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Amoakoh HB, De Kok BC, Yevoo LL, Olde Loohuis KM, Srofenyoh EK, Arhinful DK, Koi-Larbi K, Adu-Bonsaffoh K, Amoakoh-Coleman M, Browne JL. Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design. Glob Health Action 2024; 17:2336314. [PMID: 38717819 PMCID: PMC11080670 DOI: 10.1080/16549716.2024.2336314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective is to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.
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Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bregje C. De Kok
- Anthropology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Lucy Yevoo
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Klaartje M. Olde Loohuis
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emmanuel K. Srofenyoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Daniel K. Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwame Adu-Bonsaffoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Bekele D, Gudu W, Tolu LB, Birara M, Sium AF. Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia. AJOG GLOBAL REPORTS 2024; 4:100300. [PMID: 38318266 PMCID: PMC10839527 DOI: 10.1016/j.xagr.2023.100300] [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] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Knowledge and practice gaps among providers have been cited as factors behind the underuse of aspirin for preeclampsia prevention globally. OBJECTIVE This study aimed to determine the knowledge and practice levels of prenatal care providers at a national tertiary referral hospital in Ethiopia and its catchment health institutions. STUDY DESIGN This was a cross-sectional survey on the knowledge and practice of preeclampsia prevention through aspirin prophylaxis among prenatal care providers at St. Paul's Hospital Millennium Medical College (Ethiopia) and its catchment health institutions. Data were collected prospectively using a structured questionnaire on ODK (Get ODK Inc, San Diego, CA). The primary objective of our study was to determine the knowledge and practice levels among prenatal care providers. Data were analyzed using SPSS software (version 23; IBM, Chicago, IL). Simple descriptive analyses were performed to analyze the data. Proportions and percentages were used to present the results. RESULTS A total of 92 prenatal care providers working at 17 health institutions were approached, and 80 of them agreed to participate in the study, constituting a response rate of 87%. The mean scores of knowledge and practice of preeclampsia prevention using aspirin were 42.90 (±0.13) and 45.8 (±0.07), respectively. Most of the providers had poor knowledge (score of <50%) and poor practice (score of <50%). Among the 80 prenatal care providers, only 19 (23.8%) had good knowledge, and only 29 (36.3%) had good practice. More than half of the respondents (49/80 [61.3%]) mentioned "lack of national guidelines for use of aspirin in pregnancy" as the main factor that affected their practice of aspirin prophylaxis for preeclampsia prevention in pregnant women. Among the resources used as a reference for the practice of aspirin prophylaxis for preeclampsia prevention, International Federation of Gynecology and Obstetrics or World Health Organization guidelines (45/80 [56.3%]) were the most frequently used resources, followed by American College of Obstetricians and Gynecologists guidelines (36/80 [45.0%]) and clinical judgment (36/80 [45.0%]). CONCLUSION Our results support previous reports of significant knowledge-to-practice gaps in the use of aspirin prophylaxis for preeclampsia prevention among prenatal care providers. Moreover, the results underscore the need for immediate action in narrowing this gap among providers by availing practical national guidelines for preeclampsia prevention and in-service trainings.
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Affiliation(s)
- Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Malede Birara
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Sium AF, Gudu W, Tolu LB, Birara M, Bekele D. Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa. AJOG GLOBAL REPORTS 2024; 4:100295. [PMID: 38205131 PMCID: PMC10777106 DOI: 10.1016/j.xagr.2023.100295] [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] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recent studies showed that aspirin for preeclampsia prevention is underused despite its effectiveness in preventing preeclampsia among patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. OBJECTIVE This study aimed to determine the missed opportunity for aspirin prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. STUDY DESIGN This was a cross-sectional study on pregnant women who had preeclampsia and who were managed at the St. Paul's Hospital Millennium Medical College (Ethiopia) over a 6-month period (April 1-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was the proportion of women who had an indication for aspirin prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for aspirin) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. RESULTS A total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded based on the study criteria. Among the 395 pregnant women with preeclampsia who were included in the final analysis, 195 (50.6%) had an indication for aspirin prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressure measurements at presentation were 153.8±12.8 and 100.6±8.5 mm Hg, respectively. Most patients had proteinuria (51.7% of the participants had a urine test-strip protein level of +2, whereas 18.5% [74/395] had a urine test-strip protein level of +1 and 10.9% had 24-hour urine protein levels in the preeclampsia range). Among the women who had an indication for aspirin prophylaxis, only 1.1% received aspirin (the missed opportunity for aspirin prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9%, whereas the neonatal intensive care unit admission rate was 20.5%. The rate of a low Apgar score at 5 minutes was 8.9%. Eight mothers (2.1%) developed hemolysis, elevated liver enzymes, and low platelet count syndrome, whereas another 3 (0.8%) mothers developed a pulmonary edema. CONCLUSION In this study, the missed opportunity for administration of aspirin prophylaxis for the prevention of preeclampsia was high although more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates of adverse perinatal outcomes and serious maternal morbidity.
