Antenatal Visits Research Articles

Factors Associated with Pulmonary Edema among Severe Pre-Eclamptic Women: A Case Control Study

Background: Pre-eclampsia remains an important cause of hypertensive acute pulmonary edema in pregnancy. Acute pulmonary edema, which signifies severe disease, is a leading cause of death in pregnant women with pre-eclampsia and a frequent cause of admission to intensive care unit. Objective: To examine pulmonary edema’s prevalence and associated factors among severe pre-eclamptic pregnant women. Materials and Methods: The present study was an analytic retrospective case-control study. Five hundred fifty-eight gestational-age pregnant women diagnosed with pre-eclampsia with severe features according to the ACOG 2013 guidelines delivered at Pattani Provincial Hospital between July 2021 and April 2023 were enrolled by retrospective review the hospital records. Four hundred severe pre-eclamptic women met the inclusion criteria. Fifty-one pregnant women with severe pre-eclampsia who developed pulmonary edema were included as cases, and 204 severe pre-eclamptic women who did not develop pulmonary edema were included in cases for a ratio of 1 to 4. The statistical analyses involved the two groups. Multiple logistic regression analysis, odd ratio, and 95% confidence interval (CI) were performed. Results: Among severe pre-eclamptic pregnant women, the associated factors for severe preeclamptic women decreased 69% (95% CI 0.1 to 0.9) with nulliparous, decreased 88% (95% CI 0.0 to 1.1) with the first blood pressure level of more than 180/120 mmHg, decreased 98% (95% CI 0.0 to 0.1) with epigastric pain as presenting symptoms. However, the associated factors for pulmonary edema increased 2.04 (95% CI 1.0 to 4.0) times with the number of antenatal care visits of less than eight times and increased 2.79 (95% CI 1.4 to 5.6) times with gestational diabetes mellitus. Conclusion: The prevalence of pulmonary edema among severe pre-eclamptic women was 12.75%. The factors associated with pulmonary edema among severe pre-eclamptic women included gestational diabetes mellitus and poor antenatal care of less than eight visits.

The Relationship Between Premarital Reproductive Counselling and Husband Support with Increased Coverage Pure K1 Maternity Visit Coverage

Purpose: This study aims to evaluate the relationship between premarital reproductive counselling and husband support with increased coverage of pure K1 pregnancy visits at Puskesmas Ajangale in 2022. Research Design and Methodology: This study used a correlation study design with a retrospective cohort approach. Secondary data were taken from medical records and observation results, while primary data were obtained through questionnaires. The study population included first trimester pregnant women who had first contact with health workers at Ajangale Health Centre, and the sampling technique was total sampling. Findings and Discussion: The results of the analysis showed that premarital reproductive counselling and husband support had a significant correlation with increased coverage of pure K1 visits. Of the respondents who participated in premarital counselling, the majority made a pure K1 visit. Similarly, respondents who received good support from their husbands tended to be more compliant in conducting pure K1 visits. The P=0.002 value indicates a significant association between these variables. Implication: This study confirms the importance of integrating premarital reproductive counselling programmes in public health policies to increase the coverage of antenatal care visits. Husband support also needs to be improved through education and active involvement in antenatal care. The findings provide valuable insights for health practitioners and policy makers in an effort to improve maternal and child health.

Wealth and education-related inequalities in the utilisation of reproductive, maternal, newborn, and child health interventions within scheduled tribes in India: an analysis of Odisha and Jharkhand

BackgroundThe utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than among the rest of the country’s population. The tribal population’s poorest and least-educated households are further denied access to RMNCH care due to the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand.MethodologyWe have constructed two summary measures, namely, the Co-coverage indicator and a modified Composite Coverage Index (CC), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsThe results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21) whereas in Jharkhand, the wealth- and education-related absolute and relative inequalities present a reduction between 2016 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation should be improved.InterpretationThe study results underscore the urgent need of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce inequalities in access to healthcare.

