A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey

BACKGROUND

The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use.

METHODS

It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use.

RESULTS

The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151 g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001).

CONCLUSIONS

We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.

The possible impact of the universal two-child policy on pregnancy outcomes

PURPOSE

The implementation of the universal two-child policy contributes to adverse pregnancy outcomes, but how the policy change leads to adverse pregnancy outcomes is not well elaborated. In this study, we aimed to compare maternal characteristics and complications, accessed the change in the proportion of maternal characteristics and maternal complications, and evaluated the mediation of maternal characteristics on maternal complications.

METHODS

Demographic and clinical data of three-level sample facilities were extracted from China's National Maternity Near Miss Obstetrics Surveillance System from Jan 1, 2012 to May 31, 2021. The associations between the universal two-child policy and maternal risk factors, the universal two-child policy and maternal complications, and maternal risk factors and maternal complications were evaluated using multivariate logistic regression analyses, with odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was used to estimate the potential mediation effects on the associations between the policy and maternal complications. Population-attributable fractions (PAF) were conducted to quantify the maternal complications burden attributable to the implementation of the universal two-child policy.

RESULTS

In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facilities. After adjusting for covariables, there were significant associations between the universal two-child policy and maternal risk factors (P < 0.001), the universal two-child policy and an increased risk of maternal complications (P < 0.001), and maternal risk factors and maternal complications(P < 0.001). The effects of the universal two-child policy on maternal near miss and medical disease were significantly mediated by maternal risk factors with mediation proportions of 19.77% and 4.07% at the municipal-level sample facility, and mediation proportions for 2.72% at the county-level sample facility on medical disease. The universal two-child policy contributed 19.34%, 5.82%, 8.29%, and 46.19% in the incidence of the maternal near miss, antepartum or intrapartum complication, post-partum complication, and medical disease at municipal-level sample facility, respectively. The corresponding PAF% at county-level sample facility was 40.49% for maternal near miss, 32.39% for the antepartum or intrapartum complication, 61.44% for post-partum complication, and 77.72% for medical disease. For provincial-level sample facility, the incidence of maternal near miss, antepartum or intrapartum complications, and medical diseases decreased (P < 0.05) and no statistically significant difference occurred in the incidence of post-partum complications.

CONCLUSIONS

In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facility. Maternal risk factors may play a mediating role in the effect of policy change and maternal complications. Provincial hospitals have been able to improve the quality of perinatal health care and reduce adverse pregnancy outcomes by adjusting their obstetric service strategies in the context of the new birth policy.

Maternal complications and risk factors associated with assisted vaginal delivery

OBJECTIVE

This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.

METHODS

We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.

RESULTS

The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016).

CONCLUSIONS

The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).

CLINICAL TRIAL REGISTRATION

Thai Clinical Trials Registry: 20220126004.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia: A single-center experience

BACKGROUND

Preeclampsia (PE) is a pregnancy syndrome of undetermined etiology; inflammation was one of the proposed theories for its development.

AIM

To examine the platelet to lymphocyte ratio (PLR), an inflammatory biomarker, as a marker to predict poor maternal-neonatal outcomes in early-onset PE (EoPE).

METHODS

A cross-sectional study enrolled 60 pregnant women with EoPE (at 32-30 wk of gestation) at a university hospital. Demographic criteria and hematological indices were collected, including platelet counts and indices (mean platelet volume and platelet distribution width), PLR, and the Doppler study, which calculated estimated fetal weight (EFW), amniotic fluid index (AFI), resistance index (RI), and pulsatility index (PI). Participants were followed until delivery, where maternal outcomes were recorded, including; delivery mode and reason for cesarean section, and neonatal outcomes, including fetal growth restriction (FGR), meconium-stained liquid, the 5-min Apgar score, and admission to the intensive care unit.

