Birth-related Complications Research Articles

Knowledge and practice of birth preparedness and complication readiness among pregnant women attending antenatal clinic in Openzinzi Hciii, Adjumani District, Uganda.

IntroductionEvery day, approximately 830 women globally die from pregnancy-child birth related complications and all maternal deaths are mainly due to the three phases of delay usually experienced in maternal care which originates from inadequate or lack of birth and emergency preparedness. Despite the benefit of Birth Preparedness and Complications Readiness (BPACR) in the reduction of the three phases of delay and thus reduction of maternal deaths and complications, no study has been conducted in Adjumani district to assess the knowledge and practice of birth preparedness and complication readiness, thus our objective was to assess the knowledge and practice of Birth Preparedness and Complications Readiness (BPACR) among pregnant women attending antenatal clinic at Openzinzi Health Centre (HC) III in Adjumani District.MethodsA descriptive cross sectional study design with a sample of 80 respondents was used for the study. Simple random sampling was used to select the respondents in the study area. A research administered questionnaire was used for data collection.ResultsMost of the respondents (27.5%) were in the age group of 26-35 years. The majority 43.75% ended at primary level of education, 50% were unemployed, and the majority 71.25% and 70% knew identifying skilled birth attendants and health facilities respectively as components of BPACR. 76.25% of the respondents mentioned vaginal bleeding and 62.5% over vomiting as danger signs in pregnancy while 12.5% did not know any danger sign in pregnancy. 76.25% identified place for skilled birth, 66.25% identified skilled birth attendant, and only 15% identified blood donor.ConclusionThe practice of BPACR was poor among the pregnant women attending antenatal care at Openzinzi Health Centre III in Adjumani District. The knowledge about BPACR was higher among the educated respondents involved in the study.

Prevalence and Outcome of Preterm Births in the National Referral Hospital in Bhutan: An Observational Study.

Preterm birth-related complications are the leading cause of under-5 mortality globally. Bhutan does not have a reliable preterm birth rate or data regarding outcome of preterm babies. To determine the preterm birth rate at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, Bhutan, and assess their outcomes. All live preterm births at JDWNRH from 1 January 2017 to 31 December 2017 were followed from birth till hospital discharge. Maternal demographic data, pregnancy details and delivery details were collected. Morbidity and mortality information as well as discharge outcome were collected on babies admitted to neonatal intensive care unit (NICU). Preterm birth rate among live births was 6.4%. Most mothers were younger than 30 years, housewives and had secondary education. Pregnancy registration rate and adequacy of antenatal visits were high. Most preterm births were singleton and the predominant mode of delivery was cesarean section. More than half of the births were initiated spontaneously, and the male:female ratio was 1.2:1. Most babies were late preterm and low birth weight. Half of them required NICU admission. Overall mortality rate was 11% and 21.6% for admitted preterm neonates. Preterm small-for-gestational-age neonates, and those born after provider-initiated preterm birth had significantly increased risk of mortality. Most preterm neonates were discharged without complications. The rate of extrauterine growth restriction was high. This is the first study on the prevalence of preterm births and their outcomes in the largest tertiary-care hospital in Bhutan.

Neonatal arterial blood gases & immediate outcome following perinatal asphyxia.