Pengaruh Ekonomi, Pengetahuan, Dan Pelayanan Petugas Kesehatan Terhadap Kunjungan Pemeriksaan Kehamilan Di Wilayah Kerja Puskesmas Cilebut

Introduction: A pregnancy check-up visit is a visit by a pregnant woman to a midwife or doctor as early as possible since she feels she is pregnant to get pregnancy services/care. Nationally in 2010, the K1 coverage was 95,26% and the K4 coverage was 85,56%. The economy, knowledge, and services of health workers are factors that influence prenatal care visits. This study aims to determine the effect of health workers' economy, knowledge, and services on antenatal care visits in the working area of ​​the Cilebut Health Center in 2022. Methods: The research method is a quantitative cross-sectional approach. The population in this study was 150 pregnant women who were in the working area of ​​the Cilebut Health Center. The research sample was determined based on the simple random sampling technique with the calculation of the Slovin formula so that a sample of 60 respondents was obtained. Results: The results showed that there was an influence of economics (p-value 0,035); knowledge (p-value 0,000); and health worker services (p-value 0.000) on antenatal care visits. Discussion: The study concludes that there is an economic influence, knowledge, and services of health workers on antenatal care visits in the working area of ​​the Cilebut Health Center in 2022. Suggestions for pregnant women are expected to increase knowledge and understanding for pregnant women so that they are more disciplined in conducting prenatal check-ups.

Conducting a diabetes mellitus prevention trial in women with GDM in Pakistan: a feasibility study

BackgroundWomen with gestational diabetes mellitus (GDM) are at a greater risk of developing type 2 diabetes mellitus (T2DM) than women without GDM. Despite this elevated risk, few trials on the prevention of T2DM among South Asian women with GDM have been reported. Therefore, this study aimed to assess the feasibility of conducting a diabetes prevention program on women with a history of GDM to inform the development of a contextually relevant definitive trial.MethodsUsing a randomized controlled trial, women with GDM (n = 180) who delivered at the study hospitals (one public and one private teaching hospital, Karachi) with fasting blood glucose levels < 120 mg/dl at 6 weeks postpartum were randomized to the intervention (n = 88) or control arms (n = 92). Women in the intervention group received individualized home-based educational sessions from trained community health workers at 0, 1, 3, 6, and 9 months. In addition, they received short text messages, prerecorded messages, and printed educational material (calendars and pamphlets) for reinforcement. The intervention was centered on equipping women with knowledge, skills, and confidence to eat a healthy diet rich in fruits, vegetables, and low-fat dairy products and perform regular physical activity based on walking and household chores to reduce weight (up to 5% of their initial body weight). Women in the control arm received standard care. The feasibility outcomes of the study included screening, recruitment, and retention rates and in-depth interviews at 6 months post-intervention to explore women’s experiences with the intervention. Descriptive analysis and thematic analysis were performed.ResultsOf the 324 women screened during the antenatal care visits and after delivery, 255 (78.7%) were contactable 6 weeks postpartum, and 180 (70.6%) were eligible and randomized to intervention (n = 88) and control (n = 92) groups. Loss to follow-up in the intervention and control arms was 22.7% (n = 20/88) and 18.5% (n = 17/92), respectively. Women expressed satisfaction with home-based counseling and follow-up visits, text message reminders, and printed material in the form of a calendar through our qualitative interviews.ConclusionsHome-based lifestyle modification intervention augmented with text messages and printed material is feasible. However, to evaluate the intervention’s effectiveness, a larger trial is warranted to assess its long-term impact on diabetes prevention.Trial registrationISRCTN, ISRCTN11387113. Registered 5 December 2017—retrospectively registered.

