of maternal near miss morbidity: a novel indicator of maternal health. Int J Epidemiol 2024; 53:dyad169. [PMID: 38110741 PMCID: PMC11212495 DOI: 10.1093/ije/dyad169] [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: 06/15/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The lifetime risk of maternal death quantifies the probability that a 15-year-old girl will die of a maternal cause in her reproductive lifetime. Its intuitive appeal means it is a widely used summary measure for advocacy and international comparisons of maternal health. However, relative to mortality, women are at an even higher risk of experiencing life-threatening maternal morbidity called 'maternal near miss' (MNM) events-complications so severe that women almost die. As maternal mortality continues to decline, health indicators that include information on both fatal and non-fatal maternal outcomes are required. METHODS We propose a novel measure-the lifetime risk of MNM-to estimate the cumulative risk that a 15-year-old girl will experience a MNM in her reproductive lifetime, accounting for mortality between the ages 15 and 49 years. We apply the method to the case of Namibia (2019) using estimates of fertility and survival from the United Nations World Population Prospects along with nationally representative data on the MNM ratio. RESULTS We estimate a lifetime risk of MNM in Namibia in 2019 of between 1 in 40 and 1 in 35 when age-disaggregated MNM data are used, and 1 in 38 when a summary estimate for ages 15-49 years is used. This compares to a lifetime risk of maternal death of 1 in 142 and yields a lifetime risk of severe maternal outcome (MNM or death) of 1 in 30. CONCLUSIONS The lifetime risk of MNM is an urgently needed indicator of maternal morbidity because existing measures (the MNM ratio or rate) do not capture the cumulative risk over the reproductive life course, accounting for fertility and mortality levels.
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Affiliation(s)
- Ursula Gazeley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonino Polizzi
- Leverhulme Centre for Demographic Science, Nuffield College and Department of Sociology, University of Oxford, Oxford, UK
| | - Julio E Romero-Prieto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - José Manuel Aburto
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Leverhulme Centre for Demographic Science, Nuffield College and Department of Sociology, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Rodaki E, Diamanti A, Sarantaki A, Lykeridou A. The Effects of Perineal Tears during Childbirth on Women's Sex Life. MAEDICA 2022; 17:297-305. [PMID: 36032614 PMCID: PMC9375874 DOI: 10.26574/maedica.2022.17.2.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction:Perineal tears during childbirth - especially the third- and fourth-degree perineal tears - can cause annoying symptoms such as urinary or fecal incontinence and sexual discomfort. Our review revealed that little research has been published on the views and experiences of women in Greece with regards to perineal tears. Aim:The aim of our research was to study women's experiences regarding the effects of third- and fourth-degree perineal tears on their sexual activity as well as their attitudes towards future pregnancies, and to compare them with the experiences and attitudes of women with lower-grade perineal tears. Both complications and the methods of treating perineal tears were also studied. Methodology:A quantitative primary and correlational research was performed between groups in an experimental design using a closed-ended questionnaire and the Likert scale. The statistical tests chi square, independent samples t-test and Mann Whitney were used at a significance level of 5%. The sample of our study consisted of 159 women who had suffered perineal tears during childbirth. Results:With most women, labor began spontaneously. Epidural or spinal anesthesia was administered along with other medications, while most of them reported they had an episiotomy. Most women reported pain in the perineal area after childbirth, experienced nausea, urinary and fecal incontinence and half of them had difficulty in voiding their bladder. Rehabilitation methods for the perineal tears were rarely applied after leaving the maternity hospital. A moderate proportion of the sample consequently considered that medical liability played a role in them sustaining perineal tears at childbirth and subsequently going through a lengthy recovery. However, the results regarding the attitudes of women towards a future pregnancy were optimistic. Sexual activity issues were observed on a very small portion of the sample. A statistically significant correlation was found regarding the degree of perineal tears and the body weight of the newborn in the first childbirth (p=0.042), constipation (p=0.001), dyspareunia (p=0.010), urinary incontinence after labor (p=0.001), urinary leakage after labor (p <0.001), surgical rehabilitation of the scars after healing (p=0.016), prescription of antibiotics and painkillers (p <0.001), systematically performing Kegel exercises at home (p=0.001), a specific diet plan (p=0.004), medical liability on the prevention and rehabilitation of perineal tears (p <0.001), women's attitude towards a future pregnancy (p <0.001) and the quality of their sexual activity (p <0.001). Conclusions:Women who suffered a severe perineal tear gave birth to a newborn with a larger body weight (about 200 grams heavier), had more perineal tear related complications after childbirth - and in particular difficulty in voiding their bladder, dyspareunia, as well as urinary and fecal incontinence. In addition, it was found that women who had suffered a severe perineal tear had to undergo surgical rehabilitation of the scar after healing, take antibiotics and painkillers, systematically apply Kegel exercises at home and follow a specific diet plan. Furthermore, women who had suffered a severe perineal tear believed more that there was medical liability, which also affected the rehabilitation of their perineal tears. They also had a less positive attitude toward future pregnancies. They finally reported having had more sexual activity related issues.
