Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25.295
Filtrar
1.
J Pregnancy ; 2020: 6859157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029401

RESUMO

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p < 0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR = 0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR = 0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR = 0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR = 3.38; 95% CI: 1.90, 6.00), twin births (AOR = 5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR = 3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR = 4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.


Assuntos
Assistência Perinatal , Mortalidade Perinatal , Estudos de Casos e Controles , Competência Clínica , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Conhecimento , Modelos Logísticos , Estudos Longitudinais , Masculino , Complicações do Trabalho de Parto , Paridade , Gravidez , Gravidez de Gêmeos , Fatores de Risco , Inquéritos e Questionários
2.
Epidemiol Psychiatr Sci ; 29: e176, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33077022

RESUMO

AIMS: To investigate the association between parity and the risk of incident dementia in women. METHODS: We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)). RESULTS: Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02-1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1-4 parities (HR = 1.30, 95% CI = 1.02-1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02-1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00-2.55), but the risk of AD was not significantly associated with parity. CONCLUSIONS: Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.


Assuntos
Doença de Alzheimer/epidemiologia , Demência/epidemiologia , Paridade/fisiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Psiquiatria Geriátrica , Humanos , Incidência , Vida Independente , Pessoa de Meia-Idade , Gravidez , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fatores Socioeconômicos
3.
PLoS One ; 15(10): e0239045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33001988

RESUMO

Prolonged second stage of labor is a common abnormality of labor progression. Very little research exists regarding the relationship between prolonged second stage of labor and antepartum sonographic fetal head biometry parameters, especially fetal biparietal diameter (BPD). Fetal BPD assessment is essential for estimating fetal weight, and these measurements are readily available to Japanese obstetricians. We conducted a retrospective observational cohort study to evaluate the association between BPD fetal Z-score and prolonged second stage of labor in a Japanese cohort. Individual BPD data measured using a GE Voluson 730 expert ultrasound system (GE, Healthcare Japan, Tokyo, Japan) were converted to Z-scores for a particular gestational age. After excluding patients with multiple pregnancies and emergency or elective cesarean sections, a total of 2,711 (nulliparity, n = 1341) Japanese women who delivered at term were included. We analyzed the incidence of prolonged second stage of labor and the association between BPD Z-score measured <7 days before delivery and prolonged second stage of labor by parity. The overall incidence of prolonged second stage of labor was 18.3% (246/1,341) in nulliparous women and 4.6% (63/1,370) in multiparous women. In nulliparous women, multivariable analysis indicated that BPD Z-score was significantly associated with prolonged second stage of labor (adjusted odds ratio, 1.18; 95% confidence interval, 1.02-1.37). Kaplan-Meier survival analysis showed that at each time point during the second stage of labor, the percentage of women who had not yet delivered was higher among those who delivered neonates with large BPD Z-scores than among those who delivered neonates with smaller BPD Z-scores. On the contrary, in multiparous women, BPD Z-score was not statistically associated with prolonged second stage of labor. Our results suggest that considering BPD Z-score is helpful in the management of nulliparous women who are at risk of developing a prolonged second stage of labor.


Assuntos
Distocia/diagnóstico por imagem , Distocia/etnologia , Feto/diagnóstico por imagem , Segunda Fase do Trabalho de Parto , Adulto , Estudos de Coortes , Feminino , Peso Fetal , Cabeça/diagnóstico por imagem , Humanos , Recém-Nascido , Japão , Masculino , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Pré-Natal
4.
BMJ ; 371: m3377, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004347

RESUMO

OBJECTIVES: To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. DESIGN: Cohort study using linked electronic maternity records. PARTICIPANTS: 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. MAIN OUTCOME MEASURE: A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. RESULTS: Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). CONCLUSIONS: Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.


