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1.
Reprod Health ; 18(1): 142, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215256

RESUMO

BACKGROUND: Episiotomy is a surgical incision of the perineum to hasten the delivery. There is a scarce of information related to episiotomy practice, and its associated factors, in developing countries, including Ethiopia. Thus, this study was aimed to determine the level of episiotomy practice and to identify its determinants at public health facilities of Metema district, northwest, Ethiopia. METHODS: Institutional-based cross sectional study was conducted among 410 delivered mothers from March 1 to April 30, 2020. We recruited study participants using systematic random sampling technique. Data were entered to Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Stepwise backward elimination was applied for variable selection and model fitness was checked using Hosmer and Lemshows statistics test. Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables. RESULTS: In this study, the magnitude of episiotomy practice was found 44.15% (95% CI 39.32-48.97). Vaginal instrumental delivery (AOR 3.04, 95% CI 1.36-6.78), perineal tear (AOR 3.56, 95% CI 1.68-7.55), age between 25 and 35 (AOR 0.11, 95% CI 0.05-0.25), birth spacing less than 2 years (AOR 4.76, 95% CI 2.31-9.83) and use of oxytocin (AOR 2.73, 95% CI 1.19-6.25) were factors significantly associated with episiotomy practice. CONCLUSIONS: Magnitude of episiotomy practice in this study is higher than the recommended value of World Health Organization (WHO). Instrumental delivery, age, oxytocin, birth spacing and perineal tear were significant factors for episiotomy practice. Thus, specific interventions should be designed to reduce the rate of episiotomy practice. Plain English summary The routine use of episiotomy practice is not recommended by WHO. A study that compares routine episiotomy with restrictive episiotomy suggests that the latter is associated with less posterior perineal trauma, less need for suturing, and fewer complications related to healing. In addition, though, the rate of episiotomy has been declined in developed countries, still it remains high in less industrialized countries. The data for this study were taken at public health facilities of Metema district, northwest, Ethiopia. We included a total of 410 delivered mothers. The magnitude of episiotomy practice was found 44%. This result was higher than the recommended value of WHO. The WHO recommends an episiotomy rate of 10% for all normal deliveries. The result of this study showed that episiotomy practice is common among mothers whose age group are 18-24. In addition, mothers whose labor were assisted by instrumental vaginal delivery are more likely to have episiotomy as compared to those delivered by normal vaginal delivery. Laboring mothers who had used oxytocin were about three times more likely to be exposed for episiotomy than laboring mothers who did not use oxytocin drug. Moreover, episiotomy practice was nearly five times more likely among mothers who had birth spacing of 2 years and less as compared to mothers who had birth spacing of more than 2 years.


Assuntos
Parto Obstétrico/métodos , Episiotomia/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Mães/estatística & dados numéricos , Adolescente , Adulto , Peso ao Nascer , Estudos Transversais , Episiotomia/efeitos adversos , Episiotomia/métodos , Etiópia , Feminino , Humanos , Recém-Nascido , Paridade , Gravidez , Organização Mundial da Saúde , Adulto Jovem
2.
Microbiome ; 9(1): 146, 2021 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-34176489

RESUMO

BACKGROUND: The maternal microbiome has emerged as an important factor in gestational health and outcome and is associated with risk of preterm birth and offspring morbidity. Epidemiological evidence also points to successive pregnancies-referred to as maternal parity-as a risk factor for preterm birth, infant mortality, and impaired neonatal growth. Despite the fact that both the maternal microbiome and parity are linked to maternal-infant health, the impact of parity on the microbiome remains largely unexplored, in part due to the challenges of studying parity in humans. RESULTS: Using synchronized pregnancies and dense longitudinal monitoring of the microbiome in pigs, we describe a microbiome trajectory during pregnancy and determine the extent to which parity modulates this trajectory. We show that the microbiome changes reproducibly during gestation and that this remodeling occurs more rapidly as parity increases. At the time of parturition, parity was linked to the relative abundance of several bacterial species, including Treponema bryantii, Lactobacillus amylovorus, and Lactobacillus reuteri. Strain tracking carried out in 18 maternal-offspring "quadrads"-each consisting of one mother sow and three piglets-linked maternal parity to altered levels of Akkermansia muciniphila, Prevotella stercorea, and Campylobacter coli in the infant gut 10 days after birth. CONCLUSIONS: Collectively, these results identify parity as an important environmental factor that modulates the gut microbiome during pregnancy and highlight the utility of a swine model for investigating the microbiome in maternal-infant health. In addition, our data show that the impact of parity extends beyond the mother and is associated with alterations in the community of bacteria that colonize the offspring gut early in life. The bacterial species we identified as parity-associated in the mother and offspring have been shown to influence host metabolism in other systems, raising the possibility that such changes may influence host nutrient acquisition or utilization. These findings, taken together with our observation that even subtle differences in parity are associated with microbiome changes, underscore the importance of considering parity in the design and analysis of human microbiome studies during pregnancy and in infants. Video abstract.