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Affiliation(s)
- Evgenia Rodaki
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
| | - Athina Diamanti
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
| | - Antigoni Sarantaki
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
| | - Aikaterini Lykeridou
- Faculty of Health and Caring Sciences, Midwifery Department, University of West Attica, Athens, Greece
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Grussu P, Vicini B, Quatraro RM. Sexuality in the perinatal period: A systematic review of reviews and recommendations for practice. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 30:100668. [PMID: 34563859 DOI: 10.1016/j.srhc.2021.100668] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
In the time of transition to parenthood, many physical, psychological and social changes may affect the multidimensional theme of sexuality. This area plays a significant role in the overall well-being of the individual, the couple and the family. The aim of this systematic review is to consider current and emerging trends in the study of sexual function during pregnancy and after childbirth, evaluating the available evidence in the literature reported in specific reviews, and pulling together the suggestions that various authors have brought forward as being useful for daily clinical practice. A total of 4 databases were searched on EBSCOhost: MEDLINE, Cochrane reviews, CINAHAL, and PsychInfo. A systematic search strategy was formulated using the key terms Sexuality, Sexual, Pregnancy, Postpartum, Puerperium, Perinatal, and Review. Eleven articles were included. The results revealed a gradual decline in the frequency of sexual behaviour throughout pregnancy, sharper in the third trimester. Sexual activity started to be resumed around 6-8 weeks after childbirth, to fully recover only after 6 months. A simultaneous change in sexual function was also found, such as less orgasm, sexual desire and satisfaction, more dyspareunia. Many aspects are related to these changes: physical, psychological and social factors, fears about negative consequences of sexual intercourse, inadequate or absent professional counselling about sexuality, method of delivery and breastfeeding. Healthcare professionals need to adequately inform couples about the common fluctuations in sexual activity, interest, desire, and responsiveness over the course of the pregnancy and following childbirth. Joint counselling, if possible, is preferred.
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Affiliation(s)
- Pietro Grussu
- Consultorio Familiare, Azienda ULSS 6 Euganea, Veneto Region, National Health Service, Italy.
| | - Benedetta Vicini
- Consultorio Familiare, Azienda ULSS 6 Euganea, Veneto Region, National Health Service, Italy
| | - Rosa Maria Quatraro
- Hospital Psychology Unit, Obstetrics and Gynaecology Section, Azienda ULSS 8 Berica, National Health Service, Italy; Maternità in Difficoltà®, Padova and Vicenza, Italy
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Adofo E, Dun-Dery EJ, Kotoh AM, Dun-Dery F, Avoka JA, Ashinyo ME. Fear of infertility limits contraceptive usage among first-time mothers in Ghana: A cross-sectional study. SAGE Open Med 2021; 9:20503121211021256. [PMID: 34158936 PMCID: PMC8182170 DOI: 10.1177/20503121211021256] [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: 10/16/2020] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to determine postpartum modern contraceptive use among first-time young mothers attending child welfare clinics in the Eastern Region of Ghana and explore factors that influence family planning uptake after the first delivery, including fear of infertility. METHODS This facility-based, cross-sectional study used interviewer-administered structured questionnaires. The study recruited 422 first-time young mothers aged 15-24 years, with 6- to 18-month-old babies attending child welfare clinics. RESULTS Overall, less than half (44%) of first-time mothers used modern contraceptives within 18 months after delivery. Fear of infertility after contraceptive use (56%) is the main barrier reported as the reason for women's non-use of modern contraceptives. Mothers with tertiary education have higher odds of using postpartum contraceptives (adjusted odds ratio =1.6, 95% confidence interval: 0.4-2.0). Compared to mothers with younger children, those with children older than 6 months have higher odds of postpartum contraceptive use (adjusted odds ratio = 1.3, 95% confidence interval: 0.3-1.7). Nonspousal communication (adjusted odds ratio = 0.1, 95% confidence interval: 0.1-0.3) as compared to communication among partners about contraception and those in formal employment (adjusted odds ratio = 0.3, 95% confidence interval: 0.1-0.7), were less likely to use postpartum contraceptives. CONCLUSION Considering that there is low postpartum contraceptive utilization, mostly due to concerns about fear of infertility after use, it is paramount to intensify education on actual side effects and reformulate policies that address specific concerns of infertility among mothers and contraceptive use.