Assuntos
Parto Obstétrico , Complicações do Trabalho de Parto , Paridade , Nascimento a Termo , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , História Reprodutiva , Medição de Risco , Fatores de Risco
5.
Anim Sci J ; 91(1): e13471, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33078523

RESUMO

The aim of this research was to determine some non-infectious factors (sex of calf, calf birth weight, calving season and dam parity and dam body condition score at dry and calving) that can under control by breeders affecting calf health status (CHS) in neonatal period. A total of 517 calves (from delivery of calf until 28 days) and their dams (at dry and calving) were assessed according to study criteria. Relationship between CHS and dam parity (DP), body condition score at calving (BCSC ), body condition score at dry (BCSD ), sex of calf (SC), calf birth weight (CBW), and calving season (CS) was examined and connection between CHS and BCSD , CS, and CBW was found important. Also, influences of DP, SC BCSC , and BCSD on CBW were examined and while effects of DP and SC on CBW were found important, effects of others were not. These results show that relation between CHS and CBW, CS, and BCSD is important and CHS is higher in female calves or calves born to multiparous dams. As a conclusion, it can be said that planning the herd management practices according to these results will be beneficial for the healthier completion of the neonatal period.


Assuntos
Animais Recém-Nascidos/fisiologia , Bovinos/fisiologia , Indústria de Laticínios , Nível de Saúde , Animais , Peso ao Nascer , Feminino , Masculino , Paridade , Parto , Estações do Ano , Fatores Sexuais
6.
Niger J Clin Pract ; 23(10): 1456-1461, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047706

RESUMO

Background: Birth preparedness and complication readiness (BPCR) is a strategy with specific interventions to reduce pregnancy related morbidity and mortality. Aim: The study assessed the predictors of optimal birth preparedness and complication readiness among parturient in a tertiary health institution in Nigeria. Subject and Methods: This descriptive cross-sectional study was conducted among parturient at the labor and post-natal wards of University of Nigeria Teaching Hospital Enugu over a 6 months period. Demographic information and predictors of BPCR were analyzed by descriptive statistics and logistic regression respectively with P value of < 0.05 considered statistically significant. Results: Of the 420 parturient, 330 (78.6%) and 90 (21.4%) were booked and unbooked respectively. Majority (74.2%) of the booked and about half of the unbooked parturient were knowledgeable about BPCR. Most (92.4%) of the booked parturient were optimally birth prepared at delivery as against 22.2% of the unbooked. Higher parity (adj OR = 3.79; 95% CI = 1.46-9.82, P = 0.01), tertiary educational level (adj OR = 2.98; 95% CI = 1.23-7.20, P = 0.02), regular antenatal visit (adj OR = 2.68; 95% CI = 1.06-6.76, P = 0.04), information received on birth preparedness before delivery (adj OR = 0.21; 95% CI = 0.07-0.61, P = <0.01), and booked status (adj OR = 0.02; 95% CI = 0.01-0.05, P = <0.001) where significant predictors of optimal BPCR. Conclusion: Encouraging female education, regular antenatal visits, and participation in health talk is advocated to improve BPCR and ultimately reduce maternal and perinatal mortality/morbidity among women in southeast Nigeria.


Assuntos
Parto Obstétrico/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Trabalho de Parto/psicologia , Complicações do Trabalho de Parto/psicologia , Parto/psicologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Modelos Logísticos , Nigéria , Paridade , Mortalidade Perinatal , Gravidez , Adulto Jovem
7.
Medicine (Baltimore) ; 99(44): e22909, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126346

RESUMO

To analyze the prevalence of anemia and associated factors in primiparous parturient.Cross-sectional study conducted in a municipality of the Brazilian Western Amazon from July 2014 to December 2015. A convenience sample of 461 first-time pregnant women were interviewed. Data on their sociodemographic, clinical, obstetric, personal habits and nutritional status were collected. Anemia and iron depletion were measured by peripheral blood collection with hemoglobin, hematocrit, serum ferritin and transferrin saturation index. To test the association between the variables, the χ tests were applied and Poisson regression analysis with a 95% confidence interval was performed, and P < .05 values were considered significant. The Forward stepwise strategy was used to construct the adjusted model. These analyzes were performed using the STATA 14.0 program (College Station, TX, 2013).A higher risk of anemia was identified among adolescent; white; who had a partner; with unpaid occupation, with less than eight years of formal education. Residents in the countryside; smokers; who had more than six prenatal consultations and were overweight.Anemia was reported in 28.20% and iron depletion in 60.52% of parturient women. The variables studied did not have association with the anemia outcome, except alcohol consumption.