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Affiliation(s)
- Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Malede Birara
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Thi Huyen Anh N, Manh Thang N, Thanh Huong T. Maternal and perinatal outcomes of hypertensive disorders in pregnancy: Insights from the National Hospital of Obstetrics and Gynecology in Vietnam. PLoS One 2024; 19:e0297302. [PMID: 38295097 PMCID: PMC10830052 DOI: 10.1371/journal.pone.0297302] [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: 09/08/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Hypertension is the common disorder encountered during pregnancy, complicating 5% to 10% of all pregnancies. Hypertensive disorders in pregnancy (HDP) are also a leading cause of maternal and perinatal morbidity and mortality. The majority of feto-maternal complications due to HPD have occurred in the low- and middle-income countries. However, few studies have been done to assess the feto-maternal outcomes and the predictors of adverse perinatal outcome among women with HDP in these countries. METHODS A prospective cohort study was conducted on women with HDP who were delivered at National Hospital of Obstetrics and Gynecology, Vietnam from March 2023 to July 2023. Socio-demographic and obstetrics characteristics, and feto-maternal outcomes were obtained by trained study staff from interviews and medical records. Statistical analysis was performed using SPSS version 26.0. Bivariate and multiple logistic regressions were done to determine factors associated with adverse perinatal outcome. A 95% confidence interval not including 1 was considered statically significant. RESULTS A total of 255 women with HDP were enrolled. Regarding adverse maternal outcomes, HELLP syndrome (3.9%), placental abruption (1.6%), and eclampsia (1.2%) were three most common complications. There was no maternal death associated with HDP. The most common perinatal complication was preterm delivery developed in 160 (62.7%) of neonates. Eight stillbirths (3.1%) were recorded whereas the perinatal mortality was 6.3%. On bivariate logistic regression, variables such as residence, type of HDP, highest systolic BP, highest diastolic BP, platelet count, severity symptoms, and birth weight were found to be associated with adverse perinatal outcome. On multiple logistic regression, highest diastolic BP, severity symptoms, and birth weight were found to be independent predictors of adverse perinatal outcome. CONCLUSION Our study showed lower prevalence of stillbirth, perinatal mortality, and maternal complication compared to some previous studies. Regular antenatal care and early detection of abnormal signs during pregnancy help to devise an appropriate monitoring and treatment strategies for each women with HDP.
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Affiliation(s)
- Nguyen Thi Huyen Anh
- Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| | - Nguyen Manh Thang
- Hanoi Medical University, Hanoi, Vietnam
- National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| | - Truong Thanh Huong
- Hanoi Medical University, Hanoi, Vietnam
- Phenikaa University, Hanoi, Vietnam
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Sewor C, Obeng AA, Eliason S, Agbeno EK, Amegah AK. Fruits and vegetables intake improves birth outcomes of women with gestational diabetes mellitus and hypertensive disorders of pregnancy. BMC Nutr 2024; 10:2. [PMID: 38167235 PMCID: PMC10763264 DOI: 10.1186/s40795-023-00814-w] [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: 12/09/2022] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Disorders of pregnancy such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) have been associated with adverse birth outcomes. However, the ameliorating role of maternal nutrition in the relationship between disorders of pregnancy and adverse birth outcomes has received very little attention. We investigated the relationship between HDP and GDM, and adverse birth outcomes in a Ghanaian population and evaluated the effect modifying role of fruits and vegetables consumption in the relationship. METHODS We conducted a cross-sectional study among 799 mothers who had recently delivered singletons in the Cape Coast Metropolis, Ghana. Information on HDP, GDM and birth outcomes were retrieved from the maternal health book of the mothers. A food frequency questionnaire was used to assess fruits and vegetables intake during pregnancy. Modified Poisson regression was used to investigate the association between pregnancy disorders, and preterm birth (PTB) and low birth weight (LBW). Stratified analysis was used to assess the effect modifying role of fruits and vegetables consumption in the relationship. RESULTS The proportion of mothers with HDP and GDM was 11.3% and 7.5%, respectively. The proportion of the mothers with both conditions was 0.9%. The prevalence of PTB and LBW in the population was 27.9 and 7.3%, respectively. These disorders of pregnancy were associated with increased risk of PTB (Adjusted Prevalence Ration [APR] = 3.02; 95% CI: 2.42, 3.77) and LBW (APR = 5.32; 95% CI: 3.19, 8.88). In the stratified analysis, risk of PTB was higher among mothers classified in tertile I compared to mothers classified in tertiles II and III. For LBW, the risk increased with increasing fruits and vegetables consumption. The interaction p values were 0.0043 and 0.1604 for PTB and LBW, respectively. CONCLUSIONS We found mothers who were diagnosed with GDM and HDP to have increased risk of delivering a PTB and LBW baby. We also found fruits and vegetables consumption to modify the observed relationship. Mothers diagnosed with GDM and HDP should be advised during antenatal care visits to increase intake of fruits and vegetable consumption to help safeguard their health and that of the developing foetus.
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Affiliation(s)
- Christian Sewor
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Akua A Obeng
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
| | - Sebastian Eliason
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana.
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Das S, Maharjan R, Bajracharya R, Shrestha R, Karki S, Das R, Odland JØ, Odland ML. Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women's Hospital, Nepal: A retrospective study. PLoS One 2023; 18:e0286287. [PMID: 37267349 DOI: 10.1371/journal.pone.0286287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/13/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Gestational hypertension and preeclampsia are the most common types of hypertensive disorder in pregnancy and these conditions are associated with adverse maternal and fetal outcomes. This study aims to determine the differences in pregnancy outcomes in women with gestational hypertension and preeclampsia. METHODS A retrospective study was done at The Paropakar Maternity and Women's Hospital, a tertiary level hospital, in the Kathmandu, Nepal. Pregnant women who had given birth at the hospital between September 17 and December 18 of 2017 were included. Data were obtained from the non-digitalized hospital records. The adjusted odds ratio (AOR) and 95% confidence interval were computed using logistic regression analysis. Multivariable analysis of pregnancy outcomes (cesarean sections, low birth weight, and preterm birth) was adjusted for maternal age, parity, twin birth, gestational age, calcium supplementation, and maternal co-morbidity. RESULTS Preeclampsia was strongly associated with cesarean section compared to normal pregnancies (OR = 8.11, p<0.001). Whereas the odds of cesarean section among women with gestational hypertension was almost 2 times (OR = 1.89, p<0.001). Preterm birth was not significantly associated with gestational hypertension but was associated with preeclampsia (OR = 3.39, p<0.001). Gestational hypertension and preeclampsia were not associated with low birth weight. CONCLUSION In Nepal, women who develop preeclampsia seem at higher risk of having adverse pregnancy outcomes than women with gestational hypertension. These findings should be considered by national health authorities and other health organizations when setting new priorities to improve pregnancy outcomes.