Background: Perinatal asphyxia (PNA) remains a significant cause of death and disability despite the important advances in perinatal care in the past decades. Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. Estimates of the incidence of perinatal asphyxia vary, in resource-rich countries is about 1/1000 live births and in resource-poor countries is probably much more common, an incidence of 5–10/1000 live births and represents the second most common cause of neonatal death (24%) after preterm birth related complications (35%). About one quarter of all neonatal deaths globally are caused by PNA & an equal number of serious neurological consequences ranging from cerebral palsy & mental retardation to epilepsy.
 Objective: To determine how well neonatal arterial blood pH and base deficit predict immediate outcome (survival to discharge) following perinatal asphyxia.
 Methods: This was a prospective study conducted in the delivery room and adjacent neonatal area (NICU) of Ad-din Medical College Hospital (AMCH), over 6 months from 1st June and 30th November, 2017. Research assistants were trained to observe and record events related to labor and neonatal resuscitation. Patient information was obtained which included patient characteristics (gender, birth weight & gestational age) and APGAR scores at and beyond 5 minutes. Within one hour of delivery all admitted neonates were subjected to an arterial blood gas (ABG) analysis by GEM Premier 3000 blood gas analyzer and pH and base deficit were noted. All the neonates were classified according to GA, BW and Gender. After proper cleaning the collected data were analyzed thoroughly. Descriptive analyses were performed; differences in outcome by GA, BW, Gender, APGAR scores and ABG (pH and base deficit) status were determined using analysis of variance. Analyses were performed using the Statistical Package for Social Sciences (SPSS) version (Chi-Square test).
 Results: A total 50 neonates were studied in this period of which 72% survived & 28 % expired. Death was mostly observed in neonate who had very high level of base deficit (> 20mmol/L) & very low pH (pH <7.0) in 1st hour postnatal ABG. Survival rate was higher, 94.7% in >35 - <37 weeks GA group in comparison of >37 weeks (58%) of GA (p = 0.0050). The neonates with birth weight (BW ) >2000 - <2500 gm were observed 77.78% survival and 68.75% in neonates with BW >2500gm (p = 0.494). In this study most of the neonates were male (70%) & recovery rate was relatively better among baby boys (74.3%) than baby girls (66.67%) (p = 0.582). High APGAR score neonates had better rate of recovery than poor APGAR score neonates. The neonates with APGAR score 4-6 beyond 5 minutes were observed 88.33% survival & the neonates with APGAR score 0-3 beyond 5minutes were 55% survival (p= 0.028). High pH value neonates in 1st hour ABG were found higher rate of survival in comparison to low pH value neonates. It was 83.33% in pH 7.10- <7.20 neonates, 72.73% in pH 7.0- <7.10 neonates and 33.33% in pH <7.0 neonates respectively (p=0.0136). The neonates with high level of base deficit in 1st hour ABG showed lower rate of survival than low level of base deficit neonates. It was 12.5% in base deficit > 20mmol/L neonates, 33.33% in base deficit > 15 - 20mmol/L neonates & 87.18% in base deficit > 12 -15mmol/L neonates respectively (p=0.00003).
 Conclusion: From this study it is concluded that initial pH and base deficit of 1st hour ABG of neonates along with APGAR score at or beyond 5 minutes is a good predictor of risk & immediate outcome following perinatal asphyxia. A good percentage of neonates recover due to early diagnosis, meticulous nursing care and timely intervention.
 Bangladesh Journal of Medical Science Vol.18(2) 2019 p.238-243

Implementation of gestational weight gain guidelines - what\u2019s more effective for ensuring weight recording in pregnancy?

BackgroundPregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, evidence-practice gaps often exist. To address pregnancy weight management barriers, a stepped implementation science approach was used, comprising targeted in-services, provision of scales for clinic rooms, and changes to routine weight recording in a hospital electronic medical record. The aim of this study was to assess the cumulative influence of evidence-based interventions on staff’s compliance to recording of antenatal weights.MethodsRetrospective data analysis of weight recording over three 15-month cohorts across April 2014–December 2017. Variables calculated from data included: proportion of women with weight recorded at booking and proportion of women who had a weight recorded at each visit. Generalised estimating equation modelling was used to examine differences in weight recording compliance rates between cohorts, pre-pregnancy body mass index categories, model of care and clinicians.ResultsThere were approximately 13,000 pregnancies in each cohort. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts from 4.2% (baseline), 18.9% (scales and in-services) to 61.8% (medical record prompts), p < 0.001.ConclusionSignificant improvements were achieved through systematic barrier analysis and subsequent mapping and implementation of appropriate and effective interventions. Improvements were observed across the entire service, in all models of care with all professional groups demonstrating increased recording of weights.

