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Zainulina, Marina Sabirovna, Ekaterina Amirovna Kornyushina e Marina Ivanivna Krivonos. "Strategy of prevention of bleeding-related maternal mortality". Journal of obstetrics and women's diseases 64, n. 2 (15 giugno 2015): 33–41. http://dx.doi.org/10.17816/jowd64233-41.
Testo completoAbstract (sommario):
The article presents data on bleeding-related maternal mortality in St. Petersburg, North-West Federal District and in the Russian Federation. 6 times reduction of maternal mortality per 100 000 live births was observed in Russian Federation during the last three decades, however, the structure of maternal mortality due to bleeding, changes in the direction of increasing of rate of placental localization abnormalities and placenta previa. This trend may be related to the steady growth of the caesarean section rate. Particular attention is given to the formation of groups of patients at risk of developing obstetric hemorrhage, full examination, prevention of coagulopathy, the timely detection of placental localization abnormalities and placenta accreta. The article reviews the current approaches to prevention of obstetric hemorrhage using drugs, surgical techniques, and blood saving technologies.
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Sumarmi, Sri. "MODEL SOSIO EKOLOGI PERILAKU KESEHATAN DAN PENDEKATAN CONTINUUM OF CARE UNTUK MENURUNKAN ANGKA KEMATIAN IBU". Indonesian Journal of Public Health 12, n. 1 (28 dicembre 2017): 129. http://dx.doi.org/10.20473/ijph.v12i1.2017.129-141.
Testo completoAbstract (sommario):
Maternal mortality rate is the important health indicator which is used as a component of Nation Development Index or quality of life index in all countries in the world. It is the most sensitive indicator among other health indicators to assess health status or quality of life in a country. Recently, Indonesiafaces an inconvenience situation when a surprise increasing of maternal mortality rate was launched by national health survey, reflected an un-successful effort to achieve Millenium Development Goals (MDGs) target 2015 or the Sustainable Development Goals (SDGs). Reducing maternal mortality ratein Indonesia is a big challenge, because maternal mortality is a multi-causes problem. Furthermore, various factors may play a role as the root causes that could not be addressed only through health interventions, but should involve multi-sectoral approach. Base on thus issues, this paper will discuss appropriate strategies to reduce maternal mortality in Indonesia by combining concept of socio ecological model of health behavior and continuum of care approach.Keywords: Maternal Mortality Rate, Socio Ecological Model, continuum of care
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Singh, Gopal K. "Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018". International Journal of Maternal and Child Health and AIDS (IJMA) 10, n. 1 (30 dicembre 2020): 29–42. http://dx.doi.org/10.21106/ijma.444.
Testo completoAbstract (sommario):
Background: Despite the previous long-term decline and a recent increase in maternal mortality, detailed social inequalities in maternal mortality in the United States (US) have not been analyzed. This study examines trends and inequalities in US maternal mortality by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, area deprivation, urbanization level, and cause of death. Methods: National vital statistics data from 1969 to 2018 were used to compute maternal mortality rates by sociodemographic factors. Mortality trends by deprivation level were analyzed by using censusbased deprivation indices. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: Maternal mortality declined by 68% between 1969 and 1998. However, there was a recent upturn in maternal mortality, with the rate increasing from 9.9 deaths/100,000 live births in 1999 to 17.4 in 2018. The large racial disparity persisted over time; Black women in 2018 had a 2.4 times higher risk of maternal mortality than White women. During 2013-2017, the rate varied from 7.0 for Chinese women to 42.0 for non-Hispanic Black women. Unmarried status, US-born status, lower education, and rural residence were associated with 50-114% higher maternal mortality risks. Mothers in the most-deprived areas had a 120% higher risk of mortality than those in the most-affluent areas; both absolute and relative disparities in mortality by deprivation level widened between 2002 and 2018. Hemorrhage, pregnancy-related hypertension, embolism, infection, and chronic conditions were the leading causes of maternal death, with 31% of the deaths attributable to indirect obstetric causes. Conclusions and Global Health Implications: Despite the steep long-term decline in US maternal mortality, substantial racial/ethnic, socioeconomic, and rural-urban disparities remain. Monitoring disparities according to underlying social determinants is key to reducing maternal mortality as they give rise to inequalities in social conditions and health-risk factors that lead to maternal morbidity and mortality. Key words: Maternal mortality • Socioeconomic status • Deprivation • Race/ethnicity • Rural-urban • Disparities • Cause of death • Trend. Copyright © 2021 Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Darungan, Ainun Irada, Abdul Kadir e Nasrul Haq. "STRATEGI PEMERINTAH DALAM MENGURANGI ANGKA KEMATIAN IBU (AKI) MELAHIRKAN DI KABUPATEN ENREKANG". JPPM: Journal of Public Policy and Management 2, n. 2 (1 dicembre 2020): 101–9. http://dx.doi.org/10.26618/jppm.v2i2.4565.
Testo completoAbstract (sommario):
This study purposed to find out how the institutionalization of government strategy in reducing maternal mortality rate (AKI) and how to operationalize the government strategy in reducing maternal mortality rate (AKI) in Enrekang Regency. This study used descriptive qualitative research . Data collection techniques were observation, interviews with 5 informants and documentation. Data analysis used interactive analysis models and used 3 types of triangulation in data validation. The results of this study showed that the role of public health midwives in reducing maternal mortality was very important, especially in the role of community empowerment, optimizing Integrated Healthcare Center activities, and leadership roles in public health and health cadres were expected to be able to encourage the community to carry out self-help activities in improving health status. The role of community health workers in empowering cadres was very important by increasing the ability of community knowledge and awareness regarding prevention of maternal mortality in Enrekang Regency
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GOLI, SRINIVAS, e ABDUL C. P. JALEEL. "WHAT IS THE CAUSE OF THE DECLINE IN MATERNAL MORTALITY IN INDIA? EVIDENCE FROM TIME SERIES AND CROSS-SECTIONAL ANALYSES". Journal of Biosocial Science 46, n. 3 (22 ottobre 2013): 351–65. http://dx.doi.org/10.1017/s0021932013000564.
Testo completoAbstract (sommario):
SummaryStudies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (−1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (−0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=−0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between ‘increase in institutional deliveries' and ‘decline in maternal mortality ratio’ suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.
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Ghazal, Kariman, Charlote Hajjar, Georges Yared e Rabih Chahine. "Can we have many C-sections". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, n. 2 (28 gennaio 2020): 812. http://dx.doi.org/10.18203/2320-1770.ijrcog20200382.
Testo completoAbstract (sommario):
The rate of cesarean section is increasing worldwide. It decreases maternal and fetal mortality when complications happen. However, it is a major surgery that could be associated with maternal and fetal risks especially after repeat cesarean deliveries. We report a case of a woman who had her 9th C-section.
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Casella Jean-Baptiste, Meredith, Stephanie Louis, Christophe Millien, Erwine Dina Jeune, Ornella Sainterant e Jean Paul Joseph. "Postpartum quality improvement strategy for increasing long-acting contraception uptake at a University Hospital in Haiti". BMJ Open Quality 7, n. 4 (ottobre 2018): e000204. http://dx.doi.org/10.1136/bmjoq-2017-000204.
Testo completoAbstract (sommario):
To address the gap in the uptake of long-acting contraception (LAC) methods among high-risk postpartum women who fail to return for a family planning method at HôpitalUniversitaire de Mirebalais in the Central Plateau Department of Haiti, contraceptive implant trainings were held for providers on the Labour and Delivery, Post-Partum and Internal Medicine inpatient wards.A very high maternal mortality rate affects large numbers of women in Haiti; however, contraceptive use can reduce maternal mortality significantly. A quality improvement strategy to offer LAC methods to immediate postpartum women at a University Hospital in rural Haiti was initiated in March 2016. This new strategy produced an average improvement from 5% to 32% of women delivering at the hospital, accepting a long-acting method (including bilateral tubal ligations) by the end of the project and which has proved sustainable at an average of 20% to date.
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Desi Oktariana. "Efforts to Maintain the Health of Pregnant Women through Antenatal Care Education". Conferences of Medical Sciences Dies Natalis Faculty of Medicine Universitas Sriwijaya 2, n. 1 (12 novembre 2020): 45–50. http://dx.doi.org/10.32539/dies.v2i1.41.
