Frölich, Michael A; Banks, Catiffaney; Brooks, Amber; Sellers, Alethia; Swain, Ryan; Cooper, Lauren
The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009. Compared to Caucasian women, African American women were nearly 4 times as likely to die from childbirth. To better understand the reason for this trend, we conducted a case-control study at University of Alabama at Birmingham (UAB) Hospital. Our primary study hypothesis was that women who died at UAB were more likely to be African American than women in a control group who delivered an infant at UAB and did not die. We expected to find a difference in race proportions and other patient characteristics that would further help to elucidate the cause of a racial disparity in maternal deaths. We reviewed all maternal deaths (cases) at UAB Hospital from January 1990 through December 2010 identified based on electronic uniform billing data and ICD-9 codes. Each maternal death was matched 2:1 with women who delivered at a time that most closely coincided with the time of the maternal death in 2-step selection process (electronic identification and manual confirmation). Maternal variables obtained were comorbidities, duration of hospital stay, cause of death, race, distance from home to hospital, income, prenatal care, body mass index, parity, insurance type, mode of delivery, and marital status. The strength of univariate associations of maternal variables and case/control status was calculated. The association of case/control status and race was also examined after controlling for residential distance from the hospital. There was insufficient evidence to suggest racial disparity in maternal death. The proportion of African American women was 57% (42 of 77) in the maternal death group and 61% (94 of 154) in the control group (P = 0.23). The univariate odds ratio for maternal death for African American to Caucasian race was 0.66 (95% confidence interval [CI], 0.37-1.19); the
... Educators Search English Español Birthing Centers and Hospital Maternity Services KidsHealth / For Parents / Birthing Centers and Hospital Maternity Services What's in this article? Giving Birth at ...
Despite recent focus on maternal mortality in Nigeria, its rates remain unacceptably high in Nigeria. A retrospective case-control study was carried out at Adeoyo Maternity Hospital, Ibadan between January 2003 and December 2004. This was to determine the maternal mortality ratio in a secondary health facility, to identify ...
Birmingham's City Hospital's new maternity unit is an inspiring departure from conventional units. Contemporary design and the latest technology combine to give mothers a safe, yet relaxed, environment in which to give birth. HEJ reports.
The establishment of breastfeeding, as well as its duration, are facilitated through the proximity of the mother with her new baby. However, in maternity hospitals, breastfeeding mothers very often leave their baby in the nursery at night time. A study carried out in 2014 in several maternity hospitals put forward suggestions and highlighted areas to improve in everyday practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Corresponding author: Akanidomo Ibanga, Department of Psychology, University of Birmingham, ... sexual behaviour and lack of self-protection ... al abuse in childhood use drugs and alcohol to .... One of the primary aims was to examine the.
A retrospective review of hospital maternal deaths at Jimma Hospital, Southwestern Ethiopia, covering the period from September 1990 to May 1999 was conducted with the objectives of determining the overall maternal mortality rate, observing trend of maternal mortality during the period, and identifying major causes of ...
Background: Maternal death is a tragedy that leaves an enormous negative impact on the family. The objectives of the study were to determine the rate and causes of maternal mortality in Ribat University Hospital Methods: This was a descriptive, hospital-based study conducted in Ribat University Hospital, Khartoum, Sudan ...
Young, Richard A
The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.
Objective: To analyse and document our experiences with maternal mortality with the view of finding the trends over the last seven years, common causes and attributing socio-demographic factors. Design: A prospective analysis of maternal mortality. Setting: State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria.
Campbell, Katherine H; Savitz, David; Werner, Erika F; Pettker, Christian M; Goffman, Dena; Chazotte, Cynthia; Lipkind, Heather S
To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization. We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995-2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression. During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5-12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7-12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1-8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3-8.1), HIV (adjusted OR, 7.7; 95% CI 3.4-17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8-269.3) were associated with an increased risk of death during the delivery hospitalization. The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization. II.
Dervan, P; Hodgson, P; Marin-Reyes, H; Wilson, J
At the end of 2012 the proton irradiation facility at the CERN PS  will shut down for two years. With this in mind, we have been developing a new ATLAS scanning facility at the University of Birmingham Medical Physics cyclotron. With proton beams of energy approximately 30 MeV, fluences corresponding to those of the upgraded Large Hadron Collider (HL-LHC) can be reached conveniently. The facility can be used to irradiate silicon sensors, optical components and mechanical structures (e.g. carbon fibre sandwiches) for the LHC upgrade programme. Irradiations of silicon sensors can be carried out in a temperature controlled cold box that can be scanned through the beam. The facility is described in detail along with the first tests carried out with mini (1 x 1 cm^2 ) silicon sensors.
Dervan, P.; French, R.; Hodgson, P.; Marin-Reyes, H.; Wilson, J.
At the end of 2012 the proton irradiation facility at the CERN PS will shut down for two years. With this in mind, we have been developing a new ATLAS scanning facility at the University of Birmingham Medical Physics cyclotron. With proton beams of energy approximately 30 MeV, fluences corresponding to those of the upgraded Large Hadron Collider (HL-LHC) can be reached conveniently. The facility can be used to irradiate silicon sensors, optical components and mechanical structures (e.g. carbon fibre sandwiches) for the LHC upgrade programme. Irradiations of silicon sensors can be carried out in a temperature controlled cold box that can be scanned through the beam. The facility is described in detail along with the first tests carried out with mini (1×1 cm 2 ) silicon sensors
Chen, C W; Conrad, B
The purpose of this study was to examine the relationship between maternal self-esteem and maternal attachment in mothers of hospitalized premature infants. The research instruments administered included: a demographic sheet, the Maternal Self-Report Inventory (MSRI), Rosenberg Self-Esteem Scale, and Leifer's How I Feel About My Baby Now Scale. Thirty-two mothers whose premature infants were medically stable and hospitalized in the NICU were studied. Two hypotheses on the positive relationships between maternal self-esteem and maternal attachment, and global self-esteem and maternal attachment could not be tested by correlational analyses due to the inadequate internal consistency of the How I Feel About My Baby Now Scale. A significant correlation was found between maternal self-esteem and global self-esteem. Thus, maternal role influenced general self-concept in mothers. In addition, it was found that there were no significant correlations between the MSRI and demographic variables, such as: maternal age, marital status, income, and educational level. Another result indicated that increased global self-esteem was correlated (p attachment behaviors.
Murphy, Cliona M
OBJECTIVE: To assess the prevalence and causes of severe maternal morbidity in Dublin over a two year period from 2004 to 2005. STUDY DESIGN: A prospective cohort study from January 2004 to December 2005 was undertaken in the three large maternity hospitals in Dublin, which serve a population of 1.5 million people. All are tertiary referral centres for obstetrics and neonatology and have an annual combined delivery rate of circa 23,000 births. Cases of severe maternal morbidity were identified. A systems based classification was used. The primary cause of maternal morbidity and the number of events experienced per patient was recorded. RESULTS: We identified 158 women who fulfilled the definition for severe maternal morbidity, giving a rate of 3.2 per 1000 maternities. There were two maternal deaths during the time period giving mortality to morbidity ratio of 1:79. The commonest cause of severe morbidity was vascular dysfunction related to obstetric haemorrhage. Eclampsia comprised 15.4% of cases. Intensive care or coronary care admission occurred in 12% of cases. CONCLUSION: The prevalence of severe maternal morbidity in this population is 3.2\\/1000 maternities. Obstetric haemorrhage was the main cause of severe maternal morbidity.
Full Text Available Introduction: All pregnant women are at risk of obstetrical complications which occurs during labour and delivary that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH" Thapathali Kathmandu, Nepal. Methods: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period. Results: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and abortion constiuates 6.06 % each equally for maternal death. The death noted in older women (30+year were 36.36%. Primipara accounted for more deaths (51.51%. Conclusions: The fall in maternal mortality rate has been observed except for year 2063 BS. Haemorrhage is the main contributing cause behind maternal mortality.
Materials and Methods: Data were collected from available hospital records from inception on 24th February 2010 to 31st December 2014 and analysed using Microsoft Excel 2010 software. Statistical Analysis: Data analysis was done using descriptive statistics. Categorical variables were expressed as frequency ...
Shah, N.; Khan, N.H.
To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29+-6.49 years and mean parity was 3.24+-3.25. The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which included inappropriate management of pulmonary edema, delay in arranging blood for hemorrhaging patients and delay in surgical intervention. Substandard care factors were present in majority of cases of maternal deaths. Improvement of maternity care services in Civil Hospital Karachi is needed on an urgent basis. (author)
Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.
OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all
Adam Gamal K
Full Text Available Abstract Background Investigation of maternal near-miss is a useful complement to the investigation of maternal mortality with the aim of meeting the United Nations' fifth Millennium Development Goal. The present study was conducted to investigate the frequency of near-miss events, to calculate the mortality index for each event and to compare the socio-demographic and obstetrical data (age, parity, gestational age, education and antenatal care of the near-miss cases with maternal deaths. Methods Near-miss cases and events (hemorrhage, infection, hypertensive disorders, anemia and dystocia, maternal deaths and their causes were retrospectively reviewed and the mortality index for each event was calculated in Kassala Hospital, eastern Sudan over a 2-year period, from January 2008 to December 2010. Disease-specific criteria were applied for these events. Results There were 9578 deliveries, 205 near-miss cases, 228 near-miss events and 40 maternal deaths. Maternal near-miss and maternal mortality ratio were 22.1/1000 live births and 432/100 000 live births, respectively. Hemorrhage accounted for the most common event (40.8%, followed by infection (21.5%, hypertensive disorders (18.0%, anemia (11.8% and dystocia (7.9%. The mortality index were 22.2%, 10.0%, 10.0%, 8.8% and 2.4% for infection, dystocia, anemia, hemorrhage and hypertensive disorders, respectively. Conclusion There is a high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal-near miss events (hemorrhage, infections, hypertension and anemia at all care levels including primary level.
Almerie, Yara; Almerie, Muhammad Q; Matar, Hosam E; Shahrour, Yasser; Al Chamat, Ahmad Abo; Abdulsalam, Asmaa
Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. There were 28,025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100,000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU). Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health
Al Chamat Ahmad
Full Text Available Abstract Background Investigating severe maternal morbidity (near-miss is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Methods Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005 including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR, maternal near miss ratio (MNMR, mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. Results There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52% and haemorrhage (34% were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60% while sepsis had the highest mortality index (7.4%. Most cases (93% were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%, primary (5% and secondary (10% healthcare unites and private practices (11%. 26% of near-miss cases were admitted to Intensive Care Unit (ICU. Conclusion Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to
Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263
Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the
"Trojan Horse" has become journalistic shorthand for an apparent attempt by a small group in East Birmingham to secure control of local non-faith schools and impose policies and practices in keeping with the very conservative (Salafist and Wahhabi) version of Islam which they hold. In this article, Pat Yarker gives an account of two…
"The world's largest particle accelerator in Geneva is gearing up to begin work again. BBC Midlands Today science correspondent David Gregory went to see how scientists from the University of Birmingham are at the heart of trying to understand what makes our universe tick." (1 page)
Full Text Available to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC, maternal near-miss (MNM or maternal death (MD. Quality of in-hospital care was assessed using the mortality index (MI defined as ratio between mortality and severe maternal outcome (SMO where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.5551 women were included. 569 (10.3% had a potentially life-threatening condition and 65 (1.2% a severe maternal outcome (SMO: 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.
Philibert, I; Bickel, J
Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.
: The Baby-Friendly Hospital Initiative (BFHI) is a program developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to promote breastfeeding in hospitals and birthing facilities worldwide. Since the program was launched in 1991, breastfeeding initiation, duration, and exclusivity have increased globally, a trend largely attributed to changes in hospital policies and practices brought about by the BFHI. This article provides an overview of these practices and policies, the institutional benefits of achieving BFHI certification, and the process through which health care facilities can do so. All nurses-whether they work in maternity care or another nursing specialty in a hospital, ambulatory, or community setting-can play a role in promoting societal health through their support of long-term breastfeeding as recommended by the WHO and UNICEF.
Ramos, Silvina; Romero, Mariana; Ortiz, Zulma; Brizuela, Vanessa
In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communication by having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.
Bakr, A; Silva, D; Cramb, R; Flint, G; Foroughi, M
The aim of this study was to evaluate the adherence to current guidelines for the investigation of suspected subarachnoid haemorrhage and the prevalence and outcome of computed tomography (CT)-negative aneurysmal subarachnoid haemorrhage. A retrospective review in a single large tertiary referral centre. A total of 796 patients, aged 16-90 years, who underwent lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) following a negative or equivocal CT scan between January 2012 and November 2013 (23 months). Xanthochromia reports were obtained using the hospital's department of biochemistry database and clinical data for these patients were reviewed using patient notes. Of 796 CSF reports reviewed, 728 (91%) were negative for xanthochromia, 31 (4%) were positive and 37 (5%) were equivocal. Only 2 out of the 31 patients with positive spectrophotometry results were subsequently found to have an underlying aneurysm on CT angiography. A further 9 out of these 31 patients underwent digital subtraction angiography, with no cerebral aneurysms being detected. Amongst the 37 patients with equivocal xanthochromia reports, 13 underwent CT angiography and only 1 cerebral aneurysm was detected. In patients with clinically suspected SAH but who have negative or questionable CT findings, CSF analysis is likely to be negative in the vast majority of cases, which was 91% in our series. In patients yielding positive or equivocal CSF results the likelihood of an aneurysm being detected is low, amounting to three out of 68 or approximately one in 23 (approximately 4%). Overall in suspected SAH cases where CT scan has been negative, the rate for the detection of cerebral aneurysm is three out of 796 cases (0.4%).
Background: A maternal death is a calamity particularly for the immediate family members. Maternal mortality ratio is high in most developing countries. Although many studies have been carried out on maternal mortality in many parts of Nigeria there is a dearth of information on maternal mortality ratio in Imo State.
Background: Maternal mortality in sub.Saharan Africa has remained high and this is a reflection of the poor quality of maternal services. Aim: To determine the causes, trends, and level of maternal mortality rate in Abakaliki, Ebonyi. Materials and Methods: This was a review of the records of all maternal deaths related to ...
Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C
The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization. We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs. Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM. The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit
Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all
Longman, Jo; Pilcher, Jennifer M; Donoghue, Deborah A; Rolfe, Margaret; Kildea, Sue V; Kruske, Sue; Oats, Jeremy J N; Morgan, Geoffrey G; Barclay, Lesley M
This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25000 people across Australia, and presents the findings of this process. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised.
Jan 1, 2006 ... Main outcome measures: Determination of maternal mortality rates of all patients admitted to the ... complications of pregnancy and childbirth, majority of who come from ... Yearly distribution of maternal deaths. Year. Deaths.
Barabach, Lynn; Ludington-Hoe, Susan M; Dowling, Donna; Lotas, Marilyn
The objective of this pilot study was to determine women's perceptions of their levels of maternal role competence at discharge from a Baby-Friendly hospital. A convenience sample of 30 women completed two self-report questionnaires: a demographic questionnaire and the Perceived Maternal Parenting Self-Efficacy scale. Women report that they perceived high levels of maternal role competence with a mean total score of 69.80 (standard deviation = 6.86) out of 80. As women experience breastfeeding in Baby-Friendly hospitals, maternal role competence may develop with appropriate support. © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Adusi-Poku, Yaw; Antwil, Edward; Osei-Kwakye, Kingsley; Tetteh, Chris; Detoh, Eric Kwame; Antwi, Phyllis
The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths.
Habek, D; Kruhak, V
This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).
Gonzaga-Soriano, María Rode; Zonana-Nacach, Abraham; Anzaldo-Campos, María Cecilia; Olazarán-Gutiérrez, Asbeidi
To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.
Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B
To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Lumey, L. H.; Stein, A. D.; Ravelli, A. C.
Several studies have suggested that maternal recall of offspring birthweight compares well to data from birth certificates or medical records. However, these studies describe relatively short recall periods and pertain to populations where hospitalized childbirth is the norm. Accuracy of maternal
This paper provides an opportunity to share experiences and perceptions of the first 5 years of a degree programme for professional dancers. A partnership developed in the mid-1990s between the UK's Birmingham Royal Ballet and the University of Birmingham, Westhill (now School of Education), to provide a part-time, post-experience, flexible study…
Kuramoto, S Janet; Stuart, Elizabeth A; Runeson, Bo; Lichtenstein, Paul; Långström, Niklas; Wilcox, Holly C
We examined whether the risk for psychiatric morbidity requiring inpatient care was higher for offspring who experienced parental suicide, compared with offspring of fatal accident decedents, and whether the association varied according to the deceased parent's gender. Children and adolescents (0-17 years of age) who experienced maternal (N = 5600) or paternal (N = 17,847) suicide in 1973-2003 in Sweden were identified by using national, longitudinal, population-based registries. Cox regression modeling was used to compare psychiatric hospitalization risks among offspring of suicide decedents and propensity score-matched offspring of accident decedents. Offspring of maternal suicide decedents had increased risk of suicide-attempt hospitalization, after controlling for psychiatric hospitalization for decedents and surviving parents, compared with offspring of maternal accidental decedents. Offspring of paternal suicide decedents had similar risk of suicide-attempt hospitalization, compared with offspring of accident decedents, but had increased risk of hospitalization attributable to depressive and anxiety disorders. The magnitude of risks for offspring suicide-attempt hospitalization was greater for those who experienced maternal versus paternal suicide, compared with their respective control offspring (interaction P = .05; offspring of maternal decedents, adjusted hazard ratio: 1.80 [95% confidence interval: 1.19-2.74]; offspring of paternal decedents, adjusted hazard ratio: 1.14 [95% confidence interval: 0.96-1.35]). Maternal suicide is associated with increased risk of suicide-attempt hospitalization for offspring, beyond the risk associated with maternal accidental death. However, paternal suicide is not associated with suicide-attempt hospitalization. Future studies should examine factors that might differ between offspring who experience maternal versus paternal suicide, including genetic or early environmental determinants.
Bolnga, John W; Morris, Marilyn; Totona, Catherine; Laman, Moses
Maternal near-miss indices are World Health Organisation (WHO) recognised indicators that may improve our understanding of factors associated with maternal morbidity and mortality. In Papua New Guinea (PNG) where maternal mortality is among the highest in the world, only one study has documented near-miss indices in a tertiary-level hospital, but none from provincial hospitals where the majority of under-privileged women access healthcare services. To determine the near-miss ratio, maternal mortality index (MMI), and associated maternal indices for Modilon Hospital in Madang Province of PNG. All women attending Modilon Hospital who met the WHO maternal near-miss definition and/or a WHO-modified (PNG-specific) near-miss definition, were prospectively enrolled. There were 6019 live births during the audit period; 163 women presented with life-threatening conditions (153 near-misses and 10 maternal deaths). The maternal near-miss ratio was 25.4/1000 live births and the maternal mortality ratio (MMR) was 166/100 000 live births, with a maternal death to near-miss ratio of 1:15.3. The severe maternal outcome ratio was 27.1/1000 live births and the total mortality index was 6.8%. Higher proportions of near-miss women were aged ≥30 years, nulliparous, illiterate, from rural communities, lacked formal employment, referred from peripheral health facilities, unbooked, had history of still births and were anaemic. Sociodemographic factors such as women's rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Goli, Srinivas; Rammohan, Anu; Moradhvaj
The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.
cardiac failure, and asthma in pregnancy were the least important causes of maternal deaths, each accounting for ... Asia, and 64% in Latin America as opposed to 93% in East. Asia and ..... The state of the world's children 2008; Child survival.
Rulisa, S.; Umuziranenge, I.; Small, M; van Roosmalen, J.
Background: To determine the prevalence and factors associated with severe ('near miss') maternal morbidity and mortality in the University Teaching Hospital of Kigali - Rwanda. Methods: We performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali
Zakharova, Iu A; Nikolaeva, A M; Fel'dblium, I V
During prospective epidemiological surveillance cases of pyogenic and septic infections (PSI) in mothers and newborns in two maternity hospitals were studied using standard case definition and leading risk factors of their development were revealed. These factors differed in two hospitals and were connected mainly with high level of patients colonization, contamination of the environment by nosocomial strains of microorganisms, and degree of participation of mother's relatives in delivery. It was shown that permission to relatives for presence on delivery did not influence on the rate of PSI. Specificity of risk factors of PSI in mothers and newborns dictates necessity to determine them in each maternity hospital.
...] Television Broadcasting Services; Birmingham, AL AGENCY: Federal Communications Commission. ACTION: Final... Television Commission, the licensee of noncommercial educational station WBIQ(TV), channel *10, Birmingham... Part 73 Television, Television broadcasting. 0 For the reasons discussed in the preamble, the Federal...
...] Television Broadcasting Services; Birmingham, Alabama AGENCY: Federal Communications Commission. ACTION... Television Commission (``AETC''), the licensee of station WBIQ(TV), channel *39, Birmingham, Alabama... freeze on the filing of petitions for rulemaking by television stations seeking channel substitutions in...
Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation
Hayer, Kalbir S; Sitch, Alice J; Dedicoat, Martin; Wood, Annette L
The proportion of culture-confirmed tuberculosis (TB) cases in Birmingham had gradually decreased to less than 65% in 2008. Reasons for this were unclear, therefore this study assessed diagnostic methods used for confirming TB and reviewed factors involved in positive culture. A cross-sectional study was carried out. A list of notified TB cases for Birmingham in those aged 16 y and over in 2009 was collated. Where no positive culture was recorded, further data were collected from hospital databases and case notes. Of 449 TB cases, 419 (93%) had samples taken for culture testing. Of all cases, 309 (69%) were confirmed by culture testing; of those receiving culture testing, 73% were confirmed. Pulmonary TB was identified as a predictor of positive culture in both the unadjusted and adjusted analyses: odds ratio (OR) 2.05, 95% confidence interval (CI) 1.32-3.19, and OR 2.32, 95% CI 1.29-4.17, respectively. Gender, age, ethnicity, UK born, and treatment delay were not significantly associated with positive culture. Of 140 cases not confirmed by culture, 129 (92%) had their diagnosis supported by at least one other test. The vast majority of TB cases had microbiological specimens taken to help confirm the disease. Furthermore, culture confirmation rates in Birmingham were meeting national targets in 2009. However culture confirmation rates were significantly lower in extrapulmonary TB, therefore further work is suggested in this group. The role of other investigations (e.g. interferon-gamma release assay (IGRA), Mantoux) is unclear. Further collaboration between clinicians, histopathologists, and microbiologists is advised to ensure samples are sent appropriately and culture confirmation is optimized.
Atladottir, Hjordis O.; Thorsen, Poul; Ostergaard, Lars; Schendel, Diana E.; Lemcke, Sanne; Abdallah, Morsi; Parner, Erik T.
Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards…
Simon Munyua; Dr. Gladys Rotich; Dr. Michael Kimwele
Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting...
Mivšek, Ana Polona; Petročnik, Petra; Skubic, Metka; Škodič Zakšek, Teja; Jug Došler, Anita
The aim was to investigate first-care procedures for the newborn's umbilical cord at maternity hospitals in Slovenia and Croatia. The study was based on an empirical survey research approach and quantitative research paradigms and included all Slovenian (n=14) and all Croatian (n=35) maternity hospitals. Leaders of midwifery team of 14 Slovenian and 35 Croatian labor wards were invited to participate. The study was conducted in 2013, with 67% of Slovenian and 66% of Croatian maternity hospitals having responded. A causal and non-experimental method of empirical research was used. The research instrument was a questionnaire. Descriptive statistics was used on data analysis. The independence hypothesis was tested with the χ2-test or Kullback 2Î-test. A vast ma-jority of study wards employed delayed umbilical cord clamping, i.e. clamping the cord after pulsa-tion had ceased. Only 10% of Slovenian in comparison with 36.4% of Croatian maternity hospitals practiced dry cord care. Others applied disinfectant on the cord, in Slovenia most frequently 6% po-tassium permanganate, and in Croatia a combination of octenidine and phenoxyethanol. Most Croa-tian -maternity wards (95.7%) still covered the stump, while it was not regular practice in Slovenia. The authors estimate that the prevailing Slovenian and Croatian practices in regard to cord clamping are in accordance with the evidence, while improvements could be made regarding stump care, since dry cord care is the recommended method.
Igwegbe, Anthony O; Eleje, George U; Ugboaja, Joseph O; Ofiaeli, Robinson O
To evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. A retrospective and comparative study of maternal deaths between 2004 and 2010 was carried out. The main outcome measures were yearly maternal mortality ratio (MMR), relative risk (RR) of maternal mortality, and presentation-intervention interval. The yearly MMR and the RR of maternal mortality were compared with the figures from 2004, which represented the pre-SERVICOM era. There were 4916 live births and 54 maternal deaths during the study period, giving an MMR of 1098 per 100,000 live births. Pre-eclampsia/eclampsia was the most common direct cause (25.0%), followed by hemorrhage (18.8%) and sepsis (8.3%). Anemia (12.5%) was the most common indirect cause. There was a progressive reduction in MMR and RR of maternal mortality, with a corresponding increase in live births. The presentation-intervention interval improved significantly from 2006. A positive change in the attitude of health workers and the elimination of fee-for-service in emergency obstetric care would reduce type 3 delays in public health facilities, and consequently reduce maternal mortality. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Listyowardojo, Tita Alissa; Yan, Xiaoling; Leyshon, Stephen; Ray-Sannerud, Bobbie; Yu, Xin Yan; Zheng, Kai; Duan, Tao
Tita Alissa Listyowardojo,1 Xiaoling Yan,2,3 Stephen Leyshon,1 Bobbie Ray-Sannerud,1 Xin Yan Yu,4 Kai Zheng,4 Tao Duan2,3 1Life Sciences Program, Group Technology and Research, DNV GL, Hovik, Norway; 2Quality and Safety Department, Shanghai First Maternity and Infant Hospital, 3Tongji University School of Medicine, Shanghai, 4Healthcare Department, Business Assurance, DNV GL, Beijing, China Objective: To assess safety culture at a public maternity hospital in Shanghai, China, using a sequenti...
Hobeika, Elie; Abi Chaker, Samer; Harb, Hilda; Rahbany Saad, Rita; Ammar, Walid; Adib, Salim
International agencies have recently assigned Lebanon to the group H of countries with "no national data on maternal mortality," and estimated a corresponding maternal mortality ratio (MMR) of 150 per 100,000 live births. The Ministry of Public Health addressed the discrepancy perceived between the reality of the maternal mortality ratio experience in Lebanon and the international report by facilitating a hospital-based reproductive age mortality study, sponsored by the World Health Organization Representative Office in Lebanon, aiming at providing an accurate estimate of a maternal mortality ratio for 2008. The survey allowed a detailed analysis of maternal causes of deaths. Reproductive age deaths (15-49 years) were initially identified through hospital records. A trained MD traveled to each hospital to ascertain whether recorded deaths were in fact maternal deaths or not. ICD10 codes were provided by the medical controller for each confirmed maternal deaths. There were 384 RA death cases, of which 13 were confirmed maternal deaths (339%) (numerator). In 2008, there were 84823 live births in Lebanon (denominator). The MMR in Lebanon in 2008 was thus officially estimated at 23/100,000 live births, with an "uncertainty range" from 153 to 30.6. Hemorrhage was the leading cause of death, with double the frequency of all other causes (pregnancy-induced hypertension, eclampsia, infection, and embolism). This specific enquiry responded to a punctual need to correct a clearly inadequate report, and it should be relayed by an on-going valid surveillance system. Results indicate that special attention has to be devoted to the management of peri-partum hemorrhage cases. Arab, postpartum hemorrhage, development, pregnancy management, verbal autopsy
Background: There is a limited knowledge on use of drugs during pregnancy including beneficial and possible adverse effects of drugs on both the mother and the fetus. Objective: To investigate epidemiology of use of drugs during pregnancy. Methods: A cross sectional hospital based study at Medani Hospital during the ...
Full Text Available TU Agan1, EI Archibong1, JE Ekabua1, EI Ekanem1, S E Abeshi1, TA Edentekhe2, EE Bassey21Department of Obstetrics and Gynecology and 2Department of Anesthesia, College of Medical Sciences, University of Calabar Teaching Hospital, NigeriaBackground: Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.Objective: The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital.Methodology: This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009. All pregnancy-related deaths of patients managed at the hospital were included in the study.Results: A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3% of the deaths were in women aged 20–34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%, followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%. About 69.26% of these women had no antenatal care. The majority (61.04% died within the first 48 hours of admission.Conclusion: Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially
Sdona, E; Papamichail, D; Ragkou, E; Briana, D D; Malamitsi-Puchner, A; Panagiotopoulos, T
Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.
Full Text Available BACKGROUND Anaemia is the commonest nutritional deficiency disorder in the world and in India prevalence in pregnancy is 50-80%. It is a risk factor for preterm delivery, low birth weight, stillbirth and foetal anaemia. The aim of the study is to find out correlation between maternal and cord haemoglobin and birth weight of newborn. MATERIALS AND METHODS Prospective observational study of 150 pregnant women delivering in KIMS from December 2014 to June 2016 for antenatal and newborn haemoglobin and newborn weight. RESULTS Of 150 mothers, 89.33% are anaemic (24% mild, 44% moderate and 21.3% severe. The incidence of low birth weight and low cord haemoglobin varied directly with severity of anaemia. Out of 150 babies, 119 (79.3% of babies had anaemia in our study. The mean haemoglobin among babies was 12.9 g/dL with a S.D. of 2.01. CONCLUSION A significant positive correlation with maternal haemoglobin and newborn weight and cord haemoglobin. RecommendationAntenatal prophylaxis with iron and folic acid to prevent anaemia and incidence of low birth weight and infantile anaemia.
Wax, Joseph R; Lucas, F Lee; Lamont, Maryanne; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn
We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth. We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes' summary odds ratios with 95% confidence intervals were calculated. Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates. Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate. Copyright 2010 Mosby, Inc. All rights reserved.
Baeza Bacab, Manuel Antonio
In June of 1866, the empress Carlota founded the Maternity House in the Department of Secret Births at the Hospice of the Poor. Upon the reinstatement of a republican government, Dr. Ramon Pacheco was appointed director of the Maternity House. Shortly after, in February of 1868, Dr. Luis Fernandez Gallardo established a pavilion for sick children in the Hospital of San Andres. After realizing this pavilion didn't have the adequate conditions to operate properly, and in the need of a children's hospital in Mexico City, Dr. Pacheco merged both institutions in April 2, 1869 -with the help of Ms. Luciana Arrazola- and founded the Maternity and Childhood Hospital, the first institution for the care of ill children in the independent Mexico. Ever since it was founded, Dr. Eduardo Liceaga was in charge of the children's health. Later, with the help of the presidents Juarez, Lerdo de Tejada and Díaz, he was able to consolidate the hospital in academic and health services aspects. This noble institution closed its doors on February 5, 1905, upon its incorporation to the General Hospital of Mexico, after 36 years of working for the welfare of Mexican children. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.
Gerbaud, L; Biolay, S; Venet, M; Pomey, M P; Belgacem, B; Jacquetin, B; Glanddier, P Y
Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.
Tunçer Ünver, Gamze; Harmanci Seren, Arzu Kader
To determine patient safety attitudes of midwives, nurses and physicians and to examine the difference or correlation in patient safety attitudes of midwives, nurses and physicians working in maternity hospitals. It has been suggested that it is necessary to define the factors affecting patient safety attitudes of health professionals working in maternity hospitals. A descriptive and correlational design was employed.The sample comprised 58 midwives, 134 nurses and 63 physicians (255) in two maternity hospitals in Istanbul, Turkey. The data were collected using an 'information form' and a 'Patient Safety Attitude Questionnaire'. The safety attitudes of participants were generally found to be negative. However, midwives had more positive patient safety attitudes and the age, unit, adequacy of patient safety training and the importance of patient safety were the most effective variables. As health professionals working in maternity hospitals generally have negative patient safety attitudes and because patient safety training provided better attitudes among the participants, these training programmes should be developed and implemented considering the differences among age groups and units. Health professionals have different views on the patient safety culture; therefore, training needs to involve everyone to create a shared vision for patient safety. © 2018 John Wiley & Sons Ltd.
Nyamtema, Angelo S; Urassa, David P; Pembe, Andrea B; Kisanga, Felix; van Roosmalen, Jos
Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.
Khan Suhaila H
Full Text Available Abstract Objective This study investigated a the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b the factors influencing these expenses, and c the impact of these expenses on household income. Methods Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. Results All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2–$350, equivalent to 7% (range 0.04%–225% of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%–30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy and unnecessary (e.g. episiotomy medical procedures. Conclusion Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would
Rajaram, P; Agrawal, A; Swain, S
During 1981-1986, 86 maternal deaths transpired at the obstetrics department of the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India. The maternal mortality rate stood at 5.8/1000 births. 31.4% were primigravidae. The percentage of maternal deaths characterized as gravidae 2-4, 5, and multigravidae was 42.9%, 9.3%, and 16.4%, respectively. The leading causes of death were sepsis (41.9%), especially septic abortion (30.2%); eclampsia-severe preeclampsia (10.5%); ruptured uterus (9.3%); and hemorrhage and prolonged labor (8.1% each). Direct obstetric causes of death accounted for 81.4% of all maternal deaths. Indirect obstetric causes of death were hepatitis (5.8%), heart disease (4.7%), and severe anemia (2.3%). Most of the women who died were illiterate (97.6%), poor (98.8%), and had received no prenatal care (94.2%). 47.7% traveled more than 60 km to the hospital. Quacks or untrained traditional birth attendants had excessively interfered with about 33% before they reached the hospital, especially the septic induced abortion, obstructed labor, and ruptured uterus cases. Among the 48 women who delivered before dying, there were 24 live births (5 of whom died during the early neonatal period) and 24 still births. These findings indicate a need for a cooperative effort to improve and expand maternal and child health care in the community.
This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\
Shely Karma Astuti
Full Text Available Objective: To discover the factors affecting the occurrence of maternal deaths. The high maternal mortality rate (MMR in Indonesia is still a common problem which needs urgent solution. Methods: This is an analytic observational, cross-sectional study using a case control approach Fifty two cases were selected as cases, another 52 were selected as control. The sampling was performed by simple random sampling. The instruments used in this study were the medical records of mothers who gave birth in Dr. Hasan Sadikin General Hospital Bandung from 1 January 2009–31 December 2013. Data analysis was performed using chi-square test. Results: In this study, the results showed that the risk factors contributing to maternal deaths were pregnancy complication (p<0.001, delivery complication (p<0.001, puerpural complication (p=0.022, age (p=0.030, parity (p=0.427, prior medical history (p<0.001, antenatal care (p=0.007, maternal education (p=0.527, and area of residence (p=0.049. Conclusions: The risk factors that contribute to maternal deaths include pregnancy complication, delivery complication, puerpural complication, maternal age, prior medical history, antenatal care, and area of residence.
Howland, Renata E; Angley, Meghan; Won, Sang Hee; Wilcox, Wendy; Searing, Hannah; Tsao, Tsu-Yu
To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors. We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012. Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries
Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada
The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals
Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.
Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight
Miller, Jessica Eden; Wu, Chunsen; Pedersen, Lars Henning
not receive pre-hospitalization antibiotics, this association was present only in those born vaginally. Higher risks of infection-related hospitalization occurred when pregnancy antibiotic prescriptions were closer to birth and in mothers receiving more pregnancy antibiotics. Children born to mothers exposed...... hospitalization with infection. Methods: We used population-based Danish national databases for pregnancies between 1995 and 2009. Infants were followed from birth until their first infection-related hospitalization, death, 14th birthday, emigration or end-2009. Exposure was maternal antibiotics prescribed before...... and during pregnancy. Outcome was infection-related hospitalization. Results: 141 359 (18%) mothers had at least one antibiotic prescription during pregnancy, 230 886 (29.4% of those with complete data) in the 18 months before pregnancy. Of 776 657 live-born singletons, 443 546 infection...
Yelland, Jane; Krastev, Ann; Brown, Stephanie
four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care. to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives. 'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation). four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational. 1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001. the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change. mainstream maternity care can be restructured to improve women's experiences of early postnatal care. maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice
Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.
Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.
Dervan, P; Hodgson, P; Marin- Reyes; Parker, K; Wilson, J; Baca, M
The Birmingham Irradiation Facility was developed in 2013 at the University of Birmingham using the Medical Physics MC40 cyclotron. It can achieve High Luminosity LHC (HL-LHC) fluences of 10^15 (1 MeV neutron equivalent (neq)) cm^-2 in 80 s with proton beam currents of 1 μA and so can evaluate effectively the performance and durability of detector technologies and new components to be used for the HL-LHC. Irradiations of silicon sensors and passive materials can be carried out in a temperature controlled cold box which moves continuously through the homogenous beamspot. This movement is provided by a pre-configured XY-axis Cartesian robot scanning system. In 2014 the cooling system and cold box were upgraded from a recirculating glycol chiller system to a liquid nitrogen evaporative system. The new cooling system achieves a stable temperature of 50 1C in 30 min and aims to maintain sub-0 1C temperatures on the sensors during irradiations. This paper reviews the design, development, commissioning and perform...
Fabiana Pinheiro Ramos
Full Text Available Abstract: Coping is defined by actions of self-regulation of emotions, cognitions, behaviors, and motivational orientation under stress. This study analyzed the maternal coping with hospitalization of premature and low birth weight infants at the Neonatal Intensive Care Unit (NICU, using the Motivational Theory of Coping. A questionnaire, a scale and an interview were applied to 25 mothers three times between birth and hospital discharge. The results showed that the mothers’ first visit to the NICU had strong emotional impact; longer hospitalization periods were linked to the decrease in Delegation coping strategies. There was more Support Seeking after the hospital discharge. Multiparous mothers and those who had a job appeared to be more vulnerable to stress. Predominantly adaptive coping responses were identified, even among two mothers whose babies had died, including Self-Reliance strategies, which were mediated by religious beliefs.
Kumar, Santhosh; Tadakamadla, Jyothi; Tibdewal, Harish; Duraiswamy, Prabu; Kulkarni, Suhas
To estimate the prevalence and severity of dental caries along with the treatment needs; to determine the factors that influence dental caries status among pregnant women attending a district maternity hospital in Udaipur, India. Study design: Study sample comprised of 206 pregnant women attending a district maternity hospital in Udaipur, India. Clinical data were collected on dental caries by DMFT and treatment needs as described in World Health Organization Dentition statu...
Kumar, Santhosh; Tadakamadla, Jyothi; Tibdewal, Harish; Duraiswamy, Prabu; Kulkarni, Suhas
Objectives: To estimate the prevalence and severity of dental caries along with the treatment needs; to determine the factors that influence dental caries status among pregnant women attending a district maternity hospital in Udaipur, India. Study design: Study sample comprised of 206 pregnant women attending a district maternity hospital in Udaipur, India. Clinical data were collected on dental caries by DMFT and treatment needs as described in World Health Organization Dentition status and ...
Jessica J. F. Kram
Full Text Available Purpose: Maternal group B Streptococcus (GBS can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization. Methods: We retrospectively studied mothers with live birth(s in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed. Results: Study population (N = 99,305 had a mean age of 28.1 years and prepregnancy body mass index (BMI of 26.7 kg/m2; 64.0% were white, 59.2% married, 39.3% nulliparous and 25.7% cesarean delivery. Mean gestational age was 39.0 weeks. Rate of maternal GBS colonization (22.3% overall was greater in blacks (34.1% vs. 20.1% in whites, P < 0.0001, unmarried women (25.5% vs. 20.0% married, P < 0.0001, women with sexually transmitted or other genital infections (P < 0.0001 and residents of ZIP code group 532XX (P < 0.0001, and was associated with increasing BMI (P < 0.0001. All predictors of colonization were significant on multivariable analysis. Rate of infant death was 5.7 deaths/1,000 live births (n = 558 excluding lethal anomalies and stillbirths and was negatively associated with maternal GBS colonization (P < 0.0001. On multivariable analysis, 532XX ZIP code group, lower gestational age, preterm labor, hyaline membrane disease, normal spontaneous vaginal delivery, hydramnios, oligohydramnios and absence of maternal GBS were associated with infant death. Conclusions: Geographic characteristics were associated with infant death and maternal GBS colonization. Further research is needed to determine if increased surveillance or treatment of mothers colonized with GBS decreases the risk of infant
Naz, H.; Sarwar, I.; Nisa, A.U.
Postpartum Haemorrhage (PPH) remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation (DIC), blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit B, Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18th April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 (58%) cases, followed by cervical, vaginal and perineal tears in 12 (24%) cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal (haemostatic) hysterectomy was performed in 10 (20%) cases. Maternal morbidity was detected in 31 (62%) of cases; the major morbidities were DIC in 3 (6%) cases. Acute renal failure in 3 (6%) patients and shock in 2 (9.9%) cases and anaemia in 20 (90.1%) cases. The study concludes that the frequency of primary PPH in this
Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena
Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions.
Full Text Available Objectives: The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. Methods: A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Results: Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 ± 3.0 weeks, and the mean birth weight was 1,594 ± 460 g. The most common maternal complications were preterm labour in 13 pregnancies (72.2%, gestational diabetes in 7 (39% and gestational hypertension in 5 (28%. Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates (46%, hyperbilirubinaemia in 24 (43%, sepsis in 18 (33% and anaemia in 8 (15%. The perinatal mortality rate was 55 per 1,000 births. Conclusion: The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies.
Full Text Available This is a report on the experience of implementing a mental health program in a maternity hospital and three mobile clinics in the city of Port-au-Prince. We started by listening to the difficulties faced by the national teams in their daily routines at the hospital and what they expected of a mental health program. The program was planned in a way to contemplate the perceived needs of the hospital teams as well as those of the target population, pre and post-natal women, within a systemic perspective. Thus the program covered the following aspects: training with the hospital team on communication and helping relationships, a series of speeches on mental health at the hospital, psychological treatment of the patients through counseling sessions, involvement of partners and families being assisted, support groups for peri-natal mourning, men's groups with the future fathers, psychoeducation in the mobile clinics, a survey of the social network in the city, psycho-social assistance and the introduction of relaxation strategies at the hospital. We concluded that in the context of a humanitarian crisis, as in the case of Haiti, a mental health program should contemplate different levels of need and take into consideration that health care professionals are also subject to the context of social stress. At the same time, the involvement of hospital teams in the process is fundamental to the success of the program.
