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1.
Am J Obstet Gynecol ; 223(3): 445.e1-445.e15, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32883453

RESUMO

BACKGROUND: Contemporary guidelines for labor management do not characterize abnormal labor on the basis of maternal and/or neonatal morbidity. OBJECTIVE: In this study, we aimed to evaluate the association of abnormal duration of the first stage of term labor and the risk of maternal and neonatal morbidity. STUDY DESIGN: We conducted a retrospective analysis of prospectively collected data of all consecutive women admitted for delivery at a single center at ≥37 weeks and 0 to 7 days of gestation with singleton, nonanomalous, vertex infants from 2010 to 2015, who reached 10 cm cervical dilation. Multivariable logistic regression compared odds ratios for maternal and neonatal outcomes among women above and below the 90th, 95th, and 97th percentiles for first stage of labor duration. Receiver operating characteristic curves estimated the association between first stage of labor duration and maternal morbidity. Maternal morbidity was a composite of maternal fever, hemorrhage, transfusion, or endomyometritis; prolonged second stage of labor duration; and third- or fourth-degree perineal laceration. Neonatal morbidity was a composite of hypothermic therapy, need for mechanical ventilation, respiratory distress syndrome, meconium aspiration syndrome, birth injury or trauma, and neonatal seizure or sepsis. RESULTS: Of 6823 women included in this study, 682 were anticipated to have first stage of labor duration above the 90th percentile cutoff point, which was associated with an increased risk of composite maternal morbidity, maternal fever, postpartum transfusion, prolonged second stage of labor duration, third- or fourth-degree perineal laceration, and cesarean or operative vaginal delivery (P≤.02) and an increased risk of composite neonatal morbidity, respiratory distress syndrome, need for mechanical ventilation, and neonatal sepsis (P≤.03). Composite maternal morbidity was 2.2 (95% confidence interval, 1.8-2.7), 1.9 (95% confidence interval, 1.4-2.4), and 1.8 (95% confidence interval, 1.3-2.5) times more likely to occur among women above the 90th, 95th, and 97th percentile, respectively, for first stage of labor duration from 4 to 10 cm. Composite neonatal morbidity was 2.6 (95% confidence interval, 2.1-3.2), 2.2 (95% confidence interval, 1.7-2.9), and 1.9 (95% confidence interval, 1.3-2.8) times more likely to occur among infants delivered by women above the 90th, 95th, and 97th percentiles for first stage of labor duration from 4 to 10 cm. Receiver operating characteristic curves among all women from 4 to 10 cm and 6 to 10 cm, including when stratified by parity and type of labor onset, had an area under the curve of 0.51 to 0.62 and 0.53 to 0.71 for maternal and neonatal morbidity, respectively. Thus, duration of labor has moderate predictive ability, at best, for composite maternal or neonatal morbidity. No curve demonstrated a clear point at which adverse maternal or neonatal outcomes increased that could be used to define abnormal labor. CONCLUSION: The benefit of expectantly managing a prolonged first stage of labor with duration above the 90th percentile in anticipation of vaginal delivery must be weighed against the increased risk of composite maternal and neonatal morbidity. Risks associated with performing cesarean delivery as an alternative management for women with prolonged first stage of labor duration must also be considered.


Assuntos
Primeira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/epidemiologia , Assistência Perinatal , Adulto , Feminino , Humanos , Recém-Nascido , Missouri/epidemiologia , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/mortalidade , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
2.
J Pregnancy ; 2020: 6029160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695514

RESUMO

Background: Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just "tip of the iceberg," whereas maternal near-miss as the "base." Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods: A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results: The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions: Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Anemia/epidemiologia , Anemia/mortalidade , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Educação em Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/mortalidade , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Sepse/epidemiologia , Sepse/mortalidade , Inquéritos e Questionários
3.
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716

RESUMO

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
4.
BMC Pregnancy Childbirth ; 20(1): 130, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106814

RESUMO

BACKGROUND: In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. METHODS: In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05. RESULTS: Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58-0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20-0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42-8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate. CONCLUSIONS: The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.