Testo completoAbstract (sommario):
In Indonesia, maternal mortality is still an important problem that requires comprehensive treatment and follow-up. Maternal Mortality Rate (MMR) is still high and has not reached the target set by the government. Maternal mortality can be prevented through Antenatal Care (ANC) services. ANC visit, for example, is influenced by the knowledge and attitudes of pregnant women. Unfortunately, there are still pregnant women who don't know about the importance of ANC, so they don't make ANC visits. This community service activity is carried out to provide education, in the form of counseling, for pregnant women about Antenatal Care (ANC), with the aim of increasing awareness of pregnant women to maintain health during pregnancy and increase the participation of pregnant women in ANC visits.
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Soleman, Sani Rachman. "The Trend of Children Mortality Rates in Indonesia". Jurnal Ilmu Kesehatan Masyarakat 11, n. 01 (30 aprile 2020): 52–62. http://dx.doi.org/10.26553/jikm.2020.11.1.52-62.
Testo completoAbstract (sommario):
Children mortality rates describe the health services’ quality as indicators of each countries’ welfare, particularly in Indonesia. Several factors were determined as the main contributors of mortality, such as neonatal factors, maternal, environment and health services. The important of this research is to give recommendation to the government of Indonesia to propose some policies in handling of the increasing children mortality and modifying underlying disease as contributor mortality among children in Indonesia. The design of this study is cross sectional. The data was taken from World Health Organization Maternal Child Epidemiology Estimation from 2000 to 2017. There were three main categories : neonatal mortality rate (NND), post neonatal mortality rate (PND) and under five mortality rate (UFIVE). The leading causes of mortality were searched according to those categories and followed by descriptive analysis by line graphs. According to the data that had been found, there was declining on NND (102.700 to 60.986), PND (138.553 to 63.471), UFIVE (241.253 to 124.457). The children mortality tend to decline at the range of 17 years, meanwhile the highest mortality among the three of groups are : premature birth in neonates, ARI in post neonates and premature birth in under five children. In conclusion, the trend of three parameters of children mortality declined within 17 years. On several cases, there were outbreak of injury on 2004 and fluctuation of measles incident among infant and under five children. Premature birth and ARI have the highest prevalence among children in Indonesia.
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Roziqin, Ali, e Amaliana Nur Fajrina. "Understanding Public Sector Innovation from A Local Perspective: Contra War (Contraceptive for Women at Risk) Innovation Study in Malang Regency". Jurnal Borneo Administrator 17, n. 2 (31 agosto 2021): 205–22. http://dx.doi.org/10.24258/jba.v17i2.803.
Testo completoAbstract (sommario):
This research aims to understand public sector innovation from a local perspective with a study of the Contra War (Contraceptive for Women at Risk) innovation study in Malang Regency. This innovation aims to reduce maternal and infant mortality rates. This research used a qualitative study with document analysis. Researchers analysed documents from various sources such as official government reports, government regulations, online media news, scientific literature, and books. The result shows that the Contra War innovation has not significantly reduced maternal and infant mortality, but gradually the Contra-War has reduced maternal mortality index (Angka Kematian Ibu/AKI) cases from 27 in 2019 to 14 cases. Meanwhile, infant mortality rate (Angka Kematian Bayi/AKB as many as 62 people in 2020. Another side, the sustainability of innovation has not gone well because of low participation, innovative organisational capacity, and transformational leadership. Therefore, researchers provide suggestions for increasing public participation, collaborating with third parties, and creating innovative work ecosystems and bureaucratic structures.
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Muninggar, Laili, M. Yusuf e Budi Prasetyo. "Maternal mortality risk factor in pregnancy with heart disease at Dr. Soetomo General Hospital, Surabaya, Indonesia". Majalah Obstetri & Ginekologi 27, n. 1 (23 maggio 2019): 17. http://dx.doi.org/10.20473/mog.v1i12019.17-23.
Testo completoAbstract (sommario):
Objectives: This research want to identify some factors that increasing risk of maternal death in pregnant woman with heart disease.Materials and Methods: This study was a retrospective analytic study with cross sectional design, with total sampling 92 patient with heart disease in pregnancy at maternity room Dr. Soetomo hospital, Surabaya, during periode January until December 2017.Results: Prevalency of pregnancy with heart disease in dr. Soetomo hospital about 0,5% with mortality that caused by heart disease 14% from all maternal death. Factors that increase risk of maternal death are non adequate antenatal visit number (OR 1,7;CI 95%), delay of detecting heart disease (OR 2,5;CI 95%), complication such as severe pulmonal hypertension (OR 61,4;CI 95%), Eisenmenger syndrome (OR 2,9;CI 95%), Decompensatio Cordis Functional Class IV (OR 1,2;CI 95%), and Thrombo-embolism (OR 9;CI 95%).Conclusion: Mortality rate in pregnancy with heart disease is 14% of all maternal mortality. Risk of maternal death increased by non adequate antenatal visit and delay in heart disease detection, and also medical complications. Detection of heart disease since before pregnant with pre-conceptional councelling and a good managed multidisciplinary antenatal care supposed to decrease morbidity and mortality.
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Silvana, Rista, Ratih Pratiwi e Ary Rinaldzi. "Upaya menurunkan morbiditas dan mortalitas ibu hamil melalui penyuluhan dan skrining risiko kehamilan di Kelurahan Tuan Kentang Palembang". Jurnal Pengabdian Masyarakat: Humanity and Medicine 1, n. 2 (25 luglio 2020): 101–7. http://dx.doi.org/10.32539/hummed.v1i2.34.
Testo completoAbstract (sommario):
Efforts to reduce maternal morbidity and mortality through counseling and pregnancy risk screening in at Kelurahan Tuan Kentang Palembang. The maternal mortality rate in South Sumatra is still high. Maternal morbidity and mortality can be avoided by having regular antenatal care (ANC) visits. Although the coverage of ANC in Indonesia is increasing, the number in South Sumatra is still below the national average. Education is needed to increase the knowledge of mothers so that they routinely have pregnancy visits. The aim of the community service in Tuan Kentang Village are to improve knowledge of the importance of ANC and provide pregnancy risk screening to reduce maternal morbidity and mortality. A total of 20 pregnant women participated in this activity. Only nine people (45%) performed ANC in sufficient numbers. Low level of education, lack of knowledge about ANC, and distance to health services are factors that prevent mothers from doing ANC. As many as 17 people (85%) had high risk pregnancies due to age, parity, previous pregnancy history, fetal abnormalities, maternal diseases related to pregnancy or infection, and gynecological disorders. Most of the participants did less ANC visits, and were in the high pregnancy risk category.
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Dixit, Asha. "Outcomes of prolonged preterm premature rupture of the membrane: a report of six cases". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, n. 1 (26 dicembre 2018): 329. http://dx.doi.org/10.18203/2320-1770.ijrcog20185447.
Testo completoAbstract (sommario):
Preterm premature rupture of the membranes (PROM) is associated with significant maternal morbidity and perinatal mortality. With an increasing era of infertility, the main interest of an assisted reproductive technology specialist is to increase the take-home baby rate. Here authors present report on the outcomes of prolonged preterm PROM cases facilitated with expectant management. Report is based on the medical records of six women with preterm PROM between 16-31 weeks of gestation who gave their consent to continue the pregnancy. These women were diagnosed with PROM by the litmus test and per speculum examination. Ultrasound scan and clinical investigation, which included complete blood count and C-reactive protein level, were performed in all cases. Prophylactic antibiotics were administered to prevent the infection and increase the latency period. All six babies (100%) were delivered successfully. There was no foetal mortality and maternal morbidity observed. Expectant management in preterm PROM cases can increase the survival rate and hence the take-home baby rate.
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Walsh, Jennifer, Cliona Murphy, Aoife Murray, Risteard O'Laoide e Fionnuala M. McAuliffe. "Maternal cerebrovascular accidents in pregnancy: incidence and outcomes". Obstetric Medicine 3, n. 4 (dicembre 2010): 152–55. http://dx.doi.org/10.1258/om.2010.100043.
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Stroke occurring during pregnancy and the postnatal period is a rare but potentially catastrophic event. The aim of this study was to examine the incidence and outcomes of pregnancies complicated by maternal stroke in a single centre. This is a prospective study of over 35,000 consecutive pregnancies over a four-year period at the National Maternity Hospital in Dublin from 2004 to 2008; in addition we also retrospectively examined all cases of maternal mortality at our institution over a 50-year period from 1959 to 2009. We prospectively identified eight cases of strokes complicating pregnancy and the postnatal period giving an overall incidence of 22.34 per 100,000 pregnancies or 24.74 per 100,000 deliveries. There were no stroke-related mortalities during that time. Retrospective analysis of maternal mortality revealed 102 maternal deaths over a 50-year period, 19 (18.6%) of which were due to cerebrovascular accidents. In conclusion, strokes complicating pregnancy and the puerperium remain a rare event and though there appears to be evidence that the incidence is increasing, the associated maternal mortality appears to be falling.