Sajani, T T; Rahman, M T; Karim, M R
Gestational diabetes mellitus, most of which progress to type-2 diabetes mellitus is increasing worldwide. Identification of gestational diabetes and control of glucose can reduce such complications and improve maternal and neonatal health. A hospital based cross sectional study was conducted to find out maternal and fetal outcome of gestational diabetes from January to July 2011. Data were collected from 109 gestational diabetes mothers attending Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital for delivery. Study revealed that gestational diabetes was more common among mothers aged >25 years old and multiparaous women. Mean gestational age of diagnosis was 16.82±9.54 weeks. Sixty eight (68%) mothers were diagnosed before 20 weeks of gestation and more than 90% mothers with gestational diabetes delivered by caesarean section. Mean pregnancy weight gain was 6.8±1.18kg. Adverse maternal outcome observed in 24% cases and adverse fetal outcome was present in 34% cases. In univariate analysis weeks of delivery and fasting blood sugar were statistically significantly associated with adverse pregnancy outcome. Babies born to mothers with only diet restriction had less birth weight than mothers with insulin therapy. Pregnancy thought to be the most vulnerable stage of women's life and protecting her health along with her fetus during this period yields a positive impact on the health of future generation. Particular attention should be given during antenatal period to initiate screening programme and treatment protocol for gestational diabetic mothers.
Full Text Available Background & aim:The quality of communication between midwives and parturient women is a determinant of maternal satisfaction with midwifery care. Therefore, this study was conducted to determine the communication skills of midwives at maternity wards of Mashhad teaching hospitals in 2014. Methods:In this descriptive study, 49 midwives, working at Mashhad teaching hospitals, were randomly selected. All midwives worked rotating shifts at the wards. The midwives’ communication skills were assessed by the researcher, using the self-structured observation checklist of communicative performance. Results: The mean age of midwives was 39.11±9.66 years and their mean work experience was 15.9±8.77 years. In total, 68.3% of the participants experienced childbirth themselves. 66.7% of midwives were moderately keen on midwifery as a profession. The mean score of the checklist obtained by midwives was 67.9±10.7. There was no relationship between midwives’ communication skills and work experience, childbirth experience, age or interest in midwifery. Conclusion:Considering the inadequacy of midwives’ communication skills, which could be the major cause of maternal dissatisfaction with delivery care, it is recommended that in-service training courses be held by applying new teaching methods. Moreover, the educational needs of midwives, including communication skills, should be considered in these training programs .
Sorensen, Bjarke Lund; Elsass, Peter; Nielsen, Brigitte Bruun
for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in-depth interviews with staff about the underlying causes of substandard care...... in 46 (74%) of the 62 cases reviewed. During the same time period MDA identified substandard care in 18 cases. Staff perceived poor organization of work and lack of training as important causes for substandard care. Local MDA was considered useful although time-consuming and sometimes threatening......, and staff dedication to the process was questioned. CONCLUSION: Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE....
Lee, H Y; Subramaniam, N; Nordin, M M
To compare the advantages and disadvantages of the New Bird metal cups and silicone cups in terms of maternal and foetal outcome. To study the adverse effects and factors associated with failed vacuum deliveries. A prospective randomised study of all vacuum deliveries from 1 December 1991 to 31 April 1992. The Hanshin electrical vacuum pump was used. A large obstetric unit-The Maternity Hospital Kuala Lumpur (MHKL). Seventy-two consecutive patients where vacuum deliveries were indicated. Forty had metal and 32 had silicone cups. Another 7 vacuum deliveries using the manual vacuum pump were excluded. Success rate of vaginal delivery, birth canal injuries, post-partum haemorrhage, duration of hospital stay, Apgar score, foetal injuries (scalp-ecchymosis, haematomas) neonatal jaundice, the rate of special care nursery (SCN) admission and neonatal mortality rate. Failure to deliver with silicone cups alone was 21.9% compared to 10% for metal cups alone. Material morbidities and serious foetal scalp injuries were almost the same in both cups. However, minor foetal scalp injuries were significantly lower with silicone cups. Maternal height and baby's weight had no independent predictive values for successful vacuum delivery. When the foetal head was palpable per abdomen, the failure rate was 54.5% compared to 8.2% when it was not. Failed vacuum deliveries were associated with increased maternal and foetal morbidities. Silicone cups and metal cups can be equally dangerous to the baby. Although our sample size was small, we recommend that vacuum delivery be avoided if the foetal head is palpable per abdomen.
Růžičková, Vladislava; Pantůček, Roman; Petráš, Petr; Machová, Ivana; Kostýlková, Karla; Doškař, Jiří
One hundred and twenty-seven exfoliative toxin-producing (ET-positive) strains of Staphylococcus aureus collected in 23 Czech and one Slovak maternity hospitals from 1998 to 2011 were genotypically characterized by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) profiling, spa gene polymorphism analysis, and ETA-converting prophage carriage, which resulted in the identification of 21 genotypes grouped into 4 clonal complexes (CC). Ninety-one isolates carried the eta gene alone whilst 12 isolates harboured only the etb gene. Two new, to date not defined, spa types (t6644 and t6645) and 2 novel sequence types (ST2194 and ST2195) were identified in the set of strains under study. The predominant CC121 occurred in 13 Czech hospitals. CC15, CC9, and ST88 (CC88) exclusively included eta gene-positive strains while the strains belonging to ST121 harboured the eta and/or etb genes. This study highlights not only significant genomic diversity among impetigo strains and the distribution of major genotypes disseminated in the Czech and Slovak maternity hospitals, but also reveals their impact in epidermolytic infections. Copyright © 2012 Elsevier GmbH. All rights reserved.
Derijulie Siqueira Sousa
Full Text Available Abstract Objectives: to determine the prevalence of the most common morbidities in extremely low birth weight (ELBW infants hospitalized in a newborn intensive care unit (NICU and to evaluate the influence of these morbidities through the length of in-hospital stay. Methods: observational, longitudinal, prospective and analytical study in a high risk reference maternity NICU from Sergipe, realized with 158 ELBW infants admitted between March 2014 and April 2015. The analysis of the hospitalization time was realized through the Kaplan-Meier method. Results: the average weight of premature was 785,2g ± 138,2g. The gestational age vary from 22 to 35 weeks and the average was 26,8 weeks. Of those admitted at NICU, sixty three (39,9% were discharged and 95 (60,1% died. The time of hospitalization was influenced for morbidities as: patent ductus arteriosus (PDA, intraventricular hemorrhage and sepsis. Acute respiratory distress syndrome was the most common complication (157 - 99,4%. The incidence of persistent arterial duct, intraventricular hemorrhage, sepsis, hypothermia, hypoglycemia and retinopathy of prematurity was 39,2%, 17,1%, 32,3%,50,3%, 52,3% e 16,6% respectively. Conclusions: the morbidities from respiratory tract, cardiac, neurological and infectious were the most prevalent, whilst PDA, intraventricular hemorrhage and sepsis were the morbidities that significantly influenced the time of hospitalization.
Full Text Available Tita Alissa Listyowardojo,1 Xiaoling Yan,2,3 Stephen Leyshon,1 Bobbie Ray-Sannerud,1 Xin Yan Yu,4 Kai Zheng,4 Tao Duan2,3 1Life Sciences Program, Group Technology and Research, DNV GL, Hovik, Norway; 2Quality and Safety Department, Shanghai First Maternity and Infant Hospital, 3Tongji University School of Medicine, Shanghai, 4Healthcare Department, Business Assurance, DNV GL, Beijing, China Objective: To assess safety culture at a public maternity hospital in Shanghai, China, using a sequential mixed methods approach. The study was part of a bigger study looking at the application of the mixed methods approach to assess safety culture in health care in different organizations and countries.Methodology: A mixed methods approach was utilized by first distributing the Safety Attitudes Questionnaire measuring six safety culture dimensions and five independent items to all hospital staff (n=1482 working in 18 departments at a single hospital. Afterward, semistructured interviews were conducted using convenience sampling, where 48 hospital staff from nine departments at the same hospital were individually interviewed.Results: The survey received a response rate of 96%. The survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items. Similarly, the interview findings revealed that there were different, competing priorities between departments perceived to result in a reduced quality of collaboration and bottlenecks in care delivery. Another major finding was that staff who worked more hours per week would perceive working conditions significantly more negatively. Issues related to working conditions were also the most common concerns discussed in the interviews, especially the issue on high workload. High workload was also reflected in the fact that 91.45% of survey respondents reported that they worked 40 hours or longer per week. Finally, interview findings complemented
Sadaf, N.; Haq, G.; Din, S.S.U.
Objective: To determine maternal and foetal outcome in patients of Haemolysis, Elevated Liver enzyme and Low Platelet Cont syndrome. Methods: The descriptive case series was conducted at the Gynae Unit II of Civil Hospital, Karachi, over a period of 12 months in two episodes; first from December 28, 2006, to February 28, 2007, and then from September 1, 2007, to June 30, 2008. It comprised 40 consecutive women with pre-ecampsia and eclampsia along with altered platelet count who met the syndrome criteria. A pre-designed proforma was administered for data collection. Maternal and foetal outcomes were noted. SPSS 10 was used for statistical analysis. Result: Among the 40 mothers, cesarean section was the most common outcome (n=24; 60%). Pulmonary oedema was found in 2 (5%) cases, acute renal failure in 10 (25%), disseminated intravascular coagulation in 6 (15%), and abruptio placenta in 5 (12.5%). Intrauterine growth restriction as a foetal outcome was observed in 18 (45%) cases. Pre-term birth was the result in 20 (50%) cases, and perinatal mortality was high (n=23; 57.5%). Conclusion: Management and delivery of HELLP syndrome patients should be performed at tertiary care centres, where highly trained obstetrician, neonatal intensive care unit personnel and Multi-disciplinary facilities are available. Correct diagnosis and timely intervention can decrease the risk of maternal and perinatal mortality. (author)
The development of a centre for the investigation of genetic aspects of still birth, neonatal deaths and mental deficiency is described. It is suitably located in a maternity hospital and provides counselling early enough to prevent the brith of a subsequent affected infant in high-risk groups. A variety of laboratory and other facilities are in close proximity. This has the advantage of allowing procedures, such as amniocentesis and ultrasound examination for prenatal diagnosis, to be arranged in consultation with hospital staff members. The aetiology of the first 120 cases seen, their reason for referral, recurrence risk, and "decision made", are reported in detail elsewhere. The mode of operation with regard to source of case, appointments, staff and records is outlined fully in this paper. The conclusion to be reached is that, within two years of its inception, the genetic investigation centre is already providing a useful community service.
Chamber of Commerce , "Climate and Geography, Birmingham Area", March, 1984. 2. Department of Economic and Community...Affairs, State of Alabama, "Estimated 1984 Population". *3. Birmingham Area Chamber of Commerce , "An Economic Overview of Birmingham, Alabama", June... Chamber of Commerce , "New Business License List", May, 1985. 6. Birmingham Area Chamber of Commerce , "Birmingham Facts and History", (undated).
Kavitha Reddy Kothapally
Full Text Available AIM To analyse the maternal outcome in pregnancy induced hypertension and improve the management strategies. INTRODUCTION Pregnancy induced hypertension is a medical disease peculiar to pregnancy, making pregnancy a high risk condition. Among medical disorders complicating pregnancy, it stands next to anaemia in prevalence. It is responsible for majority of the maternal morbidity and mortality. It also has an adverse perinatal outcome. Hence, early detection and timely intervention of women with pregnancy induced hypertension is important for good maternal and perinatal outcome. MATERIAL & METHODS The present Prospective Observational study was done from April 2015 to February 2016 in the department of obstetrics & gynaecology at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana. A total of 102 pregnant women with pregnancy induced hypertension were enrolled into the study. Demographic details like age, parity, previous obstetric history of pregnancy induced hypertension and diabetes, past history of polycystic ovarian disease, treatment for infertility, gestational age at which hypertension developed in the present pregnancy were noted. Relevant investigations were performed. Gestational age of delivery, mode of delivery and maternal complications were noted. RESULTS The incidence of pregnancy induced hypertension was 4% in the study population. About 59.8% developed pregnancy induced hypertension in the third trimester. Out of this, 64.7% cases were gestational hypertension and 35.3% cases were preeclampsia. Nearly half (41.7% of preeclampsia cases were severe preeclampsia. Postpartum haemorrhage is the commonest complication (13.7%, next being imminent eclampsia (7.8%, abruption (4.9%, eclampsia (3.9% and HELLP syndrome (0.98%. 80% of cases could be delivered beyond 37 weeks of gestational age. 71.57% of cases had lower segment caesarean section for indicated conditions. More than half of pregnancy induced
Ade-Conde, J A
The aim of this study is to examine the trend in maternal postnatal readmission within six weeks of discharge from childbirth hospitalisation. It is a retrospective review of the maternity computer records system, patient\\'s clinical notes and HIPE data base. All women who delivered babies weighing > 500 g and\\/ > or = 24 weeks gestational age at Our Lady of Lourdes Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who were re-hospitalised within six weeks of discharge from hospital following child birth were included in the study. A total of 15782 women were delivered over the four year study period. Of these, 236 were readmitted. A series of chi-square analysis were conducted to assess the difference in readmission rates between the year 2008 86 (2.03%) and the years 2005-51(1.46%), 2006-39 (1.01%) and 2007-60 (1.42%). The readmission rate was found to be significantly higher in 2008 compared with the three preceding years. Complications of Caesarean section and secondary postpartum haemorrhage following spontaneous vaginal delivery constitute the major indications for readmission.
Obiechina, NJ; Okolie, VE; Okechukwu, ZC; Oguejiofor, CF; Udegbunam, OI; Nwajiaku, LSA; Ogbuokiri, C; Egeonu, R
NJ Obiechina, VE Okolie, ZC Okechukwu, CF Oguejiofor, OI Udegbunam, LSA Nwajiaku, C Ogbuokiri, R Egeonu Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria Background: Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless thing...
Berthelot, P; Grattard, F; Amerger, C; Frery, M C; Lucht, F; Pozzetto, B; Fargier, P
To investigate an outbreak of Serratia marcescens in a maternity hospital (November 1994 to May 1995). Retrospective analysis of epidemiological data and prospective study of systematic bacteriological samples from patients and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction. A private maternity hospital, Saint-Etienne, France. In the neonatal unit, 1 newborn developed a bacteremia, and 36 were colonized in stools with S marcescens. As the colonization of some newborns was shown to occur only a few hours after delivery, the inquiry was extended to other maternity wards, where 8 babies and 4 mothers were found to be colonized. Environmental sampling led to the isolation of S marcescens from a bottle of enteral feed additive in the neonatal unit and from the transducers of two internal tocographs in the delivery rooms. The genotyping of 27 strains showed two different profiles: a major epidemic profile shared by 22 strains (18 from babies of the neonatal unit, 2 from babies of other units, and 2 from breast milk) and another profile shared by 5 strains (2 from transducers of internal tocographs, 2 from babies, and 1 from a mother). The strain isolated from lipid enteral feeding was not available for typing. Although this source of contamination was removed soon from the neonatal unit, the outbreak stopped only when infection control measures were reinforced in the delivery rooms, including the nonreuse of internal tocographs. In delivery rooms, the quality of hygiene needs to be as high as in surgery rooms to prevent nosocomial colonization or infection of neonates at birth.
Khan, N.S.; Ashraf, R.N.; Rahman, M.U.; Mashhadi, S.F.; Rashid, Z.; Nazar, A.F.; Syed, R.
Background: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. Methods: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics-B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (<2,500 g), the 80 controls were mothers of normal weight babies (=2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. Results: Periodontitis was more in the cases than in the controls (OR: 4.167, 95 percentage CI: 2.142-8.109, ρ=0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95 percentage CI: 1.429-7.047, ρ=0.005). Other significant risk factors were educational level (aOR: 3.408, 95 percentage CI: 1.452-7.996, ρ=0.005), socioeconomic status (aOR: 3.173, 95 percentage CI: 1.366-7.368, ρ=0.007), maternal nutrition (aOR: 3.071, 95 percentage CI: 1.392-6.778, ρ=0.005) and moderate/severe anaemia (aOR: 3.035, 95 percentage CI: 1.052-8.756, p=0.040). Conclusions: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad. (author)
Akbari, Nahid; Malek, Marzieh; Ebrahimi, Parvin; Haghani, Hamid; Aazami, Sanaz
Improving quality of maternal care as well as patients' safety are two important issues in health-care service. Therefore, this study aimed to assess the culture of patient safety at maternity units. This cross-sectional study was conducted among staffs working at maternity units in seven hospitals of Ilam city, Iran. The staffs included in this study were gynecologists and midwifes working in different positions including matron, supervisors, head of departments and staffs. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC). This study indicated that 59.1% of participants reported fair level of overall perceptions of safety and 67.1% declared that no event was reported during the past 12 months. The most positively perceived dimension of safety culture was teamwork within departments in view of managers (79.41) and personnel (81.10). However, the least positively perceived dimensions of safety culture was staffing levels. The current study revealed areas of strength (teamwork within departments) and weakness (staffing, punitive responses to error) among managers and personnel. In addition, we found that staffs in Ilam's hospitals accept the patient safety culture in maternity units, but, still are far away from excellent culture of patient safety. Therefore, it is necessary to promote culture of patient's safety among professions working in the maternity units of Ilam's hospitals.
Full Text Available As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1 the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI by reproducing an Australian indicator using routinely available hospital data, 2 the impact of modifications to the indicator to address potential data quality issues, 3 the reliability of the indicator.We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES database of the Health and Social care Information centre (HSCIC. A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.EMMOI included 26 morbid events (17 diagnosis and 9 procedures. Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.
Full Text Available Abstract Background Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications. Method Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis. Results Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it. Conclusion Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing
Stensballe, Lone Graff; Ravn, Henrik; Kristensen, Kim
This study used 459 prospectively sampled cord blood samples to examine the association between maternally derived respiratory syncytial virus (RSV)-neutralizing antibodies and the RSV hospitalization season in Denmark. We found a clear temporal association and suggest that RSV-neutralizing antib......This study used 459 prospectively sampled cord blood samples to examine the association between maternally derived respiratory syncytial virus (RSV)-neutralizing antibodies and the RSV hospitalization season in Denmark. We found a clear temporal association and suggest that RSV......-neutralizing antibody level plays a role in the RSV seasonal pattern....
Thonneau, Patrick F; Matsudai, Tomohiro; Alihonou, Eusèbe; De Souza, Jose; Faye, Ousseynou; Moreau, Jean-Charles; Djanhan, Yao; Welffens-Ekra, Christiane; Goyaux, Nathalie
To assess the maternal mortality ratio in maternity units of reference hospitals in large west African cities, and to describe the distribution of complications and causes of maternal deaths. Prospective descriptive study in twelve reference maternities located in three African countries (Benin, Ivory Coast, Senegal). Data (clinical findings at hospital entry, medical history, complications, type of surgery, vital status of the women at discharge) were collected from obstetrical and surgical files and from admission hospital registers. All cases of maternal deaths were systematically reviewed by African and European staff. Of a total of 10,515 women, 1495 presented a major obstetric complication with dystocia or inappropriate management of the labour phase as the leading cause. Eighty-five maternal deaths were reported, giving a global hospital-based maternal mortality ratio of 800/100,000. Hypertensive disorders were involved in 25/85 cases (29%) and post-partum haemorrhage in 13/85 cases (15%). Relatively few cases (14) of major sepsis were reported, leading to three maternal deaths. The results of this multicentre study confirm the high rates of maternal mortality in maternity units of reference hospitals in large African cities, and in addition to dystocia the contribution of hypertensive disorders and post-partum haemorrhage to maternal deaths.
Full Text Available Tegene Legesse,1 Misra Abdulahi,2 Anteneh Dirar2 1Department of Public Health, Collage of Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia; 2Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Oromia Regional State, Ethiopia Introduction: Measures of maternal death are fundamental to a country’s health and development status. In developing countries, it remains a daunting and largely unmet public health challenge. There were two studies completed over 10 years ago in Jimma University Specialized Hospital to identify trends, but recently there have been many changes in Ethiopia to reduce maternal death. Therefore, it is important to track the achievements made in Ethiopia in the context of Jimma University Specialized Hospital. No study undertaken in the country has quantified deaths of women from specific causes after controlling confounders.Objective: To assess trends and causes of maternal death in Jimma University Specialized Hospital, southwest Ethiopia.Methods: A time-matched case–control study was conducted on 600 (120 cases and 480 controls females who utilized obstetrics and gynecology services from January 2010 to December 2014. To observe trends in maternal death, maternal mortality ratio was calculated for each year. Stata version 13 was used to analyze causal inference using propensity score matching method.Results: Maternal mortality ratio was 857/100,000 and had a decreasing trend from it’s highest in 2010 of 1,873/100,000 to it’s lowest of 350/100,000 in 2014. The leading cause of maternal death was hemorrhage (54% (β=0.477, 95% confidence interval [CI]: 0.307, 0.647, followed by pregnancy-induced hypertension (20% (β=0.232, 95% CI: 0.046, 0.419, and anemia (12% (β=0.110, 95% CI: 0.017, 0.204.Conclusion: There is a decreasing trend of maternal death. Hemorrhage was the major cause of death identified in each year of study. Keywords: maternal death, maternal
Obiechina, Nj; Okolie, Ve; Okechukwu, Zc; Oguejiofor, Cf; Udegbunam, Oi; Nwajiaku, Lsa; Ogbuokiri, C; Egeonu, R
Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. This study was conducted to assess NAUTH'S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality.
Obiechina, NJ; Okolie, VE; Okechukwu, ZC; Oguejiofor, CF; Udegbunam, OI; Nwajiaku, LSA; Ogbuokiri, C; Egeonu, R
Background Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives This study was conducted to assess NAUTH’S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. Materials and methods This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). Conclusion MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality. PMID:23901299
Dodzo, Lilian Gertrude; Mahaka, Hilda Tandazani; Mukona, Doreen; Zvinavashe, Mathilda; Haruzivishe, Clara
HIV-related conditions are one of the indirect causes of maternal deaths in Zimbabwe and the prevalence rate was estimated to be 13.63% in 2009. The study utilised a descriptive correlational design on 80 pregnant women who were HIV positive at Mbuya Nehanda maternity hospital in Harare, Zimbabwe. Participants comprised a random sample of 80 postnatal mothers. Permission to carry out the study was obtained from the respective review boards. Participants signed an informed consent. Data were collected using a structured questionnaire and record review from 1 to 20 March 2012. Interviews were done in a private room and code numbers were used to identify the participants. Completed questionnaires were kept in a lockable cupboard and the researcher had sole access to them. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 12. Descriptive statistics were used to analyse data on demographics, maternal health outcomes and self-care practices. Inferential statistics (Pearson's correlation and regression analysis) were used to analyse the relationship between self-care practices and maternal health outcomes. Self-care practices were good with a mean score of 8 out of 16. Majority (71.3%) fell within the good category. Maternal outcomes were poor with a mean score of 28 out of 62 and 67.5% falling in the poor category. Pearson's correlation indicated a weak significant positive relationship (r = .317, p = <.01). Regression analysis (R 2 ) was .10 implying that self-care practices explained 10% of the variance observed in maternal health outcomes. More research needs to be carried out to identify other variables affecting maternal outcomes in HIV-positive pregnant women.
Njuguna, John; Kamau, Njoroge; Muruka, Charles
Kenya has a high maternal mortality rate. Provision of skilled delivery plays a major role in reducing maternal mortality. Cost is a hindrance to the utilization of skilled delivery. The Government of Kenya introduced a policy of free delivery services in government facilities beginning June 2013. We sought to determine the impact of this intervention on facility based deliveries in Kenya. We compared deliveries and antenatal attendance in 47 county referral hospitals and 30 low cost private hospitals not participating in the free delivery policy for 2013 and 2014 respectively. The data was extracted from the Kenya Health Information System. Multiple regression was done to assess factors influencing increase in number of deliveries among the county referral hospitals. The number of deliveries and antenatal attendance increased by 26.8% and 16.2% in county referral hospitals and decreased by 11.9% and 5.4% respectively in low cost private hospitals. Increase in deliveries among county referral hospitals was influenced by population size of county and type of county referral hospital. Counties with level 5 hospitals recorded more deliveries compared to those with level 4 hospitals. This intervention increased the number of facility based deliveries. Policy makers may consider incorporating low cost private hospitals so as to increase the coverage of this intervention.
Culhane-Pera, K.A.; Sriphetcharawut, S.; Thawsirichuchai, Rasamee; Yangyuenkun, W.; Kunstader, P.
Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into fou...
Aguiar, Janaina Marques de; d'Oliveira, Ana Flávia Pires Lucas; Schraiber, Lilia Blima
The current article discusses institutional violence in maternity hospitals from the health workers' perspective, based on data from a study in the city of São Paulo, Brazil. Eighteen health workers from the public and private sectors were interviewed, including obstetricians, nurses, and nurse technicians. A semi-structured interview was used with questions on professional experience and the definition of violence. The analysis revealed that these health workers acknowledged the existence of discriminatory and disrespectful practices against women during prenatal care, childbirth, and the postpartum. Examples of such practices cited by interviewees included the use of pejorative slang as a form of "humor", threats, reprimands, and negligence in the management of pain. Such practices are not generally viewed by health workers as violent, but rather as the exercise of professional authority in what is considered a "difficult" context. The institutional violence is thus trivialized, disguised as purportedly good practice (i.e., "for the patient's own good"), and rendered invisible in the daily routine of care provided by maternity services.
Piper, J M; Mitchel, E F; Snowden, M; Hall, C; Adams, M; Taylor, P
In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.
Corrêa, Claudia Regina Hostim; Bonadio, Isabel Cristina; Tsunechiro, Maria Alice
This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of São Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.
Boo, N Y; Chor, C Y
A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaemia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.
Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina
Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P cesarean section performed under general anesthesia (P cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications. PMID:27347286
Full Text Available Background: Gestational diabetes mellitus (GDM is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome. Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy. Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years. Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control. The baseline characteristics (age, body mass index, religion, and socioeconomic status were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women.Results: The prevalence of GDM was 5.72% (170/2970. Most patients (79.41% could be controlled on diet alone. However, 21 (12.35% needed insulin and 14 (8.23% needed oral hypoglycemic agents. Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (13.5% than in control (6.3% (P = 0.019. Mode of delivery was not different in two groups. Instrumental deliveries and postpartum hemorrhage were also similar. However, mean birth weight was significantly higher in GDM (2848 ± 539 g than in control (2707 ± 641 g (P = 0.004. Incidence of large-for-date babies was also higher (28.2% in GDM than control (19.4% (P = 0.005. In neonatal complication, hypoglycemia was significantly higher in GDM (20.6% than in control (5.2% (P = 0.001. However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups. Conclusion: The prevalence of GDM was 5.72% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can
de Jonge, J.; Mesman, J.A.J.M.; Manniën, J.; Zwart, J.J.; van Dillen, J.; van Roosmalen, J.
Objectives: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Design: Cohort study
Full Text Available NJ Obiechina, VE Okolie, ZC Okechukwu, CF Oguejiofor, OI Udegbunam, LSA Nwajiaku, C Ogbuokiri, R Egeonu Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria Background: Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives: This study was conducted to assess NAUTH'S progress in achieving a 75% reduction in the maternal mortality ratio (MMR and to identify the major causes of maternal mortality. Materials and methods: This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results: During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%, hemorrhage (22%, and sepsis (12%. The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98% and within the first 48 hours of admission (76%. Conclusion: MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to
Bilal, Naser Eldin; Gedebou, Messele; Al-Ghamdi, Saleh
Patients admitted during a 6-month period to a maternity hospital in Saudi Arabia were studied for nosocomial infections and misuse of antibiotics. Patient history and diagnosis on admission and subsequent clinical and laboratory data were analysed. Infection developing from 72 h after admission was considered nosocomial. Therapeutic and prophylactic data as recorded on the patients' charts were assessed for possible misuse of antibiotics. Of 3439 patients, 136 (4.0%) developed nosocomial infection: 2.0%, 8.9% and 37.7% in obstetric, gynaecologic and nursery patients, respectively. Infections among adults were mostly found in the urinary (44.4%) and lower genital (33.3%) tracts. Among newborns, over 70% of cases were eye and ear (29.8%), skin (26.2%) and blood (19.0%) infections. Gram-negative bacteria caused 65.7% of the infections. Over 90% of the bacterial isolates were multidrug-resistant. About 24% of patients received single or multiple antibiotics; 57.2% were misused. The minimal hospital cost estimate for both nosocomial infections and misused antibiotics was US $318,705. The findings of this study, the first of its type in this region, should prompt improved infection control measures as well as educational and antibiotic restriction interventions.
Maria das Neves Figueiroa
Full Text Available Objective: Survey the prevalence of arbovirus infections among pregnant women provided with care at a maternity hospital school in Recife, Pernambuco, Brazil. Method: Descriptive, cross-sectional, retrospective, and quantitative study, carried out with data collected from the notification forms filled in during obstetric screening between August 2015 and July 2016. Results: Positive serology was found for arboviruses in 40.2% of the 103 suspected cases. Serology was not performed or it showed inconclusive results in 59.8% of the cases. Dengue fever occurred in 44% of the cases, chikungunya in 34%, and zika fever in 22%. Infections were more frequent among pregnant women over 20 years old, with low income and low schooling levels, living in Recife (48.5% and Olinda, Pernambuco, Brazil (24.3%. The most frequently mentioned symptoms were arthralgia (94%, exanthema (82%, and fever (78%. Infections occurred within the first trimester of pregnancy (54.5%, 63.3% of the pregnant women had to be hospitalized, and 45.4% of them did not undergo morphological ultrasonography. Most babies were born full-term and they had adequate weight. The prevalence of microcephaly was 9.7% when considering cases of arbovirose and 62.5% when considering specific cases of zika fever. Conclusion: The prevalence and repercussions of arboviruses justify the consolidation of actions to fight Aedes aegypti, as well as the effective deployment of clinical protocols and recommendations aimed at the mother and child care.
Madeiro, Alberto Pereira; Rufino, Andréa Cronemberger; Lacerda, Érica Zânia Gonçalves; Brasil, Laís Gonçalves
Maternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil. A transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined. Five thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1%) and hemorrhagic complications (10.0%) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.
This essay examines the school leadership experiences of an infant school head teacher in Birmingham, England, during the Second World War. Drawing on the letters of Dorothy Walker, the essay offers insights into school leadership wartime deprivations. The impact of an international war on the home front was not head teacher Dorothy Walker's only…
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Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I
To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.
O'Leary, Sean T; Nelson, Christina; Duran, Julie
A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV. A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV. A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49-1.85; >$75,000 vs. risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.
Shah, N.; Hossain, N.; Khan, N.H.
Objective: To study the mortality and morbidity of unsafe abortion in a University Teaching Hospital. Methods: A cross-sectional, descriptive study was conducted in Department of Obstetrics and Gynaecology, Unit III, Dow Medical College and Civil Hospital Karachi from January 2005 to December 2009. Data regarding the socio demographic characteristics, reasons and methods of abortion, nature of provider, complications and treatment were collected for 43 women, who were admitted with complications of unsafe abortion, and an analysis was done. Results: The frequency of unsafe abortion was 1.35% and the case fatality rate was 34.9%. Most of the women belonged to a very poor socioeconomic group (22/43; 51.2%) and were illiterate (27/43; 62.8%). Unsafe abortion followed an induced abortion in 29 women and other miscarriages in 14 women. The majority of women who had an induced abortion were married (19/29, 65.5%). A completed family was the main reason for induced abortion (14/29; 48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29 cases (17.2%). Instruments were the commonest method used for unsafe abortion (26/43;68.4%).The most frequent complication was septicaemia (34; 79%) followed by uterine perforation with or without bowel perforation (13, 30.2%) and haemorrhage (9; 20.9%). Majority of induced abortions were performed by untrained providers (22/26; 84.6%) compared to only 3/14 cases (21.4%) of other miscarriages (p=0.0001). Conclusion: The high maternal mortality and morbidity of unsafe abortion in our study highlights the need for improving contraceptive and safe abortion services in Pakistan. (author)
Reyal, F; Deffarges, J; Luton, D; Blot, P; Oury, J F; Sibony, O
To analyze the prevalence, cause, treatment, and risk factors of severe post-partum hemorrhage (transfusion, surgery, radiology) observed at the maternity ward of the Robert-Debré Hospital, Paris. Method. This retrospective cohort was collected from a database including 19182 deliveries from 1992 to 1998. The entire medical file was reviewed in cases of severe hemorrhage. The prevalence of severe post-partum hemorrhage was 23 per 10,000 deliveries (44 patients). Transfusion was performed in 44/44 and hysterectomy in 3/44. Three patients were transferred to the intensive care unit. There were no deaths. At multivariate analysis, risk factors for severe post-partum hemorrhage were: abnormal placental insertion (OR=7.2; 95CI: 2.18-18.3), cesarean (OR=5.8; 95CI: 2.9-11.6), multiple pregnancy (OR=3.2; 95CI: 1.3-7.8), prematurity (OR=3, 95CI: 1.5-6.2), hypertension (OR=2.9; 95CI: 1.3-6.3). Twenty-six percent of the patients had no risk factors. The prevalence of severe pot-partum hemorrhage is low in our experience. The methodology used for this retrospective cohort does not enable an explanation. Intensive obstetrical care is necessary in case of abnormal placenta insertion. In 10 out of 44 cases, severe post-partum hemorrhage occurred in a context of insufficient monitoring, late or erroneous diagnosis, or incorrect treatment.
Amaury Teixeira Leite Andrade
Full Text Available OBJETIVO: avaliar as causas de todas as mortes maternas ocorridas no período de 1927 a 2001 entre 164.161 pacientes, internadas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora. MG. MÉTODOS: estudo retrospectivo das 144 mortes maternas que ocorreram na maternidade em 75 anos, com um total de 131.048 nascidos vivos, utilizando todos os prontuários de pacientes, avaliados pela história clínica e dados da certidão de óbito (não foram realizadas necropsias. Foram registrados a idade, paridade, tempo de gestação, complicações, momento e causas de morte, estabelecendo-se o índice de mortalidade materna (IMM hospitalar por cem mil nascidos vivos. Análise estatística pelo teste do chi2 e pela técnica de amortecimento exponencial (alfa =0,05. RESULTADOS: de 1927 a 1941 o IMM foi de 1544, entre 1942 e 1956 houve redução para 314 (pPURPOSE: to evaluate all maternal deaths that occurred between 1927 and 2001, among 164,161 patients admitted to the Maternidade Therezinha de Jesus, the obstetrical service of the "Universidade Federal de Juiz de Fora", Brazil. METHODS: a retrospective study of 144 maternal deaths that occurred in the maternity hospital in 75 years, with 131,048 live births in the same period of time, analyzing all patients's records regarding their clinical history and data from death certificates. Autopsies were not performed. Data obtained were age, parity, gestation length, complications, moment, and causes of death. The index of maternal mortality (IMM period 100 thousand live births was utilized. For statistical analysis the chi2 test and the exponential smoothing technique were used (alpha=0.05. RESULTS: IMM decreased from 1544 in the period 1927-1941 to 314 (p<0.001 between 1942 and 1956 and from 1957 to 1971 it was reduced to 76.4 per 100 thousand live births (p<0.001. Nevertheless, since 1972 there was no further significant improvement (IMM=46 in the last 15 years, p=0.139. Maternal mortality was
Domple, Vijay Kishanrao; Doibale, Mohan K; Nair, Abhilasha; Rajput, Pinkesh S
To assess the maternal risk factors associated with low birth weight (LBW) neonates at a tertiary hospital, Nanded, Maharashtra. This study was carried out in a tertiary care hospital in Nanded city of Maharashtra between January 2014 and July 2014 among 160 cases (LBW-birth weight ≤2499 g) and 160 controls (normal birth weight-birth weight >2499. Data collection was done by using predesigned questionnaire and also related health documents were checked and collected the expected information during the interview after obtaining informed consent from mothers. The data were analyzed by Epi Info 7 Version. The present study found the significant association among gestational age, sex of baby, type of delivery, maternal age, religion, education of mother and husband, occupation of mother and husband, type of family, maternal height, weight gain, hemoglobin level, planned/unplanned delivery, bad obstetric history, interval between pregnancies, previous history of LBW, underlying disease, tobacco chewing, timing of first antenatal care (ANC) visit, total number of ANC visit, and iron and folic acid (IFA) tablets consumption with LBW. No significant association was found among maternal age, residence, caste, consanguinity of marriage, socioeconomic status, gravida, birth order, multiple pregnancy, and smoking with LBW in our study. It was concluded that hemoglobin level, weight gain during pregnancy, gestational age, planned/unplanned delivery, bad obstetric history, and IFA tablets consumption during pregnancy were independent risk factors for LBW.
Huda, Fauzia Akhter; Ahmed, Anisuddin; Dasgupta, Sushil Kanta; Jahan, Musharrat; Ferdous, Jannatul; Koblinsky, Marge; Ronsmans, Carine; Chowdhury, Mahbub Elahi
Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases--either spontaneous or induced--were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh.
Martins, Enrique; Varea, Ana; Apezteguía, María; González, Horacio F; Girardelli, Ana; Caro, Laura Sanchez; Lobisuto, Mario; Delgado, Griselda; Disalvo, Liliana
Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning. Copyright © 2013 Elsevier B.V. All rights reserved.
Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S
This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post
Ghazi, A.; Karim, F.; Hussain, M.; Ali, T.; Jabbar, S.
Background: In the past 30 years the rate of caesarean section (C/S) has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. Method: It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. Results: There were 50 patients in each group. In group A, 11 (22%) were booked and 33 (66%) were referred cases. In group B, 48 (96%) were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 (20%) patients in group A, and 39 (78%) patients in group B, placenta previa, chorioamionitis, obstructed labour (6, 12% each); pregnancy induced hypertension and eclampsia in 5 (10%) cases in group A only. Intra-operative complications in group A were 48 (96%) vs 15 (30%) in group B (p=0.000). Postoperative morbidity in group A was 50 (100%) and 26 (52%) in group B (p=0.000). Intra-operative complication was haemorrhage in 46 (92%) cases in group A and 11 (22%) in group B. Anaesthetic complications were 40 (80%); prolonged intubation 25 (50%), aspiration of gastric contents 8 (16%), and difficult intubation 7 (14%) in group A. Ten (20%) cases had anaesthetic complications in group B
de Jonge, Ank; Mesman, Jeanette A J M; Manniën, Judith; Zwart, Joost J; van Dillen, Jeroen; van Roosmalen, Jos
To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Cohort study using a linked dataset. Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. 146 752 low risk women in primary care at the onset of labour. Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). Low risk
Nove, Andrea; Berrington, Ann; Matthews, Zo?
Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, an...
Pembe, A.B.; Paulo, C.; D'mello, B.S.; van Roosmalen, J.
Background: Improving maternal health is one of the eight millennium development goals adopted at the millennium summit in the year 2000. Within this frame work, the international community is committed to reduce the maternal mortality ratio by 75% between 1990 and 2015. The objective of this study
Wrammert, Johan; Sapkota, Sabitri; Baral, Kedar; Kc, Ashish; Målqvist, Mats; Larsson, Margareta
The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation. Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Dobanovacki, Dusanka; Breberina, Milan; Vujosević, Bozica; Pećanac, Marija; Zakula, Nenad; Trajković, Velicko
In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.
Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael
Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase
Full Text Available Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II was preceded (Phase I by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III. In Phase III, a significantly higher percentage of mothers: (a received help to breastfeed, and also received correct information on breastfeeding and community support, (b started breastfeeding within two hours from delivery, (c reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth.
Calderón-Garcidueñas, Ana Laura; Martínez-Salazar, Griselda; Fernández-Díaz, Héctor; Cerda-Flores, Ricardo M
The aim was to study the causes of maternal mortality (MM) and the percent of concordance between the clinical diagnosis and the autopsy findings. The autopsies of maternal death (1980-1999) from the Hospital de Especialidades, Centro Médico del Noreste, IMSS in Monterrey, México, were analyzed. The cases were classified in directly obstetric maternal mortality (DOM) and indirectly obstetric maternal mortality (IOM), the causes were studied and the percent of concordance between pre- and post-mortem diagnosis was determined. There were 124 deaths. Autopsy was performed in 61 (49.1%) women. In 55 cases the clinical file and the autopsy protocol were available. This was our sample for study. Sixty percent of the cases were DO. Causes of DOM were: specific hypertensive pregnancy disease (SHPD) (51.6%), sepsis (35.5%), hypovolemic shock (9.7%), anesthetic accidents (3%); causes of IOM were: sepsis (41.7%), malignancies (16.7%), hematological diseases (12.5%), cardiopathy and systemic arterial hypertension (12.5%), hepatic disorders (12.5%), and Superior Longitudinal Sinus thrombosis (4%). A 100% clinical-pathological concordance was observed in DOM cases, while only a 41.6% was found in IOM cases. In those cases of sepsis (IOM), the etiologic agents were identified only in 20% before death. The early detection and treatment of SHPD and the prevention of sepsis should decrease the MM. This study showed some weakness in the Health Services that should be improved.
Gabkika Bray Madoue
Full Text Available Background: Post-partum haemorrhage defined as blood loss after delivery over 500mls, affects all countries and is the commonest cause of maternal mortality. It is a frequent obstetric emergency in developing countries. Objective: To identify the causes of post-partum haemorrhage and identify adequate management of immediate post-partum haemorrhage and thus reduce maternal mortality. Patients and methods: This was a prospective and descriptive study of one year from 1st January 2014 to 31stDecember 2014 conducted at South N’Djamena district hospital. Before including a patient in our survey her consent was obtained after explaining to her the need for the survey. All consenting patients with post-partum haemorrhage were included. Data were analyzed using SPSS17.0. Results: We recorded 100 cases of post-partum haemorrhage among 6815 deliveries giving an incidence of 1.47%. The average age of the women was 25.0 years. The majority of deliveries (90% were vaginal. The main cause of immediate post-partum haemorrhage was a third stage of labour bleeding (66% followed by genital lesions (32%. The management was medical (uterotonic drug, fluid replacement and blood transfusion, obstetric (manual removal of placenta or clot, and surgical (suture of lesions, vascular ligature and hysterectomy. There were two maternal deaths (2%. Conclusion: Post-partum haemorrhage is often fatal in our region. Preventive measures and efficient management can help to improve maternal prognosis.
