RESUMO
BACKGROUND: Reducing deaths from hypertensive disorders of pregnancy is a global priority. Low dietary calcium might account for the high prevalence of pre-eclampsia and eclampsia in low-income countries. Calcium supplementation in the second half of pregnancy is known to reduce the serious consequences of pre-eclampsia; however, the effect of calcium supplementation during placentation is not known. We aimed to test the hypothesis that calcium supplementation before and in early pregnancy (up to 20 weeks' gestation) prevents the development of pre-eclampsia METHODS: We did a multicountry, parallel arm, double-blind, randomised, placebo-controlled trial in South Africa, Zimbabwe, and Argentina. Participants with previous pre-eclampsia and eclampsia received 500 mg calcium or placebo daily from enrolment prepregnancy until 20 weeks' gestation. Participants were parous women whose most recent pregnancy had been complicated by pre-eclampsia or eclampsia and who were intending to become pregnant. All participants received unblinded calcium 1·5 g daily after 20 weeks' gestation. The allocation sequence (1:1 ratio) used computer-generated random numbers in balanced blocks of variable size. The primary outcome was pre-eclampsia, defined as gestational hypertension and proteinuria. The trial is registered with the Pan-African Clinical Trials Registry, number PACTR201105000267371. The trial closed on Oct 31, 2017. FINDINGS: Between July 12, 2011, and Sept 8, 2016, we randomly allocated 1355 women to receive calcium or placebo; 331 of 678 participants in the calcium group versus 320 of 677 in the placebo group became pregnant, and 298 of 678 versus 283 of 677 had pregnancies beyond 20 weeks' gestation. Pre-eclampsia occurred in 69 (23%) of 296 participants in the calcium group versus 82 (29%) of 283 participants in the placebo group with pregnancies beyond 20 weeks' gestation (risk ratio [RR] 0·80, 95% CI 0·61-1·06; p=0·121). For participants with compliance of more than 80% from the last visit before pregnancy to 20 weeks' gestation, the pre-eclampsia risk was 30 (21%) of 144 versus 47 (32%) of 149 (RR 0·66, CI 0·44-0·98; p=0·037). There were no serious adverse effects of calcium reported. INTERPRETATION: Calcium supplementation that commenced before pregnancy until 20 weeks' gestation, compared with placebo, did not show a significant reduction in recurrent pre-eclampsia. As the trial was powered to detect a large effect size, we cannot rule out a small to moderate effect of this intervention. FUNDING: The University of British Columbia, a grantee of the Bill & Melinda Gates Foundation; UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO; the Argentina Fund for Horizontal Cooperation of the Argentinean Ministry of Foreign Affairs; and the Centre for Intervention Science in Maternal and Child Health.
Assuntos
Cálcio/administração & dosagem , Suplementos Nutricionais , Pré-Eclâmpsia/prevenção & controle , Cuidado Pré-Natal/métodos , Adulto , Argentina , Países em Desenvolvimento , Método Duplo-Cego , Feminino , Idade Gestacional , Saúde Global , Humanos , Gravidez , Fatores de Risco , África do Sul , Adulto Jovem , ZimbábueRESUMO
BACKGROUND: Maternal 'near miss' can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care. METHODS: A prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal 'near miss' at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal 'near miss' and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death. RESULTS: During this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal 'near miss' morbidity and 13 were maternal deaths. The maternal 'near miss' ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission. CONCLUSION: The MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.
Assuntos
Aborto Espontâneo/epidemiologia , Serviços de Saúde Materna , Near Miss/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Unidades de Terapia Intensiva , Mortalidade Materna , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Infecção Puerperal , Qualidade da Assistência à Saúde , Centros de Atenção Terciária , Adulto Jovem , Zimbábue/epidemiologiaRESUMO
A cross-sectional qualitative study was conducted using in-depth interview guides at Chinhoyi Provincial Hospital, Zimbabwe to explore and understand health-seeking behaviors of women affected by obstetric fistula and to determine reasons why women lived with fistula. Study participants were women who had come for fistula repair between November and December 2019, who consented to participate in the study. In-depth interviews were conducted and analyzed using NVivo 10. Of the 29 women who came for the camp, 21 were enrolled. Mean period with fistula was 4.7 years (SD±12). Participants sought help from spiritual healers first before medical treatment but all sought medical care at one time during or after delivery. Reasons for staying with fistula included lack of knowledge of availability of repair services, lack of resources, and powerlessness in decision making. This study concluded that barriers to access should be addressed so that women get the treatment they require.
Assuntos
Fístula , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Transversais , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , ZimbábueAssuntos
Serviços de Saúde Comunitária/tendências , Países em Desenvolvimento , Saúde Global , Prioridades em Saúde/tendências , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Bem-Estar Materno/tendências , Tocologia/educação , Feminino , Humanos , Recém-Nascido , Bem-Estar Materno/estatística & dados numéricos , Gravidez , Recursos HumanosRESUMO
OBJECTIVE: To review the evidence and provide guidelines on the management of sexual violence against women, specifically, rape. OUTCOMES: Outcomes evaluated include effectiveness of post-rape care provision. EVIDENCE: The MEDLINE database was searched for articles published up to December 2008 on the topic of post-rape care and expert opinion was sought from the Sexual Violence Research Initiative membership. In addition, a search was performed for English-language protocols on Google. One Spanish language protocol was considered in the development of the guidelines. VALUES: The evidence was evaluated by authors and reviewers of the South African Department of Health's sexual assault curriculum, and by members of the FIGO Working Group and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: Implementation of the recommendations in this Guideline should result in more appropriate management of survivors of sexual violence and better physical and psychological outcomes.