Chemokine and cytokine profiles in preterm and term labor, in preterm prelabor rupture of the membranes, and in normal pregnancy

The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal pregnancies. The second objective was to explore immune profiles in PTL for association with early ( < 34 gestational weeks (gw)) or instant ( < 48 h) delivery.This prospective observational multi-center study included women with singleton pregnancies with PTL (n = 80) or PPROM (n = 40) before 34 gw, women with normal pregnancies scheduled for antenatal visits (n = 44), and women with normal pregnancies in active labor at term (n = 40). Plasma samples obtained at admission were analyzed for cytokine and chemokine quantification using a multiplex bead assay in order to compare the immune profiles between PTL, PPROM, and normal pregnancies.In PTL, CXCL1 and CCL17 were significantly higher compared to gestational age-matched women at antenatal visits, whereas for PPROM, CXCL1 and IL-6 were increased. Women in term labor had a more pronounced inflammatory pattern with higher levels of CXCL1, CXCL8, and IL-6 compared with PTL (p = 0.007, 0.003, and 0.013, respectively), as well as higher levels of CCL17, CXCL1 and IL-6 (all p < 0.001) compared with the women at antenatal visits. In PTL, CXCL8 was higher in women with delivery before 34 gw, whereas CXCL8, GM-CSF, and IL-6 were significantly higher in women with delivery within 48 h.To conclude, PTL and PPROM were associated with a complex pattern of inflammation, both involving Th17 (CXCL1) responses. Although further studies are needed, CXCL8, GM-CSF, and IL-6 may be potential candidates for predicting preterm birth in PTL.

Utilisation of postnatal care services among maternal in Maeen District – Sana’a City, Yemen

BackgroundOne of the most effective ways to reduce maternal and neonatal mortality is to improve mother and newborn health via the provision of appropriate postnatal care services by qualified healthcare providers. However, there is limited information on the use of postnatal care services in Yemen. This study aimed to determine the utilisation of postnatal care services among mothers in Yemen.MethodologyA descriptive cross-sectional study was conducted in the Maeen District of Sana’a City, Yemen from December 2022 to January 2023. Convenience sampling was employed to recruit 321 participants. Semi-structured questionnaires were applied as the study tool in the face-to-face survey.ResultLess than half (45.2%) of the study participants utilised postnatal care services in this study. The mode of delivery, place of delivery, and receiving information about postnatal care during antenatal visits were significantly associated with postnatal care service utilisation.ConclusionLess than half of the study participants were informed about postnatal care services, contributing to their low utilisation. Thus, it is vital to strengthen the provision of information, education, and communication with regard to postnatal care services among pregnant mothers visiting antenatal clinics.

Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study

BackgroundMalnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda.MethodsA comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1.ResultsA total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers’ age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd − 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher.ConclusionsThe comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.

Incidental intra-abdominal pregnancy diagnosed at Singida regional referral Hospital, Central zone, Tanzania: Case report

Background: Intra abdominal pregnancy is one of the rare and life-threatening types of ectopic pregnancy which has been implanted in the peritoneal cavity outside of the uterus, fallopian tube and ovary. An embryo that implants and starts to grow on the viscera or abdominal peritoneum is described as a primary abdominal pregnancy. This article will create awareness of capturing all ectopic pregnancies from the lower level to the higher level health facilities in the country so as to know the magnitude of this problem. Case Description/ Presentations: A 22 years pregnant woman, from mpambaa, kaselya, singida region, the central zone of Tanzania, G2P1L1 with Gestational Age (GA) of 41 weeks and 2 days (by LNMP) was referred from the lower level facility to Singida Regional Referral Hospital for further management, with the referral diagnosis of Intrauterine fetal demise/death(IUFD) diagnosed based on patient history (mother reported absence of fetal kicks) and physical examination(FHR not heard on fetoscope). Diagnosis of intra-abdominal pregnancy based on incidentally intra-operatively findings . The intra-operatively findings concluded the diagnosis of intra-abdominal pregnancy. The patients didn’t do obstetric ultrasound throughout the antenatal visits because the facility she was used to attending Antenatal clinic had no ultrasound. Conclusion and Recommendation: Capacity building to health practitioners in identifying and diagnosing intra-abdominal pregnancy based on clinical manifestations and radiological diagnostic features should be done to all health facilities levels.

Assessment of a Community-Based Nutrition Program for Women and Children in Nepal Using Demographic and Health Survey.