Assuntos
Mortalidade Materna , Complicações do Trabalho de Parto/mortalidade , Causas de Morte , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Morte Materna/estatística & dados numéricos , Razão de Chances , Hemorragia Pós-Parto/mortalidade , Gravidez , Ruptura Uterina/mortalidade
5.
Acta Obstet Gynecol Scand ; 99(3): 374-380, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31603530

RESUMO

INTRODUCTION: Isolated single umbilical artery (iSUA) refers to single umbilical artery cords with no other fetal malformations. The association of iSUA to adverse outcome of pregnancy has not been consistently reported, and whether iSUA carries increased risk of third stage of labor complications has not been studied. We aimed to investigate the risk of adverse perinatal outcome, third stage of labor complications, and associated placental and cord characteristics in pregnancies with iSUA. A further aim was to assess the risk of recurrence of iSUA and anomalous cord or placenta characteristics in Norway. MATERIAL AND METHODS: This was a population-based study of all singleton pregnancies with gestational age >16 weeks at birth using data from the Medical Birth Registry of Norway from 1999 to 2014 (n = 918 933). Odds ratios (OR) with 95% confidence intervals were calculated for adverse perinatal outcome (preterm birth, perinatal and intrauterine death, low Apgar score, transferral to neonatal intensive care ward, placental and cord characteristics [placental weight, cord length and knots, anomalous cord insertion, placental abruption and previa]), and third stage of labor complications (postpartum hemorrhage and the need for manual placental removal or curettage) in pregnancies with iSUA, and recurrence of iSUA using generalized estimating equations and logistic regression. RESULTS: Pregnancies with iSUA carried increased risk of adverse perinatal outcome (OR 5.06, 95% confidence interval [CI] 4.26-6.02) and perinatal and intrauterine death (OR 5.62, 95% CI 4.69-6.73), and a 73% and 55% increased risk of preterm birth and small-for-gestational-age neonate, respectively. The presence of iSUA also carried increased risk of a small placenta, placenta previa and abruption, anomalous cord insertion, long cord, cord knot and third stage of labor complications. Women with iSUA, long cord or anomalous cord insertion in one pregnancy carried increased risk of iSUA in the subsequent pregnancy. CONCLUSIONS: The presence of ISUA was associated with a more than five times increased risk of intrauterine and perinatal death and with placental and cord complications. The high associated risk of adverse outcome justifies follow up with assessment of fetal wellbeing in the third trimester, intrapartum surveillance and preparedness for third stage of labor complications.


Assuntos
Terceira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/epidemiologia , Artéria Umbilical Única/epidemiologia , Adulto , Feminino , Morte Fetal , Humanos , Recém-Nascido , Noruega/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Sistema de Registros , Fatores de Risco , Artéria Umbilical Única/mortalidade , Ultrassonografia Pré-Natal
6.
Epidemiol. serv. saúde ; 29(1): e2019185, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1090246

RESUMO

Objetivo: descrever características sociodemográficas e assistenciais de mulheres que morreram por causa materna em Recife, Pernambuco, Brasil. Métodos: estudo descritivo utilizando o Sistema de Informações sobre Mortalidade, fichas de investigação e fichas-síntese de óbitos maternos, precoces e tardios, ocorridos entre 2006 e 2017, com evitabilidade avaliada pelo Comitê Municipal de Mortalidade Materna. Resultados: identificaram-se 171 óbitos, 133 no puerpério; a maior parte dos óbitos ocorreu em negras (68,4%), sem companheiro (60,2%), acompanhadas com atendimento pré-natal (77,2%), de parto em maternidades/hospitais (97,1%), assistidas por obstetras (82,6%); das mulheres com complicações puerperais, 10,4% não tiveram assistência; óbitos evitáveis/provavelmente evitáveis corresponderam a 81,9%, por causas indiretas (n=80) e diretas (n=79). Conclusão: as mortes ocorreram principalmente no puerpério e em negras; falhas assistenciais foram frequentes; é necessária melhor vigilância e acompanhamento dos serviços de saúde no período gravídico-puerperal, em Recife.


