Association between maternal death and cesarean section in Latin America: A systematic literature review.

BACKGROUND: it is critically important to explore a possible relationship between cesarean section and maternal mortality in Latin America, where the highest cesarean section rates in the world are found. Our aim was to conduct a systematic literature review on the relationship between maternal death and caesarean section in Latin America. METHODS: we undertook a systematic review through six electronic databases. Studies that reported any association analysis between maternal mortality and the mode of delivery in Latin America were included. Papers that fulfilled the inclusion criteria were then read fully, and a quality assessment was conducted with the PROMPT tool. RESULTS: seven articles were identified for final analysis, all of which were observational studies. Most of the studies were retrospective (6) and one was prospective. Of the retrospective studies, 3 were case control and 3 were cross-sectional. Most of the publications on this topic suggest that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth (odds ratio ranging from 1.6 to 7.08). However, it is evident that there is a lack of studies with this subject, especially those that take into account the differences in risk between women delivered by cesarean section or by vaginal birth. CONCLUSIONS: most of the articles showed that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth. However, it is clear that there is a limited number of studies published on this issue. Additional studies with a better methodological design should be conducted.

Fertility intentions of HIV-infected women in the United Kingdom.

In the United Kingdom (UK), the number of pregnancies in HIV-infected women has increased dramatically over the last decade, but attitudes towards childbearing among infected women have not been previously described. The aim of this survey was to explore fertility intentions among HIV-infected women and to assess the effect of HIV treatment and interventions for prevention of mother-to-child transmission (PMTCT) on these intentions. HIV-infected women, aged between 16 and 49 years, attending one of seven HIV clinics in the UK between July 2003 and January 2004 were asked to complete a questionnaire. Information on demographic factors, HIV test history, pregnancy history and fertility intentions (i.e., desire for children) was collected. Eighty-six per cent of eligible women (450/521) completed the questionnaire. Three quarters of women (336/450) reported that they wanted (more) children. Forty-five per cent (201/450) reported that HIV diagnosis did not affect their fertility intentions, 11% (50/450) that it made them want children sooner, and 10% (44/450) did not know or reported other views. About one third of women (155/450) decided they no longer wanted children after their HIV diagnosis, but 41% of these (59/144) had changed their mind following advances in HIV management and treatment. Factors associated with an increase in fertility intentions after advances in HIV management and treatment were being in a partnership and having fewer than two children. In this survey of HIV-infected women, the majority wanted children and women were more likely to want children after improvements in HIV management and treatment. These findings highlight the need for specialised family planning and reproductive health services targeting this population.

Maternal deaths in New South Wales, Australia: a data linkage project.

BACKGROUND: The magnitude of maternal mortality is underestimated as deaths occurring beyond the traditional 42-day time period after the pregnancy ending ('late death') have not been reported routinely in Australia. AIMS: The aims of this study were to undertake a data linkage study to improve the ascertainment of maternal deaths and to determine the number of deaths occurring 43-365 days after the pregnancy ended ('late maternal death'). METHODS: Data from the New South Wales Midwives Data Collection were linked with the Australian Institute of Health and Welfare National Death Index. Australian identified pregnancy-related deaths were then coded as direct, indirect and incidental to the pregnancy. RESULTS: During the period 1994-2001, 173 maternal deaths were identified. Of these, 97 were classified as occurring up to 42 days of the pregnancy ending, 15 (15.5%) of which were previously unknown to the maternal mortality committee. In addition, 76 deaths were classified as occurring between 43 and 365 days after the pregnancy ended. The majority (70 of 76) of these late deaths were only identified through the linkage study. Most (73 of 76) of these deaths were classified as indirect maternal deaths with the most common causes of deaths suicide (n= 23), cardiac disorders (n= 16) or accident/violence (n= 16). CONCLUSIONS: The ascertainment of maternal and late maternal mortality was enhanced through data linkage of birth and mortality data. Data linkage is a viable method for monitoring late maternal deaths.

Chlamydia in the Pacific region, the silent epidemic.