Qaiser, D.H.; Ghori, G.M.; Sandila, M.P.; Omair, A.
Objective: To determine any significant correlation between the routine haematological parameters of maternal blood and umbilical cord blood of their respective newborns. Study Design: Cross sectional study. Place and Duration of Study: The study was conducted at four public and private hospitals of Karachi including Sindh Government Qatar Hospital, Sindh Government Hospital, Liaquatabad, Ziauddin University Hospital and Chinniot Maternity and Child Hospital, respectively from July 2006 to April 2008. Methodology: Three milliliters venous blood was collected in EDTA containing tube for complete blood count of mothers before delivery. Five milliliters cord blood was collected from the umbilical cord of the babies immediately after delivery by clamping and cutting the babies' end of the cord. For haematological parameters a standard coultergram was done including haemoglobin, RBCs count, haematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cell count, differential leukocyte count and platelet count. Pearson's correlation co-efficient was used to determine an association between the maternal and cord blood parameters. Results: A total of 404 maternal and umbilical cord blood samples were analyzed. All the blood parameters including haemoglobin, RBCs count, HCT, MCV, MCH, white blood cell count, differential leukocyte count and platelet count were found to be high in cord blood as compared to the maternal blood, but they showed a very weak to negligible correlation. Mean Corpuscular Haemoglobin Concentration (MCHC), showed a moderate correlation. Conclusion: Routine haematological parameters of newborns are independent of maternal routine haematological parameters. (author)
Benn, Christine Stabell; Thorsen, Poul; Jensen, Jørgen Skov
the establishment of the infant flora and, as a consequence, the development of wheezing and allergic diseases. OBJECTIVE: We sought to study the associations between the composition of the maternal vaginal microflora and the development of wheezing and asthma in childhood. METHODS: We performed a population......-based cohort study in Denmark. Vaginal samples for bacterial analysis were obtained during pregnancy. A total of 2927 women (80% of the invited women) completed the study and had 3003 live infants. Infant wheezing was assessed as one or more hospitalizations for asthma between 0 and 3 years of age. Asthma...... was assessed as use of 3 or more packages of antiasthma medication between 4 and 5 years of age. RESULTS: Maternal vaginal colonization with Ureaplasma urealyticum during pregnancy was associated with infant wheezing (odds ratio [OR], 2.0; 95% CI, 1.2-3.6), but not with asthma, during the fifth year of life...
Braat, Floris; Vermeiden, Tienke; Getnet, Gashaw; Schiffer, Rita; van den Akker, Thomas; Stekelenburg, Jelle
To examine the impact of a maternity waiting home (MWH) by comparing pregnancy outcomes between users and non-users at hospitals with and without an MWH. We conducted a retrospective cohort study in Ethiopia comparing one hospital with an MWH (Attat) to a second hospital without one (Butajira). A structured questionnaire among sampled women in 2014 and hospital records from 2011 to 2014 were used to compare sociodemographic characteristics and pregnancy outcomes between Attat MWH users and non-MWH users, Attat MWH users and Butajira, and Attat non-MWH users and Butajira. χ2 or ORs with 95% CIs were calculated. Compared with Attat non-MWH users (n=306) and Butajira women (n=153), Attat MWH users (n=244) were more often multiparous (multipara vs primigravida: OR 4.43 [95% CI 2.94 to 6.68] and OR 3.58 [95% CI 2.24 to 5.73]), less educated (no schooling vs secondary school: OR 2.62 [95% CI 1.53 to 4.46] and OR 5.21 [95% CI 2.83 to 9.61], primary vs secondary school: OR 4.84 [95% CI 2.84 to 8.25] and OR 5.19 [95% CI 2.91 to 9.27]), poor (poor vs wealthy: OR 8.94 [95% CI 5.13 to 15.61] and OR 12.34 [95% CI 6.78 to 22.44] and further from the hospital (2 h 27 min vs 1 h 00 min and 1 h 12 min: OR 3.08 [95% CI 2.50 to 3.80] and OR 2.18 [95% CI 1.78 to 2.67]). Comparing hospital records of Attat MWH users (n=2784) with Attat non-users (n=5423) and Butajira women (n=9472), maternal deaths were 0 vs 20 (0.4%; p=0.001) and 31 (0.3%; p=0.003), stillbirths 38 (1.4%) vs 393 (7.2%) (OR 0.18 [95% CI 0.13 to 0.25]) and 717 (7.6%) (OR 0.17 [95% CI 0.12 to 0.24]) and uterine ruptures 2 (0.1%) vs 40 (1.1%) (OR 0.05 [95% CI 0.01 to 0.19]) and 122 (1.8%) (OR 0.04 (95% CI 0.01 to 0.16]). No significant differences were found regarding maternal deaths and stillbirths between Attat non-users and Butajira women. Attat MWH users had less favourable sociodemographic characteristics but better birth outcomes than Attat non-users and Butajira women. © The Author(s) 2018. Published by Oxford
Full Text Available BACKGROUND: Preterm birth, the birth of an infant prior to 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Preterm infants are at greater risk of respiratory, gastrointestinal and neurological diseases. Despite significant research in developed countries, little is known about the causes of preterm birth in many developing countries, especially China. This study investigates the association between sciodemographic data, obstetric risk factor, and preterm birth in five Maternal and Child Health hospitals in Beijing, China. METHODS AND FINDINGS: A case-control study was conducted on 1391 women with preterm birth (case group and 1391 women with term delivery (control group, who were interviewed within 48 hours of delivery. Sixteen potential factors were investigated and statistical analysis was performed by univariate analysis and logistic regression analysis. Univariate analysis showed that 14 of the 16 factors were associated with preterm birth. Inter-pregnancy interval and inherited diseases were not risk factors. Logistic regression analysis showed that obesity (odds ratio (OR = 3.030, 95% confidence interval (CI 1.166-7.869, stressful life events (OR = 5.535, 95%CI 2.315-13.231, sexual activity (OR = 1.674, 95%CI 1.279-2.191, placenta previa (OR 13.577, 95%CI 2.563-71.912, gestational diabetes mellitus (OR = 3.441, 95%CI1.694-6.991, hypertensive disorder complicating pregnancy (OR = 6.034, 95%CI = 3.401-10.704, history of preterm birth (OR = 20.888, 95%CI 2.519-173.218 and reproductive abnormalities (OR = 3.049, 95%CI 1.010-9.206 were independent risk factors. Women who lived in towns and cities (OR = 0.603, 95%CI 0.430-0.846, had a balanced diet (OR = 0.533, 95%CI 0.421-0.675 and had a record of prenatal care (OR = 0.261, 95%CI 0.134-0.510 were less likely to have preterm birth. CONCLUSIONS: Obesity, stressful life events, sexual activity, placenta previa
Monincx, W. M.; Birnie, E.; Zondervan, H. A.; Bleker, O. P.; Bonsel, G. J.
To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. A university hospital. Three groups: 130 high-risk
Stoll, Kathrin H; Hauck, Yvonne L; Hall, Wendy A
Australian caesarean birth rates have exceeded 30% in most states and are approaching 45%, on average, in private hospitals. Australian midwifery practice occurs almost exclusively in hospitals; less than 3% of women deliver at home or in birthing centres. It is unclear whether the trend towards hospital-based, high interventionist birth reflects preferences of the next generation of maternity care consumers. We conducted a descriptive cross-sectional online survey of 760 Western Australian (WA) university students in 2014, to examine their preferences for place of birth, type of maternity care, mode of birth and attitudes towards birth. More students who preferred midwives (35.8%) had vaginal birth intentions, contested statements that birth is unpredictable and risky, and valued patient-provider relationships. More students who preferred obstetricians (21.8%) expressed concerns about childbirth safety, feared birth, held favourable views towards obstetric technology, and expressed concerns about the impact of pregnancy and birth on the female body. One in 8 students preferred out-of-hospital birth settings, supporting consumer demand for midwife-attended births at home and in birthing centres. Stories and experiences of friends and family shaped students' care provider preferences, rather than the media or information learned at school. Students who express preferences for midwives have significantly different views about birth compared to students who prefer obstetricians. Increasing access to midwifery care in all settings (hospital, birthing centre and home) is a cost effective strategy to decrease obstetric interventions for low risk women and a desirable option for the next generation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
He, W J; Xia, J H; Lv, X; Li, L M
Objective: To investigate the current status of depression and anxiety among female staff in a maternal and child health hospital, and to provide a basis for developing related prevention and intervention measures and promoting the mental health of female staff. Methods: The female staff from a provincial maternal and child health hospital completed a psycho-health questionnaire survey on Internet from June to October, 2016. The questionnaires used in the survey consisted of Patient Health Questionnaire (PHQ-9) , Generalized Anxiety Disorder Scale (GAD-7) , and Symptom Checklist-90 (SCL-90) . The distribution features of mental health problems such as depression and anxiety were analyzed according to the results: of the questionnaire survey. Results Of all female staff surveyed, 42.04% showed depression symptoms, 28.90% showed anxiety symptoms, and 26.12% showed comorbid symptoms of depression and anxiety. Moderate or severe depression (anxiety) was mainly distributed among the female staff with comorbid symptoms (90.63% and 97.01%, respectively) . There were significant differences in the distribution of moderate or severe anxiety symptoms between the medical staff and nursing staff (χ(2)= 5.81, P =0.05) and between those with intermediate and junior professional titles (χ(2)=7.99, P =0.018) . As for SCL-90 results, the total score, total average score, and scores on factors of somatization, compulsion, interpersonal sensitivity, depression, and anxiety in the female staff with comorbid symptoms, moderate or severe depression, and moderate or severe anxiety were significantly higher than the national norm ( P staff with comorbid symptoms than in the female staff with a single symptom and asymptomatic female staff (both P staff in the maternal and child health hospital, mainly characterized by comorbid symptoms of moderate or severe depression and anxiety. Comorbidity is accompanied by mental health problems such as interpersonal sensitivity, obsessive compulsion
Kildea, Sue; McGhie, Alexandra C; Gao, Yu; Rumbold, Alice; Rolfe, Margaret
Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, pmaternity units in Australia, r=-0.804, n=19 years, pmaternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
A program of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham. (Author)
Borrelli, Sara E; Locatelli, Anna; Nespoli, Antonella
to investigate the early pushing urge (EPU) incidence in one maternity unit and explore how it is managed by midwives. The relation to some obstetric outcomes was also observed but not analysed in depth. prospective observational study. Italian maternity hospital. 60 women (44 nullips and 16 multips) experiencing EPU during labour. the total EPU incidence percentage was 7.6%. The single midwives' incidences range had a very wide margin, noting an inverse proportion between the number of diagnoses of EPU and midwife's waiting time between urge to push and vaginal examination. Two care policies were adopted in relation to the phenomenon: the stop pushing technique (n=52/60) and the 'let the woman do what she feels' technique (n=8/60). In case of stop pushing techniques, midwives proposed several combined techniques (change of maternal position, blowing breath, vocalisation, use of the bath). The EPU diagnosis at less than 8cm of cervical dilatation was associated with more medical interventions. Maternal and neonatal outcomes were within the range of normal physiology. An association between the dilatation at EPU diagnosis and obstetric outcomes was observed, in particular the modality of childbirth and perineal outcomes. this paper contributes new knowledge to the body of literature around the EPU phenomenon during labour and midwifery practices adopted in response to it. Overall, it could be argued that EPU is a physiologic variation in labour if maternal and fetal conditions are good. Midwives might suggest techniques to woman to help her to stay with the pain, such as change of position, blowing breath, vocalisation and use of the bath. However, the impact of policies, guidelines and culture on midwifery practices of the specific setting are a limitation of the study because it is not representative of other similar maternity units. Thus, a larger scale work should be considered, including different units and settings. The optimal response to the phenomenon
Kumar, Santhosh; Tadakamadla, Jyothi; Tibdewal, Harish; Duraiswamy, Prabu; Kulkarni, Suhas
To estimate the prevalence and severity of dental caries along with the treatment needs; to determine the factors that influence dental caries status among pregnant women attending a district maternity hospital in Udaipur, India. Study sample comprised of 206 pregnant women attending a district maternity hospital in Udaipur, India. Clinical data were collected on dental caries by DMFT and treatment needs as described in World Health Organization Dentition status and Treatment needs. The overall caries prevalence was 87%. Mean caries experience differed significantly among women in various trimesters, it was found to be 3.59 and 3.00 in 1st and 2nd trimester subjects respectively while it was greatest (4.13) among those in 3rd trimester. One surface filling was the most predominant treatment need. Age and occupation of husband explained a variance of 6.8% and 4.2% for decayed and filled components respectively while the only predictor for missing teeth and DMFT that explained a variance of 9.6% and 5.7% respectively was trimester of pregnancy. Dental caries experience and the need for one surface restoration increased with age. Trimester of pregnancy was a significant predictor for missing teeth and DMFT, while decayed teeth and filled teeth were influenced by age and socio-economic level respectively. Key words:Dental caries, treatment needs, pregnant, age, trimester.
Payman Anwar Rashid
Full Text Available Background and objective: Miscarriage represents a common problem that occurs in the first trimester of pregnancy. There is no general agreement on the value of submitting tissues from uterine evacuation in cases of miscarriage for histopathological examination. This study aimed to evaluate the role of histopathological examination in cases of first-trimester miscarriage. Methods: This is a descriptive study was carried out over a period of 14 months, from January 2015 to March 2016, at Erbil Maternity Hospital. A total of 375 biopsies from patients admitted to maternity hospital with the diagnosis of the first trimester miscarriage and cases of spontaneous miscarriage were included in this study. The clinical data including age, parity, gestational age, clinical diagnosis, the method of evacuation, and other relevant information were collected and submitted for histopathological examination. Results: Incomplete miscarriage was the commonest type of miscarriage and constituted 65.3% of the studied group and surgical evacuation was the most common method of termination. The histopathology reports confirmed the pregnancy in all patients and revealed retained product of normal pregnancy in 315 (86.6% cases, partial mole in 15 (4% patients, complete hydatidiform mole in one (0.2% case, decidual reaction in 21 (5.6% cases and no product of conception in 13 (3.4% cases. Conclusion: Histopathological examination of the products of conception is an important method in detecting undiagnosed molar pregnancy that needs special follow-up and further management.
... Quality Control Region. 81.41 Section 81.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.41 Metropolitan Birmingham Intrastate Air Quality Control Region. The Metropolitan Birmingham Intrastate Air Quality Control Region (Alabama) has been revised to consist of the...
Fifty years ago, the Reverend Dr. Martin Luther King Jr. wrote his "Letter from a Birmingham Jail." In exploring the story of the events behind the essay, and the Supreme Court case that resulted, "Walker v. Birmingham", 399 U.S. 307 (1967), educators will find a pedagogically powerful lens through which to review the seminal…
Birmingham Rep, a leading producing theatre based in the UK's "second city", has historically had a complex relationship with the cultural priorities of its home city. In recent years, Birmingham City Council has faced multiple challenges represented by debt burden, government-imposed cuts in public funding, scandals linked to failing…
Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter
Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.
Atherton, Daniel Stephen; Reilly, Stephanie
Rates of autopsied deaths have decreased significantly for the last several decades. It may not be practical for some institutions to maintain the facilities and staffing required to perform autopsies. In recent years, the University of Alabama at Birmingham (UAB) has established contracts to perform autopsies for several regional institutions including the Alabama Department of Forensic Sciences (ADFS), the United States Veterans Affairs, the local prison system, local community hospitals, and with families for private autopsy services. Contracts and autopsy data from 2004 to 2015 were obtained and reviewed. Since 2004, the number of UAB hospital autopsies trended slightly downward. On average, UAB hospital cases comprised most yearly cases, and the ADFS was the second largest contributor of cases. Income generated from outside autopsies performed from 2006 to 2015 totaled just more than 2 million dollars, and most of the income was generated from referred ADFS cases. This study provides evidence that a centralized institution (regional autopsy center [RAC]) can provide regional autopsy service in a practical, feasible, and economically viable manner, and a RAC can benefit both the referring institutions as well as the RAC itself.
Full Text Available Background: Burnout in healthcare workers, especially among nurses, can have an impact on overall healthcare delivery system. For health in general and maternal health in particular, wellbeing of healthcare workers, including nurses, is of paramount importance. Material and methods: This study aimed to assess burnout among nurses working in the maternity department. One hundred nurses of a tertiary care centre, selected by non-purposive convenient sampling, were examined by a standardised questionnaire. Data were analysed by descriptive statistics. Results: Burnout in depersonalisation was moderate while that in emotional exhaustion and personal achievement were of low-levels. Conclusion: Understanding the nature of the problem of burnout can guide in better management.
Full Text Available ‘Maternal near-miss’ is defined as a woman who nearly died during pregnancy or following delivery but survived. The story of many women in sub Saharan Africa is that of an escape from death if they do eventually have a safe delivery.1This situation is not unconnected to several factors as it concerns these women, their families, the society and the choices they make.
Full Text Available BACKGROUND: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality. AIM: To evaluate maternal complications associated with severe preeclampsia. METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001, HELLP syndrome (2.4% vs. 11.0%; P < 0.001, stroke (0.5% vs 1.9%, P = 0.105 pulmonary edema (0.25% vs. 1.3%, P = 0.0035, renal failure (0.9% vs. 2.6%, P = 0.107, admission in ICU (19.5% vs. 71.4%, P = 0.007, caesarean section rates (55.5% vs. 77%, P = 0.508, placental abruption (4.3% vs. 7.8%, P = 0.103 and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628. CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications.
Dejene Ermias Mekango
Full Text Available In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. "Maternal near miss" (MNM, defined by the World Health Organization (WHO as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia.Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6 public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression ("odds ratio" analyses were calculated at 95% CI.Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37-41 weeks. Among cases, severe obstetric hemorrhage (44.7%, hypertensive disorders (38.8%, dystocia (17.5%, sepsis (9.7% and severe anemia (2.9% were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2
Parveen, T; Begum, F; Akhter, N
Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.
Kaewsuksai, Peeranan; Chandeying, Verapol
The aim of the present study was to examine the maternal and neonatal birth risk indicator and their relationship with the outcome of pregnancy. This retrospective descriptive study was conducted in a selective month of 2008, 2009, and 2010. The birth risk indicators of maternal and neonatal health were collected from the medical records. There were 385, 349 and 334 deliveries in a selective month of 2008, 2009, and 2010. There was neither maternal mortality, nor cardiovascular failure in the present study period. Three main indication of inductions of labor were premature rupture of membrane (up to 4.0%), diabetes mellitus (up to 2.0%), and postdate (up to 1.3%). The first two conditions had statistical significance in September 2009 (p = 0.0334 and 0.0053 respectively). Whereas, the three major indications of cesarean section were previous cesarean section (12.5 to 21.9%), failure to progress due to protracted/arrest of labor pattern with/without rupture of membrane and augmented labor (2.4 to 7.5%), and fetal distress (1.1 to 4.2%). The rates of low birth weight, less than 2,500 grams, were varied from 5.2 to 6.9%. The respiratory distress syndrome (RDS) related to repeat cesarean section was encountered up to 3.6%, as well as the RDS related to induction of labor was up to 1.6%. The birth risk indicators reflect the outcome of pregnancy, however the development of additional key indicators for perinatal health care outcome are required.
Ana Marina Tzul
Full Text Available OBJETIVO: Estimar la asociación entre características obstétricas, sociodemográficas y factores de riesgo relacionados con la mortalidad materna hospitalaria y no hospitalaria en Guatemala durante el año 2000 MATERIAL Y MÉTODOS: Se realizó un estudio epidemiológico transversal con 649 casos de muertes maternas (MM ocurridas en la República de Guatemala durante el año 2000, en el que se compararon las características de las muertes maternas hospitalarias y no hospitalarias RESULTADOS: De 649 MM registradas, 270 (41.6% se clasificaron como MM hospitalarias y 379 (58.4% como MM no hospitalarias. La mayor proporción de muertes ocurrió en mujeres mayores de 35 años de edad (29.28%, indígenas (65.49%, casadas o unidas (87.83%, con ocupación no remunerada (94.78%, sin educación (66.56%. El riesgo de MM no hospitalaria fue mayor en mujeres del grupo indígena (RM= 3.4; IC95% 2.8-5.3, con ocupación no remunerada (RM= 8.95; IC95% 1.7-46.4, bajo nivel escolar (RM= 1.96; IC95% 1.0-3.8, y hemorragia como causa básica de muerte (RM= 4.28; IC95% 2.3-7.9 CONCLUSIONES: De los 679 casos de MM ocurridas en Guatemala en el año 2000, 58% correspondió a MM no hospitalarias, lo que puede estar relacionado con el hecho de que una alta proporción de la población habita en áreas rurales o de alta marginalidad, además de aspectos culturales (mayoría indígena que dificultan la accesibilidad a los servicios de salud. Los resultados presentados pueden servir de orientación para determinar estrategias de intervención que prevengan la mortalidad materna en los ámbitos hospitalario y extrahospitalario, en Guatemala.OBJECTIVE:To estimate the association between obstetric and socio-demographic characteristics and risk factors related to intra- and extra-hospital maternal mortality in Guatemala during the year 2000 MATERIALS AND METHODS: A cross-sectional epidemiologic study was carried out in 649 maternal mortality (MM cases that occurred in
Najmi, N.; Sikandar, R.; Zuberi, N.F.
Objectives: To determine the prevalence of Group B Streptococcus genital tract infection in pregnant women and to determine the risk factors for its colonisation. Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi and Sobhraj Hospital, Karachi, from May to August 2007. Pregnant women at 35-37 weeks gestation attending antenatal clinic at these hospitals constituted the study population. Based on stratified sampling, 405 patients were recruited. High vaginal swabs of these patients were taken in order to calculate the prevalence of infection at each hospital. Logistic regression was used to evaluate the risk factor association. SPSS 11.5 was used for statistical analysis. Results: The overall prevalence of colonisation was 17% (n=69) (95% CI: 13.4-20.7). Of the 155(38.27%) women at the Aga Khan Hospital, 35(22.6%) were positive, while among the 250 (61.72%) women at Sobhraj Hospital, the prevalence was 13.6% (n=34). The colonisation was found to be significantly associated inversely with the body mass index of the patient (OR 0.91; 95% CI: 0.08-1.0). Conclusion: Group B Streptococcus screening should be an integral part of antenatal care and should be offered to all pregnant women. (author)
Saeed, M.K.; Al-Qahtani, J.M.
The entrance skin dose (ESD) of chest X-ray examinations for AP and PA projections of paediatric patients at Maternity and Children Hospital in Najran, Saudi Arabia have been obtained using DoseCal software. The majority of the results obtained show low measured ESD for chest X-ray examinations. The mean of ESD for the AP projection was found to be 37.5, 40.5, 41.3, and 52.3μGy for age groups 0−1, >1−5, >5−10, and >10−15 years respectively. However, the ESD for PA projection was found to be 50.7 and 56.7μGy for age groups >5−10, and >10−15 years respectively.
Mateja Šerbec Medjimurec
Full Text Available Background: The purpose of the research was to determine the prevalence and location of diastasis recti abdominis muscle (DRA during pregnancy and puerperium in women in the Ljubljana maternity hospital. Methods: The study sample included sixty randomly selected women; forty-five pregnant and postpartum women were recruited from the Ljubljana Maternity Hospital, and fifteen non-pregnant women from the larger Ljubljana area as a control group. All women were examined for the presence or absence of diastasis recti abdominis muscle along with the most and least likely location along the white lines. The measurements were performed by the finger-width method. Results: The findings indicate that the diastasis recti abdominis muscle increases with the progression of pregnancy. In the case of non-pregnant women, the diastasis is not present. The presence of DRA was first observed in the second trimester of pregnancy (9.5 % and was most common in the third trimester (52.4 %. After birth, the incidence decreased (38.1 %. The majority of diastasis recti abdominis cases were observed in the umbilical area (52.6 % in the third trimester. In the puerperium group three days after childbirth the diastasis below the umbilicus was most common (60.0 % and slightly less common above the umbilicus (53.8 %. Conclusion: Diastasis recti abdominis muscle during pregnancy and after childbirth is a common condition. It is therefore recommended that all women should be timely examined for the presence of DRA before and after birth along the linea alba to start timely and adequate physiotherapy treatment. Health professionals as well as sports teachers and coaches who work with pregnant and puerperium women should be educated/trained in the field of testing and treatment of diastasis recti abdominis muscle.
Full Text Available Intimate partner violence (IPV is the most prevalent form of gender-based violence worldwide. IPV either before or during pregnancy has been documented as a risk factor for the health of the mother and her unborn child. The aim of this study was to examine the relationship between maternal experience of IPV and low birth weight (LBW.A hospital-based survey was conducted among women in the postnatal wards of a large public hospital at Rajshahi, Bangladesh. Data on socio-economic characteristics, reproductive health characteristics, intimate partner violence, and antenatal, delivery and newborn care were collected from 400 women between July 2015 and April 2016.Results of this study indicated that 43% of women reported experiencing any physical IPV in their lifetime, 35.5% of them experienced sexual IPV, and 32.5% experienced both physical and sexual IPV. Approximately one in every three (29.2% infants was born with LBW. Physical IPV was associated with an increased risk of having a child with low birth weight (adjusted odds ratio [AOR]: 3.01, 95% CI: 2.35-5.81. The risk of infants born with LBW increased with women's lifetime experience of sexual IPV (AOR: 1.98; 95% CI: 1.23-4.15 and both physical and sexual IPV (AOR: 4.05; 95% CI: 2.79-7.33.Maternal lifetime experience of IPV is positively associated with LBW children. Preventing women from the experience of IPV may help improve neonatal and child mortality in Bangladesh.
Kim, Hyung Jin; Kim, Soo Young; Seo, Won Hee; Choi, Byung Min; Yoo, Young; Lee, Kee Hyoung; Eun, Baik Lin; Kim, Hai Joong
During a four-week period, four healthy term newborn infants born at a regional maternity hospital in Korea developed late-onset neonatal group B Streptococcus (GBS) infections, after being discharged from the same nursery. More than 10 days after their discharge, all of the infants developed fever, lethargy, and poor feeding behavior, and were subsequently admitted to the Korea University Medical Center, Ansan Hospital. GBS was isolated from the blood cultures of three babies; furthermore, G...
Ikpim, Ekott Mabel; Edet, Udo Atim; Bassey, Akpan Ubong; Asuquo, Otu Akaninyene; Inyang, Ekanem Etim
Human immunodeficiency virus (HIV) infection is likely to have untoward effects on pregnancy and its outcome. This study assessed the impact of maternal HIV infection on pregnancy outcomes in a tertiary centre in Calabar, Nigeria. This retrospective study analysed delivery records of 258 HIV-positive and 257 HIV-negative women for pregnancy and delivery complications. Maternal and fetal outcomes of HIV-positive pregnancies were compared with those of HIV-negative controls. Adverse pregnancy outcomes significantly associated with HIV status were: anaemia: 33 (8.1%) vs. 8 (3.1%) in controls; puerperal sepsis: 18 (7%) vs. 2 (0.8%); and low birth weight: 56 (21.7%) vs. 37 (14.4%). Caesarean delivery was higher among HIV-positive women than controls: 96 (37.2%) vs. 58 (22.6%). Preterm births were higher in those HIV cohorts who did not receive antiretroviral therapy (ART): 13 (16.9%) vs. 7 (3.9%). HIV-positive status increased adverse birth outcome of pregnancy. ART appeared to reduce the risk of preterm births in HIV-positive cohorts. © The Author(s) 2015.
Feigal, David W; Smith, Ruben A; Fuddy, Loretta J
Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai‘i were analyzed for 107,034 singleton births from 2003–2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401–405,642) as coded on the delivery record, low birth weight (4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1–4.4%), maternal diabetes was present in 7.7% (95% CI=7.6–7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0–9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed. PMID:24567868
Hayes, Donald K; Feigal, David W; Smith, Ruben A; Fuddy, Loretta J
Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.
Ribarova, N; Todorova, M; Khristov, Kh
The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified. 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually. A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period. Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children. The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.
Kataoka, Yaeko; Masuzawa, Yuko; Kato, Chiho; Eto, Hiromi
In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes. © 2017 Japan Academy of Nursing Science.
Khorrami, Homa; Karzai, Fatima; Macri, Charles J; Amir, Azizullah; Laube, Douglas
Since the Department of Health and Human Services chose Rabia Balkhi Hospital (RBH) in Kabul, Afghanistan, as a site for intervention in 2002, the status of women's health there has been of interest. This study created a tool to assess accessibility and quality of care of women admitted from May to July, 2005. A 39-item questionnaire was created in English and translated into Dari. Hospital staff administered the survey to 292 women admitted to RBH for obstetric and gynecological complaints. Approximately 40% of the women traveled between 1 and 5 hours to reach RBH. Only 54% (158/292) of women reported having their blood pressure monitored during their pregnancy. About one-third of women reported that they had never received an immunization. This survey tool ascertained that women who received care at RBH traveled great lengths to reach the facility. Preventative measures such as blood pressure checks and immunizations are areas that need improvement.
Tsai, Tzu-I; Huang, Shu-Her; Lee, Shoou-Yih D
Continuity of breastfeeding is infrequent and indeterminate. Evidence is lacking regarding factors associated with breastfeeding at different postpartum time points. This prospective study investigated the change in, and correlates of, breastfeeding practices after delivery at a hospital and at 1, 3, and 6 months postpartum among first-time mothers. We followed a cohort of 300 primiparous mothers of Taiwan who gave birth at two hospitals during 2010-2011. Logistic and Cox regression analyses were performed to determine factors that were correlated with breastfeeding practices. In the study sample, the rate of exclusive breastfeeding during the hospital stay was 66%; it declined to 37.5% at 1 month and 30.2% at 3 months postpartum. Only 17.1% of women reported continuing breastfeeding at 6 months. Early initiation of breastfeeding, rooming-in practice, and self-efficacy were significantly related to exclusive breastfeeding during the hospital stay. After discharge, health literacy, knowledge, intention, and self-efficacy were positively and significantly associated with breastfeeding exclusivity. Later initiation (hazard ratio=1.53; 95% confidence interval, 1.05, 1.97), shorter intention (hazard ratio=1.42; 95% confidence interval, 1.13, 1.68), and self-efficacy (hazard ratio=0.98; 95% confidence interval, 0.96, 0.99) were important predictors of breastfeeding cessation within 6 months of delivery. Continuous breastfeeding practice for 6 months is challenging and difficult for new mothers. Results showed that factors related to breastfeeding varied over time after delivery. Interventions seeking to sustain breastfeeding should consider new mothers' needs and barriers at different times.
Izquierdo, Gilda; Trelles, Miguel; Khan, Nasrullah
Introduction: Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009. Method: Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012. Results: 5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = ...
Engelmann, C; Grote, G; Miemietz, B; Vaske, B; Geyer, S
A term of maternity and paternity (parental) leave becomes frequent on the career paths of medical personnel. Hospitals are highly competitive environments. The question employees universally face is how such a leave will alter their personal work situation and prospects upon return. We questioned 709 leave-takers and 88 department heads of a German university hospital (2009-12; full data sets: n = 406 and n = 63) about their experiences. This data was validated by epidemiology data extraction and expert interviews, also in a Swiss and in a Norwegian institution. Parental leave elicited high emotionality (score: 4.0 +/- 2 out of 5). Superiors' appraisal of employees' parental leave was more positive than negative (p leave takers doubled to 39 %; 51 % of leave-takers experienced significant task profile changes. 58 % of doctors thought about changing their employer and 17 % of leave-taking executives lost status after return. Employees' "power" and "influence" dropped significantly (p leave. The Swiss and Norwegian comparators appeared to have more liberal substitution and part-time schemes than the German institution. A competitive hospital environment can effectively demote leave-taking medical employees in their jobs. Despite sufficient financial arrangements high-commitment staff will only take parental leave of adequate length when an institutional framework protects their status. Data support four requirements: 1. Formal recognition of the leave taker's status pre-leave. 2. Establishment of a written ("claimable") return policy. 3. Substitution scheme for each individual, preferably by a locum. 4. Redirection of funds to facilitate part-time work schemes temporarily after return. © Georg Thieme Verlag KG Stuttgart · New York.
Takai, Rei; Nomura, Kyoko; Hiraike, Haruko; Murakami, Aya; Tanabe, Ayumi; Tsuchiya, Akiko; Okinaga, Hiroko
To investigate factors including adherence to "maternal affection" and stereotypical gender roles associated with emotional exhaustion among hospital nurses. In 2014, among 2,690 workers recruited for this study, 891 participated with written informed consent. Of these, we investigated 464 hospital nurses. Adherence to maternal affection and emotional exhaustion were measured using valid and reliable scales developed by Egami (2005, 12 items) and Kubo (1992, 5 items), respectively. Stereotypical gender role was measured by asking "how much do you agree with the idea that women should stay home and men should work?". Workfamily conflict was measured in terms of the discrepancy in priority in life (i.e., a work or a private life) between the participant's ideal and the real world. The majority of our participants were women (86%), aged 39 or younger (80%), and single (70%). About one-quarter had workfamily conflict (26%) and agreed with the stereotypical gender role (28%). The mean scores of emotional exhaustion and adherence to maternal affection were 17.2 (out of 25) and 30.8 (out of 48), respectively. A stepwise multivariable model showed that being a woman (p=0.028), being young (p=0.022), being single (p=0.007), and having workfamily conflict (pgender role were not significantly associated with emotional exhaustion. This study demonstrated that adherence to "maternal affection" and stereotypical gender roles were not associated with psychological burnout. Special attention should be paid to hospital nurses who are women, young, or single, or who have workfamily conflict.
Gestational diabetes mellitus (GDM) is one of the commonest complications of pregnancy. The prevalence varies depending, for example, on the diagnostic criteria, the screening test used, laboratory standards and the population studied. However, the prevalence is increasing globally due to the increasing levels of maternal obesity. The detection of GDM is important because there are clinical consequences. The woman has an increased risk of pre-eclampsia and of developing Type 2 diabetes mellitus (T2DM) in later life. Up to 70% of those women with GDM develop T2DM by 28 years after the affected pregnancy2. In a pregnancy complicated by GDM there is an increased risk of fetal macrosomia and polyhydramnios due to fetal hyperglycaemia3. This is associated with an increased risk of shoulder dystocia and caesarean delivery4. Neonatal hypoglycaemia may develop due to increased insulin production secondary to intrauterine hyperglycaemia. The offspring also have an increased risk in their childhood and adult life for the development of diabetes, obesity and metabolic syndrome5.
Dumont, Alexandre; Fournier, Pierre; Abrahamowicz, Michal; Traoré, Mamadou; Haddad, Slim; Fraser, William D
Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second
Foreman, Paul M; Markert, James M; Diethelm, Arnold G; Hadley, Mark N
: The Division of Neurosurgery at the University of Alabama at Birmingham was formally founded in 1954 under the leadership of James Garber Galbraith. The following 60 years would see neurosurgery at the forefront of the development of a nationally recognized medical center in the heart of Birmingham, Alabama. The Department of Neurosurgery now employs 14 faculty members, performs more than 4500 neurosurgical procedures annually, is active in clinical and laboratory research, and boasts a contemporary, comprehensive residency training program.
Awowole, Ibraheem Olayemi; Badejoko, Olusegun Olalekan; Kuti, Oluwafemi; Ijarotimi, Omotade Adebimpe; Sowemimo, Oluwaseun Oludotun; Ogunduyile, Ifeoluwa Emmanuel
The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels. This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy
Almqvist, C; Örtqvist, A K; Gong, T; Wallas, A; Ahlén, K M; Ye, W; Lundholm, C
Exposure to antibiotics in early life may affect future health. Most antibiotics are prescribed in outpatient care, but inpatient exposure is also important. We estimated how specific diagnoses in hospitals corresponded to individual antibiotic exposure. All pregnant women and children from birth to 5 years of age with infectious diseases and common inpatient diagnoses between July 2005 and November 2011 were identified from the Swedish National Patient Register. Random samples of individuals from predefined groups were drawn, and medical records received from the clinics were manually reviewed for antibiotics. Medical records for 4319 hospital visits were requested and 3797 (88%) were received. A quarter (25%) of children diagnosed as premature had received antibiotics, and in children from one to 5 years of age, diagnoses associated with bacterial infections were more commonly treated with antibiotics (62.4-90.6%) than those associated with viruses (6.3-22.2%). Pregnant women who had undergone a Caesarean section were more likely to be treated with antibiotics than those who had had a vaginal delivery (40.1% versus 11.1%). This study defines the proportion of new mothers and young children who received individual antibiotic treatment for specific inpatient diagnoses in Sweden and provides a useful basis for future studies focusing on antibiotic use. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
[Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].
Fujihara, Satoko; Tsukisawa, Miyoko
The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.
Pauline Lorena Kale
Full Text Available Abstract: We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births and lack of prenatal care (80.8‰ live births. Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2, hemorrhage (OR = 2.2; 95%CI: 1.3-3.9, hypertension (OR = 3.0; 95%CI: 2.0-4.4, syphilis (OR = 3.3; 95%CI: 1.5-7.2, lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7, cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3, lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8 and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.
De Zordo, Silvia
The objective of this qualitative study, carried out in two maternity-hospitals in Salvador da Bahia, was to investigate the experience and representations of health professionals, and particularly obstetricians-gynecologists, regarding legal abortion in comparison with their representations and experience with illegal abortion. A questionnaire was distributed and semi-structured interviews were conducted with 25 health professionals (13 obstetricians-gynecologists) in a hospital providing legal abortion (P) and with 20 health professionals (9 obstetricians-gynecologists) in another hospital that does not provide this service (F). The factors that influence the representations and experience of abortion of most obstetricians-gynecologists and explain the high rate of conscientious objection at Hospital P were: 1- the criminalization of abortion and the fear of being denounced; 2- the stigmatization of abortion by certain religious groups and by the physicians themselves; 3- training in obstetrics and the lack of good training in the epidemiology of maternal morbidity-mortality and abortion; 4- representations on gender relations. The main factors associated with liberal attitudes were: age - under 30 and over 45 years of age - experience with high maternal mortality rates due to abortion and experience with legal abortion.
McLachlan, Helen L; Forster, Della A; Ford, Rachael L; Farrell, Tanya
In Victoria, maternity services are under significant strain due to increased numbers of women giving birth and critical workforce shortages. Hospitals have experienced challenges in adequately staffing maternity units, particularly on postnatal wards. In 2008, a tertiary maternity hospital in Melbourne introduced a model where undergraduate midwifery students were employed as Division 2 nurses (SMW_Div2) (enrolled nurses), to work in the postnatal area only. This study explored the pilot employment model from the perspective of the SMW_Div2 and hospital midwives. A web-based survey was administered to hospital midwives and the SMW_Div2s in the employment model in January 2010. The survey explored the views of midwives and SMW_Div2s regarding the perceived impact of the model on workforce readiness, recruitment and retention, and clinical competence and confidence. Forty-seven of 158 midwives (30%) and five of nine SMW_Div2s employed in the model responded to the survey. Both groups considered the model to have benefits for the organisation, including increased: student workforce readiness; clinical confidence and competence; and organisational loyalty. Both groups also considered that the model would facilitate: workforce recruitment; a teaching and learning culture within the organisation; and enhanced partnerships between students, hospitals and universities. Caution was expressed regarding workload and the need for ongoing support for SMW_Div2s working in the model. SMW_Div2s and midwives were positive about the introduction of the paid employment model at the Women's. The findings are consistent with evaluations of similar programs in the nursing setting. The employment model has potential short and long term individual and organisational advantages, which is important in the context of increasing births and workforce shortages. Progression of such models will be contingent on the collaboration and cooperation of the various stakeholders involved in maternity
Full Text Available Among 2357 prenant women at Tehran Valiasr hospital, 99 women under 18 years with their 102 neonates were evaluated retrospectively during Aprill 1999 to April 2000. frequency of adolescent pregnancy was detected in 41.5 per 1000 live birth 7 (7.1% of mothers had preeclampisa, 7 thyroidal diseases, 3 valvular heart diseases, 2 urinary tract infections and 20.3% of women had prolonged rupture of membrane (more than 24 hrs. the route of delivery in 21.2% of women was cesarean section. 32% of neonates were low birth weight and the gestational age in 38.2% of neonates was lower than 37 weeks. Intrauterine growth retardiation was detected in 11.8% of patients 38.2% of babies were admitted into neonatal care unit. Perinatal resuscitation and ventilator care were needed in 9.8% and 3.9% of neonates respectively. Nonatal mortality occurred in 6.9% of patients. Compared with total deliveries the frequency of variables was higher than could be expected except for cesarean section. Our adolescent pregnancy rate is lower than worldwide range but rates for prematurity and low birth weight are the same as other reports from developed and developing countries. Frequency of cesarean section was lower than expected range in this group as in developed countries.With respect to higher rates for rheumatic heart disease, premature labor, prolonged rupture o membrane and low birth weight, it seems that lower socioeconomic factors may result in these adverse outcomes.Higher neonatal ICU admissions, artificial ventilation and resuscitation in adolescent pregnancies suggest that confinement in hospitals with level III nurseries is advisable in these high risk group
Lukuke, Hendrick Mbutshu; Kasamba, Eric; Mahuridi, Abdulu; Nlandu, Roger Ngatu; Narufumi, Suganuma; Mukengeshayi, Abel Ntambue; Malou, Vicky; Makoutode, Michel; Kaj, Françoise Malonga
In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.
Abadía, César B; Pinilla, María Y A; Ariza, Katerine R; Ruíz, Héctor C S
To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years. A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital
Gibson, S. M.; Gibbard, P. L.; Bateman, M. D.; Boreham, S.
