1
|
Wells JCK, Desoye G, Leon DA. Reconsidering the developmental origins of adult disease paradigm: The 'metabolic coordination of childbirth' hypothesis. Evol Med Public Health 2024; 12:50-66. [PMID: 38380130 PMCID: PMC10878253 DOI: 10.1093/emph/eoae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
In uncomplicated pregnancies, birthweight is inversely associated with adult non-communicable disease (NCD) risk. One proposed mechanism is maternal malnutrition during pregnancy. Another explanation is that shared genes link birthweight with NCDs. Both hypotheses are supported, but evolutionary perspectives address only the environmental pathway. We propose that genetic and environmental associations of birthweight with NCD risk reflect coordinated regulatory systems between mother and foetus, that evolved to reduce risks of obstructed labour. First, the foetus must tailor its growth to maternal metabolic signals, as it cannot predict the size of the birth canal from its own genome. Second, we predict that maternal alleles that promote placental nutrient supply have been selected to constrain foetal growth and gestation length when fetally expressed. Conversely, maternal alleles that increase birth canal size have been selected to promote foetal growth and gestation when fetally expressed. Evidence supports these hypotheses. These regulatory mechanisms may have undergone powerful selection as hominin neonates evolved larger size and encephalisation, since every mother is at risk of gestating a baby excessively for her pelvis. Our perspective can explain the inverse association of birthweight with NCD risk across most of the birthweight range: any constraint of birthweight, through plastic or genetic mechanisms, may reduce the capacity for homeostasis and increase NCD susceptibility. However, maternal obesity and diabetes can overwhelm this coordination system, challenging vaginal delivery while increasing offspring NCD risk. We argue that selection on viable vaginal delivery played an over-arching role in shaping the association of birthweight with NCD risk.
Collapse
Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| |
Collapse
|
2
|
Mukunya D, Oguttu F, Nambozo B, Nantale R, Makoko TB, Napyo A, Tumuhamye J, Wani S, Auma P, Atim K, Okello D, Wamulugwa J, Ssegawa L, Wandabwa J, Kiguli S, Chebet M, Musaba MW, Nahurira D. Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study. Res Sq 2023:rs.3.rs-3121633. [PMID: 37503197 PMCID: PMC10371083 DOI: 10.21203/rs.3.rs-3121633/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for development of chronic kidney disease in infancy. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. Methods We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used estimated glomerular filtration rate (eGFR) by the Schwartz formula to calculate eGFR (0.413*height)/ serum creatinine as a measure of renal function. eGFR less than 90 ml/min/1.73m2 was classified as decreased renal function. Results The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR values ranged from 55 to 163ml/min/1.72m2, mean 85.8 ± SD 15.9. One third (31.3%) 45/144 had normal eGFR (> 90 ml/Min/1.72m2), two thirds (67.4%) 97/144 had a mild decrease of eGFR (60-89 ml/Min/1.72m2), and only 2/144 (1.4%) had a moderate decrease of eGFR. Overall incidence of reduced eGFR was 68.8% (99/144). Conclusion We observed a high incidence of impaired renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Josephine Tumuhamye
- Busitema University Centre of Excellency for Maternal Reproductive and Child Health
| | | | | | | | | | | | | | | | - Sarah Kiguli
- Makerere University Hospital, Makerere University Kampala
| | | | | | | |
Collapse
|
3
|
El Ayadi AM, Barageine JK, Miller S, Byamugisha J, Nalubwama H, Obore S, Korn A, Sukumar S, Kakaire O, Mwanje H, Lester F, Turan JM. Women's experiences of fistula-related stigma in Uganda: a conceptual framework to inform stigma-reduction interventions. Cult Health Sex 2020; 22:352-367. [PMID: 31035913 PMCID: PMC6821552 DOI: 10.1080/13691058.2019.1600721] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 05/26/2023]
Abstract
Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.
