Delivery-related Complications Research Articles

Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh

Background and objectivesBangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. MethodsData were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. ResultsAround 32% (95% CI: 29.7–34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. ConclusionDelivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

An Epidemiological Survey on the Assessment of Risk Factors during Pregnancy

Pregnancy is described as a condition or a state from the time of conception up to the time of delivery. The ‘high-risk’ pregnancy means a woman has one or more things that raise her-or her baby’s chances for health problems or preterm (early) delivery. High blood pressure, obesity, diabetes, epilepsy, thyroid disease, smoking, alcohol, using illegal drugs, heart or blood disorder, poorly controlled asthma, malnutrition anemia, multiple pregnancy, pregnancy history and infection can increase the risk of pregnancy. This study was basically a descriptive type of epidemiological study based on the concept of active surveillance. The elements involved to study were risk factors involved during pregnancy like Pre-eclampsia, Gestational Diabetes, Thyroid, delivery related complications and weight gain during pregnancy. The data obtained was categorized and analyzed using graphical representations as charts, graphs and other means. The descriptive responses were analyzed individaually. Out of 100, 27 women were suffering from complications during late age pregnancy include Gestational Diabetes, Thyroid, complications due to High Blood Pressure, Cyst in Uterus, Bed Rest due to previous Miscarriage, Bleeding in Second Trimester, Acute Body Pain, Acute Rise in Blood pressure. Premature delivery was seen due to late age pregnancy. 16 out of 100 women had premature delivery i.e in 33 to 35 weeks of pregnancy or 7th and 8th month of pregnancy. In late age pregnancy, there were total 59 responses out of 100, 27(45.7%) women facing problems due to late age pregnancy like high BP, stillbirth, death of fetus in womb, thyroid, gestational diabetes and complications during delivery and 54.20% women were not having any problems. Women who suffered pregnancy induced hypertension, out of 57women 17(29.82%) were facing problems like depression, anxiety, miscarriage, weakness, vomiting, nausea. Out of 100 women, 9 women suffered from gestational diabetes and 10 women had prolonged diabetes. So from above results, it is considered that women who are 35 years and above are considered to be at “high risk” for pregnancy. Women who were aged 22-30 years didn’t suffer from such diseases but gestational diabetes was observed in some cases. Women who were aged 28-35 years suffered miscarriage and abortion due to reasons unknown.

Maternal Complications Related to Operative Vaginal Delivery and Their Associated Factors among Women Delivered at NEMCS Hospital, Southwest Ethiopia.

Operative vaginal delivery refers to vaginal delivery performed with the use of instruments such as forceps or vacuum. Operative vaginal delivery-related maternal complications are still a serious problem, but they are one of the least investigated in Ethiopia, particularly in the study area. Increased difficulties have been attributed to a lack of understanding on how to anticipate the procedure's complications. Identifying typical OVD complications can assist health providers in detecting and intervening early. The goal of this study was to find out which characteristics contributed to maternal problems during surgical vaginal birth. A health facility-based cross-sectional study design was used. From December 2019 to November 2021, a total of 326 mother's OVD medical records were selected from a total of 1000 OVD medical records using a simple random sampling method. A checklist was used to collect the data. Binary logistic regression was computed and variables with a p value ≤0.2 in the bivariate logistic regression were taken to multivariate logistic regression analysis to examine the real relationship or statistical association with the outcome variable. The p value of <0.05 with a 95% confidence interval was considered a significant variable. The results are presented using tables, figures, and texts. Maternal complications were prevalent in 62 of the cases (19%). The type of operative vaginal delivery instrument used (AOR = 2.248; 95% CI (1.144, 4.416)), the station of the presenting part at which the OVD was performed (AOR = 3.199; 95% CI (1.359, 7.533)), neonatal birth weight (AOR = 3.342; 95% CI (1.435, 7.787)), and duration of the second stage (AOR = 2.556; 95% CI (1.039, 6.284)) were significantly associated with the unfavorable maternal outcomes of operative vaginal delivery. Maternal complications are high in the study area. The type of operative vaginal delivery used, the duration of the second stage, the station of the presenting part at which the OVD was performed, and neonatal birth weights were all significantly related to maternal complications. While using the instrument, mothers with the identified factors should be given special attention.

