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1.
BMC Public Health ; 20(1): 783, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456627

RESUMO

BACKGROUND: In the Netherlands, several initiatives started after the publication of the PERISTAT findings that showed the perinatal mortality risk was higher than in other European countries. The objective of this study is 1) to report recent trends in perinatal mortality and in intermediate risk groups (preterm birth, congenital anomalies and small for gestational age (SGA)), 2) describing perinatal mortality risk among children born preterm, with congenital anomalies or SGA, and born in maternal high risk groups (parity, age, ethnicity and socio-economic status (SES)). METHODS: A nationwide cohort study in the Netherlands among 996,423 singleton births in 2010-2015 with a gestational age between 24.0 and 42.6 weeks. Trend tests, univariate and multivariable logistic regression analyses were used. We did separate analyses for gestational age subgroups and line of care. RESULTS: The perinatal mortality rate was 5.0 per 1000 and it decreased significantly from 5.6 in 2010 to 4.6 per 1000 in 2015. Preterm birth significantly declined (6.1% in 2010 to 5.6% in 2015). Analysis by gestational age groups showed that the largest decline in perinatal mortality of 32% was seen at 24-27 weeks of gestation where the risk declined from 497 to 339 per 1000. At term, the decline was 23% from 2.2 to 1.7 per 1000. The smallest decline was 3% between 32 and 36 weeks. In children with preterm birth, congenital anomalies or SGA, the perinatal mortality risk significantly declined. Main risk factors for perinatal mortality were African ethnicity (adjusted odds ratio (aOR) 2.1 95%CI [1.9-2.4]), maternal age ≥ 40 years (aOR1.9 95%CI [1.7-2.2]) and parity 2+ (aOR 1.4 95%CI [1.3-1.5]). Among the (post)term born neonates, there was no significant decline in perinatal mortality in women with low age, low or high SES, non-Western ethnicity and among women who started or delivered under primary care. CONCLUSIONS: There is a decline in preterm birth and in perinatal mortality between 2010 and 2015. The decline in perinatal mortality is both in stillbirths and in neonatal mortality, most prominently among 24-27 weeks and among (post)term births. A possible future target could be deliveries among 32-36 weeks, women with high maternal age or non-Western ethnicity.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade Perinatal/tendências , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Idade Materna , Países Baixos/epidemiologia , Mortalidade Perinatal/etnologia , Gravidez , Nascimento Prematuro/etnologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 190-195, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31248963

RESUMO

OBJECTIVE: To determine if survival rates of preterm infants receiving active perinatal care improve over time. DESIGN: The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016. SETTING: 43 German level III neonatal intensive care units (NICUs). PATIENTS: 8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care. INTERVENTIONS: Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25-P75) and low (

Assuntos
Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Assistência Perinatal/métodos , Assistência Perinatal/estatística & dados numéricos , Mortalidade Perinatal/tendências , Causas de Morte , Comorbidade , Feminino , Idade Gestacional , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Fatores de Risco , Fatores Sexuais , Centros de Atenção Terciária
3.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 184-189, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31201254

RESUMO

OBJECTIVE: The aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants. DESIGN: Prospective cohort study. SETTING: Patients were enrolled in 53 neonatal intensive care units. PATIENTS: Preterm infants with a birth weight below 1500 g. EXPOSURES: Genetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score). MAIN OUTCOME MEASURES: Lowest blood pressure on the first day of life and mortality. RESULTS: 5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (-1.26 mm Hg/week) and mechanical ventilation (-2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher's exact test). This survival advantage was independent of treatment with catecholamines. CONCLUSIONS: Our study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.


Assuntos
Predisposição Genética para Doença , Hipertensão/genética , Recém-Nascido Prematuro/fisiologia , Mortalidade Perinatal/tendências , Pressão Sanguínea , Feminino , Genótipo , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Prospectivos , Fatores de Risco
4.
Taiwan J Obstet Gynecol ; 58(6): 793-797, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31759529