Undernutrition is a particularly acute problem in middle- and low-income countries. The "Suaahara" program is a 5-year community-focused program in Nepal, aimed at improving the health and nutrition of pregnant and lactating women and their children under the age of 2 years. This research contributes to evidence on the impact of the "Suaahara" program in 41 treated districts compared to 34 control districts. Using the difference-in-differences method, we found that the weight-for-height z-score and body mass index z-score of children under the age of 2 in the treated districts significantly increased by 0.223 standard deviations (SDs) and 0.236 SDs, respectively, compared with the control districts 5 years before and after the program. The number of antenatal care visits (at least four visits) and safe deliveries significantly increased for pregnant women by 10.4% and 9.1%, respectively, in the treated districts compared with the control districts. The prevalence of fever in children under 2 years of age was significantly reduced by 6.2% in the treated districts. The results show the significance of a policy evaluation with transparent indicators on public health, which is necessary for policymakers so that they can propose evidence-based policy.

Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic.

To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

The impact of a reproductive health voucher in Uganda using a quasi-experimental matching design

This study assesses the impact of a voucher project that targeted vulnerable and poor pregnant women in Uganda. Highly subsidised vouchers gave access to a package of safe delivery services consisting of four antenatal visits, safe delivery, one postnatal visit, the treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. Vouchers were sold during the project’s operational period from 2016 to 2019. This study covers 8 out of 25 project-benefiting districts in Uganda and a total of 1,881 pregnancies, including both beneficiary and non-beneficiary mothers. Using a matching design, the results show a positive effect on the survival of new-born babies. The difference in the survival rate between the control group and the treatment group is 5.4% points, indicating that the voucher project reduced infant mortality by more than 65 per cent.

Magnitude and associated factors of thrombocytopenia, among pregnant women at Mizan Tepi university teaching hospital south west Ethiopia

BackgroundThrombocytopenia in pregnancy is a common multifactorial abnormality of the hematological system, next to anemia. It leads to more increased risk of bleeding during delivery, labour, or the postpartum period. Despite being a significant public health concern, there are limited studies done concerning thrombocytopenia during pregnancy.ObjectiveTo assess the magnitude and associated factors of thrombocytopenia among pregnant women at Mizan Tepi University Teaching Hospital from September 2023 to November 2023.MethodsAn institutional-based cross-sectional study was carried out on 230 systematic randomly selected pregnant women who attended antenatal visits from September 2023 to November 2023 G.C using data collection tools. The pretested structured questionnaires were employed to obtain clinical, nutritional, and sociodemographic information. Additionally, three millilitres of venous blood were collected from each participant and analyzed using a Sysmex hematology analyzer. The data was entered into Epidata version 4.6 and analyzed using STATA version 14. Descriptive statistics were computed, and logistic regression was used to identify predictors with a significance level of less than 0.05.ResultsTwo hundred thirty pregnant women participated in the study. Among study participants, the magnitude of thrombocytopenia was 55(24.35%) with 32 (57.14%) mild, 19 (33.93%) moderate, and 5 (8.93%) severe thrombocytopenia. The determinant factors which shown significant association were Malaria parasite infection (AOR 9.27 at 95% CI 7.42, 10.87), one-year Inter-birth interval (AOR 1.7 at 95% CI 1.24, 2.14), History of abortion (AOR 3.94 95% CI 3.13, 4.86), History of hypertension (AOR 3.12 95% CI 1.56, 4.12), HIV infection (AOR 1.81 95% CI 1.32.2.52) and HBV infection (AOR 3.0 95% CI 2.82, 3.34).ConclusionThrombocytopenia is a public health problem and mild type of thrombocytopenia was the most predominant. The determinant factors that showed significant association with thrombocytopenia were Malaria Parasitic infection, one-year Inter-birth interval, History of abortion, History of hypertension, HIV infection, and HBV infection. Therefore, pregnant women should be continuously screened for thrombocytopenia to avoid excessive bleeding. Increasing Inter-birth interval, preventing abortion as well as timely diagnosis and treatment of underlying causes such as malaria infection, hypertension, HBV, and HIV is important to reduce the burden of thrombocytopenia.

Awareness, Acceptability and Uptake of Cervical Cancer Screening among Pregnant Women in Ekiti State, Nigeria.