RESULTS

There was a trend of insignificant increases in cesarean sections. Sixty-one-point two percent (37/60) fetuses were admitted to the neonatal care unit; 70.0% of admitted fetuses were meconium-stained liquor, and 56.7% of them had FGR. PLR was positively correlated with AFI and EFW as r = 0.98, 0.97, P < 0.001; PLR showed negative correlations with PI and RI as r = -0.99, -0.98, P < 0.001. The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation (0.69, -0.98), P < 0.0001, respectively. Receiver operating characteristic calculated a PLR cutoff value (7.49) that distinguished FGR at 100% sensitivity and 80% specificity.

CONCLUSION

Strong, meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications. Further studies are suggested to see the impact on maternal-neonatal health.

Proportion and associated factors of maternal complications of cesarean sections among mothers who deliver at Bahir Dar City Public Specialized Hospitals, Bahir Dar, Ethiopia

INTRODUCTION

Cesarean delivery carries both short term and long-term maternal complications. Eventhough it's being a public burden, the proportion of complications and underlying risk factors are not studied well in our setup. This study aimed to assess the proportion and associated factors of complications of cesarean sections among mothers who delivered at Bahir Dar city public specialized hospitals, Bahir Dar, Ethiopia 2021.

METHODS

A cross-sectional study was conducted at two specialized Hospitals in Bahir Dar city, Ethiopia. The sample size was 495 mothers who had cesarean section in the time period from January 1, 2020 to December 30, 2020. Checklist was used to retrieve information from the patient medical document. Study population was selected from the operation registration book. Systematic sampling was used after arranging the study frame based on date of operation. Both bivariable and multivariable logistic regression was done. In multivariable logistic regression variables with p value < 0.05 at 95% confidence interval were significantly associated with outcome variable.

RESULT

Overall maternal complication rate was 44.04% (95% CI: 39.6-48.5). Living in rural setting (AOR = 4.247,95%CI: 2.765-6.522), having one or more obstetric complication (AOR = 1.913,95% CI: 1.214-3.015), cesarean section done at Second stage of labor (AOR = 4.358,95%CI: 1.841-10.317), having previous cesarean section (AOR = 3.540,95%CI: 2.121-5.910), emergency operation (AOR = 2.967,95%CI: 1.492-5.901), duration of surgery taking more than 60 min (AOR = 3.476,95%CI: 1.521-7.947) were found to be significantly associated with maternal complications.

CONCLUSION

The magnitude of maternal complication of cesarean section was higher than most studies. Living in rural setting, having obstetric complications, previous cesarean scar, emergency surgeries, operation done in second stage of labor and prolonged duration of surgery are important predictors of maternal complication. Therefore, we recommend timely and adequate progress of labor evaluation, timely decision for cesarean delivery and vigilant care in post-operative period shall be conducted.

Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease?

BACKGROUND

Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging, especially due to physiological haemodynamic modifications that inevitably occur during pregnancy.

AIMS

To compare the accuracy of the existing pregnancy cardiovascular risk scores in prediction of maternal complications during pregnancy in CHD patients.

METHOD AND RESULTS

From 2007 to 2018, all pregnant women with a CHD who delivered birth after 20 weeks of gestation were identified. The discriminating power and the accuracy of the five existing pregnancy cardiovascular risk scores [CARPREG, CARPREG II, HARRIS, ZAHARA risk scores, and modified WHO (mWHO)] were evaluated.Out of 104 pregnancies in 65 CHD patients, 29% experienced cardiovascular complications during pregnancy or post-partum. For the five scores, the observed rate of cardiovascular events was higher than the expected risk. The values of area under the ROC curve were 0.75 (0.62-0.88) for mWHO, 0.65 (0.53-0.77) for CARPREG II, 0.60 (0.40-0.80) for HARRIS, 0.59 (0.47-0.72) for ZAHARA, and 0.58 (0.43-0.73) for CARPREG.

CONCLUSION

The modified WHO classification appeared to better predict cardiovascular outcome in pregnant women with CHD than the four other existing risk scores.Clinical Trial Registration: Clinicaltrials.gov: NCT04221048.