RESUMO

OBJECTIVE: To compare the different pregnancy outcomes of women with a reduced dichorionic triamniotic (DCTA) triplet managed with radiofrequency ablation (RFA) or potassium chloride (KCL). MATERIALS AND METHODS: This was a retrospective cohort study. We studied 30 women of DCTA triplets managed with RFA as well as 85 managed with KCL. We compared the mean neonatal birthweight, median gestational age and perinatal mortality of two groups. RESULTS: The mean neonatal birthweight of children in RFA group was 2572.4 g (SD, 407.0), vs 2899.3 g (SD, 554.9) in KCL group (P < 0.001). The rate of low birth weight infants was 23 (42.6%) vs. 16 (18.0%), respectively, (p < 0.005). However, there was no statistically significant difference in the median gestational age of delivery, premature birth before 32&37 weeks' gestation, neonatal brain injury or successful pregnancy between two groups. (We define the successful pregnancy as the condition that at least one child survives for a specific woman, while the failed one as no child survives.) CONCLUSION: What we took it for granted was that pregnancy outcomes in women with a reduced DCTA triplet managed with RFA was riskier than with KCL, however, we proved that it is not accurate. For women with a reduced DCTA triplet, managed with RFA is not much riskier than with KCL. What's more, most women have two children survived in RFA group, while in KCL group, only one child survives for most women. This result may change the management alternative for those women with DCTA triplet pregnancies who choose reduction, especially for women who desire to have two surviving and healthy fetuses.


Assuntos
Ablação por Cateter/métodos , Cloreto de Potássio/uso terapêutico , Redução de Gravidez Multifetal/métodos , Gravidez de Trigêmeos , Adulto , China/epidemiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal/tendências , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
5.
BMC Public Health ; 19(1): 1301, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619210

RESUMO

BACKGROUND: Though Ethiopia achieved the fourth Millennium Development Goal, commit to reducing under five child mortalities by the year 2015, but perinatal mortality has remained a major public health problem in Ethiopia, and the Tigray region is experiencing a high perinatal mortality rate. This study aimed to assess the risk factors attributed to perinatal death in the Tigray region. METHODS: A retrospective cross-sectional study was used. The information collected from 2738 children born five years preceding the survey was considered. Variables such as maternal social and demographic characteristics, child demographic characteristics, health and environmental factors were considered as risk factors of perinatal death. The study used descriptive statistics, and logistic regression model to identify significant correlates of perinatal mortality. RESULTS: The data showed that from total children included in the study, 4.1% are early neonatal deaths, and 2.1% are stillbirth. Overall the prevalence of experiencing perinatal mortality was 6.2% the Tigray region. The logistic analysis revealed, factors small birth interval (less than 15 months) (AOR = 7.902; 95% CI: (4.526-13.795)) and 16-26 months (AOR =2.088; 95% CI: (1.292-3.375)), poor wealth index (AOR = 1.948; 95% CI: (1.011-3.754)), having no toilet facility (AOR =1.649; 95% CI: (1.093-2.488)), child sex (being male) (AOR =1.74; 95% CI: (1.234-2.454)), giving birth at older maternal age (45-49 years) (AOR = 0.293; 95% CI: (0.128-0.668)), rural residence and using the unprotected well water were significantly associated with a higher risk of perinatal death. CONCLUSIONS: The study identified sex of a child, previous birth intervals, availability of toilet facilities, wealth index, birth type, mother's age, parity, place of residence, mother's occupation and source of drinking water were the factors significantly associated with perinatal mortality. The prevalence of perinatal mortality shows that Tigray region was experiencing a high perinatal mortality rate than the national.


Assuntos
Mortalidade Perinatal/tendências , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos
6.
BMC Health Serv Res ; 19(1): 611, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470854

RESUMO

BACKGROUND: This paper examines perinatal death reporting and reviews in Bungoma county, Kenya, where substantial progress has been made, providing important insights for wider scale up to other contexts. METHODS: Quantitative methods were used to analyse trends in perinatal death reporting and reviews between 2014 and 2017 throughout Kenya based on data from the District Health Information System. Qualitative methods helped further understand the success of perinatal death reporting and review in Bungoma county through focus group discussions and individual interviews at 5 hospitals and 1 health centre. Thematic analysis was used to draw out codes for the analysis. RESULTS: Only 13 of the 47 counties in Kenya conduct perinatal death reviews. In 2017, the year after the perinatal death review system was introduced, only 3.6% of perinatal deaths were reviewed in Kenya. Bungoma county has made the greatest strides in Kenya, reviewing 59% of the perinatal deaths that occurred within the county in 2017. Bungoma accounted for 51% of all the perinatal deaths reviewed in Kenya. Factors contributing to the success in Bungoma include harmonisation of facility based perinatal reporting tools with the national level; prioritising the need to document and report mortalities; tailoring continual medical education and supportive supervision visits to needs identified from the review; and better documentation and referral processes. Supportive management and administrative staff have also helped drive forward implementation of actions and increased health staff motivation to reduce perinatal deaths and improve quality of care. CONCLUSIONS: Successful implementation of perinatal death reviews requires clear delineation of roles and responsibilities for action, which are routinely monitored to track implementation progress. As in other low-income settings, Bungoma county has demonstrated that in Kenya, perinatal death reviews can be effectively implemented and sustained, through a focus on learning, solution-oriented responses, influencing those in a power to act, accountability for results, and observable quality of care improvements.