Assuntos
Microbioma Gastrointestinal , Nascimento Prematuro , Animais , Feminino , Paridade , Gravidez , Prevotella , Suínos , Treponema
3.
BMC Public Health ; 21(1): 1219, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167500

RESUMO

OBJECTIVES: The relationship between reproductive factors and breast cancer (BC) risk has been investigated in previous studies. Considering the discrepancies in the results, the aim of this study was to estimate the causal effect of reproductive factors on BC risk in a case-control study using the double robust approach of targeted maximum likelihood estimation. METHODS: This is a causal reanalysis of a case-control study done between 2005 and 2008 in Shiraz, Iran, in which 787 confirmed BC cases and 928 controls were enrolled. Targeted maximum likelihood estimation along with super Learner were used to analyze the data, and risk ratio (RR), risk difference (RD), andpopulation attributable fraction (PAF) were reported. RESULTS: Our findings did not support parity and age at the first pregnancy as risk factors for BC. The risk of BC was higher among postmenopausal women (RR = 3.3, 95% confidence interval (CI) = (2.3, 4.6)), women with the age at first marriage ≥20 years (RR = 1.6, 95% CI = (1.3, 2.1)), and the history of oral contraceptive (OC) use (RR = 1.6, 95% CI = (1.3, 2.1)) or breastfeeding duration ≤60 months (RR = 1.8, 95% CI = (1.3, 2.5)). The PAF for menopause status, breastfeeding duration, and OC use were 40.3% (95% CI = 39.5, 40.6), 27.3% (95% CI = 23.1, 30.8) and 24.4% (95% CI = 10.5, 35.5), respectively. CONCLUSIONS: Postmenopausal women, and women with a higher age at first marriage, shorter duration of breastfeeding, and history of OC use are at the higher risk of BC.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Funções Verossimilhança , Paridade , Gravidez , História Reprodutiva , Fatores de Risco
4.
BMC Public Health ; 21(1): 1221, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167514

RESUMO

BACKGROUND: The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. METHODS: The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15-49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. RESULTS: The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC's use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. CONCLUSIONS: The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.


Assuntos
Cuidado Pré-Natal , População Rural , Adolescente , Adulto , Ásia Sudeste , Extremo Oriente , Feminino , Humanos , Indonésia/epidemiologia , Pessoa de Meia-Idade , Paridade , Filipinas/epidemiologia , Gravidez , Fatores Socioeconômicos , Adulto Jovem
5.
Nutrients ; 13(5)2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-34068716

RESUMO

BACKGROUND: To evaluate the potential factors associated with the nutritional composition of human milk of puerperal women. METHODS: cross-sectional study, conducted between March 2016 and August 2017, with 107 women, selected in a Tertiary Health Care Tertiary Health Facility of the Unified Health System (SUS) in the Municipality of Rio de Janeiro. Data were collected two months after delivery. The dependent variable of the study was the nutritional composition of human milk. We divided the independent variables into hierarchical levels: distal (age, schooling, parity and pregestational nutritional status), intermediate (number of prenatal visits and gestational weight gain) and proximal (alcohol consumption, smoking, diabetes mellitus and hypertension). For data analysis, we applied the multiple linear regression, centered on the hierarchical model. Only the variables associated with the nutritional composition of breast milk remained in the final model at a 5% level of significance. RESULTS: The nutritional composition of human milk yielded by women with pregestational overweight, smokers and hypertensive had higher amounts of lipids and energy. Conversely, women with gestational weight gain below the recommended had lower amounts of these components. CONCLUSION: The evaluation of factors associated with the nutritional composition of human milk is extremely important to assist post-partum care practices. In this study, we observed that lipid and energy contents were associated to pregestational nutritional status, gestational weight gain, smoking and hypertension.