Objetivo: describir características sociodemográficas y asistenciales de mujeres que murieron por causa materna en Recife, Pernambuco, Brasil. Métodos: estudio descriptivo utilizando el Sistema de Informaciones sobre Mortalidad, fichas de investigación y síntesis de muertes maternas, tempranas y tardías, entre 2006 y 2017, con evaluación de la evitabilidad por el Comité Municipal de la Mortalidad Materna. Resultados: se identificaron 171 óbitos maternos, 133 en el puerperio; la mayoría de las muertes ocurrió en negras (68,4%), sin compañero (60,2%), acompañadas con atención prenatal (77,2%), de parto en maternidades/hospitales (97,1%), asistidas por obstetras (82,6%); de las mujeres con complicaciones puerperales, el 10,4% no tuvo asistencia; muertes evitables/probablemente evitables correspondieron al 81,9%, por causas indirectas (n=80) y directas (n=79). Conclusión: las muertes ocurrieron principalmente en el período del puerperio y en mujeres negras, con frecuentes fallas en la atención; se requiere una mayor vigilancia y acompañamiento de los servicios de salud en el período de embarazo-puerperio, en Recife.


Objective: to describe the sociodemographic and health care characteristics of women dying due to maternal causes in Recife, Pernambuco, Brazil. Methods: this was a descriptive study using the Mortality Information System, case investigation sheets and summary sheets of early and late maternal deaths occurring between 2006 and 2017, with avoidability assessed by the Municipal Maternal Mortality Committee. Results: we identified 171 deaths, of which 133 were in the puerperium; most deaths occurred among Black women (68.4%), women without partners (60.2%), women who had prenatal care (77.2%), during maternity hospital/general hospital delivery (97.1%), women attended to by obstetricians (82.6%);10.4% of women with puerperal complications had no health care; avoidable/probably avoidable deaths corresponded to 81.9%, for indirect causes (n=80), and direct causes (n=79). Conclusion: deaths occurred mainly in the postpartum period, among Black women; care failures were frequent; improved health service surveillance and follow-up is needed in the pregnancy-puerperal period, in Recife.


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Complicações na Gravidez/mortalidade , Mortalidade Materna/tendências , Registros de Mortalidade , Causas de Morte , Período Pós-Parto , Disparidades nos Níveis de Saúde , Complicações do Trabalho de Parto/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Brasil/epidemiologia , Epidemiologia Descritiva , Sistemas de Informação em Saúde/estatística & dados numéricos , Saúde Materna
7.
Afr Health Sci ; 19(2): 1833-1840, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656465

RESUMO

Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high. Objectives: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training. Methods: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic characteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used. Findings: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia was the commonest cause of maternal death before EMOC between training & and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times. Conclusion: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to determine why EMOC training has not resulted in significant reduction in MMR in Botswana.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Complicações na Gravidez/mortalidade , Adulto , Parto Obstétrico/métodos , Feminino , Hospitais , Humanos , Estudos Longitudinais , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/etnologia , Gravidez , Gestantes , Encaminhamento e Consulta , Estudos Retrospectivos
8.
BMC Pregnancy Childbirth ; 19(1): 330, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500581

RESUMO

BACKGROUND: In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. MATERIAL AND METHODS: Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. RESULTS: Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. CONCLUSION: All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.


Assuntos
Apresentação Pélvica , Cesárea , Parto Obstétrico , Complicações do Trabalho de Parto , Morte Perinatal/prevenção & controle , Cuidado Pré-Natal , Adulto , Estudos de Casos e Controles , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Determinação de Necessidades de Cuidados de Saúde , Noruega/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/mortalidade , Complicações do Trabalho de Parto/cirurgia , Mortalidade Perinatal , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Melhoria de Qualidade
9.
BMC Health Serv Res ; 19(1): 651, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500615

RESUMO

BACKGROUND: Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the 'bottom-up' development process of context-tailored national obstetric guidelines in middle-income country Suriname. METHODS: Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH). RESULTS: The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented. CONCLUSION: Development of national context-tailored guidelines is achievable in a middle-income country when using a 'bottom-up' approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Complicações na Gravidez/mortalidade , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Suriname/epidemiologia
10.
Rev Epidemiol Sante Publique ; 67(4): 233-238, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31235190