Assuntos
Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Assistência à Saúde/tendências , Saúde da Família , Feminino , Grupos Focais , Hospitais/estatística & dados numéricos , Hospitais/tendências , Humanos , Quênia/epidemiologia , Morte Perinatal , Gravidez
7.
PLoS One ; 14(9): e0222583, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536573

RESUMO

Maternal, fetal, and neonatal health outcomes are interdependent. Designing public health strategies that link fetal and neonatal outcomes with maternal outcomes is necessary in order to successfully reduce perinatal and neonatal mortality, particularly in low- and middle- income countries. However, to date, there has been no standardized method for documenting, reporting, and reviewing facility-based stillbirths and neonatal deaths that links to maternal health outcomes would enable a more comprehensive understanding of the burden and determinants of poor fetal and neonatal outcomes. We developed and pilot-tested an adapted RAPID tool, Perinatal-Neonatal Rapid Ascertainment Process for Institutional Deaths (PN RAPID), to systematically identify and quantify facility-based stillbirths and neonatal deaths and link them to maternal health factors in two countries: Liberia and Nepal. This study found an absence of stillbirth timing documented in records, a high proportion of neonatal deaths occurring within the first 24 hours, and an absence of documentation of pregnancy-related and maternal factors that might be associated with fetal and neonatal outcomes. The use of an adapted RAPID methodology and tools was limited by these data gaps, highlighting the need for concurrent strengthening of death documentation through training and standardized record templates.


Assuntos
Mortalidade Infantil/tendências , Mortalidade Perinatal/tendências , Natimorto/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Libéria/epidemiologia , Nepal/epidemiologia , Morte Perinatal , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
8.
PLoS One ; 14(8): e0221503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31442258

RESUMO

BACKGROUND: Although the perinatal mortality rate (PNMR) has been reduced over time in Bangladesh, the rate is still very high. Only a few studies explored the determinants of high PNMR in Bangladesh, yet most of them were small-scale or conducted for stillbirths and early neonatal deaths separately. The objective of this study was to explore the trends in and determinants of perinatal deaths in Bangladesh which would be an advanced step in effective policies to tackle the issue. METHODS: The data used for this study was extracted from four rounds of Bangladesh Demographic and Health Surveys (BDHSs) 2004, 2007, 2011 and 2014. We considered the outcome of the 26604 pregnancies reaching seven months of their gestation. The trends of perinatal mortality was assessed using the Cochran-Armitage test, while the logistic regression with generalized estimating equation (GEE) to account for the clustering effect was implemented to explore the association between perinatal mortality and its risk factors. RESULTS: The PNMR was significantly reduced from 64 (95% CI: 57-73) to 41 (95% CI: 35-48) per 1000 pregnancies between 2004 and 2014 (stillbirths: 34 to 19 and early neonatal deaths: 30 to 22). After adjusting for potential covariates in the model, we found that administrative division, type of cooking fuel, child's gender, maternal occupation, body mass index, birth interval, history of miscarriage, previous deaths of children, total number of under 5 children, mode of delivery, type of delivery, access to participation in decision making, paternal education and occupation were significantly associated with perinatal deaths. CONCLUSION: The study highlights the importance of strengthening proper postnatal care services in the healthcare facilities. Alongside this, effort should also be stressed to ensure proper pregnancy care and to improve the socio-economic condition of the households to address the issue.