Birmingham is built on a complex sequence of Middle Pleistocene sediments, representing at least three lowland glaciations (MIS12, MIS6, and MIS2). British Geological Survey mapping accounts 75% of the land mass as Quaternary deposits; predominantly glacial-sandy tills, glacial-fluvial sands, clays and organic silts and peats. Understanding the age of fluvial-glacial outwash, related to specific glaciations, is critical in establishing a Geochronology of Birmingham. Shotton (1953) found a series of Middle Pleistocene glacial sediments, termed the Wolstonian, intermediate in age between MIS11 and MIS5e Interglacial's. Uncertainty surrounding the relation to East Anglian sequences developed by Rose (1987) implies Birmingham sequences should be referred to MIS12. Despite this, younger Middle Pleistocene glacial sequences occur in Birmingham, yet uncertainty has deepened over our understanding of the complex, inaccessible sediments, especially as deposits have similar extent with MIS2 sequences. Five Optical Stimulated Luminescence (OSL) dates from three sites around Birmingham have been sampled. East of Birmingham, ice advanced from the Irish Sea and later the North East. In Wolston, a sample of outwash sand, associated with the Thurssington Till, is dated. In Meriden, two samples of outwash sands, associated with a distal Oadby Till, are dated. West of Birmingham, ice advanced from the Welsh Ice Sheet. In Seisdon, two samples of an Esker and outwash sand, associated with a Ridgeacre Till, are dated. Correlation of OSL dates provide an important constraint on understanding the history of Birmingham. Using GSI3D modeling to correlate geochronology and sedimentology, the significance of OSL dating can be understood within the complex sequences (and regional stratigraphy), complimented by Cosmogenic and Palynology dates taken in South West and North East. OSL dating on Birmingham's outwash sands, deposited by extensive repeated Middle Pleistocene glaciations, asserts the
Full Text Available Abstract Background Emerging research evidence suggests a potential benefit in being upright in the first stage of labour and a systematic review of trials suggests both benefits and harmful effects associated with being upright in the second stage of labour. Implementing evidence-based obstetric care in African countries with scarce resources is particularly challenging, and requires an understanding of the cumulative nature of science and commitment to applying the most up to date evidence to clinical decisions. In this study, we documented current practice rates, explored the barriers and opportunities to implementing these procedures from the provider perspective, and documented women's preferences and satisfaction with care. Methods This was an exploratory study using quantitative and qualitative methods. Practice rates were determined by exit interviews with a consecutive sample of postnatal women. Provider views were explored using semi-structured interviews (with doctors and traditional birth attendants and focus group discussions (with midwives. The study was conducted at four government hospitals, two in Dar es Salaam and two in the neighbouring Coast region, Tanzania. Main outcome measures Practice rates for mobility during labour and delivery position; women's experiences, preferences and views about the care provided; and provider views of current practice and barriers and opportunities to evidence-based obstetric practice. Results Across all study sites more women were mobile at home (15.0% than in the labour ward (2.9%, but movement was quite restricted at home before women were admitted to labour ward (51.6% chose to rest with little movement. Supine position for delivery was used routinely at all four hospitals; this was consistent with women's preferred choice of position, although very few women are aware of other positions. Qualitative findings suggest obstetricians and midwives favoured confining to bed during the first
Bickerton, Wai-Ling; Riddoch, M Jane; Samson, Dana; Balani, Alex Bahrami; Mistry, Bejal; Humphreys, Glyn W
The validity and functional predictive values of the apraxia tests in the Birmingham Cognitive Screen (BCoS) were evaluated. BCoS was developed to identify patients with different forms of praxic deficit using procedures designed to be inclusive for patients with aphasia and/or spatial neglect. Observational studies were conducted from a university neuropsychological assessment centre and from acute and rehabilitation stroke care hospitals throughout an English region. Volunteers from referred patients with chronic acquired brain injuries, a consecutive hospital sample of patients within 3 months of stroke (n=635) and a population based healthy control sample (n=100) were recruited. The main outcome measures used were the Barthel Index, the Nottingham Extended Activities of Daily Living Scale as well as recovery from apraxia. There were high inter-rater reliabilities and correlations between the BCoS apraxia tasks and counterpart tests from the literature. The vast majority (88.3%) of the stroke survivors were able to complete the screen. Pantomime and gesture recognition tasks were more sensitive in differentiating between individuals with left hemisphere damage and right hemisphere damage whereas the Multistep Object Use test and the imitation task had higher functional correlates over and above effects of hemiplegia. Together, the initial scores of the four tasks enabled predictions with 75% accuracy, the recovery of apraxia and independence level at 9 months. As a model based assessment, BCoS offers a quick and valid way to detect apraxia and predict functional recovery. It enables early and informative assessment of most stroke patients for rehabilitation planning.
Mowat, Alex; Gardener, Glenn
There are minimal data involving predictors of success of external cephalic version (ECV) in an Australian healthcare setting. To determine the predictors of successful ECV as well as the success rate of ECV and the mode of, and presentation at, delivery for women undergoing ECV for breech presentation from 36-weeks gestation. A prospective review was carried out on all women who had undergone ECV from 36-weeks gestation at the Mater Mothers Hospital over an 8-year period from 2001 to 2008. Data were collected prospectively and were collated in conjunction with database review, chart review and telephonic patient interviews. A total of 355 women underwent ECV for breech presentation. The overall success rate was 66% (57% for nulliparous, 76% for multiparous). A woman who underwent ECV had a 46% chance of a vaginal birth. If the ECV was successful, she had a 70% chance of vaginal birth. From bivariate analysis, parity, amniotic fluid index (AFI) and estimated fetal weight (EFW) were determined to be possible predictors of success of ECV and were included in the logistic regression modelling. In the regression analysis, multiparity increased the odds of successful ECV by 2.18. For every one unit increase in AFI, the odds of successful ECV increased by 1.18. Multiparity and amniotic fluid volume as assessed by AFI were the significant predictors of immediate success of ECV. Conversely, lower AFI and nulliparity are factors that are likely to reduce the likelihood of successful ECV. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Bassett, R.; Thornes, J.; Cai, X.; Rees, R.
The BUCCANEER project is a knowledge transfer partnership between the University of Birmingham and Birmingham City Council to help ensure that the city is prepared for the impacts of climate change. The project will equip service areas such as planners and health protection agencies with the necessary information and tools needed to adapt. UK climate projections indicate a 3.7oC temperature increase for Birmingham, UK by 2080 (medium emissions scenario). The 2003 heat-wave that caused over 2000 deaths in England and Wales will become an average summer by 2040. By the end of the century, the 2003 heat wave will be considered a cool summer. The dense urban fabric of Birmingham, the UK's second largest city, creates a warming effect when compared to surrounding rural areas. Past studies have found the nature of this urban heat island (UHI) to be related to city size, moisture availability, land-use, anthropogenic emissions, building materials and geometry. The UHI effect can lead to heat stress and air pollution problems which are a major health concern. Birmingham's UHI is not currently modelled. More specifically the UK climate projections treat Birmingham as a homogeneous slab of grassland. The inclusions of the urban areas in a climate model will show an intensification of the likely heat risk in future projections. In the present study, the JULES (Joint UK Land Environment Simulator) model has been setup and run for Birmingham and surrounding areas. The UHI was found to be greater than 3.5oC in Birmingham when modelled during heat waves. The model's performance is evaluated against data from two UK Met Office standard sites: Edgbaston (urban) and Winterbourne (rural). The temperatures predicted by the model over a 12 month (2010) simulation show a strong correlation with the observations. The model also reproduces the diurnal UHI intensity averaged over a year reasonably well. The model evaluation is also complemented by a data set of tiny-tag data logger
Full Text Available Abstract Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1 bad quality of information in medical files; (2 non-participation of the head of department in the audit meetings; (3 lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1 high level of professional qualifications or experience of the data collector; (2 involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3 participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We
Full Text Available Xiaoping Pan,1,* Haobo Chen,1,2,* Wai-Ling Bickerton,2 Johnny King Lam Lau,2 Anthony Pak Hin Kong,3 Pia Rotshtein,2 Aihua Guo,1 Jianxi Hu,1 Glyn W Humphreys4 1Department of Neurology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China; 2School of Psychology, University of Birmingham, Birmingham, UK; 3Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA; 4Department of Experimental Psychology, University of Oxford, Oxford, UK *These authors contributed equally to this work Background: There are no currently effective cognitive assessment tools for patients who have suffered stroke in the People’s Republic of China. The Birmingham Cognitive Screen (BCoS has been shown to be a promising tool for revealing patients’ poststroke cognitive deficits in specific domains, which facilitates more individually designed rehabilitation in the long run. Hence we examined the reliability and validity of a Cantonese version BCoS in patients with acute ischemic stroke, in Guangzhou.Method: A total of 98 patients with acute ischemic stroke were assessed with the Cantonese version of the BCoS, and an additional 133 healthy individuals were recruited as controls. Apart from the BCoS, the patients also completed a number of external cognitive tests, including the Montreal Cognitive Assessment Test (MoCA, Mini Mental State Examination (MMSE, Albert’s cancellation test, the Rey–Osterrieth Complex Figure Test, and six gesture matching tasks. Cutoff scores for failing each subtest, ie, deficits, were computed based on the performance of the controls. The validity and reliability of the Cantonese BCoS were examined, as well as interrater and test–retest reliability. We also compared the proportions of cases being classified as deficits in controlled attention, memory, character writing, and praxis, between patients with and without spoken language impairment
Nelissen, E.J.T.; Mduma, E.; Ersdal, H.L.; Evjen-Olsen, B.; van Roosmalen, J.; van Stekelenburg, J.
Background: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study
Full Text Available Background and Purpose: Appropriate maternal care is necessary to provide Physical growth and mental development of neonate which is related to establishing a good relationship between mother and infant. Positive perception of mothers to their neonates, creates a better relationship between them. Maternal perception of neonates is based on her understanding of biological behavior of the infant. Special features of prematurity, maternal stress and anxiety due to premature delivery are effective on maternal perceptions. The purpose of this study was to determine the maternal perception of premature infants as determining it’s related factors. Methods: In a cross-sectional design, 150 mothers of preterm infants who were been admitted to Neonatal intensive care units of 2 selected hospitals of Iran University of Medical Sciences, entered the study. Broussard questionnaire were used to measure the maternal perception. Data were analyzed by using descriptive statistical analysis and Kay square and Fisher's exact tests were used for analyzing the data. Results: Most of mother’s had a negative perception of their preterm infant. Based on the results, Mather’s job, fathers’ job, mothers’ age, husband’s support, desire about the pregnancy, history of miscarriage and still birth were related with perception of mothers of preterm infants. Discussion: Negative perceptions in mothers of preterm infants are prevalent and in some groups are in higher risk. As negative perception can have a role in developmental processes and cause problems in future, preparing circumstances to decrease mothers’ stress and providing facilities and interventions to increase mother-infant communications are essential. These are treatment team’s duties. The health care team can screen susceptible cases and by supportive interventions, it is possible to create better mother-baby relationship and prepare better care to prevent future developmental problems.
Full Text Available Background: Congenital anomalies are a major cause of perinatal and neonatal deaths, both in low- and high-income countries. They are relatively common worldwide, affecting 3% to 5% of live births. Methods: A cross-sectional study was conducted from January 2014 to June 2014 at the Khyber teaching hospital in Peshawar. Specific patient information was obtained from patient records at the beginning of the study. Those individuals found to have at least one birth defect were approached and their attendants (mothers were interviewed. Information regarding various risk factors was collected. Descriptive analyses were carried out. Results: Out of 1062 deliveries, 2.9% (31 of newborns had various congenital anomalies. Hydrocephalus (22.6%, anencephaly (12.9%, and spina bifida (9.7% were major anomalies. The maternal age ranged from 18 years to 46 years (mean: 30 ± 8. Most of the anomalies (35.5% were present in the 26-30 years age group. Out of 31 babies, 6.4% had multiple anomalies. The preponderance of various congenital anomalies was seen in parity 1 (35.4%; parities 2 to 4 had lower incidences (35.4%. The consanguinity rate was 67.7%; only 32.3% of patients were using folic acid. History of passive smoking was positive in 16.1% of cases. Conclusion: Anencephaly and hydrocephalus were the most prominent anomaly detected; early prenatal diagnosis may be helpful in decreasing mortality by offering early termination. Low intake of folic acid and a high consanguinity rate were the most common associated risk factors for congenital anomalies. These risk factors may be reduced by creating awareness regarding the avoidance of consanguineous marriage and promoting the use of folic acid during pregnancy.
Vânia Muniz Néquer Soares
áveis.PURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010. Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007 and in 71% (2008 - 2010 of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
Full Text Available Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988–2000 inclusive, excluding ‘high-risk’ pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. Results Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8. The ‘home birth’ group included women who were transferred to hospital during labour or shortly after birth. Conclusions Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a whether the same pattern applies to the more life-threatening categories of PPH, and (b why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.
Nove, Andrea; Berrington, Ann; Matthews, Zoë
The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988-2000 inclusive, excluding 'high-risk' pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost) are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8). The 'home birth' group included women who were transferred to hospital during labour or shortly after birth. Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a) whether the same pattern applies to the more life-threatening categories of PPH, and (b) why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.
Wieczorek, Christina C; Marent, Benjamin; Dorner, Thomas E; Dür, Wolfgang
The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice. In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis. Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice. Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter
Tissot-Guerraz, F; Moussy, L; Agniel, F; André, A; Reverdy, M E; Miellet, C C; Audra, P; Putet, G; Sepetjan, M; Dargent, D
Hospital or nosocomial infection, or infection acquired in hospitals, is a health problem in all hospital departments and particularly in the maternity department. We report on a prospective survey of surveillance of hospital-acquired infections both from the mother and the baby's point of view after delivery vaginally or with caesarean carried out at the obstetrical clinic of the Edouard Herriot Hospital in Lyon (France) over three successive years with a series of 9,204 deliveries. The incidence of infection in women who were delivered without caesarean section was 1.37% when urinary tract infections had been excluded but 13% in women who had caesarean sections. Endometritis, skin infections and urinary tract infections were the leading causes. As far as the newborn were concerned, hospital infection ran at about 2.60% and this in the main was due to staphylococcal pustules in the skin. These figures are still too high and prevention should be based on more information given and more care taken by the whole staff of such a hospital.
Kim, Hyung Jin; Kim, Soo Young; Seo, Won Hee; Choi, Byung Min; Yoo, Young; Lee, Kee Hyoung; Eun, Baik Lin; Kim, Hai Joong
During a four-week period, four healthy term newborn infants born at a regional maternity hospital in Korea developed late-onset neonatal group B Streptococcus (GBS) infections, after being discharged from the same nursery. More than 10 days after their discharge, all of the infants developed fever, lethargy, and poor feeding behavior, and were subsequently admitted to the Korea University Medical Center, Ansan Hospital. GBS was isolated from the blood cultures of three babies; furthermore, GBS was isolated from 2 cerebral spinal fluid cultures. Three babies had meningitis, and GBS was isolated from their cerebral spinal fluid cultures. This outbreak was believed to reflect delayed infection after early colonization, originating from nosocomial sources within the hospital environment. This report underlines the necessity for Korean obstetricians and pediatricians to be aware of the risk of nosocomial transmissions of GBS infection in the delivery room and/or the nursery.
John Birmingham (1814-1884) of Millbrook, County Galway, was an outstanding amateur astronomer, now completely forgotten. He discovered the 1866 nova, T Coronae Borealis. Later his name was assigned to a feature near Anaxagoras on the Moon. In 1884 the Royal Irish Academy awarded him its Cunningham Gold Medal for his catalogue of the red variable stars. John Birmingham was not only an acute observer, he also wrote numerous semi-popular articles on many aspects of astronomy. He was also active in geology and railway surveying.
In 2014, the city of Birmingham (UK) became embroiled in a high-profile scandal that would bring it and the wider education system under disrepute. The 'Trojan Horse' affair, as it become known, began with an anonymised letter that claimed hard-line 'Islamists' were plotting and planning to take over a number of schools in Birmingham. Amongst the…
Mráčková, Veronika; Baťa, J.
Roč. 51, 3-4 (2014), s. 414-417 ISSN 0018-7003. [Medieval and Renaissance Music Conference. Birmingham, 03.07.2014-06.07.2014] Institutional support: RVO:68378076 Keywords : conference * medieval * music Subject RIV: AL - Art, Architecture, Cultural Heritage
Andrews, Judith; Eade, Eleanor
Birmingham City University's Library and Learning Resources' strategic aim is to improve student satisfaction. A key element is the achievement of the Customer Excellence Standard. An important component of the standard is the mapping of services to improve quality. Library and Learning Resources has developed a methodology to map these…
The "Floodgate Street area" was a notorious slum district in the city of Birmingham in the late nineteenth and early twentieth centuries. This article presents a case study, drawing on the rich archival sources available for this area, to examine the language that local authority and voluntary workers used to describe the local area, and…
Barton, Sarah; Hatcher, Richard
The UK government seized the opportunity of the Trojan Horse affair to launch a damaging Islamophobic attack, eagerly relayed by a racist press, on the Muslim community in Birmingham and beyond, abusing Ofsted and the Prevent strategy as blatant instruments of ideologically-driven policy. The various reports found no evidence of radicalisation or…
Parker, Stephen G.; Freathy, Rob J. K.
The present article offers an historical perspective on the 1975, 1995 and 2007 Birmingham Agreed Syllabuses for Religious Education. It draws upon historical evidence uncovered as part of "The hidden history of curriculum change in religious education in English schools, 1969-1979" project, and curriculum history theories, especially…
Loder-Jackson, Tondra L.
Drawing on scholarship from the politics and history of education, narrative and archival data, and the author's emic perspectives, this article examines social and political transformations in the Birmingham City Schools (BCS) and some of the surrounding metropolitan school districts during the pre- and post-classical phases of the American civil…
O'Kelly, Sonia M; Moore, Zena Eh
rate, re-attendance or re-admission to hospital, pain, health-related quality of life, maternal bonding, and negative emotional experiences. Further study is warranted in this area given the significant physical, psychological and economic impact of perineal wounds, and the large proportion of childbearing women who have experienced a postnatal wound. The benefits of any future research in this field would be maximised by incorporating women in a range of socio-economic groups, and with a range of healthcare options. This research could take both a qualitative and a quantitative approach and examine the outcomes identified in this review in order to assess fully the potential benefits of a tailored antenatal package, and to make recommendations for future practice. There is currently no evidence to inform practice in this regard.
Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan
In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Full Text Available Neonatal alloimmune thrombocytopenia (NAIT is a clinical syndrome that resembles hemolytic disease of the newborn, affecting the platelets only. The thrombocytopenia results from the maternal alloantibodies reacting with specific human platelet antigens (HPAs on the fetal platelets. Forty-four maternal plasma samples were screened for platelet alloantibodies using qualitative solid phase enzyme-linked immunosorbent assay (ELISA commercial kit (LIFECODES Pakplus, Hologic Gen-Probe GTI Diagnostics, Waukesha, WI, USA, and both the maternal and the corresponding cord blood samples were genotyped (LIFECODES ThromboType, Hologic Gen-Probe GTI Diagnostics, Waukesha, WI, USA. HPA genotyping results correlated with the genetic frequencies in the Taiwan population. A total of 34 newborns (77.3% had partial HPA genotyping mismatches with the corresponding mothers. The most common partial mismatches between mothers and neonates in HPA genotypes were 13 (29.5% in both HPA-3b and HPA-15a, followed by 12 (27.3% in HPA-15b, and 8 (18.2% in HPA-3a. The frequencies of homozygotic mother with heterozygotic neonate were 15.9% in both HPA-3a and HPA-15b, 9.1% in HPA-15a, 6.8% in HPA-3b, and 2.3% in both HPA-2a and HPA-6a. In this study, maternal HPA antibodies were found in five samples, whereas HLA class I antibodies were found in seven maternal plasma samples from the antibody screen. The results from this study have demonstrated that HPA mismatch is not the main cause for the production of HPA alloantibodies.
This dissertation constitutes a reflection on two initiatives seeking to reconfigure maternity care. One initiative sought to digitalise maternity records and included a pilot run of an electronic maternity record in a Danish county. The other consisted of a collaboration between a maternity ward...... at a hospital and a group of researchers which included me. Both initiatives involved numerous seemingly different interests that were held together and related to reconfiguring maternity care. None of the initiatives can unequivocally be labelled a success, as neither managed to change maternity care, at least...... experimental designs are constructed. The consequences and the politics of the proposed changes are engaged with in laboratory manner through collaborative development of the designs and through exposing them to members of field of maternity care...
Morbidade materna grave em um hospital universitário de referência municipal em Campinas, Estado de São Paulo Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil
Adriana Gomes Luz
Full Text Available OBJETIVO: avaliar a prevalência e os fatores de risco associados à morbidade materna grave numa maternidade terciária. MÉTODOS: trata-se de um estudo de corte transversal dos casos de morbidade materna grave atendidos no Hospital e Maternidade Celso Pierro entre outubro de 2005 e julho de 2006, identificados a partir dos livros de controle das unidades de internação, pronto atendimento e centro obstétrico. Foram estudadas gestantes e puérperas que apresentavam condições definidoras de morbidade materna grave a partir dos diagnósticos clínicos segundo critérios propostos por Waterstone. Posteriormente, os casos de maior gravidade clínica, chamados de morbidade extremamente grave, foram reclassificados utilizando-se os critérios definidores de Mantel, baseados em disfunção orgânica e manejo. RESULTADOS: foram identificadas 114 mulheres com morbidade materna grave entre 2.207 partos, com razão de outra morbidade grave e morbidade extremamente grave de 44,9 e 6,8 casos por 1.000 partos, respectivamente. A média da idade gestacional no parto foi de 35 semanas e 87% das mulheres vieram de área de cobertura da maternidade no município. A hipertensão (pré-eclâmpsia grave representou 96% de outras morbidades graves e a hemorragia esteve presente em 60% dos casos de morbidade extremamente grave, seguida de hipertensão. A prevalência de morbidade extremamente grave entre os casos de morbidade grave não se associou com estado marital, escolaridade, idade materna, tipo de parto, gestações, idade gestacional e distrito de saúde de moradia. CONCLUSÕES: as outras morbidades graves foram 6,6 vezes mais freqüentes que os casos extremamente graves, sem diferenças entre os grupos por fatores de risco epidemiológicos.PURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity
On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.
Hirani, Birjna A; Mchome, Bariki L; Mazuguni, Nicholaus S; Mahande, Michael J
Decision delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of our study was to determine the DDI and its associated fetalmaternal outcomes at a tertiary referral hospital in Tanzania. This was a retrospectivecross-sectional study of inpatient cases who underwent emergency caesarean section from January to September 2014. Data were collected from birth registry and case files of patients. Data analysis was performed using statistical package for social science (SPSS) version 22.0. Odds ratio (ORs) and 95% confidence interval for maternal and fetal outcomes associated with DDI were estimated using Logistic regression models. A p-value of less than 5% was considered statistically significant. A total of 598 women who underwent emergency caesarean section were recruited. The median Decision Delivery Interval was 60 min [IQR 40-120]. Only 12% were operated within 30 min from decision time. Shortest DDI was seen in patients with Cephalopelvic Disproportion (CPD) and uterine rupture (40 min and 45.5 min) as compared to other conditions. Cases with impending uterine rupture, cord prolapse, APH and fetal distress showed to have shorter DDI. There was no significant association between DDI and neonatal transfer,1st and 5 th minute Apgar score, maternal blood loss (OR: 5.79; 95% CI 0.63-1.64) and hospital stay (OR: 1.02; 95% 0.63-1.64). Contrary to the recommended DDI by ACOG & AAP of 30 min is not feasible in our setting, time frame of 75 min could be acceptable but clinical judgment is required to assess on the
Miles, T. A.; Raychaudhury, S.; Mulchaey, J. S.
We present the first results from the BOXING (Birmingham-OCIW XMM and IMACS Nearby Groups) project, a collaboration between the Observatories of the Carnegie Institute of Washington (OCIW) and the University of Birmingham U.K. to study a sample of 25 galaxy groups (z ˜ 0.06) by means of optical photometry and spectroscopy (du Pont 2.5m; IMACS/Magellan) combined with x-ray observations (XMM). The combination of x-ray with optical data allows us to study the nature of the relationship between the properties of the groups and the galaxies that they contain. In this preliminary study, we present optical luminosity functions, which shows bimodal behavior in the poorer systems, interpreted as result of rapid merging. We also examine the dependence of galaxy morphology on local environment. Once spectroscopic observations are completed, we will be able to study velocity dispersions, star formation and nuclear activity in individual galaxies.
Copeland, C.W.; Beg, M.A.
This document is a facsimile edition (with accompanying maps) of geologic reports on the Birmingham, Gadsden, and Montgomery 1 0 x 2 0 NTMS quadrangles prepared for SRL by the Geological Survey of Alabama. The purpose of these reports is to provide background geologic information to aid in the interpretation of NURE geochemical reconnaissance data. Each report includes descriptions of economic mineral localities as well as a mineral locality map and a geologic map
Copeland, C.W.; Beg, M.A.
This document is a facsimile edition (with accompanying maps) of geologic reports on the Birmingham, Gadsden, and Montgomery 1 0 x 2 0 NTMS quadrangles prepared for SRL by the Geological Survey of Alabama. Purpose of these reports is to provide background geologic information to aid in the interpretation of NURE geochemical reconnaissance data. Each report includes descriptions of economic mineral localities as well as a mineral locality map and a geologic map
Harvey, E. A.
This thesis considers philanthropic activities directed towards new mothers and destitute children both “at home” and in a particular colonial context. Philanthropic encounters in Birmingham and Sydney are utilised as a lens through which to explore the intersections between discourses of race, gender and class in metropole and colony. Moreover, philanthropic and missionary efforts towards women and children facilitate a broader discussion of ideas of citizenship and nation. Du...
Tracy K. Mulvaney
Full Text Available The TAPin Project and its implementation at the University of Birmingham is described. Local issues and key features of a hybrid approach to Networked Learner Support are addressed. The methods of NLS adopted included electronic mail and the Internet. The key role in NLS played by subject librarians is stressed. Transfer of skills to learners by means of targeted individual training and a web guide is discussed.
Kaye, Dan K; Mirembe, Florence M; Bantebya, Grace; Johansson, Annika; Ekstrom, Anna Mia
To investigate whether domestic violence during pregnancy is a risk factor for antepartum hospitalization or low birthweight (LBW) delivery. A prospective cohort study was conducted in Mulago hospital, Kampala, Uganda, among 612 women recruited in the second pregnancy trimester and followed up to delivery, from May 2004 through July 2005. The exposure (physical, sexual or psychological violence during pregnancy) was assessed using the Abuse Assessment Screen. The relative and attributable risks of LBW and antepartum hospitalization were estimated using multivariate logistic regression analysis. The 169 women [27.7% 95% CI (24.3-31.5%)] who reported domestic violence during pregnancy did not differ significantly from the unexposed regarding sociodemographic characteristics, but differed significantly (P violence was 3.78 (95% CI 2.86-5.00). Such women had a 37% higher risk of obstetric complications (such as hypertension, premature rupture of membranes and anaemia) that necessitated antepartum hospitalization [RR 1.37 (95% CI 1.01-1.84)]. In this pregnancy cohort, domestic violence during pregnancy was a risk factor for LBW delivery and antepartum hospitalization.
Aberese-Ako, M.; Agyepong, I.A.; Gerrits, T.; van Dijk, H.
Background and Objectives: This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology: The study used ethnographic methods including participant
The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...
Santos, Luciana Angélica Vieira; Lara, Maristela Oliveira; Lima, Renata Caroline Ribeiro; Rocha, André Freire; Rocha, Euza Mara; Glória, José Cristiano Ramos; Ribeiro, Gabriela de Cássia
The scope of this research was to analyze the gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital located in a city in Minas Gerais, which is a hospital of reference in the macro-region of health of Jequitinhonha. It involved a descriptive cross-sectional study. A total of 327 mothers were interviewed between May 2013 and March 2014 using a semi-structured questionnaire. With a sample of 255, the number of adult women was predominant. With respect to prenatal care, 324 pregnant women had medical appointments. In terms of the location for prenatal care, 79.2% of adolescents were attended in the public health service, while that percentage was 60.4% among adult women. Regarding the type of birth, 54.7% of mothers had normal delivery and 45% had cesarean section. Among adolescents, there was a higher percentage of normal delivery compared to adult women and this data had a statistically significant relationship with the age of the pregnant women. With respect to gestational age at birth, 85.9% had full-term deliveries, 13.5% had preterm delivery and 0.6% had post-term delivery. It was revealed that adolescent mothers were at a disadvantage compared to the other mothers in terms of both socioeconomic characteristics and prenatal care received.
Sy, T; Diallo, Y; Diallo, A; Soumah, A; Diallo, F B; Hyjazi, Y; Diallo, M S
The authors in a prospective, analytical study of 8 months from January 1st to August 31st performed at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital; assessed the impact of the mode of delivery in breech presentation on maternal and fetal outcome in the African context of Guinea. Breech presentation in mono fetal pregnancy of at least 28 weeks of amenorrhea was the inclusion criterion in this study. Among 1490 deliveries, 144 breech presentations were reviewed, representing a frequency of 9.66%. Half of breech deliveries (49.99%) were premature against only 11.85% in cephalic presentations. The breech was incomplete in 57.64% cases and complete in 42.35%. Caesarean section was performed in 40.97% of cases against 39.54% in cephalic presentation. The indications were often primiparity (30.50%), acute fetal distress (28.81%) and macrosomia (23.72%). Deliveries through the lower route frequently used the maneuver of Bracht (52.50%). 54.16% of the new-born babies had a fetal weight lower than 2500 g at born. Morbid Apgar score at the 1st minute after delivery through the lower route was found in 69.40% of the breech presentation born babies; however, this rate was 32.70% in cephalic presentation (p=0.000). The maternal morbidity concerned essentially perineal lesions (26.53%). The outcome is largely better in case of delivery through the upper route. The caesarean section is an alternative for the improvement of fetal outcome in countries with low resources.
Dhanjal, T S; Lal, M; Haynes, R; Lip, G
Indo-Asians in the UK are at an increased risk of coronary artery disease (CAD); this may be a reflection of their cardiovascular risk factor profile as well as of a more sedentary lifestyle. We hypothesised that Indo-Asians in Malaysia and the UK may exhibit a similar cardiovascular risk factor and physical activity profile, which would be more adverse compared with caucasians. We studied 70 consecutive Indo-Asian patients admitted to hospitals in Kuala Lumpur, Malaysia (n=42; 35 males; mean age 60.6 years, SD 11.8); and Birmingham, England (n=28; 20 males; mean age 60.8 years, SD 12.9). Both groups of Indo-Asian patients were compared with 20 caucasian patients (13 males; mean age 62.7 years, SD 9.4) admitted with myocardial infarction from Birmingham. There was a higher prevalence of diabetes among Indo-Asians in both countries than among caucasians (p=0.0225). By contrast, caucasians had a higher prevalence of hypercholesterolaemia (p=0.0113), peripheral vascular disease (p=0.0008), regular alcohol consumption (pleisure activity score (p=0.001) and total physical activity score (p=0.003) among Indo-Asians in both countries than among caucasians. This survey has demonstrated differences in cardiovascular risk factors among Indo-Asian and caucasian patients. The high prevalence of diabetes, as well as the lower physical activity and sedentary lifestyles among Indo-Asians, in both Malaysia and the UK, may in part contribute to the high incidence of CAD in this ethnic group.
Débora de Araújo Milfont
Full Text Available Objective: Verify the prevalence of dental caries and its relationship with the type of feeding, oral hygiene habits, and gender of children at the Cândida Vargas Maternity hospital in João Pessoa, Paraíba, Brazil. Methods: The study population included 50 mentally and physically healthy children ranging from 12 the 48 months of age. This was descriptive study using direct documentation (forms and the clinical examinations performed by one calibrated examiner (Kappa = 1. Dental caries diagnosis was according to World Health Organization criteria. Interviews were conducted with the parents for information about the children’s oral hygiene and dietary habits. Data was analysed by means of descriptive statistics (frequencies and percentages and statistical analyses, using the Pearson Chi – Square and Fisher tests. Results: the prevalence of dental caries was 28%; the majority of the parents cared for the children’s daytime oral hygiene (60%, and the prevalent type of feeding was with powdered milk. The average dmf-t was 0.28 and 16% of children had early childhood caries. There was no statistically significant association with any of the variables studied.Conclusion: the prevalence of caries–free children was high. However, the poor oral hygiene after nocturnal breast-feeding and the early introduction of artificial milk, especially with bottle feeding suggests the need to reinforce educational strategies for the parents.
Domínguez, Fernando; Gorry, Conner
Neonatologist Dr Fernando Domínguez served two years in a remote municipality of Cuba's Guantánamo Province upon graduation from medical school in 1973. Continuing his commitment to vulnerable populations, he joined the Cuban team in the Democratic Republic of the Congo, serving as a family doctor attending neonates and children. After returning to Cuba, he completed his pediatric residency and later became head of the neurodevelopment department at Havana's Ramón González Coro University Maternity Hospital, where he has worked for over three decades. Dr Domínguez holds a doctorate in medical sciences, and since 1995 has served on the board of the Cuban Society of Pediatrics, where he was President from 2005-2011. He is also a member of the Ministry of Public Health's National Bioethics Commission; President of the Scientific Council of the Manuel Fajardo Medical School; on the Executive Board of the Latin American Association of Pediatrics; and a member of the Permanent Commission of the International Pediatric Association (IPA). Since 2010, he has served on IPA's Commission for Child Environmental Health and is the Editor-in-Chief of the pediatric section of Infomed, Cuba's national health portal.
Marcello Braga Viggiano
mortalidade materna e duração da internação (48 horas nas UTI's (p=0,08. A RMI encontrada foi de 18,8/1.000 partos. CONCLUSÕES: a necessidade de cuidados intensivos estimada pela RMI foi de 18,8/1.000 partos, sendo que as síndromes hipertensivas induzidas pela gestação foram responsáveis pela maioria das indicações para as transferências maternas.OBJECTIVE: to evaluate the epidemiological and parturitional aspects of obstetric patients admitted to intensive care units (ICU, and analyze the frequency of intensive support needed by them. METHODS: observational and descriptive study of all obstetric patients' transfers to ICU from the Hospital Materno Infantil of Goiânia-Go, from January 1999 to December 2001. The analysis has included variables as maternal age, parity, obstetric and non-obstetric indications for ICU admissions, moment of transfer, mode of delivery, maternal death, and the frequency of ICU utilization per 1,000 deliveries (IDR - imminent death ratio. The statistical analysis was performed by the chi2 test or the Fisher exact test and a significant difference was set at a level of 5%. RESULTS: over the 36-month period analyzed, 86 pregnancy-associated ICU admissions were identified (among 4,560 deliveries. Of the 86 patients, 52.33% (n=45 were nulliparae and 63 (73.26% were between 19 and 35 years old. Hypertensive disorders accounted for 41 (57.75% of the admissions and hemorrhage for 14 (19.72%. Eclampsia (n=23, HELLP syndrome (n=13 and premature abruptio placentae (n=5 were the most common obstetric indications for ICU admissions. Maternal cardiac disorders accounted for 4 cases of non-obstetric indications. There was a predominance of postpartum transfers (82.35%. Fifty-five (72.37% patients needed delivery by caesarian section. The average time spent in the UCI by those patients was 5.1 days. Maternal mortality found in this study was 24.29%, hypertensive disorders being responsible for 52.94% (9/17 of all obstetric-associated deaths. There were
Full Text Available Abstract Background Death of an infant in utero or at birth has always been a devastating experience for the mother and of concern in clinical practice. Infant mortality remains a challenge in the care of pregnant women worldwide, but particularly for developing countries and the need to understand contributory factors is crucial for addressing appropriate perinatal health. Methods Using information available in obstetric records for all deliveries (17,072 births at Harare Maternity Hospital, Zimbabwe, we conducted a cross-sectional retrospective analysis of a one-year data, (1997–1998 to assess demographic and obstetric risk factors for stillbirth and early neonatal death. We estimated risk of stillbirth and early neonatal death for each potential risk factor. Results The annual frequency of stillbirth was 56 per 1,000 total births. Women delivering stillbirths and early neonatal deaths were less likely to receive prenatal care (adjusted relative risk [RR] = 2.54; 95% confidence intervals [CI] 2.19–2.94 and RR = 2.52; 95% CI 1.63–3.91, which for combined stillbirths and early neonatal deaths increased with increasing gestational age (Hazard Ratio [HR] = 3.98, HR = 7.49 at 28 and 40 weeks of gestation, respectively. Rural residence was associated with risk of infant dying in utero, (RR = 1.33; 95% CI 1.12–1.59, and the risk of death increased with increasing gestational age (HR = 1.04, HR = 1.69, at 28 and 40 weeks of gestation, respectively. Older maternal age was associated with risk of death (HR = 1.50; 95% CI 1.21–1.84. Stillbirths were less likely to be delivered by Cesarean section (RR = 0.64; 95% CI 0.51–0.79, but more likely to be delivered as breech (RR = 4.65; 95% CI 3.88–5.57, as were early neonatal deaths (RR = 3.38; 95% CI 1.64–6.96. Conclusion The frequency of stillbirth, especially macerated, is high, 27 per 1000 total births. Early prenatal care could help reduce perinatal death linking the woman to the health
Manji Karim P
Full Text Available Abstract Background The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE and preterm low-birth-weight (PTLBW infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH, Tanzania. Methods A retrospective case-control study was conducted, involving 373 postpartum mothers aged 14–44 years (PTLBW – 150 cases and at term normal-birth-weight (TNBW – 223 controls, using structured questionnaire and full-mouth examination for periodontal and dentition status. Results The mean number of sites with gingival bleeding was higher in PTLBW than in TNBW (P = 0.026. No significant differences were observed for sites with plaque, calculus, teeth with decay, missing, filling (DMFT between PTLBW and TNBW. Controlling for known risk factors in all post-partum (n = 373, and primiparaous (n = 206 mothers, no significant differences were found regarding periodontal disease diagnosis threshold (PDT (four sites or more that had probing periodontal pocket depth 4+mm and gingival bleeding ≥ 30% sites, and CPE between cases and controls. Significant risk factors for PTLBW among primi- and multiparous mothers together were age ≤ 19 years (adjusted Odds Ratio (aOR = 2.09, 95% Confidence interval (95% CI: 1.18 – 3.67, P = 0.011, hypertension (aOR = 2.44, (95% CI: 1.20 – 4.93, P = 0.013 and being un-married (aOR = 1.59, (95% CI: 1.00 – 2.53, P = 0.049. For primiparous mothers significant risk factors for PTLBW were age ≤ 19 years (aOR = 2.07, 95% CI: 1.13 – 3.81, P = 0.019, and being un-married (aOR = 2.58, 95% CI: 1.42 – 4.67, P = 0.002. Conclusions These clinical findings show no evidence for periodontal disease or carious pulpal exposure being significant risk factors in PTLBW infant delivery among Tanzanian-Africans mothers at MNH, except for young age, hypertension, and being unmarried. Further research incorporating periodontal pathogens is recommended.
"Absconditi Viscus" (or "Hidden Entries") is a series of sound compositions based on the history of Birmingham School of Art during the First World War. Sound artist Justin Wiggan explored the concept of historical sonic information that although lost could still potentially permeate the archival record and the fabric of the…
This paper offers new insights into the effects of neo-liberal education policies on some Muslim majority schools in Birmingham. It critically reveals how the implementation of neo-liberal education policies, pursued by both Labour and Conservative Governments, has contributed to the failure of some mechanisms of school leadership and governance.…
The Art of ATLAS is an multimedia installation, developed by Neal Hartman and Claudia Marcelloni about the physicists, engineers and technicians behind the ATLAS Experiment. The installation will been shown at Planetarium entrance of the Thinktank science museum in Birmingham, UK from October 2010 until January 2011.
Gladys GB Mariotoni
Full Text Available OBJETIVO: Conhecer a evolução do peso ao nascer e a mortalidade hospitalar de nascidos vivos em maternidade de Campinas, SP. MÉTODOS: Foram estudados 215.435 nascimentos ocorridos em maternidade do Município de Campinas, SP, de 1975 a 1996. As informações foram coletadas de livros de registro e relatórios de assistência médica. Foram analisados os óbitos ocorridos antes da alta hospitalar, independentemente da idade. Para a análise dos dados, utilizou-se o programa Epi Info 6.01. RESULTADOS: O baixo peso se manteve próximo a 9% desde os anos 70, concentrando82% dos óbitos hospitalares em 1996. O peso insuficiente foi observado em 24% dos nascidos vivos. Em 1975, 13,3% dos nascidos com peso entre 1.000 g e 1.499 g sobreviveram e 73,8% dos nascidos com peso entre 1.500 g e 1.999 g. Em 1996, a sobrevida foi 69,1% e 87,7%, respectivamente. Houve grande diminuição do número de óbitos especialmente na faixa de 1.000 g a 1.499 g (de 867 para 309 por mil nascidos vivos, redução de 64,5% e de 1.500 g a 1.999 g (de 264 para 123 por mil nascidos vivos, redução de 53,4%. A mortalidade hospitalar entre aqueles de peso abaixo de 1.000 g permaneceu entre 78,9% e 100,0%, mesmo nos anos 90. Observou-se queda da mortalidade hospitalar de 17 para 11 por mil nascidos vivos. CONCLUSÕES: Não houve modificação na distribuição do peso ao nascer, a despeito deavanços apresentados por Campinas. Contudo, observou-se queda da mortalidade hospitalar. Outros estudos são necessários para compreender esse perfil.OBJECTIVE: To assess the trend of birth weight and hospital mortality rate of newborns, in a maternity hospital of Campinas, SP. METHODS: A total of 215,435 births of a maternity hospital in Campinas, S. Paulo State, Brazil, was studied between 1976 and 1996. Information was collected from registration files and annual reports of medical care. All the newborns from that period were included. The causes of death that occurred before the
Branger, B; Gillard, P; Monrigal, C; Thelu, S; Robidas, E; Viot, S; Descamps, P; Philippe, H-J; Sentilhes, L; Winer, N
The aim of the study is to assess the compliance rate of treatment of postpartum hemorrhage (PPH) according to guidelines developed by the CNGOF within our network by a first audit, and evaluate the impact of this first audit by conducting a second audit. An initial audit of resources and management of postpartum hemorrhage (PPH) was conducted in 2006-2008 in 24 maternity hospitals of the Pays-de-la-Loire. The audit had identified six areas for improvement. A second audit was implemented in 2009-2010 to evaluate the actions of prevention and measure changes in the management of PPH. Two interns have distributed the 24 maternity homes and moved in each hospital to see 10 cases of vaginal delivery (VD) (section "Prevention"), and the last cases of PPH following a VD. The results are in compliance rate compared to the repository of the HAS in 2004. The first audit was conducted on 101 PPH in total. It has allowed us to propose corrective actions to the 24 maternity hospitals: leaf specific monitoring, reporting amounts of blood loss, transfusion on these clinical criteria without waiting for the blood cell counts, indicating more frequent and rapid sulprostone, set for maternity hospitals without surgical skill an agreement with a visceral surgery department, and avoid maternal transfers for PPH. For the second audit, the compliance rate of the preventive aspect was 73% (95: 71-75%) of 239 cases of BA with variations according to maternity from 48 to 93%. Compliance rates according to the criteria were: 99% obstetric consultations, 98% for anesthesia, 92% for hemoglobin, 77% for the group card available in the record, 89% agglutinins, 35% for the notification of the installation of bag, 36% for the notification of the amount of blood lost, 69% for the supervisor within two hours, and 64% for the directed delivery. For component "Support", the overall compliance rate was 81% (95: 79-83%) of 118 PPH AVB, and 85% in the 71 uterine atonies in 21 pregnancies (3 had no HPP
Tamaki, S.; Sakai, M.; Yoshihashi, S.; Manabe, M.; Zushi, N.; Murata, I.; Hoashi, E.; Kato, I.; Kuri, S.; Oshiro, S.; Nagasaki, M.; Horiike, H.