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Affiliation(s)
| | - Elvis J Dun-Dery
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
- Department of Population and Health
Research, Research Web Africa, Sunyani, Ghana
| | - Agnes M Kotoh
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
| | - Frederick Dun-Dery
- Heidelberg Institute of Global Health,
Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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von Rosen IEW, Shiekh RM, Mchome B, Chunsen W, Khan KS, Rasch V, Linde DS. Quality of life after maternal near miss: A systematic review. Acta Obstet Gynecol Scand 2021; 100:704-714. [PMID: 33599289 DOI: 10.1111/aogs.14128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Maternal near miss is a major global health issue; approximately 7 million women worldwide experience it each year. Maternal near miss can have several different health consequences and can affect the women's quality of life, yet little is known about the size and magnitude of this association. The aim of this study was to assess the evidence of the association between women who have experienced maternal near miss and quality of life and women who had an uncomplicated pregnancy and delivery. MATERIAL AND METHODS Cochrane library, Embase, CINAHL, Web of Science, MEDLINE, Scopus and PubMed were searched for published studies. Studies were selected according to the PECO model (population, exposure, control and outcome) and were included if they investigated quality of life as an outcome after maternal near miss among women of all ages with no limitation on country or time (up to June 2020). Maternal near miss was defined as a life-threatening condition arising from complications related to pregnancy and/or childbirth. The quality of the studies was assessed according to the Newcastle-Ottawa scale and a Forest plot was constructed based on quality of life outcomes and study quality. PROSPERO registration number: CRD42020169232. RESULTS Fifteen studies were included in the review with a total of 31 558 women. Quality of life was reported in various ways, and 25 different confounders were controlled for. Compared with women who did not experience maternal near miss, women exposed to maternal near miss had an overall lower quality of life (n = 2/2), had poorer mental (n = 6/10) and social health (n = 2/3), and maternal near miss had negative economic consequences (n = 4/4). Maternal near miss was not associated with sexual dysfunction (n = 1/5). Ten of 15 studies were assessed as being of poor quality. CONCLUSIONS Evidence shows that maternal near miss is negatively associated with various aspects of quality of life. This highlights the importance of addressing the adverse effects associated with maternal near miss and follow up maternal near miss after discharge. Quality of life is a multidimensional concept that is assessed in various ways, and the literature on the field is heterogeneous. More high-quality studies are needed.
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Affiliation(s)
- Ida E W von Rosen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Rayan M Shiekh
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Wu Chunsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - Vibeke Rasch
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte S Linde
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Ferreira EC, Costa ML, Pacagnella RC, Silveira C, Andreucci CB, Zanardi DMT, Santos JP, Angelini CR, Souza RT, Parpinelli MA, Sousa MH, Cecatti JG. Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study. BMJ Open 2020; 10:e041138. [PMID: 33303455 PMCID: PMC7733206 DOI: 10.1136/bmjopen-2020-041138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children. DESIGN A retrospective cohort study. SETTING A tertiary maternity hospital from the southeast region of Brazil. PARTICIPANTS The exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth. PRIMARY AND SECONDARY OUTCOME VARIABLES Validated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview. RESULTS All instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold). CONCLUSION SMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.