Institutional Delivery Service Utilization and Associated Factors Among Women in West Central Ethiopia

Pregnancy and child birth related complications are main causes of death and disability among women of childbearing age in developing countries. The Sub-Saharan Africa accounts for more than half of the global maternal deaths and most of these deaths occur during labor and following child birth from preventable causes that can be averted by professional intervention. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in West Central Ethiopia. A community based cross-sectional study was conducted from January 10 to February 10, 2014. Quantitative data were collected using a structured questionnaire and analyzed using SPSS V.20.0. Descriptive statistics were used to present the data and logistic regression was applied to check the association between the dependent and independent variables. A total of 410 women were included in the study of whom70.7% had given birth their last baby at health facilities. Women with secondary and above educational status (AOR [95%CI] = 4.525 [95% CI: 1.831-11.180]), those who had an access to Radio and TV (AOR [95%CI] = 3.214 [1.361-7.591]), women from families with average monthly income greater than 1,000.00 Ethiopian Birr (AOR [95%CI] = 3.300 [1.555-6.999]), and women who had antenatal care follow up during their last pregnancy (AOR [95%CI] = 2.409 [1.088-5.335]) were more likely to utilize institutional delivery service. In conclusion, a significant number of women did not give birth their last baby at health facilities. Maternal educational status, access to mass media, family income status and antenatal care visit were important predictors of institutional delivery service utilization. Increasing Health Extension Workers’ involvement in improving community awareness, and women empowerment through education and economic development are important measures to improve institutional delivery service utilization.

A facility-based study of women\u2019 satisfaction and perceived quality of reproductive and maternal health services in the Kenya output-based approach voucher program

BackgroundThis is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients’ perspective.MethodAn exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed.ResultsClients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact.ConclusionMajority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client’s perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients’ level of satisfaction.

Descriptive Epidemiology of Congenital Clubfoot Deformity in Sri Lanka.

A retrospective descriptive study was conducted, based on database of Sri Lanka Clubfoot Program, under theInternational Clubfoot Registry. Patients with Clubfoot deformity treated at Orthopaedic unit of Lady Ridgeway Children's Hospital (LRCH), Sri Lanka were evaluated from June 2012 to March 2015. There were a total of 354 patients with male: female ratio of 2.7:1. Bilateral deformity was detected in 48% (171) with positive family history in 14% (49). Majority was hospital births (95%) and 14% were preterm deliveries-pregnancy, and birth-related complications were found in 28.5% (101) and 11% (39), respectively. Cause of clubfoot was idiopathic in 87% (309) and syndromic in 13%. None of the mothers were smoker; three mothers have consumed alcohol during pregnancy. No significant associations among sex of the patient, laterality of clubfoot and the cause of the clubfoot, and there was no seasonal variation among births of clubfoot patients.

Increased Risk of Peripartum Perinatal Mortality in Unplanned Births Outside an Institution: A Retrospective Population-Based Study

(Abstracted from Am J Obstet Gynecol 2017;217:210.e1–210.e12) Birth-related complications require immediate and skilled care. Studies have debated whether care is better (safer and less expensive) in smaller or larger institutions, but conclusive studies on the effects of births occurring outside institutions have not been done.

Alterations in inter-alpha inhibitor protein expression after hypoxic-ischemic brain injury in neonatal rats