Assuntos
Anemia Ferropriva , Paridade , Complicações Hematológicas na Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Demografia , Escolaridade , Feminino , Humanos , Estado Nutricional , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/epidemiologia , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Saúde da Mulher/estatística & dados numéricos
8.
J Pregnancy ; 2020: 8395142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32953178

RESUMO

Background: Episiotomy is the most common obstetric procedure, performed when the clinical circumstances place the patient at a high risk of high-degree laceration. However, episiotomy should be done with judicious indication to lower perineal laceration with fewer complications. Despite its adverse effects, the magnitude of episiotomy is increasing due to different factors. Therefore, this study is aimed at determining the recent magnitude of episiotomy and at identifying associated factors among women who gave delivery in Arba Minch General Hospital, Southern Ethiopia. Methods: An institution-based cross-sectional study was conducted from December 15, 2018, to January 30, 2019. A systematic random sampling technique was used to select study participants. A semistructured questionnaire was used to collect data. This was supplemented with a review of the labor and delivery records. Binary and multivariable logistic regression analyses were performed to identify factors associated with the magnitude of episiotomy. P value ≤ 0.05 was used to determine the level of statistically significant variables. Results: The magnitude of episiotomy was found to be 272 (68.0%) with 95%CI = 64.0-72.5. Women who attended secondary education [AOR = 10.24, 95%CI = 2.81-37.34], women who attended college and above [AOR = 4.61, 95%CI = 1.27-16.71], birth weight ≥ 3000 g [AOR = 4.84, 95%CI = 2.66-8.82], primipara [AOR = 4.13, 95%CI = 2.40-7.12], being housewife occupants [AOR = 3.43, 95%CI = 1.20-9.98], married women [AOR = 2.86, 95%CI = 1.40-5.84], and body mass index < 25 kg/m2 [AOR = 2.85, 95%CI = 1.50-5.44] were independent variables found to have significant association with episiotomy. Conclusion: The magnitude of episiotomy was 68.0% which is higher than the recommended practice by WHO (10%). The study participants' occupational status, marital status, educational status, parity, birth weight, and BMI were significantly associated with the magnitude of episiotomy in the study area. Therefore, to reduce the rate of episiotomy, it is better to have periodic training for birth attendants regarding the indication of episiotomy.


Assuntos
Episiotomia/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Trabalho de Parto , Lacerações/prevenção & controle , Mães/estatística & dados numéricos , Adolescente , Adulto , Peso ao Nascer , Índice de Massa Corporal , Estudos Transversais , Escolaridade , Episiotomia/efeitos adversos , Etiópia/epidemiologia , Feminino , Humanos , Ocupações , Paridade , Gravidez , Risco , Cônjuges , Inquéritos e Questionários , Adulto Jovem
9.
S Afr Med J ; 110(7): 671-677, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880346

RESUMO

BACKGROUND: Despite substantial progress in reducing pregnancy-related preventable morbidity and mortality, these remain unacceptably high in developing countries. In 2016, the World Health Organization (WHO) revised recommendations for antenatal care (ANC) from a 4-visit model to a minimum of 8 ANC contacts to reduce perinatal mortality further and improve women's experience of care. The guidelines also recommend that the first ANC visit (ANC-1) should occur during the first trimester. OBJECTIVES: To describe the uptake of routine ANC and its associated factors in South Africa (SA) prior to the 2016 WHO recommendations, when the country recommended 4 ANC visits, to bring to light potential challenges in achieving the current recommendations. METHODS: Secondary data analyses were performed from 3 facility-based, cross-sectional national surveys, conducted to measure 6-week mother-to-child transmission of HIV and coverage of related interventions in SA. These surveys recruited mother-infant pairs attending selected public primary healthcare facilities for their infants' 6-week immunisation in 2010, 2011 -2012 and 2012 -2013. Quantitative questionnaires were used to gather sociodemographic and antenatal-to-peripartum information from Road to Health cards and maternal recall. The inclusion criteria for this secondary assessment were at least 1 ANC visit, the primary outcome being uptake of ≥4 ANC visits. A multivariable logistic regression model was used to: (i) identify maternal factors associated with ANC visits; and (ii) establish whether receiving selected ANC activities was associated with frequency or timing of ANC-1. RESULTS: Of the 9 470, 9 646 and 8 763 women who attended at least 1 ANC visit, only 47.5% (95% confidence interval (CI) 45.4 -49.6), 55.6% (95% CI 53.2 -58.0) and 56.7% (95% CI 54.3 -59.1) adhered to ≥4 ANC visits, while 36.0% (95% CI 34.5 -37.5), 43.5% (95% CI 42.0 -45.1) and 50.8% (95% CI 49.3 -52.2) attended ANC-1 early (before 20 weeks' gestation) in 2010, 2011 -2012 and 2012 -2013, respectively. Multiparity and lower socioeconomic status were significantly associated with non-adherence to the 4-visit ANC recommendation, while a later survey year, higher education, being married, >19 years old, HIV-positive, planned pregnancy and knowing how HIV is transmitted vertically were strongly related to ≥4 ANC visits. The number of women who received selected ANC activities increased significantly with survey year and ≥4 ANC visits, but was not associated with timing of ANC-1. CONCLUSIONS: Despite increases in the uptake of ≥4 ANC visits and early ANC-1 rates between 2010 and 2013, these practices remain suboptimal. Adhering to ≥4 ANC visits improved coverage of selected ANC activities, implying that strengthening efforts to increase the uptake of ANC from at least 4 to 8, could improve overall outcomes.