Perinatal period affecting neuropsychic state of children in Arctic zone

Aim: to identify potential causes accounting for development or predisposition to congenital neuropsychiatric disorders (NPD) in childhood and assessing an opportunity for conducting preventive interventions to lower a risk of childbirth coupled to congenital malformations.Materials and Methods. The pediatric medical records with NPD and psychomotor retardation were analyzed: data on the pattern of pregnancy and maternal delivery-related complications as well as delivery-associated complications and fetal developmental abnormalities, the maternal morbidity pattern before and during pregnancy; data on paternal health state as well as available social information about parents were also assessed.Results. It was revealed that potential causes for delivery of children with NPD and subsequent development of psychomotor retardation were due to complications during pregnancy such as infections of pregnant women, gestosis, anemia; among maternal complications in childbirth of special attention were long anhydrous period as well as surgical interventions.Conclusion. The course of pregnancy and childbirth as well as emerging neonatal pathology may be also influenced by the climatic and meteorological conditions of the Arctic zone causing Arctic hypoxia. Significant correlations between solar wind parameters and morbidity of pregnant women may indicate a need for more extensive studies regarding effects of geocosmic factors on course of pregnancy, childbirth and fetal gestation.

Perinatal predictors of postpartum depression

Pregnancy is not only a period of immense pleasure for a woman; it is also a time of tremendous stress for her, both psychologically and physically. Even in healthy women, pregnancy can elicit a great deal of anxiety because of the uncertainty that arises with it. Obstetric complications related to pregnancy and deliveries affect the mother physically and mentally and are one of the prediction variables for postpartum depression. Obstetric factors include pregnancy related complications like hyperemesis, preeclampsia, eclampsia, hypothyroidism, hyperthyroidism, early labour and contractions, oligohydramnios, polyhydramnios, placental abnormalities, anemia, gestational diabetes mellitus, and delivery-related complications, such as challenging and painful labor, caesarean section, instrumental delivery, premature delivery, and complicated postpartum-like excessive bleeding, have been researched as potential risk factors for PPD. For mothers, infant-related issues are often extremely stressful situations. PPD is more likely to occur among mothers of premature infants, mothers of infants with illnesses, disabilities, or distress, challenging temperaments, and mothers who may face stress in childcare and lack childcare competence.

Association of Ultrasonography and Health Education during Antenatal Visits among Pregnant Women to Reduce Unnecessary Caesarean Section in Bangladesh: Study Protocol for a Cluster Randomized Control Trial.

The rate of caesarean section (C/S) has been increasing globally. The proposed study aims to evaluate the effects of ultrasonography (USG) and health education in reducing unnecessary C/S among pregnant women. The secondary objectives are to increase antenatal care (ANC) and post-natal care (PNC) visit rates, increase USG use, increase institutional (hospitals and clinics) delivery, reduce delivery related complications and reduce the number of still births. This is a prospective, open-label, two-arm cluster randomized controlled trial (RCT). A total of 288 pregnant women are enrolled from two urban and two rural hospitals in Bangladesh. Women were screened during their first ANC visits, then written informed consent was taken from the participants. Women in intervention hospitals receive eight ANC visits, two additional USG, and health education eight times during their ANC visits. In contrast, participants at control hospitals receive usual care consisting of four ANC visits and two USG during their ANC visits. The primary outcome is to compare the rate of unnecessary C/S during PNC visits. This study obtained approval from the Institutional Review Board of North South University (2021/OR-NSU/IRB/0804), Bangladesh in November 2021 and was registered in clinicalTrails.gov (#NCT05135026).

Women’s experience of post-natal care: A study from Uttarakhand, India

ABSTRACT Although significant strides have been made in improving maternal and child health outcomes following the millennium development goals, India's progress has been slow, as reflected by its relatively high maternal and child mortality rates. This calls for investigation into the quality of care (QOC) offered to women during pregnancy and childbirth. This study uses primary data to evaluate women's experience of the postnatal care they receive in order to understand maternal perceptions about QOC in Uttarakhand, India. Specifically, we try to measure women's satisfaction with postnatal care and construct a maternal satisfaction index. We also attempt to understand the demographic, socio-economic and obstetric factors that affect them. Results show that a sufficient number of postnatal checks for both the mother and baby were done, while they felt the length of stay in health facilities had been adequate and they had adequate privacy during these processes. These emerged as the most important components of maternal satisfaction. Factors such as women's working status, place of residence, number of children born, pregnancy and delivery related complications, and planned place of delivery were important for their satisfaction. This study may have policy implications to help bridge the supply-demand gaps in the QOC framework.

Factors Associated with Maternal and Child Healthcare Service Utilization: A Comparative Study of East and Western Uttar Pradesh

Every year, thousands of women die around the world as a result of pregnancy and delivery-related complications, and thousands of children suffer from diseases that could be avoided with vaccination. The objective of this study is to explore the factors determining the utilization of maternal and child healthcare service utilization in the eastern and western Uttar Pradesh. For the study Researchers used National Family Health Survey round 4 (2015-2016) data which is a multi-round, large-scale survey conducted on a representative sample of households from across the country. Chi-square test was used to find the significance level during bivariate analysis. Additionally, binary logistic regression analysis was used to establish the association between outcome variables and other explanatory variables. The result suggests that the percentage use of full antenatal care services by mothers age, media exposure, caste, and birth order is almost similar in both the regions while for education it depicts a surprising result as women with higher education in WUP tend to have lesser utilization of full ANC as compared to the women of EUP of the same category. The mothers of eastern Uttar Pradesh lag behind in utilizing the PNC services as compared to the western Uttar Pradesh. The prevalence of full immunization, and PNC is tended to be higher among the children of western Uttar Pradesh. Women in the higher quantiles and with more education were more likely to get their child vaccinated and have a PNC visit.

Compliance of Iron and Folic Acid Supplementation among Postpartum Urban Mothers of Kathmandu Valley

Introduction: Globally, iron deficiency anaemia is considered as a risk factor for maternal morbidity and mortality. It is estimated to cause 591,000 perinatal deaths and 115,000 maternal deaths annually. The World Health Organisation recommends iron supplementation to first trimester to 45 days after delivery. The Government of Nepal is supplementing Iron and Folic Acid (IFA) to pregnant and postpartum women to reduce the burden of disease and deaths, however Nepal reports low compliance and coverage. We sought to determine compliance of IFA and associated factors among postnatal mothers in Kathmandu valley. Methods: This was a cross-sectional study involving 132 mothers attending the immunisation clinic. Face to face interview was done using structured questionnaire consisting of sociodemographic information, IFA, maternal knowledge and compliance practices. Statistical analysis was done using SPSS version 23. Results: We found 68.9% compliance of iron and folic acid among the respondents. The mean age of the respondents was 27.53 ± 4.6 years (Mean ± SD). Significant association was observed between the compliance of the IFA with education,age,employment status of women and family type (p &lt; 0.00). No significant association was observed in between the compliance of IFA and religion (p = 0.93) and delivery related complications (p = 0.143). Similarly, delivery type showed significant association with the compliance of IFA (p &lt; 0.00). Conclusions: This study concludes that mothers from Kathmandu had better compliance and coverage of IFA than provincial as well as the national average. Private pharmacy is an important service provider for urban women.

Abstract P226: Transcriptome Signature Of Placentas From Diabetic Pregnancies Is Confounded By Fetal Sex.

Hypertension-associated obstetric diseases like diabetes mellitus (DM) or preeclampsia occur in 25-35% of pregnancies and are related to placental dysfunction. The placenta has a unique structure and function to guarantee healthy pregnancy, fetal development, and outcome. Thus, the diabetic environment featuring inflammation, metabolic alterations, and hypoxia, is challenging with increased stress for mother and foetus. Delivery-related complications and adverse post-pregnancy outcomes, for example the increased risk for preeclampsia, are related to placental pathology in the different types of DM. Therefore, understanding disturbed placental development during pathologic pregnancy is important. We hypothesize a placental transcriptome signature present in pathologic pregnancy. We aimed to broaden our understanding of placental adaptations to various forms of diabetic pregnancy. Human placenta samples from healthy controls (n = 29), women with gestational DM (GDM, n = 12), DM type 1 (DM1, n = 17), DM type 2 (DM2, n = 3) and GDM, DM1 or DM2 superimposed by preeclampsia (n = 16) were included. We quantified gene expression by Illumina TruSeq stranded total RNA Sequencing and analyzed data by means of principal component analysis (PCA), differential expression and gene set enrichment. The samples were mainly split by fetal sex in the PCA rather than diabetic subgroups. Genes associated with the principal components were primary located on the male sex chromosome ( Xist, Uty, Usp9y, Ddx3y ) and only weakly enriched in functionally relevant gene sets. The fetal sex was identified as single main explanatory variable when the principal components were associated with clinical patient data. Placentas complicated by DM2 identified 93 and 27 significant differential expressed genes (DEG; adj. p-value &lt; 0.05) in comparison to healthy controls and GDM, respectively. Comparison of DM1 to DM2 or GDM showed four and two significant genes. In this cohort possible effects of GDM and preeclampsia were not observed.We conclude that fetal sex is dominating placental gene expression and confounding transcriptome signatures resulting from diabetes, in settings of well controlled diabetic disease.

An Experience Survey Report on Post Caesarean Complications among Young Women

Aim: To assess the post caesarean complications among young women through a survey study. Background: Caesarean section delivery has many adverse effects in the post natal period and later including pain, muscle weakness, reduced endurance, adverse reactions from anaesthesia and difficulty in breast feeding. There are several studies reported the health-related complications following caesarean section. However it is not been fully understood the various complications and its reasons. Design: An explorative cross sectional survey study. Method: participants were identified based on the inclusion criteria. Information on caesarean section delivery related complications and experience were gathered. Conclusion: The complications following the caesarean survey may increase the risk of physical difficulties, incidence of lower back pain, reduced abdominal strength, and difficulty in selfcare activities. Keywords: caesarean delivery, complications, child labour, Postpartum period pain.

Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach

BackgroundMaternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services.MethodsA sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12.Study findingsApproximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services.ConclusionsUtilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed.

Factors influencing place of delivery: Evidence from three south-Asian countries.

BackgroundHigh maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women’s preferences for such in three selected South-Asian countries.MethodsWe extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017–18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted.ResultsOverall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09–1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20–1.67, P<0.001) and Pakistan (aOR = 1.17, 95% CI: 1.03–1.32, P = 0.013). Higher education of husband was a significant predictor for facility delivery in Bangladesh (aOR = 1.73, 95% CI:1.27–2.35, P = 0.001) and Pakistan (aOR = 1.19, 95% CI: 0.99–1.43, P = 0.065); husband’s occupation was also a significant factor in Bangladesh (aOR = 1.30, 95% CI:1.04–1.61, P = 0.020) and Nepal (aOR = 1.26, 95% CI:1.01–1.58, P = 0.041).ConclusionOur findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.

PENGARUH METODE GENTLE BIRTH TERHADAP TINGKAT NYERI DAN DURASI KALA I PERSALINAN PADA IBU PRIMIPARA

According to World Health Organization (WHO), it is estimated that one woman dies in every minute, 1,400 in every day, or 500,000 in every year from pregnancy- and delivery-related complications. A large number of delivery-related complications reported in SDKI in 2017 are long delivery (41%). Both long delivery and pain that distress the mother during a delivery process is the reason for delivery trauma and increases in delivery by sectio caesarea operation. Due to a phenomenon of increasing trends in caesarea operation and other unnecessary medical interventions, there reemerges an awareness to back to a natural delivery concept that considers the whole aspects of human body holistically (called gentle birth).”Gentle birth” is a serene, smooth, gentle delivery and utilizes all natural elements in human (body, mind, and soul). Currently, some alternative methods of delivery process with a gentle birth concept are developing, such as prental yoga and hypnobirthing relaxation.&#x0D; The objective of the present research is to analyze the effect of gentle birth method on the pain level and phase-I duration of delivery in primipara mother. The research is a quasi-experimental research with a post test control group design. Sampling was performed by a consecutive sampling up to the number of sample the researcher wanted has been met according to an inclusion criterion.&#x0D; The research result revealed that there was some significant average difference in the pain level and phase-I duration of delivery between the experimental and control groups. Expectantly, the research result contributes to midwifery science as an attempt to deliver a holistic delivery midwifery care (gentle birth) so as to relieve delivery-related pain and to shorten delivery duration.&#x0D; &#x0D; KEYWORDS: &#x0D; Gentle birth, prental yoga, hypnobirthing, delivery pain, delivery duration&#x0D; &#x0D; &#x0D;

Pregnancy in Liver Transplantation Recipients Is Associated With Increased Complications and Healthcare Utilization.

Given the increased rates of pregnancy in liver transplant recipients, evaluating the safety of pregnancy is crucial. We aim to evaluate pregnancy-related complications and outcomes in liver transplant recipients. A retrospective nationwide review comparing pregnancy outcomes in liver transplant recipients vs the general population was performed between 2005 and 2013. Propensity-matched and multivariable regression analyses were performed to study pregnancy- and delivery-related complications in addition to patient and hospital outcomes. A total of 38,449,030 pregnancy-related admissions were evaluated in this study including 1,469 (0.004%) admissions in liver transplant recipients. Liver transplant recipients were more likely to undergo a caesarean delivery (60% vs 36%) and have a pregnancy-related complication (56% vs 27%) including miscarriage, intrauterine growth restriction, portpartum hemorrhage, hypertension, preeclampsia, and thromboembolism (P < 0.001) compared with the general population. Propensity-weighted analysis revealed higher rates of pregnancy complications (odds ratio 2.11, 95% confidence interval [CI] 1.63-2.73), cost ($3,023, 95% CI $850-$5,197), and longer length of stay (1.52 days, 95% CI 0.62-2.41) in transplant recipients. Liver transplant recipients experienced zero inpatient mortalities compared with 0.01% of the general population. Transplant recipients with at least 1 complication had a longer length of stay (2.45 days, 95% CI 1.44-3.45) and higher cost of admission ($5,205, 95% CI $2,848-$7,561) compared with transplant recipients without a complication. Pregnancy after liver transplant is associated with higher rates of complications and worse outcomes without an increased risk of mortality.

Factors Associated with Postnatal Depression among Mothers Attending at Bharatpur Hospital, Chitwan.

Postnatal depression is linked with adverse outcomes for mothers, offspring, and her entire family, which stands as a significant public health problem and is often taken as a neglected issue of maternal and child health in the developing world. Postnatal depression is often falsely interpreted as common consequences related to the recent delivery. The main objective of this study is to find out the status of postnatal depression and the factors associated with it among the postnatal mothers attending at Bharatpur Hospital. Methodology. A total of 242 postnatal women were included in a hospital-based cross-sectional descriptive study. A systematic random sampling technique was done to get the sampling interval. Face to face interview technique was used for data collection, and depressive symptoms were measured by the Edinburgh Postnatal Depression Scale. Data was entered in Epi-Data and imported to SPSS for analysis. The data were summarized in terms of frequency (percentage), mean (SD), or median (IQR) as per necessity for descriptive analysis. The chi-square test and binary logistic regression were performed to find out the association between the covariates and depression status, assuming significance at p value <0.05. Results. The study revealed that the prevalence of postnatal depression was 16.9% by EPDS at cutoff point ≥12. It was found that postnatal depression was associated with current age, smoking, pressure to conceive a child, intent of pregnancy, and delivery-related complications. Conclusion. Postnatal depression within six months of delivery was found among nearly one-fifth of women, where 13.6% also had suicidal thoughts. More than half of the postnatal women had an early marriage. It is recommended that mothers with high risk should be routinely screened for postnatal depression followed by necessary interventions as well as safe motherhood counseling.

Menses, pregnancy, delivery, and menopause in hidradenitis suppurativa: A patient survey.

BackgroundHidradenitis suppurativa (HS) is a chronic inflammatory disorder that primarily affects women of childbearing age. There is a paucity of data on HS disease activity during menstruation, pregnancy, and menopause and the potential impact of HS on the method of delivery.ObjectiveWe aimed to characterize the natural history of HS symptoms during menses, pregnancy, and menopause. We also sought to evaluate the potential impact of HS on delivery method and whether there were delivery-related healing complications unique to women with HS.MethodsAn anonymous survey was distributed via social media to international HS support groups and patients at three HS specialty clinics in North America. Responses were collected from March to July 2019.ResultsA total of 279 respondents answered questions on disease changes during pregnancy. Menstruation caused worsening of HS symptoms in 76.7%, no change in 22.2%, and improvement in 1.1%. During pregnancy, the distribution between symptoms worsening (34.8%), having no change (28.7%), and improving (36.6%) was relatively even. After menopause, participants typically reported either worsening (39.5%) or no change (44.2%) in HS symptoms. Among respondents with anogenital HS involvement who delivered vaginally, 3.1% believed that HS interfered with vaginal delivery (VD), and 23.5% believed that VD caused an HS flare. Cesarean section (C-section) delivery was reported by 44.2% of participants. Ten participants reported that they were advised by their doctor to have a C-section instead of a VD because of severe anogenital HS. Of those who underwent a C-section, 33.9% reported that HS interfered with incision healing, and 51.2% reported developing new HS lesions in their C-section scar.ConclusionTo our knowledge, this is the first study describing the potential influence of HS on a patient’s method of delivery. Multidisciplinary collaboration plays a pivotal role in developing individualized treatment and birth plans for pregnant women with HS.