RESUMO

BACKGROUND: Per-partum stillbirth continues to represent a public health burden despite the efforts of countries around the world. Prevention of this mortality can only be effective with a better knowledge of factors that are life-threatening to the fetus or newborn. This work aims to determine associated factors with intrapartum and very early neonatal mortality. METHODS: A case-control study was carried out at the maternity of the university hospital in Marrakech, where 290 subjects were selected: 145 cases of intrapartum fetal death or a very early neonatal death, and 145 controls of surviving newborn weighing 2500g or more at birth. Data were collected from obstetric, partogram and death records for the year 2016. The factors that were compared between the two groups were factors before admission to maternity, factors related to the management during labor and to the care of newborn. RESULTS: Statistically significant associations were found between these deaths and several factors including: multiparity versus primiparity adjusted OR=2.27 [1.17-4.42], pregnant women referral from another health facility adjusted OR=2.11 [1.12-3.99], care for women during the transfer adjusted OR=0.21 [0.9-0.49] and prenatal follow-up of pregnancy adjusted OR=0.22 [0.12-0.4]. Were also associated: fetal monitoring during labor adjusted OR=0.22 [0.08-0.62], neonatal respiratory distress adjusted OR=18.48 [7.60-44.98] and Apgar score (⩽7) adjusted OR=6.05 [2.51-14.62]. CONCLUSION: Intrapartum and very early neonatal mortality is closely related to the newborn's condition at birth, fetal monitoring during labor, pregnancy monitoring, and the organization of the referral system.


Assuntos
Mortalidade Infantil , Complicações do Trabalho de Parto/mortalidade , Natimorto/epidemiologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Materna/estatística & dados numéricos , Marrocos/epidemiologia , Morte Perinatal/etiologia , Gravidez , Fatores de Risco , Adulto Jovem
11.
Acta Obstet Gynecol Scand ; 98(11): 1464-1472, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31220332

RESUMO

INTRODUCTION: Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. MATERIAL AND METHODS: A retrospective case-control study of women who delivered at a tertiary university-affiliated medical center in Jerusalem, Israel, during 2009-2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one-to-one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. RESULTS: In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second-stage duration (for each 30-minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04-1.25; P = .006), presence of meconium-stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52-4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11-2.88; P = .01), duration of VAD (for each 3-minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66-3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42-8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. CONCLUSIONS: Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.


Assuntos
Complicações do Trabalho de Parto/diagnóstico , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Vácuo-Extração/efeitos adversos , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Idade Gestacional , Hospitais Universitários , Humanos , Recém-Nascido , Israel , Segunda Fase do Trabalho de Parto , Modelos Logísticos , Complicações do Trabalho de Parto/mortalidade , Gravidez , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/mortalidade , Taxa de Sobrevida , Adulto Jovem
12.
S Afr Med J ; 109(4): 241-245, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084689

RESUMO

BACKGROUND: The institutional maternal mortality ratio (iMMR) in South Africa (SA) is still unacceptably high. A key recommendation from the National Committee on Confidential Enquiries into Maternal Deaths has been to improve the availability and quality of care for women suffering obstetric emergencies. OBJECTIVES: To determine whether there was a change in the number of maternal deaths and in the iMMR over time that could be attributed to the training of >80% of healthcare professionals by means of a specifically designed emergency obstetric care (EmOC) training programme. METHODS: A before-and-after study was conducted in 12 healthcare districts in SA, with the remaining 40 districts serving as a comparison group. Twelve 'most-in-need' healthcare districts in SA were selected using a composite scoring system. Multiprofessional skills-and-drills workshops were held off-site using the Essential Steps in Managing Obstetric Emergencies and Emergency Obstetric Simulation Training programme. Eighty percent or more of healthcare professionals providing maternity care in each district were trained between October 2012 and March 2015. Institutional births and maternal deaths were assessed for the period January 2011 - December 2016 and a before-and-after-training comparison was made. The number of maternal deaths and the iMMR were used as outcome measures. RESULTS: A total of 3 237 healthcare professionals were trained at 346 workshops. In all, 1 248 333 live births and 2 212 maternal deaths were identified and reviewed for cause of death as part of the SA confidential enquiries. During the same period there were 5 961 maternal deaths and 5 439 870 live births in the remaining 40 districts. Significant reductions of 29.3% in the number of maternal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.66 - 0.77) and 17.5% in the number of maternal deaths from direct obstetric causes (RR 0.825, 95% CI 0.73 - 0.93) were recorded. When comparing the percentage change in iMMR for equivalent before-and-after periods, there was a greater reduction in all categories of causes of maternal death in the intervention districts than in the comparison districts. CONCLUSIONS: Implementing a skills-and-drills EmOC training package was associated with a significant reduction in maternal deaths.