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Okoror, Collins E. M. "Maternal and perinatal outcome in women with eclampsia: a retrospective study at the University of Benin Teaching Hospital". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, n. 1 (26 dicembre 2018): 108. http://dx.doi.org/10.18203/2320-1770.ijrcog20185404.
Testo completoAbstract (sommario):
Background: Eclampsia is a serious obstetric complication with attendant high maternal and perinatal morbidity and mortality especially in the developing countries. This study aims to assess the maternal and perinatal outcomes of eclampsia and suggest ways to improve them.Methods: This was a 5-year retrospective study (2009-2013) of cases of eclampsia managed at the University of Benin Teaching Hospital, Benin City, Nigeria. The number of cases managed was obtained from records at the emergency room, labour ward, theatre, lying-in wards and special care baby unit and case notes of patients satisfying the inclusion criteria retrieved from the medical records library.Results: The prevalence of eclampsia was 1.99% of total deliveries. It was highest in teenagers (29%), nulliparous (3.1%) and the unbooked (8.5%). Antepartum eclampsia accounted for 69.6% of the cases and a majority (74.6%) was delivered by emergency caesarean section. Eclampsia resulted in 27.78% of total maternal mortality, case fatality rate of 15.96% and eclampsia-related maternal mortality ratio of 318/100,000 deliveries. Perinatal mortality rate was 131/1000 eclamptic deliveries.Conclusions: The maternal outcome worsened with increasing blood pressure, number of convulsion episodes prior to presentation, the time interval between 1st convulsions to delivery, level of proteinuria on dip stick and reduced urine output. Vaginal delivery was associated with more early neonatal deaths and birth asphyxia. More awareness and enabling factors should be created for more women to access antenatal facilities. The government should be committed to providing emergency obstetric care facilities in our hospitals for effective management of eclampsia.
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METCALF, C. J. E., P. KLEPAC, M. FERRARI, R. F. GRAIS, A. DJIBO e B. T. GRENFELL. "Modelling the first dose of measles vaccination: the role of maternal immunity, demographic factors, and delivery systems". Epidemiology and Infection 139, n. 2 (7 giugno 2010): 265–74. http://dx.doi.org/10.1017/s0950268810001329.
Testo completoAbstract (sommario):
SUMMARYMeasles vaccine efficacy is higher at 12 months than 9 months because of maternal immunity, but delaying vaccination exposes the children most vulnerable to measles mortality to infection. We explored how this trade-off changes as a function of regionally varying epidemiological drivers, e.g. demography, transmission seasonality, and vaccination coverage. High birth rates and low coverage both favour early vaccination, and initiating vaccination at 9–11 months, then switching to 12–14 months can reduce case numbers. Overall however, increasing the age-window of vaccination decreases case numbers relative to vaccinating within a narrow age-window (e.g. 9–11 months). The width of the age-window that minimizes mortality varies as a function of birth rate, vaccination coverage and patterns of access to care. Our results suggest that locally age-targeted strategies, at both national and sub-national scales, tuned to local variation in birth rate, seasonality, and access to care may substantially decrease case numbers and fatalities for routine vaccination.
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Beer, Sunita Kumari, Jaya Chaudhary, Kalpana Tiwari e Sonam Choudhary. "Assessment of maternal and fetal outcome in trial of labor after cesarean". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, n. 4 (26 marzo 2019): 1563. http://dx.doi.org/10.18203/2320-1770.ijrcog20191219.
Testo completoAbstract (sommario):
Background: Nowadays, cesarean sections are increasing consistently. Repeat cesarean sections are performed for a large percentage and associated with a higher rate of surgical complications and Long-term morbidities. The trial of labor after cesarean offers an alternative choice. This study carried out to assess the maternal and fetal outcome and to evaluate various parameters as a predictor of success of TOLAC.Methods: This prospective observational study conducted on 150 pregnant women with one previous LSCS who delivered at Mahatma Gandhi hospital, from January 2017 to July 2018. Patient having a singleton pregnancy, cephalic presentation, adequate pelvis size with spontaneous onset of labor were included. Cases were monitored carefully during the labor. Emergency LSCS was done if any indication appeared.Results: 78% of cases delivered safely by the vaginal birth and 22% of cases had an emergency repeat cesarean section (EmRCS). Favorable Bishop Score, active stage of labor and prior vaginal delivery were associated with higher success rate. One (0.66%) case of uterine scar rupture and 2 (1.33%) cases of scar dehiscence noted. No maternal mortality observed. Perinatal mortality occurred in 2 cases (1.33%).Conclusions: Present study shows that appropriate clinical settings and the properly selected group of patients can make the TOLAC safe and effective.
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Barros, Patrícia De Sá, Érika Carvalho de Aquino e Marta Rovery de Souza. "Fetal mortality and the challenges for women’s health care in Brazil". Revista de Saúde Pública 53 (30 gennaio 2019): 12. http://dx.doi.org/10.11606/s1518-8787.2019053000714.
Testo completoAbstract (sommario):
OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country’s fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.
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Silva, Josy Maria de Pinho da, Sandra Costa Fonseca, Marcos Augusto Bastos Dias, Aline Silva Izzo, Gabrielle Pires Teixeira e Pamela Pinto Belfort. "Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review". Revista Brasileira de Saúde Materno Infantil 18, n. 1 (marzo 2018): 7–35. http://dx.doi.org/10.1590/1806-93042018000100002.
Testo completoAbstract (sommario):
Abstract Objectives: to analyze frequency, characteristics and causes of severe maternal morbidity (maternal near miss) in Brazil. Methods: a systematic review on quantitative studies about characteristics, causes, and associated factors on severe maternal morbidity (maternal near miss). The search was done through MEDLINE (maternal near miss or severe maternal morbidity and Brazil) and LILACS (maternal near miss, maternal morbidity). Data were extracted from methodological characteristics of the article, criteria for maternal morbidity and main results. Near miss ratios and indicators were described and estimated. Results: we identified 48 studies: 37 were on hospital based; six were based on health surveys and five were based on information systems. Different definitions were adopted. Maternal near miss ratio ranged from 2.4/1000 LB to 188.4/1000 LB, depending on the criteria and epidemiological scenario. The mortality rate for maternal near miss varied between 3.3% and 32.2%. Hypertensive diseases and hemorrhage were the most common morbidities, but indirect causes have been increasing. Flaws in the healthcare were associated to near miss and also sociodemographic factors (non-white skin color, adolescence/ age ≥ 35 years old, low schooling level). Conclusions: the frequency of maternal near miss in Brazil is high, with a profile of similar causes to maternal mortality. Inequities and delays in the healthcare were identified as association.
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JORGE MACHADO, CARLA, e KENNETH HILL. "MATERNAL, NEONATAL AND COMMUNITY FACTORS INFLUENCING NEONATAL MORTALITY IN BRAZIL". Journal of Biosocial Science 37, n. 2 (13 settembre 2004): 193–208. http://dx.doi.org/10.1017/s0021932004006595.
Testo completoAbstract (sommario):
Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death.
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Lothian, Judith A. "Safe Childbirth: A Call to Action". Journal of Perinatal Education 28, n. 2 (1 aprile 2019): 65–67. http://dx.doi.org/10.1891/1058-1243.28.2.65.
Testo completoAbstract (sommario):
Since the publication of Lamaze's Six Healthy Birth Practice papers in 2014, there has been increasing concern with the safety of the current maternity care system. A doubling of the maternal mortality rate in the United States and the continued high cesarean rate, as well as ongoing research that supports physiologic birth and identifies the risks of interfering with the physiologic process, has resulted in updated guidelines for care and has spurred advocacy efforts to transform maternity care. This article presents a number of these advocacy efforts.
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Kapoor, Dipanwita, e Suzanne Wallace. "Trends in maternal deaths from epilepsy in the United Kingdom: a 30-year retrospective review". Obstetric Medicine 7, n. 4 (25 settembre 2014): 160–64. http://dx.doi.org/10.1177/1753495x14553257.
Testo completoAbstract (sommario):
Objective Neurological diseases remain the second most common cause of maternal mortality from indirect causes, according to the last United Kingdom confidential enquiry into maternal death. The maternal mortality rate from epilepsy is reported as 0.61 per 100,000 maternities. The aim of this study was to analyse the trends and causes of maternal death from epilepsy in the UK over the last 30 years. Information on sub-standard care associated with fatalities was also consolidated to inform guidance and clinical care by obstetricians and physicians caring for pregnant women with epilepsy. Study design A retrospective review of 10 triennial confidential enquiry into maternal death reports (1979–2008) was performed, encompassing 21,514,457 maternities. Late and coincidental deaths were not included in the analyses. Results Between 1979 and 2008, there were 92 maternal deaths from epilepsy. The proportion of total maternal deaths from epilepsy over 30 years is 3.7% (95% CI 3.0–4.5), which showed an increasing trend. Sudden unexpected death in epilepsy remains the single greatest cause of maternal death from epilepsy followed by aspiration of gastric contents during seizures and drowning during bathing. Conclusion All women with epilepsy should be looked after by specialist combined obstetric and medical or neurological teams in pregnancy to improve maternal and fetal outcomes.
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Desai, Ranjana, Bhanwar Singh Jodha e Richa Garg. "Morbidly adherent placenta and it’s maternal and fetal outcome". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, n. 5 (27 aprile 2017): 1890. http://dx.doi.org/10.18203/2320-1770.ijrcog20171943.
Testo completoAbstract (sommario):
Background: Morbidly adherent placenta, a grave complication of pregnancy is becoming an emerging cause of increased maternal morbidity and mortality. Objectives of present study are to evaluate the etiopathogenesis of MAP, its clinical mode of presentation and maternal and fetal outcome with the aim to reduce maternal morbidity and mortality.Methods: It was a retrospective and prospective study at Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur in which data of patients with clinical diagnosis of MAP were reviewed from October 2014 to January 2016.Results: In this study of 10 cases of morbidly adherent placenta of Umaid hospital from October-2014 to January 2016 were studied, it was found that the mean age of presentation was 30.2 year. 60% cases were unbooked and 40% cases were booked with regular ANC visit. 60% cases presented with bleeding per vagina as a chief complaint and 30% cases were admitted for elective LSCS. 60% cases were already diagnosed case of placenta praevia. 90% cases had a history of previous LSCS. 80% cases were given BT intraoperatively and postoperatively. 60% cases underwent caesarean hysterectomy, 80% cases were shifted to ICU, and there was one maternal death.Conclusions: The incidence of MAP is increasing due to higher cesarean section (C/S) rate. Antenatal diagnosis via USG and color-doppler imaging, preoperative counseling, planning and multidisciplinary approach is necessary to reduce morbidity and mortality associated with MAP.
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Nahar, Kamrun, Hosna Akter, Summyia Nazmeen e Saria Tasnim. "Expectant Management of Severe Pre-eclampsia remote from term: Maternal and Perinatal outcome". Bangladesh Journal of Obstetrics & Gynaecology 32, n. 2 (19 luglio 2020): 73–78. http://dx.doi.org/10.3329/bjog.v32i2.48276.
Testo completoAbstract (sommario):
Background: Management of severe pre eclampsia remote from term remains one of the most difficult challenges in obstetric practice. Expectant management of early onset severe pre eclampsia improves neonatal outcome.
Methods: A prospective case series extending over five years peiod were recorded to evaluate the maternal and perinatal outcome of expectant management of severe preeclampsia presenting between 24-34 weeks of gestation in a tertiary referral center. All women (n=160) presenting with early onset (24-34 weeks of gestation) severe preeclampsia , where both the mother and the fetus were otherwise stable. Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Foetal surveillance included six hourly foetal heart rate monitoring, bi weekly non stress test and weekly USG evaluation.
Results: Mean number of days of prolongation of gestation was 6 days ( range 1-24days). The largest prolongation of pregnancy was recorded in patients with the lowest gestational age. Conservative management was associated with a 1.63% ( 17/160) intrauterine fetal loss rate. The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at <30 weeks. Increasing gestational age correlated with a reduction of RDS ( respiratory distress syndrome). Maternal morbidities were significantly higher among those managed at < 32 weeks. But there was no maternal mortality.
Conclusion: Good perinatal outcome and less risk to mother can be achieved at 30-34 weeks gestation.
Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 73-78
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Khalil, Adiba Akhtar, e Khurram Akhtar. "OPTIMIZING CLINICAL APPROACH TO THE FORM OF DELIVERY DURING PREGNANCY IN PATIENTS WITH CARDIAC DISEASE; A REVIEW OF THE EFFECTS OF PRACTICE CHANGE BY CONCURRING TO INTERNATIONAL GUIDELINES". PAFMJ 71, Suppl-1 (27 gennaio 2021): S92–96. http://dx.doi.org/10.51253/pafmj.v71isuppl-1.6201.
Testo completoAbstract (sommario):
Objective: To assess if adherence to international guidelines for pregnant cardiac patients’ mode of delivery is achievable with available local resources.
Study Design: Prospective quasi experimental descriptive study.
Place and Duration of Study: All Pregnant patients with cardiac disease reporting to Armed Forces Institute of Cardiac Disease/National Institute of Heart Disease (AFIC/NIHD) who were admitted for and were delivered from Oct 2009 to Sep 2011 were included in the study.
Methodology: International guidelines and recommendations for mode of delivery for cardiac patients with pregnancy were followed for patients. Caesarean sections were reserved only for obstetrical reasons and absolute cardiac indications. The patients with first trimester miscarriage were not included. Data was collected on a personal computer Microsoft excel sheet. Frequency was calculated from the data entered. The reduction in caesarean section rate and increase in vaginal delivery rate as per guidelines without an increase in maternal mortality, was the main outcome.
Results: Total of 221 patients were delivered in the 2 year period between October 2009 to September 2011 at AFIC/NIHD. The caesarean section rate the year before 2008-2009 had been 48.6%. After the change in practice by concurring to international guidelines, the caesarean section rate for the 2 year period dropped to 26.7%. The hospital maternal deaths were 5. This was slightly better to the year 2008-2009 which had 3 maternal deaths.
Conclusion: It’s possible to adhere to international recommendations and protocols for pregnant cardiac patients and achieve internationally comparable outcome in terms of mode of delivery without increasing current institutional maternal mortality rate with local hospital resources.
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Musta'in, Mukhamad, Sri Achadi Nugraheni e Untung Sujianto. "Analisis Sistem Program One Student One Client Pendampingan Ibu Hamil oleh Mahasiswa Keperawatan di Kota Semarang". Jurnal Manajemen Kesehatan Indonesia 5, n. 2 (31 agosto 2017): 104–10. http://dx.doi.org/10.14710/jmki.5.2.2017.104-110.
Testo completoAbstract (sommario):
Maternal mortality rate (MMR) and infant mortality rate (IMR) are one of the main indicators of a country's health status. MMR in Semarang was increasing since 2013 (107.95 per 100,000 live birth) become (128.05 per 100,000 live birth) in 2015. Various efforts have been made to handle the increase in maternal mortality rate in Semarang, one of them is OSOC program to accompany pregnant women. However, its implementation has not run optimally and encounters several obstacles. The purpose of the research was to analyze the input, process, and output aspects of the One Student One Client Program to accompany pregnant women by Nursing Students in Semarang. This was qualitative research with descriptive explorative approach through in-depth interview and focus of group discussion. The main informants were; Head of Health Section of Central Java Provincial Health Office and triangulation informant; 2 Heads of Public health services and 2 nurses / midwife coordinator, 2 Head of study program, 2 field supervisors, 14 nursing students and 7 pregnant women / postpartum. Data processed and analysed by content analysis method. The result showed that the input aspect: which was human resources, had been sufficient, but insufficient in funds, infrastructure facilities only in the form of modules, the policy had not been written and there was no memorandum of understanding / MoU between the health office and educational institutions.
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Geller, Stacie, Janet Moore, Elizabeth McClure, Shivaprasad Goudar, Sangappa Dhaded, Bhalachandra Kodkany, Sarah Saleem et al. "The Relationship between Body Mass Index in Pregnancy and Adverse Maternal, Perinatal, and Neonatal Outcomes in Rural India and Pakistan". American Journal of Perinatology 35, n. 09 (24 gennaio 2018): 844–51. http://dx.doi.org/10.1055/s-0037-1621733.
Testo completoAbstract (sommario):
Objective The objective of this study was to describe the relationship between early pregnancy body mass index (BMI) and maternal, perinatal, and neonatal outcomes in rural India and Pakistan. Study Design In a prospective, population-based pregnancy registry implemented in communities in Thatta, Pakistan and Nagpur and Belagavi, India, we obtained women's BMI prior to 12 weeks' gestation (categorized as underweight, normal, overweight, and obese following World Health Organization criteria). Outcomes were assessed 42 days postpartum. Results The proportion of women with an adverse maternal outcome increased with increasing maternal BMI. Less than one-third of nonoverweight/nonobese women, 47.2% of overweight women, and 56.0% of obese women experienced an adverse maternal outcome. After controlling for site, maternal age and parity, risks of hypertensive disease/severe preeclampsia/eclampsia, cesarean/assisted delivery, and antibiotic use were higher among women with higher BMIs. Overweight women also had significantly higher risk of perinatal and early neonatal mortality compared with underweight/normal BMI women. Overweight women had a significantly higher perinatal mortality rate. Conclusion High BMI in early pregnancy was associated with increased risk of adverse maternal, perinatal, and neonatal outcomes in rural India and Pakistan. These findings present an opportunity to inform efforts for women to optimize weight prior to conception to improve pregnancy outcomes.
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Ogundipe, Oluwatomisin M., Oluranti I. Olurinola e Adeyemi A. Ogundipe. "Health Interventions and Child Health in Sub-Saharan Africa: Assessing the Impact of the Millennium Development Goal". Journal of Sustainable Development 9, n. 1 (26 gennaio 2016): 187. http://dx.doi.org/10.5539/jsd.v9n1p187.
Testo completoAbstract (sommario):
The study investigates the role of health interventions on child health in developing Africa for the period 1990-2013 using a dynamic panel approach. Among others, the study examines the effect of millennium development intervention programme on child health outcomes. Our analysis reveals MDG intervention as extremely pertinent in reducing the incidence of child mortality in Africa. It implies that introduction of MDGs culminates into increasing the rate of child survival in Africa. Similarly, maternal literacy, maternal health and other child protective measures adopted were found to be statistically significant in improving child health outcomes. The proportion of under-five mortality (proxy for child health) responds more strongly and negatively to immunization coverage, exclusive breastfeeding and DPT vaccines. On the other hand, the quality of institution contributively impact under-five mortality in Africa. Finally, there is need to strengthen institutional arrangement, ensure compulsory basic education for women and strengthen the health system to achieve full packages of intervention, curtain the rising incidence of child deaths and attain the MDGs.
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Mayadeo, Niranjan M., e Sachi N. Shah. "Pregnancy outcome with hepatitis E infection". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, n. 2 (25 gennaio 2019): 467. http://dx.doi.org/10.18203/2320-1770.ijrcog20190269.
Testo completoAbstract (sommario):
Background: Hepatitis E is usually a self-limited viral infection in men and non-pregnant women, but during pregnancy it is associated with high maternal and perinatal mortality. This needs to be studied for early diagnosis and better management.Methods: The study commenced after the approval of Institutional Ethics Committee. This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology and Department of Medical Intensive Care Unit in present tertiary care hospital between February 2012 and July 2017. An analysis of 120 cases was made over a period of five years.Results: In this study the incidence of pregnant patients with hepatitis E was 3.09 per 1000 deliveries. It was found that majority of the patients which were diagnosed with hepatitis E were young and belonged to the age group of 21-25 years. Most of the affected patients were primigravida with increasing severity of the disease in their third trimester. The maternal morbidity was 51% with a mortality rate of 20%. The percentage of still birth was 25.64% with increased incidence of preterm deliveries and poor perinatal outcome.Conclusions: Early diagnosis and rapid management of the complications such as correction of abnormal coagulation and supportive management is the best treatment available at present. ICU admission and with strict maternal and foetal monitoring can help improve the outcome and thereby reducing the maternal and perinatal mortality.
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Khanum, Saima, Hafsa Hina e Muhammad Hanif. "A Review of Frequency and Pattern of Diseases among Patients in Pakistan". Pakistan Journal of Pharmaceutical Research 1, n. 2 (1 giugno 2015): 92. http://dx.doi.org/10.22200/pjpr.2015292-94.
Testo completoAbstract (sommario):
An important aspect of human life is a sound health. The chance of illness reduces with better health. It is proved that level of mortality, morbidity and infertility lowers with healthy life style. In healthy population the rate of diseases is minimum. Better health also improves school children attendance due to fewer leaves as comparative in illness. For better development of human resource investment should be done on health departments of the country (World Bank, 1993). In Pakistan health care system has been improved by view of physical infrastructure and manpower growth in both public and private setup. However, health care delivery system is not fulfilling the needs of fast growing population of the country. Maternal and infants mortality rate is still high as compared to its other neighboring countries. The conditions would be better by increasing budget allocation to the health sector.
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Onebunne, Chinedum A. C., e Christopher O. Aimakhu. "Prevalence and pregnancy outcomes in patients with antepartum haemorrhage in a tertiary hospital in Ibadan, Nigeria". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, n. 7 (29 giugno 2019): 2631. http://dx.doi.org/10.18203/2320-1770.ijrcog20193017.
Testo completoAbstract (sommario):
Background: Antepartum haemorrhage (APH) as one of the major obstetric emergencies contributing greatly to maternal and fetal morbidity and mortality is of serious concern in the developing world. A retrospective analysis of the APH cases and evaluation of its impact on fetal and maternal outcomes was conducted.Methods: A retrospective study of cases managed between January 2013 and December 2014 at the University College Hospital Ibadan; all cases at a minimum of 28 weeks of gestation with antepartum bleeding were selected. Data was retrieved from the hospital records.Results: Around 5.8% prevalence rate of APH was documented during the study period with placental abruption and placenta praevia accounting for 46.8% and 39.2% of these cases respectively. Only 28.5% of cases were booked. Three-fifths of the women had anemia, 17.7% suffered hypovolemic shock, 33.9% also had primary PPH while 4 out of every 10 (39.8%) were transfused with blood. Seven out of every ten premature deliveries (prior to 34weeks gestation) were due to placental abruption with p value of <0.001. There were 2 maternal deaths (1%), 61 (31%) still births and 11 (5.6%) early neonatal deaths giving a perinatal mortality rate of 35.6%.Conclusions: Antepartum hemorrhage was associated with poor maternal and neonatal outcome in this study. There is need to improve on infrastructures, such as functional blood banks, appropriate antenatal care and referral system in our health facilities to be able to cope with increasing challenges of this obstetric hemorrhage.
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Wulandari, Tri, e Ajib Susanto. "Deteksi Tingkat Risiko Kehamilan dengan Metode Fuzzy Mamdani dan Simple Additive Weighting". Jurnal Teknologi dan Sistem Komputer 6, n. 3 (31 luglio 2018): 110–14. http://dx.doi.org/10.14710/jtsiskom.6.3.2018.110-114.
Testo completoAbstract (sommario):
The risk of pregnancy is a contributing factor in increasing mother maternal mortality (MMR). This study aimed to produce a pregnancy risk detection system based on patient examination results. This research combines fuzzy Mamdani and Simple Additive Weighting (SAW) methods using 11 criteria to determine the risk of pregnant women, that is low, high, and very high. The criteria that determine the risk of pregnancy are expressed as fuzzy statements. In system testing to 100 pregnant women patients, obtained an accuracy of 88% using recognition rate method.
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Zacharasiewicz, Angela. "Maternal smoking in pregnancy and its influence on childhood asthma". ERJ Open Research 2, n. 3 (luglio 2016): 00042–2016. http://dx.doi.org/10.1183/23120541.00042-2016.
Testo completoAbstract (sommario):
Maternal smoking in pregnancy (MSP) is a large modifiable risk factor for pregnancy related mortality and morbidity and also the most important known modifiable risk factor for asthma.This review summarises the effects of MSP throughout infancy, childhood and adolescence with regards to asthma (development and severity). Firstly, the direct damage caused by nicotine on fetal lung development, fetal growth and neuronal differentiation is discussed, as well as the indirect effects of nicotine on placental functioning. Secondly, the effects of MSP on later immune functioning resulting in increased infection rate are summarised and details are given on the effects of MSP modulating airway hyperreactivity, reducing lung function and therefore increasing asthma morbidity.Furthermore, epigenetic effects are increasingly being recognised. These can also result in transgenerational detrimental effects induced by cigarette smoke.In summary, the causal relationship between MSP and asthma development is well documented and presents a major health problem for generations to come. The high prevalence of MSP is alarming and epigenetic effects of nicotine on immune functioning potentiate this danger. A considerable part of the increase in asthma prevalence worldwide is due to MSP.
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Batool, Asma, Mussarat Sultana e Saima Perveen. "Fetomaternal outcome in patients with previous one lower segment cesarean section, complications with repeat scar and trial of scar." Professional Medical Journal 26, n. 10 (10 ottobre 2019): 1600–1605. http://dx.doi.org/10.29309/tpmj/2019.26.10.217.
Testo completoAbstract (sommario):
Objectives: The aim of our study is to see the maternal and fetal outcome of pregnancies with previous one lower segment cesarean section. Study Design: Prospective study. Setting: Department of obstetrics and gynecology at DHQ Teaching Hospital Rawalpindi. Period: 1st July 2018 to 31st June 2018. Material and Methods: All pregnant women with previous one LSCS and at the gestation of more than 34 week are included after taking consent. Results: 258 patients were included. 132(51.2%) had elective LSCS, 106(41%) had emergency LSCS. 77(29.8%) patients actually took trial of scar, 20(25.9%) patients delivered vaginally. 179 (69.8%) patients had no maternal morbidity. 3(1.2%) patients had peripartum hysterectomy secondary to PPH due to placenta previa. The most common indication for emergency LSCS was fetal distress. The second commonest indication was failure to progress in first stage of labour. 248 (96.1%) of our neonates had good APGAR score(>7 at one minute).We had very low rate for NICU admission, only 10(3.9%) neonates were admitted to NICU. 4 neonates were premature, 5 neonates were admitted due to low birth weight and one with fetal hypoxia. Conclusion: Rate of repeat LSCS is increasing on maternal demand and fetal distress, by careful selection of the patients for VBAC, proper counseling and advanced facilities for monitoring of fetus, repeat LSCS rate can be decreased with associated decrease in maternal and perinatal morbidity and mortality. Comfortable environment and tender loving care during first delivery can decrease the number of patients with refused trial of labour.
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Siahanidou, Tania, Nick Dessypris, Antonis Analitis, Constantinos Mihas, Evangelos Evangelou, George Chrousos e Eleni Petridou. "Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study". BMJ Open 9, n. 8 (agosto 2019): e025287. http://dx.doi.org/10.1136/bmjopen-2018-025287.
Testo completoAbstract (sommario):
ObjectiveTo study trends of infant mortality rate (IMR) and neonatal mortality rate in Greece during the period 2004–2016 and explore the role of sociodemographic factors in the years of crisis.DesignNationwide individual data for live births and infant (0–11 months) deaths provided by the Hellenic Statistical Authority were examined using Poisson, joinpoint regression and interrupted time series (ITS) analyses.SettingGreece.ParticipantsAll infant deaths (n=4862) over the 13-year period, of which 87.2% were born to Greek mothers, and respective live births.Main outcome measuresEvolution of IMR (0–364 days), early (<7 days) neonatal mortality rate (ENMR), late (7–27 days) neonatal mortality rate (LNMR) and post neonatal (28–364 days) mortality rate (PNMR) trends, by maternal nationality, place of residence and Human Development Index (HDI).ResultsBy Poisson regression, overall, during the study period, among infants of Greek mothers, IMR and PNMR declined significantly (−0.9%; 95% CI −1.7% to −0.1% and −1.6%; −3.0% to −0.2% annually, respectively), although differentially by place of residence (IMRurban: −2.1%; −2.9% to −1.3%, IMRrural: +10.6%; 7.6% to 13.6%). By contrast, among infants of non-Greek mothers, the low starting IMR/ENMR/LNMR/PNMR increased significantly (max ENMR:+12.5%; 8.6% to 16.5%) leading to a non-significant time–trend pattern overall in Greece. The inverse associations of HDI with IMR, ENMR and PNMR were restricted to Greek mothers’ infants. Joinpoint regression analyses among Greek mothers’ infants indicated non-significant increasing trends of IMR and ENMR following the crisis (+9.3%, 2012–2016, p=0.07 and +10.2%, 2011–2016, p=0.06, respectively). By contrast, the high (+17.1%; 8.1% to 26.9%, p=0.002) IMR increases among non-Greek infants were restricted to 2004–2011 and equalised to those of Greek mothers’ infants thereafter. ITS analyses in preset years (2008, 2010, 2012) identified significantly increasing trends in IMR, LNMR and PNMR after 2012, and in ENMR after 2010, among Greek mothers’ infants.ConclusionsHDI and rural residence were significantly associated with IMR. The strongly decreasing IMR trends among Greek-mothers’ infants were stagnated after a lag time of ~4 years of crisis approximating the previously sharply increasing trends among non-Greeks.
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Liabsuetrakul, Tippawan, Jarawee Sukmanee, Jutatip Thungthong e Pisake Lumbiganon. "Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data". American Journal of Perinatology Reports 09, n. 04 (ottobre 2019): e328-e336. http://dx.doi.org/10.1055/s-0039-1697656.
Testo completoAbstract (sommario):
Abstract Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs (r= 0.20, p = 0.03) and birth asphyxia (r= 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.
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Dontsov, Vitaly I. "CHANGES OF MORTALITY AND RATE OF AGING IN THE SECOND HALF OF 20TH CENTURY IN RUSSIA". Health Care of the Russian Federation 63, n. 1 (24 maggio 2019): 42–47. http://dx.doi.org/10.18821/0044-197x-2019-63-1-42-47.
Testo completoAbstract (sommario):
Introduction. The deepening of medical and demographic problems associated with the sharp aging of the population is an obstacle to the effective socio-economic development of countries, determining the increased interest in the problem of aging. The aim of the study is to study the features and causes of changes in age mortality in Russia of the twentieth century. Material and methods. Used a table of survival for the 1960-2000 years for Russia to calculate the components of the formula of Gompertz, the intensity of mortality and its increments, using the Excel program, and developed the computer program “Aging of populations»; the adequacy of the calculated (according to the Gompertz formula) and true mortality rate was estimated by the correlation coefficient (“r”). Results. The data obtained clearly show the presence of 4 stages of mortality change: reduction of child mortality; increased mortality of working age (20-65 years); the same mortality of retirement ages (65-85 years); increased mortality in the ages of long-livers (from 85-90 years). Discussion. It can be concluded that the improvement of medical and social care for children and pensioners reduces child mortality and produces the phenomenon of “delayed mortality” of pensioners: reducing the intensity of mortality (the rate of aging) in this age period. The latter leads to the phenomenon of inversion of total mortality for ages of long-livers (from reduced to increased). Use instead of overall intensity of mortality of its increment leads to the conclusion however, that the decrease in the rate of ageing for the ages of centenarians persists. For working person age mortality is increasing, which is obviously due to the increasing stress and environmental difficulties of modern cities. During the pension period, mortality rates are equalized for all studied historical periods. The reduction of the external component of mortality of the Gompertz formula makes the graph more linear over a longer age period (the contribution of the external component of Makeham, the constant, to the exponential component of biological aging, decreases). Conclusion. The detected trends in mortality indicate the direction of preventive and socio-medical impact on the health of the population.
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Egic, Amira, Zeljko Mikovic, Dejan Filimonovic e Anka Cirovic. "Birth weight discordance and perinatal mortality among triplets". Srpski arhiv za celokupno lekarstvo 133, n. 5-6 (2005): 254–57. http://dx.doi.org/10.2298/sarh0506254e.
Testo completoAbstract (sommario):
INTRODUCTION. The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births. OBJECTIVE. The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality. METHOD A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clinic "Narodni Front" in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet's weight of more than 20%. RESULTS. The rate of triplets has increased by almost 75% between the first (7.7%) and the last (29.6%) 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treatment for infertility. In the period 1993-2003, there were a total of 40 triplet live births (24 weeks and greater) with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and disorders complicating pregnancy with birth discordance more than 20%. Regarding birth weight groups, statistical significance occurred only in the <999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120), and the neonatal (0-28 days) mortality rate was 9.1% (11/120). An odds ratio of 95% confidence interval shows 3 times greater risk for adverse perinatal outcome in the discordant group. However, the difference was not significant. CONCLUSION. Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal growth abnormality and discordance, which increase foetal surveillance, through the use of biophysical profiles, non-stress tests, and Doppler velocimetry, thus assessing foetal well-being and the appropriate moment for obstetric intervention.
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Almutairi, Wedad M. "Incidences of Atonic Postpartum Hemorrhage and Related Risk Factors at a Tertiary Hospital in Saudi Arabia". Nursing Reports 10, n. 2 (16 dicembre 2020): 164–71. http://dx.doi.org/10.3390/nursrep10020020.
Testo completoAbstract (sommario):
Background: In 2017, there were 295,000 maternal deaths worldwide from preventable causes related to birth. The leading cause of maternal mortality is obstetric hemorrhage. In Saudi Arabia, a paucity of evidence about incidences of atonic Postpartum Hemorrhage (PPH) and related risk factors exists. Therefore, aims were to (a) identify incidences of atonic PPH from 2015 to 2018 (b) determine risk factors of atonic PPH in vaginal birth. Methods: Retrospective chart review with purposive sampling conducted revealed 386 charts, 220 (57%) vaginal birth and 166 (43%) caesarian section (CS). Logistic regression analysis was used. Results: Incidences of atonic PPH were 2.5% from 2015 to 2017, with the rate increasing by 12% from 2017 to 2018. In vaginal birth, significant associations between the severity of blood loss with epidural (F = 6.314, df = 1, p = 0.013), episiotomy (F = 4.38, df = 1, p = 0.038), induction of labor (IOL) (F = 1.224, df = 1, p = 0.004), and Interaction between IOL, AUG, and epidural (F = 7.24, df = 1, p = 0.041) found. Discussion: Increasing rate of atonic PPH confirmed. Epidural, episiotomy, induction of labor, and induction with augmentation are factors associated with severe atonic PPH in vaginal birth.
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Astiannis, Rella. "JOHANNES LEIMENA DALAM KESEHATAN IBU DAN ANAK DI INDONESIA (1946-1956)". FACTUM: Jurnal Sejarah dan Pendidikan Sejarah 7, n. 2 (1 ottobre 2018): 203–14. http://dx.doi.org/10.17509/factum.v7i2.15606.
Testo completoAbstract (sommario):
Mother and child welfare are very important in every country and one of the most important issues that should have an attention from the Minister of Health. Because it will affect a country’s progress and resilience. To increasing mother and child welfare, a comprehensive act such as economic, social, and health itself need to be implemented. For a newly independent state, that was a difficult thing to be done. Likewise, Indonesia after gained independence which also dealt with difficulties in improving their society health particularly mother and child health where at that time mortality were very high. Coupled with Indonesia which was confronted the revolutionary era (1945-1956) after gained its independence. Dr Johannes Leimena as a Minister of Health of the Republic of Indonesia from 1946 to 1956 was the one who has responsibility for public health in that period. This research was intended to analyse on increasing mother and child’s programs under Johannes Leimena era which referred to historical research methods such as heuristic, criticism, and historiography. Based on the result, in1940-1950 Indonesia has a low rate of population growth and one of them was due to the high rate of maternal and child mortality. At that time, Indonesia experienced an economic crisis that must strive to provide primary health care for mothers and children in Indonesia. So in 1951, Dr Johannes Leimena established BKIA (Balai Kesejahteraan Ibu dan Anak or Mother and Child Welfare Center) as a solution to these problems. BKIA is a regional health service centre including providing counselling to mothers and children. In its implementation in Indonesia, the BKIA assisted by UNICEF as an international child protection institution, as well as the government and the community who also participated in succeeded in the program. With its consistency, BKIA as the frontline for maternal and child health services that also served public health can reduce population's mortality rates in Indonesia and even gave an impact on increasing public awareness of the importance of maintaining health.
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Jain, Shuchi, Pramod Kumar, Manish Jain, Megha Bathla, Shiv Joshi, Sushil Srivastava, Mahtab Singh, Ajit Sudke, Vikram Datta e Poonam Shivkumar. "Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India". BMJ Open Quality 10, Suppl 1 (luglio 2021): e001404. http://dx.doi.org/10.1136/bmjoq-2021-001404.
Testo completoAbstract (sommario):
Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.
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Helle, Samuli, Jon E. Brommer, Jenni E. Pettay, Virpi Lummaa, Matti Enbuske e Jukka Jokela. "Evolutionary demography of agricultural expansion in preindustrial northern Finland". Proceedings of the Royal Society B: Biological Sciences 281, n. 1794 (7 novembre 2014): 20141559. http://dx.doi.org/10.1098/rspb.2014.1559.
Testo completoAbstract (sommario):
A shift from nomadic foraging to sedentary agriculture was a major turning point in human evolutionary history, increasing our population size and eventually leading to the development of modern societies. We however lack understanding of the changes in life histories that contributed to the increased population growth rate of agriculturalists, because comparable individual-based reproductive records of sympatric populations of agriculturalists and foragers are rarely found. Here, we compared key life-history traits and population growth rate using comprehensive data from the seventieth to nineteenth century Northern Finland: indigenous Sami were nomadic hunter-fishers and reindeer herders, whereas sympatric agricultural Finns relied predominantly on animal husbandry. We found that agriculture-based families had higher lifetime fecundity, faster birth spacing and lower maternal mortality. Furthermore, agricultural Finns had 6.2% higher annual population growth rate than traditional Sami, which was accounted by differences between the subsistence modes in age-specific fecundity but not in mortality. Our results provide, to our knowledge, the most detailed demonstration yet of the demographic changes and evolutionary benefits that resulted from agricultural revolution.
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Hidayati, Ratna, e Dwi Setyorini. "Multi Level Education Katoga Improve The Competence of Health Cadres, Public Figure, and Family in Preventing, Early Detection and Handling Pregnancy Emergency". INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) 4, n. 2 (10 febbraio 2020): 118. http://dx.doi.org/10.24990/injec.v4i2.242.
Testo completoAbstract (sommario):
Introduction: Extraordinary policies have been launched by the government to reduce Maternal Mortality Rate/ Infant Mortality Rate (MMR/IMR) , however this has not been comparable with the expected results. The purpose of this study was to determine the effectiveness of Katoga's multi-level education on the competence of cadres, public figure, and families in preventing, detecting early and handling emergency pregnancy to reduce MMR/IMR. Methods: This research study used action research with stratified respondents, 10 health cadres who will provide training to 30 community leader respondents and subsequently public figure will provide training to 60 selected families with simple random sampling. The independent variable was multi-level education and the dependent variable was competence in early detection of emergencies in pregnancy. Data were collected using a questionnaire and analyzed by t-test. Results: The results showed that the increasing of the competence in preventing, early detecting and handling emergency pregnancy after receiving multilevel education training in health cadres from the previous value of 70 to 93; in community leaders from 61.1 to 80.5 and in families from 58.0 to 78.9. There was a significant increase in competency with multi-level education training in increasing competency in a larger population with a cadre pValue of 0.003; community leaders 0,000 and families 0,000. Conclusions: Community empowerment in the health sector through multi-level education can spread knowledge in preventing, detecting high-risk pregnancies early and managing maternal emergencies so as to facilitate the task of health nurses to obtain information about pregnant women detected as high-risk populations.
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Parvej, Md Iftakhar, Mimma Tabassum e Nelufa Aktar. "Preferences between Caesarean Section and Normal Vaginal Delivery among the reproductive women in Bangladesh". Journal of Applied Science, Engineering, Technology, and Education 3, n. 1 (28 settembre 2020): 82–89. http://dx.doi.org/10.35877/454ri.asci152.
Testo completoAbstract (sommario):
Amount of death due to pregnancy are gradually decreasing worldwide, among all of these estimated deaths, one-fifth of the maternal death recorded in southern Asia. The increasing rate of caesarean section (CS) delivery and the improved safety of surgical skill are the big reason of reduced pregnancy related mortality rate. Bangladesh has the increasing CS rate on southern Asia. This study aimed to identify the different factors affecting the increasing rate of CS in Bangladesh This cross-sectional survey was conducted between January 2020 - March 2020 among the married women at reproductive age (15-49 years age) having at least one under five years child of Dhaka and Noakhali district in Bangladesh. A questionnaire was designed to survey the preference of their delivery mode. Bivariate logistic regression analysis was performed to identify the factors. A total of 357 Bangladeshi women participated in the survey and 55.7% declared they would prefer normal vaginal delivery (NVD) and 37.3% had no clear preference. The actual scenario was the overall CS rate was 51.8% during 2015-2019. But it was very high (77.8%) for the 40 years and above women. The study revealed several important factors that significantly affect the increasing rate of CS for childbirth. Maternal age, religion, current place of residence, working status, monthly household income, birth order, marital age and year of childbirth were found to have significant effect on the high rate of CS. All those who have had face CS at least once in our study faced various problem, they reported. Most of them was feeling tired to do little work and suffered long term back pain. This study will help policy makers in formulating appropriate programs to cope with this challenge efficiently and effectively. Some Special programs should be taken to increase the social awareness and values to save both mother and child, which may lead to decrease the rate of CS in Bangladesh.
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Dharmawan, Yudhy, Atha Rifqia Pradana e Sri Winarni. "Factors Related to Utilization of Maternal Child Health Handbook Data by Midwives". Unnes Journal of Public Health 10, n. 2 (15 luglio 2021): 120–26. http://dx.doi.org/10.15294/ujph.v10i2.38408.
Testo completoAbstract (sommario):
Midwives are one of the health workers utilizing the MCH (Maternal Child Health) handbook which records the data used to prevent infant, under-five, and maternal mortality. This study aimed to investigate factors related to utilization of the MCH handbook data, namely individual, organizational, and operational techniques. Quantitative approach was used in a cross-sectional survey with a structured questionnaire. Thirty-one midwives were selected as the sample from Active Alert Village in Temanggung district with rural and urban area representative consideration. Besides, descriptive data were tabulated, and inferential analysis was conducted by Pearson product-moment correlation. Result showed the rate of MCH Handbook data utilization was 78.54%. Also, data requirement perception, data filling skill, motivation, attitudes of midwives and facilities availablity (p < 0.05) are significantly related. The MCH handbook data utilization was determined by the individual factor, but with no significant relationship to operational and organizational factors except facilities availability. Therefore, efforts are required to improve data utilization by increasing data requirement perception, data filling skills, motivation and midwives attitudes.
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Meshram, Rajkumar M., Ruchi A. Gedam, Shivangi Garg, Kalyani S. Kadu, Madhabika R. Chakraborty e Swaroop B. Kumar. "Predictors of mortality in extramural very low birth weight neonates: a prospective observational study". International Journal of Contemporary Pediatrics 8, n. 1 (23 dicembre 2020): 107. http://dx.doi.org/10.18203/2349-3291.ijcp20205515.
Testo completoAbstract (sommario):
Background: Over the past few decades, the burdens of very low birth weight (VLBW) preterm infants are increasing due to advances in obstetrics and perinatal services. Objectives of the study were to assess predictors of mortality of extramural VLBW neonates.Methods: Prospective one year cohort study was undertaken on VLBW neonates fulfilling the inclusion criteria at a tertiary institute. Maternal and neonatal demographic data were analyzed.Results: Male to female ratio was 1.26:1. One hundred and thirty seven (74.9%) neonates had birth weights from 1000-1499 g while 46 (25.1%) had birth weights <1000 g (ELBW) and 90% were preterm. One hundred and sixty five (90.2%) neonates were admitted in early neonatal period. Anaemia was the commonest maternal illness and preeclampsia/eclampsia was the most common obstetric complication. Respiratory distress, temperature instability and lethargy were common clinical presentations. Respiratory distress, sepsis and perinatal asphyxia were common diagnoses on admission. Mortality rate in VLBW neonates was 59.6% and respiratory distress was the commonest cause of death. Male gender (p=0.01), home delivery (p=0.04), vaginal delivery (p=0.05) and positive septic screen (p=0.003) had significantly higher mortality while mode of delivery (aOR 0.27 CI 0.086-0.83 p=0.02) and positive septic screen (aOR 4.0 CI 1.67-9.84 p=0.002) were independent risk factors for mortality.Conclusions: In extramural VLBW neonates, male gender, home delivery, vaginal delivery and positive septic screen had significantly higher mortality whilst mode of delivery and positive septic screen were independent risk factors for mortality.
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Sallout, Bahauddin, e Lawrence Oppenheimer. "The role of transvaginal ultrasound in the management of a low-lying placenta". Fetal and Maternal Medicine Review 13, n. 4 (novembre 2002): 261–75. http://dx.doi.org/10.1017/s0965539502000438.
Testo completoAbstract (sommario):
Placenta praevia is an uncommon but dangerous and occasionally fatal condition. It increases maternal, fetal and neonatal morbidity and mortality. Placenta praevia is one of the leading causes of third-trimester bleeding and the incidence of both placenta praevia and placenta accreta is steadily increasing due to the rising caesarean section rate. At delivery, women with placenta praevia have an increased risk of abruptio placenta, caesarean delivery, fetal malpresentation, postpartum haemorrhage and disseminated intravascular coagulation. Massive obstetric haemorrhage is still a leading cause of pregnancy-related deaths, and placenta praevia/accreta remains one of the major predisposing factors.
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Silva, Flávio Xavier, e Alex Sandro Rolland Souza. "Puerperal sepsis caused by liver abscess: case report". Revista Brasileira de Saúde Materno Infantil 17, n. 4 (dicembre 2017): 853–58. http://dx.doi.org/10.1590/1806-93042017000400013.
Testo completoAbstract (sommario):
Abstract Introduction: sepsis is a serious public health problem, affecting millions of people in the world each year, with a high mortality rate (one out of four patients) and an increasing incidence. Sepsis is one of the main causes of maternal mortality and an important cause of admission to obstetric intensive care units. Case description: In this study, the authors report the case of a woman having been submitted to cesarean section three days before presenting clinical signs of sepsis and septic shock caused by a liver abscess. The patient had a set of complications secondary to shock, such as thrombocytopenia, coagulopathy, toe ischemia and acute kidney failure. The patient had cholelithiasis and recurrent pain in the right hypochondrium during pregnancy. During hospitalization, the mechanism involved in the development of hepatic abscess was infection of the biliary tract. The patient was treated in an obstetric intensive care unit with antibiotics and drainage of the liver abscess. Progress was favorable and the patient was discharged in good health. Discussion: pyogenic liver abscess during pregnancy and puerperium is a serious condition which represents a diagnostic and therapeutic challenge, with few cases reported. The normally nonspecific clinical and laboratory findings can lead to a late diagnosis, which increases the risk of maternal morbidity and mortality.
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Dameria, Netty Katrina, Djaswadi Dasuki e Rukmono Siswishanto. "Analisis Angka Seksio Caesarea di RSUP Dr. Sardjito Yogyakarta Tahun 2009-2013". Jurnal Kesehatan Reproduksi 3, n. 1 (22 aprile 2016): 14. http://dx.doi.org/10.22146/jkr.36192.
Testo completoAbstract (sommario):
Background: Caesarean section is a procedure to reduce maternal and perinatal mortality and morbidity. The caesarean section rate is continuously uprising in the last 3 decades. However, the increasing rate, especially in low risk women, may compromise maternal and perinatal outcome. In 1985, WHO recommended that optimal national caesarean rates should be in the range of 5% to 10% and the rate above 15% might be less benefits. Previous study conducted in DR Sardjito hospital reported caesarean section rate in 1996 was 13.38%, while in 2001 was 18.39%. In national level, based on Indonesia Basic Health Survey 2010, caesarean section rate was 10.8%. Therefore, in this study we analyzed the rate of Caesarean section performed in DR Sardjito hospital, and studied whether the operations occurred in high-risk group or low-risk group.Objective: To compare the rate of caesarean section between high-risk group and low-risk group in DR Sardjito hospitalMethod: Retrospective cohortResult and Discussion: Participants of this study were 7821 patients undergoing labor at RSUP DR Sardjito in 2009-2013. Among them, 3152 patients underwent caesarean section and 4669 patients underwent vaginal delivery. There was an increasing in the overall caesarean section rate of 38,7% in 2009 to 43% in 2013. T-test found the presence of significant differences between the caesarean section rate of high-risk group and low-risk group in 2009-2013 (p<0.05) with a mean difference was 28.5 (20.2-36.8). Caesarean section rate of high-risk group was significantly higher than the low-risk group (p<0.05).Conclusion: There was a difference in caesarean section rate of high-risk group compared to low-risk group. Caesarean section rate in high-risk group was significantly higher than in the low-risk group.Keywords: caesarean section rate, caesarean section, low-risk group, high- risk group
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Kafle, Deepak Raj, e Prem Raj Pageni. "Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara". Medical Journal of Pokhara Academy of Health Sciences 3, n. 1 (9 ottobre 2020): 234–38. http://dx.doi.org/10.3126/mjpahs.v3i1.31918.
Testo completoAbstract (sommario):
Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage.
Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program.
Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute.
Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.