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Affiliation(s)
- Seema Das
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Renusha Maharjan
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, United States of America
| | - Rashmita Bajracharya
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Rabina Shrestha
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Sulata Karki
- Research and Development Division, Department of Public Health and Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rupesh Das
- Department of Medicine, Janaki Medical College Teaching Hospital, Janakpur, Nepal
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maria Lisa Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Asres AW, Samuel S, Daga WB, Tena A, Alemu A, Workie SB, Alemayehu M, Messel H. Association between iron-folic acid supplementation and pregnancy-induced hypertension among pregnant women in public hospitals, Wolaita Sodo, Ethiopia 2021: a case- control study. BMC Public Health 2023; 23:843. [PMID: 37165342 PMCID: PMC10170668 DOI: 10.1186/s12889-023-15794-6] [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: 12/09/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Pregnancy-induced hypertension is the new onset of high blood pressure after 20 weeks of gestation in women with previously normal blood pressure. To the best of our knowledge, no study has been conducted in our country to investigate the association between this pregnancy problem and iron-folic acid supplementation. The aim of this study was to determine the association between iron-folic acid supplementation and pregnancy-induced hypertension (PIH) in pregnant women at public hospitals in the Wolaita Sodo zone. METHODS An institution-based case-control study was conducted among pregnant women who visited public hospitals in the Wolaita Sodo zone from March 3, 2022, to August 30, 2022. A consecutive sampling method was used to select the study participants. The total sample size was 492, of which 164 were cases and 328 were controls. The data were collected by conducting face-to-face interviews and measurements. The data were entered into EpiData version 4.6 and exported to STATA 14 for analysis. Those variables with a p-value less than 0.05 were considered statistically significant. Descriptive statistics and odds ratios were presented using texts, tables, and figures. RESULTS A total of 471 women participated in this study, yielding a response rate of 96%. The cases had a mean age of 25 ± 4.43, while the controls had a mean age of 25 ± 3.99. The mean age at first pregnancy among cases was 20 ± 2.82 and among controls was 20 ± 2.97. The average number of deliveries for cases and controls was 1.97 ± 1.41 and 1.95 ± 1.38, respectively. There is no significant association between iron-folic acid supplementation and PIH. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it (AOR = 3.65; 95% CI: 1.0-12.9). Eating kocho (AOR = 14.4; 95% CI: 1.2-16.7) was positively associated with PIH. CONCLUSIONS There is no association between iron-folic acid supplementation during pregnancy and pregnancy-induced hypertension. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it. There is an association between kocho consumption and PIH. More research should be done using stronger designs.
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Affiliation(s)
- Abiyot Wolie Asres
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Serawit Samuel
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Wakgari Binu Daga
- Department of Reproductive Health and Nutrition, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Atsede Tena
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Afework Alemu
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Shimelash Bitew Workie
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mihiretu Alemayehu
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Habtamu Messel
- Health Professionals Education Partnership Initiative Project Office, Addis Ababa University, Addis Ababa, Ethiopia
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Robbins T, Shennan A, Sandall J, Eshetu Guangul T, Demissew R, Abdella A, Mayston R, Hanlon C. Understanding challenges as they impact on hospital-level care for pre-eclampsia in rural Ethiopia: a qualitative study. BMJ Open 2023; 13:e061500. [PMID: 37068897 PMCID: PMC10111927 DOI: 10.1136/bmjopen-2022-061500] [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] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To explore hospital-level care for pre-eclampsia in Ethiopia, considering the perspectives of those affected and healthcare providers, in order to understand barriers and facilitators to early detection, care escalation and appropriate management. SETTING A primary and a general hospital in southern Ethiopia. PARTICIPANTS Women with lived experience of pre-eclampsia care in the hospital, families of women deceased due to pre-eclampsia, midwives, doctors, integrated emergency surgical officers and healthcare managers. RESULTS This study identified numerous systemic barriers to provision of quality, person-centred care for pre-eclampsia in hospitals. Individual staff efforts to respond to maternal emergencies were undermined by a lack of consistency in availability of resources and support. The ways in which policies were applied exacerbated inequities in care. Staff improvised as a means of managing with limited material or human resources and knowledge. Social hierarchies and punitive cultures challenged adequacy of communication with women, documentation of care given and supportive environments for quality improvement. CONCLUSIONS Quality care for pre-eclampsia requires organisational change to create a safe space for learning and improvement, alongside efforts to offer patient-centred care and ensure providers are equipped with knowledge, resources and support to adhere to evidence-based practice.