Assuntos
Mortalidade Perinatal/tendências , Bangladesh/epidemiologia , Características da Família , Feminino , Humanos , Recém-Nascido , Masculino , Mortalidade , Gravidez
9.
BMC Res Notes ; 12(1): 500, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409378

RESUMO

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Identifying mothers and babies at greatest risk of complications would enable intervention to be targeted to those most likely to benefit from them. However, current risk prediction models have a wide range of sensitivity (42-81%) and specificity (87-92%) indicating that improvements are needed. Furthermore, no predictive models have been developed or evaluated in Zimbabwe. This proposal describes a single centre retrospective cross-sectional study which will address the need to further develop and test statistical risk prediction models for adverse maternal and neonatal outcomes in low-resource settings; this will be the first such research to be carried out in Zimbabwe. Data will be collected on maternal demographics characteristics, outcome of prior pregnancies, past medical history, symptoms and signs on admission, results of biochemical and haematological investigations. Adverse outcome will be defined as a composite of maternal morbidity and mortality and perinatal morbidity and mortality. Association between variables and outcomes will be explored using multivariable logistic regression. Critically, new risk prediction models introduced for our clinical setting may reduce avoidable maternal and neonatal morbidity and mortality at local, national, regional and international level.


Assuntos
Modelos Estatísticos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/mortalidade , Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Hospitais , Humanos , Recém-Nascido , Modelos Logísticos , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Pré-Eclâmpsia/economia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Zimbábue
10.
PLoS Med ; 16(7): e1002846, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31283770

RESUMO

BACKGROUND: The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS AND FINDINGS: This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. CONCLUSIONS: Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.


Assuntos
Cesárea/tendências , Educação em Saúde/tendências , Assistência Perinatal/tendências , Padrões de Prática Médica/tendências , Adulto , Fortalecimento Institucional/tendências , Cesárea/efeitos adversos , Cesárea/mortalidade , China , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Capacitação em Serviço/tendências , Mortalidade Materna/tendências , Educação de Pacientes como Assunto/tendências , Mortalidade Perinatal/tendências , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
BMC Pregnancy Childbirth ; 19(1): 224, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269904

RESUMO

BACKGROUND: The objective of this survey was to explore the association between pregnancy complications and perinatal outcome from regionally total birth population. METHODS: In this prospectively collected data of complete birth registries from all level I-III hospitals in Huai'an in 2015, perinatal morbidity and mortality in relation to pregnancy complications and perinatal outcome were analyzed using international definitions. The results were compared with that of 2010 survey in the same region. RESULTS: Of 59,424 total births in the hospitals of level I (n = 85), II (16) and III (6), delivery rate was 30.4, 40.1 and 29.5%, and rates of pregnancy complications were 12.9, 9.8 and 21.1% (average 14.1%), with antenatal corticosteroids rate in < 37 gestational weeks being 17.3, 31.0 and 39.9% (mean 36.6%), respectively. The preterm birth rate was 0.6, 2.7 and 9.5% (mean 4.06%), and the composite rate of fetal death, stillbirth, and death immediately after delivery was 0.1, 0.4 and 0.6%, respectively. By multivariable logistic regression analysis, congenital anomalies, low Apgar scores, multi-pregnancy and amniotic fluid contamination were risk factors of adverse perinatal outcomes. Despite a higher rate of pregnancy complications than in 2010 survey, perinatal and neonatal mortality continued to fall, in particular in very preterm births. The high cesarean delivery rate in non-medically indicated cases remained a challenge. CONCLUSIONS: Our regional birth-population data in 2015 revealed a robust and persistent improvement in the perinatal care and management of high risk pregnancies and deliveries, which should enable more studies using similar concept and protocol for vital statistics to verify the reliability and feasibility.


Assuntos
Parto Obstétrico/mortalidade , Assistência Perinatal/tendências , Mortalidade Perinatal/tendências , Complicações na Gravidez/mortalidade , Gravidez de Alto Risco , Adulto , China , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Sistema de Registros , Fatores de Risco
13.
Prensa méd. argent ; 105(6): 331-339, Jul 2019. tab, graf
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1023702