Assuntos
Infecções por HIV/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Fatores Etários , Estudos Transversais , Escolaridade , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Estado Civil , Paridade , Cooperação do Paciente , Gravidez , Classe Social , África do Sul/epidemiologia
10.
PLoS One ; 15(9): e0237450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898139

RESUMO

INTRODUCTION: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings. METHODS: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum. RESULTS: Among the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones. CONCLUSION: In South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones.


Assuntos
Cesárea , Apresentação no Trabalho de Parto , Paridade , Adulto , Apresentação Pélvica/cirurgia , Cesárea/estatística & dados numéricos , Congo , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Gravidez Múltipla , Nascimento Prematuro/cirurgia , Fatores Socioeconômicos , Adulto Jovem
12.
PLoS One ; 15(9): e0239724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976520

RESUMO

OBJECTIVE: To describe the duration, progression and patterns of first stage of labor among Swedish women. DESIGN: Population-based cohort study. POPULATION: Data from Stockholm-Gotland Obstetric Cohort 2008-2014 including » of all births in Sweden, the final sample involved a total of 85,408 women with term, singleton, vertex, live fetuses experiencing spontaneous labor onset and vaginal delivery with normal neonatal outcomes. MAIN OUTCOME MEASURES: Time to progress during first stage of labor using three approaches: 1) Traverse time in hours to progress centimeter to centimeter, 5th, 50th (and 95th percentile); 2) Dilation curves for different percentiles, and; 3) Cumulative duration for the 95th percentile by parity and dilation at admission. RESULTS: Variation in both the total duration and the trajectory of cervical change over time is large. Similar to the general held view, the rate of cervical dilation accelerates at 5-6 centimeters. Among nulliparous women, the median time found in our population was faster than their counterparts in studies conducted on American and African cohorts. Among nulliparous and multiparous women our data suggest that the median cervical change over time is faster than 1 cm per hour during the first stage of labor. However, traverse time of cervical change at and beyond the 95th percentile is longer than 1 cm per hour. CONCLUSIONS: Labor progression varies widely and labors experiencing a prolonged first stage can still result in normal outcomes. The assumption of 1 cm per hour cervical dilation rate for the first stage of labor may not be universally meaningful. There are differences in progression for women during first stage of labor in different populations. For prolonged labor progression to be more clinically meaningful, the association with adverse birth outcomes needs to be further investigated in specific populations.