Mock-up experiment for development of accelerator based neutron source for Osaka University BNCT project was carried out at Birmingham University, UK. In this paper, spatial distribution of neutron flux intensity was evaluated by foil activation method. Validity of the design code system was confirmed by comparing measured gold foil activities with calculations. As a result, it was found that the epi-thermal neutron beam was well collimated by our neutron moderator assembly. Also, the design accuracy was evaluated to have less than 20% error. - Highlights: • Accelerator based neutron source for BNCT is being developed in Osaka University. • Mock-up experiment was carried out at Birmingham University, UK. • Neutronics performance of our assembly was evaluated from gold foil activation. • Gold foil activation was determined by using HPGe detectors. • Validity of the neutronics design code system was confirmed.
Introduction: Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital. Materials and Methods: It was a prospective audit of all consecutive maternal deaths in the hospital over a ...
Egenberg, Signe; Puntervoll, Stein Atle; Øian, Pål
Out-of-hospital maternity care in Norway is randomly organised and not properly formalized. We wished to examine the extent, organisation and quality of this service. We obtained information from the Norwegian Medical Birth Registry on all unplanned out-of-hospital births in 2008. A questionnaire was sent to all maternity institutions, municipalities and emergency dispatch centres, with questions regarding the practical and formal organisation of the service using figures from 2008. 430 children, all above 22 weeks gestation, were born unplanned outside of hospitals in Norway in 2008. Of these, 194 were born unplanned at home, 189 while being transported and 47 in other locations (doctor's offices, infirmaries, unknown). Five out of 53 maternity institutions (9 %) confirmed they had a formal midwife service agreement for out-of-hospital births. 247 municipalities (79 %) claimed to have no such assistance. Of these, 33 are located at least 90 minutes away from the nearest maternity ward. Half of the emergency dispatch centres had no registration identifying formal agreements on assistance by midwives for out-of-hospital births. There is an urgent need to put in place formal agreements between the regional health authorities and the municipalities on out-of-hospital midwife services. A distance of 90 minutes' journey time to a maternity ward to fulfil the right to qualified assistance is not well-founded.
Harty, J A
INTRODUCTION: Numerous reports in the literature refer to the femoral neck fracture rate in hip resurfacing. The aim of this study was to determine the bone mineral density and evidence of stress shielding around the femoral component of the Birmingham resurfacing prosthesis. MATERIAL AND METHODS: Twenty-eight patients with primary unilateral osteoarthritis had a Birmingham resurfacing prosthesis. DEXA analysis of the proximal femur and femoral neck was performed and compared with the opposite unaffected side. RESULTS: Total periprosthetic bone mineral density was 0.49% greater than the control, but this did not achieve statistical significance. Although the BMD of the femoral neck was slightly increased on the prosthetic side (1.002 g\\/cm2) as opposed to the control side, this difference did not reach statistical significance. CONCLUSION: The Birmingham resurfacing prosthesis does not appear to reduce femoral neck bone mineral density in comparison to the normal femoral neck bone density. We conclude that femoral neck fractures are unlikely to be due to stress shielding related to the prosthesis.
Susan E. Lee
Full Text Available Cities are dependent on their hinterlands for their function and survival. They provide resources such as people, materials, water, food and energy, as well as areas for waste disposal. Over the last 50 years, commerce and trade has become increasingly global with resources sourced from further afield often due to cheap labour costs, better transportation and a plentiful supply of energy and raw materials. However, the use and transportation of resources is becoming increasingly unsustainable as the global population increases, raw materials become increasing scarce, and energy costs rise. This paper builds on research undertaken in the Liveable Cities Programme on the resource flows of Birmingham, UK. It investigates how people, material, and food flows interact within regional, national, and international hinterlands through road and rail transportation and assesses their sustainability across all three pillars (economic, social, and environmental. The type and weight of goods is highlighted together with their costs and energy used. For a city to move with greatest effect towards sustainability it needs to: (i source as much as it can locally, to minimise transportation and energy costs; (ii adopt such principles as the “circular economy”; and (iii provide clean and efficient means to move people, especially public transportation.
Rai, Kiran K; Adab, Peymané; Ayres, Jon G; Siebert, W Stanley; Sadhra, Steven S; Sitch, Alice J; Fitzmaurice, David A; Jordan, Rachel E
Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. To assess the factors associated with work productivity among COPD patients. Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László
Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.
AJRH Managing Editor
were collected from the files of the hospitalized pregnant women in the hospital. There were 38 maternal ... Mortality Ratio (MMR) is the “number of women died while ..... ASJOG, March. 2005. 4. ... World Bank, Washington DC. March 2011.
Pallavi S. Kalewad; Trupti Nadkarni
Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling. Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion cr...
van Wolfswinkel, M. E.; Zwart, J. J.; Schutte, J. M.; Duvekot, J. J.; Pel, M.; van Roosmalen, J.
To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in The Netherlands. A retrospective study of case notes. All tertiary care centres, general teaching hospitals and other general hospitals in The Netherlands. All
Van Wolfswinkel, M. E.; Zwart, J. J.; Schutte, J. M.; Duvekot, J. J.; Pel, M.; Van Roosmalen, J.
To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands. A retrospective study of case notes. All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands. All
Ludescher, K; Baumgartner, E; Roner, A; Brezinka, C
Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in
MAHR, ALFRED D.; NEOGI, TUHINA; LAVALLEY, MICHAEL P.; DAVIS, JOHN C.; HOFFMAN, GARY S.; MCCUNE, W. JOSEPH; SPECKS, ULRICH; SPIERA, ROBERT F.; ST.CLAIR, E. WILLIAM; STONE, JOHN H.; MERKEL, PETER A.
Objective To assess the Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG) with respect to its selection and weighting of items. Methods This study used the BVAS/WG data from the Wegener's Granulomatosis Etanercept Trial. The scoring frequencies of the 34 predefined items and any “other” items added by clinicians were calculated. Using linear regression with generalized estimating equations in which the physician global assessment (PGA) of disease activity was the dependent variable, we computed weights for all predefined items. We also created variables for clinical manifestations frequently added as other items, and computed weights for these as well. We searched for the model that included the items and their generated weights yielding an activity score with the highest R2 to predict the PGA. Results We analyzed 2,044 BVAS/WG assessments from 180 patients; 734 assessments were scored during active disease. The highest R2 with the PGA was obtained by scoring WG activity based on the following items: the 25 predefined items rated on ≥5 visits, the 2 newly created fatigue and weight loss variables, the remaining minor other and major other items, and a variable that signified whether new or worse items were present at a specific visit. The weights assigned to the items ranged from 1 to 21. Compared with the original BVAS/WG, this modified score correlated significantly more strongly with the PGA. Conclusion This study suggests possibilities to enhance the item selection and weighting of the BVAS/WG. These changes may increase this instrument's ability to capture the continuum of disease activity in WG. PMID:18512722
Wearn, Christopher; Hardwicke, Joseph; Kitsios, Andreas; Siddons, Victoria; Nightingale, Peter; Moiemen, Naiem
Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
Fisher, Arielle M; Herbert, Mary I; Douglas, Gerald P
The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However, pharmacists' tasks involving medication management and dispensing have become more challenging since EMR implementation due to its inability to support workflows between the medical and pharmaceutical services. To inform the design of a systematic intervention, we conducted a needs assessment study to identify workflow challenges and process inefficiencies in the dispensary. We used contextual inquiry to document the dispensary workflow and facilitate identification of critical aspects of intervention design specific to the user. Pharmacists were observed according to contextual inquiry guidelines. Graphical models were produced to aid data and process visualization. We created a list of themes describing workflow challenges and asked the pharmacists to rank them in order of significance to narrow the scope of intervention design. Three pharmacists were observed at the BFC. Observer notes were documented and analyzed to produce 13 themes outlining the primary challenges pharmacists encounter during dispensation at the BFC. The dispensary workflow is labor intensive, redundant, and inefficient when integrated with the clinical service. Observations identified inefficiencies that may benefit from the introduction of informatics interventions including: medication labeling, insufficient process notification, triple documentation, and inventory control. We propose a system for Prescription Management and General Inventory Control (RxMAGIC). RxMAGIC is a framework designed to mitigate workflow challenges and improve the processes of medication management and inventory control. While RxMAGIC is described in the context of the BFC
Short, T.M.; Giddings, E.M.P.; Zappia, H.; Coles, J.F.
Relations between stream habitat and urban land-use intensity were examined in 90 stream reaches located in or near the metropolitan areas of Salt Lake City, Utah (SLC); Birmingham, Alabama (BIR); and Boston, Massachusetts (BOS). Urban intensity was based on a multi-metric index (urban intensity index or UII) that included measures of land cover, socioeconomic organization, and urban infrastructure. Twenty-eight physical variables describing channel morphology, hydraulic properties, and streambed conditions were examined. None of the habitat variables was significantly correlated with urbanization intensity in all three study areas. Urbanization effects on stream habitat were less apparent for streams in SLC and BIR, owing to the strong influence of basin slope (SLC) and drought conditions (BIR) on local flow regimes. Streamflow in the BOS study area was not unduly influenced by similar conditions of climate and physiography, and habitat conditions in these streams were more responsive to urbanization. Urbanization in BOS contributed to higher discharge, channel deepening, and increased loading of fine-grained particles to stream channels. The modifying influence of basin slope and climate on hydrology of streams in SLC and BIR limited our ability to effectively compare habitat responses among different urban settings and identify common responses that might be of interest to restoration or water management programs. Successful application of land-use models such as the UII to compare urbanization effects on stream habitat in different environmental settings must account for inherent differences in natural and anthropogenic factors affecting stream hydrology and geomorphology. The challenge to future management of urban development is to further quantify these differences by building upon existing models, and ultimately develop a broader understanding of urbanization effects on aquatic ecosystems. ?? 2005 by the American Fisheries Society.
Jenkins, D; O'Brien, I; Johnson, A; Shakespear, R; Sheppard, M C; Stewart, P M
Reduction of GH concentrations in acromegalic subjects may improve the increased mortality associated with the condition. Audit of the biochemical outcome of the management of acromegaly is, therefore, important. (1) To audit the biochemical 'cure' rate of acromegalic patients treated by surgery and/or radiotherapy under the care of the South Birmingham Endocrine Clinic. (2) To assess the correlation between random or basal GH with IGF-I and nadir GH during an oral glucose tolerance test. Ascertainment of acromegalic patients from a pituitary database. Mode of therapy, pretreatment GH, pretreatment tumour size, post-treatment GH, post-treatment IGF-I and post-treatment nadir GH were recorded. Biochemical cure was defined as a most recent random or basal GH < 5 mU/l. Cure rates were determined. Eighty-nine acromegalic patients were identified as having received surgery and/or radiotherapy. In 35/89 (39%) the most recent GH was < 5 mU/l. The cure rate following surgery was 26/78 (33%). This was not significantly associated with tumour size, but was associated with pretreatment GH concentration (chi 2 = 7.1, 2d.f., P < 0.05). Random/basal GH showed a log-linear association with IGF-I, r = 0.72, and a linear association with nadir GH, r = 0.93. Biochemical cure of acromegaly was more strongly associated with pretreatment GH than with tumour size. Random/basal GH measurements are useful and convenient for the audit of treatment outcome in acromegaly. Ways of improving the biochemical outcome of acromegaly should be sought.
Full Text Available This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital.The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings.Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12 and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned.Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients.To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in
Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han
Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers
Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han
This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place
Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2010
Steeds Richard P
Full Text Available Abstract Background Serum phosphate is an independent predictor of cardiovascular morbidity and mortality in patients with chronic kidney disease and the general population. There is accumulating evidence that phosphate promotes arterial stiffening through structural vascular alterations such as medial calcification, which are already apparent in the early stages of chronic kidney disease. Aim To determine the effects of phosphate binding with sevelamer carbonate on left ventricular mass and function together with arterial stiffness in patients with stage 3 chronic kidney disease. Methods/Design A single-centre, prospective, randomised, double-blind, placebo-controlled trial of 120 subjects with stage 3 chronic kidney disease recruited from University Hospitals Birmingham NHS Foundation Trust. Baseline investigations include transthoracic echocardiography and cardiac magnetic resonance imaging to assess ventricular mass, volumes and function, applanation tonometry to determine pulse wave velocity and pulse wave analysis as surrogate measures of arterial stiffness and dual energy x-ray absorptiometry scanning to determine bone density. During an open-label run in phase, subjects will receive 1600 mg sevelamer carbonate with meals for four weeks. They will then be randomised to either continue sevelamer carbonate or receive an identical placebo (60 subjects per arm for the remaining 36 weeks. Four-weekly monitoring of serum electrolytes and bone biochemistry will be performed. All baseline investigations will be repeated at the end of the treatment period. The primary endpoint of the study is a reduction in left ventricular mass after 40 weeks of treatment. Secondary endpoints are: i change in aortic compliance; ii change in arterial stiffness; iii change in arterial elastance; iv change in left ventricular systolic and diastolic elastance; v change in left ventricular function; and vi change in bone density. Trial Registration This trial is
Kidanto Hussein L
Full Text Available Abstract Background Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS and low birth weight deliveries (LBWT at Muhimbili National Hospital in Tanzania. Methods We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value Results The proportion of teenage mothers (12–19 years progressively decreased over time while that of 30–34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6–1.8] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71–0.82. The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30–34 years age group had no impact on this. Conclusion The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.
This study assessed the contribution of delay to maternal deaths and also determined the socio¬demographic characteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 ...
Silva, Andréa de Albuquerque Arruda; Coutinho, Isabela C; Katz, Leila; Souza, Alex Sandro Rolland
Repeat teen pregnancy is a frequent issue and is considered an aggravating factor for increased maternal and fetal morbidity and social problems. The aim of the study was to identify factors associated with repeat teen pregnancy. A case-control study was conducted in 90 postpartum adolescents with more than one pregnancy (cases) and 90 adult women with a history of only one pregnancy during adolescence (controls). Statistical analysis used hierarchical logistic regression with 5% significance. Early sexual initiation (pregnancy (pregnancy, while partner change was inversely associated. Repeat teen pregnancy was mainly associated with reproductive and socioeconomic factors. Partner change appeared as a protective factor. Measures should be adopted during the postpartum period of teenage mothers in order to avoid repeat pregnancy.
Lofty-John Chukwuemeka Anyanwu
Conclusion: Most of the opportunities to educate women on breast awareness were missed at the postnatal and ICs of our hospital. Integrating breast health education into MCH care programs in developing countries will assist in the early detection of breast pathologies.
Morbidade materna extremamente grave: uso do Sistema de Informação Hospitalar Morbilidad materna extremadamente grave: uso del sistema de información hospitalaria Severe acute maternal morbidity: use of the Brazilian Hospital Information System
Maria da Consolação Magalhães
mostraron útiles para la vigilancia de la morbimortalidad materna y para ampliar el conocimiento sobre los aspectos que las involucran, contribuyendo en la mejoría en la calidad de la asistencia a la mujer en el período embarazo-puerperio.OBJECTIVE: To estimate the prevalence of severe acute maternal morbitidy and identify its associated hospital procedures. METHODS: Data from the Hospital Information System, obtained from the Municipal Secretariat of Health of the city of Juiz de Fora, Southeastern Brazil, for the years 2006 and 2007, were used. The studied women included those admitted to the hospital for obstetric procedures (n = 8,620, and whose primary diagnosis was included within chapter XV: pregnancy, childbirth and puerperium of the International Classification of Diseases, 10th revision. Codes for routine procedures, special procedures, and professional acts that fulfilled the World Health Organization's criteria for severe acute maternal morbidity were identified, as well as other procedures infrequently employed during pregnancy and the postnatal period. Logistic regression analysis was employed to identify associations between the outcome and selected variables. RESULTS: Prevalence of maternal morbidity was 37.8/1000 women, and that of mortality was 12/100,000 women. Hospitalization for more than 4 days was 13 times more frequent among women with some form of morbidity. After adjustment, predictors of severe acute maternal morbidity were: duration of hospitalization, number of hospitalizations, and still births, and the most frequent procedures and conditions were blood product transfusions (15.7/1,000, "extended stay" (9.5/1.000 and severe pre-eclampsia/eclampsia (8.2/1,000. CONCLUSIONS: Prevalence of severe acute maternal morbidity was high, and was related especially to hospitalization and to newborn variables. The criterion for identifying cases and the use of the National Hospital Information System proved to be useful for monitoring maternal morbidity
This study measured food security and hunger of households enrolled in Head Start in Houston, Texas, and Birmingham, Alabama and assessed factors that could affect food security. Interviewers collected data from primary caregivers on demographic characteristics, dietary intake, and the six-item US f...
Barnett, James; Bull, Stephen; Cooper, Helen
Aligning with student engagement and promotional strategies, a Pop-Up Library project was initiated at the University of Birmingham. This involved setting up temporary, staffed stalls in different locations across campus in order to informally communicate with students and effectively take "the Library" to them. This article discusses…
Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E
This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.
Estimation of the incidence of bacterial vaginosis and other vaginal infections and its consequences on maternal/fetal outcome in pregnant women attending an antenatal clinic in a tertiary care hospital in North India
Full Text Available Aims: This study was undertaken to estimate the incidence of bacterial vaginosis (BV and other vaginal infections during pregnancy and its association with urinary tract infections (UTI and its consequences on pregnancy outcome, maternal and fetal morbidity and mortality. Settings and Design: Prospective cohort study. Materials and Methods: The present prospective cohort study was conducted on 200 women attending the antenatal clinic (ANC of a tertiary hospital. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth were collected. BV was detected by both Gram stain and gold standard clinical criteria (Amsel′s composite criteria. Statistical analysis used: Data were analyzed using SPSS version 9. Fischer′s exact test, chi square tests and Student′s′ test has been used for analysis. The probability of 5% was considered as significant for continuous variables such as age, period of gestation and birth weight. Odds ratio (OR and confidence interval (CI with 95% probability were determined. Results: The incidence of bacterial vaginosis was 41 in 200 patients. Adverse outcomes such as preterm labor, PROM and fetal complications were found more in pregnant women who had bacterial vaginosis (N=41, bacterial vaginosis with UTI (N=14 as compared to those without bacterial vaginosis (N=118. Conclusions: The incidence of poor pregnancy outcome was higher in bacterial vaginosis with UTI. Prevention of BV and UTI is cost effective to minimize the pregnancy-related complications and preterm labor to decrease in perinatal and maternal mortality and morbidity. We recommend all antenatal patients should be screened for the presence of bacterial vaginosis, other infections and UTI.
Savage, Grant T; Duncan, W Jack; Knowles, Kathy L; Nelson, Kathleen; Rogers, David A; Kennedy, Karen N
The study describes the genesis of the University of Alabama at Birmingham's Healthcare Leadership Academy (HLA), highlights the HLA's outcomes, discloses how the HLA has changed, and delineates future directions for academic health center (AHC) interprofessional leadership training. While interprofessional training is recognized as an important component of the professional education for health professionals, AHCs have not focused on interprofessional leadership training to prepare future AHC leaders. As professional bureaucracies, AHCs require leadership distributed across different professions; these leaders not only should be technical experts, but also skilled at interprofessional teamwork and collaborative governance. The HLA is examined using the case method, which is supplemented with a descriptive analysis of program evaluation data and outcomes. The HLA has created a networked community of AHC leaders; the HLA's interprofessional team projects foster innovative problem solving. Interprofessional leadership training expands individuals' networks and has multiple organizational benefits. © 2014.
Ydesen, Christian; Myers, Kevin
This article approaches debates about how the history of the post-1945 English welfare state might be written. It argues that professionals’ interventions on immigrant children can serve as a prism for understanding the crafting of the modern English welfare state. In this sense the article engages...... multiculturalism. Due to its influential impact on the development of immigrant education policies in England and because of its extensive education archive the article uses the Birmingham Local Education Administration (LEA) as an empirical and historical case. The significant British Nationality Act of 1948...... and the Immigration Act of 1971 serve as demarcations of the period treated. The article concludes that the immigrant child, and the child’s background, were consistently presented as educational problems and as the cause of both poor academic attainment and a more intangible unwillingness to assimilate. In this lens...
The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.
Harper, Doreen C; Davey, Kimberly S; Fordham, Pamela N
This article analyzes the components of Florence Nightingale's visionary leadership for global health and nursing within the historical context of Great Britain's colonization of India. The descriptive study used the qualitative approach of narrative analysis to analyze selected letters in the Nightingale Letter Collection at the University of Alabama at Birmingham that Nightingale wrote to or about Dr. Thomas Gillham Hewlett, a physician and health officer in Bombay, India. The authors sought to increase understanding of Nightingale's visionary leadership for global nursing and health through a study of the form and content of the letters analyzed as temporally contextualized data, focusing on how the narratives are composed and what is conveyed. Several recurring themes central to Nightingale's leadership on global nursing and health emerge throughout these letters, including health and sanitation reform, collaborative partnerships, data-driven policy development, and advocacy for public health. These themes are illustrated through her letters to and testimony about Dr. Thomas Gillham Hewlett in her vivid descriptions of health education and promotion, data-driven policy documents, public health and sanitation advice, and collaboration with citizens, medicine, policy makers, and governments to improve the health and welfare of the people of India. The focus on leadership in nursing as a global construct highlights the lessons learned from University of Alabama at Birmingham's Nightingale Letter Collection that has relevance for the future of nursing and health care, particularly Nightingale's collaboration with policy leaders, her analysis of data to set policy agendas, and public health reform centered on improving the health and well-being of underserved populations.
Joao Paulo Souza
Full Text Available OBJECTIVES: To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. METHODS: In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. RESULTS: Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6. The maternal severity index (MSI model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993. CONCLUSION: The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.
Ahn, Young-Mee; Kim, Mi-Ran
This study was performed to investigate the quantities of three neo-maternal exposures; visiting frequency, auditory contact and physical contact, and to examine the relationship between the quantities of each exposure and maternal attachment, maternal self-esteem and postpartum depression in 40 mothers of NICU babies during the first week in the NICU. Each neo-maternal exposure was counted at every mother's visit to the newborn and maternal attachment, maternal self-esteem and postpartum depression were measured using the maternal attachment inventory, the maternal self-report inventory and Edinburgh Postpartum Depression Scale (EPDS) on the first and seventh day in the NICU. The Mean of each neo-maternal exposure was 8.77(2.81) for the visiting frequency, 5.82(3.66) for the auditory contact and 5.60(2.89) for the physical contact during 7 days in the NICU. No significant changes were found in the scores of maternal attachment, maternal self-esteem and postpartum depression between the first and the seventh day in the NICU. The quantities of neo-maternal exposures were positively related to the scores of maternal attachment and maternal self-esteem but not related to postpartum depression. The results of the study suggest the lack of early neo-maternal exposure in cases of NICU hospitalization negate its beneficial effects on maternal psychological well-being in increasing maternal attachment and self-esteem. More efforts are needed for the neo-maternal interaction and the reevaluation of NICU visitation hours in order to promote maternal-infant interaction.
Full Text Available É descrito estudo sobre morbidade e mortalidade ocorridas no período perinatal por meio da coleta de dados referentes ao evento, ao produto e à mãe. O estudo foi feito, de maneira coordenada e padronizada, em nove maternidades, sendo sete no Estado de São Paulo, uma no Rio de Janeiro e outra em Florianópolis, SC, o que possibilitou a coleta de dados referentes à 13.130 eventos, dos quais 12.782 eram nascidos vivos; 217 nascidos mortos e 131 abortos. Esta apresentação é a primeira de uma série e que visou descrever detalhadamente o projeto, bem como apresentar alguns resultados globais, sendo que resultados mais específicos serão apresentados futuramente. Dentre os resultados globais chama a atenção a alta mortalidade perinatal, a alta percentagem de cesária e o baixo peso nos casos de nascidos mortos ser, aproximadamente, cinco vezes mais forte que o baixo peso ao nascer nos casos de nascidos vivos.Collecting data on deliveries, newborn and mothers, in maternity-hospitals, is the best way to conduct research into perinatal morbidity and mortality. The kind of study which was carried out in nine Brazilian maternity-hospitals, seven of then situated in cities in the State of S. Paulo, one in Rio de Janeiro and another in Florianópolis, Santa Catarina, is described. The study called for the collection of data on 13,130 deliveries, of which 12,782 were live births, 217 still-births and 131 abortions. This is the first of a series of papers; the aims of this one are to describe the project and to present some general results; however, more specific results will be presented in the future. The high perinatal mortality rate, the high proportion of cesarian sections and the several times greater incidence of low birth-weight in still-births as compared with live births, deserved particular attention.
Full Text Available Phenylketonuria is a hereditary metabolic disorder inherited in an autosomal recessive pattern. Elevated phenylalanine levels in a pregnant woman with phenylketonuria result in phenylalanine embryopathy. Failure to follow special diets during gestation results in neonatal dysplasia. More favorable outcomes are observed when phenylalanine levels remain within normal ranges prior to conception, or at least when they reach normal levels by the 4th-10th weeks of gestation. We report the case of a newborn with maternal phenylketonuria.
Abeer El Sakka
Full Text Available The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW. Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb, electrolytes, blood urea nitrogen (BUN and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430, length 0.76 and 0.58 cm/week (P=0.0027, and head circumference of 0.59 and 0.5 cm/week (P=0.0217 in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls, P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources.
The studies of distribution patterns of 51 Cr-labelled lymphocytes in pregnant mice were designed to explore the effect of pregnancy on the immunologic behaviour of the intact pregnant animal rather than on the isolated maternal lymphocyte. The distribution pattern of 51 Cr-labelled syngenic and semiallogenic lymphocytes was studied in intact primigravida mice, and there was no difference between interstrain and intrastrain pregnant mice, and there was no evidence of immunologically specific 'trapping' in the para-aortic lymph nodes draining the interstrain pregnant uterus. There is little evidence that the primigravida animal is even immunologically aware of the 'foreignness'of a semiallogenic fetus. (JIW)
Lyamuya Eligius F
Full Text Available Abstract Background Group B streptococcus (GBS, which asymptomatically colonises the vaginal and rectal areas of women, is the leading cause of septicemia, meningitis and pneumonia in neonates. In Tanzania no studies have been done on GBS colonisation of pregnant women and neonates. This study was conducted in Dar es Salaam, Tanzania to determine the prevalence of GBS colonisation among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility, thus providing essential information to formulate a policy for treatment and prevention regarding perinatal GBS diseases. Methods This cross sectional study involved 300 pregnant women attending antenatal clinic and their newborns delivered at Muhimbili National Hospital (MNH between October 2008 and March 2009. High vaginal, rectal, nasal, ear and umbilical swabs were cultured on Todd Hewitt Broth and in 5% sheep blood agar followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the Kirby-Bauer method. Results GBS colonisation was confirmed in 23% of pregnant women and 8.9% of neonates. A higher proportion of GBS were isolated from the vagina (12.3% as compared to the rectum (5%. Prolonged duration of labour (>12 hrs was significantly shown to influence GBS colonisation in neonates P Conclusion Our findings seem to suggest that a quarter of pregnant women attending ANC clinic at MNH and approximately 10% of their newborns are colonised with GBS. All isolates were found to be sensitive to vancomycin and ampicillin which seem to be the most effective antibiotics for the time being. However there is a need for continuous antibiotics surveillance of GBS to monitor trend of resistance. The high isolation frequency of GBS among pregnant women suggests routine antenatal screening at 35 to 37 weeks of gestation in order to provide antibiotic prophylaxis to GBS carrier.
Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.
Xu, Qian; Séguin, Louise; Goulet, Lise
To identify the contribution of the duration of the prenatal maternity leave on term delivery. Characteristics of the prenatal maternity leave and delivery among 363 working women who had delivered a full-term infant at 1 of 4 hospitals in Montreal during 1996 were studied. The presence of an intervention or complication during delivery was observed in 68.9% of the participants. The average duration of the prenatal maternity leave was about 8 weeks (SD = 7). The adjusted risk of a difficult delivery decreased significantly with the duration of the prenatal maternity leave (OR = 0.96; 95% CI: 0.93-0.99). The duration of the maternity leave before delivery is associated with an easier term delivery for working women.
Vangen, Siri; Bødker, Birgit; Ellingsen, Liv
reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated. RESULTS: We registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from......INTRODUCTION: Despite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based...... on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths. MATERIAL AND METHODS: We present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct...
Roberts, D; Vause, S; Martin, W; Green, P; Walkinshaw, S; Bricker, L; Beardsmore, C; Shaw, N; McKay, A; Skotny, G; Williamson, P; Alfirevic, Z
To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk (RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group (RR 9.0 (95% CI, 0.51-159.70)). This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy
Full Text Available La revolución industrial brindó a Inglaterra importantes desarrollos en el campo del transporte, comercio e industria. Por otro lado, también generó nuevos problemas sociales y medioambientales tales como polución atmosférica, superpoblación de areas urbanas sin adecuados recursos sanitarios, servicios cloacales y condiciones de trabajo extenuantes e inhumanas. Como los niños son los miembros más vulnerables de la sociedad, es esperado que sean los más severamente afectados por estas condiciones de vida limitantes y consequentemente muestren más indicadores de stress. El objetivo de este trabajo es analizar la presencia de enfermedades relacionadas con deficiencias vitamínicas tales como raquitismo, escorbuto, criba orbitalia e hipoplasia dentaria así como evaluar su prevalencia e interpretar sus posibles causas en una población infantil de 56 individuos que datan del S. XIX de la ciudad de Wolverhampton, en Birmingham, Inglaterra.
Shital G. Sonone
Full Text Available Background : The current maternal mortality rate (MMR in Maharashtra is 104/100000 live births, ranking 3rd in India. There is scope for reducing it as majority of the causes of MMR are preventable and curable. Aims and Objectives: To study the sociodemographic profile and causes of maternal deaths at Dr. V. M. Govt. Medical College, Solapur. Material and Methods: The study population included all deliveries i.e. women admitted in the hospital during pregnancy, child-birth or within 42 days of termination of pregnancy from any cause related to or aggravated due to pregnancy during the period of 2 years from 1st August 2009 to 31st July 2011. IPD case records and autopsy reports of all maternal deaths were taken and various variables were studied. The present study is prospective study of maternal mortality conducted in Dept. of Obstetrics and Gynaecology, Dr. V. M. Medical College Solapur. Cases were distributed ac-cording to their age, literacy rate, residence,socioeconomic status, ante-natal care, gestational age, gravida/parity, place of referral, pregnancy outcome, and place of delivery, perinatal outcome and etiological factors. This study also suggests the measures to reduce maternal mortality. Results: The total number of live births during the study period were 13,188 and total number of maternal deaths were 63 and MMR was 477 per 1, 00,000 live births. In the maternal deaths studied, 1/3rd of the women were illiterate, half of the women belonged to urban slum areas and of lower socioeconomic class.1/3rd of the deaths occurred in primigravida,within 24 hrs from admission, 58.73% of the patients were referred from outside. Out of that 86.49% of women were sent from private hospital and died in post partum period, having poor perinatal outcome. Haemorrhage (28.57% and hypertension (12.69% are two direct causes and severe anemia (33.33% is most common in direct cause of maternal death in our study.
qualification, test environment (noise and subject, false-negative, evasion and evaluation time were assessed in a cross-sectional study which included the hearing screening of all newborns in two public maternity hospitals, through otoacoustic emissions. RESULTS: Out of 4951 newborns in the period from 2002 to 2005, 3364 (67.9% were assessed; 425 (12.61% had risk indicators for hearing impairment. Hearing loss was confirmed in seven newborns (0.3% through the Brainstem Auditory Evoked Potential. CONCLUSIONS: The need for protocols with well defined "pass and fail" criterion for each target population was verified. Hearing screening should be carried out within 30 days following birth and should not be limited to maternity hospitals. Team training and supervision is crucial, as well as electronic appointment and monitoring system, in order to decrease evasion and to detect late hearing loss, associating screening programs with the responsibility of diagnostic confirmation and intervention. This way, one will be able to measure hearing deficiency in Brazil and compare it with epidemiological profiles of countries where such programs have already outlined the hearing health of their population.
Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005–2014: Quality assurance of linkage of routine data for singleton and multiple births
Objectives To quality assure a Trusted Third Party linked data set to prepare it for analysis. Setting Birth registration and notification records from the Office for National Statistics for all births in England 2005–2014 linked to Maternity Hospital Episode Statistics (HES) delivery records by NHS Digital using mothers’ identifiers. Participants All 6 676 912 births that occurred in England from 1 January 2005 to 31 December 2014. Primary and secondary outcome measures Every link between a registered birth and an HES delivery record for the study period was categorised as either the same baby or a different baby to the same mother, or as a wrong link, by comparing common baby data items and valid values in key fields with stepwise deterministic rules. Rates of preserved and discarded links were calculated and which features were more common in each group were assessed. Results Ninety-eight per cent of births originally linked to HES were left with one preserved link. The majority of discarded links were due to duplicate HES delivery records. Of the 4854 discarded links categorised as wrong links, clerical checks found 85% were false-positives links, 13% were quality assurance false negatives and 2% were undeterminable. Births linked using a less reliable stage of the linkage algorithm, births at home and in the London region, and with birth weight or gestational age values missing in HES were more likely to have all links discarded. Conclusions Linkage error, data quality issues, and false negatives in the quality assurance procedure were uncovered. The procedure could be improved by allowing for transposition in date fields, and more discrimination between missing and differing values. The availability of identifiers in the datasets supported clerical checking. Other research using Trusted Third Party linkage should not assume the linked dataset is error-free or optimised for their analysis, and allow sufficient resources for this. PMID:29500200
Feasibility of Pulse Oximetry Pre-discharge Screening Implementation for detecting Critical Congenital heart Lesions in newborns in a secondary level maternity hospital in the Western Cape, South Africa: The 'POPSICLe' study.
Van Niekerk, A M; Cullis, R M; Linley, L L; Zühlke, L
Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world. To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital, a busy government hospital in Cape Town, South Africa. Parent and staff acceptance was assessed. We conducted a prospective study of predischarge POx screening in one postnatal ward, following informed parental consent. During the 4-month study period, 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0% of tests took <3 minutes to perform, 4.3% 3 - 5 minutes and 1.7% >5 minutes. Eighteen patients needed second screens and three required third screens. Only 3.1% protocol errors were made, all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time to perform the study screening in addition to their daily tasks, but ~75% felt that with a full nursing staff complement and if done routinely (not part of a study), pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Two babies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity and specificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%), respectively, with a percentage correct of 99.8%. POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is done routinely before discharge, not as part of a study, we conclude that POx screening could be implemented successfully without excessive false positives or errors, or any additional burden to cardiology services.
Haerskjold, Ann; Kristensen, Kim; Kamper-Jørgensen, Mads
of gestational age. Plurality was associated with a decreased risk in children born between 23 and 36 weeks of gestation, whereas young maternal age, maternal asthma, single parenthood, maternal smoking, being born small for gestational age, Caesarian section, male gender and day care were associated...... with an increased risk of hospitalization for RSV infection in term children. In postterm children, young maternal age, male sex, being born small for gestational age and maternal smoking were associated with an increased risk of hospitalization for RSV. Asthma hospitalization before the RSV infection and siblings...
Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2011
Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan
Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level ...
Context: Various interventions have been introduced to reduce the very high maternal mortality ratio in our environmentbut to date the success is only marginal at best. Objective: To determine the trend in maternal mortality in University of Maiduguri Teaching Hospital (UMTH). Methods: Analysis of records of all women who ...
Objective: To have a 5-year review of the maternal mortality ratio in the largest centrally located Mission hospital in Benin City where a large proportion of women deliver yearly. Method: This was a 5-year (January 1, 1996 through December 31, 2000) review of the causes of maternal mortality at the Saint Philomena ...
Background: This study examined maternal morbidity and mortality and neonatal mortality over a multi-year period from de-identified retrospective medical records at Nyakahanga Designated District Hospital in north-western Tanzania. The study aimed to examine factors related to maternal mortality (MMR) and morbidity in ...
Kermani, TA; Cuthbertson, D; Carette, S; Hoffman, GS; Khalidi, NA; Koening, CL; Langford, CA; McKinnon-Maksimowicz, K; McAlear, CA; Monach, PA; Seo, P; Warrington, KJ; Ytterberg, SR; Merkel, PA; Matteson, EL
Objective To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) in the assessment of disease activity in giant cell arteritis (GCA). Methods Patients with GCA enrolled in a prospective, multicenter, longitudinal study with symptoms of active vasculitis during any visit were included. Spearman’s rank correlation was used to explore the association of the BVAS with other measures of disease activity. Results During a mean (SD) follow-up of 2.3 (1.6) years, symptoms of active GCA were present in 236 visits in 136 subjects (100 female, 74%). Median (range) BVAS1 (new/worse symptoms) was 1 (0–10) and median (range) BVAS2 (persistent symptoms) was 0 (0–5). Median (range) physician global assessment (PGA) was 4 (0–9) for disease activity in the past 28 days and 2 (0–9) for activity on the day of the visit. Important ischemic manifestations of active vasculitis not captured by the BVAS included tongue/jaw claudication (27%), upper extremity claudication (15%), lower extremity claudication (5%), carotidynia (7%), ischemic retinopathy (5%). During 25 visits (11%) with active disease, all symptoms of active vasculitis were captured in the “Other” category yet still resulted in a BVAS 1 and BVAS 2 of 0. BVAS1 moderately correlated with PGA for the past 28 days (Spearman’s correlation 0.50) and physician-rated disease activity for the past 28 days (Spearman’s correlation 0.46). Conclusions The BVAS has limited utility in GCA. Patients with active GCA can have a BVAS of 0. Many important ischemic symptoms attributable to active vasculitis are not captured in the composite score. PMID:27036388
Antunes Azevedo, Juliana; Burghardt, René; Chapman, Lee; Katzchner, Lutz; Muller, Catherine L.