Collapse
Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
- Save the Mothers, Uganda Christian University, Mukono, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Obore
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Smrithi Sukumar
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Alabama, AL, USA
| |
Collapse
|
4
|
Abstract
BACKGROUND Perinatal and neonatal mortality rates have been described as sensitive indices of the quality of health care services. Regular audits of perinatal and neonatal mortalities are desirable to evaluate the various global interventions. OBJECTIVE To describe the current pattern of perinatal and neonatal mortality in a Nigerian tertiary health facility. METHODS Using a prospective audit method, the socio-demographic parameters of all perinatal and neonatal deaths recorded in a Nigerian tertiary facility between February 2017 and January 2018 were studied. RESULTS There were 1,019 deliveries with stillbirth rate of 27.5/1000 total births and early neonatal death (END) rate among in-born babies of 27.2/1000 live births. The overall perinatal mortality rate for in-facility deliveries was 53.9/1000 total births and neonatal mortality (till the end of 28 days) rate of 27.2/1000 live births. Severe perinatal asphyxia and prematurity were the leading causes of neonatal deaths while obstructed labour and intra-partum eclampsia were the two leading maternal conditions related to stillbirths (25.0% and 21.4% respectively).Gestational age < 32 weeks, age < 24 hours and inborn status were significantly associated with END (p = 0.002, p <0.001 and p = 0.002 respectively). CONCLUSION The in-facility perinatal mortality rate was high though stillbirth rate was relatively low. There is a need to improve the quality of emergency obstetric and neonatal services prior to referral to tertiary facilities.
Collapse
Affiliation(s)
- Tinuade A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Victor A Ayeni
- Department of Paediatrics, OlabisiOnabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Olusoga B Ogunfowora
- Department of Paediatrics, OlabisiOnabanjo University Teaching Hospital, Sagam, Nigeria
| | - Edward O Jagun
- Department of Obstetrics and Gynaecology, OlabisiOnabanjo University Teaching Hospital, Sagamu
| |
Collapse
|
5
|
Abstract
Predicting how and when a pregnant woman will deliver her fetus has always been a problem for the clinician, and, consequently, there has been little progress made in preventing poor outcomes from pregnancies that deliver too soon or too late. In the opinion of the author, a maternal-fetal medicine specialist, rethinking labour within a biomechanical framework and studying it like an engineering problem could be a promising approach to unlocking the mysteries of labour.
Collapse
Affiliation(s)
- Helen Feltovich
- Maternal Fetal Medicine, Intermountain Health Care, Salt Lake City, UT 84111-1453, USA.,Medical Physics, University of Wisconsin Madison, 1003 WIMR, 1111 Highland Avenue, Madison, WI 53706, USA
| |
Collapse
|
6
|
Tolentino L, Yigeremu M, Teklu S, Attia S, Weiler M, Frank N, Dixon JB, Gleason RL. Three-dimensional camera anthropometry to assess risk of cephalopelvic disproportion-related obstructed labour in Ethiopia. Interface Focus 2019; 9:20190036. [PMID: 31485318 DOI: 10.1098/rsfs.2019.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 11/12/2022] Open
Abstract
Cephalopelvic disproportion (CPD)-related obstructed labour requires delivery via Caesarean section (C/S); however, in low-resource settings around the world, facilities with C/S capabilities are often far away. This paper reports three low-cost tools to assess the risk of CPD, well before labour, to provide adequate time for referral and planning for delivery. We performed tape measurement- and three-dimensional (3D) camera-based anthropometry, using two 3D cameras (Kinect and Structure) on primigravida, gestational age ≥ 36 weeks, from Addis Ababa, Ethiopia. Novel risk scores were developed and tested to identify models with the highest predicted area under the receiver-operator characteristic curve (AUC), detection rate (true positive rate at a 5% false-positive rate, FPR) and triage rate (true negative rate at a 0% false-negative rate). For tape measure, Kinect and Structure, the detection rates were 53%, 61% and 64% (at 5% FPR), the triage rates were 30%, 56% and 63%, and the AUCs were 0.871, 0.908 and 0.918, respectively. Detection rates were 77%, 80% and 84% at the maximum J-statistic, which corresponded to FPRs of 10%, 15% and 11%, respectively, for tape measure, Kinect and Structure. Thus, tape measurement anthropometry was a very good predictor and Kinect and Structure anthropometry were excellent predictors of CPD risk.
