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Oyato BT, Debele T, Edosa D, Abasimel HZ, Awol M, Kebede ET, Gezahagn A, Desta AA, Alemu FT, Asfaw SB. Determinants of puerperal sepsis among postpartum women: a case-control study in East Shoa Zone public hospitals, Central Ethiopia. BMJ Open 2024; 14:e083230. [PMID: 38908838 DOI: 10.1136/bmjopen-2023-083230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVE To identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023. DESIGN AND SETTING An institutional-based, unmatched case-control study was conducted from 19 June 2023 to 4 September 2023, in East Shoa Zone public hospitals. PARTICIPANTS 495 postpartum women (100 cases and 395 controls) were selected using systematic sampling techniques. Data were collected through face-to-face interviews and from medical charts using a pretested, structured questionnaire. The AOR with its corresponding 95% CI was used to identify determinant variables. Findings were presented in texts and tables. OUTCOME MEASURES The medical charts of participants were reviewed to identify those who had developed puerperal sepsis. RESULTS Anaemia (AOR 6.05; 95% CI 2.57 to 14.26), undernourishment (AOR 4.43; 95% CI 1.96 to 10.01), gestational diabetes mellitus (AOR 3.26; 95% CI 1.22 to 8.74), postpartum haemorrhage (AOR 3.17; 95% CI 1.28 to 7.87), obstructed labour (AOR 2.76; 95% CI 1.17 to 6.52), multiparity (AOR 2.54; 95% CI 1.17 to 5.50), placenta previa (AOR 2.27; 95% CI 1.11 to 4.67) and vaginal examination ≥5 times (AOR 2.19; 95% CI 1.05 to 4.54) were the independent determinants of puerperal sepsis in this study. CONCLUSION This study found that gestational diabetes mellitus, anaemia, undernourishment, placenta previa, obstructed labour, postpartum haemorrhage and five or more per-vaginal examinations during labour were the determinants of puerperal sepsis. Therefore, it is recommended that obstetric care providers strictly adhere to guidelines on the number of vaginal exams that should be performed throughout labour and that they perform these exams using the appropriate infection-prevention techniques. In addition, they should provide comprehensive health education on nutrition during pregnancy and postnatal periods and the importance of iron supplements.
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Affiliation(s)
| | - Tirunesh Debele
- Department of Midwifery, Salale University, Fitche, Oromia, Ethiopia
| | - Dejene Edosa
- Department of Midwifery, Salale University, Fitche, Oromia, Ethiopia
| | | | - Mukemil Awol
- Department of Midwifery, Salale University, Fitche, Oromia, Ethiopia
| | | | - Andualem Gezahagn
- Department of Midwifery, Salale University, Fitche, Oromia, Ethiopia
| | | | | | - Samuel Boja Asfaw
- Department of Midwifery, Salale University, Fitche, Oromia, Ethiopia
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Dysfunctional labor and delivery: adverse effects on offspring. Am J Obstet Gynecol 2023; 228:S1104-S1109. [PMID: 36997398 DOI: 10.1016/j.ajog.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/10/2022] [Indexed: 03/18/2023]
Abstract
There is no doubt that parturition can produce fetal and neonatal adversity, but the frequency with which this occurs is uncertain, particularly in modern healthcare settings. Moreover, there is a paucity of recent studies in this area. Substantial challenges impede epidemiologic study of the effect of parturition on offspring. Randomized trials would be ethically fraught. Therefore, large observational samples with detailed data concerning labor and delivery events are needed. Importantly, long-term follow-up of infants is necessary to reach reliable conclusions. Few such data sets exist, and it is difficult, expensive, and time-consuming to create and to study them. Reports of immediate newborn condition in relation to the antecedent labor are helpful, but this evidence is an imperfect predictor of long-term neurologic status. In this review, we endeavor to summarize existing information about the relationship between objectively defined abnormalities of labor progress and long-term disability in offspring. The only data available are from collected experiential information on outcomes stratified according to labor and delivery events. Most studies do not ensure against confounding by the many concurrent conditions that may affect outcome, or use inconsistent criteria to define abnormal labor. According to the best available evidence, dysfunctional labor patterns are potentially associated with poor outcomes for surviving infants. The question of whether these adverse effects can be mitigated by early diagnosis and expeditious management deserves to be answered, but cannot be at this time. In the absence of more conclusive results from well-designed studies, we can conclude that the best interests of offspring are served by adhering to evidence-based paradigms for the prompt identification and treatment of dysfunctional labor patterns.