Background: Cervical cancer is a significant global public health concern, particularly in developing countries. Antenatal care visits provide a unique opportunity to educate and screen women for cervical cancer. This study was undertaken to explore the awareness and acceptability of cervical cancer screening among antenatal attendees. Methods: This study was a descriptive cross-sectional survey of 422 pregnant women attending antenatal clinics at the Ekiti State University Teaching Hospital using a self-administered structured questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 software. Results: Of the 410 respondents who returned completed questionnaires, 61.7% had heard about cervical cancer, and only 40.3% reported awareness of the screening modalities. Healthcare providers were the primary source of information about screening methods in 59.0%. Approximately half agreed that information about cervical cancer screening during antenatal care would be beneficial. 90.5% had never undergone cervical cancer screening. Multivariate analysis shows that 32.4% of our clients who were aware of the cervical screening modalities before the current pregnancy had never been screened. OR 0.578, CI (0.036-9.321), p-value 0.699. 3.20% and 4.40.0% were aware and had done cervical cancer screening once and twice respectively before the current pregnancy. OR 1.444, CI(0.080-26.230); p-value 0.804 and OR 4.667, CI (0.223-97.497); p-value 0.321 respectively. Conclusion: The study highlights a concerning gap between awareness and practice of cervical cancer screening among pregnant women in Ekiti State, Nigeria.

Associations between Antenatal Care Visit Attendance and Infant Mortality and Growth.

This study examines the association between antenatal care (ANC) attendance and infant mortality and growth outcomes. The study used data from the Nouveux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) trial conducted in Burkina Faso. This analysis included 21,795 neonates aged 8 to 27 days who were enrolled in the trial and had ANC data available. Infants were followed until 6 months of age. The analysis adjusted for potential confounders including infant's sex, maternal age, education, urbanicity, geographic region, season (dry versus rainy), pregnancy type (singleton versus multiple), number of previous pregnancies, if the infant was breastfed, and if the facility had an onsite physician to account for level of care. We used logistic and linear regression models to evaluate the association between ANC visits and all-cause infant mortality and infant growth measurements at 6 months. There was no significant association between ANC visits and 6-month mortality. Higher ANC attendance was associated with improved growth outcomes in infants at 6 months of age. After adjusting for potential confounders, each additional ANC visit was associated with a 0.03 kg increase in mean weight, 0.07 cm increase in mean length, 0.04 SD increase in mean mid-upper-arm circumference, 0.04 SD increase in mean height-for-age, 0.04 SD mean weight-for-age, and 0.02 SD mean weight-for-length Z-scores. These mean differences were statistically significant (except for weight-for-length Z-scores) but may not be clinically meaningful. Further research is warranted to explore the relationship between ANC attendance and longer-term health outcomes among infants.

Attitudes and Behaviors Around Preventative Measures Against Malaria During Pregnancy in The Luwero District of Uganda