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Affiliation(s)
- Tanya Robbins
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, UK
| | - Tigist Eshetu Guangul
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Rahel Demissew
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Rosie Mayston
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
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Teka H, Yemane A, Abraha HE, Berhe E, Tadesse H, Gebru F, Yahya M, Tadesse Y, Gebre D, Abrha M, Tesfay B, Tekle A, Gebremariam T, Amare B, Ebrahim MM, Zelelow YB, Mulugeta A. Clinical presentation, maternal-fetal, and neonatal outcomes of early-onset versus late onset preeclampsia-eclampsia syndrome in a teaching hospital in a low-resource setting: A retrospective cohort study. PLoS One 2023; 18:e0281952. [PMID: 36848332 PMCID: PMC9970097 DOI: 10.1371/journal.pone.0281952] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/04/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Pre-eclampsia-eclampsia syndrome remains the leading cause of maternal and neonatal mortality worldwide. Both from pathophysiologic and clinical stand points, early and late onset preeclampsia are thought to be two different disease entities. However, the magnitude of preeclampsia-eclampsia and maternal-fetal and neonatal outcomes of early and late onset preeclampsia are not adequately investigated in resource-limited settings. This study sought to examine the clinical presentation and maternal-fetal and neonatal outcome of these two entities of the disease in Ayder comprehensive specialized hospital, an academic setting in Tigray, Ethiopia, from January 1, 2015-December 31, 2021. METHODS A retrospective cohort design was employed. The patient charts were reviewed to see the baseline characteristics and their progress from the onset of the disease in the antepartum, intrapartum and postpartum periods. Women who developed pre-eclampsia before 34 weeks of gestation were defined as having early-onset pre-eclampsia, and those who developed at 34 weeks or later were identified as late-onset preeclampsia. We used chi-square, t-test and multivariable logistic regression analyses to determine differences between early- and late onset diseases in terms of clinical presentation, maternal-fetal, and neonatal outcomes. RESULTS Among the 27,350 mothers who gave birth at the Ayder comprehensive specialized hospital, 1095 mothers had preeclampsia-eclampsia syndrome, with a prevalence of 4.0% (95% CI: 3.8, 4.2)]. Of the 934 mothers analyzed early and late onset diseases accounted for 253 (27.1%) and 681 (72.9%) respectively. Overall, death of 25 mothers was recorded. Women with early onset disease had significant unfavorable maternal outcomes including having preeclampsia with severity features (AOR = 2.92, 95% CI: 1.92, 4.45), liver dysfunction (AOR = 1.75, 95% CI: 1.04, 2.95), uncontrolled diastolic blood pressure (AOR = 1.71, 95% CI: 1.03, 2.84), and prolonged hospitalization (AOR = 4.70, 95% CI: 2.15, 10.28). Similarly, they also had increased unfavorable perinatal outcomes, including the APGAR score at the 5th minute (AOR = 13.79, 95% CI: 1.16, 163.78), low birth weight (AOR = 10.14, 95% CI 4.29, 23.91), and neonatal death (AOR = 6.82, 95% CI: 1.89, 24.58). CONCLUSION The present study highlights the clinical differences between early versus late onset preeclampsia. Women with early-onset disease are at increased levels of unfavorable maternal outcomes. Perinatal morbidity and mortality were also increased significantly in women with early onset disease. Therefore, gestational age at the onset of the disease should be taken as an important indicator of the severity of the disease with unfavorable maternal, fetal, and neonatal outcomes.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
- * E-mail:
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Hiluf Ebuy Abraha
- Ayder Comprehensive Specialized Hospital, Quality Assurance Office, Mekelle University, Mek’ele, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Fanos Gebru
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Mohammedtahir Yahya
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Ytbarek Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Daniel Gebre
- Department of Midwifery, Ayder Comprehensive Specialised Hospital, Mekelle University, Mek’ele, Ethiopia
| | - Marta Abrha
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Bisrat Tesfay
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Ashenafi Tekle
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Birhane Amare
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | | | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition, School of Public Health, Mekelle University, Mek’ele, Ethiopia
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Medjedovic E, Kurjak A, Stanojević M, Begic E. Pre-eclampsia and maternal health through the prism of low-income countries. J Perinat Med 2023; 51:261-268. [PMID: 36205639 DOI: 10.1515/jpm-2022-0437] [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: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022]
Abstract
Hypertensive syndrome in pregnancy complicates up to 15% of pregnancies, and preeclampsia (PE) occurs in about 3-10% of pregnant women. Inadequate prenatal care is associated with higher mortality from PE, possibly due to reduced monitoring, detection, and missed opportunities for early intervention. The imperative of the clinician's work is to monitor the symptoms and clinical signs of PE, and stratification of patients in relation to the risk of PE is essential. PE represents a multisystem inflammatory response, and the consequences can be expected in all organs. The question of the effect of PE on long-term maternal health is raised. The aim of the paper is to present the effect of PE on the patient's health through the prism of low-income countries.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina.,Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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Garanet F, Samadoulougou S, Baguiya A, Bonnechère B, Millogo T, Degryse JM, Kirakoya-Samadoulougou F, Kouanda S. Low prevalence of high blood pressure in pregnant women in Burkina Faso: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:955. [PMID: 36544103 PMCID: PMC9773536 DOI: 10.1186/s12884-022-05242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High blood pressure (HBP) during pregnancy causes maternal and fetal mortality. Studies regarding its prevalence and associated factors in frontline level health care settings are scarce. We thus aimed to evaluate the prevalence of HBP and its associated factors among pregnant women at the first level of the health care system in Burkina Faso. METHODS This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. HBP was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Multivariable logistic regression analysis was performed to identify factors associated with HBP. RESULTS A total of 1027 pregnant women were included. The overall prevalence of HBP was 1.4% (14/1027; 95% confidence interval [CI] 0.7-2.3), with 1.6% (7/590; 95% CI 0.8-3.3) in rural and 1.2% (7/437; 95% CI 0.6- 2.5) in semi-urban areas. The prevalence was 0.7% (3/440; 95% CI 0.2-2.1) among women in the first, 1.5% (7/452; 95% CI 0.7-3.2) in the second and 3% (4/135; 95% CI 1.1-7.7) in the third trimester. In the multivariable analysis, pregnancy trimester, maternal age, household income, occupation, parity, and residential area were not associated with HBP during pregnancy. CONCLUSION The prevalence of HBP among pregnant women at the first level of health system care is significantly lower compared to prevalence's from hospital studies. Public health surveillance, primary prevention activities, early screening, and treatment of HDP should be reinforced in all health facilities to reduce the burden of adverse pregnancy outcomes in Burkina Faso.