Assuntos
Variação Biológica da População , Primeira Fase do Trabalho de Parto/fisiologia , Adulto , Colo do Útero/fisiologia , Feminino , Idade Gestacional , Humanos , Paridade , Gravidez , Suécia
13.
PLoS One ; 15(9): e0238957, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915880

RESUMO

BACKGROUND: Anemia in women of reproductive age is a major public health challenge for low- and middle-income countries with a long-term negative impact on the health of women, their children, and the economic growth of the society. Even though the world health organization targeted a 50% global reduction of anemia among women of reproductive age by 2025, with the current trend it is unlikely to achieve this goal. OBJECTIVE: This study aimed to assess the prevalence and associated factors of anemia among women of reproductive age in eastern Africa. METHODS: A secondary data analysis, using demographic and health survey (DHS) data of 10 eastern African countries, was conducted. For our study, a total weighted sample of 101524 women of reproductive age was used. We employed a multilevel mixed-effects generalized linear model (using Poisson regression with robust error variance). Both unadjusted and adjusted prevalence ratios with their 95% confidence interval were reported. RESULTS: The prevalence of anemia in eastern Africa was 34.85 (95%CI: 34.56-35.14) ranging from 19.23% in Rwanda to 53.98% in Mozambique. In the multivariable multilevel analysis, being older age, having primary and above education, being from households with second to highest wealth quantiles, being currently working, not perceiving distance as a big problem, use of modern contraceptive methods, and rural residence was associated with a lower prevalence of anemia. While, being married and divorced/separated/widowed, women from female-headed households, women from households with unimproved toilet facility and unimproved water source, ever had of a terminated pregnancy, having high parity, and being from large household size was associated with a higher prevalence of anemia. CONCLUSION: The prevalence of anemia in eastern Africa was relatively high. Both individual level and community level factors were associated with the prevalence of anemia in women of reproductive age. Therefore, giving special attention to those women who are at a higher prevalence of anemia such as younger women, those who are from households with low socioeconomic status, unimproved toilet facility, and source of drinking water, as well as pregnant women could decrease anemia in women of reproductive age.


Assuntos
Anemia/epidemiologia , Adolescente , Adulto , África Oriental/epidemiologia , Fatores Etários , Água Potável , Feminino , Humanos , Modelos Lineares , Estado Civil , Casamento , Pessoa de Meia-Idade , Análise Multinível , Paridade , Gravidez , Prevalência , Fatores de Risco , Classe Social , Toaletes , Mulheres Trabalhadoras , Adulto Jovem
14.
PLoS One ; 15(8): e0237476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813709

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden of maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to systematically examine factors associated with HDP among women in SSA countries. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Articles conducted in SSA and published in English from January 2000 to May 2020 from electronic databases including MEDLINE, EMBASE, PubMed, and CINAHL were included. Articles, which focused on HDP and found to be relevant through the reference check, were included. Additional articles found through a hand search of reference lists were also included. The quality of papers was appraised using the Critical Appraisal Skills Programme (CASP) scale. Two reviewers independently screened, extracted, and assessed the quality of the articles. STATA 16 software was used to compute the pooled estimated odds ratios for each of the identified associated factor. Both random and fixed effect models were used for analysis. Heterogeneity of the studies and small study bias were checked by I2 and asymmetric test, respectively. RESULTS: Twenty-seven studies met the inclusion criteria and included in the systematic review and meta-analysis. Significant associations with HDP were identified through meta-analysis for the following variables: being primiparous (OR: 1.78; 95% CI: 1.11, 2.44), having previous HDP (OR: 3.75; 95% CI: 2.05, 5.45), family history of HDP (OR: 2.73; 95% CI: 1.85, 3.6), and lower maternal educational level (OR: 1.65; 95% CI: 1.17, 2.13). Due to the limited number of studies found specific to each variable, there was inconclusive evidence for a relationship with a number of factors, such as maternal nutrition, antenatal care visits, birth spacing, multiple birth, physical activity during pregnancy, use of contraceptives, place of residency, family size, and other related associated factors. CONCLUSIONS: The risk of developing HDP is worse among women who have a history of HDP (either themselves or their family), are primiparous, or have a lower maternal educational level. Therefore, investment in women's health needs considered to reduce the problem, and health service providers need to give due attention to women with at increased risk to HDP. Additionally, interventions need to focus on increasing women's access to education and their awareness of potential associated factors for HDP.