Assuntos
Parto Obstétrico/métodos , Educação Médica Continuada/métodos , Educação Continuada em Enfermagem/métodos , Serviços Médicos de Emergência/métodos , Morte Materna/prevenção & controle , Complicações do Trabalho de Parto/terapia , Treinamento por Simulação , Competência Clínica , Parto Obstétrico/mortalidade , Emergências , Feminino , Humanos , Morte Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Gravidez , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , África do Sul
13.
J Obstet Gynecol Neonatal Nurs ; 48(3): 252-262, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30981725

RESUMO

OBJECTIVE: To describe quality improvement opportunities (QIOs) associated with the five leading causes of pregnancy-related death in California and the methods by which the QIOs were collected by the California Pregnancy-Associated Mortality Review committee. DESIGN: Qualitative, descriptive design using thematic analysis. SAMPLE: A total of 907 QIOs identified from 203 cases of pregnancy-related deaths from cardiovascular disease, preeclampsia/eclampsia, hemorrhage, venous thromboembolism, and sepsis that occurred in California from 2002 to 2007. METHODS: We coded and thematically organized QIO data using three of the four domains commonly applied in quality improvement initiatives for maternal health care: Readiness, Recognition, and Response. Data did not include reporting issues, so the Reporting domain was excluded from the analysis. We refer to the domains collectively as the 4R Framework. RESULTS: We identified key themes across the five leading causes of death. In the Readiness domain, themes were related to overall facility readiness and helping women be prepared and knowledgeable about pregnancy and childbirth. Themes that emerged as central in the Recognition domain addressed the need for clinicians to better recognize risk factors and women's signs and symptoms to ensure an accurate diagnosis. In the Response domain, three themes were predominant, and they were related to the coordination of care, timing of treatment, and follow-up care. CONCLUSION: Results from our study show the utility and transferability of the first three domains of the 4R Framework as applied to quality improvement data from a large statewide maternal mortality review. Nursing leadership is necessary to support and guide national, statewide, and local efforts to improve the quality of maternity care through the implementation of quality improvement at the system, facility, clinician, and patient levels.


Assuntos
Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Melhoria de Qualidade/organização & administração , Adulto , California , Parto Obstétrico/mortalidade , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal
15.
BMC Pregnancy Childbirth ; 19(1): 63, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744576

RESUMO

BACKGROUND: Nigeria still ranks second globally in the number of maternal deaths. Most maternal death reviews in Nigeria are isolated research based reports from a single health facility. This study determined causes and contributory factors of maternal mortality in Ogun statefollowing a periodic State-widematernal and perinatal deaths surveillance and response (MPDSR) review. METHODS: We carried out a retrospective analysis of cases of maternal deaths notified (n = 77) and reviewed (n = 45) in health facilities in Ogun State from 2015 to 2016selected using total sampling method. Using the national MPDSR structured and validated data collection tools or questionnaire, collected data was extracted from existing MPDSR data base, andanalyzed using the Statistical Package for Social Sciences (SPSS) software 20.0. We obtained approval from the State Ministry of Health for this study. RESULTS: Average age at maternal death was 30.8 ± 5.7 years. Haemorrhageand pre-eclampsia or eclampsia account for 43.4 and 36.9% of causes respectively. Leading contributory factors ofmaternal deaths include inadequate human resource for health, delay in seeking care, inadequate equipment, lack of ambulance transportation, and delay in referrals services. 51.1%of the women had antenatal care while a significant proportion of the women were referred from Traditional Births Attendants (TBAs) and mission houses. CONCLUSION: We concluded that many of the contributory factors of maternal mortality could be avoided if preventive measures were taken and adequate care available. MPDSR provides a platform for critical evidence of where the main problems lie, and can provide valuable information on strategies which maternal mortality prevention programs should focus on. The implementation and institutionalization of MPDSR programme is on course in Ogun State. MPDSR is feasible and should be institutionalized in all states of Nigeria. A commitment to act upon the findings of MPDSR is a key prerequisite for success.