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Affiliation(s)
- Franck Garanet
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,grid.4989.c0000 0001 2348 0746Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgique ,Université Ouaga1 Joseph Ki-Zerbo, Ecole Doctorale Science de la Santé (ED2S), Laboratoire de Santé Publique (LASAP), Ouagadougou, Burkina Faso
| | - Sekou Samadoulougou
- grid.23856.3a0000 0004 1936 8390Centre for Research on Planning and Development (CRAD), Laval University, Quebec, G1V 0A6 Canada ,grid.421142.00000 0000 8521 1798Evaluation Platform On Obesity Prevention, Quebec Heart and Lung Institute, Quebec, G1V 4G5 Canada
| | - Adama Baguiya
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Bruno Bonnechère
- grid.12155.320000 0001 0604 5662REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tieba Millogo
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
| | - Jean-Marie Degryse
- grid.7942.80000 0001 2294 713XInstitut de Recherche Sciences et Société (IRSS), Université Catholique de Louvain, Bruxelles, Belgique ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care - Katholieke Universiteit Leuven, Leuven, Belgique
| | - Fati Kirakoya-Samadoulougou
- grid.4989.c0000 0001 2348 0746Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgique
| | - Seni Kouanda
- grid.457337.10000 0004 0564 0509Centre National de la Recherche Scientifique et Technologique (CNRST), Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso ,Institut Africain de Santé Publique (IASP), Ouagadougou, Burkina Faso
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Ulloa-Sabogal IM, Pérez-Jaimes GA, Arias-Rojas EM, Cañon-Montañez W. Intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado para los trastornos hipertensivos durante el embarazo: protocolo de revisión sistemática y meta análisis. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introducción: Los trastornos hipertensivos durante el embarazo constituyen un problema de salud a nivel mundial. La educación para la salud es una estrategia que brinda a la mujer embarazada conocimientos y habilidades para el autocuidado. Objetivo: evaluar el efecto de intervenciones en educación para la salud sobre el conocimiento y las prácticas de autocuidado de mujeres embarazadas ante los trastornos hipertensivos en el embarazo, en comparación con la atención estándar del control prenatal. Materiales y Métodos: Protocolo de revisión sistemática y metaanálisis. El registro del estudio puede ser consultado en PROSPERO (CRD42021252401). La búsqueda se realizará en las siguientes bases de datos, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE y WoS. Adicionalmente, registros de ensayos clínicos en ClinicalTrials y literatura gris en OpenGrey y Google Scholar. La búsqueda incluirá estudios de intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado ante los trastornos hipertensivos del embarazo. Los análisis estadísticos se llevarán a cabo con el software Review Manager. Los datos se combinarán mediante modelos de efectos aleatorios, los datos binarios con odds ratios o riesgos relativos y los datos continuos mediante diferencia de medias. La heterogeneidad entre los estudios se evaluará mediante la prueba Q-Cochran para medir la significancia y el estadístico l2 para medir la magnitud. Discusión: Este estudio aportará en el conocimiento de las intervenciones en salud que son efectivas para orientar y educar a las mujeres embarazadas sobre la enfermedad y prácticas de autocuidado. Conclusión: Los resultados de este estudio servirán para proporcionar recomendaciones en la gestión del cuidado materno perinatal, que promuevan atención integral acorde con la política de Atención Primaria en Salud.
Como citar este artículo: Ulloa-Sabogal Iliana Milena, Pérez-Jaimes Giovanny Andrés, Arias-Rojas Edier Mauricio, Cañon-Montañez Wilson. Health education interventions on knowledge and self-care practices for hypertensive disorders during pregnancy: systematic review and meta-analysis protocol. Revista Cuidarte. 2023;14(1):e2495. http://dx.doi.org/10.15649/cuidarte.2495
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Leta M, Assefa N, Tefera M. Obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia; A systematic review and meta-analysis. Front Glob Womens Health 2022; 3:942668. [PMID: 36386434 PMCID: PMC9643843 DOI: 10.3389/fgwh.2022.942668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders. Purpose The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia. Method We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I 2 statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated. Result A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women. Conclusion This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth via CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
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Affiliation(s)
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maleda Tefera
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Debele GR, Siraj SZ, Tsegaye D, Temesgen E. Determinants of neonatal near-miss among neonates delivered in public hospitals of Ilu Abba Bor Zone, Southwest Ethiopia: An unmatched case-control study during the COVID-19 pandemic. Front Public Health 2022; 10:923408. [PMID: 36203670 PMCID: PMC9531017 DOI: 10.3389/fpubh.2022.923408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 01/22/2023] Open
Abstract
Background The neonatal period is the time with the highest risk of neonatal and infant mortality. The COVID-19 pandemic diverted resources from routine maternal health services, which raises the possibility of neonatal near misses (NNMs). To implement prompt treatments that could improve the standard of infant care and lower neonatal mortality, it has been theorized that pinpointing the determinants of NNM during this outbreak is crucial. In light of this, the current study identified the determinants of NNM in neonates delivered in public hospitals of Ilu Abba Bor Zone, South West Ethiopia. Methods An institution-based unmatched case-control study was conducted among randomly selected 303 (101 cases and 202 controls) neonates admitted to Mettu Karl Comprehensive Specialized Hospital (MKCSH) and Darimu Primary Hospital (DPH) from 1 November to 28 December 2020. Data were collected using interviewer-administered structured questionnaire and checklist. The collected data were coded and entered into Epi-Data version 4.6 and then exported to SPSS version 20 for analysis. Adjusted odds ratios (AOR) along with a 95% confidence interval was used to assess the strength of the association, and a p-value < 0.05 was considered to declare the statistical significance in the multivariable logistic regression analysis. Result A total of 303 (101 cases and 202 controls) neonates admitted to MKCSH and DPH were included in the study making a 97.4% response rate. In the multivariable logistic regression analysis, no formal maternal education [AOR = 3.534, 95% CI: (1.194-10.455)], Breech presentation during birth [AOR = 3.088, 95% CI: (1.029-9.268)], < 4 antenatal care (ANC) visits [AOR = 1.920, 95% CI: (1.065-3.461], cesarean section delivery [AOR = 4.347, 95% CI: (1.718-10.996)], antepartum hemorrhage (APH) [AOR = 3.37, 95% CI: (1.23-9.24)], and hypertensive disorders of pregnancy (HDP) [AOR = 4.05, 95% CI: (2.36-11.05)] were independent determinants of NNM. Conclusion The study's result revealed that factors such as education level, birth presentation, ANC visit, mode of delivery, APH, and HDP continued to be important determinants of the NNM in Ethiopia during this pandemic. Therefore, much work is needed to improve neonatal health by providing adequate ANC services and other identified potential determinant factors that predispose the newborn to life-threatening (near-miss) conditions especially during this pandemic.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sabit Zenu Siraj
