RESUMO
BACKGROUND: Trichomoniasis commonly affects women of childbearing age and has been linked to several adverse birth outcomes. OBJECTIVE: To elucidate the association between trichomoniasis in pregnant women and adverse birth outcomes, including preterm delivery, prelabour rupture of membranes and low birthweight. SEARCH STRATEGY: MEDLINE, EMBASE and ClinicalTrials.gov were systematically searched in December 2020 without time or language restrictions. SELECTION CRITERIA: Original research studies were included if they assessed at least one of the specified adverse birth outcomes in pregnant women with laboratory-diagnosed trichomoniasis. DATA COLLECTION AND ANALYSIS: Estimates from included articles were either extracted or calculated and then pooled to produce a combined estimate of the association of trichomoniasis with each adverse birth outcome using the random effects model. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. MAIN RESULTS: Literature search produced 1658 publications after removal of duplicates (n = 770), with five additional publications identified by hand search. After screening titles and abstracts for relevance, full text of 84 studies was reviewed and 19 met inclusion criteria for meta-analysis. Significant associations were found between trichomoniasis and preterm delivery (OR 1.27; 95% CI 1.08-1.50), prelabour rupture of membranes (OR 1.87; 95% CI 1.53-2.29) and low birthweight (OR 2.12; 95% CI 1.15-3.91). CONCLUSIONS: Trichomoniasis in pregnant women is associated with preterm delivery, prelabour rupture of membranes and low birthweight. Rigorous studies are needed to determine the impact of universal trichomoniasis screening and treatment during pregnancy on reducing perinatal morbidity. TWEETABLE ABSTRACT: This systematic review and meta-analysis found that in the setting of pregnancy, trichomoniasis is significantly associated with multiple adverse birth outcomes, including preterm delivery, low birthweight, and prelabour rupture of membranes.
Assuntos
Complicações Parasitárias na Gravidez/parasitologia , Resultado da Gravidez , Vaginite por Trichomonas/complicações , Trichomonas vaginalis , Feminino , Ruptura Prematura de Membranas Fetais/parasitologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/parasitologiaRESUMO
BACKGROUND: The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. METHODS: This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. RESULTS: After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. CONCLUSION: The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.
Assuntos
Apresentação Pélvica/terapia , Parto Obstétrico/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Índice de Apgar , Bélgica/epidemiologia , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Chagas disease is caused by the parasite Trypanosoma cruzi and is endemic in much of Latin America. With increased globalisation and immigration, it is a risk in any country, partly through congenital transmission. The frequency of congenital transmission is unclear. OBJECTIVE: To assess the frequency of congenital transmission of T. cruzi. SEARCH STRATEGY: PubMed, Journals@Ovid Full Text, EMBASE, CINAHL, Fuente Academica and BIREME databases were searched using seven search terms related to Chagas disease or T. cruzi and congenital transmission. SELECTION CRITERIA: The inclusion criteria were the following: Dutch, English, French, Portuguese or Spanish language; case report, case series or observational study; original data on congenital T. cruzi infection in humans; congenital infection rate reported or it could be derived. This systematic review included 13 case reports/series and 51 observational studies. DATA COLLECTION AND ANALYSIS: Two investigators independently collected data on study characteristics, diagnosis and congenital infection rate. The principal summary measure--the congenital transmission rate--is defined as the number of congenitally infected infants divided by the number of infants born to infected mothers. A random effects model was used. MAIN RESULTS: The pooled congenital transmission rate was 4.7% (95% confidence interval: 3.9-5.6%). Countries where T. cruzi is endemic had a higher rate of congenital transmission compared with countries where it is not endemic (5.0% versus 2.7%). CONCLUSIONS: Congenital transmission of Chagas disease is a global problem. Overall risk of congenital infection in infants born to infected mothers is about 5%. The congenital mode of transmission requires targeted screening to prevent future cases of Chagas disease.
Assuntos
Doença de Chagas/congênito , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Trypanosoma cruzi , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS: Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS: Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION: Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.
Assuntos
Sorodiagnóstico da AIDS , Salas de Parto , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Sorodiagnóstico da AIDS/métodos , Adolescente , Adulto , Aconselhamento , República Democrática do Congo/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Diagnóstico Pré-Natal , Prevalência , Fatores de RiscoRESUMO
Mexican-American women have similar low socio-economic status as compared to Non-Hispanic Blacks. However, Mexican-American women have consistently been shown to have a lower rate of low birth weight births as compared to Non-Hispanic Blacks and similar to Non-Hispanic Whites. This phenomenon is referred to as the "Mexican paradox", and the explanation for this is still unclear. We used data from the third US National Health and Nutrition Examination Survey (NHANES III) to compare the rate of periodontal disease in Non-Hispanic Black, Non-Hispanic White and Mexican-American pregnant and non-pregnant women. We found that Mexican-American women have a lower rate of periodontal disease before and during pregnancy when compared to Non-Hispanic Blacks. Since periodontal disease has been associated with an increased risk of preterm birth and low birth weight, we hypothesize that the lower prevalence of periodontal disease before and during pregnancy among Mexican-American women may contribute to the "Mexican paradox".
Assuntos
Americanos Mexicanos/estatística & dados numéricos , Modelos Biológicos , Doenças Periodontais/epidemiologia , Doenças Periodontais/fisiopatologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Estudos de Coortes , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Inquéritos Nutricionais , Doenças Periodontais/etnologia , Vigilância da População/métodos , Gravidez , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/etnologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Introduction: Background cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. The vast majority of women attend prenatal care, which is a unique source of population-based blood samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. Methods: We randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018 in Tegucigalpa, Honduras, at least 1 year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers' instructions. Pictures were taken for all tests and read by two blinded trained evaluators. Results: We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests (95% confidence intervals [CI] 97.0-100 and 95.5-100, respectively). The third test had a specificity of 98.9% (95% CI 94.0-100) for IgM and 94.4% (95% CI 87.5-98.2) for IgG. The fourth test had a specificity of 88.9% (95% CI 80.5-94.5) for IgM and 100% (95% CI 96.0-100) for IgG. Discussion: COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples. (AU)
Assuntos
Cuidado Pré-Natal/métodos , Testes Sorológicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/sangue , Valor Preditivo dos Testes , Técnicas de Laboratório Clínico , Pandemias/prevenção & controleRESUMO
BACKGROUND: In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades. METHODS: A case-control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries. RESULTS: Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1-47.1]). Women with inadequate prenatal care were more likely to be aged < 20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4-1.3]). CONCLUSIONS: Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.
Assuntos
Acessibilidade aos Serviços de Saúde/normas , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde , Adulto , Estudos de Casos e Controles , Escolaridade , Europa (Continente) , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Idade Materna , Mães/educação , Mães/estatística & dados numéricos , Paridade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
A group of women with unknown last menstrual period was studied representing 16% of a total of 22 404 pregnant women recorded using a common perinatal form. Unknown menstrual period is associated with high rates of low birth weight and with low socioeconomic and sociodemographic status. Such characteristics are also associated with a high rate of preterm deliveries. Thus any possible bias introduced in studies of prematurity by ignoring the group of women with unknown last menstrual period should be carefully checked.
Assuntos
Menstruação , Gravidez , Adolescente , Adulto , Estatura , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Idade Materna , Menarca , Paridade , Fatores SocioeconômicosRESUMO
The purpose of the study was to identify prenatal care incentives and benefits in 17 European countries. All participating countries completed a questionnaire on their prenatal care delivery system, incentives and benefits. Results were analyzed according to their direct or indirect relationship with prenatal care attendance. Direct incentives require a prenatal care visit to be eligible for the benefit. Indirect incentives support the pregnant woman but do not require a prenatal care visit to be eligible for the benefit. All 17 countries offer direct incentives, such as paid maternity leave. In 9 countries, pregnant women receive direct financial incentives. Eleven countries offer indirect incentives, such as transportation benefits. Prenatal care incentives such as financial benefits and social supports are widespread in Europe. The combination of incentives superimposed upon an inclusive health care system create a supportive environment which encourages prenatal care attendance.
Assuntos
Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/estatística & dados numéricos , Atenção à Saúde/economia , Europa (Continente) , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Cuidado Pré-Natal/economia , Apoio Social , Inquéritos e QuestionáriosRESUMO
Because of inconsistent findings among case-control studies on the relationship between IUD use and the risk of ectopic pregnancy, a meta-analysis of published literature was conducted. From 1977 through 1994, 19 publications regarding 16 studies of ectopic pregnancy and IUD use were found by MEDLINE and manual search. The odds ratio (ORs) of ectopic pregnancy with current and past IUD use in each study were pooled. A quality score system was developed to assess each study. Funnel plot was used to assess potential publication biases. For current IUD use, when cases were compared to pregnant controls, there was an increased risk of ectopic pregnancy (pooled OR: 10.63, 95% confidence interval (CI): 7.66-14.74); when cases were compared to non-pregnant controls, there was no risk of ectopic pregnancy (pooled OR: 1.06, 95% CI: 0.91-1.24). Past IUD use could mildly increase the risk of ectopic pregnancy (pooled OR: 1.40, 95% CI: 1.23-1.59). Selecting pregnant or non-pregnant women as controls, however, did not affect the OR estimates of past IUD use. Current IUD use does not increase the risk of the ectopic pregnancy. However, a pregnancy with an IUD in situ is more often an ectopic one than a pregnancy with no IUD. Past IUD use could mildly elevate the risk of ectopic pregnancy.
Assuntos
Dispositivos Intrauterinos/efeitos adversos , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , China/epidemiologia , Coleta de Dados , Feminino , Finlândia/epidemiologia , França/epidemiologia , Grécia/epidemiologia , Humanos , Incidência , Indonésia/epidemiologia , Itália/epidemiologia , MEDLINE , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Suécia/epidemiologia , Estados Unidos/epidemiologia , Organização Mundial da SaúdeRESUMO
OBJECTIVE: One of the prevailing hypotheses for the pathogenesis of preeclampsia is the "ischemic model." It assumes that reduced uteroplacental perfusion is the primary step and the point of convergence of diverse pathogenic processes in the development of preeclampsia. One might expect a fetus under such "ischemic conditions" to be at an increased risk of later development of cerebral palsy (CP). The objective of this study was to test the hypothesis that maternal preeclampsia increases the risk of CP in preterm and low-birth-weight infants. METHODS: A meta-analysis was performed based on published articles identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, Current Contents, Biological Abstracts, and Dissertation Abstracts) from 1966 through 1999. Ten observational studies on the association between preeclampsia and CP were identified based on prespecified inclusion criteria. Two independent reviewers extracted data and assessed the methodological quality of eligible articles. Odds ratios (OR) of CP for preeclampsia from individual studies were pooled. MAIN OUTCOME MEASURE: Cerebral palsy. RESULTS: In case-control studies, preeclampsia was associated with a statistically significant decreased risk of CP [pooled adjusted OR, 0.50; 95% confidence interval (CI), 0.33-0.81; p < 0.01). In cohort studies, preeclampsia was associated with a nonstatistically significant reduced risk of CP (pooled OR, 0.91; 95% CI, 0.35-2.41; p > 0.05). CONCLUSIONS: Preeclampsia may be associated with a decreased risk of CP in preterm and low-birth-weight infants. This challenges the currently held belief that reduced uteroplacental perfusion is the unique pathophysiological process in preeclampsia.
Assuntos
Paralisia Cerebral/epidemiologia , Recém-Nascido de Baixo Peso , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Feminino , Humanos , Recém-Nascido , Modelos Teóricos , Razão de Chances , Gravidez , Fatores de RiscoRESUMO
The findings of first-trimester ultrasound scans are analyzed. The patients were divided into two groups according to the reliability of their alleged date of last menstrual period and the regularity of their menstrual cycle. The cost-effectiveness of a routine first trimester scan as compared to a selective approach is calculated. Based on these data we question the performance of a routine first-trimester scan.
Assuntos
Diagnóstico Pré-Natal , Ultrassonografia/economia , Bélgica , Anormalidades Congênitas/diagnóstico , Análise Custo-Benefício , Feminino , Idade Gestacional , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Gravidez MúltiplaRESUMO
OBJECTIVE: The purpose of the study was to compare prenatal care attendance in European Union countries, Hungary and Norway. STUDY DESIGN: We analysed live births or deliveries from national registers in five countries, national surveys in five countries, and regional register or surveys in three countries. RESULTS: The frequency of no prenatal care was lower than 0.5% in 10 countries, 0.9% in Hungary, 2.1% in Greece and 2.6% in Portugal. Late prenatal care varied from 3.1% in Finland to 29.2% in Ireland. Late care among women with parity 4 and more varied from 7.7% in Finland to 41.5% in Hungary. Among women under 20 years old, late care varied from 11.8% in Finland to 39.5% in Portugal. The median number of prenatal visits varied from seven in Greece to 14 in Finland. CONCLUSION: Prenatal care attendance varies widely among European countries. Late attendance is frequent in many countries.
Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Vigilância da População , Gravidez , Sistema de RegistrosRESUMO
We performed a study on depressive symptoms in gynaecological practice in Belgium, identifying depressive symptoms according to both practitioners' opinions and the scores on a scale developed to detect depression in general medical settings. According to the 170 participating gynaecologists, 12% of the 2174 women they interviewed had symptoms of depression. However, 35% had two or more positive answers on the Depression Scale, and 19% had four or more positive answers. Our results suggest that depressive symptoms are often not identified in clinical gynaecological practice.
Assuntos
Depressão/diagnóstico , Ginecologia , Adulto , Bélgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel do MédicoRESUMO
OBJECTIVES: To study prevalence, risk factors, and birth outcomes of women with anemia during pregnancy in a Chinese population. METHODS: A retrospective cohort study was performed based on 16936 pregnancies delivered between January 1989 and December 1990 in Suzhou, China. Anemia was defined as hemoglobin less than 10 g/dl. Multivariate logistic regression was used to estimate odds ratio, 95% confidence interval, and to control for confounding variables. RESULTS: The prevalence of anemia was 10.3% at the first trimester, 18.9% at the third trimester. Overall, 26.2% pregnant women experienced anemia in pregnancy. Anemia during early pregnancy was not associated with increased risk of adverse perinatal outcomes. However, anemia in later pregnancy was inversely associated with preterm birth and low birth weight. CONCLUSIONS: Anemia during pregnancy does not increase the risk of poor birth outcomes.
Assuntos
Anemia/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: We sought to estimate the proportion of women immunized against tetanus while attending prenatal care in the developing countries. METHOD: We computed the ratio of the percentage of births to women immunized against tetanus to the percentage of births to women with prenatal care (TP ratio). A TP ratio is lower than 100% if not every woman attending prenatal care is immunized. We used 1986-1992 Demographic and Health Surveys data from 38 countries. RESULTS: The mean TP ratios were 86% in Africa (n = 23), 79% in Asia (n = 6) and 60% in Latin American and the Caribbean (n = 9). The TP ratio was lower than 75% in 15 countries. Of these, four had a TP ratio lower than 50%. CONCLUSION: In many countries the number of pregnant women immunized against tetanus is lower than the number of women attending prenatal care, suggesting that prenatal services are missing opportunities to immunize attending women.
Assuntos
Países em Desenvolvimento , Imunização/estatística & dados numéricos , Cuidado Pré-Natal , Toxoide Tetânico , Tétano/prevenção & controle , Feminino , Humanos , GravidezRESUMO
OBJECTIVES: A prospective multicenter study of obstetric practices was conducted in three developing countries (Benin, Congo and Senegal) to analyze oxytocic use during labor. One of the objectives was to assess the possible negative effects of the treatment regimens instituted during the labor monitoring phase. METHODS: Four health districts participated in the study. All women who gave birth in one of the participating health facilities over a 6-month period in Benin and Congo, and over a 3-month period in Senegal, were recruited. The number of deliveries studied in each district varied from 457 to 1048. For each case a partogram was used to assess the progress of labor and the onset of dysfunctional labor. Information was collected on the risk factors for dysfunctional labor, stillbirths and resuscitation of the neonate. RESULTS: Each of the four collaborating centers used oxytocics preferentially to treat dysfunctional labor, but even in normal labor (i.e. with a normal partogram) oxytocics were used in 4.4-21.5% of cases. In normal labor the incidence of neonatal resuscitation was higher in cases with than in those without oxytocic use: the relative risks (R.R.) varied from 1.9 to 5.6; the odds ratios varied from 2.4 to 7.0, and both were statistically significant in the four settings. In addition the stillbirth rate was always higher, though not significantly, when oxytocics were used in normal labor (R.R. 1.2-2.2). When the data of the four centers were pooled, the global relative risk for stillbirths was 1.9, and the 95% confidence interval was 1.1-3.4. Logistic regression analysis was carried out for five confounding factors (primiparity, a previous complicated delivery, presence of meconium, ruptured membranes and educational level) to adjust the odds ratio for the risk of neonatal resuscitation when oxytocics were used in normal labor. Except in the case of Abomey in Benin, where the variable 'presence of meconium' decreased the odds ratio from 6.4 to 3.4, the adjusted odds ratios remained similar to their non-adjusted values. In cases of non-dysfunctional labor, nurses and midwives used oxytocics more often than lesser trained health personnel (R.R. 4.0 [3.2-5.1]). CONCLUSION: Our results show that an obstetric treatment which is safe when used in certain well-defined indications, may have significant negative effects when used in situations where the same technical quality of care cannot be guaranteed.
Assuntos
Países em Desenvolvimento , Trabalho de Parto , Ocitócicos , Padrões de Prática Médica , Uso de Medicamentos , Feminino , Humanos , Complicações do Trabalho de Parto/terapia , Gravidez , Estudos Prospectivos , Qualidade da Assistência à SaúdeRESUMO
Screening for rubella in the beginning of pregnancy includes at least one assay for rubella antibodies. If a significant level of antibodies is found, two strategies are possible: 1) to consider the patient as protected if there is no other sign of rubella, or 2) to assess the date of the infection in all cases, repeating the serological tests. In this paper we study the cost of this second strategy. Using a theoretical model of the rubella infection we calculated that the incidence of congenital rubella would be 9 cases in 10 000 newborns in populations with 10% of susceptible women at the age of 25. We studied the cost-effectiveness of a screening strategy including a second assay for rubella antibodies (inhibition of hemagglutination) after a positive one. This strategy is 10% more sensitive than a single test. Nevertheless, the cost of one case of congenital rubella prevented by this strategy is 13.3 higher than the cost of a case prevented by a strategy including the vaccination of boys and girls at the age of 2 years and of girls at the age of 12. Thus, the vaccination strategy is a priority for rubella prevention while the multiplication of the screening test is not a priority.
Assuntos
Rubéola (Sarampo Alemão)/congênito , Bélgica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Vacina contra RubéolaRESUMO
The Belgian health system imposes no regulations regarding antenatal care. A special study was carried out by questionnaire in a sample of 32 maternity units representative of the French-speaking region to determine the coverage rate achieved by the health system. The study also compared the private and public sectors for rate of use, socioeconomic profile of users and regularity of antenatal care. Overall results show that despite the generosity of the system, a utilization rate of 98.8%, and a coverage rate of 84%, are reached. Public and private sector attendance is comparable but their respective populations are different. Regularity of antenatal care varies considerably between the two sectors. The public sector performs better in this regard, especially when it is endowed with medico-public health teams. The results suggest that the regularity of antenatal care is a better indicator of the quality of services than of their accessibility.