Assuntos
Hipertensão Induzida pela Gravidez/patologia , Fatores Etários , Índice de Massa Corporal , Diabetes Mellitus/patologia , Escolaridade , Feminino , Humanos , Razão de Chances , Paridade , Gravidez
15.
Medicine (Baltimore) ; 99(29): e20186, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702808

RESUMO

It has been well established that dietary patterns play important roles in the pathogenesis and development of hypertension. Our aim was to investigate the association between pregnancy dietary patterns and the risk of hypertension among nulliparous pregnant Chinese women.A cross-sectional, case-control study.Three hospitals in Haikou, the capital of Hainan Province, South China.A total of 2580 participants who reported dietary intake using a validated food frequency questionnaire (FFQ).Four primary dietary patterns were identified by principal component factor analysis and labeled as traditional Chinese, animal food, Western food, and salty snacks patterns. Women with high scores on pattern characterized by salty snacks were at increased risk.This study suggests that dietary pattern characterized by salty snack increases the risk of hypertension during pregnancy.


Assuntos
Dieta Ocidental/efeitos adversos , Dieta/efeitos adversos , Hipertensão Induzida pela Gravidez/epidemiologia , Sais/efeitos adversos , Adulto , Estudos de Casos e Controles , China/epidemiologia , Estudos Transversais , Dieta/tendências , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Incidência , Paridade/fisiologia , Gravidez , Inquéritos e Questionários
16.
Niger J Clin Pract ; 23(7): 889-896, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620715

RESUMO

Anemia in pregnancy is a public health problem in Nigeria and it is more than likely that iron deficiency is the major cause. This study aimed to review relevant publications in order to summarize the prevalence of iron deficiency anemia, risk factors associated with iron deficiency, anemia in pregnancy as well as factors associated with compliance to routine iron therapy. MEDLINE Entrez PubMed search was performed in August 2017 and studies that investigated iron deficiency anemia in pregnancy in Nigeria from 1968 to 2017 were sought. Search keywords included "iron deficiency anemia, pregnancy, Nigeria." Only studies that provided information on the prevalence of iron deficiency anemia, risk factors associated with iron deficiency anemia and risk factors associated with compliance to routine iron therapy in pregnancy in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations, not reviews, studies conducted in Nigeria between 1968 and 2017 and studies written in the English language. A total of six relevant studies that fulfilled the study inclusion criteria were identified out of 36 studies found. All the studies reported a high prevalence of iron deficiency anemia among pregnant women and risk factors associated with iron deficiency anemia in pregnancy include multiparity, third trimester of pregnancy, and low socioeconomic status. Risk factors associated with noncompliance to routine iron therapy include poor utilization of antenatal services, low educational attainment, distance to a health facility, single or teenage pregnancy, increasing age of the pregnant women, and living in the rural areas. The prevalence of iron deficiency anemia among pregnant women was reported to be high. Awareness creation and education on the importance of family planning and proper utilization of antenatal care services should be encouraged. There should be economic empowerment of women, provision of health facilities to areas where they are absent to encourage early booking and utilization of antenatal care services.


Assuntos
Anemia Ferropriva/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Adolescente , Adulto , Anemia/epidemiologia , Feminino , Humanos , Nigéria/epidemiologia , Paridade , Gravidez , Cuidado Pré-Natal , Prevalência , Fatores de Risco
17.
Isr Med Assoc J ; 7(22): 354-359, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32692496

RESUMO

BACKGROUND: While the ratio of male to female births (sex-ratio at birth [SRB]) in humans is remarkably stable on the population level, there are many families with multiple same-sex offspring. OBJECTIVES: To identify a putative sub-population with skewed SRB and explore potential factors affecting the SRB. METHODS: A retrospective cohort study including 66,054 families with up to nine same-sex offspring evaluated between 2003 and 2015 at Hadassah-Hebrew University Medical Center. Outcome measures were observed prevalence and SRB of families with up to nine same-sex offspring in a single family. Analyses included the effect of parity, month and year of delivery, inter-delivery interval, and presence of a sequence of previous same-sex offspring on the SRB. RESULTS: The study comprised 193,411 live-born babies with SRB of 1.057 in favor of males. The proportion of SRB in families with up to nine same-sex offspring did not differ from the calculated presumed proportion. Furthermore, none of the tested factors (parity, month and year of delivery, inter-delivery interval, and the sequence of previous same-sex offspring) were significantly associated with SRB. CONCLUSIONS: SRB was not associated with any of the tested demographic characteristics. We could not identify a skew in SRB even in families with up to nine consecutive same sex offspring. This finding suggests that in the majority of the population the chance of a male or female fetus in each pregnancy remains similar in every pregnancy, regardless of any of the tested variables.