Climate is a key driving factor in energy consumption. However, income, vegetation, building mass structure, topography also impact on the amount of energy consumption. In a changing climate, increased temperatures are likely to lead to increased electricity consumption, affecting demand, distribution and generation. Furthermore, as the world population becomes more urbanized, increasing numbers of people will need to deal with not only increased temperatures from climate change, but also from the unintentional modification of the urban climate in the form of urban heat islands. Hence, climate and climate change needs to be taken into account for future urban planning aspects to increase the climate and energy resilience of the community and decrease the future social and economic costs. Geographical Information Systems provide a means to create urban climate maps as part of the urban planning process. Geostatistical analyses linking these maps with demographic and social data, enables a geo-statistical analysis to identify linkages to high-risk groups of the community and vulnerable areas of town and cities. Presently, the climatope classification is oriented towards thermal aspects and the ventilation quality (roughness) of the urban areas but can also be adapted to take into account other structural "environmental factors". This study aims to use the climatope approach to predict areas of potential high electricity consumption in Birmingham, UK. Several datasets were used to produce an average surface temperature map, vegetation map, land use map, topography map, building height map, built-up area roughness calculations, an average air temperature map and a domestic electricity consumption map. From the correlations obtained between the layers it is possible to average the importance of each factor and create a map for domestic electricity consumption to understand the influence of environmental aspects on spatial energy consumption. Based on these results city
Pan, Xiaoping; Chen, Haobo; Bickerton, Wai-Ling; Lau, Johnny King Lam; Kong, Anthony Pak Hin; Rotshtein, Pia; Guo, Aihua; Hu, Jianxi; Humphreys, Glyn W
There are no currently effective cognitive assessment tools for patients who have suffered stroke in the People's Republic of China. The Birmingham Cognitive Screen (BCoS) has been shown to be a promising tool for revealing patients' poststroke cognitive deficits in specific domains, which facilitates more individually designed rehabilitation in the long run. Hence we examined the reliability and validity of a Cantonese version BCoS in patients with acute ischemic stroke, in Guangzhou. A total of 98 patients with acute ischemic stroke were assessed with the Cantonese version of the BCoS, and an additional 133 healthy individuals were recruited as controls. Apart from the BCoS, the patients also completed a number of external cognitive tests, including the Montreal Cognitive Assessment Test (MoCA), Mini Mental State Examination (MMSE), Albert's cancellation test, the Rey-Osterrieth Complex Figure Test, and six gesture matching tasks. Cutoff scores for failing each subtest, ie, deficits, were computed based on the performance of the controls. The validity and reliability of the Cantonese BCoS were examined, as well as interrater and test-retest reliability. We also compared the proportions of cases being classified as deficits in controlled attention, memory, character writing, and praxis, between patients with and without spoken language impairment. Analyses showed high test-retest reliability and agreement across independent raters on the qualitative aspects of measurement. Significant correlations were observed between the subtests of the Cantonese BCoS and the other external cognitive tests, providing evidence for convergent validity of the Cantonese BCoS. The screen was also able to generate measures of cognitive functions that were relatively uncontaminated by the presence of aphasia. This study suggests good reliability and validity of the Cantonese version of the BCoS. The Cantonese BCoS is a very promising tool for the detection of cognitive problems in
Perfis de mortalidade neonatal precoce: um estudo para uma Maternidade Pública de Belo Horizonte (MG, 2001-2006 Profiles of early neonatal deaths: a study for a Public Maternity Hospital of Belo Horizonte (MG, 2001 - 2006
Heloísa Maria de Assis
Full Text Available Trata-se de estudo seccional, com base em dados secundários, com o objetivo de traçar o perfil dos óbitos neonatais precoces ocorridos em uma Maternidade Pública de referência no Estado de Minas Gerais (Maternidade Odete Valadares, Belo Horizonte, no período de 2001 a 2006. Foram utilizadas variáveis relacionadas ao recém-nascido (período de ocorrência do óbito, idade ao óbito, sexo, idade gestacional e peso ao nascer, à mãe (tipo de gravidez, tipo de parto, idade, parturição e número de nascidos mortos, bem como causas múltiplas de mortalidade categorizadas. Obtiveram-se três perfis de óbitos neonatais precoces por meio do método Grade of Membership, que possibilitou também encontrar a prevalência destes perfis. O Perfil 1 foi caracterizado por óbitos de difícil redução e teve prevalência de 41,4%; o Perfil 2, pelos óbitos passíveis de redução (prevalência de 28,3%; e o Perfil 3, pelos óbitos redutíveis (prevalência de 30,4%. Estes perfis possibilitaram a compreensão da mortalidade neonatal precoce na Maternidade Odete Valadares e a análise da sua relação com a história reprodutiva e obstétrica materna, bem como com as condições do recém-nascido. Chama a atenção a elevada prevalência de óbitos evitáveis, realidade que deve ser enfrentada pelos profissionais e pela rede pública de saúde.This is a cross-sectional study with the aim of describing the early neonatal deaths that took place at a Public Maternity Hospital, Maternidade Odete Valadares in Belo Horizonte, Minas Gerais, Brazil, from 2001 to 2006. It used variables related to the newborn (period the death took place, age at death, gender, gestational age, and birth weight, to the mother (type of pregnancy, type of delivery, age, parity, and number of stillborn children, and to the multiple causes of death. Three profiles of early neonatal death were obtained through the Grade of Membership method (GoM, which also made it possible to find
Jou, Judy; Kozhimannil, Katy B; Abraham, Jean M; Blewett, Lynn A; McGovern, Patricia M
Objectives The United States is one of only three countries worldwide with no national policy guaranteeing paid leave to employed women who give birth. While maternity leave has been linked to improved maternal and child outcomes in international contexts, up-to-date research evidence in the U.S. context is needed to inform current policy debates on paid family leave. Methods Using data from Listening to Mothers III, a national survey of women ages 18-45 who gave birth in 2011-2012, we conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. Results Use of paid and unpaid leave varied significantly by race/ethnicity and household income. Women who took paid maternity leave experienced a 47% decrease in the odds of re-hospitalizing their infants (95% CI 0.3, 1.0) and a 51% decrease in the odds of being re-hospitalized themselves (95% CI 0.3, 0.9) at 21 months postpartum, compared to women taking unpaid or no leave. They also had 1.8 times the odds of doing well with exercise (95% CI 1.1, 3.0) and stress management (95% CI 1.1, 2.8), compared to women taking only unpaid leave. Conclusions for Practice Paid maternity leave significantly predicts lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management. Policies aimed at expanding access to paid maternity and family leave may contribute toward reducing socio-demographic disparities in paid leave use and its associated health benefits.
. This study is aimed to document policies and programs that are directed towards addressing maternal health issues in Kano state of Nigeria. Relevant data was obtained from the state hospital management board, NDHS 2008, and national ...
Cho, June; Su, Xiaogang; Phillips, Vivien; Holditch-Davis, Diane
The purpose of this study was to determine whether maternal mental and physical health is associated with maternal testosterone and cortisol levels, parenting of very low birth weight infants, physical exercise, and White vs non-White race. A total of 40 mothers of very low birth weight infants were recruited from a neonatal intensive care unit at a University Hospital in the Southeast United States. Data were collected through a review of medical records, standardized questionnaires, and bio...
Full Text Available Objectives : To study tile socio-economic and maternal risk factors associated with low birth weight babies and to measure the strength of association. Study Design : Hospital based case-control study. Setting : Shri Sayajirao General Hospital, Vadodara. Sample size : 312 cases and 312 controls. Participants : Cases Mothers who delivered single, live baby less than 2500 gms i.e. low birth weight. Controls:- Mothers who delivered single live baby more than 2500 gms. Study Variable : Maternal age, literacy, anaemia, outcome of last pregnancy. Statistical Analysis : Chi-square test and odd’s ratio. Result : Among cases, 14.5% mothers had age less titan 20 yrs as compared to 7.3% mothers in control group. 68.6% mothers amongst cases were illiterate against 46.5% mothers in control group. 53.8% mothers had haemoglobin level 10gm% or less amongst cases and no statistically significant difference was found between low birth weight and outcome of last pregnancy Conclusion : The maternal risk factors associated with low birth weight in mothers attending S.S.G. hospital age maternal anaemia (OR 2.66, illiteracy (OR 2.51, maternal age less than 20 yrs. (OR 2.OS. No association was found between low birth rate and outcome of last pregnancy
Roberts, Christine L; Ford, Jane B; Algert, Charles S; Bell, Jane C; Simpson, Judy M; Morris, Jonathan M
Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI) developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH). We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3-5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising
Algert Charles S
Full Text Available Abstract Background Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH. Methods We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Results Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000 suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3–5.3%. This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Conclusion Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was
Howell, Elizabeth A; Egorova, Natalia N; Balbierz, Amy; Zeitlin, Jennifer; Hebert, Paul L
The black-white maternal mortality disparity is the largest disparity among all conventional population perinatal health measures, and the mortality gap between black and white women in New York City has nearly doubled in recent years. For every maternal death, 100 women experience severe maternal morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during their delivery hospitalization. Like maternal mortality, severe maternal morbidity is more common among black than white women. A significant portion of maternal morbidity and mortality is preventable, making quality of care in hospitals a critical lever for improving outcomes. Hospital variation in risk-adjusted severe maternal morbidity rates exists. The extent to which variation in hospital performance on severe maternal morbidity rates contributes to black-white disparities in New York City hospitals has not been studied. We examined the extent to which black-white differences in severe maternal morbidity rates in New York City hospitals can be explained by differences in the hospitals in which black and white women deliver. We conducted a population-based study using linked 2011-2013 New York City discharge and birth certificate datasets (n = 353,773 deliveries) to examine black-white differences in severe maternal morbidity rates in New York City hospitals. A mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-standardized severe maternal morbidity rates for each hospital (n = 40). We then assessed differences in the distributions of black and white deliveries among these hospitals. Severe maternal morbidity occurred in 8882 deliveries (2.5%) and was higher among black than white women (4.2% vs 1.5%, P rates among New York City hospitals ranged from 0.8 to 5.7 per 100 deliveries. White deliveries were more likely to be delivered in low-morbidity hospitals: 65% of white vs 23% of black deliveries occurred in hospitals in the lowest
Rosa Maria Soares Madeira Domingues
Full Text Available Este estudo tem por objetivo analisar os fatores que estiveram associados à satisfação das mulheres com a assistência ao parto normal na Maternidade Leila Diniz. Realizou-se um estudo com desenho transversal por meio de entrevista com puérperas de parto vaginal internadas no período de 1º a 30 de março de 1999. Para averiguar o grau de satisfação, foram utilizadas: (a uma escala para avaliação global do parto; (b a descrição das razões alegadas pelas mulheres para essa avaliação e (c análise de fatores associados à satisfação com o parto. O Qui-quadrado para teste de tendência, com nível de significância de 5%, foi utilizado para a análise dos resultados. Encontrou-se uma elevada satisfação com o parto (67%, sendo os principais determinantes da satisfação a rapidez do parto, o bom tratamento da equipe, o pouco sofrimento, o bom estado da mãe e do bebê, bem como a presença do acompanhante familiar. Verificou-se também associação dessa satisfação com a informação fornecida durante a assistência ao trabalho de parto e ao parto, e com a percepção positiva dos profissionais que forneceram essa assistência.The objective of this study was to evaluate factors associated with women's satisfaction with vaginal delivery at the Leila Diniz Maternity Hospital in Rio de Janeiro, Brazil. A cross-sectional study was conducted from March 1 to 30, 1999, using interviews with women who had undergone vaginal delivery. In order to analyze women's satisfaction, the following were used: (a a scale to evaluate overall satisfaction with the birthing process; (b description of the woman's reasons for this evaluation; and (c analysis of factors associated with the evaluation of childbirth satisfaction. Chi-square for trend with a 5% significance level was used to analyze the results. The results of the study showed high satisfaction with childbirth care (67%, determined mainly by short labor time, good treatment by staff, low
Linkage of Maternity Hospital Episode Statistics data to birth registration and notification records for births in England 2005-2014: Quality assurance of linkage of routine data for singleton and multiple births.
To quality assure a Trusted Third Party linked data set to prepare it for analysis. Birth registration and notification records from the Office for National Statistics for all births in England 2005-2014 linked to Maternity Hospital Episode Statistics (HES) delivery records by NHS Digital using mothers' identifiers. All 6 676 912 births that occurred in England from 1 January 2005 to 31 December 2014. Every link between a registered birth and an HES delivery record for the study period was categorised as either the same baby or a different baby to the same mother, or as a wrong link, by comparing common baby data items and valid values in key fields with stepwise deterministic rules. Rates of preserved and discarded links were calculated and which features were more common in each group were assessed. Ninety-eight per cent of births originally linked to HES were left with one preserved link. The majority of discarded links were due to duplicate HES delivery records. Of the 4854 discarded links categorised as wrong links, clerical checks found 85% were false-positives links, 13% were quality assurance false negatives and 2% were undeterminable. Births linked using a less reliable stage of the linkage algorithm, births at home and in the London region, and with birth weight or gestational age values missing in HES were more likely to have all links discarded. Linkage error, data quality issues, and false negatives in the quality assurance procedure were uncovered. The procedure could be improved by allowing for transposition in date fields, and more discrimination between missing and differing values. The availability of identifiers in the datasets supported clerical checking. Other research using Trusted Third Party linkage should not assume the linked dataset is error-free or optimised for their analysis, and allow sufficient resources for this. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved
Sikdar, K; Kundu, S; Mandal, G S
A study of 26 maternal deaths following 3647 caesarean sections was conducted in Eden Hospital from 1974-1977. During the time period there were 35,544 births and 308 total maternal deaths (8.74/1000). Indications for Caesarean sections included: 1) abnormal presentation; 2) cephalopelvic disproportion; 3) toxemia; 4) prolonged labor; 5) fetal distress; and 6) post-caesarean pregnancies. Highest mortality rates were among cephalopelvic disproportion, toxemia, and prolonged labor patients. 38.4% of the patients died due to septicaemia and peritonitis, but other deaths were due to preclampsia, shock, and hemorrhage. Proper antenatal care may have prevented anemia and preclampsia and treated other pre-existing or superimposed diseases.
Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi
Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.
Bødker, Birgit; Hvidman, Lone; Weber, Tom
OBJECTIVE: To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. DESIGN: Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. SET...
Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates.
Objective: Maternal weight gain in pregnancy can offer a good means of assessing the well being of the pregnant mother and by inference, her baby. The cross – sectional prospective study was carried out carried out between November 1996 and December 1997, in Jos University Teaching hospital to assess the influence ...
Nation's Schools, 1972
In precedent-setting decrees, courts and federal and State authorities have branded compulsory maternity leaves either unconstitutional or illegal. School administrators are urged to prod boards of education to adopt more lenient maternity leave policies -- now. (Author)
Full Text Available Abstract Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases. Birmingham Own Health® is a telephone-based care service (nurse-delivered motivational coaching and support for self-management and lifestyle change for patients with poorly controlled diabetes, delivered in Birmingham, UK. We used a novel method to evaluate its effectiveness in a real-life setting. Methods Retrospective cohort study in the UK. 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health® (intervention cohort and with > 90 days follow-up, were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Database (GPRD to create a pool of 21,052 controls (control cohort. Controls were further selected from the main control cohort, matching as close as possible to the cases for baseline test levels, followed by as close as possible length of follow-up (within +/-30 days limits and within +/-90 days baseline test date. The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible. Effect sizes were computed using linear regression analysis adjusting for age, sex, deprivation quintile, length of follow-up and baseline test levels. Results After adjusting for baseline values and other potential confounders, the intervention showed significant mean reductions among people with diabetes of 0.3% (95%CI 0.1, 0.4% in HbA1c; 3.5 mmHg (1.5, 5.5 in systolic blood pressure, 1.6 mmHg (0.4, 2.7 in diastolic blood pressure and 0.7 unit reduction (0.3, 1.0 in BMI, over a mean follow-up of around 10 months. Only small effects were seen on average on serum cholesterol levels (0.1 mmol/l reduction (0.1, 0.2. More marked effects were seen for each clinical outcome among patients with worse baseline levels. Conclusions Despite the limitations of the study design, the results are consistent with the
Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A.
Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety
Stevenson-Hinde, J.; Chicot, R.; Schouldice, A.; Hinde, C.A.
Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels
Ramesh, K N; Vidyadaran, M K; Goh, Y M; Nasaruddin, A A; Jammal, A B E; Zainab, S
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle's method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed (r = 0.315; p = 0.013) and (r = 0.265; p = 0.038), and non-exposed (r = 0.224; p = 0.035) and (r = 0.241; p = 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r = 0.405; p = 0.020) and Indian (r = 0.553; p = 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results.
World of Work, 1998
Discusses the need for maternity benefits for working women. Suggests that although most countries provide paid maternity leave by law, there is a gap between that law and practice. Includes a chart depicting maternity protection (length of leave, cash benefits, who pays) around the world. (JOW)
Full Text Available This prospective study aimed to estimate the incidence and associated factors of severe maternal morbidity in southeast Iran. During a 9-month period in 2013, all women referring to eight hospitals for termination of pregnancy as well as women admitted during 42 days after the termination of pregnancy were enrolled into the study. Maternal near miss conditions were defined based on Say et al.’s recommendations. Five hundred and one cases of maternal near miss and 19,908 live births occurred in the study period, yielding a maternal near miss ratio of 25.2 per 1000 live births. This rate was 7.5 and 105 per 1000 in private and tertiary care settings, respectively. The rate of maternal death in near miss cases was 0.40% with a case:fatality ratio of 250 : 1. The most prevalent causes of near miss were severe preeclampsia (27.3%, ectopic pregnancy (18.4%, and abruptio placentae (16.2%. Higher age, higher education, and being primiparous were associated with a higher risk of near miss. Considering the high rate of maternal near miss in referral hospitals, maternal near miss surveillance system should be set up in these hospitals to identify cases of severe maternal morbidity as soon as possible.
Choolani, M; Ratnam, S S
Reduction of maternal mortality in developing countries is possible through elimination of unsafe abortion, active management of labor, appropriate management of pregnancy complications, and availability of adequate facilities. Prevention and early recognition are key factors in preventing maternal deaths due to ruptured uteri. A well equipped hospital is the appropriate place for delivery of mothers with a history of previous cesarean sections, a grossly contracted pelvis, previous myomectomies, previous multiple births, and previous abnormal births or complications during delivery. Complicated procedures, use of oxytocins, and administration of anesthesia should be performed with experienced, trained medical personnel. Surveillance of and correction for anemia should occur during the course of the pregnancy. Infections can be controlled with tetanus toxoid immunization and use of chest X-rays. The health care system should be tiered with primary health care services located in suburbs and rural districts. Services should be situated to account for population distribution, extent of maternal mortality in the region, transportation facilities, and the nearest secondary hospital. Birthing homes with sanitary facilities are an option for rural districts. A two-way referral system should be established between the primary, secondary, and tertiary level hospitals. Audits should be conducted as a means of checking for needed improvements in the system. Planning that includes proper roads, transportation, and communication facilities is important. Funding can come in the form of money, materials, and manpower. Safe motherhood requires the commitment of local people and local governments. The first step in a safe motherhood program is creating awareness among the political and economic elite. Governments are encouraged to shift resources from the military to housing, transportation, communications, education, and health during peace-times. Local professional associations
Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA: a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population [ISRCTN89345269
Full Text Available Abstract Background Atrial fibrillation (AF is an important independent risk factor for stroke. Randomised controlled trials have shown that this risk can be reduced substantially by treatment with warfarin or more modestly by treatment with aspirin. Existing trial data for the effectiveness of warfarin are drawn largely from studies in selected secondary care populations that under-represent the elderly. The Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA study will provide evidence of the risks and benefits of warfarin versus aspirin for the prevention of stroke for older people with AF in a primary care setting. Study design A randomised controlled trial where older patients with AF are randomised to receive adjusted dose warfarin or aspirin. Patients will be followed up at three months post-randomisation, then at six monthly intervals there after for an average of three years by their general practitioner. Patients will also receive an annual health questionnaire. 1240 patients will be recruited from over 200 practices in England. Patients must be aged 75 years or over and have AF. Patients will be excluded if they have a history of any of the following conditions: rheumatic heart disease; major non-traumatic haemorrhage; intra-cranial haemorrhage; oesophageal varices; active endoscopically proven peptic ulcer disease; allergic hypersensitivity to warfarin or aspirin; or terminal illness. Patients will also be excluded if the GP considers that there are clinical reasons to treat a patient with warfarin in preference to aspirin (or vice versa. The primary end-point is fatal or non-fatal disabling stroke (ischaemic or haemorrhagic or significant arterial embolism. Secondary outcomes include major extra-cranial haemorrhage, death (all cause, vascular, hospital admissions (all cause, vascular, cognition, quality of life, disability and compliance with study medication.
Smith, Eberle M.
Full Text Available Había que proyectar para un suburbio una escuela del grado primero al sexto, con 18 clases, dos jardines de infancia, biblioteca, amplio salón de actos, sala de arte y de música, clínica y oficina de administración; todo ello sin contar con ampliaciones en el futuro. La exigencia especial del cliente era la separación de la zona de juego para los cursos inferiores y superiores, y acceso fácil al jardín de infancia para las madres que traen sus niños en coche.
Parker, G; Lipscombe, P
While maternal overprotection appears associated with several neurotic and psychotic disorders, little is known about determinants of such a parental characteristic. Several hypotheses have been tested in a large nonclinical sample. Maternal and cultural factors seemed of greater relevance than characteristics in the child. Overprotective mothers gave evidence of marked maternal preoccupations before having children, of showing a capacity to be overprotective after the active stage of mothering, and of having personality characteristics of high anxiety, obsessionality and a need to control. Maternal overprotection appears associated with low, rather than with high maternal care. This has important primary prevention and treatment implications.
Beuchert-Pedersen, Louise Voldby; Humlum, Maria Knoth; Vejlin, Rune Majlund
We study the relationship between the length of maternity leave and the physical and psychological health of the family. Using a reform of the parental leave scheme in Denmark that increased the number of weeks of leave with full benefit compensation, we estimate the effect of the lenght...... of maternity leave on a range of health indicators including the number of hospital admissions for both mother and child and the probability of the mother receiving antidepressants. The reform led to an increase in average post-birth maternity leave matters for child or maternal health outcomes and thus we...... complement the existing evidence on maternity leave expansions that tends to find limited effects on children's later deveopmental, educational, and labor market outcomes. Our results suggest that any beneficial effects of increasing the lenght of maternity leave are greater for low-resource families....
Baeva, Sonia; Archer, Natalie P; Ruggiero, Karen; Hall, Manda; Stagg, Julie; Interis, Evelyn Coronado; Vega, Rachelle; Delgado, Evelyn; Hellerstedt, John; Hankins, Gary; Hollier, Lisa M
A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Kapinos, Kandice A; Yakusheva, Olga; Weiss, Marianne
Cesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery. We used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally. We found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy. After accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.
van den Broek Nynke
Full Text Available Abstract Background Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. Methods SWOT (strengths, weaknesses, opportunities and threats analysis of the process of maternal death review during a workshop in Malawi. Results Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Conclusion Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.
Kongnyuy, Eugene J; van den Broek, Nynke
Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi. Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.
Impacto das malformações congênitas na mortalidade perinatal e neonatal em uma maternidade-escola do Recife Impact of congenital malformations on perinatal and neonatal mortality in an university maternity hospital in Recife
Melania Maria Ramos de Amorim
Full Text Available OBJETIVOS: determinar a incidência de malformações congênitas em recém-nascidos assistidos em uma maternidade-escola de Recife e avaliar o impacto destas malformações na mortalidade perinatal e neonatal. MÉTODOS: realizou-se um estudo longitudinal durante os meses de setembro de 2004 a maio de 2005, analisando-se todos os partos assistidos no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Determinou-se a freqüência e o tipo de malformações congênitas e foram calculados os coeficientes de mortalidade fetal, mortalidade perinatal, mortalidade neonatal precoce e tardia. RESULTADOS: a freqüência de malformações foi de 2,8% (em 4043 nascimentos. O percentual de malformações entre os nativivos foi de 2,7%, e entre os natimortos foi de 6,7%. Dentre as malformações, as mais freqüentes foram as do sistema nervoso central (principalmente hidrocefalia e meningomielocele, as do sistema osteomuscular e as cardiopatias. Não houve associação entre malformações e sexo, porém a freqüência de prematuridade e baixo peso foi maior entre os casos de malformações. Constatou-se, entre os malformados, mortalidade neonatal precoce de 32,7% e tardia de 10,6%. Os casos de malformações representaram 6,7% dos natimortos, 24,2% das mortes neonatais precoces e 25,8% do total de mortes neonatais. CONCLUSÕES: a freqüência de malformações correspondeu a 2,8% dos nascimentos. As malformações representaram a segunda causa mais freqüente de mortes neonatais, depois da prematuridade.OBJECTIVES: to determine the incidence of congenital malformations in newborns in a university maternity hospital in Recife and assess the impact of malformation in perinatal and neonatal mortality. METHODS: a longitudinal study was performed from September 2004 to May 2005 with all deliveries at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP analyzed. The type and incidence of congenital malformations were determined, and fetal mortality
Gibson, D.L.; Uh, S.H.; Miller, J.R.
The role of preconception irradiation in the etiology of Down Syndrome was examined using the techniques of record linkage. Although 909 cases of Down Syndrome, born in B.C. between 1952-70, were ascertained through a system of linked vital and health registrations, interest was restricted to the 348 case/control pairs born in the greater Vancouver area. The maternal identifying information routinely recorded on birth and ill-health registrations was used to link 155 Down Syndrome mothers and 116 control mothers to patient files at the Vancouver General Hospital. Only 28 of the case and 25 of the control mothers were subjected to diagnostic irradiation at the Vancouver Ganeral Hospital. The difference was not significant at the 5% level
Institute of Obstetricians & Gynaecologists RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting Nov 2010
Care of adolescents sheltered in maternity hospitals from the perspective of health professionals Asistencia a las adolescentes albergadas en una maternidad bajo la óptica de profesionales de salud Assistência às adolescentes abrigadas em maternidade sob a ótica de profissionais de saúde
Lucia Helena Garcia Penna
Full Text Available OBJECTIVE: Discuss determinant aspects of quality care of pregnant adolescents sheltered in a maternity hospital, according to the perspective of health professionals. METHODS: Study with a qualitative, exploratory approach, conducted in a maternity hospital in the Municipality of Rio de Janeiro - RJ, reference for sheltered youngsters. The subjects of the study were 14 health professionals. The data were treated according to the Content Analysis technique. RESULTS: Two categories of analysis emerged: Characteristics of care provided by health professionals at the maternity hospital directed towards the sheltered adolescent mother and her child; Characteristics of the organization/structure of the maternity hospital that affected the care of the sheltered pregnant adolescents. CONCLUSION: It is necessary to incorporate the guiding practices of integrality/interdisciplinarity into the service. The stigmatization of these youngsters is one of the greatest challenges to full assistance and care. The maternity hospital space is a rich environment for the nurse-adolescent dialogic process.OBJETIVO: Discutir aspectos determinantes de una asistencia de calidad a adolescentes embarazadas, albergadas en una maternidad, conforme la óptica de profesionales de salud. MÉTODOS: Estudio de abordaje cualitativo, exploratorio, realizado en una maternidad del Municipio de Rio de Janeiro - RJ, referencia para jóvenes albergadas. Los sujetos del estudio fueron 14 profesionales del equipo de salud. Los datos fueron tratados, conforme a la técnica del análisis de contenido. RESULTADOS: Emergieron del análisis dos categorías: Características de la atención de los profesionales de salud de la maternidad direccionadas a la madre adolescente albergada y su hijo; Características de la organización/estructura de la maternidad que afectan la atención a las adolescentes albergadas embarazadas. CONCLUSIÓN: Se hace necesario incorporar las prácticas norteadoras
Severe acute maternal morbidity and maternal death audit - a rapid diagnostic tool for evaluating maternal care. L Cochet, R.C. Pattinson, A.P. Macdonald. Abstract. Objective. To analyse severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria region over a 2-year period (2000 - 2001). Setting.
van Lonkhuijzen, L.; Stekelenburg, J.; van Roosmalen, J.
Background A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre which provides Emergency Obstetric Care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and
Full Text Available Kiran K Rai,1 Rachel E Jordan,1 W Stanley Siebert,2 Steven S Sadhra,3 David A Fitzmaurice,1 Alice J Sitch,1 Jon G Ayres,1,3 Peymané Adab1 1Institute of Applied Health Research, 2The Department of Business and Labour Economics, 3Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK Background: Employment rates among those with chronic obstructive pulmonary disease (COPD are lower than those without COPD, but little is known about the factors that affect COPD patients’ ability to work. Methods: Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. Results: In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8% were in work. Older age (60–64 years vs 30–49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12–0.65, lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19–0.97, poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE score: OR =0.10; 95% CI =0.03–0.33, and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12–0.85 were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. Conclusion: This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD. Keywords: chronic obstructive pulmonary disease, work, employed, breathlessness, severity, VGDF, UK
It is estimated that, in Ireland, there are 10,000 women with epilepsy of childbearing potential1. In this paper the maternal mortality rate for women with epilepsy attending the Rotunda Hospital Epilepsy Clinic 2004 - 2013 was determined. There were 3 maternal deaths in women with epilepsy during this time, which represents a mortality rate of 0.8%. In those women who died, there were concerns in relation to risks to the foetus by taking Anti-Epileptic Drugs (AED) and also issues with access to neurology services before pregnancy, acceptance of specialist support and lack of consistency in advice from health care professionals outside of Ireland. Implementing the nationally agreed care plan for women with epilepsy will improve the quality of care given and potentially we will see a reduction in maternal mortality in these women.
Hasegawa, Junichi; Ikeda, Tomoaki; Sekizawa, Akihiko; Tanaka, Hiroaki; Nakamura, Masamitsu; Katsuragi, Shinji; Osato, Kazuhiro; Tanaka, Kayo; Murakoshi, Takeshi; Nakata, Masahiko; Ishiwata, Isamu
To make recommendations for saving mothers' lives, issues related to maternal deaths including diseases, causes, treatments, and hospital and regional systems are analyzed by the Maternal Death Exploratory Committee in Japan. In this report, we present ten clinical important recommendations based on the analysis of maternal deaths between 2010 and 2014 in Japan. © 2016 Japan Society of Obstetrics and Gynecology.
Vardoulakis, Sotiris; Solazzo, Efisio; Lumbreras, Julio
Automatic monitoring networks have the ability of capturing air pollution episodes, as well as short- and long-term air quality trends in urban areas that can be used in epidemiological studies. However, due to practical constraints (e.g. cost and bulk of equipment), the use of automatic analysers is restricted to a limited number of roadside and background locations within a city. As a result, certain localised air pollution hotspots may be overlooked or overemphasised, especially near heavily trafficked street canyons and intersections. This has implications for compliance with regulatory standards and may cause exposure misclassification in epidemiological studies. Apart from automatic analysers, low cost passive diffusion tubes can be used to characterise the spatial variability of air pollution in urban areas. In this study, BTEX, NO 2 and O 3 data from a one-year passive sampling survey were used to characterise the intra-urban and street scale spatial variability of traffic-related pollutants in Birmingham (UK). In addition, continuous monitoring of NO 2, NO x, O 3, CO, SO 2, PM 10 and PM 2.5 from three permanent monitoring sites was used to identify seasonal and annual pollution patterns. The passive sampling measurements allowed us to evaluate the representativeness of a permanent roadside monitoring site that has recorded some of the highest NO 2 and PM 10 concentrations in Birmingham in recent years. Dispersion modelling was also used to gain further insight into pollutant sources and dispersion characteristics at this location. The strong spatial concentration gradients observed in busy streets, as well as the differences between roadside and urban background levels highlight the importance of appropriate positioning of air quality monitoring equipment in cities.
Representações e experiências sobre aborto legal e ilegal dos ginecologistas-obstetras trabalhando em dois hospitais maternidade de Salvador da Bahia Representations and experiences of obstetrician/gynecologists with legal and illegal abortion in two maternity-hospitals in Salvador da Bahia
Silvia De Zordo
Full Text Available O objetivo deste estudo qualitativo, realizado em dois hospitais-maternidade de Salvador da Bahia, foi investigar a experiência e as representações do aborto legal, analisadas em contraste com as representações do aborto ilegal, dos profissionais de saúde, em particular dos ginecologistas-obstetras.Usou-se como instrumentos um questionário e entrevistas semi-estruturadas com 25 profissionais de saúde (dos quais 13 ginecologistas-obstetras num hospital que oferece um serviço de aborto legal (P, e 20 profissionais de saúde (dos quais 9 ginecologistas-obstetras em outro hospital, que não oferece este serviço (F. Os fatores que mais influenciam as representações dos ginecologistas-obstetras entrevistados acerca do aborto e que explicam a alta taxa de objeção de consciencia no hospital P foram: 1- a criminalização do aborto e o medo de serem denunciados; 2- a estigmatização do aborto por certos grupos religiosos e pelos proprios médicos; 3- o treinamento em obstetrícia e a falta de uma formação boa no campo da epidemiologia da morbi-mortalidade materna e do aborto; 4- as representações acerca das relações de gênero. Os fatores principais associados à atitudes liberais foram: a idade - abaixo de 30/acima de 45 anos - a experiência com altas taxas de mortalidade materna devidas ao aborto e a experiência com o aborto legal.The objective of this qualitative study, carried out in two maternity-hospitals in Salvador da Bahia, was to investigate the experience and representations of health professionals, and particularly obstetricians-gynecologists, regarding legal abortion in comparison with their representations and experience with illegal abortion. A questionnaire was distributed and semi-structured interviews were conducted with 25 health professionals (13 obstetricians-gynecologists in a hospital providing legal abortion (P and with 20 health professionals (9 obstetricians-gynecologists in another hospital that does not
Hoffman, Lois Wladis
Maternal employment is a part of modern family life, a response to changes such as smaller families and more efficient household management. Not only does maternal employment meet parents' needs, but it is a pattern better suited for socializing the child for the adult role s/he will occupy. (Author/GC)
Although the maternal mortality rate receives no newspaper headlines, the number of mothers dying throughout the world is equivalent to a full jumbo jet crashing every 5 hours. Population surveys carried out between 1981-83 by Family Health International indicated maternal mortality rates of 1.9/1000 live births in Menoufia, Egypt, and 7.2/1000 in Bali, Indonesia. 20-25% of all deaths in women aged 15-49 were directly related to pregnancy and delivery, compared to 1% in western countries where there is better prenatal care, medical assistance in almost all deliveries, and elimination of most high risk pregnancies through voluntary fertility control. Maternal mortality could be controlled by teaching traditional midwives to identify high risk patients at the beginning of their pregnancies and to refer them to appropriate health services. Maternal survival would also be improved if all women were in good health at the beginning of pregnancy. Families should be taught to seek medical care for the mother in cases of prolonged labor; many women arrive at hospitals beyond hope of recovery after hours or days of futile labor. Health policy makers should set new priorities. Sri Lanka, for example, has a lower per capita income than Pakistan, but also a lower maternal mortality rate because of better use of family planning services, more emphasis on prenatal care, and a tradition of care and attention on the part of the public health services.
Shin, Hyunjeong; Park, Young-Joo; Ryu, Hosihn; Seomun, Gyeong-Ae
The aim of this paper is to report a concept analysis of maternal sensitivity. Maternal sensitivity is a broad concept encompassing a variety of interrelated affective and behavioural caregiving attributes. It is used interchangeably with the terms maternal responsiveness or maternal competency, with no consistency of use. There is a need to clarify the concept of maternal sensitivity for research and practice. A search was performed on the CINAHL and Ovid MEDLINE databases using 'maternal sensitivity', 'maternal responsiveness' and 'sensitive mothering' as key words. The searches yielded 54 records for the years 1981-2007. Rodgers' method of evolutionary concept analysis was used to analyse the material. Four critical attributes of maternal sensitivity were identified: (a) dynamic process involving maternal abilities; (b) reciprocal give-and-take with the infant; (c) contingency on the infant's behaviour and (d) quality of maternal behaviours. Maternal identity and infant's needs and cues are antecedents for these attributes. The consequences are infant's comfort, mother-infant attachment and infant development. In addition, three positive affecting factors (social support, maternal-foetal attachment and high self-esteem) and three negative affecting factors (maternal depression, maternal stress and maternal anxiety) were identified. A clear understanding of the concept of maternal sensitivity could be useful for developing ways to enhance maternal sensitivity and to maximize the developmental potential of infants. Knowledge of the attributes of maternal sensitivity identified in this concept analysis may be helpful for constructing measuring items or dimensions.
Andersen, Stine Linding; Laurberg, Peter; Wu, Chunsen
Thyroid hormones are essential for brain development, and maternal thyroid disease may affect child neurocognitive development. Some types of seizures may also depend upon early exposure of the developing central nervous system, and we hypothesized that maternal thyroid dysfunction could increase...... the risk of seizure in the child. In a Danish population-based study we included 1,699,693 liveborn singletons, and from the Danish National Hospital Register we obtained information on maternal diagnosis of hyper- or hypothyroidism and neonatal seizure, febrile seizure, and epilepsy in the child. Maternal...... diagnosis of thyroid dysfunction before or after birth of the child was registered in two percent of the singleton births. In adjusted analyses, maternal hyperthyroidism and hypothyroidism first time diagnosed after birth of the child were associated with a significant increased risk of epilepsy...
Andersgaard, Alice Beate; Langhoff-Roos, J.; Oian, P.
AIMS: To report direct maternal mortality ratio (MMR) in Norway between 1976 and 1995 including a description of the underlying complications in pregnancy, the causes of death and assessment of standard of care. METHODS: The maternal deaths were identified through the Cause of Death Registry......, Statistics Norway, and Medical Birth Registry of Norway. We requested copies of the hospital case records and the maternal death autopsies. The direct maternal deaths were classified on the basis underlying causes and assessed for substandard care according to the guidelines at the time of death...... and preventability provided optimal conditions and up to date guidelines. RESULTS: In the period 1976-1995 we identified 61 direct maternal deaths in Norway. The direct MMR was 5.5/100,000 births. Sufficient information was available for analysis in 51 of these cases. Six deaths occurred in early pregnancy. Among...
Beuchert, Louise Voldby; Humlum, Maria Knoth; Vejlin, Rune Majlund
We study the relationship between the length of maternity leave and the physical and psychological health of the family. Using a reform of the parental leave scheme in Denmark that increased the number of weeks of leave with full benefit compensation,we estimate the effect of the length of maternity leave on a range of health indicators including the number of hospital admissions for both mother and child and the probability of the mother receiving antidepressants. The reform led to an increa...
Rishworth, Andrea; Dixon, Jenna; Luginaah, Isaac; Mkandawire, Paul; Tampah Prince, Caesar
This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations. Copyright © 2015 Elsevier Ltd. All rights reserved.
Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai
Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.
AJRH Managing Editor
translated from Hausa to English language. Using a pre-determined coding framework, coding and thematic analyses were carried out on the qualitative data collected from the baseline. LGA. Community. Estimated. Community. Population. Community maternal support systems established. Community savings. Emergency.
Kozhimannil, Katy B; Henning-Smith, Carrie; Hung, Peiyin
Workforce shortages limit access to care for pregnant women in rural and remote areas. The goal of this analysis was to describe the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variation in rural CNM practice. We identified 306 rural hospitals with at least 10 births in 2010 using discharge data from the Statewide Inpatient Databases for 9 US states. We conducted a telephone survey of hospital maternity unit managers (N = 244) from November 2013 to March 2014 to understand their maternity care workforce and practice models. We describe the presence of CNMs attending births by hospital and state characteristics. Using logistic multivariate regression, we examined whether CNMs attend births, adjusting for hospital characteristics, practice regulations, and state. We also analyzed the content of open-ended responses about staffing plans, challenges, and opportunities that unit managers identified, with a focus on midwifery practice. CNMs attend births at one-third of rural maternity hospitals in 9 US states. Significant variability across states appears to be partially related to autonomous practice regulations: states allowing autonomous midwifery practice have a greater proportion of rural hospitals with midwives attending births (34% vs 28% without autonomous midwifery practice). In rural maternity hospitals, CNMs practice alongside obstetricians in 86%, and with family physicians in 44%, of hospitals. Fourteen percent of all respondents planned recruitment to increase the number of midwives at their hospital, although many, especially in smaller hospitals, noted challenges in doing so. CNMs play a crucial role in the maternity care workforce in rural US hospitals. The participation of CNMs in birth attendance varies by hospital birth volume and across state settings. Interprofessional practice is common for CNMs attending births in rural hospitals, and administrators hope to increase the
Full Text Available OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999 of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57 is five times greater than that of a normal vaginal delivery ($105.61. A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.
... mothers to community programs for support once they leave the hospital. Hospitals can Implement the Ten Steps to Successful Breastfeeding and work towards achieving Baby-Friendly designation. Use CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey ...
Jackson, Dylan B; Vaughn, Michael G
Research has indicated that maternal health during the prenatal period and at delivery carries far reaching significance for the development of offspring. Even so, the role of the accumulation of maternal medical risks during pregnancy in the development of externalizing behavior during childhood has generally been overlooked. The present study investigates whether the accumulation of maternal medical risks during the prenatal period is positively associated with childhood externalizing behavior, and whether this association is stronger among male offspring. We examined a large, nationally representative sample of children who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Information concerning maternal medical history, including the presence of a number of medical risks during pregnancy, was obtained through hospital records. A subsample of children with both parent and teacher reports of externalizing behavior during kindergarten was employed in the present study. A greater number of maternal medical risks during pregnancy increased the odds of childhood externalizing behavior across settings, but only among male offspring. The predicted probability of persistent externalizing behavior among males increased from .084 in the absence of maternal medical risks during pregnancy to .241 in the presence of three or more maternal medical risks during pregnancy. Our findings suggest that maternal medical risks during the prenatal period can have far-reaching consequences for the behavioral development of male offspring. Treatment of medical risks among expectant mothers may have the added benefit of reducing the likelihood of childhood externalizing behavior among male progeny. Copyright © 2018 Elsevier Ltd. All rights reserved.
Nisar, Nusrat; Abbasi, Razia Mustafa; Chana, Shehla Raza; Rizwan, Noushaba; Badar, Razia
Every year more than half million mother die due to pregnancy related preventable causes like haemorrhage, hypertensive disorders, sepsis, and obstructed labour and unsafe abortion. Among these deaths 99% occur in developing countries. The study was conducted to assess the maternal death rate and to analyse its trends over a period of 20 years in tertiary care hospital in Sindh Province Pakistan. A retrospective analysis of maternal mortality records were carried out for a period of 20 years from 1986-1995 and 2011-2015 at the Department of Obstetrics and gynaecology Liaquat University of Medical and Health Sciences Hyderabad Sindh Pakistan. The record retrieved was categorized into four 5 yearly periods 1986- 1990, 1991-995, 2006-2010 and 2011-2015 for comparison of trends. The cumulative maternal mortality ratio (MMR) was 1521.5 per 100,000 live births. The comparison of first 5 years' period (1986-1990) and last 5 years (2011-2015) showed downward trend in maternal mortality rate from 2368.6-1265.1. Direct causes of death have accounted for 2820 (84.78%) of total maternal death. Sepsis was the major cause of death for first 5 years accounted for 196(35.1%) of maternal death while in the last 5 years' eclampsia causes 284 (27.84%) of direct maternal deaths. The reduction in the maternal deaths has been very slow. The direct causes were still the main reasons for obstetrical deaths.
Pearson, Luwei; Gandhi, Meena; Admasu, Keseteberhan; Keyes, Emily B
To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia. The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008. Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively. Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under
University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....