BACKGROUND: Second generation surveillance of HIV infection and sexually transmitted infections (STIs) among pregnant women in 6 Pacific Island Countries and Territories were undertaken to improve knowledge and to make recommendations on future prevention and management of STIs. METHODS: Cross-sectional studies, using standardized questionnaire, laboratory tests, and protocols were undertaken in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu between 2004 and 2005. For each country, between 200 and 350 pregnant women aged 15 to 44 years were consecutively recruited from antenatal clinics located in the main hospital of the major urban centre of each Pacific Island Countries and Territories. Consenting participants were interviewed about their socio-demographic characteristics and their sexual behavior, and were tested for HIV, chlamydia, syphilis (Treponema pallidum antibody seroactivity), and gonorrhoea. RESULTS: Amongst the 1618 pregnant women studied, the most prevalent STI was chlamydia with 26.1% of women under 25 and 11.9% of women aged 25 years and over being positive. Highest infection was detected in single teenage women with 38.1% positive for chlamydia. The overall prevalence of gonorrhoea and syphilis was 1.7% and 3.4%, respectively. No case of HIV was detected. Chlamydia infection was independently associated with younger age, being nulliparous, single status, multiple lifetime sexual partners, and commercial sex activity. CONCLUSION: In a population of young women, chlamydia infection was endemic. Regional leadership is needed to implement strategies to prevent the spread of chlamydia and to implement HIV and STI prevention and management.

Uptake of antenatal HIV testing in the United Kingdom: 2000-2003.

BACKGROUND: A policy for routine antenatal HIV testing was introduced in England in 1999, with uptake targets for 2000 and 2002; similar policies were subsequently introduced throughout the UK. METHODS: Date of implementation of the policy and data for estimating annual uptake of testing 2000-2003 were collected through postal survey of unit-based obstetric respondents to the National Study of HIV in Pregnancy and Childhood (NSHPC). RESULTS: Implementation date was reported for every unit; uptake data were provided for about three-quarters of implementing units each year. The policy was implemented in 78% (152/195) of English units by end of 2000; 78% (89/114) of units providing data achieved at least 50% uptake that year. By 2002, almost one-third (46/151) of English units reported 90% uptake or more, and over half (84/151) 80%. All but three UK units introduced the policy by the end of 2003, and of those providing adequate uptake data, 38% (66/175) reported at least 90% uptake and 69% (121/175) at least 80%; however, 19% (41/216) of respondents still had difficulty providing adequate data for estimating uptake. CONCLUSIONS: High uptake of HIV testing was reported from most UK units for 2003, but simple, robust and uniform methods for monitoring uptake at local and regional levels are still required.

HIV prevalence in pregnant women in an ethnically diverse population in the UK: 1998-2002.

OBJECTIVE: To describe trends in the prevalence of HIV in an ethnically diverse population of pregnant women in the United Kingdom. METHODS: Data on parental country of birth from national birth registration records were linked to neonatal dried blood spot samples routinely collected for neonatal screening in the North Thames region between 1998 and 2002. Identifiers were subsequently irreversibly deleted prior to establishing maternal HIV status by testing the neonatal samples. RESULTS: A total of 491 213 dried blood spot samples were collected, and 490 879 (99.93%) were tested for HIV. Of these, 1029 were seropositive. There was an overall significant increasing trend (P-value = 0.001) between 1998 and 2002. Maternal region of birth was available for 89.8% of HIV-infected samples, and, among these, 80.5% of mothers were born in sub-Saharan Africa and 11.1% in the UK. The highest prevalences of HIV were in women born in sub-Saharan Africa (2.09%). If both parents were born in the UK, overall seroprevalence was 0.016%. CONCLUSION: HIV infection in pregnant women in the UK continues to occur predominantly in women born in sub-Saharan Africa with prevalence in this group increasing significantly. Although the absolute number of HIV-infected women rose in some other groups, there was no evidence for a statistically significant rise in HIV prevalence in women born outside sub-Saharan Africa. Over 93% of children at risk of vertical transmission of HIV had at least one parent born abroad. This paper underlines the value of data linkage in monitoring HIV prevalence in a diverse population.