Assuntos
Leite Humano/química , Valor Nutritivo , Adulto , Brasil , Estudos Transversais , Feminino , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Fator de Acasalamento , Estado Nutricional , Sobrepeso , Paridade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
6.
J Anim Sci ; 99(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34086897

RESUMO

Gestating sows may be more susceptible to increasing dry bulb temperatures (TDB) due to greater metabolic heat production and increased body mass, especially as gestation advances. However, there are few studies on the thermoregulatory and physiological responses of sows at differing gestation stages exposed to gradually increasing temperatures. The study objective was to determine the thermoregulatory and physiological responses of nonpregnant (n = 12; parity 3.27 ± 0.86), mid-gestation (59.7 ± 9.6 d pregnant, n = 12; parity 3.25 ± 0.83), and late-gestation (99.0 ± 4.8 d pregnant, n = 12; parity 3.33 ± 0.75) sows exposed to increasing TDB. Prior to the experiment (5.0 ± 0.7 d), jugular catheters were placed in all sows. During the experiment, the TDB was increased incrementally by 2.45 ± 0.43 °C every 60 min from 19.84 ± 2.15 to 35.54 ± 0.43 °C over 400 min, and relative humidity was recorded at 40.49 ± 18.57%. Respiration rate (RR), heart rate (HR), skin temperature, and vaginal temperature were measured, and blood samples were obtained via the jugular catheter every 20 min. Data were analyzed using PROC MIXED in SAS 9.4. RR increased at a lower TDB (P < 0.01) in late-gestation sows compared with mid-gestation and nonpregnant sows, but no differences were detected between mid-gestation and nonpregnant sows. Overall, late-gestation sows had greater RR (P < 0.01; 23 ± 2 breaths per min [brpm]) compared with mid-gestation (16 ± 2 brpm) and nonpregnant (15 ± 2 brpm) sows. Late-gestation sows had an overall greater HR (P < 0.01; 84 ± 5 beats per min [bpm]) than mid-gestation (76 ± 5 bpm) and nonpregnant (69 ± 5 bpm) sows. Late-gestation sows had overall reduced bicarbonate and total carbon dioxide levels (P = 0.02; 23.89 ± 1.97 and 25.41 ± 2.07 mmol/L, respectively) compared with mid-gestation (27.03 ± 1.97 and 28.58 ± 2.07 mmol/L, respectively) and nonpregnant (26.08 ± 1.97 and 27.58 ± 2.07 mmol/L, respectively) sows. Moreover, late-gestation sows had overall greater nitric oxide levels (P < 0.01; 248.82 ± 34.54 µM) compared with mid-gestation (110.47 ± 34.54 µM) and nonpregnant (41.55 ± 34.54 µM) sows. In summary, late-gestation sows appear to be more sensitive to increasing TDB as indicated by thermoregulatory and physiological responses when compared with mid-gestation or nonpregnant sows. The results from this study provide valuable information regarding thermoregulatory thresholds of sows at differing gestation stages.


Assuntos
Regulação da Temperatura Corporal , Lactação , Ração Animal/análise , Animais , Dieta , Feminino , Paridade , Gravidez , Suínos , Temperatura
7.
Animal ; 15(7): 100221, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34144402

RESUMO

Limited information is available on lysine requirement estimates of modern, high-producing gestating sows Therefore, the objective of this study was to evaluate the effects of increasing standardized ileal digestible (SID) lysine during gestation on piglet birthweight and reproductive performance of gilts and sows. A total of 936 females (498 gilts, 438 sows; Camborough®, PIC, Hendersonville, TN) were group-housed (approximately 275 females per pen) and individually fed with electronic sow feeders. Females were moved from the breeding stall to pens on d 4 of gestation and allotted to one of four dietary treatments on d 5. Dietary treatments included increasing SID lysine intake (11.0, 13.5, 16.0, and 18.5 g/d). Gilts (parity 1) and sows (parity 2+) received 2.1 and 2.3 kg (22.2 and 24.3 MJ net energy per day) of feed throughout the entire gestation period, respectively. Dietary treatments were achieved by different blends of low (0.48% SID lysine) and high (0.88% SID lysine) lysine diets, prepared by changing the amount of corn and soybean meal in these two diets. Female weight and backfat were recorded on d 4 and 111 of gestation. Individual piglet weight was obtained within 12 h of birth on litters from 895 females. Final weight, and calculated maternal BW, body lipid, and body lean at d 111 of gestation increased (linear, P < 0.01) for gilts and sows as SID lysine increased. There was no evidence for differences in final backfat depth. Average total born for gilts and sows was 15.3 and 16.0 pigs with no evidence for differences among treatments. The percentage of pigs born alive increased (P = 0.01) with increasing SID lysine intake for sows, but not in gilts as a result of a treatment by parity group interaction (P = 0.04) for percentage of stillborn pigs. Increasing SID lysine intake during gestation did not affect the percentage of mummified fetuses, total born, or birthweight of piglets born alive in this study. In addition, increasing SID lysine intake during gestation did not affect subsequent reproductive performance. In conclusion, increasing dietary SID lysine intake in gestation increased female BW, without changing backfat depth. The minimal effects on female reproductive performance and piglet birthweight suggest that 11 g/day of SID lysine intake appears to be adequate for gestating gilts and sows; however, providing sows with 18.5 g/d SID lysine reduced (P = 0.01) stillbirth rate by 2.3 percentage points.


Assuntos
Ração Animal , Lisina , Ração Animal/análise , Animais , Dieta/veterinária , Feminino , Lactação , Paridade , Melhoramento Vegetal , Gravidez , Reprodução , Sus scrofa , Suínos
8.
Animal ; 15(7): 100273, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34171569

RESUMO

Sows are strongly driven to build a nest prior to farrowing, and the performance of this behaviour is linked to the environment in which the animal is housed. The aim of this study was to investigate the impact of two nest-building materials, hessian and straw, on peri-parturient sow behaviour, plasma cortisol concentration and piglet survival and performance in farrowing crates. In the first experiment, sows (parity 1.7 ± 0.1) were allocated to four treatments: (n = 15), straw provided in the lead up to farrowing in an open farrowing pen, with the pen closed after farrowing (STRAW OPEN); (n = 14), straw provided in the lead up to farrowing in a closed farrowing pen (STRAW CLOSED); (n = 15), a closed farrowing pen with hessian sacks provided in the lead up to farrowing (HESSIAN) and; (n = 13), a closed farrowing pen with no nesting materials provided (CONTROL). A second experiment was performed on a separate farm to assess the effect of the same four treatments were applied to sows (parity 2.9 ± 0.1): SRAW OPEN (n = 68), STRAW CLOSED (n = 64), HESSIAN (n = 66) and CONTROL (n = 66), at a commercial level. The first experiment revealed that providing conventionally housed sows with straw or hessian in the lead up to parturition stimulated sows to perform nest-building behaviours similar to sows housed in an open pen with access to straw (nosing events; 16 ± 11 (CONTROL); 169 ± 36 (HESSIAN); 118 ± 29 (STRAW CLOSED); 199 ± 53 (STRAW OPEN); P < 0.05). Additionally, crated sows provided with straw had reduced cortisol levels immediately after farrowing compared to all other treatments (21.9 ± 6.1 ng/ml vs CONTROL; 49.3 ± 8.6 ng/ml; P < 0.01). Piglets born to STRAW CLOSED sows displayed the highest colostrum intake levels (404.8 ± 22.7 g vs CONTROL 361.9 ± 21.9 g; P < 0.01). The second experiment demonstrated a reduced incidence of piglet mortality both prior to fostering (0.7 ± 0.2; P = 0.001) and after fostering (0.7 ± 0.2; P = 0.001) in litters born to sows which were housed in conventional farrowing crates and provided with straw compared to CONTROL (prior to fostering 1.3 ± 0.2, and postfostering 1.1 ± 0.2). In conclusion, straw and hessian sacks are a suitable substrate for stimulating sows to exhibit nest-building behaviour under crated conditions. However, only the provision of straw in the crate environment improved piglet survival and positively affected sow welfare.


Assuntos
Abrigo para Animais , Parto , Animais , Animais Recém-Nascidos , Feminino , Lactação , Paridade , Gravidez , Suínos , Desmame
9.
Medicine (Baltimore) ; 100(25): e25912, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160380

RESUMO

ABSTRACT: The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019.Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants.Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.


Assuntos
Antibacterianos/administração & dosagem , Tratamento Conservador/métodos , Drenagem/métodos , Mastite Granulomatosa/terapia , Complicações na Gravidez/terapia , Administração Oral , Adulto , Mama/diagnóstico por imagem , Mama/cirurgia , Aleitamento Materno , Cefalosporinas/administração & dosagem , Feminino , Seguimentos , Idade Gestacional , Mastite Granulomatosa/diagnóstico , Mastite Granulomatosa/epidemiologia , Mastite Granulomatosa/fisiopatologia , Humanos , Lactente , Recém-Nascido , Lactação/fisiologia , Paridade/fisiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
10.
Trop Anim Health Prod ; 53(3): 373, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34173076

RESUMO

Brown Swiss cattle have replaced Zebus in some dual-purpose farms in tropical and subtropical regions of Mexico, under extensive grazing management. There is limited information about the productive and reproductive performance of this breed under tropical conditions; the lack of records from small farms may be the main reason. The objectives of the study were to evaluate the relationship between calving interval (CI) and milk and beef (weaned male calves) profit in Brown Swiss cows from a dual-purpose farm under extensive management in a subtropical region of Mexico. Data from 156 cows calving from 2000 to 2014 were analysed with both a linear and a survival model. Mean CI was 438 ± 49 days, mean age at first calving was 40 ± 6 months and length of productive life was 7 ± 3 years. The effects of parity, calving year and calving season were significantly related to CI (P < 0.05), whereas the effect of calf sex was not. Cows calving in the autumn and winter had shorter calving intervals, probably because supplements received during the dry season months improved energy balance. The highest culling rate was 28% at 45 months of age. Milk yield and total profit increased as CI increased from 12 to 20 months; beef contribution to total profit decreased as CI and milk yield increased. Calving intervals of more than 12 and up to 20 months had a positive effect on the milk production and profitability of dual-purpose cows in a subtropical region of Mexico.


Assuntos
Lactação , Leite , Animais , Bovinos , Feminino , Masculino , México , Paridade , Gravidez , Reprodução
11.
Pan Afr Med J ; 38: 247, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104295

RESUMO

Introduction: a significant proportion of pregnancy related deaths result from delay in decision to seek care and this often stems from failure to identify obstetric danger signs earlier. Early identification of these danger signs will therefore reduce maternal mortality. However, studies on obstetric danger signs awareness are lacking in Cameroon. The objective of this study was to assess the determinants of obstetric danger signs awareness of women at immediate postpartum period. This will inform ANC providers´ practice. Methods: between June and September 2019, women who delivered at the Buea Regional Hospital were interviewed within 24 hours following their delivery using a researcher-administered questionnaire that covered socio-demographic and obstetric variables. Data were entered into EpiData and analysis done using SPSS 16 and OpenEpi. Statistical significance was set at p-value < 0.05. Results: of the 532 participants, majority (230/532: 43.2%) were those aged 26-35; danger signs awareness rate was 73.3%. There was a statistically significant relation between age and awareness of obstetric danger signs which showed that older women were more aware than their younger counterparts (p=0.00). Other statistically significant determinants of danger sign awareness included occupation, level of education, parity, trimester of onset of antenatal visits and the number of visits before delivery (p<0.05). Multiparity (370/490: 75.5%) and grand multiparity (14/22: 63.6%) were more likely to be aware of obstetric danger signs than primiparous women (6/20: 30%). Similarly, those who started antenatal visits earlier (first or second trimester) and those who attended more visits were more likely to be aware of obstetric danger signs than their counterparts who started later or had lesser antenatal visits before delivery. The most reported danger signs were severe vaginal bleed (71.4%), fever (62.0%) and reduced fetal movement. Conclusion: conclusively, more focus should be placed on the sensitisation about obstetric danger signs when in contact with primiparous and younger parturient during ANC visits.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/epidemiologia , Período Pós-Parto , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Camarões , Estudos Transversais , Escolaridade , Feminino , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Paridade , Gravidez , Inquéritos e Questionários , Adulto Jovem
12.
Afr J Reprod Health ; 25(1): 56-66, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077111

RESUMO

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990's, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73- 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Adolescente , Adulto , Causas de Morte , Feminino , Gana/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Morte Materna/etnologia , Paridade , Gravidez , Estudos Retrospectivos , Adulto Jovem
13.
Front Public Health ; 9: 666337, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34123990

RESUMO

Objective: The number of women having a caesarean section has significantly increased worldwide, in particular in China. Maternal requestion makes a moderate contribution to this increased rate in China. Reducing the caesarean section rate is now becoming a big challenge to midwives and obstetricians as well as health policymakers in China. Our recent survey found that pre-natal education course had some positive effects on the reduction of caesarean section on maternal request. However, pre-natal education course is relatively new in China. In this study, we investigated whether pre-natal education course influences delivery mode in the largest tertiary women's hospital in China. Methods: In this retrospective study, during the study period, 644 pregnant women attended a pre-natal education course and 4,134 pregnant women did not. Data on maternal age, parity, gravida, delivery mode, delivery weeks, birthweight, gestational age at attending pre-natal education course and maternal body mass index before pregnancy were collected and analysed. Results: The numbers of women who attempted vaginal delivery were significantly higher in women who attended a pre-natal education course, compared to women who did not (87 vs. 60%). In addition, the rate of caesarean section on maternal request was 23% in women who attended a pre-natal education course. Conclusion: Attendance of a pre-natal education course influences the mode of delivery and reduces the unnecessary caesarean section in China. Our findings suggest that the promotion of pre-natal education courses is important to reduce the higher caesarean section rate in China, by midwives or obstetricians or health policy-makers as part of China's strategy.


Assuntos
Cesárea , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Paridade , Gravidez , Estudos Retrospectivos
14.
Biomed Res Int ; 2021: 8888267, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997044

RESUMO

Background: Addressing inequalities in accessing emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was undertaken to examine the time trends and sociodemographic correlates of cesarean section (CS) utilization in Nepal between 2006 and 2016. Methods. Data from the Nepal Demographic and Health Surveys (NDHS) 2006, 2011, and 2016 were sourced for this study. Women who had a live birth in the last five years of the survey were the unit of analysis for this study. Absolute and relative inequalities in CS utilization were expressed in terms of rate difference and rate ratios, respectively. We used multivariable regression models to assess the CS rate by background sociodemographic characteristics of women. Results: Age and parity-adjusted CS rates were found to have increased almost threefold (from 3.2%, 95% CI: 2.1-4.3 in 2006 to 10.5%; 95% CI: 8.9-11.9 in 2016) over the decade. In 2016, women from mountain region (3.0%), those from the lowest wealth quintile (2.4%), and those living in Karnali province (2.4%) had CS rate below 5%. Whereas women from the highest wealth quintile (25.1%), with higher education (21.2%), and those delivering in private facilities (37.1%) had CS rate above 15%. Women from the highest wealth quintile (OR-3.3; 95% CI: 1.6-7.0) compared to women from the lowest wealth quintile and those delivered in private/NGO-run facilities (OR-3.6; 95% CI: 2.7-4.9) compared to women delivering in public facilities were more than three times more likely to deliver by CS. Conclusion: To improve maternal and newborn health, strategies need to be revised to address the underuse of CS among poor, those living in mountain region and Province 2, Lumbini province, Karnali province, and Sudhurpaschim province. Simultaneously, there is a pressing need for policies, guidelines, and continuous monitoring of CS rates to reduce overuse among rich women, women with higher education, and those giving childbirth in private facilities.