Hypoxic-ischemic (HI) brain injury is frequently associated with premature and/or full-term birth-related complications that reflect widespread damage to cerebral cortical structures. Inflammation has been implicated in the long-term evolution and severity of HI brain injury. Inter-Alpha Inhibitor Proteins (IAIPs) are immune modulator proteins that are reduced in systemic neonatal inflammatory states. We have shown that endogenous IAIPs are present in neurons, astrocytes and microglia and that exogenous treatment with human plasma purified IAIPs decreases neuronal injury and improves behavioral outcomes in neonatal rats with HI brain injury. In addition, we have shown that endogenous IAIPs are reduced in the brain of the ovine fetus shortly after ischemic injury. However, the effect of HI on changes in circulating and endogenous brain IAIPs has not been examined in neonatal rats. In the current study, we examined changes in endogenous IAIPs in the systemic circulation and brain of neonatal rats after exposure to HI brain injury. Postnatal day 7 rats were exposed to right carotid artery ligation and 8% oxygen for 2h. Sera were obtained immediately, 3, 12, 24, and 48h and brains 3 and 24h after HI. IAIPs levels were determined by a competitive enzyme-linked immunosorbent assay (ELISA) in sera and by Western immunoblots in cerebral cortices. Serum IAIPs were decreased 3h after HI and remained lower than in non-ischemic rats up to 7days after HI. IAIP expression increased in the ipsilateral cerebral cortices 24h after HI brain injury and in the hypoxic contralateral cortices. However, 3h after hypoxia alone the 250kDa IAIP moiety was reduced in the contralateral cortices. We speculate that changes in endogenous IAIPs levels in blood and brain represent constituents of endogenous anti-inflammatory neuroprotective mechanism(s) after HI in neonatal rats.

Physical Activity Assessment During Gestation and Its Outcomes: A Review.

Physical activity recommendations emphasize a positive influence of exercise on health. It is particularly recognized during pregnancy for both the mother and fetus. This review aims to identify the main trends of activity undertaken by women during gestation and to find out how it affects the expecting mother and her child. Review of the literature comprising the following databases: PubMed, Academic Search Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, EMBASE (2000 to May 2013), used detailed search strategies. The review was restricted to experimental studies. Trials were excluded if they met any of the following criteria: reviews, letters, commentaries or editorials, only abstracts available, and any kind of pathology during pregnancy. Three assessors reviewed the titles, abstracts, and full articles using standardized data abstraction forms, and they assessed the study quality. A total of 474 potential articles remained for analyses. Twenty-eight articles were eligible for inclusion in the present review: randomized controlled trials and observational studies that evaluated maternal and offspring outcomes as a result of physical activity during pregnancy. Quasi-randomized trials were excluded. The activities that were most frequently assessed included occupational activity, housework/caregiving, sport/exercise, and active living, as well as habits. The authors evaluated different types of physical activity in the loading conditions. The aerobic activities most frequently used for assessment included treadmill walking program; step aerobics or stair stepper; aerobics; bicycle ergometer; combination of rowing, stationary cycling, and walk jogging; rhythmic calisthenics class and step class; brisk walks; stretching; and relaxation. The benefits following being active during pregnancy are associated with improved maternal psychological well-being, a reduced risk of preterm birth and excessive gestational weight gain, and lower risk of birth-related complications. Patterns of activity change during pregnancy. Although exercise is safe for both the mother and fetus, most women reduce their activity level during the first weeks of gestation. Specifically, physical activity tends to be of lower duration, frequency, and intensity. Therefore, women should be encouraged by professionals to initiate or continue exercising during a healthy pregnancy.

INTER-ACT: prevention of pregnancy complications through an e-health driven interpregnancy lifestyle intervention \u2013 study protocol of a multicentre randomised controlled trial