RESUMO

Introducción: La edad gestacional, definida como semanas de gestación completas, es el principal predictor de resultados perinatales. El monitoreo de las tendencias en la distribución de la edad gestacinal puede ser un indicador importante de los resultados de salud y desarrollo a largo plazo. Objetivos: Primario: Examinar la tendencia de la edad gestacional de los partos asistidos en el Servicio de Obstetricia del Hospital Nacional A. Posadas durante el período comprendido entre 2008-2017. Secundarios: Evaluar la tendencia en la edad gestacional según forma de inicio del parto. Determinar vía de finalización del embarazo según edad gestacional. Establecer complicaciones perinatales asociadas a la edad gestacional. Material y Métodos: Estudio observacional descriptivo y transversal. El relevamiento de datos se realizó a través del SIP. Criterio de inclusión: edad gestacional igual o mayor a 37 semanas. Criterios de exclusión: faltante de datos para la variable principal de interés. Las variables se presentan a través de medidas de frecuencia (%). Las comparaciones se realizaron con test Chi cuadrado/Fisher exact test según la conformación de la tabla de doble entrada. Se consideró un p valor<=0.05. Stata 12.0 Resultados: Durante el período de estudio se registraron 38977 nacimientos, de los cuales 28835 cumplieron con los criterios de inclusión. El mayor porcentaje de nacimientos se produjo a las 39 semanas, variando entre 27% (2008) y 35% (2016). Se encontró una disminución gradual de los nacimientos a las 40 semanas, siendo de 12% en 2008 y 6% en 2017. La edad gestacional más frecuente de finalización programada, hasta el 2014 la edad gestacional más frecuente fue 38 semanas (25%-33%) y a partir del 2015 se postergó a las 39 semanas (29%-37%). En cuanto a la vía de finalización, la prevalencia de partos vaginales fue mayor en todas las semanas, aumentando la frecuencia a mayor edad gestacional (p=0.001). Al analizar las complicaciones perinatales se encontró que la tasa de mortalidad perinatal fue en disminución hasta las 39 semanas, con una diferencia mayor a menor edad gestacional al comparar nacimientos programados y espontáneos (24.5%00 vs 13%00; 13%00 vs 7%00; y 4%00 vs 3%00 a las 37, 38 y 39 semanas respectivamente). El 39% de los nacimientos producidos a las 37 semanas de modo programaado requirieron ingreso a terapia intensiva neonatal, disminuyendo a 19% a las 38 y 14% a las 39 semanas. Conclusión: La distribución de la edad gestacional al término del embarazo ha cambiado en los últimos 10 años a expensas de un aumento de la finalización espntánea a las 39 semanas y a un cambio en la práctica obstétrica con respecto a la postergación de una semana en la finalización programada en aquellas mujeres con patologías materno fetales o cesáreas iterativas. Este cambio constribuye a disminuir la morbimortalidad perinatal ya que fue observado que a menos edad gestacional aumentó el ingreso a terapia intensiva neonatal luego del nacimiento programado, así como también contribuye a la disminución del gasto en salud (AU)


This article details trends of the gestational age and changes in the obstetrical practice during a 10 yr, period. We can define gestational age as weeks of complete gestation, as the main predictor of perinatal results. The monitoring of the trends in the distribution of the gestational age can be an important indicator of the results of the health and development in a long term. Objectives: Primary: to examine the tendency of the gestational age of the deliveries attended in our Hospital between 2008-2017. Secondary to evaluate the tendency of the gestational age according to the start of the delivery. To determine the route of ending of the pregnancy according to the start of the delivery. To determine the route of ending of the pregnancy according with the gestational age. To establish perinatal complications associated to the gestational age. With this study it is proposed to evaluate the tendency to the gestational age at the birth, in a 10-yr. period in our institution and if changes in the obstetric practice in that period influenced in it. In conclusion, the results obtained in this investigation, justify the change of behaviour in the programmed ending of the pregnancy, contributing to the decrease of the perinatal morbi-mortality, and in consecuence, to the diminishing of the waste in health (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Índice de Apgar , Epidemiologia Descritiva , Estudos Transversais , Idade Gestacional , Pesquisa Qualitativa , Mortalidade Perinatal/tendências , Obstetrícia/tendências
14.
BMC Public Health ; 19(1): 811, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234805

RESUMO

BACKGROUND: The perinatal mortality rate (PMR) in Nigeria rose by approximately 5% from 39 to 41 deaths per 1000 total births between 2008 and 2013, indicating a reversal in earlier gains. This study sought to identify factors associated with increased PMR. METHODS: Nationally representative data including 31,121 pregnancies of 7 months or longer obtained from the 2013 Nigeria Demographic and Health Survey were used to investigate the community-, socio-economic-, proximate- and environmental-level factors related to perinatal mortality (PM). Generalized linear latent and mixed models with the logit link and binomial family that adjusted for clustering and sampling weights was employed for the analyses. RESULTS: Babies born to obese women (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.13-1.89) and babies whose mothers perceived their body size after birth to be smaller than the average size (aOR = 1.92, 95% CI: 1.61-2.30) showed greater odds of PM. Babies delivered through caesarean section were more likely to die (aOR = 2.85, 95% CI: 2.02-4.02) than those born through vaginal delivery. Other factors that significantly increased PM included age of the women (≥40 years), living in rural areas, gender (being male) and a fourth or higher birth order with a birth interval ≤ 2 years. CONCLUSIONS: Newborn and maternal care interventions are needed, especially for rural communities, that aim at counselling women that are obese. Promoting well-timed caesarean delivery, Kangaroo mother care of small-for-gestational-age babies, child spacing, timely referral for ailing babies and adequate medical check-up for older pregnant women may substantially reduce PM in Nigeria.