Assuntos
Morte Materna/tendências , Mortalidade Materna/tendências , Morte Perinatal/prevenção & controle , Vigilância da População , Adulto , Causas de Morte , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Nigéria , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Estudos Retrospectivos , Adulto Jovem
16.
Semin Perinatol ; 43(1): 2-4, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30691692

RESUMO

Obstetric hemorrhage is the leading cause of maternal morbidity and mortality in the world. Disparities in the prevalence of obstetric hemorrhage and its related mortality both on a global scale and locally in the United States indicate that a significant proportion is preventable. In many parts of the world, including the United States, there has also been an unexplainable increase in rates of postpartum hemorrhage. Efforts should focus on implementing comprehensive hemorrhage toolkit/bundles, which research has shown may have the potential to reduce severe maternal morbidity from hemorrhage.


Assuntos
Tocologia/normas , Complicações do Trabalho de Parto/terapia , Obstetrícia/normas , Segurança do Paciente/normas , Hemorragia Pós-Parto/prevenção & controle , Transfusão de Sangue/estatística & dados numéricos , Competência Clínica , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Equipe de Assistência ao Paciente/normas , Hemorragia Pós-Parto/mortalidade , Gravidez , Melhoria de Qualidade
17.
J Obstet Gynaecol Can ; 41(3): 327-337, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30366887

RESUMO

OBJECTIVE: This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station. METHODS: The investigators conducted a population-based, retrospective cohort study of term singleton deliveries by operative delivery with prolonged second stage of labour in Canada (2003-2013) using national hospitalization data. The primary study outcomes were severe perinatal morbidity and mortality (i.e., seizures, assisted ventilation, severe birth trauma, and perinatal death) and severe maternal morbidity and mortality (i.e., severe postpartum hemorrhage, cardiac complication, and maternal death). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) after stratifying by indication (dystocia or fetal distress). The Breslow-Day chi-square test for heterogeneity in ORs was used to test effect modification by pelvic station (outlet, low, or midpelvic). RESULTS: There were 61 106 deliveries included in the study. Among women with dystocia, forceps and vacuum deliveries were associated with higher rates of perinatal morbidity and mortality compared with Caesarean delivery (forceps: aOR 1.56; 95% CI 1.13-2.17; vacuum: aOR 1.44; 95% CI 1.06-1.97). Vacuum delivery was associated with lower rates of maternal morbidity and mortality compared with Caesarean delivery (dystocia: aOR 0.64; 95% CI 0.51-0.81; fetal distress: aOR 0.43; 95% CI 0.32-0.57). Pelvic station did not significantly modify the associations between forceps or vacuum and perinatal or maternal morbidity and mortality. CONCLUSION: Forceps and vacuum delivery is associated with increased rates of severe perinatal morbidity and mortality compared with Caesarean delivery among women with dystocia, whereas vacuum delivery is associated with decreased rates of severe maternal morbidity and mortality.


Assuntos
Traumatismos do Nascimento/epidemiologia , Cesárea/efeitos adversos , Distocia/cirurgia , Sofrimento Fetal/cirurgia , Complicações do Trabalho de Parto/epidemiologia , Vácuo-Extração/efeitos adversos , Adulto , Traumatismos do Nascimento/mortalidade , Feminino , Idade Gestacional , Humanos , Segunda Fase do Trabalho de Parto , Complicações do Trabalho de Parto/mortalidade , Forceps Obstétrico , Gravidez , Estudos Retrospectivos , Vácuo-Extração/instrumentação , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 18(1): 493, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547771