Assuntos
Distribuição por Sexo , Razão de Masculinidade , Irmãos , Estudos de Coortes , Feminino , Humanos , Israel , Masculino , Paridade , Gravidez , Estudos Retrospectivos
18.
Anim Sci J ; 91(1): e13417, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32662131

RESUMO

The performance of the two-trait animal model that regards the first parity and later parities as two different traits in estimating genetic parameters for number of born alive (NBA) was examined using real and simulated data. Genetic parameters for NBA were estimated in purebred Landrace and Large White pigs using a single-trait repeatability model (Model 1) that regards all parities as the same trait and a two-trait animal model (Model 2) that regards the first and the later parities as different traits. For Model 2, the permanent environmental effect was fitted to only the records of the later parities. Heritability for NBA estimated using Model 1 was 0.12 for Landrace and 0.11 for Large White. Estimated heritability for NBA of the first parity and the later parities was 0.21 and 0.16, respectively, for Landrace; 0.18 and 0.16, respectively, for Large White obtained using Model 2, and higher than those in both breeds obtained using Model 1. Further results based on data simulated using the Monte Carlo method suggest that estimated additive genetic variance could be more biased using Model 2 than Model 1.


Assuntos
Cruzamento/estatística & dados numéricos , Simulação por Computador , Tamanho da Ninhada de Vivíparos/genética , Modelos Animais , Modelos Genéticos , Paridade/genética , Parto/genética , Animais , Feminino , Método de Monte Carlo , Gravidez , Característica Quantitativa Herdável , Suínos
19.
Arch Gynecol Obstet ; 302(4): 845-852, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32643042

RESUMO

PURPOSE: To establish the frequency of vacuum extraction among parturients with twin pregnancies, identify the risk factors and perinatal outcomes. METHODS: A retrospective cohort database study was conducted between 2005-2018. Twin fetuses with vertex presentation >34 weeks gestation who achieved vaginal delivery were included. Outcomes were compared between neonates who were delivered by vacuum extraction and neonates delivered by spontaneous vaginal delivery (aORs; [95% CI]). RESULTS: A total of 1751 neonates of 905 parturients with twin pregnancies met inclusion criteria, of which 163 (18%) parturients had vacuum extraction and 225 (12.8%) neonates were delivered by vacuum extraction. The most significant risk factors for vacuum extraction were primiparity (6.79 [4.77-9.66]), previous cesarean delivery (5.59 [3.13-9.97]), and epidural analgesia (4.34 [1.83-10.31]). Vacuum extractions were associated with a spectrum of adverse maternal outcomes (2.60 [1.61-4.19]), particularly postpartum hemorrhage and its associated morbidities. From the neonatal aspect, vacuum extraction deliveries were associated with a composite of birth trauma injuries (21.81 [6.43-73.91]). CONCLUSION: Vacuum extractions among twin pregnancies were found to be associated with significantly higher rates of postpartum hemorrhage, blood transfusion, and perinatal birth trauma. These findings should be presented to women when counseling on mode of delivery and considered individually against cesarean delivery disadvantages.


Assuntos
Traumatismos do Nascimento/etiologia , Parto Obstétrico/métodos , Doenças do Recém-Nascido/etiologia , Gravidez de Gêmeos , Vácuo-Extração/estatística & dados numéricos , Adulto , Traumatismos do Nascimento/epidemiologia , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Paridade , Hemorragia Pós-Parto/etiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Vácuo-Extração/efeitos adversos , Adulto Jovem
20.
PLoS One ; 15(7): e0235917, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645088

RESUMO

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors.


Assuntos
Aborto Induzido/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Teorema de Bayes , Escolaridade , Feminino , Gana/epidemiologia , Inquéritos Epidemiológicos , Humanos , Cobertura do Seguro , Modelos Logísticos , Estado Civil , Pessoa de Meia-Idade , Paridade , Pobreza , Gravidez , Prevalência , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA