Comprehensive Obstetric Care Research Articles

Anesthetic considerations for fetal interventions

Fetal therapy is a well-established but rapidly evolving field discipline. Fetal interventions require a multidisciplinary team approach that emphasizes collaboration and communication. The success of a fetal therapy program relies on the availability of a comprehensive obstetric and neonatal care team, support services, and advanced imaging. Technological advancements in prenatal fetal imaging and genetic diagnosis have improved our understanding of various fetal anomalies. Surgical techniques and anesthetic management have also advanced, leading to better outcomes. Fetal anesthesia presents unique challenges as it involves managing both the mother and the fetus. Anesthetic management focuses on ensuring maternal safety and comfort, maintaining adequate uteroplacental perfusion, optimizing surgical conditions, and minimizing risks for both the mother and the fetus. This article reviews current anesthesia practices for fetal surgery, highlighting recent advances and future directions.

Maternal Status during and after Labor Beyond 28 Weeks of Gestation at a Tertiary Hospital

Background: The journey of pregnancy and childbirth embodies a critical period in a woman's life, impacting both maternal and child well-being. Understanding maternal status during and after labor beyond 28 weeks of gestation holds significant clinical relevance, given its implications for obstetric management and outcomes. Objective: This study aimed to assess maternal status during and after labor beyond 28 weeks of gestation at a tertiary hospital. Methods: A cross-sectional descriptive observational study was conducted at Mymensingh Medical College Hospital from March 2019 to August 2019. The study included pregnant women with fetal malpresentation from 28 to 42 weeks of gestation admitted to the labor and antenatal ward. A total of 50 participants were purposively sampled. Data were collected using a structured questionnaire and analyzed using SPSS version 16. Ethical approval was obtained, and informed consent was obtained from all participants. Results: The study revealed a diverse age distribution among mothers, with the majority falling within the 26-30 age bracket (40.0%). Parity distribution showed a significant proportion of mothers with four or more children (40.0%). Prolonged labor emerged as the most common complication (6.0%), followed by obstructed labor (4.0%). Maximum vaginal deliveries occurred at 28-31 weeks of gestation, while cesarean sections were predominant at or above 36 weeks. Cesarean section exhibited the highest survival frequency (100%), followed by vaginal delivery (90%) and assisted breech delivery (80%). Postpartum hemorrhage was the most common maternal morbidity (6.0%). Conclusion: In conclusion, our study sheds light on maternal demographics, labor complications, delivery modes, and perinatal outcomes at a tertiary hospital. The age distribution revealed diversity, with most mothers aged 26-30. Many were multiparous, underscoring the importance of obstetric history. Prolonged labor was predominant, emphasizing the need for vigilant monitoring. Cesarean sections were common after 36 weeks, ensuring higher survival rates. Despite benefits, postpartum hemorrhage posed a significant concern. This highlights the necessity for comprehensive obstetric care to improve maternal and neonatal outcomes. Further research is imperative to refine maternal-fetal care in tertiary settings.

Fertility and pregnancy outcomes in women with Turner syndrome: A single centre experience.

Many women with Turner syndrome (TS) will consider fertility options and pregnancy. We wished to examine the fertility and pregnancy outcomes in women with TS undergoing oocyte donation (OD) treatment or spontaneous pregnancy in a large single-centre cohort. General population reference dataor data from those with idiopathic premature ovarian insufficiencywere used as comparators. A retrospective single-centre cross-sectional study. Seventy-four women with TS underwent OD treatment with a total of 105 pregnancies, and 31 women with TS had 71 spontaneous conceptions. Fertility outcomes included clinical pregnancy and live birth rate. Pregnancy outcomes included miscarriage rate, prevalence of hypertension, gestational diabetes, lower segment caesarean section (LSCS), small for gestational age (SGA), prematurity and vertical transmission of TS. In those with TS, OD pregnancies were associated with increased rates of LSCS and SGA compared to spontaneous pregnancies; LSCS (OR: 4.19, 95% CI: 1.6-10.8,p = .003) and SGA (OR: 2.92, 95% CI: 1.02-8.38,p = .04). There were no recorded cardiac events but 5 (17.2%) cases of vertical transmissions of TS in daughters were identified. OD in those with TS was associated with a lower live birth rate per cycle started (OR: 0.53, 95% CI: 0.34-0.84,p = .008) and a higher rate of miscarriage compared to women with POI (40% vs. 26.2%,p = .04). We show that pregnancy in women with TS, whether OD or spontaneously conceived, carries obstetric risks, and therefore, women with TS, considering pregnancy, should receive comprehensive pre-pregnancy counselling and optimal obstetric care.

A Pregnant Patient with Sjögren’s Syndrome and non-Hodgkin Lymphoma: A Case Report

Background: Sjögren's syndrome is an autoimmune disease primarily affecting women around the age of 50, but can also occur in women of reproductive age, leading to serious maternal-fetal complications during pregnancy. The exact cause of this condition is not entirely understood, however, it is assumed to attack the exocrine glands, leading to impairment of their function. Additionally, an increased risk of developing lymphomas, particularly non-Hodgkin lymphoma is recognized among affected patients. Objective: To illustrate the management of pregnancy in a patient with Sjögren's syndrome and non-Hodgkin's lymphoma and the achievement of obstetric success without maternal-fetal complications. Case report: In the article, a 36-year-old pregnant patient with Sjögren's syndrome history, two miscarriages, and non-Hodgkin's lymphoma is presented. Due to unexpected pregnancy, the patient discontinued lymphoma treatment. Through the pregnancy, fetal well-being, blood flow, and maternal health were meticulously monitored, showcasing successful obstetric management. Due to Sjögren's syndrome, fetal atrioventricular conduction was monitored weekly from the 16th to the 30th week, showing no abnormalities. Additionally, during the course of pregnancy gestational diabetes, cervical insufficiency treated with pessary insertion, anemia and thyroid insufficiency were diagnosed. Multidisciplinary care addressed these issues, allowing our patient to give birth to a healthy child at 37 weeks via cesarean section. Conclusion: Pregnancies in Sjögren's syndrome patients pose elevated risks due to the presence of antibodies causing tissue damage and complications. These antibodies contribute to fetal myocardial issues and congenital heart conditions. Regular fetal heart ultrasounds, especially for those positive for Ro/SS-A antibodies, are crucial between the 16th and 31st weeks. Maternal-fetal complications include a higher risk of preterm delivery and lower birth weight of the offspring, often due to fetal growth restriction. Additionally, considering the potential for oncohematologic disorders in adults, comprehensive obstetric care is essential for minimizing complications risk.

Effect of Decision-to-Delivery Time of Emergency Cesarean Section on Adverse Newborn Outcomes at East Gojjam Zone Public Hospital, Ethiopia, March 2023: Multicenter Prospective Observational Study Design.

An emergency cesarean section requires prompt delivery to reduce the risk for a pregnant woman or newborn. Studies have been conducted to investigate the relationship between decision-to-delivery time and neonatal outcomes, but the findings are contradictory. Therefore, this study aimed to assess the average of decision-to-delivery time of an emergency cesarean section and its effect on adverse neonatal outcomes at East Gojjam Zone Public Hospital. A multicenter prospective study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 352 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. Measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05. Decision-to-delivery time interval within 30 minute was seen in 21.9% of emergency cesarean delivery. The study found a significant relationship between the first-minute low Apgar score and the delayed decision-to-delivery time interval (OR = 2.6, 95% CI: 1.1-6, p = 0.03). In addition, determinant factors for poor 1st-minute Apgar scores include danger signs during pregnancy (AOR: 2.9, 95% CI: 1.1-7.8, p = 0.03), women referred from another facility (AOR: 2.6, 95% CI: 1.5-4.6, p = 001), and non-reassuring fetal heart rate (AOR: 4.2, 95% CI: 1.1-17, p = 0.04). A delayed decision-to-delivery time interval is not statistically significantly associated with a low 5th-minute Apgar score or neonatal intensive care unit (NICU) admission. The study found unfavorable 1st-minute Apgar score and a longer decision-to-delivery period than recommended. This duration and negative newborn outcomes may be reduced by increasing and involving comprehensive obstetric and neonatal care facilities with skilled emergency obstetric surgeons, such as clinical midwife, integrated emergency surgeon officers, and physician.

The Association of Federal Medicaid Abortion Funding Restrictions With Adverse Obstetric Outcomes Among United States Medicaid Recipients

(Abstracted from Contraception 2023;126:110116) Obstetric care in the United States is predominantly paid for by Medicaid, which covers nearly half of all births. An essential component of comprehensive obstetric care is legal, safe abortion, and restricted access to such procedures is related to increased maternal mortality and morbidity.

ARV Therapy in Integrated Pregnancy Care For Pregnant Women With HIV/AIDS and Anemia

Background: HIV / AIDS was still a syndrome to be very wary of in Southwest Papua. HIV/AIDS with Anemia has been associated with advanced disease in pregnant women (provide a citation). Management during pregnancy is one of the benchmarks for the welfare of mothers and babies. Medical treatment includes comprehensive obstetric care to support the pregnancy. The purpose of this study is to report on the management of obstetric care in a pregnant woman with HIV/AIDS and anemia. Method: This research followed 36-year-old female patient who became pregnant for the 4th time, reportedly visited a community health center because she was dizzy, weak, and easily tired during pregnancy, had a risk of alcohol consumption, and was an active smoker. Result: Hemoglobin (Hb) content is 10.5 gr/dl, which is below the healthy range (Mayo Clinic-citation). Since the beginning of pregnancy has not been in contact with health workers. Conclusion: ARVs that are quick, accurate, consistent, and long-lasting can help lessen the impact of HIV and anemia because it can inhibit the virus and reducing its activity.

Asuhan Kebidanan Komprehensif Pada Ny “ P “ Umur 27 Tahun Di Puskesmas Kairatu Kabupaten Seram Bagian Barat Tahun 2023

The period of pregnancy, childbirth, perurperium, newborns are circumstances that can threaten the life of the mother and the baby even death. One of the goals is to implement comprehensive obstetric care. Comprehensive midwifery care is the care provided by midwives from pregnancy, delivery, newborn, postpartum and until the mother decide to use birth control aimed at providing services an a continuity of care (COC) basis to prevent complications in pregnancy, childbirth, newborns, postpartum and birth control. The method used is descriptive observational research design with case study approach. The results obtained are comprehensive obstetric care provided ranging prom pregnancy, delivery, puerperium, newborn to normal running birth control acceptors.

Comprehensive obstetric care with oxytocin massage on mrs. M for increased breast milk production in postpartum mothers

Background: Breast milk is the best food for newborns and is the only healthy food a baby needs in the first month of life. However, not all mothers can exclusively breastfeed their babies. One of the main obstacles for a mother in breastfeeding is because milk production is not smooth. The way that can be done to facilitate breast milk production is to do oxytocin massage. Objective: Carry out obstetric care for Mrs. M which includes obstetric care for pregnancy, childbirth, puerperium, and neonates comprehensively and to determine the effect of oxytocin massage during the puerperium to increase breast milk production in postpartum mothers. Method: The method used is a case study and assesses the effect of oxytocin massage performed on Mrs. M with data collection techniques through interviews, observation, physical examination, documentation studies, literature studies, and giving questionnaires to patients before and after oxytocin piat. Results: After comprehensive obstetric care during pregnancy, childbirth, puerperium and neonates in Mrs. M with oxytocin massage for 15 minutes for 6 consecutive days there was an increase in breast milk production in postpartum mothers. Conclusion: The obstetric care that has been given to Mrs. M with oxytocin massage is useful in increasing breast milk production.

Comprehensive Obstetric Care In Ny "Y" With Oxytocin Massage Intervention Against Uterine Involution In Postpartum Mothers

The number of maternal mortality in South Sumatra Province in 2020 is 128 people per 100,000 live births. The highest cause of death in mothers was bleeding by 42 people (31.25%). Bleeding can be prevented if the mother's uterine contractions are good. Uterine contractions are both obtained from the hormone oxytocin. The hormone oxytocin can be obtained from oxytocin massage. The goal is to provide obstetric care to Mrs. "Y" comprehensively. From the period of pregnancy, childbirth, puerperium, by applying oxytocin massage The method used is a case study, the subject of this report is postpartum mothers the application of oxytocin massage is carried out 2x a day for 7 consecutive days since giving birth. Data collection techniques through interviews, observations, physical examinations, SOAP forms, giving questionnaires to patients before oxytocin massage and after oxytocin massage. The result is that after comprehensive obstetric care, the mother did not experience any dangerous cases. The labor process takes place normally, during the puerperium there are no special complaints that are dangerous, the mother is given oxytocin massage for 7 days postpartum in a duration of 10-15 minutes. The results of the study on Mrs. "Y" there was a significant influence of uterine involution when the mother was given oxytocin massage. On day 7, the decrease in uterine fundal height occurred faster than in mothers who did not do oxytocin massage. In conclusion, oxytocin massage care affects the decrease in fundus height of the uteri.

Spatial distribution of caesarean deliveries and their determinants in Bangladesh: evidence from linked data of population and health facility survey.

Health facility-level factors play a crucial role in women's access to and use of caesarean section (CS) services, but lacks relevant evidence. The study aimed to understand the effects of health facility-level factors on CS delivery in Bangladesh. The 2017-18 Bangladesh Demographic and Health Survey (2017-18 BDHS) and the 2017 Bangladesh Health Facility Survey (2017 BHFS) were linked and analysed in this study. The sample comprised of 4954 women gave at least one live birth within three years preceding the survey. The outcome variable was delivery through CS (yes, no) and the explanatory variables were health facility-level, individual-level, household-level, and community-level factors. Moran's I and Getis-Ord General G statistic were used to identify the hotspots of delivery through CS. Mixed-effect multilevel logistic regression was used to examine the association of the outcome variable with explanatory variables. Around 33% of women in Bangladesh underwent CS in their most recent pregnancies. The hotspots of delivery through CS are located primarily in Rajshahi, Dhaka, and Khulna divisions. The likelihood of delivered through CS increased with the rising scores of the management (Adjusted Odds Ratio (AOR), 1.83; 95% CI 1.04-2.07) and infrastructure (AOR, 3.14; 95% CI 1.40-5.12) of the nearest health facility. The readiness of health facilities to provide comprehensive obstetric care was significantly associated with an increased likelihood of delivery through CS (AOR, 2.18; 95% CI 1.15-3.28). These relationships were strong for private than non-government and government health facilities. The proximity of comprehensive obstetric care facilities to women's residences and their readiness to provide services play critical roles in the access to and use of CS in Bangladesh. The findings highlight the importance of necessary healthcare personnel, including midwives, availability of government hospitals where undue CS are avoided, and awareness-building programmes about the adverse effects of CS delivery. None.

Systematic review and meta-analysis of women's awareness of obstetric fistula and its determinants in Ethiopia.

Although obstetric fistula has been extensively eliminated in high-income countries due to comprehensive obstetric health care services, in developing countries including Ethiopia, many women and girls are still silently suffering from obstetric fistula due to early marriage, poor socioeconomic status, lack of access to skilled birth attendants, and limited awareness of obstetric fistula. To determine the magnitude of women's awareness of obstetric fistula and its contributing factors in Ethiopia. To perform this analysis, we strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations. To evaluate publication bias, we employed an Egger's test and an eye assessment of the funnel plot's symmetry. To look for signs of study heterogeneity, the Cochrane Q-test and I2 statistics were used. A Microsoft Excel spreadsheet was used to extract the data, and STATA version 14 was used to analyze it. A total of six studies involving 3,024 women were included. The pooled prevalence of women's awareness of obstetric fistula in Ethiopia was 41.24% (95% CI; 32.94%-49.54%). Urban residence (AOR = 2.32, 95% CI: 1.40-3.85), giving birth at a health institution (AOR = 2.84, 95% CI: 1.92-4.21), having secondary or above educational status (AOR = 3.27, 95% CI: 2.15-4.97), receiving antenatal care follow-up (AOR = 2.73, 95% CI: 1.71-4.35), and participation in pregnant women's conferences (AOR = 4.64, 95% CI: 2.88-7.49) were factors associated with good awareness of obstetric fistula in women in Ethiopia. The pooled prevalence of women's awareness of obstetric fistula was low. Urban residence, giving birth at a health institution, having secondary and above educational status, having antenatal care follow-up, and participating in pregnant women's conferences were factors associated with women's awareness of obstetric fistula. Therefore, enhancing women's awareness of obstetric fistula and promoting institutional delivery and antenatal follow-up is recommended. Furthermore, policymakers and stakeholders should empower women and pay particular attention to the neglected but important public health problem that is obstetric fistula.

A 10-Year Retrospective Analysis of Uterine Rupture in a University Teaching Hospital in Nnewi, Nigeria

Background: One of the most serious obstetric emergencies that seriously endanger both mother and fetus and dramatically increase maternal and perinatal mortality in our community is uterine rupture. The aim of the study is to ascertain the prevalence of uterine rupture and the various aetiologies/predisposing factors associated with it. Methods: From January 1, 2007, to December 31, 2016, patients with ruptured uteruses were studied retrospectively and cross-sectionally at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria. Outcome measures included prevalence rate, surgical choices, maternal and fetal outcomes, and maternal case fatality rate. Stata 13.0 (StataCorp LP, Texas, USA) was used to analyze the data. Results: There were 10,777 deliveries and a total of 66 cases of ruptured uterus were treated, giving a ratio of 1 in 163 deliveries or prevalence of 6.0/1000 deliveries. Sixty four case notes were retrieved giving retrieval rate of 97.0% and prolonged obstructed labour was the commonest aetiologic factor identified (42.2%). Other associated factors were grand multiparity (36.0%), previous caesarean section (28.1%), previous myomectomy (3.1%), injudicious use of oxytocin (25.0%), use of misoprostol (3.1%) and abnormal lie (17.2%). Twenty of the patients (31.3%) had repair of the ruptured uterus alone, and 28(43.8%) had repair with bilateral tubal ligation. Six of the patients (9.4%) had total abdominal hysterectomies while 10(15.6%) had sub-total hysterectomies. There were a total of 4 maternal deaths giving a case fatality rate of 6.3%. The fetal outcome was poor with only 11 (17.2%) survivors. Conclusion: Only 17.2% of surviving fetuses had a good result, and 6.1 per 1000 deliveries involved uterine rupture. The rupture of gravid uterus will be decreased, if not completely eliminated, by adequate health education, widespread availability of comprehensive obstetric care facilities, enhanced antenatal care, a decline in the prevalence of primary caesarean sections, and population empowerment of women

The prevalence of trimester-specific dietary supplements and associated factors during pregnancy: An observational study.

Objectives: This study aimed to assess the prevalence of trimester-specific dietary supplements (DS)s use and their possible correlates during pregnancy. Method: Pregnant women were convenience sampled and recruited from a comprehensive obstetric care center in Shanghai, China. Data relating to the use of DS during pregnancy, social support and other social-demographic and obstetric data were collected. Trimester-specific DS use and factors related DS were explored. Results: Of the 2803 women participating in this study, 94.8%, 96.2%, 93.8%, and 94.4% reported the use of at least one DS during pregnancy (all trimesters) and in the first, second, and third trimesters of pregnancy, respectively. Significant differences were noted in the use of DS containing folic acid, calcium, iron, vitamins, and docosahexaenoic acid (DHA), during the three trimesters of pregnancy. A higher proportion of DS use was negatively associated with certain categories of pregnant woman, including unemployed/housewife, low education level, obese, and low social support. A positive association was identified with gestational age. Conclusion for practice: Considering the high prevalence of DS use during pregnancy, future studies are needed to evaluate the accuracy and suitability of DS usage during pregnancy.

ASUHAN KEBIDANAN KOMPREHENSIF PADA Ny. A G1P0A0 USIA KEHAMILAN 32 MINGGU 1 HARI PERSALINAN, NIFAS, BAYI BARU LAHIR DAN KELUARGA BERENCANA DI KLINIK PRATAMA MANDIRI BERASTAGI TAHUN 2022

In Pregnancy, childbirth, newborns, postpartum, and family planning are physiological processes; However, if not monitored and managed properly, this physiological process can develop into problems or complications that endanger the health of the mother and baby. Increasing health personnel, including midwives, is needed to participate in supporting the health of pregnant women, postpartum women, postpartum women, family planning and newborn babies. Mrs. A, 33 years old, G1P0A0, 32 weeks pregnant, received this comprehensive obstetric care. The physiological labor process is carried out at 32 weeks 5 days of gestation. After delivery, postpartum and consultation regarding postnatal contraception are carried out physiologically. There is no difference between theory and practice in pregnancy, postpartum and newborns. In the case study Mrs. A, management of midwifery care has been implemented and documented using the SOAP method. The conclusion of this final project report is that there is a difference between the implementation of APN during childbirth between theory and implementation in the field. It is hoped that the care provided can reduce MMR and AKN for mothers and babies.

COMPREHENSIVE OBJECTIVE CARE IN NY “W” G1P0A0 WITH SWOLLEN LEGS AND BLISTERING NIPPLES IN CLINIC "BI" CIPATAT DISTRICT WEST BANDUNG

Introduction to this study Physiological changes in pregnant women are changes in shape or anatomical and hormonal changes. Swelling of the legs is one of the pregnancy discomforts that pregnant women often complain about. According to the results of a survey at the "BI" CLINIC of 61 pregnant women encountered, as many as 49 experienced the discomfort of swelling of the legs and there were 10 puerperal mothers and 2 of them had nipple blister problems. The purpose of this study was to be able to provide comprehensive obstetric care to Mrs. "W" by giving warm water baths, at the "BI" Citatah Clinic, Cipatat District. Methods The research method used is a case study study by conducting an assessment and upbringing the subject of the study, namely Mrs. "W" with complaints of leg swelling in the III trimester pregnancy. Results & Analysis. The results of the case study carried out were the provision of soaking soaking warm water with a temperature of 380C for 20 minutes carried out 3 times a day regularly, so that the mother felt that the swelling that the mother experienced was reduced. In the puerperium, the mother experiences blistered nipples and is given breastfeeding technique care and the results of the nipples heal after 6 days. Discussion. The conclusion of this case study is that after a warm water bath for 2 weeks with 3x sahari the natural swelling is reduced, as well as in the puerperium the lecat nipples heal after being given the correct breastfeeding technique care.

Medical officers as the key stakeholders in district level hospitals in Kenya

Background: A core component of the World Health Organization (WHO) infection prevention and control (IPC) recommends that staffing levels be adequate for the patient workload. The lack of health-care workers in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa is well documented; one way to alleviate the burden of surgical infections without a large commitment of resources is to better train and educate existing facility staff. The study aimed to understand the current allocation of the surgical workload in district level hospitals in Kenya to create targeted task-shifting and education programs. Methods: We developed a cross-sectional survey on IPC practices, adapted from the WHO Guideline on Core Components for IPC and the WHO Emergency and Essential Surgical Care Situational Analysis Tool, for use in district level facilities in LMICs. The survey components included IPC guidelines, surveillance, workload and environment, hospital characteristics, clinical workforce, obstetrical outcomes, and perioperative care practices. In a pilot feasibility trial of the survey tool, data were collected from 27 district level hospitals in Kenya from March to May 2019. These facilities were selected in part based on their capacity to provide comprehensive maternal and obstetric care, including cesarean operations, as cesareans make up the majority of surgeries in the regions and are associated with high surgical site infection rates. Results: The facilities included in the survey pilot serve an estimated population of 3,615,166. The average number of annual admissions was 7801 (Range: 1190–25,783). Thirteen of the 27 total facilities (48.1%) had no certified surgeons, six facilities had one certified surgeon (22.2%), and eight facilities employed two or more certified surgeons. In contrast, almost all facilities (n = 25; range: 2–15) employed medical officers who performed cesarean operations. The number of nurses in surgical and obstetricians and gynecologists wards ranged from 4 to 101, with an average of 27 years. Conclusion: Dedicating specialized training and education to medical officers and engaging them as key stakeholders is the key to creating practical and sustainable change when it comes to safe surgical provision of surgical and obstetric care within Kenya.

Determinants of Obstetricians’ Pattern of Care for Sickle Cell Disease in Pregnancy

Pregnancy in sickle cell disease (SCD) is high risk. With improved comprehensive obstetric care, pregnant females with SCD can achieve successful pregnancy outcomes, especially in resource-poor settings. To determine the predictors of Obstetricians' pattern of care for SCD in pregnancy in Nigeria. Self-administered, pre-tested, pre-validated questionnaires containing 18 questions on demographic details of obstetricians, and their pattern of practice towards antenatal care for pregnant SCD patients were distributed to attendees of the 2018 conference of the Society of Obstetrics and Gynaecology of Nigeria (SOGON). Regression analysis was done to determine the possible predictors, and a significant level was <0.05. Almost all the respondents (98.4%) considered pregnancy in SCD as high risk, and 96.2% proposed for preconception care in a tertiary hospital. The majority, (62%) agreed that antenatal visits in the first and second trimesters should be more frequent. The majority (96.2%) reported they would routinely order urine tests among other investigations. Majority of respondents,74.9% and 98.4% knew that foetal medicine specialists and haematologists should be part of preconception care team, respectively. Respondents' practice centre and designation, significantly contributed to their "willingness to consult a haematologist" (P = 0.004)," and willingness to consult a foetal specialist" (P = 0.047), while practice centre and practice population significantly contributed to their response to "ideal centre for management of SCD pregnancy": (P = 0.049), (P = 0.024) respectively. Obstetricians' level of training, practice centre, and practice population of pregnant women with SCD are significant contributors to their pattern of care towards antenatal care for pregnancy in SCD.

Maternity waiting homes utilization and associated factors among childbearing women in rural settings of Finfinnee special zone, central Ethiopia: A community based cross-sectional study.

Maternity waiting home (MWH) is one of the strategies designed for improved access to comprehensive obstetric care for pregnant women living far from health facilities. Hence, it is vital to promote MWHs for pregnant women in Ethiopia, where most people reside in rural settings and have a high mortality rate. Therefore, this study aimed to assess MWHs utilization and associated factors among women who gave birth in the rural settings of Finfinnee special zone, central Ethiopia. A community-based cross-sectional study was conducted from 15th October to 20th November 2019 among women who gave birth in the last six months before data collection. Multistage random sampling was employed among 636 women from six rural kebeles to collect data through a face-to-face interview. Multivariable logistic regression analysis was fitted, and a 95% confidence level with a p-value <0.05 was used to determine the level and significance of the association. Overall, MWHs utilization was 34.0% (30.3% - 37.7%). The higher age (AOR: 4.77; 95% CI: 2.76-8.24), career women (AOR: 0.39 95% CI: 0.20-0.74), non-farmer husband (AOR: 0.28; 95% CI: 0.14-0.55), rich women (AOR:1.84; 95% CI: 1.12-3.02), living greater than 60 minutes far from a health facility (AOR: 1.80; 95% CI: 1.16-2.80), and four and more livebirths (AOR: 5.72; 95% CI: 1.53-21.35) significantly associated with MWHs utilization. The common services provided were latrine, bedding, and health professional checkups with 98.2%, 96.8%, and 75.4%, respectively. Besides, feeding service was provided by 39.8%. The primary reason not to use MWHs was the absence of enough information on MWHs. One-third of the women who delivered within the last six months utilized MWHs in the Finfinnee special zone. Our results support the primary purpose of MWHs, that women far from the health facility are more likely to utilize MWHs, but lack of adequate information is the reason not to use MWHs. Therefore, it is better to promote MWHs to fill the information gap among women with geographical barriers to reach health facilities.

Effect of emergency obstetric care and proximity to comprehensive facilities on facility-based delivery in Malawi and Haiti.

Proximity of households to comprehensive obstetric care is a key determinant for preventing maternal mortality due to obstetric emergencies. The relationship between proximity to comprehensive care and facility delivery is further complicated by the use of varied methods in measuring facility obstetric capacity-which may misrepresent the real scenario of obstetric care availability in a service environment. We investigated the joint effects of proximity and two emergency obstetric care assessment (EmOC) methods on women's place of delivery in Malawi and Haiti. Household level and health facility data were obtained from the 2013-2018 Demographic and Health Surveys and Service Provision Assessment surveys. Records of women aged 15 to 49 years who had a childbirth in the last 5 years were linked to obstetric facilities within 5km, 10km and 15km from their households using Kernel Density Estimation. Log-binomial models were fitted to estimate the joint effects of proximity to comprehensive facilities on place of delivery and two EmOC methods (1. the facility's recent performance of signal functions only, and 2. a composite index of obstetric care), and whether this varied by urban/rural setting. Proximity to comprehensive facilities was significantly associated with facility delivery in Malawi among women living 5km of a comprehensive facility (using EmOC method 2), in addition, living further (15km) from facilities with high capacity of EmOC was associated with reduced likelihood for facility delivery in urban settings in stratified analyses. In contrast, positive associations were present in Haiti in both urban and rural settings, with the likelihood of facility delivery being higher with greater proximity of women to comprehensive facilities, regardless of methods to define EmOC. Women living within 5km of a comprehensive facility in Haiti were the most likely to deliver in facilities based on EmOC method 1 (APR: 1.81, 95% CI 1.56, 2.09). Findings from Malawi elucidates the relevance of context and suggests the need for research in diverse settings.