Obstetric anesthesia in China: associated challenges and long-term goals.

Obstetric anesthesia in China: associated challenges and long-term goals.

Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception.

The use of in vitro fertilization is increasing. The incidence of adverse outcomes is greater for women who undergo in vitro fertilization, potentially leading to intensive care unit admission. This study aimed to assess the etiology and course of intensive care unit admission in women who underwent in vitro fertilization compared to those who did not, with specific focus on intensive care unit admission due to postpartum hemorrhage. In this retrospective study, medical records of patients admitted to the intensive care unit during pregnancy or the peripartum period at 2 medical centers (2005-2016 at Mount Sinai Hospital, New York, NY, and 2005-2013 at Shaare Zedek Medical Center, Jerusalem, Israel) were analyzed. Demographic, past medical and obstetric history, and details regarding delivery and intensive care unit stay were collected, as was information regarding mode of conception (in vitro fertilization versus non-in vitro fertilization) for the current pregnancy. The primary outcome measure was difference in etiology of intensive care unit admission between in vitro fertilization and non-in vitro fertilization groups. Secondary outcome measures included differences in prepregnancy characteristics, incidence, severity, and management of postpartum hemorrhage, as well as incidence of other clinical major morbidity events and delivery-related complications. Multivariable logistic regression was performed to study the relationship between in vitro fertilization and the odds of having been admitted to the intensive care unit due to hemorrhage. During the study period, there were nearly 192,000 deliveries, with 428 pregnant and peripartum women admitted to the intensive care unit. Of the 409 cases analyzed, 60 had conceived following in vitro fertilization and 349 had conceived without in vitro fertilization. The non-in vitro fertilization group was more likely to have multiple medical comorbidities, and the in vitro fertilization group was more likely to have multiple gestations. The groups also differed in etiology of intensive care unit admission; more women in the in vitro fertilization group were admitted due to a pregnancy-related complication. Intensive care unit admission for postpartum hemorrhage was more frequent in the in vitro fertilization group (60.0% vs 43.1%, P = .014), with a 2-fold increase in the incidence of hemorrhagic shock. Logistic regression analysis revealed a 2-fold increase in the odds that intensive care unit admission was due to hemorrhage in women undergoing in vitro fertilization, a finding that was not statistically significant when multiple gestation was added to the model. Among patients admitted to the intensive care unit, patients with different modes of conception had dissimilar etiologies for intensive care unit admission with intensive care unit admission due to hemorrhage greater in those with in vitro fertilization. Higher rates of multiple gestation pregnancies may explain this difference. Differences in pregnancies conceived via in vitro fertilization versus without in vitro fertilization may affect the obstetric intensive care unit case mix.

A retrospective review of facility-level obstetric complications and stillbirths in southern Haiti, 2013 - 2016.

ABSTRACTObjective.To assess the incidence of obstetric complications—eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths—in hospitals in southern Haiti in 2013 – 2016 and to discuss implications for improvements to the surveillance of birth outcomes.Methods.This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 – 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated.Results.The incidence of eclampsia in the study sample was 2% – 3% and of dystocia approximately 5%, comparable to elsewhere in Haiti and other low-income countries. Cesarean delivery rates averaged about 15% annually. Postpartum hemorrhage rates were lower than published data from similar settings. Stillbirth rates ranged from 30 – 62 per 1 000 births at all facilities, higher than previously recorded by the country’s population surveys. The rates of macerated stillbirths were remarkably high, close to 50% of total stillbirths, indicating severe delays in seeking or receiving emergency obstetric care.Conclusions.This study provides important benchmarks for the current burden of preventable labor- and delivery-related complications in Haiti. Surveillance data suggest an urgent need for the management of hypertensive disorders during pregnancy, timely cesarean sections for dystocia, and management and treatment of postpartum hemorrhage in Haiti. Frequent data reviews may help address facility-specific bottlenecks.