Assuntos
Parto Obstétrico/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Complicações na Gravidez/mortalidade , Adulto , Intervalo entre Nascimentos , Cesárea/mortalidade , Demografia , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Serviços de Saúde Materna , Mães/estatística & dados numéricos , Nigéria , Obesidade/mortalidade , Razão de Chances , Gravidez , Adulto Jovem
15.
Med Sci Monit ; 25: 4202-4206, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31168048

RESUMO

BACKGROUND To study the clinical effective of emergency cervical cerclage (ECC) in pregnant women who have cervical insufficiency with prolapsed membranes. MATERIAL AND METHODS This study was devised as a retrospective cohort in a single medical center, in which we collected clinical data from patient records. Inclusion criteria were: physical examination indicated ECC was performed at 15 to 25 gestational weeks at the Sixth Medical Center of the PLA General Hospital, and singleton pregnancy. The collected clinical data included: duration of pregnancy at delivery, interval between ECC and delivery, neonatal weight, neonatal mortality, neonatal morbidity, and Neonatal Intensive Care Unit (NICU) admission. RESULTS We included 50 women with singleton pregnancies. No surgical complications occurred in any patients. The gestational age at cerclage was 21.3±2.2 weeks. No patients had membrane damage due to surgery. No surgical complications were reported. Five (10%) patients underwent chorioamnionitis. The time interval between ECC and delivery was 11.2±7.1 weeks. The mean gestational age at delivery was 34.1 weeks. The rate of vaginal delivery was 96%. Ten patients had pregnancy lasting longer than 36 weeks. The mean neonate delivery weight was 2510.7 g. Twenty neonates were admitted to the Neonatal Intensive Care Unit (NICU), and the mean NICU stay was 21 days. CONCLUSIONS ECC has good perinatal results. Our results provide clinical evidence for the efficacy and risks of ECC.


Assuntos
Cerclagem Cervical/mortalidade , Resultado da Gravidez/epidemiologia , Cerclagem Cervical/efeitos adversos , Cerclagem Cervical/métodos , Colo do Útero/cirurgia , China , Emergências , Feminino , Ruptura Prematura de Membranas Fetais/cirurgia , Idade Gestacional , Humanos , Recém-Nascido , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Suturas , Incompetência do Colo do Útero/cirurgia , Prolapso Uterino/complicações
16.
S Afr Med J ; 109(5): 347-352, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31131803

RESUMO

BACKGROUND: In South Africa (SA), the largest category of perinatal deaths is unexplained stillbirths. Two-thirds of these occur in the antenatal period and most fetuses are macerated, but at antenatal clinics the mothers were generally regarded as healthy, with low-risk pregnancies. Innovative methods are urgently required to detect fetuses at risk of stillbirth and manage the mothers appropriately. OBJECTIVES: To determine the prevalence of raised resistance indices (RIs) of the umbilical artery in a low-risk, low-income population and ascertain whether use of this information can prevent perinatal deaths. METHODS: A descriptive study was performed in Mamelodi township, east of Pretoria, SA, on pregnant women attending antenatal clinics draining to two community health centres (CHCs). These women, classified as having low-risk pregnancies, were screened for placental insufficiency using a continuous-wave Doppler ultrasound apparatus (Umbiflow) between 28 and 32 weeks' gestation. When a raised RI was detected, the mother was referred to a high-risk clinic and managed according to a standard protocol. A cohort analytical study compared women who attended antenatal care at the same clinics as the Umbiflow group but did not have an Umbiflow test with those who had an Umbiflow test. The outcomes of all the deliveries in Mamelodi were recorded. The prevalences of abnormal RIs, absent end-diastolic flow (AEDF), stillbirths and neonatal deaths were the main outcome measures. RESULTS: An Umbiflow RI was performed in 2 868 women, and pregnancy outcome was available for 2 539 fetuses (88.5%); 297 fetuses (11.7%) were regarded as at high risk. AEDF was found in 1.5% of the population screened with an outcome. There were 29 perinatal deaths in the Umbiflow group (low risk n=18, high risk n=11). The perinatal mortality rate for 12 168 women attending the CHCs and the antenatal clinics draining to the CHCs who did not have an RI was 21.3/1 000 births, significantly higher than that in the Umbiflow group (11.4/1 000 births) (risk ratio 0.58, 95% confidence interval 0.42 - 0.81). CONCLUSIONS: The prevalence of AEDF in this low-risk population is ~10 times higher than that previously recorded. Use of the information prevented a number of perinatal deaths, most of which would have been macerated stillbirths. Screening a low-risk pregnant population using continuous-wave Doppler ultrasound may substantially reduce the prevalence of unexplained stillbirths in SA.