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Dereje Tsegaye
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Ermiyas Temesgen
- Department of Public Health, Mettu Health Science College, Mettu, Ethiopia
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Li Y, Wei Y, Shao J. Diagnostic value of miR-101 levels in blood and urine of patients with hypertensive disorder complicating pregnancy. Clin Exp Hypertens 2022; 44:1-7. [PMID: 36047533 DOI: 10.1080/10641963.2022.2110258] [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: 01/27/2022] [Revised: 06/30/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study explored the miR-101 clinical significance in hypertensive disorder complicating pregnancy (HDCP). METHODS Pregnant women with gestational hypertension (GH)/mild preeclampsia (mPE)/severe preeclampsia (sPE) were included. The miR-101 levels were measured. Correlation between miR-101 and soluble fmslike tyrosine kinase-1 (sFlt-1), miR-101 predictive value, and factors influencing HDCP grade were evaluated. RESULTS Serum miR-101 was down-regulated and negatively correlated with sFlt-1. miR-101 was an independent risk factor for HDCP and decreased with HDCP severity. The area under the curve of miR-101 in differentiating GH from mPE and mPE from sPE was 0.7764 and 0.8529. CONCLUSION Serum miR-101 level may be a biomarker for grading HDCP.
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Affiliation(s)
- Yushan Li
- Department of Obstetrics and Gynecology, Jincheng People's Hospital, Jincheng, China
| | - Yuanyuan Wei
- Department of Obstetrics and Gynecology, Jincheng People's Hospital, Jincheng, China
| | - Jiong Shao
- Department of Obstetrics and Gynecology, Jincheng People's Hospital, Jincheng, China
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Jikamo B, Adefris M, Azale T, Gelaye KA. Incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia, southern Ethiopia: a prospective open cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001567. [PMID: 36053644 PMCID: PMC9438059 DOI: 10.1136/bmjpo-2022-001567] [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: 06/03/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In Ethiopia, in 2021, more than 80% of all newborn deaths were caused by preventable and treatable conditions. This study aimed to measure the incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia in the Sidama region of southern Ethiopia. METHODS A prospective open cohort study was conducted from 8 August 2019 to 1 October 2020. We enrolled 363 women with pre-eclampsia and 367 normotensive women at ≥20 weeks of gestation and followed them until the 37th week. We then followed them until the seventh day after delivery up to the last perinatal outcome status was ascertained. A log-binomial logistic regression model was used to estimate the incidence of adverse perinatal outcomes and its risk factors among women with pre-eclampsia. Relative risk (RR) with a 95% CI was reported. A p<0.05 was considered statistically significant. RESULTS There were 224 adverse perinatal outcomes observed in the 363 women with pre-eclampsia compared with 136 adverse perinatal outcomes in the 367 normotensive women (p<0.001). There were 23 early neonatal deaths in the pre-eclampsia group compared with six deaths in the normotensive group (p<0.001). There were 35 perinatal deaths in the pre-eclampsia group compared with 16 deaths in the normotensive group (p<0.05). Women with severe features of pre-eclampsia had a 46% (adjusted RR 1.46, 95% CI 1.38 to 2.77) higher risk for adverse perinatal outcomes compared with women without severe features of pre-eclampsia. CONCLUSIONS In this study, more adverse perinatal outcomes occurred among women with pre-eclampsia after controlling for confounders. A higher perinatal outcome observed among women with pre-eclampsia, especially among women with severe features of pre-eclampsia, and those admitted to hospital at <34 weeks. This paper highlights the significantly elevated perinatal risks associated with pre-eclampsia, especially when it has severe features.
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Affiliation(s)
- Birhanu Jikamo
- Hawassa University College of Medicine and Health Sciences, Hawassa, Southern Nations, Ethiopia
| | - Mulat Adefris
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Telake Azale
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Amare M, Olani A, Hassen H, Jiregna B, Getachew N, Belina S. Perinatal Outcomes and Associated Factors among women with hypertensive Disorders of Pregnancy Delivered in Jimma Zone Hospitals, Southwest Ethiopia. Ethiop J Health Sci 2021; 31:1145-1154. [PMID: 35392349 PMCID: PMC8968375 DOI: 10.4314/ejhs.v31i6.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are multisystem diseases that increase the risk of adverse perinatal outcomes worldwide. It Led to early and late serious health consequence on the baby, with a significant proportion occurring in low-income countries. Hence the objective of this study was to determine perinatal outcomes and associated factors among women with hypertensive disorders of pregnancy delivered in Jimma zone hospitals. METHOD A Facility based cross-sectional study design was employed from March to May 2020 on 211 hypertensive women delivered in the four randomly selected hospitals. The data were collected by reviewing medical record and face to face interview using consecutive sampling technique. Binary and multivariable logistic regression was performed to identify association. RESULT Ninety-one (43.1%) of fetuses developed unfavorable perinatal outcome. Inability to read and write (AOR=2.5; 95% CI:1.03-6.17), being primipara (AOR=4.6; 95% CI:1.6-13.2) and multi-para (AOR=3.1; 95% CI:1.09-9.17), Lack of antenatal care visit (AOR=4.2; 95% CI:1.2-15.01), having preeclampsia (AOR=4.2; 95% CI:1.1-16.6) and eclampsia (AOR=5.8; 95% CI:1.2-26.2) and late provision of drug (AOR=3.9;95% CI:1.9-7.9) were independent factors. CONCLUSION Pregnancy complicated with hypertensive disorders was associated with increased unfavorable perinatal outcomes. Preeclampsia and eclampsia, inability to read and write, primipara and multipara, lack of antenatal care and late provision of drug were factors associated with unfavorable perinatal outcomes.