Full Text Available Meredith Kilgore,1 Harshali K Patel,2 Adrian Kielhorn,2 Juan F Maya,2 Pradeep Sharma1 1Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 2Amgen, Inc., Thousand Oaks, CA, USA Objective: The objective of this study was to assess the costs associated with the hospitalization and the cumulative 30-, 60-, and 90-day readmission rates in a cohort of Medicare beneficiaries with heart failure (HF.Methods: This was a retrospective, observational study based on data from the national 5% sample of Medicare beneficiaries. Inpatient data were gathered for Medicare beneficiaries with at least one HF-related hospitalization between July 1, 2005, and December 31, 2011. The primary end point was the average per-patient cost of hospitalization for individuals with HF. Secondary end points included the cumulative rate of hospitalization, the average length of hospital stay, and the cumulative 30-, 60-, and 90-day readmission rates.Results: Data from 63,678 patients with a mean age of 81.8 years were included in the analysis. All costs were inflated to $2,015 based on the medical care component of the Consumer Price Index. The mean per-patient cost of an HF-related hospitalization was $14,631. The mean per-patient cost of a cardiovascular (CV-related or all-cause hospitalization was $16,000 and $15,924, respectively. The cumulative rate of all-cause hospitalization was 218.8 admissions per 100 person-years, and the median length of stay for HF-related, CV-related, and all-cause hospitalizations was 5 days. Also, 22.3% of patients were readmitted within 30 days, 33.3% were readmitted within 60 days, and 40.2% were readmitted within 90 days.Conclusion: The costs associated with hospitalization for Medicare beneficiaries with HF are substantial and are compounded by a high rate of readmission. Keywords: heart failure, Medicare, health economics, hospitalization, costs
Jean, D; Croize, J; Hirtz, P; Legeais, C; Pelloux, I; Favier, M; Mallaret, M R; Le Noc, P; Rambaud, P
Nosocomial infection with Listeria monocytogenes 4b occurred in January 1990 in a maternity hospital in Grenoble. The 3 patients involved were born within a 24 hour-interval. The premature newborn responsible for contamination was asymptomatic. Two other newborns without any perinatal infectious risk presented with meningitis, one on the 5th day of life in the maternity hospital, the other one on the 11th day while already at home. The 3 strains of Listeria had the same serovar and lysovar. Epidemiologic investigations led to suspect a contamination in the delivery room and during the care of the children. Strict respect of hygiene orders is imperative to avoid nosocomial infections.
Defossez, A C; Fassin, D
Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality
Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting Nov 2010
Khan, Ainee; Dickens, Andrew P; Adab, Peymane; Jordan, Rachel E
Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided. CALL FOR
Holditch-Davis, Diane; Miles, Margaret Shandor; Burchinal, Margaret R; Goldman, Barbara Davis
We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011. Copyright © 2010 Wiley Periodicals, Inc.
Rivett, Michael O; Turner, Ryan J; Glibbery Née Murcott, Penny; Cuthbert, Mark O
Licensed abstraction well data collected during 1986-2008 from a total of 77 wells mainly located at industrial sites combined with historic land use data from 1975 has allowed insight into the legacy of chlorinated solvent contamination in the Birmingham aquifer that underlies the UK's second largest city. This legacy, expected to be reasonably symptomatic of those occurring in other urban aquifers, was characterised by: dominance of parent solvents, particularly TCE (trichloroethene) that widely exceeded drinking-water quality criteria; greater TCE occurrence in wells in proximity to increased historic land use by the metal/engineering solvent-user industry (the relationship providing a first-pass indicator of future resource development potential); regional groundwater vulnerability controls; well abstraction changes (over months to decades) influential of observed concentration transients and anticipated plume capture or release; persistence of contamination over decades (with less soluble PCE (perchloroethene) showing increased persistence relative to TCE) that was reasonably ascribed to slow contaminant release from DNAPL (dense non-aqueous phase liquid) sources and, or low permeability layers; presence of dechlorination products arising from solvent (bio)degradation, although this key attenuation process appeared to have moderate to weak influence regionally on plumes; and, inadvertent, but significant solvent mass removal from the aquifer by industrial abstractions. Key challenges to realising future urban groundwater development were identified based on the observed legacy and well capture zone simulations. Despite the extensive contamination of the aquifer, it should still be possible to develop wells of high (several megalitres per day) capacity for drinking water supply (or other lower grade uses) without the requirement for solvent treatment. In those areas with higher risk of contamination, our dataset, together with application of emergent risk
Background Key Words: Maternal HIV positive sero-prevalence, delivery, birth sex ratio,Orlu.: The duo of HIV/AIDS infection has become a Global public health problem. This study was conducted to determine the maternal HIV positive seroprevalence at delivery at the Imo State University Teaching Hospital, Orlu. Methods: ...
Shamim Khandaker; Shabana Munshi
Objective: To estimate the risk of delivering large-for gestational age (LGA) fetuses associated with maternal obesity, excessive maternal weight gain, and gestational diabetes mellitus (GDM)- in Indian mothers. Design: Retrospective study. Settings: Fernandez Hospital Private Limited, Hyderabad, Andhra Pradesh, India; a tertiary perinatal centre. Populations: Pregnant singleton mothers with correct pregnancy dating. Methods: Estimated fetal weight (EFW) is determined using ultrasound variabl...
Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer
To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in
Lin, Wan-Chien; Chang, Shin-Yow; Chen, Yi-Ting; Lee, Hsin-Chien; Chen, Yi-Hua
Recently, studies have begun emphasizing paternal involvement during the perinatal period and its impact on maternal health. However, most studies have assessed maternal perception and focused on adolescents or minority groups in Western countries. Therefore, the current study investigated the association between paternal involvement and maternal postnatal depression and anxiety, along with the effects of maternal job status in the Asian society of Taiwan. This study recruited pregnant women in the first trimester of pregnancy as well as their partners on prenatal visits from July 2011 to September 2013 at four selected hospitals in metropolitan areas of Taipei, Taiwan. In total, 593 parental pairs completed the first interview and responded to the follow-up questionnaires until 6 months postpartum. Self-reported data were collected, and multiple logistic regression models were used for analyses. Lower paternal childcare and nursing frequency was independently associated with an increased risk of maternal postpartum depression (adjusted odds ratio (OR) =4.33, 95% confidence interval (CI)=1.34-13.98), particularly among unemployed mothers. Furthermore, among unemployed mothers, the risk of postnatal anxiety was 3.14 times higher in couples with fathers spending less time with the child, compared with couples with fathers spending more time (95% CI=1.10-8.98). However, no significant findings were obtained for employed mothers. The high prevalence of maternal postnatal emotional disturbances warrants continual consideration. Higher paternal involvement in childcare arrangements should be emphasized to aid in ameliorating these maternal emotional disturbances, particularly among unemployed mothers. Copyright © 2017 Elsevier B.V. All rights reserved.
Zhou, Yubo; Blustein, Jan; Li, Hongtian; Ye, Rongwei; Zhu, Liping; Liu, Jianmeng
To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. We followed 1,019,576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. During the 18-year period, 404,971 (39.7%) caesareans and 93,927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice. © 2015 John Wiley & Sons Ltd.
Emmanuel, Elizabeth N; Creedy, Debra K; St John, Winsome; Brown, Claire
to explore the relationship between maternal role development (MRD), maternal distress (MD) and social support following childbirth. prospective longitudinal survey. three public hospital maternity units in Brisbane, Australia. 630 pregnant women were invited to participate in the study, with a 77% (n=473) completion rate. to measure MRD, the Prenatal Maternal Expectation Scale was used at 36 weeks of pregnancy, and the revised What Being the Parent of a New Baby is Like (with subscales of evaluation, centrality and life change) was used at six and 12 weeks post partum. At all three data collection points, the Edinburgh Postnatal Depression Scale was used to measure MD, and the Maternal Social Support Scale was used to measure social support. at 36 weeks of gestation, optimal scaling for MRD produced a parsimonious model with MD providing 39% of predictive power. At six weeks post partum, similar models predicting MRD were found (evaluation: r(2)=0.14, MD providing 64% of predictive power; centrality: r(2)=0.07, MD providing 11% of predictive power; life change: r(2)=0.26, MD providing 59% of predictive power). At 12 weeks post partum, MD was a predictor for evaluation (r(2)=0.11) and life change (r(2)=0.26, 54% of predictive power). there is a statistically significant but moderate correlation between MRD and MD. The transition to motherhood can be stressful, but may be facilitated by appropriate acknowledgement and support with an emphasis on MRD. Copyright © 2009 Elsevier Ltd. All rights reserved.
(CERN-HI-1009225 02-12): visiting the LHC superconducting magnet test hall with Beams Department Head P. Collier; (CERN-HI-1009225 27-34): visiting the ATLAS visitor centre with Collaboration Spokesperson F. Gianotti and Deputy D. Charlton, University of Birmingham. D.Eastwood is accompnied by Pro-Vice-Chancellor and Head of College (Engineering and Physical Sciences) N. Weatherill and Head of School, School of Physics & Astronomy A.Schofield.
Norton, E C; Zarkin, G A; Calingaert, B; Bradley, C J
This study addresses the effect of maternal substance abuse on the cost of neonatal care in a sample of all singleton live births in Maryland in 1991. Most other cost studies have analyzed data from only one hospital; we analyzed data from 54 hospitals and therefore can control for individual hospital effects and correlation of observations within hospitals. We find that maternal drug abuse has a significant positive effect on total hospital charges, length of stay, and average daily charges, with the increase in length of stay being proportionally greater than the increase in average daily charges. Maternal alcohol abuse also has a positive effect on hospital charges and length of stay, but the effects are not statistically significant. About half the effect of drug abuse on total charges works indirectly through premature birth and other comorbidities.
Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki
To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Descriptive study. Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). The preventability and problems in each maternal death. Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Kennedy, Richard E; Williams, Courtney P; Sawyer, Patricia; Allman, Richard M; Crowe, Michael
To validate the Mini-Mental State Examination (MMSE) Telephone (MMSET) against the MMSE. Cross-sectional. Homes of community-dwelling older adults. African-American and non-Hispanic white adults aged 75 and older participating in the University of Alabama at Birmingham Study of Aging II, a longitudinal epidemiological study across the state of Alabama (N = 419). Cognition, measured using the MMSE, MMSET, and Six-Item Screener (SIS), and function, based on self-reported difficulty performing instrumental activities of daily living (IADLs). Correlation and agreement coefficients were used to examine concordance of the MMSE and MMSET; linear and logistic regressions were used to test associations with clinical outcomes of IADL difficulty and verified diagnoses of dementia. The MMSET showed good internal consistency (Cronbach α = 0.845), similar to the full MMSE, and strong correlation with the latter (Spearman ρ = 0.694, P < .001). The MMSET explained a similar proportion of IADL difficulty as the full MMSE (coefficient of variation = 0.201 and 0.189, respectively). The MMSET was also associated with verified dementia diagnoses (area under the receiver operating characteristic curve = 0.73), which was similar to the full MMSE. The MMSET is a brief, valid measure of cognition in older adults with psychometric properties similar to that of the full MMSE. Because it can be administered over the telephone, further use in epidemiological studies is promising. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Full Text Available The purpose of this study was to determine whether maternal mental and physical health is associated with maternal testosterone and cortisol levels, parenting of very low birth weight infants, physical exercise, and White vs non-White race. A total of 40 mothers of very low birth weight infants were recruited from a neonatal intensive care unit at a University Hospital in the Southeast United States. Data were collected through a review of medical records, standardized questionnaires, and biochemical measurement. Maternal mental and physical health status using questionnaires as well as maternal testosterone and cortisol levels using an enzyme immunoassay were measured four times (birth, 40 weeks postmenstrual age [PMA], and 6 and 12 months [age of infant, corrected age]. General linear models showed that higher testosterone levels were associated with greater depressive symptoms, stress, and poorer physical health at 40 weeks PMA, and at 6 and 12 months. High cortisol levels were associated with greater anxiety at 40 weeks PMA; however, with better mental and physical health at 40 weeks PMA, and 6 and 12 months. Physical activity was associated with lower maternal perceived stress at 12 months. Maternal health did not differ by race, except anxiety, which was higher in White than non-White mothers after birth. As very low birth weight infants grew up, maternal physical health improved but mental health deteriorated. Testosterone and cortisol levels were found to be positively correlated in women but testosterone was more predictive of maternal mental and physical health than cortisol. Indeed testosterone consistently showed its associations with maternal health. Maternal stress might be improved through regular physical exercise.
Stensballe, Lone Graff; Ravn, Henrik; Kristensen, Kim
BACKGROUND: Respiratory syncytial virus (RSV) hospitalization is associated with wheeze. OBJECTIVE: To examine the influence of maternally derived RSV neutralizing antibodies in cord blood on RSV hospitalization and recurrent wheeze in infancy. METHODS: Among children from the Danish National Birth...
U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...
U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...
Recent studies indicate that death certificate-based single-cause-of-death diagnoses can substantially underestimate the contribution of sepsis to mortality in the general population and among maternal decedents. There are no population-based data in the United States on the patterns of the contribution of sepsis to pregnancy-associated deaths. We studied the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations with reported hospital death during 2001-2010. We then examined the annual reporting of sepsis, and that of other reported most common causes of maternal death, including hemorrhage, embolism, preeclampsia/eclampsia, cardiovascular conditions, cardiomyopathy, cerebrovascular accidents, and anesthesia complications. The annual rate of sepsis among decedents, its trend over time, and changes of its annual rank among other examined potential causes of maternal death were assessed. There were 557 pregnancy-associated hospital deaths during study period. Sepsis was reported in 131 (23.5%) decedents. Sepsis has been increasingly reported among decedents, rising by 9.1%/year (P = 0.0025). The rank of sepsis, as compared to the other examined potential causes of maternal death rose from the 5th in 2001 to 1st since 2008. At the end of the last decade, sepsis has been reported in 28.1% of pregnancy-associated deaths. More than one potential cause of maternal death was reported in 39% of decedents. Sepsis has become the most commonly reported potential cause of death among maternal decedents in the present cohort, noted in over 1 in 4 fatal hospitalizations by the end of the last decade. Although causality cannot be inferred from administrative data, given its known contribution to maternal death, it is likely that sepsis plays an increasing role in fatal maternal hospital outcomes. The prevalent co-reporting of multiple potential causes of maternal death in the present cohort underscores the complexity of determining the sources of
Garbarski, Dana; Witt, Whitney P.
While maternal socioeconomic status and health predict in part children’s future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal physical and mental health outcomes. We hypothesize that poor child health may also increase the risk of poor maternal health outcomes through an interact...
Background: Maternal measles antibodies (MMA) are actively transferred through the placenta from mother to foetus. A relationship could exist between MMA of mother-infant pairs and maternal nutritional indicator (haemoglobin). Objectives: This study reviewed the effects of maternal haemoglobin (Hb) on MMA of ...
Joelcio Francisco Abbade
Full Text Available CONTEXT: HELLP syndrome is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. Some pregnant women develop just one or two of the characteristics of this syndrome, which is termed Partial HELLP Syndrome (PHS. OBJECTIVE: The objective of this study was to evaluate the repercussions on maternal and perinatal outcomes among women that developed PHS and to compare these women with those whose gestational hypertension or preeclampsia did not show alterations for HELLP syndrome in laboratory tests. DESIGN: Observational, retrospective and analytical study. SETTING: Maternity Department of Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. SAMPLE: Pregnant or post-delivery women who had a blood pressure elevation that was first detected after mid-pregnancy, with or without proteinuria, between January 1990 and December 1995. MAIN MEASUREMENTS: Analysis was made of maternal age, race, parity, hypertension classification, gestational age at the PHS diagnosis, alterations in laboratory tests for HELLP syndrome, time elapsed to discharge from hospital, maternal complications, mode of delivery, incidence of preterm birth, intrauterine growth restriction, stillborn and neonatal death. RESULTS: Three hundred and eighteen women were selected; forty-one women (12.9% had PHS and 277 of them (87.1% did not develop any of the alterations of the HELLP syndrome diagnosis. Preeclampsia was a more frequent type of hypertension in the PHS group than in the hypertension group. None of the women with isolated chronic hypertension developed PHS. The rate of cesarean delivery, eclampsia, and preterm delivery was significantly greater in the PHS group than in the hypertension group. CONCLUSION: We observed that aggressive procedures had been adopted for patients with PHS. These resulted in immediate interruption of pregnancy, with elevated cesarean
Obstetric practice continues to change, particularly assisted vaginal delivery. Vacuum delivery is a mode of delivery technique in Jos University Teaching Hospital (JUTH) in the maternity unit. The objective of the study was to determine the rate of ventouse delivery, its indications, and maternal and fetal morbidity in our ...
Background: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice. Objective: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices. Methods: In a cross-sectional survey, mothers whose ...
Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from ...
Objective: To determine the association between maternal gingivitis and pregnancy outcome, including low birth weight (LBW) and preterm delivery. This prospective study was conducted among 300 randomly selected pregnant women aged 20-34 years attending the antenatal clinic, University of Benin Teaching Hospital, ...
Method. Fifty-six case notes from the 80 reported maternal deaths in 2010 were reviewed. ... Sixty-six percent of deaths occurred in Botswana's two referral hospitals. Cases in .... with meningitis, pre-eclampsia and heart failure. ... General anaesthetic. 2 .... Several equipment failures were reported, involving X-ray, blood.
Design. A descriptive study with analytic components. Characteristics of patients who died from the most ... authorities on how to collect data on maternal deaths throughout a whole region. This surveillance may be ... Following the publication of perinatal data from 18 ruraJ. hospitalsT in the Cape Province, the Continuing ...
Zinc is a crucial micronutrient in early childhood survival and the development of innate and acquired immunity. The objective is to determine the relationship between of maternal social class and antenatal care to serum zinc level in newborns in a tertiary and a rural hospital. It is prospective study using questionnaires on ...
services does not expose the user to financial hardship‖. This is based on the .... statements of the two hospitals at inception was ―to run integrated maternal and child .... consolidated revenue for primary health care which will essentially be ...
Full Text Available BACKGROUND DM WIMS is the only tertiary care referral hospital in the hilly tribal district of Wayanad. This is an observational study of 20 maternal near miss cases that presented in our hospital over a period of 4 months. MATERIALS AND METHODS This study was conducted by collecting data over a period of 4 months. Total number of live births in this period was 373. There were 20 cases of maternal near miss cases. Maternal near miss cases were chosen based on the inclusion criteria provided by WHO near miss approach for maternal health. RESULTS There were 373 live births in the 4-month observational period. In these 4 months, there were 20 cases of maternal near miss cases in our hospital. That is, maternal near miss ratio was 53.6/1000 live births. The majority were referred cases with MNM ratio of intrahospital cases being 13.4/1000 live births. The potentially life-threatening complications were obstetric haemorrhage and hypertensive disorders, which coexisted in majority of the women. The obstetric haemorrhage was mainly due to abruptio placenta, which can be attributed to the hypertensive complications. Preexisting anaemia was present in 35% of the MNM cases increasing their morbidity. CONCLUSION The maternal near miss ratio was 53.6/1000 live births, which is high. This can be attributed to the fact that our hospital is the only tertiary referral hospital in the hilly tribal district of Wayanad. Despite the MNM ratio being high, there were no cases of maternal death in this period. Low maternal mortality indicates the good first line of management given at the periphery hospital.
Estudo da morbidade e da mortalidade perinatal em maternidades: III - Anomalias congênitas em nascidos vivos A study of perinatal morbidity and mortality in maternity hospitals: III - Congenital anomalies in live briths
José Maria Pacheco de Souza
Full Text Available Realizou-se estudo das anomalias congênitas encontradas em recém-nascidos vivos, em nove maternidades, durante o ano de 1981-1982. O material é parte de uma pesquisa desenvolvida em sete maternidade do Estado de São Paulo, uma do Rio de Janeiro e uma de Florianópolis, Santa Catarina (Brasil, no período de agosto de 1981 a julho de 1982, quando foram coletados dados sobre todos os nascimentos ocorridos nesses nove serviços. As anomalias congênitas foram definidas como as descritas no XIV.° capítulo da Classificação Internacional de Doenças - 1975, 9ª Revisão, tendo sido utilizada essa classificação para codificá-las. Na análise estatística foram utilizados o X² (com um grau de liberdade, o teste de inclinação para proporções ("Trend test" e a técnica de Berkson para a verificação da hipótese de aderência à distribuição de Poisson. Em 12.782 recém-nascidos vivos, 286 (2,24% apresentavam algum tipo de anomalia congênita, tendo havido 26 (0,20% crianças com duas anomalias, 9 (0,07% com três e duas (0,02 apresentando quatro tipos de malformações congênitas. As deformidades osteomusculares congênitas (código 754 da CID foram as mais freqüentes (19%;segue-se as outras anomalias congênitas do coração (746 com uma freqüência de 14,1%. Ao se analisar a prevalência dessas malformações pela idade da mãe nota-se que há um aumento da prevalência à medida que a idade avança, apenas para Sindrome de Down (758.Congenital anomalies in live births in nine maternities in the period 1981-1982 were studied. This was one aspect of a research project carried out in seven maternities in the State of S.Paulo, one in Rio de Janeiro and another in Florianópolis (Brazil, from which data on all births occurring between August 1981 and July 1982 were obtained. Congenital anomalies were classified according to the XIVth chapter of the CID-1975 - 9thRevision. Chi square for associations and for trend and Berkson
Comparação da mortalidade neonatal em recém-nascidos de muito baixo peso ao nascimento, em maternidades do Município do Rio de Janeiro, Brasil Comparison of neonatal mortality in very low birth weight newborns at maternity hospitals in the city of Rio de Janeiro, Brazil
José Luiz Muniz Bandeira Duarte
Full Text Available Foi realizada a comparação das taxas de mortalidade neonatal em quatro maternidades do Município do Rio de Janeiro, Brasil. A população estudada foi de recém-nascidos com peso inferior a 1.500g. O instrumento utilizado foi um questionário com dados informados pela mãe e o prontuário médico. Foram calculados, para cada instituição, as Razões Padronizadas de Mortalidade (RPM com o método direto e indireto, tendo como padrão a distribuição por peso do National Institute of Child Health and Human Development Neonatal Research. A amostra final apresentou 487 recém-nascidos. As padronizações pelo método direto e indireto mostraram elevadas taxas de mortalidade em todas as instituições; as que apresentaram a maior quantidade de recém-nascidos nas faixas com os menores pesos, foram aquelas que mostraram os menores valores de RPM. A menor razão de mortalidade por faixa de peso foi encontrada na faixa de peso entre 500 e 749g. Os resultados da RPM estão inversamente associados ao quantitativo populacional de recém-nascidos nas faixas com os menores pesos. Os coeficientes de mortalidade mostraram taxas altas, principalmente nas faixas de peso mais elevados. Os resultados apontam para uma qualidade deficiente na atenção perinatal.This study was a comparison of neonatal mortality rates in four maternity hospitals in the city of Rio de Janeiro, Brazil. The study population consisted of newborns with birth weight below 1,500g. The research instrument was a questionnaire with data reported by the mother and collected from the patient record. For each maternity hospital the standardized mortality ratio (SMR was calculated using the direct and indirect method, using the weight distribution of the National Institute of Child Health and Human Development Neonatal Research as the standard. The final sample consisted of 487 newborns. Standardizations by the direct and indirect method showed high mortality rates in all four institutions
Maternal health Indicators Signal Optimism. Abraham Haileamlak, MD, Professor of Pediatrics and Child Health. Maternal health is a major health priority for international agencies and the Ethiopian. Government. Many low income countries including. Ethiopia, made substantial improvements in maternal health achieving ...
Full Text Available Severe maternal morbidity conditions such as sepsis, embolism and cardiac arrest during the delivery hospitalization period can lead to extended length of hospital stays, life-long maternal health problems, and high medical costs. Most importantly, these conditions also contribute to the risk of maternal death. This population-based observational study proposed and evaluated the impact of expanding the Centers for Disease Control and Prevention (CDC measure of severe maternal morbidity by including additional comorbidities and intensive care admissions during delivery hospitalizations and examined associated factors. A New York State linked hospitalization and birth record database was used. Study participants included all New York State female residents, ages 10 to 55 years, who delivered a live infant in a New York acute care hospital between 2008 and 2013, inclusive. Incidence trends for both severe maternal morbidity measures were evaluated longitudinally. Associations between covariates and the two severe maternal morbidity measures were examined with logistic regression models, solved using generalized estimating equations and stratified by method of delivery. The New York expanded severe maternal morbidity measure identified 34,478 cases among 1,352,600 hospital deliveries (estimated incidence 2.55% representing a 3% increase in the number of cases compared to the CDC measure. Both estimates increased over the study period (p 1.5 included most measured comorbidities (e.g., pregnancy-induced hypertension, placentation disorder, multiple births, preterm birth, no prenatal care, hospitalization prior to delivery, higher levels of perinatal care birthing facilities and race/ethnicity. Expanding the measure for severe maternal morbidity during delivery to capture intensive care admissions provides a more sensitive estimate of disease burden. Perinatal regionalization in New York appears effective in routing high risk pregnancies to higher
Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David
Abstract Objective To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Design Qualitative research using semistructured telephone interviews. Setting Purposive sample of 6 family medicine programs from 5 Canadian provinces. Participants Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be “successful.” Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Main findings Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program’s success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine–friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Conclusion Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. PMID:29760273
Donnolley, Natasha R; Chambers, Georgina M; Butler-Henderson, Kerryn A; Chapman, Michael G; Sullivan, Elizabeth A
Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
In this paper I consider the ways in which lactation has been discussed as a form of maternal sexuality, and the implications this carries for our understanding of breastfeeding practices and sexuality. Drawing on knowledge constructed in the western world during the last half of the twentieth century, the paper identifies a shift between the…
Feng, Joyce Yen; Han, Wen-Jui
Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk…
Strang, Lucy; Broeks, Miriam
Abstract Over recent years many European Union countries have made changes to the design of the maternity leave provision. These policy developments reflect calls for greater gender equality in the workforce and more equal share of childcare responsibilities. However, while research shows that long period of leave can have negative effects on women's labour market attachment and career advancements, early return to work can be seen as a factor preventing exclusive breastfeeding, and therefore, potentially having negative health impacts for babies. Indeed, the World Health Organisation recommends exclusive breastfeeding up to 6 months of age to provide babies with the nutrition for healthy growth and brain development, protection from life-threatening ailments, obesity and non-communicable diseases such as asthma and diabetes. Therefore, labour market demands on women may be at odds with the health benefits for children gained by longer periods of maternity leave. The aim of this article is to examine the relationship between leave provision and health benefits for children. We examine maternity and parental leave provision across European countries and its potential impact on the breastfeeding of very young babies (up to 6-months of age). We also consider economic factors of potential extension of maternity leave provision to 6 months, such as costs to businesses, effects on the female labour market attachment, and wider consequences (benefits and costs) for individuals, families, employers and the wider society. PMID:28983432
Fujita, K; Murono, K
The delivery of infants in hospitals is desirable for obstetric reasons, but exposes the neonates to the microbiological hazards of a maternity unit. When neonates are born and cared for in hospital, the Escherichia coli strains that colonize the intestine tend to be acquired from the environment or from other babies, and are potentially pathogenic. The colonization of the infant with maternal flora should be promoted by strict rooming-in of mother and baby, or by delivery at home.
McPhie, Skye; Skouteris, Helen; Daniels, Lynne; Jansen, Elena
Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation. © 2012 John Wiley & Sons Ltd.
Users' and providers' perspectives on technological procedures for 'normal' childbirth in a public maternity hospital in Salvador, Brazil Perspectivas de usuarios y proveedores sobre procedimientos tecnológicos para el parto 'normal' en una maternidad pública de Salvador, Brasil
Full Text Available OBJECTIVE: To reveal the effect of cultural practices on the way in which normal birth is conducted in a public hospital in Brazil. MATERIAL AND METHODS: This article about a public maternity hospital in Salvador, Brazil, compares the points of view of providers and users on four technological normal childbirth procedures: trichotomy, episiotomy, oxytocin infusion, and epidural analgesia. Fieldwork carried out from 2002 to 2003 combined qualitative and quantitative methods. RESULTS: Institutional practices make childbirth unnecessarily difficult for women. Nonetheless, most women accept the conditions because the medical procedures make sense according to their cultural understandings. Service providers support the use of such procedures, although doctors are aware that they contradict recommendations found in scientific medical literature. This article argues that from the perspective of both providers and users, the technological procedures are infused with a culturally specific set of meanings and values. CONCLUSIONS: Policymakers must address the cultural understandings of both users and health care professionals in order to improve maternal healthcare in public hospitals in Brazil.OBJETIVO: Revelar el efecto de las prácticas culturales en el parto normal en un hospital público en Brasil. MATERIAL Y MÉTODOS: Este artículo sobre el parto en una maternidad pública de Salvador, Brasil, compara el punto de vista de los proveedores de servicios de salud y los usuarios de dichos servicios con respecto a cuatro procedimientos para el parto normal: tricotomía, episiotomía, infusión de oxitocina y analgésico epidural. La investigación, realizada entre 2002 y 2003, utilizó métodos cualitativos y cuantitativos. RESULTADOS: La práctica institucional hace que el parto sea innecesariamente dificultoso para las mujeres, sin embargo, la mayoría de ellas aceptan las condiciones, porque los procedimientos médicos tienen sentido dentro de su
Resultados maternos e neonatais em Centro de Parto Normal peri-hospitalar na cidade de São Paulo, Brasil Resultados maternos y neonatales en un Centro de Parto Normal perihospitalario en la ciudad de São Paulo, Brasil Maternal and perinatal outcomes of an alongside hospital Birth Center in the city of São Paulo, Brazil
Sheila Fagundes Lobo
describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM, located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%, amniotomy (62.6%, walking (47.6%, massage comfort (29.8% and episiotomy (25.7%. Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.
McPherson, Ann K.; Abrahamsen, Thomas A.; Journey, Celeste A.
The U.S. Geological Survey conducted a 16-month investigation of water quality, aquatic-community structure, bed sediment, and fish tissue in Village and Valley Creeks, two urban streams that drain areas of highly intensive residential, commercial, and industrial land use in Birmingham, Alabama. Water-quality data were collected between February 2000 and March 2001 at four sites on Village Creek, three sites on Valley Creek, and at two reference sites near Birmingham?Fivemile Creek and Little Cahaba River, both of which drain less-urbanized areas. Stream samples were analyzed for major ions, nutrients, fecal bacteria, trace and major elements, pesticides, and selected organic constituents. Bed-sediment and fish-tissue samples were analyzed for trace and major elements, pesticides, polychlorinated biphenyls, and additional organic compounds. Aquatic-community structure was evaluated by conducting one survey of the fish community and in-stream habitat and two surveys of the benthic-invertebrate community. Bed-sediment and fish-tissue samples, benthic-invertebrates, and habitat data were collected between June 2000 and October 2000 at six of the nine water-quality sites; fish communities were evaluated in April and May 2001 at the six sites where habitat and benthic-invertebrate data were collected. The occurrence and distribution of chemical constituents in the water column and bed sediment provided an initial assessment of water quality in the streams. The structure of the aquatic communities, the physical condition of the fish, and the chemical analyses of fish tissue provided an indication of the cumulative effects of water quality on the aquatic biota. Water chemistry was similar at all sites, characterized by strong calcium-bicarbonate component and magnesium components. Median concentrations of total nitrogen and total phosphorus were highest at the headwaters of Valley Creek and lowest at the reference site on Fivemile Creek. In Village Creek, median
Zongo, Augustin; Dumont, Alexandre; Fournier, Pierre; Traore, Mamadou; Kouanda, Séni; Sondo, Blaise
To explore the differential effect of a multifaceted intervention on hospital-based maternal mortality between patients with cesarean and vaginal delivery in low-resource settings. We reanalyzed the data from a major cluster-randomized controlled trial, QUARITE (Quality of care, Risk management and technology in obstetrics). These subgroup analyses were not pre-specified and were treated as exploratory. The intervention consisted of an initial interactive workshop and quarterly educational clinically oriented and evidence-based outreach visits focused on maternal death reviews (MDR) and best practices implementation. The trial originally recruited 191,167 patients who delivered in each of the 46 participating hospitals in Mali and Senegal, between 2007 and 2011. The primary endpoint was hospital-based maternal mortality. Subgroup-specific Odds Ratios (ORs) of maternal mortality were computed and tested for differential intervention effect using generalized linear mixed model between two subgroups (cesarean: 40,975; and vaginal delivery: 150,192). The test for homogeneity of intervention effects on hospital-based maternal mortality among the two delivery mode subgroups was statistically significant (p-value: 0.0201). Compared to the control, the adjusted OR of maternal mortality was 0.71 (95% CI: 0.58-0.82, p=0.0034) among women with cesarean delivery. The intervention had no significant effect among women with vaginal delivery (adjusted OR 0.87, 95% CI 0.69-1.11, p=0.6213). This differential effect was particularly marked for district hospitals. Maternal deaths reviews and on-site training on emergency obstetric care may be more effective in reducing maternal mortality among high-risk women who need a cesarean section than among low-risk women with vaginal delivery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Cokkinides, V E; Coker, A L; Sanderson, M; Addy, C; Bethea, L
To assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes. We used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women's physical violence during pregnancy were based on self-reports of "partner-inflicted physical hurt and being involved in a physical fight." Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes. The prevalence of physical violence was 11.1%. Among women who experienced physical violence, 54% reported having been involved in physical fights only and 46% had been hurt by husbands or partners. In the latter group, 70% also reported having been involved in fighting. Compared with those not reporting physical violence, women who did were more likely to deliver by cesarean and be hospitalized before delivery for maternal complications such as kidney infection, premature labor, and trauma due to falls or blows to the abdomen. Physical violence during the 12 months before delivery is common and is associated with adverse maternal conditions. The findings support the need for research on how to screen for physical violence early in pregnancy and to prevent its consequences.
Inoue, Sachiko; Naruse, Hiroo; Yorifuji, Takashi; Kato, Tsuguhiko; Murakoshi, Takeshi; Doi, Hiroyuki; Subramanian, S V
The adverse effects of maternal and paternal smoking on child health have been studied. However, few studies demonstrate the interaction effects of maternal/paternal smoking, and birth outcomes other than birth weight have not been evaluated. The present study examined individual effects of maternal/paternal smoking and their interactions on birth outcomes. A follow-up hospital-based study from pregnancy to delivery was conducted from 1997 to 2010 with parents and newborn infants who delivered at a large hospital in Hamamatsu, Japan. The relationships between smoking and growth were evaluated with logistic regression. The individual effects of maternal smoking are related to low birth weight (LBW), short birth length and small head circumference. The individual effects of paternal smoking are related to short birth length and small head circumference. In the adjusted model, both parents' smoking showed clear associations with LBW (odds ratio [OR] = 1.64, 95% confidence interval [CI] 1.18-2.27) and short birth length (-1 standard deviation [SD] OR = 1.38, 95% CI 1.07-1.79; -2 SD OR = 2.75, 95% CI 1.84-4.10). Maternal smoking was significantly associated with birth weight and length, but paternal smoking was not. However, if both parents smoked, the risk of shorter birth length increased. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
Abu-Saad, Kathleen; Fraser, Drora
In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.
The experience and practice of the author is described in her appointment as a breast feeding advisor to the paediatric and obstetric units at University College Hospital with special responsibility for supervising infant feeding, especially breast feeding in the maternity unit. During 1980-5 there were 13,185 mothers whose babies fed. The feeding method of 12,842 mothers was recorded on discharge from the postnatal wards and 77% were breast feeding; only 3% of these mothers gave complement f...
Melania Maria Ramos de Amorim
: hypertension (87%, obstetric hemorrhage (4.9% and obstetric infection (2.1% were the major cause of the admissions analyzed. Mean age was 25 years, 65% of the patients delivered by cesarean-section. Anemia was a very common finding (58.4%. Other diagnoses were renal insufficiency, thromboembolic disease, cardiac disease, acute pulmonary edema, sepsis, and hemorrhagic shock. Of the 814 patients with pregnancy-associated hypertension 65% had severe pre-ecclampsia, 16% mild pre-ecclampsia, and 11% ecclampsia. HELLP syndrome was found in 46%. Mechanical ventilation was necessary in 3.6% and hemotransfusion in 17% of the patients. Mean stay was five day (1 a 41 days. Death occurred in 2.4% of the patients. CONCLUSIONS: the rate of deaths was low. An obstetric ICU managed by obstetricians could be a feasible way of dealing with maternal mortality.
Nahar, S; Costello, A
We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.
Hieu, D T; Hanenberg, R; Vach, T H; Vinh, D Q; Sokal, D
This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available.
Walsh, Jennifer; Murphy, Cliona; Murray, Aoife; O'Laoide, Risteard; McAuliffe, Fionnuala M
Stroke occurring during pregnancy and the postnatal period is a rare but potentially catastrophic event. The aim of this study was to examine the incidence and outcomes of pregnancies complicated by maternal stroke in a single centre. This is a prospective study of over 35,000 consecutive pregnancies over a four-year period at the National Maternity Hospital in Dublin from 2004 to 2008; in addition we also retrospectively examined all cases of maternal mortality at our institution over a 50-year period from 1959 to 2009. We prospectively identified eight cases of strokes complicating pregnancy and the postnatal period giving an overall incidence of 22.34 per 100,000 pregnancies or 24.74 per 100,000 deliveries. There were no stroke-related mortalities during that time. Retrospective analysis of maternal mortality revealed 102 maternal deaths over a 50-year period, 19 (18.6%) of which were due to cerebrovascular accidents. In conclusion, strokes complicating pregnancy and the puerperium remain a rare event and though there appears to be evidence that the incidence is increasing, the associated maternal mortality appears to be falling.
van Teijlingen, E R; Pitchforth, E
In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens. Copyright 2009 Elsevier Ltd. All rights reserved.
Full Text Available Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC. Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC’s website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women’s socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.
Bakhtiar, U.J.; Khan, Y.; Nisar, R.
To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)
Nguyen, M-L; Lefèvre, P; Dreyfus, M
Know the impact of the unplanned deliveries in a town of medium size, the characteristics of these women and maternal and neonatal risks. This was a retrospective study conducted between January 2002 and December 2009. Unexpected delivery was defined as any delivery taking place outside of a non-elective way maternity. Each unexpected delivery was matched at nearest delivery of equivalent term, at the CHU maternity, with an onset of spontaneous labour. Ninety-four women gave birth unexpectedly for a total of 48,721 births (incidence of 0.19%). There was a significant difference between cases and controls for parity (1.8 versus 0.9), the lack of follow-up of pregnancy (21.3% versus 1.1%), tobacco (57.4% versus 25.5%), the socio-economic level, the type of feeding (artificial: 61.7% versus 30.6%), the home-hospital distance and obstetric follow-up. We found a significant increase in perinatal mortality (6.4% versus 1%) and stay in Neonatal ICU (19.1% versus 9.2%). The main neonatal morbidity was hypothermia. It is difficult to target a population at risk because the type of these women is non-specific. Prevention of unplanned deliveries and their morbidities through information of patients on the grounds of urgent consultation and support of the newborn to limit hypothermia. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Full Text Available Objective: The treatment of neonatal hyperbilirubinemia remains aproblem because it can lead to sequelae in both children and adults. Theobjective of this study was to evaluate how neonatal jaundice is treatedin maternity hospitals in the city of São Paulo. Methods: Prospective andtransversal study on maternity hospitals in the city of São Paulo, Brazil. Aquestionnaire was applied to doctors working at neonatal wards withinmaternity hospitals in the city of São Paulo, divided into public (n = 6 andprivate maternity clinics (n = 18. The results obtained from the differentitems of the questionnaire were then compared. Statistical analysis wasperformed using the Student’s t test, chi-square test and Mann-Whitneytest when appropriate, and a p value < 0.005 was considered significant.Results: There were no significant differences between the two typesof maternity hospitals in relation to the treatment method for neonataljaundice. However, among private maternities there were some that didnot have written guidelines (5/17 and those that performed exchangetransfusion (3/18. Teaching was significantly more present amongpublic (100% than private maternity hospitals (17.6%. The mean serumbilirubin levels to initiate treatment did not show significant differencesbetween the two types of maternities. Some clinical practices in use bymaternity hospitals are not evidence based. Conclusions: The presentdata were considered preliminary and showed that further research inthe area is required and if our findings are confirmed, indicate the needfor continuous medical education on the part of health professionals incharge of newborns.
Hoang, Ha; Le, Quynh; Terry, Daniel
This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Klemetti, Reija; Regushevskaya, Elena; Zhang, Wei-Hong; Wu, Zhuochun; Yan, Hong; Wang, Yang; Hemminki, Elina
To describe the use of maternity care in rural China by the legal status of the pregnancy. Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors. Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint. Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.
Han, Yingying; Jiang, Panhua; Dong, Tianyu; Ding, Xinliang; Chen, Ting; Villanger, Gro Dehli; Aase, Heidi; Huang, Lu; Xia, Yankai
Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous. This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age. In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM 10 ), and ozone (O 3 ), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group ( = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age air pollution exposure. With adjustment for covariates, the highest level of PM 10 exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM 10 exposure was positively associated with gestational age, whereas O 3 exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM 10 exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM 10 exposure associated with preterm birth was modified by advanced maternal age (OR interaction = 2.00, 95% CI: 1.02, 3.91, P interaction = 0.032). Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution
Breda, Joao; Robertson, Aileen
This publication has three parts: •a summary of the results of a systematic review of the most recent evidence on maternal nutrition, the prevention of obesity and noncommunicable diseases; •a review of existing recommendations for nutrition, physical activity and weight gain during pregnancy...... in European countries; and •lists of possible opportunities for action in European countries. The overview and exploration of the national recommendations for nutrition, physical activity and weight gain during pregnancy are based on the results of a survey in which 51 of the 53 Member States in the WHO....... These are opportunities to promote nutrition and health throughout the life-course, ensure optimal diet-related fetal development and reduce the impact of morbidity and risk factors for noncommunicable diseases by improving maternal nutrition....
During a 12-month period there were 17 baby falls on the maternity wards at Nottingham University Hospitals Trust; two of the babies who fell were injured. By collecting information about the baby falls and how they happened, we were able to compile a guideline for both preventing and managing baby falls. This formed part of the trust's patient safety programme. We then piloted and implemented risk-prevention strategies for baby falls. These involved a risk assessment to identify women needing closer observation and the installation of bedside cots. These strategies brought about a marked reduction of baby falls and are now being established across all the maternity units across the trust.