RESUMO

BACKGROUND: One of the essential components of antenatal care (ANC) is birth preparedness and complication readiness (BP/CR). Strengthening BP/CR measures is one of the principal strategies to reduce maternal mortality and morbidity. The current study aimed at determining the level of men's knowledge about obstetric danger signs, and their involvement in BP/CR among community of Northwest Ethiopia. METHOD: A cross-sectional community based survey was conducted in Northwest Ethiopia from May 2016 to July 2016. Data was analyzed by the Statistical Package for the Social Sciences software Version 21.0 for Windows. Participants' socio-demographic characteristics, knowledge of obstetric danger signs, and level of involvement in BP/CR were described using frequencies and percentages. Bivariate and multivariable logistic regressions were employed to explore the associated factors and P-value of 0.05 was used as a cut-off point to declare significant association. RESULT: From 856 men who were invited for the study, 824 men agreed for the interview giving a response rate of 96.2%. Half of the men stated one danger sign that may occur during pregnancy 407(49.4%); one third during delivery 271(32.9%); and 213(25.8%) during postpartum period. Among all participants, 256(31.1%) had not made any preparations; 363(44.1%) made one step; 116(14.1%) made two steps; 82(9.9%) made three steps; 5(0.6%) made four steps; 2(0.24%) made five steps; and no one made all the birth preparation steps during the birth of their last child. BP/CR was significantly association with knowledge of at least one danger sign during pregnancy (AOR = 3.3, 95% CI: 3.1, 3.9); during delivery (AOR = 2.2, 95% CI: 1.1, 2.8); and post partum period (AOR = 1.8, 95% CI: 1.1, 2.4). Furthermore, BP/CR was found to be positively associated with being married, completing college education, escorting wife to antenatal care, and urban residence. CONCLUSIONS: Men's level of knowledge about obstetric danger signs, and their involvement in BP/CR was found to be very poor. Considering the importance of male involvement in the maternal health care, it is recommended to advocate policies and strategies that can improve awareness of men and enhance their engagement in the maternal care.


Assuntos
Pai , Saúde Materna , Complicações do Trabalho de Parto , Complicações na Gravidez , Cuidado Pré-Natal/métodos , Adulto , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Etiópia/epidemiologia , Pai/educação , Pai/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Mortalidade Materna , Complicações do Trabalho de Parto/mortalidade , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , População Rural , Apoio Social , Inquéritos e Questionários , População Urbana
19.
BMC Womens Health ; 18(1): 198, 2018 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-30518368

RESUMO

BACKGROUND: Despite efforts at curbing maternal morbidity and mortality, developing countries are still burdened with high rates of maternal morbidity and mortality. Ethiopia is not an exception and has one of the world's highest rates of maternal deaths. Reducing the huge burden of maternal mortality remains the single most serious challenge in Ethiopia. There is a paucity of information with regards to the local level magnitude and causes of maternal mortality. We assessed the magnitude, trends and causes of maternal mortality using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia. METHOD: The analysis used surveillance data extracted from the Kersa HDSS database for the duration of 2008 to 2014. Data on maternal deaths and live births during the seven year period were used to determine the maternal mortality ratio in the study. The data were mainly extracted from a verbal autopsy database. The sample was comprised of all reproductive aged women who died during pregnancy, childbirth or 42 days after delivery. Chi-squared test for linear trend was used to examine the significance of change in rates over time. RESULTS: Out of the total 311 deaths of reproductive aged women during the study period, 72 (23.2%) died during pregnancy or within 42 days of delivery. The overall estimated maternal mortality ratio was 324 per 100,000 live births (95% CI: 256, 384). The observed maternal mortality ratio has shown a declining trend over the seven years period though there is no statistical significance for the reduction (χ2 = 0.56, P = 0.57). The estimated pregnancy related mortality ratio was 543 per 100,000 live births (95% CI: 437, 663). Out of those who died due to pregnancy and related causes, only 26% attended at least one antenatal care service. The most common cause of maternal death was postpartum haemorrhage (46.5%) followed by hypertensive disorders of pregnancy (16.3%). CONCLUSION: The magnitude of maternal mortality is considerably high but has shown a decreasing trend. Community-based initiatives that aim to improve maternal health should be strengthened further to reduce the prevailing maternal mortality. Targeted information education and communication should be provided.


Assuntos
Morte Materna/estatística & dados numéricos , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Adolescente , Adulto , Parto Obstétrico/estatística & dados numéricos , Etiópia , Feminino , Humanos , Mortalidade/tendências , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Adulto Jovem
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