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Affiliation(s)
- Mesganew Amare
- Department of Midwifery, College of Health Science, Mettu University, Ethiopia,
| | - Adugna Olani
- School of Nursing and Midwifery, Institute of Health, Wollega University, Nekemte, Ethiopia
| | - Habtamu Hassen
- Department of public health, Hossana Health Sciences College, Ethiopia
| | - Bikila Jiregna
- Department of Midwifery, College of Health Science, Mettu University, Ethiopia
| | - Nigusu Getachew
- Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Ethiopia
| | - Sena Belina
- School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, Ethiopia
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19
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Adverse Outcomes of Preeclampsia in Previous and Subsequent Pregnancies and the Risk of Recurrence. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:426-431. [PMID: 34712087 PMCID: PMC8526236 DOI: 10.14744/semb.2020.56650] [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: 07/29/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022]
Abstract
Objectives We evaluated the fetal and maternal outcomes of pregnant women with preeclampsia who gave birth in our hospital; we also evaluated preeclampsia recurrence rates in these patients and their fetal and maternal outcomes in their subsequent pregnancy. Methods In this retrospective cohort study, 126 patients whose medical records were accessed completely and who got pregnant again and gave birth in our hospital were analyzed. The primary aim was to show the recurrence rate of preeclampsia, while the secondary aim was to evaluate the maternal and fetal results of the first pregnancy in which preeclampsia developed and the subsequent pregnancy. Results The incidence of preeclampsia was found to be 2.1% in our clinic. The first pregnancy in which preeclampsia developed; 111 (80.2%) pregnancies resulted in a live birth, 7 (5.6%) resulted in termination, and 8 (6.3%) resulted in stillbirth. Neonatal death occurred in 10 (7.9%) pregnancies. While 105 of the subsequent pregnancies resulted in a live birth, 10 (7.9%) resulted in abortion, 9 (7.1%) resulted in stillbirth, and 2 (1.6%) resulted in termination due to preeclampsia. Neonatal death developed in 3 (2.6%) pregnancies. In the subsequent pregnancy, preeclampsia developed in 70 (55.5%) patients and 39 (55.7%) of these had preeclampsia with severe features. Conclusion The present study guides us on the risk factors related to preeclampsia and the rate of fetomaternal adverse outcomes and emphasizes the need for strict and regular antenatal follow-up in the subsequent pregnancies of women who have a history preeclampsia. Improvement of maternal and fetal morbidity and mortality in this way is the utmost goal.
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20
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Verma I, Chugh C, Sood D, Soni RK. Perinatal Outcome in Pregnancies Associated with Hypertension: A Prospective Cohort Study in a Rural Tertiary Care Teaching Hospital of North India. Indian J Community Med 2021; 46:651-656. [PMID: 35068728 PMCID: PMC8729303 DOI: 10.4103/ijcm.ijcm_6_21] [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: 01/02/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The objective of the study is to know type of hypertension affecting pregnant women and impact on perinatal outcome. SUBJECT AND METHODS This is a prospective cohort study; 120 women with hypertensive disorders of pregnancy (HDP) at gestation ≥28 weeks who delivered in our institute were enrolled. Sociodemography, gestational age, mode of delivery, APGAR, birth weight, fetal growth restriction (FGR), and perinatal outcome were recorded. Mean ± standard deviation or proportions, analysis of variance, Chi-square test, and odds ratio were used for statistical analysis. RESULTS Preeclampsia (PE) was most prevalent hypertensive disorder of pregnancy (44.2%), followed by eclampsia (27.50%), gestational hypertension (23.3%), and chronic hypertension (CH) (5.0%). In PE group, 61.8% had FGR, 65.5% newborns were preterm, 74.6% had low birth weight, and 54.1% needed neonatal intensive care unit (NICU) admission. In eclampsia group, 42.9% had fetal growth restriction, 65.7% preterm, 80% low birth weight, and 78.6% NICU admission. PE women delivered more fetal growth-restricted babies with odd ratio of 2.37 (95% confidence interval [CI]: 1.15, 4.9) and at lower gestation with odd ratio of 2.00 (95% CI: 0.95, 4.21). Eclampsia group had more newborn with low APGAR 1 min, NICU admissions, and those requiring ventilator with odds ratio of 3.10 (95% CI: 1.37, 7.03), 4.48 (95% CI: 1.64, 12.24), and 4.09 (95% CI: 1.6, 10.46), respectively. Perinatal mortality was 10, 9, and 2 in eclampsia, PE, and gestational hypertension groups, respectively, with overall rate of 16.9%. PE and eclampsia comprised 71.70% of HDP but contributed 90.5% of all perinatal deaths. CONCLUSION Preeclampsia-eclampsia is associated with increased risk of adverse perinatal outcomes as compared to gestational and CH, necessitating screening, vigilant antenatal care, timely intervention, and referral.