Collapse
Affiliation(s)
| | - Mahlet Yigeremu
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Teklu
- Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shehab Attia
- The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA
| | | | | | - J Brandon Dixon
- LymphaTech, Inc., Atlanta, GA, USA.,The George W. Woodruff School of Mechanical Engineering, Atlanta, GA, USA
| | - Rudolph L Gleason
- Because of Kennedy, Inc., Acworth, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA.,The George W. Woodruff School of Mechanical Engineering, Atlanta, GA, USA
| |
Collapse
|
7
|
Traore SI, Dembele O, Traore S, Diallo A, Maiga A, Sylla M, Maiga A, Kante M. [Urogenital fistulas at Sikasso: about 150 cases]. Pan Afr Med J 2019; 33:133. [PMID: 31558932 PMCID: PMC6754838 DOI: 10.11604/pamj.2019.33.133.16455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022] Open
Abstract
L'objectif de cette étude était d'analyser les aspects épidémiocliniques, thérapeutiques et anatomopathologiques de la fistule urogénitale (FUG). L'étude rétrospective porte sur les cas de FUG admis dans le Service de Chirurgie Générale et Gynéco-obstétrique entre le 1er janvier 2014 et le 30 décembre 2015 y compris les 5 premières campagnes du projet fistule-Mali. La FUG occupe 19,53% de nos activités urologiques. L'âge moyen au 1er mariage: 16,57 ans. La majorité (96,70%) de nos patientes étaient analphabètes et non salariées provenant à 85,36% des communes rurales. La stagnation du travail était l'étiologie dominante avec 91,50% de mort-né. Les patientes étaient primipares à 43,33% et, parmi elles 53,60% n'ont effectué aucune consultation prénatale. Le taux de divorce lié à la maladie était estimé à 7,30%. La plupart des patientes ont bénéficié d'une fistulorraphie simple dont 121 par voie basse, 26 par voies hautes et 3 par la voie mixte. Les résultats ont été satisfaisants chez 65,33% et mauvais chez 34,66% des patientes. Les fistules type I et type V ont montré les plus forts taux de succès comparés aux fistules types IV. La fistule urogénitale demeure un réel problème de santé publique. Le traitement est surtout chirurgical et son pronostic est compromis par l'étroitesse du champ, la complexité des lésions et l'état du tissu environnant. L'accent doit être mis sur la promotion socioéconomique des filles et l'accessibilité aux soins obstétricaux d'urgence. La recherche et les échanges doivent continuer afin de faciliter la mise au point d'une classification standard.
Collapse
Affiliation(s)
| | | | | | - Aly Diallo
- Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali
| | - Amadou Maiga
- Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali
| | - Malla Sylla
- Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali
| | - Adan Maiga
- Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali
| | - Moussa Kante
- Service Urologie, Hôpital de Sikasso, Sikasso Ville, Mali
| |
Collapse
|
8
|
Musaba MW, Barageine JK, Ndeezi G, Wandabwa JN, Weeks A. Effect of preoperative bicarbonate infusion on maternal and perinatal outcomes of obstructed labour in Mbale Regional Referral Hospital: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e026675. [PMID: 31048444 PMCID: PMC6502014 DOI: 10.1136/bmjopen-2018-026675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION To improve maternal and fetal outcomes among patients with obstructed labour (OL) in low-resource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Oral fluid intake during labour and preoperative intravenous fluid replacement following OL corrects the associated dehydration and electrolyte changes, but it does not completely reverse the metabolic acidosis, that is, a cause of intrapartum birth asphyxia and a risk factor for primary postpartum haemorrhage due to uterine atony. Sodium bicarbonate is a safe, effective, cheap and readily available acid buffer, that is widely used by sportspeople to improve performance. It also appears to improve fetal and maternal outcomes in abnormally progressing labour. However, its effects on maternal and fetal outcomes among patients with OL is unknown. We aim at establishing the effect of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal lactate levels and clinical outcomes among patients with OL. METHODS AND ANALYSIS This will be a double blind, randomised controlled clinical phase IIb trial. We will randomise 478 patients with OL to receive either 50 mL of placebo with standard preoperative infusion of normal saline (1.5 L) or 4.2 g of sodium bicarbonate solution (50 mL of 50 mmol/L) with the preoperative infusion of normal saline (1.5 L). The primary outcome will be mean lactate levels in maternal capillary blood at 1 hour after study drug administration and in the arterial cord blood at birth. We will use the intention-to-treat analysis approach. Secondary outcomes will include safety, maternal and fetal morbidity and mortality up to 14 days postpartum. ETHICS AND DISSEMINATION Makerere University School of Medicine Research and Ethics Committee and Uganda National Council for Science and Technology have approved the protocol. Each participant will give informed consent at enrollment. TRIAL REGISTRATION NUMBER PACTR201805003364421.
Collapse
Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital & Busitema University, Mbale, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital & Busitema University, Mbale, Uganda
| | - Andrew Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Gondwe MS, Maharaj P. Factors that impact the timely treatment of obstetric fistulas in Malawi: The perspective of health care providers. Afr J Prim Health Care Fam Med 2019; 11:e1-e9. [PMID: 31038345 PMCID: PMC6556935 DOI: 10.4102/phcfm.v11i1.1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 11/05/2022] Open
Abstract
Background In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. Aim The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. Setting The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. Methods An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. Results The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. Conclusion The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.