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Bambo GM, Kebede SS, Sitotaw C, Shiferaw E, Melku M. Postpartum anemia and its determinant factors among postnatal women in two selected health institutes in Gondar, Northwest Ethiopia: A facility-based, cross-sectional study. Front Med (Lausanne) 2023; 10:1105307. [PMID: 37153091 PMCID: PMC10157165 DOI: 10.3389/fmed.2023.1105307] [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: 11/22/2022] [Accepted: 03/15/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anemia is highly prevalent globally and disproportionately affects postnatal women. It is a significant cause of maternal mortality and morbidity globally. Objective The main aim of this study was to determine the extent of postpartum anemia and associated factors among postnatal women in two selected health facilities in Gondar, Northwest Ethiopia. Methods A facility-based, cross-sectional study was conducted among 282 postnatal women from March to May 2021. A systematic sampling technique was used to recruit study participants from each institute. Sociodemographic, obstetric, and clinical data were collected through a semi-structured questionnaire. A venous blood sample was collected to determine the red blood cell parameters. A thin blood smear preparation was performed to examine blood morphology. In addition, direct wet mount and formalin-ether sedimentation techniques were used for stool examination to identify intestinal parasites. Data were entered into EpiData and exported to Stata 14 for statistical analysis. Descriptive statistics were presented in text, tables, and figures. A binary logistic regression model was used to identify factors associated with postpartum anemia. A p-value <0.05 was considered statistically significant. Results The proportion of postpartum anemia was 47.16%; 95% CI; 41.30-53.03 with moderate, mild, and severe anemia accounting for 45.11, 42.86, and 12.03%, respectively. The majority of the anemia (94%) was of the normocytic normochromic type. It was associated with postpartum hemorrhage (AOR = 2.23; 95% CI: 1.24-4.01), cesarean section (AOR = 4.10; 95% CI: 2.11-7.78), lack of iron and folate supplementation during pregnancy (AOR = 2.12; 95% CI: 1.17-4.02), and low diet diversity level (AOR = 1.83; 95% CI: 1.05-3.18). Conclusion The prevalence of anemia was found to be a major public health concern. Iron and folate supplementation during pregnancy, improved management of PPH, an effective cesarean section with post-operative care, and taking a diversified diet will reduce the burden. Therefore, identified factors should be considered to prevent and control postpartum anemia.
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Affiliation(s)
- Getachew Mesfin Bambo
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Science, College of Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
- *Correspondence: Getachew Mesfin Bambo,;
| | - Samuel Sahile Kebede
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Science, College of Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Chomaw Sitotaw
- University of Gondar Comprehensive Specialized Hospital Laboratory, Gondar, Ethiopia
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Yeshitila YG, Daniel B, Desta M, Kassa GM. Obstructed labor and its effect on adverse maternal and fetal outcomes in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0275400. [PMID: 36178921 PMCID: PMC9524671 DOI: 10.1371/journal.pone.0275400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/15/2022] [Indexed: 01/22/2023] Open
Abstract
Background Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries’ online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. Result Eighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91–21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated. Conclusions In Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities’ health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Beniam Daniel
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Mullu Kassa
- College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Oguejiofor CB, Ezugwu CJ, Eleje GU, Emeka EA, Akabuike JC, Umeobika JC, Ogelle OM, Umeononihu OS, Eke AC. Emerging Predictors of Obstructed Labour in a Single Nigerian Centre Population of a Low Resource Setting. TRENDS IN MEDICAL RESEARCH 2022; 17:136-144. [PMID: 36281306 PMCID: PMC9588426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Objective Despite the stigma attached to obstructed labour in Nigeria, it has remained largely uninvestigated. Study determined the prevalence, emerging predictors, management modalities and complications of obstructed labour, compare them with cases without obstructed labour who delivered within the same period. Materials and Methods A retrospective study and case-controlled analysis of obstructed labour managed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria were undertaken. One control per case was randomly selected from the remaining births by selecting the non-obstructed labour cases. Bivariate analysis was performed by the Chi-squared test and conditional logistic regression analysis was used to determine variables associated with obstructed labour. Statistical significance was accepted when the p<0.05. Results Of all the 5,301 deliveries during the study period, 80 cases of obstructed labour were recorded, giving a prevalence of 1.5%. Only 73 case files were available with complete information for the study's further analysis. A conditional logistic regression analysis, the risk factors were teenage pregnancy (p<0.001, Adjusted Odds Ratio (AOR):5.43, 95% Confidence Interval (CI):1.20-8.05), unbooked status (p<0.001, AOR:0.01, 95%CI:0.00-0.02), nulliparity (p<0.001, AOR:4.15, 95%CI:2.42-7.25), short stature (p<0.001, AOR:44.74, 95%CI:19.51-113.53) and birth weight (p<0.001, AOR:4.52, 95%CI:2.69-7.71). The case fatality rate was 5.5% and the perinatal mortality rate was 21.9%. Conclusion Majority obstructed labour have high maternal morbidity and perinatal mortality.