Traditional medicine utilisation and maternal complications during antenatal care among women in Bulilima, Plumtree, Zimbabwe

BACKGROUND

As part of the expectation enshrined in the Sustainable Development Goals, countries are expected to ensure maternal health outcomes are improved. It follows that under ideal circumstances, pregnant women should deliver safely without complications, neonatal, and maternal mortality. This paper analyses the relationship between traditional medicine utilisation and maternal complications during antenatal care among women in Bulilima, Plumtree, Zimbabwe.

METHODS

A quantitative cross-sectional survey was conducted on 185 randomly selected women who responded to a pre-tested semi-structured questionnaire. The Fisher's Exact Test and the Test of Proportions were used to probe the relationship between traditional medicine utilisation and the prevalence of maternal complications using STATA SE Version 13.

RESULTS

Complications were reported by (51) 29% of the women who were under study. The proportion of women who developed complications was higher in those that did not use traditional medicine as compared to those that used traditional medicine (30 and 26% respectively). In a generalised assessment, women who did not use traditional medicine contributed a significantly higher proportion of complications as compared to those that utilised traditional medicine.

CONCLUSION

This study found a significant relationship between the utilisation of traditional medicines and lesser chances of experiencing maternal complications. Significantly higher prevalence of maternal complications was observed in women who did not use traditional medicine compared to those that did. There is, therefore, a need to investigate further the constituents or active ingredients in this traditional medicine. This study provides a window of opportunity for fully recognising and integrating traditional medicine into Modern Health Systems. It can be argued that traditional medicine utilisation could be a viable alternative to modern medicine, particularly in resource-poor settings where access to modern medicine is seriously constrained.

Maternal complication related to instrumental delivery at Felege Hiwot Specialized Hospital, Northwest Ethiopia: a retrospective cross-sectional study

OBJECTIVE

The study aimed to determine proportion and risk factors for maternal complication related to forceps and vacuum delivery among mother who gave birth at Felege Hiwot Comprehensive Specialized Hospital (FHCSH).

RESULTS

Records of 406 mothers managed with instrumental vaginal delivery were reviewed and 97% of the reviewed card had complete documentation. The proportion of maternal complications related to instrumental delivery was 12.1%. A major complication of forceps assisted delivery was 2nd-degree perineal tear (7.4%), 3rd-degree perineal tear (1.5%), cervical tear (1.5%) and episiotomy extension (1%). However, the complication of vacuum-assisted vaginal delivery was only cervical tear (0.5%) and episiotomy extension (0.5%). Episiotomy during instrumental delivery reduce maternal complication by 86% [AOR = 0.14, 95% CI 0.07-0.3]. Forceps assisted vaginal delivery had 3.4 times more risk for maternal complication compared to vacuum-assisted vaginal delivery [AOR = 3.4, 95% CI 1.08-10.67] and the same is true for primiparity that primipara women who gave birth by the help of instrument had 3.5 times more risk for maternal complication compared to a multipara women [AOR = 3.5, 95% CI 1.26-9.98].

Effects of central obesity on maternal complications in Korean women of reproductive age

BACKGROUND

Considering the obesity-related complications in pregnancy and during delivery, prepregnancy central obesity may also affect pregnancy-related complications. This study aimed to assess the relationship between prepregnancy central obesity and adverse maternal outcomes in Korean women, by using the Korean National Health Insurance Service (NHIS) cohort.

METHODS

In this population-based retrospective cohort study, we used data from the NHIS database, which contains information of health-care utilisation, diagnosis and prescription, and mortality for almost the whole Korean population, together with data from the NHIS health checkup database from 2005 to 2015. The NHIS health checkup data (645-280 days before childbirth) of mothers who had deliveries (total, 783,406 deliveries) from 2006 to 2015 were collected. For maternal adverse outcome data, we searched for diagnoses of maternal complications made during the period of 280 days before each delivery. The odds for maternal complications according to 8 body mass index (BMI) and 10 waist circumference (WC) categories were analysed using logistic regression.

RESULTS

The incidence rates of eclampsia/preeclampsia, caesarean section, multiple gestation, and polycystic ovary syndrome (PCOS) increased according to the increase of BMI and WC. In contrast, the incidence rate of premature rupture of membrane (PROM) was inversely correlated with BMI and WC. In the low BMI (<17.5 and 17.5-19.9 kg/m²) and low WC (<60 and 60.0-64.0 cm) groups, the odds of threatened abortion were elevated.