Collapse
Affiliation(s)
- Mwawi S Gondwe
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
10
|
Wells JCK. The New "Obstetrical Dilemma": Stunting, Obesity and the Risk of Obstructed Labour. Anat Rec (Hoboken) 2017; 300:716-731. [PMID: 28297186 DOI: 10.1002/ar.23540] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 01/24/2023]
Abstract
The "obstetrical dilemma" refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low- and middle-income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population-specific data on the association between maternal obesity and birth injuries. Anat Rec, 300:716-731, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| |
Collapse
|
11
|
Wilson A, Truchanowicz EG, Elmoghazy D, MacArthur C, Coomarasamy A. Symphysiotomy for obstructed labour: a systematic review and meta-analysis. BJOG 2016; 123:1453-61. [PMID: 27126671 DOI: 10.1111/1471-0528.14040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low- and middle-income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure. OBJECTIVES To compare symphysiotomy and caesarean section for obstructed labour. SEARCH STRATEGY MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction. SELECTION CRITERIA Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes. DATA COLLECTION AND ANALYSIS Quality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I(2) tests. MAIN RESULTS Seven studies (n = 1266 women), all of which were set in low- and middle-income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta-analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13-1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64-1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14-0.62) but an increase in fistulae (RR 4.19, 95% CI 1.07-16.39) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23-31.21). CONCLUSION There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section. TWEETABLE ABSTRACT Symphysiotomy could be an alternative to caesarean section when resources are limited.
Collapse
Affiliation(s)
- A Wilson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - E G Truchanowicz
- Centre for Cardiovascular Sciences, Institute for Biomedical Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - D Elmoghazy
- Faculty of Medicine, Minia University, Minia, Egypt
| | - C MacArthur
- Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
12
|
Abstract
The place of symphysiotomy, as an alternative to Caesarean section (CS), in the management of established obstructed labour in low- and middle-income, resource-poor countries (LMICs), is reviewed. It is suggested that it does have a very definite place, especially in mothers of low age and parity, in circumstances where medical facilities are limited, where antenatal care and hospital delivery are not assured in a future pregnancy, and in cultures where it is important to the woman that a vaginal delivery is achieved.
Collapse
Affiliation(s)
- Peter Armon
- Formerly Department of Obstetrics & Gynaecology, Kilimanjaro Christian Medical Centre, Tanzania (1973-1978) Formerly Department of Obstetrics & Gynaecology, Furness General Hospital, Barrow in Furness, UK (1978-1990)
| |
Collapse
|
13
|
Abstract
OBJECTIVE This study was undertaken to determine the stillbirth rate and causes in Birnin Kudu, North-west, Nigeria. METHOD This was a retrospective study. It involved 705 women who presented for delivery in Federal Medical Centre, Birnin Kudu and had stillbirths. The hospital maternity and theatre registers were used to identify the women who had stillbirth during the study period from 1 January 2008 to 31 December 2012. The data obtained were analyzed using SPSS version 16.0 statistical software. Significant association between socio-demographic/obstetrics factors and stillbirth were tested using the chi-square test and p < 0.05 was considered significant. RESULT The stillbirth rate was 170 per 1000 births. Most of the women who had stillbirths (29.1%) were aged 20-24 years, followed by those aged ≥35 years (27.1%). The uneducated women were more than those who had only primary education and this was statistically significant (p = 0.001). The mean parity of the women was 5 ± 3. Obstructed labour was the common cause of stillbirth followed by placental abruption (17.73%) and pre-eclampsia/eclampsia (13.33%). CONCLUSION The stillbirth rate reported in this study was higher than those reported from other regions of Nigeria and obstructed labour was the common cause.
Collapse
Affiliation(s)
- Emmanuel A Ugwa
- a Department of Obstetrics and Gynaecology , Federal Medical Centre , Birnin Kudu , Jigawa State , Nigeria
| | | |
Collapse
|
14
|
Abstract
BACKGROUND Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section. All three clinical practices require relatively expensive equipment (e.g., a surgical theatre for caesarean section) and/or highly trained staff which are often not available in low resource settings. The specific aim of the proposed study is to test the safety and feasibility of a new device (Odón device) to effectively deliver the fetus during prolonged second stage of labour. The Odón device is a low-cost technological innovation to facilitate operative vaginal delivery and designed to minimize trauma to the mother and baby. These features combined make it a potentially revolutionary development in obstetrics, particularly for improving intrapartum care and reducing maternal and perinatal morbidity and mortality in low resource settings. METHODS/DESIGN This will be a hospital-based, multicenter prospective phase 1 cohort study with no control group. Delivery with the Odón device will be attempted under normal labour and non-emergency conditions on all the women enrolled in the study. One-hundred and thirty pregnant women will be recruited in tertiary care facilities in Argentina. Safety will be assessed by examining maternal and infant outcomes until discharge. Feasibility will be evaluated by observing successful expulsion of the fetal head after one-time application of the device under standardized conditions (full cervical dilation, anterior presentation, +2 station, normal fetal heart rate). TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR). Identifier: ACTRN12613000141741.