BackgroundExcessive maternal pre-pregnancy and gestational weight gain are related to pregnancy- and birth outcomes. The interpregnancy time window offers a unique opportunity to intervene in order to acquire a healthy lifestyle before the start of a new pregnancy.MethodsINTER-ACT is an e-health driven multicentre randomised controlled intervention trial targeting women at high risk of pregnancy- and birth related complications. Eligible women are recruited for the study at day 2 or 3 postpartum. At week 6 postpartum, participants are randomised into the intervention or control arm of the study. The intervention focuses on weight, diet, physical activity and mental well-being, and comprises face-to-face coaching, in which behavioural change techniques are central, and use of a mobile application, which is Bluetooth-connected to a weighing scale and activity tracker. The intervention is rolled out postpartum (4 coaching sessions between week 6 and month 6) and in a new pregnancy (3 coaching sessions, one in each trimester of pregnancy); the mobile app is used throughout the two intervention phases. Data collection includes data from the medical record of the participants (pregnancy outcomes and medical history), anthropometric data (height, weight, waist- and hip circumferences, skinfold thickness and body composition by bio-electrical impedance analysis), data from the mobile app (physical activity and weight; intervention group only) and questionnaires (socio-demographics, breastfeeding, food intake, physical activity, lifestyle, psychosocial factors and process evaluation). Medical record data are collected at inclusion and at delivery of the subsequent pregnancy. All other data are collected at week 6 and month 6 postpartum and every subsequent 6 months until a new pregnancy, and in every trimester in the new pregnancy. Primary outcome is the composite endpoint score of pregnancy-induced hypertension, gestational diabetes mellitus, caesarean section, and large-for-gestational-age infant in the subsequent pregnancy.DiscussionINTER-ACT is a unique randomised controlled lifestyle intervention trial in its implementation between pregnancies and during the subsequent pregnancy, with an e-health driven approach.Trial registrationClinicalTrials.gov Identifier: NCT02989142. Registered August 2016.

Institutional delivery service utilization and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji Zone, Oromia, Southern Ethiopia: a cross sectional study

BackgroundGlobally, an estimated 289,000 maternal deaths occurred in 2013. Majority of these deaths occurred in sub-Saharan Africa and Southern Asia. Mobility of pastoralists is a well-recognized survival strategy in arid and semi-arid land of sub-Saharan Africa. However governments often encourage settlement as a solution to the difficulty of providing health services for mobile pastoralists. This study aimed to assess utilization of institutional delivery and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji zone, Oromia, Ethiopia.MethodsA Community based cross-sectional survey was conducted among the mobile pastoralist community of the Liban District. Seven hundred ninety-one (791) randomly selected women, who had birth within the last 2 years preceding the survey, were interviewed using a pretested structured questionnaire. Data were entered into Epi-Info version 3.5.4 and analyzed by Statistical Package for Social Science (SPSS) version 16. Bivariate and multivariate analyses were done.ResultsOut of 791 women who gave birth within the last 2 years preceding the survey, only 110 (13.9%) gave birth in health institutions. Majority (74.1%) of the women gave birth at their home. Ninety-one women (11.5%) gave birth at traditional birth attendant’s home; assisted by traditional birth attendants. Multiple logistic regression shows that women who had readily available cash at the onset of labor (aOR 2.79, 95% CI: 1.29–6.25), delivered the birth preceding the most recent birth in a health institution (aOR 6.8, 95% CI: 3.44–13.45) and had birth related complications during the birth preceding the most recent birth (aOR 1.90, 95% CI: 1.08–3.36) were more likely to deliver at health institutions.ConclusionMajority of the pastoral women seek institutional delivery, only when labor related complications are perceived. Mechanisms of alleviating indirect health care costs affecting institutional delivery need to be addressed in future studies.

Maternal and Newborn Health Care Practices in Rural Bangladesh

Maternal and child health indicators have improved in Bangladesh but still pregnancy and child birth related complications are the leading causes of death of mother and children. Practices associated with these mortality reductions are not followed similarly throughout the country. This descriptive study was carried out to examine the prevalence of maternal and newborn-care practices in the rural area of Bangladesh. Face to face interview was conducted to collect data using closed end questionnaire from the purposively selected 589 women of reproductive age having at least one child. SPSS version 16 software was used for computation and analysis of data. Among the respondents, 58.4% received ANC visits but only 32.3% had completed minimum required visits ( 3). Effective immunization of mothers against tetanus was 93.3%. Home delivery incidence was 72.3 % and 92.2% of all deliveries were attended by trained health professionals. Only 17.0% got PNC visits. Birth weight recording coverage was only 34.5%. Maternal and newborn health care practices could not be eulogized for low coverage of ANC, PNC, birth weight recording and high incidence of home delivery. Recommendations were made to improve the quality of MCH service and service providers and to strengthen the motivational program for community participation.KYAMC Journal Vol. 5, No.-1, Jul 2014, Page 453-457