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Affiliation(s)
- Charlotte B. Oguejiofor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chinedu J. Ezugwu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, P.M.B. 5025, Nnewi, Nigeria
| | - George U. Eleje
- Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, P.M.B. 5025, Nnewi, Nigeria
| | - Ekene A. Emeka
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Josephat C. Akabuike
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Joseph C. Umeobika
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Onyecherelam M. Ogelle
- Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, P.M.B. 5025, Nnewi, Nigeria
| | - Osita S. Umeononihu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, P.M.B. 5025, Nnewi, Nigeria
| | - Ahizechukwu C. Eke
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The John Hopkins University School of Medicine, Baltimore, Maryland, United States
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Getachew A, Wakgari N, Gishille T. Feto-Maternal Outcomes of Obstructed Labor and Associated Factors among Mothers Who Gave Birth in Public Hospitals of West Shoa Zone, Central Ethiopia: Cross-Sectional Study. Ethiop J Health Sci 2021; 31:467-474. [PMID: 34483603 PMCID: PMC8365494 DOI: 10.4314/ejhs.v31i3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obstructed labor the major cause of adverse feto-maternal outcomes. Hence, the study assessed adverse fetomaternal outcomes of obstructed labor and associated factors among women who gave birth in public Hospitals of West Shoa Zone. METHODS Cross-sectional study design was conducted among 277 respondents. The required data were extracted from the mothers' chart by using a systematic random sampling method. Checklists were used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with feto-maternal outcomes. The odds ratio with 95%CI and p-value were used to identify the significant variables. RESULTS In this study, 145(52.3%) and 157(56.7%) of the respondents had adverse maternal and fetal outcomes respectively. Mothers who were referred from the health center (AOR: 3.96, 95%CI: 1.61-9.8) and who had a trial of labor at the health center and home had a more likelihood of adverse maternal outcomes than those who were referred and had trial of labor at hospital respectively. In addition, mothers who were not followed by partograph and in labor for >24hrs had also a more likelihood of adverse maternal outcomes than their counterparts. Likewise, newborns whom their mothers were not followed by partograph and mothers in labor for >24 hrs had also a more likelihood of adverse fetal outcomes than their counterparts. Hence, health professionals should give special attention to early diagnosis and referral of obstructed labor to higher facilities.
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Affiliation(s)
- Alem Getachew
- Dire Incini Health Center, West Shoa Zone, Oromia Region, Central Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Tolosa Gishille
- Department of Obstetrics and Gynecology, Ambo University Referral Hospitals, Ambo, Ethiopia
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Ayenew AA. Incidence, causes, and maternofetal outcomes of obstructed labor in Ethiopia: systematic review and meta-analysis. Reprod Health 2021; 18:61. [PMID: 33691736 PMCID: PMC7944638 DOI: 10.1186/s12978-021-01103-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia. Method for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis. Results I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44–15.42, I2 = 98.0%, p < 0.001). Out of these, 67.3% (95% CI: 33.32–101.28) did not have antenatal care follow-up, 77.86% (95% CI: 63.07–92.66) were from the rural area, and 58.52% (95% CI: 35.73– 82.31) were referred from health centers and visited hospitals after 12 h of labor. The major causes of obstructed labor were cephalo-pelvic disproportion 64.65% (95% CI: 57.15– 72.14), and malpresentation and malposition in 27.24% (95% CI: 22.05–32.42) of the cases. The commonest complications were sepsis in 38.59% (95% CI: 25.49–51.68), stillbirth in 38.08% (95% CI: 29.55–46.61), postpartum hemorrhage in 33.54% (95% CI:12.06– 55.02), uterine rupture in 29.84% (95% CI: 21.09–38.58), and maternal death in 17.27% (95% CI: 13.47–48.02) of mothers who gave birth in Ethiopia. Conclusion This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01103-0.