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Affiliation(s)
- Elton C Ferreira
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carla B Andreucci
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | | | - Juliana P Santos
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carina R Angelini
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Mary A Parpinelli
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Maria Helena Sousa
- Department of Statistics, Faculdade de Medicina de Jundiai, Jundiai, Brazil
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Herklots T, Yussuf SS, Mbarouk KS, O'Meara M, Carson E, Plug SB, van Acht F, Terpstra P, Prebevšek D, Franx A, Meguid T, Jacod B. "I lost my happiness, I felt half dead and half alive" - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania. BMC Pregnancy Childbirth 2020; 20:594. [PMID: 33028246 PMCID: PMC7539452 DOI: 10.1186/s12884-020-03261-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 09/18/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas. METHODS This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly by the informants and within the study team. The findings were then positioned in the existing literature. Approval was granted by Zanzibar's Medical Ethical Research Committee (reference number: ZAMREC/0002/JUN/17). RESULTS The impact of severe maternal morbidity was found to be multi-dimensional and to extend beyond hospital discharge and thus institutionalized care. Four key areas impacted by maternal morbidities emerged, namely (1) social, (2) sexual and reproductive, (3) psychological, and (4) economic well-being. CONCLUSIONS This study showed how three women's lives and livelihoods were profoundly impacted by the severe obstetric complications they had survived, even up to 16 months later. These impacts took a toll on their physical, social, economic, sexual and psychological well-being, and affected family and community members alike. These findings advocate for a holistic, dignified, patient value-based approach to the necessary improvement of maternal health care in low-income settings. Furthermore, it emphasizes the need for strategies to be directed not only towards quality of care during pregnancy and delivery, but also towards support after obstetric complications.
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Affiliation(s)
- Tanneke Herklots
- Department of Obstetrics & Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Suhaila Salum Yussuf
- Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania
| | - Khairat Said Mbarouk
- Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania
| | - Molly O'Meara
- School of Global Health, University of Copenhagen, Copenhagen, Denmark
| | - Emma Carson
- Faculty of Humanities, University Utrecht, Utrecht, the Netherlands
| | - Sebastiaan Beschoor Plug
- Department of Technology, Policy and Management, Technical University Delft, Delft, the Netherlands
| | - Fleur van Acht
- School of Global Health, University of Copenhagen, Copenhagen, Denmark
| | - Pleun Terpstra
- Faculty of Medicine, University Utrecht, Utrecht, the Netherlands
| | - Deja Prebevšek
- Faculty of Medicine, University of Maastricht, Maastricht, the Netherlands
| | - Arie Franx
- Department of Obstetrics & Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Benoit Jacod
- Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
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Alves LC, Costa JR, Monteiro JCDS, Gomes-Sponholz FA. Women's sexual health six months after a severe maternal morbidity event. Rev Lat Am Enfermagem 2020; 28:e3293. [PMID: 32578751 PMCID: PMC7304979 DOI: 10.1590/1518-8345.3500.3293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM). METHOD a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed. RESULTS FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM. CONCLUSION white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.
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Affiliation(s)
- Lisiane Camargo Alves
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Jessica Ribeiro Costa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Juliana Cristina Dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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Ferreira EC, Costa ML, Pacagnella RC, Silveira C, Andreucci CB, Zanardi DM, Santos JP, Angelini CR, Souza RT, Parpinelli MA, Sousa MH, Cecatti JG. General and reproductive health among women after an episode of severe maternal morbidity: Results from the
COMMAG
study. Int J Gynaecol Obstet 2020; 150:83-91. [DOI: 10.1002/ijgo.13161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/13/2020] [Accepted: 04/06/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Elton C. Ferreira
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Rodolfo C. Pacagnella
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Carla B. Andreucci
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
- Department of Medicine Federal University of Sao Carlos (UFSCAR) Sao Carlos Brazil
| | - Dulce M. Zanardi
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Juliana P. Santos
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Carina R. Angelini
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Mary A. Parpinelli
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
| | - Maria H. Sousa
- Statistics Unit Jundiai School of Medicine Jundiai Brazil
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology University of Campinas (UNICAMP) School of Medicine Campinas Brazil
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11
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Daniele MAS, Martinez-Alvarez M, Etyang AK, Vidler M, Salisbury T, Makanga PT, Musitia P, Flint-O'Kane M, Brown TW, Diallo BA, Boene H, Stones W, von Dadelszen P, Magee LA, Sandall J. The contribution of qualitative research within the PRECISE study in sub-Saharan Africa. Reprod Health 2020; 17:58. [PMID: 32354359 PMCID: PMC7191675 DOI: 10.1186/s12978-020-0875-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as "placental disorders") in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE's objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally.We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health.
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Affiliation(s)
- Marina A S Daniele
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Angela Koech Etyang
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Marianne Vidler
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tatiana Salisbury
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Prestige Tatenda Makanga
- Department of Surveying and Geomatics, Faculty of Science and Technology, Midlands State University, Gweru, Zimbabwe
| | - Peris Musitia
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Meriel Flint-O'Kane
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Wells Brown
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Brahima Amara Diallo
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo Province, Mozambique
| | - William Stones
- Department of Public Health and Department of Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
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12
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Sombié I, Méda ZC, Blaise Geswendé Savadogo L, Télesphore Somé D, Fatoumata Bamouni S, Dadjoari M, Windsouri Sawadogo R, Sanon-Ouédraogo D. [Is the fight against maternal mortality in Burkina Faso adapted to reduce the three delays?]. SANTE PUBLIQUE 2018; 30:273-282. [PMID: 30148315 DOI: 10.3917/spub.182.0273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Maternal mortality remains high in Burkina Faso despite numerous interventions designed to reduce this mortality. It therefore appeared important to analyse attempts to lower maternal mortality in Burkina Faso over the last fifteen years in order to identify the strengths and weaknesses and to improve the national programme. METHODS Analysis according to the ?three delays? model using the strengths, weaknesses, opportunities and threats method was conducted. Data sources were scientific publications as well as national gray literature. RESULTS Many studies have identified factors predisposing to the first delay, but very few effective interventions covering all of the country have been conducted to reduce this delay. The development of infrastructures, a rapid transfer system and integration of the cost of transfer into the cost of delivery subsidy were interventions designed to reduce the second delay. The promotion of blood transfusion, emergency obstetric and neonatal care, an increased number of trained health professionals, delegation of tasks, subsidy and then free delivery costs were interventions designed to reduce the third delay. The analysis globally demonstrated that interventions on the first delay were insufficient and rarely implemented and weaknesses were observed in relation to the intervention designed to act on the last two delays. CONCLUSION Due to their inadequacy and poor quality, the interventions failed to significantly reduce the three delays. Priority needs to be given to new interventions, especially community-based interventions, and reinforcement of the quality of care by health training.
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13
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Daniele MA, Ganaba R, Sarrassat S, Cousens S, Rossier C, Drabo S, Ouedraogo D, Filippi V. Involving male partners in maternity care in Burkina Faso: a randomized controlled trial. Bull World Health Organ 2018; 96:450-461. [PMID: 29962548 PMCID: PMC6022615 DOI: 10.2471/blt.17.206466] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso. Methods In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks’ gestation at five primary health centres in Bobo-Dioulasso. The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum. Findings The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confidence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3). Conclusion Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth.
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Affiliation(s)
- Marina As Daniele
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | | | - Sophie Sarrassat
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | - Simon Cousens
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | - Clémentine Rossier
- Institut de démographie et socioéconomie, University of Geneva, Geneva, Switzerland
| | - Seydou Drabo
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Veronique Filippi
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
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14
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Norhayati MN, Azman Yacob M. Long-term postpartum effect of severe maternal morbidity on sexual function. Int J Psychiatry Med 2017; 52:328-344. [PMID: 29117756 DOI: 10.1177/0091217417738933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There was limited knowledge on the sexual function in women who have survived severe obstetric complications. The aim of this study was to compare the level of sexual functioning among women with and without severe morbidity at six months postpartum and to identify the factors associated with sexual function scores of women. A prospective double-cohort study design was applied at two tertiary hospitals over a six-month period. Postpartum women with and without severe maternal morbidity were selected as the exposed and the non-exposed group, respectively. The study included 145 exposed and 187 non-exposed women. Those with severe maternal morbidity were significantly ( P < 0.001) older (mean (SD): 31.6 years (6.26) vs. 29.2 years (5.65)) and had longer hospital stays (mean (SD): 5.9 days (3.79) vs. 3.6 days (2.23)). They were also more likely to have delivered preterm (75.9 vs. 93.0) and to have had a caesarean section (80.7 vs. 67.9) than those without severe maternal morbidity. After adjusting for age and mental health, there was no significant difference in Female Sexual Function Index scores ( P = 0.895) between the two groups. Both groups showed the highest sexual dysfunction in pain and the lowest dysfunction in orgasm. Linear regression analyses showed no association between Female Sexual Function Index scores and sociodemographic characteristics, reproductive history, or quality of life. Sexual function in women with severe maternal morbidity did not differ from that in women without severe maternal morbidity. In-depth qualitative studies of women who have experienced potentially life-threatening conditions may improve the understanding of their sexual function.