Assuntos
Cesárea/estatística & dados numéricos , Cesárea/tendências , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Nepal/epidemiologia , Paridade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
15.
Medicine (Baltimore) ; 100(20): e25796, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011042

RESUMO

ABSTRACT: Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042-4.394), diabetes (OR: 2.250, 95% CI: 1.891-3.544), abortion history (OR: 3.909, 95% CI: 1.187-5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042-4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095-2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226-3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084-2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.


Assuntos
Paridade , Período Pós-Parto , Incontinência Urinária por Estresse/epidemiologia , Adolescente , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/estatística & dados numéricos , Peso ao Nascer , Índice de Massa Corporal , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Segunda Fase do Trabalho de Parto , Idade Materna , Gravidez , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Incontinência Urinária por Estresse/prevenção & controle , Adulto Jovem
16.
Cad Saude Publica ; 37(4): e00057520, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34008734

RESUMO

Fertility reduction is a phenomenon observed in demographic transition. The demographic changes noted in female fertility represent a need for adjustment on health services regarding female health and family planning support. Thus, this study aimed to perform a descriptive analysis by tracing the sociodemographic profile of primiparous mothers belonging to nine Brazilian birth cohorts, in three cities from different states. Standardized questionnaires were applied to assess reproductive characteristics and covariables. Primiparous mothers were defined as women whose child included in birth cohorts was their firstborn child. Sample description was performed using analysis of variance (continuous variables) and chi-square (categorical variables). In total, 44,615 women were included in the analyses and 41.8% (95%CI: 41.3; 42.2) were categorized as primiparous. The primiparity rates were the lowest in Ribeirão Preto (São Paulo State) 1978 (32%; 95%CI: 30.9; 33.1) and the highest in most recent cohorts, reaching up to 50% of the participants (São Luís - Maranhão State 2010: 47.2%; 95%CI: 45.8; 48.6; Ribeirão Preto 2010: 50.2%; 95%CI: 49.1; 51.4); Pelotas (Rio Grande do Sul State) 2015: 49.4% (95%CI: 47.9; 50.9). Primiparous mothers' age and schooling increased over the years in all cohorts. Maternal age at the first childbirth behaved similarly in the three studied cities. There was an increase in the proportion of first-time mothers that were older, higher educated and belonged to richer income groups. Also, the proportion of teenage mothers (aged 15 years or younger) increased until the early 2000's and started decreasing around the years 2010, especially among women in the poorer income groups.


Assuntos
Mães , Adolescente , Brasil , Criança , Cidades , Estudos de Coortes , Feminino , Humanos , Paridade , Gravidez , Fatores Socioeconômicos
17.
Croat Med J ; 62(2): 130-136, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33938652

RESUMO

AIM: To examine the characteristics of pregnancies at a very advanced maternal age and the effect of parity on adverse obstetric outcomes. METHODS: We retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydani Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%). RESULTS: Significantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher. CONCLUSION: Since primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.


Assuntos
Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Paridade , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
18.
BMC Pregnancy Childbirth ; 21(1): 351, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941083

RESUMO

BACKGROUND: Yoga can reduce the risk of preterm delivery, cesarean section (CS), and fetal death. The aim of the present study was to investigate the effects of Yoga on pregnancy, delivery, and neonatal outcomes. METHODS: This was a clinical trial study and using the random sampling without replacement 70 pregnant women entered Hatha Yoga and control groups according to the color of the ball they took from a bag containing two balls (blue or red). The data collection tool was a questionnaire pregnancy, delivery, and neonatal outcomes. The intervention in this study included pregnancy Hatha Yoga exercises that first session of pregnancy Yoga started from the 26th week and samples attended the last session in the 37th week. They exercised Yoga twice a week (each session lasting 75 min) in a Yoga specialized sports club. The control group received the routine prenatal care that all pregnant women receive. RESULTS: The results showed that yoga reduced the induction of labor, the episiotomy rupture, duration of labor, also had a significant effect on normal birth weight and delivery at the appropriate gestational age. There were significant differences between the first and second Apgar scores of the infants. CONCLUSION: The results of the present study showed that Yoga can improve the outcomes of pregnancy and childbirth. They can be used as part of the care protocol along with childbirth preparation classes to reduce the complications of pregnancy and childbirth. TRIAL REGISTRATION: IRCT20180623040197N2 (2019-02-11).