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Affiliation(s)
- Indu Verma
- Department of Obstetrics and Gynaecology, ESICMC Alwar, Rajasthan, India
| | - Charvi Chugh
- Department of Obstetrics and Gynaecology, MMIMS&R, Mullana, Ambala, Haryana, India
| | - Dinesh Sood
- Department of Anaesthesia, ESICMC Alwar, Rajasthan, India
| | - R. K. Soni
- Department of PSM, DMCH Ludhiana, Punjab, India
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21
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Panda S, Das R, Sharma N, Das A, Deb P, Singh K. Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India. Cureus 2021; 13:e13982. [PMID: 33880307 PMCID: PMC8053022 DOI: 10.7759/cureus.13982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention. Methods This prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results In our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socio-economic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia. Conclusion Routine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.
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Affiliation(s)
- Subrat Panda
- Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Rituparna Das
- Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Nalini Sharma
- Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Ananya Das
- Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Prakash Deb
- Anesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Kaushiki Singh
- Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
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Mezmur H, Assefa N, Alemayehu T. An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study. Glob Pediatr Health 2021; 8:2333794X21999154. [PMID: 33748345 PMCID: PMC7940719 DOI: 10.1177/2333794x21999154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference (P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.
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Maeland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Placental abruption in immigrant women in Norway: A population-based study. Acta Obstet Gynecol Scand 2021; 100:658-665. [PMID: 33341933 DOI: 10.1111/aogs.14067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. MATERIAL AND METHODS We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. RESULTS The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. CONCLUSIONS Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.
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Affiliation(s)
- Karolina S Maeland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Getaneh T, Negesse A, Dessie G, Desta M. The impact of pregnancy induced hypertension on low birth weight in Ethiopia: systematic review and meta-analysis. Ital J Pediatr 2020; 46:174. [PMID: 33243285 PMCID: PMC7690116 DOI: 10.1186/s13052-020-00926-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Even though neonatal mortality reduction is the major goal needed to be achieved by 2030, it is still unacceptably high especially in Ethiopia. In the other hand, low birth weight is the major cause of neonatal mortality and morbidity. More than 10 millions of low birth weight infants occurred as a result of pregnancy induced hypertension. However, in Ethiopia the association between low birth weight and pregnancy induced hypertension was represented with un-updated, inconclusive and different studies. Therefore, this review aimed to estimate the overall pooled impact of pregnancy induced hypertension on low birth weight and its association in Ethiopia. Methods articles searched on PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google, Google Scholar and local shelves. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was applied for critical appraisal. The I2 statistic was computed to check the presence of heterogeneity. Publication bias was evaluated using funnel plot asymmetry and Egger’s test. A random effect model was used to estimate the pooled prevalence of low birth weight. Result From the total 131 identified original articles, 25 were eligible and included for the final analysis. The overall pooled prevalence of low birth weight among women who had pregnancy induced hypertension in Ethiopia was 39.7% (95% CI: 33.3, 46.2). But, I2 statistic estimation evidenced significant heterogeneity across included studies (I2 = 89.4, p < 0.001). In addition, the odds of having low birth weight newborns among women who had pregnancy induced hypertension was 3.89 times higher compared to their counterparts (OR = 3.89, 95% CI: 2.66, 5.69). Conclusion The pooled prevalence of low birth weight among women who had pregnancy induced hypertension was more than two times higher than the pooled estimate of low birth weight among all reproductive aged women. The odds of low birth weight also increased nearly four times among women with pregnancy induced hypertension than normotensive women. Therefore, health policies which provide better and quality antenatal care with more oriented on importance of early detection and management of pregnancy induced hypertension should be implemented.
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Affiliation(s)
- Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Center of excellence in Human Nutrition, School of Human Nutrition, Food Science and Technology, Hawassa University, Hawasa, Ethiopia
| | - Getenet Dessie
- Department of Nursing, School of Health science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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25
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Lugobe HM, Muhindo R, Kayondo M, Wilkinson I, Agaba DC, McEniery C, Okello S, Wylie BJ, Boatin AA. Risks of adverse perinatal and maternal outcomes among women with hypertensive disorders of pregnancy in southwestern Uganda. PLoS One 2020; 15:e0241207. [PMID: 33112915 PMCID: PMC7592727 DOI: 10.1371/journal.pone.0241207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) are a leading cause of global perinatal (fetal and neonatal) and maternal morbidity and mortality. We sought to describe HDP and determine the magnitude and risk factors for adverse perinatal and maternal outcomes among women with HDP in southwestern Uganda. METHODS We prospectively enrolled pregnant women admitted for delivery and diagnosed with HDP at a tertiary referral hospital in southwestern Uganda from January 2019 to November 2019, excluding women with pre-existing hypertension. The participants were observed and adverse perinatal and maternal outcomes were documented. We used multivariable logistic regression models to determine independent risk factors associated with adverse perinatal and maternal outcomes. RESULTS A total of 103 pregnant women with a new-onset HDP were enrolled. Almost all women, 93.2% (n = 96) had either pre-eclampsia with severe features or eclampsia. The majority, 58% (n = 60) of the participants had an adverse perinatal outcome (36.9% admitted to the neonatal intensive care unit (ICU), 20.3% stillbirths, and 1.1% neonatal deaths). Fewer participants, 19.4% (n = 20) had an adverse maternal outcome HELLP syndrome (7.8%), ICU admission (3%), and postpartum hemorrhage (3%). In adjusted analyses, gestational age of < 34 weeks at delivery and birth weight <2.5kg were independent risk factors for adverse perinatal outcomes while referral from another health facility and eclampsia were independent risk factors for adverse maternal outcomes. CONCLUSION Among women with HDP at our institution, majority had preeclampsia with severe symptoms or eclampsia and an unacceptably high rate of adverse perinatal and maternal outcomes; over a fifth of the mothers experiencing stillbirth. This calls for improved antenatal surveillance of women with HDP and in particular improved neonatal and maternal critical care expertise at delivering facilities. Earlier detection and referral, as well as improvement in initial management at lower level health units and on arrival at the referral site is imperative.
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Affiliation(s)
- Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rose Muhindo
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Musa Kayondo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David Collins Agaba
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Blair J. Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adeline A. Boatin
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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