Background: In Uganda, the rate of malaria in pregnancy ranges from 8.9-50% depending on the level of transmission within the region. It is estimated that malaria may contribute to 8-14% of low birth weight, 3-8% of infant mortality, and 3-15% of maternal anemia. There is limited information on the attitudes and behaviors of pregnant women related to malaria prevention-health impacts for the child, including infant and maternal death. Methods: A cross-sectional study was conducted in June of 2023. A structured interview was used to collect data on demographics, attitudes, and preventative behaviors related to malaria during pregnancy. Interviews conducted in participants’ homes took approximately 50 minutes. Descriptive statistics were run for demographic data. Chi-squared test and Pearson Product Moment Correlation with a significance level set at p &lt; 0.05 were conducted to test relationships between variables of interest. Results: Data were collected from 63 women with a mean age of 37. All women had at least one pregnancy resulting in a live birth. Almost one-third of women (31.7%, n = 20) reported getting malaria during their most recent pregnancy. Most respondents (82%, n = 52) received prenatal care and 87.3% (n = 55) used at least one prevention measure against malaria during their last pregnancy. For the participants that reported not protecting themselves (12.7%, n = 8) it was found to be statistically significant in preventing malaria (χ2 = 9.744, p = .008). Bed net use was found significant in preventing malaria during pregnancy (χ2 = 7.113, p = .029) and SP/Fansidar (χ2 = 46.534, p = &lt; .001) during their most recent pregnancy. Receiving prenatal care was found to be significant (χ2 = 24.186, p = &lt;.001). Education level was also found to be significant in to whether women received prenatal care (χ2 = 14.634, p = .023) and in the attitudes that pregnant women should receive malaria treatment during pregnancy (χ2 = 17.084, p = .009). Conclusion: This study sheds light on the attitudes and behaviors surrounding preventative measures against malaria during pregnancy among a sample of women in rural Uganda. The study emphasizes the need for targeted health campaigns to promote bed net use, addressing barriers to IPTp implementation, and advocacy for improved policy change and antenatal care attendance. Improving access to prenatal care services, particularly in rural communities, is needed to keep women and children healthy. Implications for Practice: Recognizing the challenges related to policy implementation, there is a pressing need to advocate for policies that support effective prevention strategies during pregnancy. Advocacy efforts should be directed towards improved policy implementation and encouraging regular antenatal care visits.

Predictors of neonatal mortality among neonates admitted to NICU at Dubti General hospital, Northeast Ethiopia

BackgroundIn Ethiopia, despite various strategies and interventions being implemented, the rate of neonatal mortality remains high. Despite numerous published articles in Ethiopia, there is a lack of sufficient data regarding the time to death and its predictors in neonatal mortality, especially in pastoral communities like the Afar region. Therefore, this study aims to evaluate neonatal mortality and its predictors among neonates admitted to the neonatal intensive care unit at Dubti General Hospital, Northeast Ethiopia. MethodWe conducted a facility-based retrospective follow-up study, involving a sample of 479 neonates admitted to the neonatal intensive care unit at Dubti General Hospital. Data entry was performed using Epi-Data version 4.6, and subsequent analysis was carried out using STATA version 14.1. To identify predictors of neonatal mortality, we applied the Cox-proportional hazard model. ResultsOut of the total, 87 neonates (18.16 %) passed away. The overall incidence of neonatal mortality was 27.2 deaths per 1000 neonate-days spent in the neonatal intensive care unit, with a 95 % confidence interval of [21.8, 34.2]. Appearance, pulse, grimace, activity, and respiration score less than or equal to 5 [AHR = 0.33, 95%CI: 0.07, 0.62], respiratory distress syndrome [AHR = 3.22, 95%CI: 1.71, 6.07], Neonatal hypothermia [AHR = 3.12, 95%CI: 1.31, 7.42]. No initiation of breastfeeding [AHR = 3.68, 95%CI: 1.44, 9.36], no antenatal care visits [AHR = 0.25, 95%CI: 0.13, 0.48] and maternal birth related complication [AHR = 2.71, 95%CI: 2.43, 11.14] are predictors. ConclusionThe mortality rate was notably high, with several factors identified as independent predictors of newborn death, including Appearance, pulse, grimace, activity, and respiration, respiratory distress syndrome, hypothermia, initiation of breastfeeding, antenatal care visits, and maternal birth-related complications. There is a pressing need for intensified programming efforts aimed at improving child survival within healthcare facilities, particularly addressing neonatal complications. Enhancing prenatal care during pregnancy and early detection and treatment of intrapartum disorders are recommended strategies for enhancing newborn health outcomes.

Ophthalmic artery Doppler in women with hypertensive disorders of pregnancy: relationship to blood pressure control and renal dysfunction at 6-9 weeks postnatally.

