High Risk Of Maternal Death Research Articles

Adverse maternal and fetal outcomes among tribal pregnant women suffering from sickle cell disease: A retrospective cohort study in a community-based hospital situated in a tribal block of Gujarat, India.

The study presents the risk of the maternal-fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity. This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal-fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal-fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression. A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted-odds-ratio [AOR] 13.7, 95% CI: 4.5-42.7), anemia (AOR 6.8, 95% CI: 4.5-10.2), severe anemia (AOR 4.3, 95% CI: 3.3-5.6), preterm delivery (AOR 4.5, 95% CI: 3.6-5.7), cesarean section (AOR 5.5, 95% CI: 4.7-7.0), stillbirth (AOR 3.4, 95% CI: 2.3-5.3), and low birth weight (AOR 3.1, 95% CI: 2.4-39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities. We concluded that SCD might be an independent risk-factor for developing maternal-fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest.

Novel Approach to Identify Severe Maternal Morbidity Clusters: A Latent Class Analysis.

Whether clusters exist within severe maternal morbidity (SMM), a set of life-threatening heterogeneous conditions, is not known. Our primary objective was to identify SMM clusters using a data-driven clustering technique, their associated predictors and outcomes. From 2008 to 2017, we used a delivery database supplemented by state data and medical record abstraction from a single institution in Pennsylvania. To identify SMM clusters, we applied latent class modeling that included 23 conditions defined by 21 Centers for Disease Control SMM indicators, intensive care unit (ICU) admission, or prolonged postpartum length of stay. Logistic regression models estimated risk for SMM clusters and associations between clusters and maternal and neonatal outcomes. Among 97,492 deliveries, 2.7% (N = 2,666) experienced SMM by any of the 23 conditions. Four clusters were identified as archetypes of SMM. Deliveries labeled as Hemorrhage (37.7%, N = 1,004) were characterized by blood transfusions and sickle cell anemia; Critical Care (28.1%, N = 748) by ICU admission and amniotic embolism; Vascular (24.5%, N = 654) by cerebrovascular conditions; and Shock (9.8%, N = 260) by ventilatory support and shock. Hypertensive disorders of pregnancy, depression, and Medicaid insurance were associated with Shock cluster. People in all clusters had a high risk of maternal death within 1 year (odds ratio: 12.0, 95% confidence interval: 6.2-23). Infants born to those in the shock cluster had the highest odds of neonatal death, low Apgar scores, and neonatal ICU admission. We identified four novel SMM clusters that may help understand the collection of conditions defining SMM, underlying pathways and the importance of comorbidities such as depression and social determinants of health markers that amplify the well-established risk factors for SMM such as hypertensive disorders of pregnancy. · A total of 2.7% of deliveries experienced SMM events.. · There are four distinct SMM clusters: Hemorrhage, Critical Care, Vascular, and Shock.. · Not all SMM clusters bear the same risk for adverse perinatal outcomes..

The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil.

The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2. This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes. We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73-95% confidence interval [95%CI] 11.07-31.69), fetal death/stillbirth (RR 1.96-95%CI 1.18-3.25), preterm birth [RR 1.18-95%CI 1.01-1.39], cesarean delivery (RR 1.07-95%CI 1.02-1.11), and cesarean delivery occurring before the onset of labor (RR 1.33-95%CI 1.23-1.44). COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.

SARS-CoV-2 Infection and Preeclampsia-How an Infection Can Help Us to Know More about an Obstetric Condition.

Pregnant women with SARS-CoV-2 infection have a significantly higher risk of maternal death, ICU admission, preterm delivery, and stillbirth compared to those without infection. Additionally, the risk of preeclampsia (PE) increases in pregnant women infected with SARS-CoV-2, particularly in severe cases. The association between COVID-19 and PE is likely attributed to various mechanisms, including direct effects of the virus on trophoblast function and the arterial wall, exaggerated inflammatory response in pregnant women, local inflammation leading to placental ischemia, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microangiopathy. This paper aims to explore the similarities between PE and SARS-CoV-2 infection, considering COVID-19 as a valuable study model. By examining these parallels, we can enhance our knowledge and comprehension of PE. We wish to emphasize the potential for COVID-19-induced myocardial injury in pregnant women and its connection to the increased maternal mortality rate.