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Trabalho de Parto Prematuro/epidemiologia , Resultado da Gravidez , Cuidado Pré-Natal , Ioga , Adolescente , Adulto , Episiotomia/efeitos adversos , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Irã (Geográfico) , Trabalho de Parto Prematuro/prevenção & controle , Paridade , Gravidez , Inquéritos e Questionários , Adulto Jovem
19.
BMC Pregnancy Childbirth ; 21(1): 360, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952183

RESUMO

BACKGROUND: Currently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects. METHODS: We included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China's National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture. RESULTS: This study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53-2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81-27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32-1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37-0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52-1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24-0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number. CONCLUSION: The uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture.


Assuntos
Política de Planejamento Familiar , Ruptura Uterina/epidemiologia , Cesárea/efeitos adversos , China/epidemiologia , Feminino , Humanos , Incidência , Paridade , Gravidez , Resultado da Gravidez , Fatores de Risco , Natimorto/epidemiologia
20.
Obstet Gynecol ; 137(6): 991-998, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33957657

RESUMO

OBJECTIVE: To evaluate whether a high-dose oxytocin regimen reduces the risk for primary cesarean birth and other obstetric morbidities when compared with standard dosing. METHODS: In a double-blind randomized clinical trial of nulliparous women at or beyond 36 weeks of gestation who were undergoing augmentation of labor, participants were assigned to high-dose (initial and incremental rates of 6 milliunits/min) or standard-dose (initial and incremental rates of 2 milliunits/min) oxytocin regimens. The primary outcome was cesarean birth. Prespecified secondary outcomes included labor duration, clinical chorioamnionitis, endometritis, postpartum hemorrhage, Apgar score 3 or less at 5 minutes, umbilical artery acidemia, neonatal intensive care unit admission, perinatal death, and a severe perinatal morbidity composite. A sample size of 501 per group (n=1,002) was planned to detect a 6.6% absolute reduction in rate of the primary outcome, from 20% in the standard-dose group to 13.4% in the high-dose group with 80% power. RESULTS: From September 2015 to September 2020, 1,003 participants were randomized-502 assigned to high-dose and 501 assigned to standard dosing. The majority of participants were of White race, were married or living as married, and had commercial insurance. Baseline characteristics between groups were similar. The primary outcome occurred in 14.5% of those receiving high-dose compared with 14.4% of those receiving standard-dose oxytocin (relative risk, 1.01; 95% CI 0.75-1.37). The high-dose group had a significantly shorter mean labor duration (9.1 vs 10.5 hours; P<.001), and a significantly lower chorioamnionitis incidence (10.4% vs 15.6%; relative risk, 0.67; 95% CI 0.48-0.92) compared with standard dosing. Umbilical artery acidemia was significantly less frequent in the high-dose group in complete case analysis, but this finding did not persist after multiple imputation (relative risk, 0.55; 95% CI 0.29-1.04). There were no significant differences in other secondary outcomes. CONCLUSION: Among nulliparous participants who were undergoing augmentation of labor, a high-dose oxytocin regimen, compared with standard dosing, did not affect the cesarean birth risk but significantly reduced labor duration and clinical chorioamnionitis frequency without adverse effects on perinatal outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02487797.


Assuntos
Cesárea , Trabalho de Parto/efeitos dos fármacos , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Acidose/sangue , Adulto , Índice de Apgar , Corioamnionite/etiologia , Método Duplo-Cego , Feminino , Sangue Fetal/química , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Paridade , Admissão do Paciente , Gravidez , Fatores de Tempo , Artérias Umbilicais
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