To examine the postnatal course of ophthalmic artery (OA) Doppler in women with hypertensive disorders of pregnancy (HDP) and to evaluate the correlation between OA Doppler parameters and poor postnatal blood pressure control and renal dysfunction at 2-3 weeks and 6-9 weeks postnatally. This was a prospective cohort study of women with a singleton pregnancy and HDP seen at a tertiary pregnancy hypertension clinic between 2019 and 2021. Three visits were included: Visit 1, the last visit to the antenatal hypertension clinic within 2 weeks prior to delivery; Visit 2, at 2-3 weeks postnatally; and Visit 3, at 6-9 weeks postnatally. At each visit, maternal demographic characteristics, medical history, blood pressure and OA Doppler were obtained. In addition, fetal growth and fetal Dopplers were examined antenatally and, at 6-9 weeks postnatally, estimated glomerular filtration rate and proteinuria were quantified. Study participants were divided into four hypertension groups, according to longitudinal changes in blood pressure at the three visits. For the postnatal visits, hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg in the absence of antihypertensive medication, and SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg whilst taking antihypertensives. Group 1 was hypertensive at all three visits; Group 2 was hypertensive at Visits 1 and 2 but normotensive at Visit 3; Group 3 was hypertensive at Visits 1 and 3 but normotensive at Visit 2; and Group 4 was hypertensive at Visit 1 but normotensive at Visits 2 and 3. The longitudinal changes in mean arterial pressure (MAP), peak systolic velocity (PSV) 1, PSV2 and the ratio of PSV2/PSV1 over the three timepoints were examined by a repeated-measures, multilevel, linear mixed-effects analysis, controlling for maternal age, weight at presentation and use of antihypertensive medication. In addition, we examined the longitudinal change in OA Doppler parameters in women with different degrees of postnatal blood pressure control and in those with and those without renal dysfunction at 6-9 weeks postnatally. A total of 108 women were recruited to the study, of whom 86 had new-onset hypertension and 22 had chronic hypertension. When controlling for maternal age, weight at presentation and use of antihypertensive medication, a significant decline in log10 MAP (P < 0.001), log10 PSV1 (P < 0.001) and log10 PSV2 (P = 0.01) was seen between Visits 1 and 3. Log10 PSVR did not change with time. When assessing OA Doppler against hypertension group, log10 PSV1 and log10 PSV2 did not differ between the hypertension groups, whilst Group 4 had a lower log10 PSVR compared with Group 1 (P < 0.01), Group 2 (P = 0.03) and Group 3 (P < 0.01). At 6-9 weeks postnatally, log10 PSVR was lower in those without compared to those with renal dysfunction (-0.021, P = 0.01), whilst log10 MAP, log10 PSV1 and log10 PSV2 values did not differ. Log10 PSVR did not change with time and remained at -0.12 (95% CI, -0.13 to -0.11) across the three visits. In women with HDP, the OA-PSVR was significantly higher in those with labile or persistently raised blood pressure postnatally compared to women whose blood pressure normalized. Similarly, the OA-PSVR at 6-9 weeks postnatally was significantly higher in women with renal dysfunction vs those without dysfunction. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study

BackgroundEarly antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.MethodsAn institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.ResultsThe median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.ConclusionHalf of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

Pregnant Women's Knowledge about Bleeding and The Adherence to Antenatal Visits

Physiological and psychological changes during pregnancy can run normally if the mother is able to adapt to these changes. If there is a failure to adapt or there are other factors that affect the health of the mother during pregnancy, complications will arise. One of the abnormal complications during pregnancy is bleeding. To determine the relationship between the knowledge of pregnant women in the third trimester of signs of bleeding during pregnancy with compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. Using a quantitative study with a cross sectional approach to 30 third trimester pregnant women with a purposive sampling technique. Data analysis using Chi-Square. The study was conducted in October-November 2020. The research instrument used a questionnaire made by the researcher about signs of bleeding during pregnancy. The results showed that the characteristics of the respondents were mostly aged 20-35 years (93.3%), primigravida (56.7%), secondary education (60%), less knowledgeable (60%), and obedient to antenatal visits (76.7%). The results of the bivariate analysis obtained p-value=1,000. There is no significant relationship between the knowledge of pregnant women in the third trimester of signs of bleeding during pregnancy and compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. With this research, it is hoped that health workers, especially nursing staff, can provide information on the importance of adherence to antenatal visits to prevent risks for pregnant women, especially related to bleeding.