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Affiliation(s)
- Asteray Assmie Ayenew
- Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Yeshitila YG, Desta M, Kebede A. Obstructed labor and its association with adverse feto-maternal outcome in Ethiopia: a protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:57. [PMID: 33593436 PMCID: PMC7887789 DOI: 10.1186/s13643-021-01611-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obstructed labor accounted for 22% of obstetrical complications and 9% of all maternal deaths in low- and middle-income countries. Even though there are separate studies regarding obstructed labor and its complication in Ethiopia, their results are inconsistent. The objectives of this review will be to estimate the pooled the prevalence of obstructed labor and to identify adverse feto-maternal outcomes associated with obstructed labor in Ethiopia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed to conduct this systematic review and meta-analysis. The databases we will search will be PubMed, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions, and Summon per country online databases. To search the relevant literature, we will use the following key search terms: "prevalence," "adverse outcome," "obstructed labour," "maternal near miss," "neonatal near miss," "perinatal outcome," "cesarean section," "obstetric fistula," "uterine rupture," and "Ethiopia." Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument will be used for evaluating the quality of the studies. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 15 will be used for statistical analysis. DISCUSSION Our systematic review and meta-analysis will provide the pooled prevalence of obstructed labor and its association with adverse feto-maternal outcomes in Ethiopia. The finding of this study will be helpful to design appropriate preventive and promotive strategies for reducing of obstructed labor-related maternal mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020196153 .
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Affiliation(s)
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Burden of obstructed labor in ethiopia: A systematic review and meta-analysis. Midwifery 2021; 95:102930. [PMID: 33581417 DOI: 10.1016/j.midw.2021.102930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obstructed labor is a major cause of maternal and neonatal morbidity and mortality mainly in low-income countries, particularly in Ethiopia. In Ethiopia, the prevalence and determinant factors of obstructed labor described by different studies were highly inconsistent. Therefore, this study aimed to determine the pooled prevalence and determinants of obstructed labor in Ethiopia. METHODS International databases (PubMed, Hinari, Google scholar, Cochrane library, and web of science) and Ethiopian universities' digital libraries were used to search relevant articles. Both cross-sectional and case control studies were included. A total of 15 studies were included in this study. All the necessary data were extracted by two authors independently using Microsoft excel and exported to STATA Version 11 for analysis. Heterogeneity of the studies was assessed by using I2 test. The funnel plot and Egger's test were used to assess publication bias between the studies. The pooled prevalence of obstructed labor was estimated using random effects model. Furthermore, the associations between determinant factors and obstructed labor were examined using both random and fixed effect models. RESULTS A total of 15 studies with 34632 study participants were involved in this meta-analysis. The overall prevalence of obstructed labor was 11.79% with 95% CI (9.78, 13.80). In this study, maternal age between 15-19 years [OR=8.03, 95% CI=4.21, 15.30], malpresentation [OR=7.73, 95% CI=3.78, 15.83], lack of Ante Natal Care follow-up [OR=4.37, 95%CI=1.51, 12.67] and fetal weight ≥4kg [OR=5.83, 95% CI=2.74, 12.41] were associated with obstructed labor. CONCLUSION The overall prevalence of obstructed labor was high in Ethiopia. Maternal age between 15-19 years, malpresentation, lack of Ante Natal Care follow-up and fetal Wight ≥4kg were determinants of obstructed labor. Hence, this study implies the need to develop plans and policies to improve Ante Natal Care follow and labor and delivery management at each level of the health system. Besides to this, fetal malpresentation and macrosomia should be recognized and intervene early during labor and delivery.
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