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Affiliation(s)
- Mohd Noor Norhayati
- 1 Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Azman Yacob
- 2 Hospital Raja Perempuan Zainab II Hospital, Kelantan, Malaysia
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15
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Yugbaré Belemsaga D, Bado A, Goujon A, Duysburgh E, Degomme O, Kouanda S, Temmerman M. A cross-sectional mixed study of the opportunity to improve maternal postpartum care in reproductive, maternal, newborn, and child health services in the Kaya health district of Burkina Faso. Int J Gynaecol Obstet 2017; 135 Suppl 1:S20-S26. [PMID: 27836080 DOI: 10.1016/j.ijgo.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To propose a rationale to improve maternal postpartum care in reproductive, maternal, newborn, and child health (RMNCH) services. METHODS We conducted a cross-sectional mixed study in the Kaya health district in Burkina Faso based on two data collection exercises conducted between December 2012 and May 2013. A household survey of 757 mothers in their first year after delivery was processed. It was complemented with a qualitative analysis using in-depth interviews with key informants, focus group discussions with mothers, and participant observation. RESULTS Postpartum services showed serious weaknesses. Overall, 52% (n=384) of mothers did not receive any maternal postpartum care; however among them, 47% (n= 349) received infant postpartum care. CONCLUSION We suggest the integration of maternal postpartum care in RMNCH services as a key step to improving postpartum care. The intervention would require the overcoming of challenges related to the quality and cost of services, and to reaching the poor populations with low education and a high parity.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.
| | - Aristide Bado
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Seni Kouanda
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium; Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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16
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Filippi V, Ganaba R, Calvert C, Murray SF, Storeng KT. After surgery: the effects of life-saving caesarean sections in Burkina Faso. BMC Pregnancy Childbirth 2015; 15:348. [PMID: 26694035 PMCID: PMC4688946 DOI: 10.1186/s12884-015-0778-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso. Methods We conducted a 4 year prospective cohort study of women and their babies using mixed methods. The quantitative sample was selected in seven hospitals and included 950 women: 100 women with a caesarean section associated with near-miss complication (life-saving caesareans); 173 women with a vaginal birth associated with near-miss complication; and 677 women with uncomplicated vaginal childbirth. Structured interviews were conducted at 3 months, 6 months, 12 months and 3 and 4 years postpartum. These were supplemented by medical record data on delivery and physical examinations at 6 and 12 months postpartum. The lives and experiences of 21 women were documented ethnographically. Data were analysed with multivariable logistic regressions, using survival analysis and thematic analysis. Results The physical effects of life-saving caesareans appeared to be similar to women who had an uncomplicated childbirth, although 55 % of women with life-saving caesareans had another caesarean in their next pregnancy. The negative effects were generally economic, social and reproductive when compared to vaginal births, including increased debts (AOR = 3.91 (1.46–10.48) and sexual violence (AOR = 4.71 (1.04–21.3)) and lower fertility (AOR = 0.44 (0.24–0.80)) 4 years after life-saving caesareans. In the short and medium term, women with life-saving caesareans appeared to suffer increased psychological distress compared to uncomplicated births. They were more likely to use contraceptives (AOR = 5.95 (1.53–23.06); 3 months). Mortality of the index child was increased in both near-miss groups, independent of delivery mode. Ethnographic data suggest that these consequences are significant for Burkinabe women, whose well-being and social standing are mostly determined by their fertility, marriage strength and family links. Conclusions Life-saving caesareans have broad consequences beyond clinical sequelae. The recent policy to subsidise emergency obstetric care costs implemented in Burkina Faso should help avoid the majority of catastrophic costs, shown to be problematic for women undergoing emergency caesarean section.