Método mãe canguru nos hospitais / maternidades públicos de Salvador e atuação dos profissionais da saúde na segunda etapa do método Kangaroo mother method in hospitals / public maternity in Salvador and performance of health professionals in the second stage of the method
Juliana Rodrigues da Silva
Full Text Available OBJETIVO: investigar quantos hospitais/ maternidades públicos em Salvador utilizam o método mãe-canguru, quais os profissionais estão inseridos na equipe e caracterizar a atuação dos profissionais de saúde que estão inseridos na segunda etapa do método. MÉTODO: trata-se de um estudo quantitativo descritivo do qual participaram os responsáveis pelo setor de neonatologia e os profissionais de saúde inseridos na segunda etapa do método respondendo a questionários. Os dados obtidos foram analisados por meio de estatística descritiva calculando-se frequências simples. RESULTADOS:das sete instituições públicas de Salvador quatro utilizam o método. Nas três instituições pesquisadas realizam-se as três etapas preconizadas, em duas delas o quadro profissional tem pelo menos um atuante de cada especialidade recomendada pelo Ministério da Saúde, no entanto evidencia-se reduzido número de fonoaudiólogos nos serviços. Dentre as principais ações dos profissionais da saúde inseridos na segunda etapa estão o incentivo ao posicionamento canguru, ao aleitamento materno exclusivo e orientação às mães quanto aos cuidados com o bebê. CONCLUSÕES:evidencia-se que a recomendação do Ministério da Saúde de que o método seja implantado nas unidades médico-assistenciais integrante do Sistema Único de Saúde ainda não é uma realidade em todos os hospitais/ maternidades públicos de Salvador, no entanto evidenciou-se quadro profissional em conformidade com a recomendação em duas das instituições pesquisadas e a atuação dos profissionais entrevistados se incorpora no campo da transdisciplinaridade.PURPOSE:to investigate how many public hospitals and maternity hospitals in Salvador use the Kangaroo Mother Method, who are the professionals inserted in the team, and to characterize the acting of the health professionals who are inserted in the second stage of the method. METHOD: a descriptive quantitative study, in which the
Priscilla Rocha Araújo Nader
Full Text Available O objetivo do estudo foi descrever as características do abortamento de mulheres admitidas em uma maternidade pública do Espírito Santo. É um estudo transversal. A amostra constituiu-se de 21 mulheres que induziram o abortamento e 62 que o declararam como espontâneo, internadas no período de agosto de 2005 a janeiro de 2006. Para a coleta de dados, foi utilizado um formulário. Os dados foram analisados pelo SPSS, versão 14.0. Em ambos os tipos de abortamento, a maioria das mulheres (85,5% não planejou a gestação e a idade gestacional predominante foi de dez semanas e menos. Um maior percentual de mulheres do grupo do abortamento induzido foi aconselhado a abortar (47,6%, apresentou hemorragia (28,6% e sinais de infecção (19,1% à admissão, e necessitou utilizar antibioticoterapia (19,1%. O método de escolha para a prática do abortamento foi o Misoprostol (76,2%. O pai do concepto teve maior participação na decisão do aborto do que a família. Os principais motivos que levaram à indução do abortamento foram falta de condições financeiras (29,4%, falta de apoio do pai do concepto (20,6%, e ter uma relação conjugal instável (17,7%. Conclui-se que é necessário aumentar as possibilidades de se planejar a gestação e valorizar o Planejamento Familiar como um componente indispensável para o processo global de desenvolvimento social e econômico do País.The study aimed to describe the characteristics of abortion of women in a public hospital in the state of Espírito Santo. It is a cross-sectional study. The sample consisted of 21 women who had induced abortion, and 62 who declared miscarriage, hospitalized in the period between August 2005 and January 2006. A form was used for data collection. Data were analyzed by SPSS, version 14.0. In both kinds of abortion, most women (85.5% had not planned to become pregnant and the predominant gestational age was 10 weeks and less. A greater percentage of women from the induced
Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal death is a great tragedy in the family life. It is crusade to know not just the medical cause of the death but the circumstances what makes these continued tragic death even more unacceptable is that deaths are largely preventable
Prakash, A; Swain, S; Seth, A
The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the
Dowell, S F; Török, T J; Thorp, J A; Hedrick, J; Erdman, D D; Zaki, S R; Hinkle, C J; Bayer, W L; Anderson, L J
A suspected nosocomial outbreak of parvovirus B19 infection in a maternity ward was investigated in February 1994. Questionnaires were administered and sera collected from maternity ward staff (n = 91), other ward staff in the same hospital (n = 101), and maternity ward staff at a nearby hospital (n = 81). Blood donors (n = 265) were used as community controls. Recent infection (parvovirus B19 IgM positivity) in susceptible persons (parvovirus B19 IgG-negative or IgM-positive) was common among all 4 groups (23%-30%). This high rate of recent infection occurred during a large community outbreak of fifth disease. Environmental samples collected from a room where a stillborn parvovirus B19-infected fetus was delivered were positive for parvovirus B19 DNA. Thus, this suspected nosocomial outbreak actually reflected transmission outside the hospital, but contaminated environmental surfaces were identified as one potential source for transmission of parvovirus B19.
OBJECTIVE: To identify the maternal body composition parameters that independently influence birth weight. STUDY DESIGN: A longitudinal prospective observational study in a large university teaching hospital. One hundred and eighty-four non-diabetic caucasian women with a singleton pregnancy were studied. In early pregnancy maternal weight and height were measured digitally in a standardised way and the body mass index (BMI) was calculated. At 28 and 37 weeks\\' gestation maternal body composition was assessed using segmental multifrequency bioelectrical impedance analysis. At delivery the baby was weighed and the clinical details were recorded. RESULTS: Of the women studied, 29.2% were overweight and 34.8% were obese. Birth weight did not correlate with maternal weight or BMI in early pregnancy. Birth weight correlated with gestational weight gain (GWG) before the third trimester (r=0.163, p=0.027), but not with GWG in the third trimester. Birth weight correlated with maternal fat-free mass, and not fat mass at 28 and 37 weeks gestation. Birth weight did not correlate with increases in maternal fat and fat-free masses between 28 and 37 weeks. CONCLUSIONS: Contrary to previous reports, we found that early pregnancy maternal BMI in a non-diabetic population does not influence birth weight. Interestingly, it was the GWG before the third trimester and not the GWG in the third trimester that influenced birth weight. Our findings have implications for the design of future intervention studies aimed at optimising gestational weight gain and birth weight. CONDENSATION: Maternal fat-free mass and gestational weight gain both influence birth weight.
Shawky, S; Milaat, W M; Abalkhail, B A; Soliman, N K
The objectives of this study were to determine the relation between maternal education and various maternal risk factors, identify the impact of maternal education on the risk of childhood handicap and estimate the proportion of childhood handicap that can be prevented by maternal education. Data was collected from all married women attending the two major maternity and child hospitals in Jeddah during April 1999. Women with at least one living child were interviewed for sociodemographic factors and having at least one handicapped child. The risk of having a handicapped child and the population attributable risk percent were calculated. Some potential risk factors are dominant in our society as approximately 30% of women did not attend school and 84% did not work. Consanguineous marriages accounted for about 43%. Pre-marriage counseling was limited as only 10% of women counseled before marriage. The proportion of unemployment and consanguineous marriages decreased significantly by increase in maternal education level. Conversely, the proportion of women reporting pre-marriage counseling increased significantly by increase in maternal education level. Approximately, 7% of women reported having at least one handicapped child. The risk of having a handicapped child showed a significant sharp decline with increase in maternal education level. At least 25% of childhood handicap can be prevented by achieving female primary education and up to half of cases can be prevented if mothers finish their intermediate education. Female education plays a major role in child health. The results of this study suggest investment in female education, which would have substantial positive effects in reducing incidence of childhood handicap in Jeddah.
Cesarianas: percepção de risco e sua indicação pelo obstetra em uma maternidade pública no Município do Rio de Janeiro Cesarean sections: risk perception and indication by attending obstetricians in a public maternity hospital in Rio de Janeiro
Marcos Augusto Bastos Dias
Full Text Available A taxa de cesariana entre as maternidades públicas municipais da cidade do Rio de Janeiro no ano de 2000 foi de 30,1%. Com taxas tão elevadas, nossas hipóteses são que as indicações de cesarianas nestas unidades não estão restritas apenas às indicações clínicas. Este artigo tem como objetivo analisar as representações de médicos sobre os riscos inerentes da cesariana que influenciam a sua indicação. Neste estudo qualitativo, realizado com observação participante de plantões e entrevistas com obstetras, pudemos identificar que as indicações feitas pelos obstetras da unidade pública estudada sofrem influência de diversos fatores não obstétricos: a insegurança quanto às manobras obstétricas, a fragmentação do atendimento e o medo da responsabilização jurídica, entre outros. O artigo sugere que a banalização desta intervenção no serviço privado traz para o serviço público um desvio da prática obstétrica que compromete não apenas a qualidade da assistência pública, como pode colocar em risco a vida de mulheres e bebês.The cesarean section rate in municipal public maternity hospitals in the city of Rio de Janeiro in the year of 2000 was 30.1%. With such a high rate, our hypothesis is that attending obstetricians in these units are indicating cesarean sections for reasons not restricted to clinical factors. The article aims to analyze physicians' representations of the inherent risks in cesarean sections that influence the medical decision for their indication. In this qualitative study, conducted through participant observation during ward duty and interviews with obstetricians, we observed that C-section indications by obstetricians are influenced by various non-obstetric factors, including insecurity about performing obstetric maneuvers, fragmented care, and fear of legal liability. The paper suggests that the widespread use of this intervention in private maternity services has fostered a practice in
Full Text Available Andrew Browning,1,2 Birhanu Menber21Maternity Africa, Arusha, Tanzania; 2Vision Maternity Care, Barhirdar, Ethiopia Objectives: To determine the impact of volunteer obstetricians and midwife teams on obstetric services in a rural hospital in Ethiopia.Methods: The intervention was undertaken in Mota district hospital, a rural hospital in the Amhara region of Ethiopia, which is the only hospital for 1.2 million people. Before the placement of volunteer teams it had a rudimentary basic obstetric service, no blood transfusion service, and no operative delivery. The study prospectively analyzed delivery data before, during, and after the placement of volunteer obstetrician and midwife teams. The volunteers established emergency obstetric care, and trained and supervised local staff over a 3-year period. Measurable outcomes consisted of the number of women delivering, the number of referrals of pregnant women, the number of maternal deaths, and the number of referrals of obstetric fistula patients.Results: With the establishment of the service the number of women attending hospital for delivery increased by 40%. In the hospital maternal mortality decreased from 7.1% to <0.5%, and morbidity, as measured by number of obstetric fistulae, decreased from 1.5% deliveries to 0.5% over the 3-year intervention period. The improvements were sustained after handing the project back to the government.Conclusion: The placement of volunteer teams was an effective method of decreasing maternal mortality and morbidity. Keywords: emergency obstetric care, volunteers, obstetric fistula, emergency obstetric care
Finger, W R
Various separate studies indicate maternal morbidity is more common than had been believed. A Safe Motherhood Survey was conducted in 1993 in the Philippines among 9000 women, as part of efforts to study women's language and perceptions about pregnancy and symptoms of morbidity. In El Salvador, interviews were conducted among 2000 women on morbidity issues. Preliminary results from a Family Health International (FHI) five-country survey of 16,000 women revealed that 7 out of every 10 women reported a health problem related to maternity or chronic conditions stemming from pregnancy or childbirth. Conditions ranged from obstructed labor, complications from unsafe abortions, and bacterial infections, to anemia, hemorrhage, and eclampsia. The quality of care determines whether the health problems are life threatening. Less serious morbidity cases involve fatigue or back pain, which is exacerbated by poor nutrition and hard physical labor. Other reproductive morbidities are sexually transmitted diseases, side effects from contraceptives, and general gynecological problems. The FHI results from Ghana, Indonesia, and Egypt showed 240-300 morbidities for every maternal death; maternal mortality worldwide is estimated at 500,000 annually. A study of fistula (an injury during labor to the vagina and bladder that results in urinary or fecal incontinence) found that Nigerian community norms and limited access to emergency health care were factors. The women reported costs, poor roads, and transportation problems. A study in Ethiopia found that, in an Addis Ababa hospital between 1983-88, 600 fistulas were repaired every year, of which almost 66% occurred at first delivery. A study in Cairo in 1988 found that nearly 6 out of every 10 women reported a prolapsed uterus. Women in the studies were able to talk openly and willingly about their problems, when concepts and language were appropriate and interviewers were trained. A small study in India confirmed the correlation between
Beer, A E; Billingham, R E
Without altering the structural integrity of the placenta by irradiation or drugs, we have shown that it is possible to immunize females both adoptively and actively against the paternally inherited transplantation antigens of their fetuses. Such immunization causes a high incidence of runt disease among the litters. Although the putative chimeric status of the affected offspring has yet to be confirmed, the results of our experiments support the thesis that runt disease is caused by the activities of "unwanted" immigrant lymphocytes from the maternal circulation. Our results suggest that immunologically activated cells are more likely to cross the placenta than normal cells and that this greater mobility may not be related to the immunologic specificity of the activated cells. Two factors may have contributed to the apparent failure of numerous previous attempts to demonstrate the capacity of transplantation immunity to affect the well-being of a fetus or, more correctly, its placenta, in the way that might be expected of a homograft. (i) Investigators were preoccupied with obtaining a classic type of rejection, in utero, analogous to the rejection of an orthotopic skin homograft. The birth of consistently healthy-looking litters, interpreted as a failure of the experiment, convinced the investigators of the efficacy of nature's solution of the homograft problem and there was no reason for them to suspect its possible limitations. Observation of the litters for several weeks might have uncovered the phenomenon of maternally induced runt disease. (ii) Most investigators resorted to hyperimmunization of the mothers. This would have facilitated the synthesis of protective isoantibodies capable of interfering with the expression of the potentially harmful cellular immune response (6). Ever since the abnormalities of runt disease were first described they have repeatedly been compared to those observed in patients with certain lymphomas (17). Various theories have been
Schmidt, Nina; Abelsen, Birgit; Øian, Pål
The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.
Full Text Available Average maternal age at birth has been rising steadily in Western and some Asian countries. Older maternal age has been associated with adverse pregnancy and birth outcomes; however, studies on the relationship between maternal age and young children's health remain scarce. Therefore, we sought to investigate the association of maternal age with child health outcomes in the Japanese population. We analyzed data from two birth cohorts of the nationwide Japanese Longitudinal Survey of Babies in 21st Century (n2001 = 47,715 and n2010 = 38,554. We estimated risks of unintentional injuries and hospital admissions at 18 and 66 months according to maternal age, controlling for the following potential confounders: parental education; maternal parity, smoking status, and employment status; household income; paternal age, and sex of the child. We also included the following as potential mediators: preterm births and birthweight. We observed a decreasing trend in the risks of children's unintentional injuries and hospital admissions at 18 months according to maternal age in both cohorts. In the 2001 cohort, compared to mothers 40.0 years, respectively, controlling for confounders. Our findings were in line with previous findings from population-based studies conducted in the United Kingdom and Canada suggesting that older maternal age may be beneficial for early child health.
The Government of Nepal revised free maternity health services, "Aama Surakshya Karyakram", beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2-19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during
Katsuragi, Shinji; Tanaka, Hiroaki; Hasegawa, Junichi; Nakamura, Masamitsu; Kanayama, Naohiro; Nakata, Masahiko; Murakoshi, Takeshi; Yoshimatsu, Jun; Osato, Kazuhiro; Tanaka, Kayo; Sekizawa, Akihiko; Ishiwata, Isamu; Ikeda, Tomoaki
Hypertensive disorder of pregnancy (HDP) is a major cause of maternal death. The goal of this study was to investigate factors associated with maternal death due to HDP. HDP-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor and Welfare from 2010 to 2015 were examined. Out of 47 cases of HDP, 30 were identified as the major cause of maternal death. The median maternal age was 34 years (range 24-45) and the mortality in women aged ≥40 years was seven times higher that than in women aged deaths in Japan. Mothers aged ≥40 years are most at risk for HDP-related maternal death. Major concerns for preventabilities were late hospitalization, maternal transportation, and termination of pregnancy for term or near-term HDP. Regular vital checks and prompt lowering of BP were lacked during labor in most cases. HELLP syndrome should be managed at a general hospital with sufficient medical resources.
Liu, Laura X.; Arany, Zolt
Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal ‘invasion’ profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314
Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan
AIMS: To assess the effect of maternal BMI on complications in pregnancy, mode of delivery, complications of labour and delivery.METHODS:A crossectional study was carried out in the Obst and Gynae department, Kasturba Hospital, Delhi. The study enrolled 100 pregnant women. They were divided into 2 groups based on their BMI, more than or equal to 30.0 kg/m2 were categorized as obese and less than 30 kg/m2 as non obese respectively. Maternal complications in both types of patients were studied.RESULTS:CONCLUSION: As the obstetrical outcome is significantly altered due to obesity, we can improve maternal outcome by overcoming obesity. As obesity is a modifiable risk factor, preconception counseling creating awareness regarding health risk associated with obesity should be encouraged and obstetrical complications reduced.
With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work. (paper)
With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.
1Department of Preventive Dentistry, Lagos University Teaching Hospital, ... parents interviewed believed that teething causes no .... prevalent in Nigeria but also in other parts of the world. 14 .... Ahmed I S, Elton A R, Karrar Z A. Knowledge,.
Østrup, Esben; Hyttel, Poul; Østrup, Olga
Communication during early pregnancy is essential for successful reproduction. In this review we address the beginning of the communication between mother and developing embryo; including morphological and transcriptional changes in the endometrium as well as epigenetic regulation mechanisms dire...... directing the placentation. An increasing knowledge of the embryo-maternal communication might not only help to improve the fertility of our farm animals but also our understanding of human health and reproduction.......Communication during early pregnancy is essential for successful reproduction. In this review we address the beginning of the communication between mother and developing embryo; including morphological and transcriptional changes in the endometrium as well as epigenetic regulation mechanisms...
Devlieger, Roland; Benhalima, Katrien; Damm, Peter
and offspring. These effects are often aggravated by the high incidence of abnormal glucose tolerance and excessive gestational weight gain found in this group. The main controversies around the management of the obese pregnant women are related to (1) the value of repeated weighing during pregnancy, (2......, the prevalence of maternal obesity varies from 7 to 25% and seems strongly related to social and educational inequalities. Obesity during pregnancy represents an important preventable risk factor for adverse pregnancy outcomes and is associated with negative long-term health outcomes for both mothers...
Liver glycogen availability in the newborn is of major importance for the maintenance of postnatal blood glucose levels. This study examined the effect of maternal ethanol ingestion on maternal and neonatal glucose balance in the rate. Female rats were placed on 1) the Lieber-DeCarli liquid ethanol diet, 2) an isocaloric liquid pair-diet, or 3) an ad libitum rat chow diet at 3 wk before mating and throughout gestation. Blood and livers were obtained from dams and rat pups on gestational days 21 and 22. The pups were studied up to 6 h in the fasted state and up to 24 h in the fed state. Maternal ethanol ingestion significantly decreased litter size, birth weight, and growth. A significantly higher mortality during the early postnatal period was seen in the prenatal ethanol exposed pups. Ethanol significantly decreased fed maternal liver glycogen stores but not maternal plasma glucose levels. The newborn rats from ethanol ingesting dams also had significantly decreased liver glycogen stores. Despite mobilizing their available glycogen, these prenatal ethanol exposed pups became hypoglycemic by 6 h postnatal. This was more marked in the fasted pups. Ethanol did not affect maternal nor neonatal plasma insulin levels. Thus maternal ethanol ingestion reduces maternal and neonatal liver glycogen stores and leads to postnatal hypoglycemia in the newborn rat
Tompson, Martha C.; Pierre, Claudette B.; Boger, Kathryn Dingman; McKowen, James W.; Chan, Priscilla T.; Freed, Rachel D.
Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two…
relationship could exist between MMA of mother-infant pairs and maternal nutritional indicator (haemoglobin). Objectives: This study reviewed the effects of maternal haemoglobin (Hb) on MMA of mother-infant pairs at birth. Methods: One hundred and fifty three mother-infant pairs were enrolled in this study using the ...
Rana, Ashma; Baral, Gehanath; Dangal, Ganesh
Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing Maternal Mortality Ratio is one of the challenges to achieve Millennium Development Goal. The objective was to determine the frequency and the nature of near-miss events and to analyze the near-miss morbidities among pregnant women. A prospective surveillance was done for a year in 2012 at nine hospitals in Kathmandu valley. Cases eligible by deﬁnition were recorded as a census based on WHO near-miss guideline. Similar questionnaires and dummy tables were used to present the results by non-inferential statistics. Out of 157 cases identiﬁed with near-miss rate of 3.8 per 1000 live births, severe complications were postpartum hemorrhage 62 (40%) and preeclampsia-eclampsia 25 (17%). Blood transfusion 102 (65%), ICU admission 85 (54%) and surgery 53 (32%) were common critical interventions. Oxytocin was main uterotonic used both prophylactically and therapeutically at health facilities. Total of 30 (19%) cases arrived at health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All laparotomies were performed within three hours of arrival. Near-miss to maternal death ratio was 6:1 and MMR was 62. Study result yielded similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualiﬁed the recommended standard of care. The near-miss event could be used as a surrogate marker of maternal death and a window for system level intervention.
Full Text Available Introduction: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing maternal mortality ratio is one of the challenges to achieve Millennium Development Goal. Objective was to determine the frequency and the nature of near-miss (severe acute maternal morbidity events and analysis of near-miss morbidities among pregnant women. Methods: Prospective surveillance was done for a year in 2012 in nine hospitals in Kathmandu valley. Cases eligible by definition recorded as a census based on WHO near-miss guideline. Similar questionnaire and dummy tables were used to present the result by non-inferential statistics. Results: Out of 157 cases identified with near-miss rate of 3.8, severe complications were PPH (40% and preeclampsia-eclampsia (17%. Blood transfusion (65%, ICU admission (54% and surgery (32% were the common critical intervention. Oxytocin was the main uterotonic used both prophylactically (86% and therapeutically (76%, and 19% arrived health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All of the laparotomies were performed within 3 hours of arrival. Near-miss to mortality ratio was 6:1 and MMR 62. Conclusions: Study result yields similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualify the recommended standard of care. The near-miss event can be used as a surrogate marker of maternal death and a window for system level intervention. Keywords: abortion, eclampsia, hemorrhage, near-miss, surveillance
Natália P. Castro
Full Text Available Increased maternal blood concentrations of leptin and decreased adiponectin levels, which are common disturbances in obesity, may be involved in offspring adiposity by programming fetal adipose tissue development. The aim of this study was to assess the relationship between maternal leptin and adiponectin concentrations and newborn adiposity. This was a cross-sectional study involving 210 healthy mother-newborn pairs from a public maternity hospital in São Paulo, Brazil. Maternal blood samples were collected after delivery and leptin and adiponectin concentrations were measured by enzyme-linked immunosorbent assay. Newborn body composition was estimated by air displacement plethysmography. The association between maternal leptin and adiponectin concentrations and newborn adiposity (fat mass percentage, FM% was evaluated by multiple linear regression, controlling for maternal age, socioeconomic status, parity, pre-pregnancy body mass index (BMI, weight gain, gestational age, and newborn age at the time of measurement. No relationship was found between maternal leptin and FM% of male or female newborn infants. Maternal adiponectin (p = 0.001 and pre-pregnancy BMI (p < 0.001; adj. R2 = 0.19 were positively associated with FM% of newborn males, indicating that maternal adiponectin is involved in fetal fat deposition in a sex-specific manner. Large-scale epidemiological, longitudinal studies are necessary to confirm our results.
OBJECTIVE: Previous studies on weight gain in pregnancy suggested that maternal weight on average increased by 0.5-2.0 kg in the first trimester of pregnancy. This study examined whether mean maternal weight or body composition changes in the first trimester of pregnancy. DESIGN: Prospective observational study. POPULATION: We studied 1,000 Caucasian women booking for antenatal care in the first trimester of pregnancy. SETTING: Large university teaching hospital. METHODS: Maternal height and weight were measured digitally in a standardized way and Body Mass Index (BMI) was calculated. Maternal body composition was measured using segmental multifrequency Bioelectrical Impedance Analysis (BIA). Sonographic examination confirmed the gestational age and a normal ongoing singleton pregnancy in all subjects. MAIN OUTCOME MEASURES: Maternal weight, maternal body composition. RESULTS: The mean BMI was 25.7 kg\\/m(2) and 19.0% of the women were in the obese category (> or =30.0 kg\\/m(2)). Cross-sectional analysis by gestational age showed that there was no change in mean maternal weight, BMI, total body water, fat mass, fat-free mass or bone mass before 14 weeks gestation. CONCLUSIONS: Contrary to previous reports, mean maternal weight and mean body composition values remain unchanged in the first trimester of pregnancy. This has implications for guidelines on maternal weight gain during pregnancy. We also recommend that calculation of BMI in pregnancy and gestational weight gain should be based on accurate early pregnancy measurements, and not on self-reported or prepregnancy measurements.
Castro, Natália P; Euclydes, Verônica V; Simões, Fernanda A; Vaz-de-Lima, Lourdes R A; De Brito, Cyro A; Luzia, Liania A; Devakumar, Delan; Rondó, Patrícia H C
Increased maternal blood concentrations of leptin and decreased adiponectin levels, which are common disturbances in obesity, may be involved in offspring adiposity by programming fetal adipose tissue development. The aim of this study was to assess the relationship between maternal leptin and adiponectin concentrations and newborn adiposity. This was a cross-sectional study involving 210 healthy mother-newborn pairs from a public maternity hospital in São Paulo, Brazil. Maternal blood samples were collected after delivery and leptin and adiponectin concentrations were measured by enzyme-linked immunosorbent assay. Newborn body composition was estimated by air displacement plethysmography. The association between maternal leptin and adiponectin concentrations and newborn adiposity (fat mass percentage, FM%) was evaluated by multiple linear regression, controlling for maternal age, socioeconomic status, parity, pre-pregnancy body mass index (BMI), weight gain, gestational age, and newborn age at the time of measurement. No relationship was found between maternal leptin and FM% of male or female newborn infants. Maternal adiponectin ( p = 0.001) and pre-pregnancy BMI ( p < 0.001; adj. R ² = 0.19) were positively associated with FM% of newborn males, indicating that maternal adiponectin is involved in fetal fat deposition in a sex-specific manner. Large-scale epidemiological, longitudinal studies are necessary to confirm our results.
Andrew, R R
A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.
Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2010
Brown, Callie L; Pesch, Megan H; Perrin, Eliana M; Appugliese, Danielle P; Miller, Alison L; Rosenblum, Katherine; Lumeng, Julie C
To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Introduction: Postpartum depression is an uncommon and frequently undocumented issue that impacts negatively on maternal and child health. Methods: The study was carried out among mothers who attended postpartum clinics from two teaching hospitals and three private hospitals all in Enugu metropolis.
Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada Women's representations and experiences with vaginal and cesarean delivery in public and private maternity hospitals
Andréa de Sousa Gama
Full Text Available Este estudo analisa as diferentes representações e experiências quanto ao parto vaginal e cesárea de mulheres de diferentes estratos sócio-econômicos, bem como a natureza das relações profissionais de saúde/usuárias no contexto institucional em que estão inseridas. A pesquisa de natureza qualitativa foi desenvolvida em três maternidades do Município do Rio de Janeiro, Brasil, sendo uma pública, uma conveniada com o SUS e uma particular, com mulheres que tiveram os dois tipos de parto. Os resultados revelam que o modelo de organização dos serviços público e privado apresentam variações que produzem diferentes tipos de assistência e de relação entre os profissionais de saúde e as usuárias, dando forma a experiências distintas entre as mulheres pesquisadas. Todavia, ao empreendermos uma crítica assentada nas relações de gênero, podemos verificar que o modelo de assistência ao parto permanece submetendo quem deve ser sujeito e reproduzindo o projeto da medicalização - mesmo que este processo se manifeste de formas diferenciadas entre os grupos estudados -, o que reduz o campo da assistência e inviabiliza um lugar de poder diferenciado das usuárias.This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system. The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the
Shah, Pankaj; Shah, Shobha; Kutty, Raman V; Modi, Dhiren
To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. Thirty-two thousand eight hundred and ninety-three pregnancies, 29,817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002-2003 to 161 (five deaths) in 2010-2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75-0.91, P-value rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential
Aghlmand, Siamak; Lameei, Aboulfath; Small, Rhonda
The purpose of this paper is to describe the use of voice of customer (VoC) analysis in a maternity care case study, where the aim was to identify the most important requirements of women giving birth and to determine targets for the improvement of maternity care in Fayazbakhsh Hospital in Tehran, Iran. The tools of VoC analysis were used to identify: the main customer segment of maternity care; the most important of women's needs and requirements; the level of maternal satisfaction with delivered services at the study hospital and at a competitor; the nature of women's of requirements (termed Kano levels: assumed, expected, and unexpected); and the priorities of the study hospital for meeting these requirements. Women identified the well-being of mother and baby as the most important requirements. Women's satisfaction with the services was, with a few exceptions, low to moderate. Services related to most of the maternal requirements were ranked better in the competitor hospital than the study hospital. The results form a solid basis for achieving improvements in the processes of care for mothers and babies. The paper presents a systematic approach to VoC analysis in health care settings as a basis for clinical process improvement initiatives.
Gardiner, Helena M; Kovacevic, Alexander; van der Heijden, Laila B; Pfeiffer, Patricia W; Franklin, Rodney Cg; Gibbs, John L; Averiss, Ian E; Larovere, Joan M
Determine maternity hospital and lesion-specific prenatal detection rates of major congenital heart disease (mCHD) for hospitals referring prenatally and postnatally to one Congenital Cardiac Centre, and assess interhospital relative performance (relative risk, RR). We manually linked maternity data (3 hospitals prospectively and another 16 retrospectively) with admissions, fetal diagnostic and surgical cardiac data from one Congenital Cardiac Centre. This Centre submits verified information to National Institute for Cardiovascular Outcomes Research (NICOR-Congenital), which publishes aggregate antenatal diagnosis data from infant surgical procedures. We included 120 198 unselected women screened prospectively over 11 years in 3 maternity hospitals (A, B, C). Hospital A: colocated with fetal medicine, proactive superintendent, on-site training, case-review and audit, hospital B: on-site training, proactive superintendent, monthly telemedicine clinics, and hospital C: sonographers supported by local obstetrician. We then studied 321 infants undergoing surgery for complete transposition (transposition of the great arteries (TGA), n=157) and isolated aortic coarctation (CoA, n=164) screened in hospitals A, B, C prospectively, and 16 hospitals retrospectively. 385 mCHD recorded prospectively from 120 198 (3.2/1000) screened women in 3 hospitals. Interhospital relative performance (RR) in Hospital A:1.68 (1.4 to 2.0), B:0.70 (0.54 to 0.91), C:0.65 (0.5 to 0.8). Standardised prenatal detection rates (funnel plots) demonstrating inter-hospital variation across 19 hospitals for TGA (37%, 0.00 to 0.81) and CoA (34%, 0.00 to 1.06). Manually linking data sources produced hospital-specific and lesion-specific prenatal mCHD detection rates. More granular, rather than aggregate, data provides meaningful feedback to improve screening performance. Automatic maternal and infant record linkage on a national scale, requires verified, prospective maternity audit and integration of
Nordeng, Hedvig; Eskild, Anne; Nesheim, Britt-Ingjerd
To investigate factors related to analgesic use after delivery, and especially whether rates of analgesic use were different in a midwife-managed maternity hotel as compared to conventional postnatal wards. One maternity hotel and two conventional postnatal wards at Ullevål University Hospital in Oslo, Norway. Data were obtained from hospital records for 804 women with vaginal deliveries. Postnatal analgesic use. Overall, approximately half the women used analgesics after vaginal delivery in both conventional postnatal wards and maternity hotel. The factors that were significantly associated with use of analgesics postnatally in multivariate analysis were multiparity, having a non-Western ethnicity, smoking in pregnancy, younger age, instrumental delivery, analgesic use during labour, maternal complications post partum, and duration of postnatal stay 4 days or more. The use of analgesics is determined by socio-demographic and obstetric factors rather than the organisation of the ward.
Maternal and neonatal deaths and morbidity still pose an enormous challenge for health authorities in Ghana, a lower middle income country. Despite massive investments in maternal and neonatal health and special attention through Millennium Development Goals (MDG) 4
Lopez, Linda C.; Holmes, William M.
The potential impact of several maternal involvement behaviors on teachers' ratings of children's academic skills was examined through statistical analyses. Data, based on mothers' responses to selected questions concerning maternal involvement and on teachers' ratings on the Classroom Behavior Inventory, were obtained for 115 kindergarten…
Montemayor, Raymond; Clayton, Mark D.
The relationship between maternal employment and adolescent development is enormously complex, and no simple generalizations are possible. Many intervening variables alter the impact that maternal employment has on adolescent development. There is an urgent need to discover what impact this arrangement has on adolescent development. (CJ)
Masroor, I.; Ajmal, F.; Ahmed, H.
To determine whether ultrasound consultation reduces maternal anxiety and increases feto-maternal attachment ( the desire to care for the fetus and care for self). Patients coming for routine obstetric ultrasound at the Department of Radiology, Aga Khan University Hospital Karachi were recruited in the study. The study was carried out over the period of two months from January-February 2007 in which sixty patients were included in the study. Patients were randomly assigned to a standard care group or an ultrasound consultation group (30 patients in each arm). Both groups were required to fill a questionnaire before and after their ultrasound examination. The ultrasound consultation group in addition received counseling before they went in for the ultrasound regarding fetal development and maternal-fetal interaction. The two groups were then compared for difference of change in feto maternal attachment scores and change in anxiety levels regarding their pregnancies before and after the ultrasound. SPSS software (version 14) was used for compilation of the data and the statistical computations. Categorical data was compared using Chi-square test and continuous variables were analyzed with paired t-test. P value <0.05 was considered significant. A positive difference in feto-maternal attachment and reduction in anxiety levels was seen in both the groups but this difference was statistically significant in the ultrasound consultation group only. This study suggests that ultrasound examinations with prior consultation has a positive impact on patients as it strengthens bonding toward the fetus, reduces maternal anxiety and increases maternal investment in health during the pregnancy. (author)
Kiran, N.; Zubair, A.; Malik, T.M.
To evaluate the histopathological parameters of the placenta like weight, infarct and syncytial knots, at different maternal hemoglobin levels, in both qualitative and quantitative manner. Study design: Descriptive study Place and Duration of Study: Army Medical College, National University of Sciences and Technology in collaboration with Department of Obstetrics and Gynecology, Military Hospital, Rawalpindi, Pakistan, from December 2011 to November 2012. Patients and Methods: A total of 75 placentas were included, that were collected from full term mothers at the time of childbirth. Placental weight was taken without umbilical cord and gross placental infarcts were noted. Samples of placental tissue were taken and stained by haematoxylin and eosin (H and E). Microscopic study was done to evaluate placental infarcts and syncytial knots. Results: Mean placental weight at normal and low maternal hemoglobin was 581.67 ± 83.97g and 482.58 ± 104.74g respectively. Gross placental infarcts were found in all cases having low maternal hemoglobin concentration (60% cases). Syncytial knots were found in all placentas but they were considerably more at decreasing levels of maternal hemoglobin (19.79 ± 5.22). Conclusion: The present study showed decrease in placental weight, increase in placental infarcts and syncytial knot hyperplasia at low maternal hemoglobin concentration, displaying adaptive alterations. (author)
Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre
This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD.
Gibson, Lisa Y; Byrne, Susan M; Davis, Elizabeth A; Blair, Eve; Jacoby, Peter; Zubrick, Stephen R
To investigate the relationship between a child's weight and a broad range of family and maternal factors. Cross-sectional data from a population-based prospective study, collected between January 2004 and December 2005, for 329 children aged 6-13 years (192 healthy weight, 97 overweight and 40 obese) and their mothers (n=265) recruited from a paediatric hospital endocrinology department and eight randomly selected primary schools in Perth, Western Australia. Height, weight and body mass index (BMI) of children and mothers; demographic information; maternal depression, anxiety, stress and self-esteem; general family functioning; parenting style; and negative life events. In a multilevel model, maternal BMI and family structure (single-parent v two-parent families) were the only significant predictors of child BMI z scores. Childhood obesity is not associated with adverse maternal or family characteristics such as maternal depression, negative life events, poor general family functioning or ineffective parenting style. However, having an overweight mother and a single-parent (single-mother) family increases the likelihood of a child being overweight or obese.
The World Health Organization (WHO) has defined maternal mortality (MM) as a death following a delivery or during the 42 day period following a prolonged or complicated delivery. This definition is ambiguous because it does not take into account the institutional causes (deficiencies) that lead to MM in Sub-Saharan Africa (SSA) nor does it reflect all the reasons leading to MM because of the lack of nationwide health information systems and the lack of accurate statistics. While developed countries can depend on the state to provide accurate statistics, developing countries depend on hospitals, health training centers and special surveys to provide such data which often leads to 25-50% gross underestimations of MM. The most recent WHO data (1989) shows that SSA has the highest MM rates worldwide, ranging from 500- 700/100,000 as compared to Asia with 55-650; Latin America with 110-210 and the developed countries with 10-48. The data for SSA doesn't reflect the true situation in the rural areas where MM rates are over 1000/1000,000. MM is a symptom of poor countries where women contribute to their own deaths through repeated pregnancies, causing significant socioeconomic losses to society. UNICEF (1988) has categorized the demographic factors as high risk for women based on: 1) the age of the mother, and 2) the number of pregnancies. Family planning (FP) reduces MM by preventing illegal abortions; it reduces the number of unwanted pregnancies and increases the earnings of a community by reducing the number of pregnant women. The experience of developed countries demonstrates how women have avoided high-risk and unwanted pregnancies.
F. Akhlaghi A. B. Hamedi
Presence of maternal diabetes mellitus (DM) during pregnancy has important consequences for both mother and child. To determine maternal and fetal/neonatal complications of gestational DM and compare them with pre-gestational DM, a prospective study was performed in 100 diabetic women delivered in our hospital from January 2001 to April 2002. Pregnancy outcome in 27 women with gestational DM and 73 women with pre-gestational DM and their offspring were studied and analyzed. The mean age of wo...
Wehby, George L; López-Camelo, Jorge S
Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father's education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father's education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more
Boztepe, Handan; Ay, Ayşe; Kerimoğlu Yıldız, Gizem; Çınar, Sevil
To determine whether congenital anomaly visibility affects maternal-infant attachment levels. The study population consisted of mothers who had infants with cleft lip/palate or congenital heart anomalies who were receiving treatment in a university hospital. The data were collected using the Structured Questionnaire Form and the Maternal Attachment Inventory. Statistically significant differences in maternal-infant attachment levels were observed between infants with cleft lips/palates and healthy infants and between infants with congenital heart anomalies and healthy infants. It is important to apply appropriate nursing interventions for these mothers during the postpartum period. © 2016, Wiley Periodicals, Inc.
Full Text Available Jeffrey D Lebensburger, Rakeshkumar J Patel, Prasannalaxmi Palabindela, Christina J Bemrich-Stolz, Thomas H Howard, Lee M HilliardDivision of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USAPurpose: Patients with hemoglobin SC (Hb SC and hemoglobin SB+ (Hb SB+ thalassemia suffer from frequent hospitalizations yet strong evidence of a clinical benefit of hydroxyurea (HU in this population is lacking. Patients with recurrent hospitalizations for pain crisis are offered HU at our institution based on small cohort data and anecdotal benefit. This study identifies outcomes from a large cohort of patients with Hb SC and SB+ thalassemia who were treated with HU for 2 years.Materials and methods: A retrospective review was conducted of 32 patients with Hb SC and SB+ thalassemia who were treated with HU. We reviewed the number, and reasons for hospitalization in the 2 years prior to, and 2 years post-HU treatment as well as laboratory changes from baseline, over 1 year.Results: Patients with Hb SC and SB+ thalassemia started on HU for frequent pain, had a significant reduction in hospitalizations over 2 years as compared to the 2 years prior to HU initiation (mean total hospitalizations/year: pre-HU: 1.6 vs post-HU 0.4 hospitalizations, P<0.001; mean pain hospitalizations/year: pre-HU 1.5 vs post-HU 0.3 hospitalizations, P<0.001. Patients demonstrated hematologic changes including an increase in percent fetal hemoglobin (%HbF pre–post HU (4.5% to 7.7%, P=0.002, mean corpuscular volume (74 to 86 fL, P<0,0001, and decrease in absolute neutrophil count (5.0 to 3.2×109/L, P=0.007. Patients with higher doses of HU demonstrated the greatest reduction in hospitalizations but this was unrelated to absolute neutrophil count.Conclusion: This cohort of patients with Hb SC and SB+ thalassemia provides additional support for using HU in patients with recurrent hospitalizations for pain. A large randomized multicenter trial of
Baker, Michael; Milligan, Kevin
Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.
Defline, A; Obadia, M; El Djerbi, A; Plevy, P; Lepercq, J
The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth. Copyright © 2013. Published by Elsevier Masson SAS.. All rights reserved.
Crisham Janik, Mary D; Newman, Thomas B; Cheng, Yvonne W; Xing, Guibo; Gilbert, William M; Wu, Yvonne W
To examine the association between maternal hospital diagnoses of obesity and risk of cerebral palsy (CP) in the child. For all California hospital births from 1991-2001, we linked infant and maternal hospitalization discharge abstracts to California Department of Developmental Services records of children receiving services for CP. We identified maternal hospital discharge diagnoses of obesity (International Classification of Diseases, 9th edition 646.1, 278.00, or 278.01) and morbid obesity (International Classification of Diseases, 9th edition 278.01), and performed logistic regression to explore the relationship between maternal obesity diagnoses and CP. Among 6.2 million births, 67 200 (1.1%) mothers were diagnosed with obesity, and 7878 (0.1%) with morbid obesity; 8798 (0.14%) children had CP. A maternal diagnosis of obesity (relative risk [RR] 1.30, 95% CI 1.09-1.55) or morbid obesity (RR 2.70, 95% CI 1.89-3.86) was associated with increased risk of CP. In multivariable analysis adjusting for maternal r