Nutrition promotion messages: The effect of information on consumer sensory expectations, experiences and emotions of vitamin A-biofortified sweet potato

Vitamin A deficiency (VAD) is a major public health problem in many developing countries globally. It is estimated that 250 million children under the age of five years suffer from clinical VAD. The effects of VAD include eye damage, weakened immunity and general increases in the incidence and severity of infectious diseases and mortality associated with e.g. birth-related complications, measles and diarrhoea among children. Biofortification is an essential strategy to alleviate VAD by incorporation of micronutrients into food staples through conventional breeding processes. However, vitamin A biofortification involves changes in other product attributes such as colour and taste that may be undesirable to some consumers. This study investigated how information about vitamin A biofortification influences the expected and actual sensory evaluation and the emotions evoked through actual tasting. For this, 501 randomly selected caregivers of children aged less than five years or pregnant women in western Kenya participated in a field information experiment combined with sensory testing of vitamin A-biofortified orange-fleshed sweet potato (OFSP). Surprisingly, the results showed that detailed information about nutritional benefits decreased consumer acceptance. Information about attribute drawbacks had discriminatory effects only in relation to expected taste and experienced texture. The findings indicated that the appropriateness of the nutritional aspect of OFSP was related to the information treatment and to household food insecurity status, but not to income or age of participants. An EmoSemio profile indicated a positive effect of nutrition information on emotions that did not correspond to the sensory assessment. These results raise important questions relating to how nutrition information should be provided to generate consumer acceptance and adoption of OFSP.

Preterm Birth and Hypertension: Is There a Link?

Factors in perinatal life have recently been recognized as determinants of later life health and diseases, especially hypertension. The detection of higher values of blood pressure in preterm-born individuals reaching adulthood has turned the attention to preterm birth-related complications and deleterious conditions as factors triggering early cardiovascular alterations, which may increase hypertension risk and associated complications in this population. Further, preterm birth is frequently associated with pregnancy complications such as lower placental perfusion, increased blood pressure in the mother and preeclampsia, often resulting in intrauterine growth restriction. These conditions further impact the risk of hypertension in the offspring whether through inherited genetic factors or perpetuated pathophysiology leading to preeclampsia, preterm delivery, and chronic hypertension. In this review, we will highlight evidence of developmental cardiovascular alterations and potential mechanisms linking preterm birth to the risk of hypertension and cardiovascular diseases into adulthood.

Prevalence of Home Delivery and Factors associated among women who gave Birth in the last two years in Tulla Sub City, Hawassa, Southern Ethiopia, 2014

Introduction : Maternal morbidity and mortality is concern throughout the world. Pregnancy and birth related complications are among the leading causes of maternal deaths. Even though increasing number of births given in health institution with the assistance of health care provider is considered basic to improve the bad outcomes the situation is worse in Ethiopia. As intervening for improvement needs sound understanding this research work aimed to assess prevalence of home delivery and associated factors among births given in the last two years in Tulla sub-city, Hawassa, Southern Ethiopia, 2014. Methodology : A community based cross-sectional study design was employed. By using simple random sampling technique 83 mothers were selected and interviewed with semi-structured questionnaire. Data was analyzed using descriptive statistics and chi-square test. Result : Prevalence of home delivery was found being 32 (38.5%). Wish to give birth with the presence of relatives, short duration of labor and non-kind care of health workers were commonly reported reasons for home delivery. Educational status of the women (X 2 =16.71, df=3ap-value <0.001), household monthly income(X 2 =5.11, df=2ap-value <0.05) and receiving ANC follow up (X 2 =16.25,df=2, p-value <0.01) and distance of health institution from home (X 2 =24.90 , df=1 , p-value <0.001) were significantly associated with place of delivery. Conclusion : Prevalence of home delivery was less than regional figure and in country research findings. Wish to give birth with the presence of relative, short duration of labor and non-kind behavior of health care providers were common reasons of home delivery. Women educational status, household monthly income, ANC follow up and distance are associated with place of delivery. Even though home delivery prevalence is low in the study area it is considerable as the country is with motto of no maternal death. Due emphasis better be given to improve women educational status, household income, attendance of ANC and distance. Further research could also be conducted with large sample size and statistics showing strength and direction of association.