Assuntos
Programas de Rastreamento/métodos , Cuidado Pré-Natal/métodos , Gestão de Riscos/métodos , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Resistência Vascular/fisiologia , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal/tendências , Pobreza , Gravidez , Resultado da Gravidez , Fluxo Sanguíneo Regional/fisiologia , Fatores de Risco , África do Sul/epidemiologia , Taxa de Sobrevida/tendências , Artérias Umbilicais/fisiopatologia , Adulto Jovem
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 37, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953532

RESUMO

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published Article. We proved that the obtained results are subjected to the sparse data bias and presented some remedial tools such as penalization approaches. In addition, model fitting and performance aroused some controversies. In conclusion, the results of this study should be interpreted with caution and further reanalysis is necessary.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Doenças do Recém-Nascido/mortalidade , Nascimento Prematuro/mortalidade , Medição de Risco , Feminino , Seguimentos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Mortalidade Perinatal/tendências , Gravidez , Estudos Prospectivos , Fatores de Risco
18.
BMJ Open ; 9(3): e023875, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898805

RESUMO

OBJECTIVES: This paper analyses the patterns and trends in the mortality rates of infants and children under the age of 5 in India (1992-2016) and quantifies the variation in performance between different geographical states through three rounds of nationally representative household surveys. DESIGN: Three rounds of cross-sectional survey data. SETTING: The study is conducted at the national level: India and its selected good-performing states, namely Haryana, Kerala, Maharashtra, Punjab and Tamil Nadu, and selected poor-performing states, namely Bihar, Chhattisgarh, Madhya Pradesh and Uttar Pradesh. PARTICIPANTS: Adopting a multistage, stratified random sampling, 601 509 households with 699 686 women aged 15-49 years in 2015-2016, 109 041 households with 124 385 women aged 15-49 years in 2005-2006, and 88 562 households with 89 777 ever married women in the age group 13-49 years in 1992-1993 were selected. RESULTS: Through the use of maps, this paper clearly shows that the overall trend in infant and child mortality is on a decline in India. Computation of relative change shows that majority of the states have witnessed over 50% reduction in both infant and under-5 mortality rates from National Family Health Survey (NFHS)-I to NFHS-4. However, the improvements are not evenly distributed, and there is huge variation in performance between states over time. Funnel plots show that the most populous states like Uttar Pradesh Bihar and Madhya Pradesh have underperformed consistently across the survey period from 1992 to 2016. Regression analysis comparing high-performing and low-performing states revealed that female infants and women with shorter birth intervals had greater risk of infant deaths in poor-performing states. CONCLUSION: Attempts to reduce infant and child mortality rates in India are heading in the right direction. Even so, there is huge variation in performance between states. This paper recommends a mix of strategies that reduce child and infant mortality among the high-impact states where the biggest improvements can be expected, including the need to address neonatal mortality.


Assuntos
Causas de Morte , Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , Mortalidade Perinatal/tendências , Mortalidade da Criança/etnologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Masculino , Mortalidade Perinatal/etnologia , Análise de Regressão , Religião , Características de Residência , Risco , Classe Social
19.
Glob Health Action ; 12(1): 1581466, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30849300

RESUMO

BACKGROUND: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India. OBJECTIVE: We present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach. METHODS: The mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data. DISCUSSION: This is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices.


Assuntos
Serviços de Saúde Materna/organização & administração , Melhoria de Qualidade/organização & administração , Comportamento Cooperativo , Prática Clínica Baseada em Evidências , Feminino , Humanos , Índia , Recém-Nascido , Relações Interinstitucionais , Serviços de Saúde Materna/normas , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Gravidez
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