CONCLUSION

Prepregnancy WC was closely linked to some maternal complications, including eclampsia/preeclampsia, cesarean section, PCOS, and PROM, in a manner similar to prepregnancy BMI.

Use of a qualitative case study to learn lessons from severe preeclampsia causing a maternal near-miss: a case report

BACKGROUND

Maternal mortality is a critical indicator in assessing the quality of services provided by a health care system. Approximately 99% of all maternal deaths occur in developing countries; where a majority of the causes of these deaths are preventable.

CASE PRESENTATION

A 25-year-old, married, multigravida, black woman who has had six live births presented to a health center with the chief compliant of abnormal body swelling of 2 days' duration and loss of consciousness. On arrival to the first contact health center her blood pressure was 170/105 mmHg and her temperature was 36.5 °C. She had generalized swelling, a history of blurred vision, and headache. She had no history of abortion, stillbirth, and cesarean section and no history of antenatal care follow-up. She gave birth to her previous children at home with no history of obstetric complications. The gestational age at the time of arrival was 37 weeks. She was referred to a general hospital for further management. At the general hospital she was diagnosed as having severe preeclampsia and she was managed with magnesium sulfate and an antihypertensive medication for 2 days. She was counseled to have induction of labor by the attending physician but refused to give consent and went home. She returned to the referral hospital 2 days later after labor had started spontaneously at home and the delivery was a spontaneous vaginal delivery with outcome of a live male baby, his Apgar score was 6/10 immediately after birth and he weighed 1.9 kg.

CONCLUSIONS

If there were no previous obstetric problems, the women perceived that she will not face complications in her future pregnancies and stay home until she had developed life-threatening complications. If women visit health facilities and if the health care providers are responsive and there is robust referral in place, maternal and fetal complications will be prevented.

Magnesium sulfate for 6 vs 24 hours post delivery in patients who received magnesium sulfate for less than 8 hours before birth: a randomized clinical trial

BACKGROUND

To compare the benefits of magnesium sulfate for 24 h (h) postpartum versus 6 h postpartum in patients who received magnesium sulfate (Mg) for less than 8 h before birth.

METHODS

A randomized, multicenter, open study was conducted between November 2013 and October 2016 in three teaching maternity hospitals in Panama. Pregnant women diagnosed with severe pre-eclampsia or pre-eclampsia with severe features at more than 20 weeks gestation were invited to participate. They were randomized to the following groups in a 1:1 ratio: A- continue Mg for 24 h after birth (control group); and B- receive Mg for 6 h after birth (experimental group). The primary endpoint and variable was seizure (eclampsia) in the first 72 h postpartum.

RESULTS

During the study period, 284 patients agreed to participate in the study; 143 were randomized to receive Mg for 24 h postpartum and 141 to receive Mg for 6 h postpartum. There were no significant differences in the baseline characteristics of the two groups studied. There was no eclampsia in the entire population; therefore, there was no significant difference in the primary variable. Two secondary variables showed a significant difference: time to onset of ambulation, which was 14 h shorter (p = 0.0001) in the group that received 6 h of postpartum Mg, and time to initiation of breastfeeding, which was 11 h earlier (p = 0.0001) in the group that received 6 h of postpartum Mg. There were not significant differences between the groups with respect to total complications or any particular complication. There were no cases of maternal death.

CONCLUSION

Maintaining Mg for 6 h postpartum is equally effective in preventing eclampsia as receiving Mg for 24 h postpartum in patients with severe pre-eclampsia who receive less than 8 h of Mg treatment before birth. The onset of maternal ambulation and initiation of breastfeeding are faster in patients who only receive Mg for 6 h postpartum.

TRIAL REGISTRATION

The study was registered at clinical-trials.gov, number NCT02317146 . Date of registration: December 11, 2014. This study was registered at clinical trials after the beginning of recruitment of patients.