Maternofetal Trauma in Craniosynostosis.

Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis. Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications. Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05). In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor. Risk, IV.

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.

BackgroundHigh quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions.Methods and FindingsGlobal maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.ConclusionsAs facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.

Factors associated with Institutional delivery in Boricha district of Sidama zone, southern Ethiopia

&lt;p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;"&gt;Every year, 40 million women give birth at home without the help of a&lt;br /&gt;skilled birth attendant. In 2011, 287,000 women died during pregnancy or childbirth. Almost all these deaths occur in developing countries where mothers and children lack access to basic health care. Reports showed the low utilization of health facility for delivery service in Ethiopia. This study aimed to determine the utilization and factors influencing institutional delivery. Community based cross sectional study was conducted from January to February 2013/14 in Boricha District of Southern Ethiopia among mothers who gave birth in the last 1 year. Multistage sampling techniques were used to collect data from 546 mothers. Taking in to account place of birth for the last child, only 4.9% women gave birth in a health facility. Women’s education level (AOR=4.4 (95% CI=1.36-14.33)), timing of firstANC visit (AOR= .03 (95% CI=0.004 - 0.205)), women’s advice to deliver in a health facility during ANC (AOR = 31.15 (95% CI=2.02-479.52)), women’s knowledge of birth related complications (AOR= 12.4 (95% CI=2.67-57.16)) and decision making power (AOR=0.2 (95% CI=0.060.82)) showed significant association with institutionional delivery. Institutional delivery in the study area was found to be very low. Raising awareness on institutional delivery to maximize delivery service utilization and strengthening provision of education and counseling to deliver in health facility during antenatal care visits at individual and community level should be given due emphasis.&lt;/p&gt;

Factors associated with Institutional delivery in Boricha district of Sidama zone, southern Ethiopia

&lt;p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;"&gt;Every year, 40 million women give birth at home without the help of a&lt;br /&gt;skilled birth attendant. In 2011, 287,000 women died during pregnancy or childbirth. Almost all these deaths occur in developing countries where mothers and children lack access to basic health care. Reports showed the low utilization of health facility for delivery service in Ethiopia. This study aimed to determine the utilization and factors influencing institutional delivery. Community based cross sectional study was conducted from January to February 2013/14 in Boricha District of Southern Ethiopia among mothers who gave birth in the last 1 year. Multistage sampling techniques were used to collect data from 546 mothers. Taking in to account place of birth for the last child, only 4.9% women gave birth in a health facility. Women’s education level (AOR=4.4 (95% CI=1.36-14.33)), timing of firstANC visit (AOR= .03 (95% CI=0.004 - 0.205)), women’s advice to deliver in a health facility during ANC (AOR = 31.15 (95% CI=2.02-479.52)), women’s knowledge of birth related complications (AOR= 12.4 (95% CI=2.67-57.16)) and decision making power (AOR=0.2 (95% CI=0.060.82)) showed significant association with institutionional delivery. Institutional delivery in the study area was found to be very low. Raising awareness on institutional delivery to maximize delivery service utilization and strengthening provision of education and counseling to deliver in health facility during antenatal care visits at individual and community level should be given due emphasis.&lt;/p&gt;