Collapse
|
15
|
Mukasa PK, Kabakyenga J, Senkungu JK, Ngonzi J, Kyalimpa M, Roosmalen VJ. Uterine rupture in a teaching hospital in Mbarara, western Uganda, unmatched case- control study. Reprod Health 2013; 10:29. [PMID: 23718798 PMCID: PMC3668214 DOI: 10.1186/1742-4755-10-29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 05/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine rupture is one of the most devastating complications of labour that exposes the mother and foetus to grave danger hence contributing to the high maternal and perinatal mortality and morbidity in Uganda. Every year, 6000 women die due to complications of pregnancy and childbirth, uterine rupture accounts for about 8% of all maternal deaths. METHODS Case-control design of women with uterine rupture during 2005-2006. Controls were women who had spontaneous vaginal delivery or were delivered by caesarean section without uterine rupture as a complication. For every case, three consecutive in-patient chart numbers were picked and retrieved as controls. All available case files, labour ward and theater records were reviewed. RESULTS A total of 83 cases of uterine rupture out of 10940 deliveries were recorded giving an incidence of uterine rupture of 1 in 131 deliveries. Predisposing factors for uterine rupture were previous cesarean section delivery(OR 5.3 95% CI 2.7-10.2), attending < 4 antenatal visits (OR 3.3 95% CI 1.6-6.9), parity ≥ 5(OR 3.67 95% CI 2.0-6.72), no formal education (OR 2.0 95% CI 1.0-3.9), use of herbs (OR15.2 95% CI 6.2-37.0), self referral (OR 6.1 95% CI 3.3-11.2) and living in a distance >5 km from the facility (OR 10.86 95% CI 1.46-81.03). There were 106 maternal deaths during the study period giving a facility maternal mortality ratio of 1034 /100,000 live births, there were 10 maternal deaths due to uterine rupture giving a case fatality rate of 12%. CONCLUSION Uterine rupture still remains one of the major causes of maternal and newborn morbidity and mortality in Mbarara Regional referral Hospital in Western Uganda. Promotion of skilled attendance at birth, use of family planning among those at high risk, avoiding use of herbs during pregnancy and labour, correct use of partograph and preventing un necessary c-sections are essential in reducing the occurrences of uterine rupture.
Collapse
Affiliation(s)
- Peter K Mukasa
- Ministry of Health, 7272, Kampala, Uganda
- UNFPA, Uganda Country office, P.O. BOX 7184, Kampala, Uganda
| | - Jerome Kabakyenga
- Mbarara University of Science and Technology, Faculty of Medicine, P.O. BOX 1410, Mbarara, Uganda
| | - Jude K Senkungu
- Mbarara University of Science and Technology, Faculty of Medicine, P.O. BOX 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, Faculty of Medicine, P.O. BOX 1410, Mbarara, Uganda
| | - Monica Kyalimpa
- School of Nursing Sciences, Kampala International University, Western Campus, P.O. BOX, 71, Ishaka-Bushenyi, Uganda
| | - Van J Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, Amsterdam, the Netherlands
- Department of Medical Humanities, EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Kabakyenga JK, Östergren PO, Emmelin M, Kyomuhendo P, Odberg Pettersson K. The pathway of obstructed labour as perceived by communities in south-western Uganda: a grounded theory study. Glob Health Action 2011; 4:GHA-4-8529. [PMID: 22216018 PMCID: PMC3248029 DOI: 10.3402/gha.v4i0.8529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 08/25/2011] [Accepted: 11/28/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs. OBJECTIVE The objective of the study was to explore community members' understanding of and actions taken in cases of obstructed labour in south-western Uganda. DESIGN Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities. RESULTS A conceptual model based on the community members' understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women's desire to 'protecting own integrity' (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) 'taking control of own birth process'; (2) 'reaching the limit--failing to give birth' (individual level); (3) 'exhausting traditional options'; (4) 'partner taking charge'; (5) 'facing challenging referral conditions' (community level); and finally (6) 'enduring a non-responsive healthcare system' (healthcare system level). CONCLUSIONS There is a need to understand and acknowledge women's reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended.
Collapse
Affiliation(s)
- Jerome K Kabakyenga
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmo, Sweden.
| | | | | | | | | |
Collapse
|