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Affiliation(s)
| | | | - Clara Calvert
- London School of Hygiene and Tropical Medicine, London, UK.
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17
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Campanharo FF, Cecatti JG, Haddad SM, Parpinelli MA, Born D, Costa ML, Mattar R. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil. PLoS One 2015; 10:e0144385. [PMID: 26650684 PMCID: PMC4674155 DOI: 10.1371/journal.pone.0144385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/17/2015] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity.
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Affiliation(s)
- Felipe F. Campanharo
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- * E-mail:
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Samira M. Haddad
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Mary A. Parpinelli
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Daniel Born
- Discipline of Cardiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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18
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Andreucci CB, Cecatti JG, Pacagnella RC, Silveira C, Parpinelli MA, Ferreira EC, Angelini CR, Santos JP, Zanardi DM, Bussadori JC, Cecchino GN, Souza RT, Sousa MH, Costa ML. Does Severe Maternal Morbidity Affect Female Sexual Activity and Function? Evidence from a Brazilian Cohort Study. PLoS One 2015; 10:e0143581. [PMID: 26629897 PMCID: PMC4668121 DOI: 10.1371/journal.pone.0143581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/07/2015] [Indexed: 01/23/2023] Open
Abstract
Objective to assess Female Sexual Function Index (FSFI) scores and delay to resume sexual activity associated with a previous severe maternal morbidity. Method This was a multidimensional retrospective cohort study. Women who gave birth at a Brazilian tertiary maternity between 2008 and 2012 were included, with data extraction from the hospital information system. Those with potentially life-threatening conditions and maternal near miss episodes (severe maternal morbidity) were considered the exposed group. The control group was a random sample of women who had had uncomplicated pregnancy. Female sexual function was evaluated through FSFI questionnaire, and general and reproductive aspects were addressed through specific questions. Statistical analyses were performed using Mann-Whitney and Pearson´s Chi-square for bivariate analyses. Logistic regression was used to identify variables independently associated with lower FSFI scores. Results 638 women were included (315 at exposed and 323 at not exposed groups). The majority of women were under 30 years-old in the control group and between 30 and 46 years-old in the exposed group (p = 0.003). Women who experienced severe maternal morbidity (SMM) had statistically significant differences regarding cesarean section (82.4% versus 47.1% among deliveries without complications, p<0.001), and some previous pathological conditions. FSFI mean scores were similar among groups ranging from 24.39 to 24.42. It took longer for exposed women to resume sexual activity after index pregnancy (mean 84 days after SMM and 65 days for control group, p = 0.01). Multiple analyses showed no significant association of FSFI below cut-off value with any predictor. Conclusion FSFI scores were not different in both groups. However, they were lower than expected. SMM delayed resumption of sexual activity after delivery, beyond postpartum period. However, the proportion of women in both groups having sex at 3 months after delivery was similar. Altered sexual response may be evaluated as one of possible long-term consequences after SMM episodes. Further studies on the growing population of women surviving severe maternal conditions might be worth for improvement of care for women.
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Affiliation(s)
- Carla B. Andreucci
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
- Federal University of Sao Carlos (UFSCar), Sao Carlos, SP, Brazil
| | - José G. Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
- * E-mail:
| | - Rodolfo C. Pacagnella
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Mary A. Parpinelli
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Elton C. Ferreira
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Carina R. Angelini
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Juliana P. Santos
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Dulce M. Zanardi
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Gustavo N. Cecchino
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Maria H. Sousa
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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19
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Andreucci CB, Bussadori JC, Pacagnella RC, Chou D, Filippi V, Say L, Cecatti JG. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth 2015; 15:307. [PMID: 26596506 PMCID: PMC4657322 DOI: 10.1186/s12884-015-0742-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women´s sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Methods Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22nd, 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. Results A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3rd or 4th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Conclusion Investigation of long-term repercussions on women’s sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women.
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Affiliation(s)
- Carla B Andreucci
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil. .,Federal University of Sao Carlos, Sao Carlos, Brazil.
| | | | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | - Doris Chou
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, University of London, London, England, UK.
| | - Lale Say
- Reproductive Health Research unit, World Health Organization, Geneva, Switzerland.
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
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Contraception post severe maternal morbidity: a retrospective audit. Contraception 2015; 92:308-12. [DOI: 10.1016/j.contraception.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/27/2015] [Accepted: 05/31/2015] [Indexed: 11/23/2022]
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Storeng KT, Drabo S, Filippi V. Too poor to live? A case study of vulnerability and maternal mortality in Burkina Faso. Glob Health Promot 2013; 20:33-8. [DOI: 10.1177/1757975912462420] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper examines the concept of vulnerability in the context of maternal morbidity and mortality in Burkina Faso, an impoverished country in West Africa. Drawing on a longitudinal cohort study into the consequences of life-threatening or ‘near miss’ obstetric complications, we provide an in-depth case study of one woman’s experience of such morbidity and its aftermath. We follow Kalizeta’s trajectory from her near miss and the stillbirth of her child to her death from pregnancy-related hypertension after a subsequent delivery less than two years later, in order to examine the impact of severe and persistent illness and catastrophic health expenditure on her health and on her family’s everyday life. Kalizeta’s case illustrates how vulnerability in health emerges and is maintained or exacerbated over time. Even where social arrangements are supportive, structural impediments, including unaffordable and inadequate healthcare, can severely limit individual resilience to mitigate the negative social and economic consequences of ill health.
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Affiliation(s)
- Katerini T. Storeng
- Centre for Development and the Environment, University of Oslo, Oslo, Norway
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Seydou Drabo
- Centre for Development and the Environment, University of Oslo, Oslo, Norway
| | - Véronique Filippi
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Storeng KT, Drabo S, Ganaba R, Sundby J, Calvert C, Filippi V. Mortality after near-miss obstetric complications in Burkina Faso: medical, social and health-care factors. Bull World Health Organ 2012; 90:418-425B. [PMID: 22690031 PMCID: PMC3370364 DOI: 10.2471/blt.11.094011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/18/2011] [Accepted: 01/23/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate mortality in women in Burkina Faso in the 4 years following a life-threatening near-miss obstetric complication and to identify the medical, social and health-care-related causes of death. METHODS In total, 1014 women were recruited after hospital discharge and followed for up to 4 years: 337 had near-miss complications and 677 had uncomplicated pregnancies. Significant differences in mortality between the groups were assessed using Fisher's exact test. The medical causes of death were identified from medical records and verbal autopsy data; social and health-care-related factors associated with death were identified from interviews with the deceased women's relatives. FINDINGS In the 4 years, 15 (5.3%) women died in the near-miss group and 5 (0.9%) died after uncomplicated pregnancies (P < 0.001). More than half the deaths after a near miss, but none after an uncomplicated delivery, were pregnancy-related. Indirect factors contributed to many of these deaths, particularly human immunodeficiency virus infection. Relatives' accounts suggested that the high cost and poor quality of health care, a lack of follow-up care and an unmet need for contraception contributed to the excess mortality in the near-miss group. CONCLUSION Women in Burkina Faso who initially survived a near-miss obstetric complication had an increased risk of all-cause and pregnancy-related death in the ensuing 4 years. The likelihood of survival over the longer term could be increased by offering a continuum of care that addresses the indirect and social causes of death and supplements the emergency intrapartum obstetric care provided by current safe motherhood programmes.
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Affiliation(s)
- Katerini T Storeng
- Centre for Development and the Environment, University of Oslo, PB 1116 Blindern, Oslo 0317, Norway.
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Kaye DK, Kakaire O, Osinde MO. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010. BMC Pregnancy Childbirth 2011; 11:65. [PMID: 21955698 PMCID: PMC3203082 DOI: 10.1186/1471-2393-11-65] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 09/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. METHODS We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments). We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated. RESULTS We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals), others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72.7%. CONCLUSION The incidence/prevalence ratio and case fatality ratio of maternal near misses are very high in studies from sub-Saharan Africa. Large differences exist between countries on the prevalence/incidence of maternal near misses. This could be due to different contexts/settings, variation in the criteria used to define the maternal near misses morbidity, or rigor used carrying out the study. Future research on maternal near misses should adopt the WHO recommendation on classification of maternal morbidity and mortality.
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Affiliation(s)
- Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
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