Timing of intra-abdominal aortic balloon occlusion for prevention of hemorrhage in patients with placenta previa and placenta accreta spectrum.

Placenta accreta spectrum (PAS) has been linked to severe negative maternal-fetal pregnancy outcomes, including a high risk of maternal death. The goal of this study was to determine whether an abdominal aortic balloon block performed before fetal birth lowered intraoperative bleeding and the risk of severe bleeding, as opposed to a block performed after fetal birth. In this retrospective cohort study, patients who underwent pre-delivery or post-delivery inflation were compared for intraoperative hemorrhage, transfusion rate, hysterectomy rate, intensive care unit (ICU) hospitalization, and newborn indices. To ensure the robustness of our findings, we applied multivariate logistic regression, propensity score analysis, and an inverse probability-weighting model. This study included 168 patients who underwent balloon occlusion (62 pre-delivery, 106 post-delivery). The overall probability of major bleeding was 56.5% (95/168), and the pre-delivery and post-delivery probabilities for major bleeding were 64.5% (40/62) and 51.9% (55/106) (P = 0.112), respectively. In the multivariable-adjusted model, post-delivery inflation was associated with a 33% numerically higher probability of massive bleeding (odds ratio 1.33, 95% confidence interval 0.54-3.25, P = 0.535). However, the difference was not statistically significant. According to our findings, pre-delivery inflation did not significantly reduce the risk or amount of severe bleeding.

Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey.

Maternal mortality studies conducted at national level do not provide information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district level variations in Sidama National Regional State, southern Ethiopia. A cross sectional population-based survey was carried in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. We registered 10602 live births (LB) and 48 maternal deaths yielding the overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at health facility. Mothers who did not have formal education had higher risk of maternal death (AOR: 4.4; 95% CI: 1.7-11.0). The risk of maternal death was higher in districts with low midwife to population ratio (AOR: 2.9; 95% CI: 1.0-8.9). The high maternal mortality with district level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the life of mothers.

The trouble with maternal death narratives: Race, representation, and reproduction

ABSTRACTThe high risk of maternal death in Africa has cast a shadow over representations and experiences of pregnancy and childbirth. In the 1980s, amid new awareness of disparities in maternal mortality rates between high and low-income countries, tragic anecdotes of women dying during childbirth emerged as a tool to garner political and economic support for global health interventions aimed at women. While successfully raising public concern and billions of dollars in aid, given that these stories are some of the few stories of African women so widely circulated, it is important to ask: what else does the genre of maternal death narrative do? How might discursive practices around childbirth structure the care offered to African women? What power relations are revealed in this form of knowledge production and promotion? This article examines how maternal death narratives function, circulate, and structure potential solutions to the problem of maternal mortality. In focusing on the pathways to death, women’s bodies are foregrounded as sites of knowledge production over their experiences. I use fieldwork with pregnant and birthing women in southwest Nigeria to explore the ways that women piece together different sources of care in an effort to ensure successful deliveries amidst considerable uncertainty.

Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study

Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP. Impact of statement What is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms. What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP. What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.

CULTURAL BELIEFS AND PRACTICES REGARDING MATERNAL HEALTH: A CASE STUDY OF RURAL AREAS OF PUNJAB

People are strongly influenced by practices and beliefs whether they are based on custom or tradition, and these beliefs are difficult to change just by requesting scientific evidence. Traditional beliefs are more focused on pregnancy and childbirth than other aspects of life, making women more susceptible to them. This research study mainly focused on cultural beliefs which are contributing in determining the reproductive life of women in Pakistan particularly of rural areas. This research used a hybrid technique for data processing and interpretation. This approach mixed both qualitative and quantitative methods, and required researchers to seek and explain reality in its natural setting. Field data collection was carried out in Punjab's area; Jampur which is the tehsil headquarters in District Rajanpur, Punjab, Pakistan. Married women having at least one child were selected through purposive sampling. It was concluded that women in Jampur preferred to follow indigenous food habits, advised by their elders, during pregnancy. Women depend on their husbands or mother-in-law regarding maternal healthcare decisions. According to health professionals, the maternal health depends on the education and social status of families. The ordinary Pakistani woman will continue to endure a high risk of maternal death and would leave behind stories of misery, prejudice, and vulnerability if social and cultural practises are not addressed in broad integrated policies aiming at improving maternal health in the area. Findings of this study will be helpful for the health service providers to arise with worthwhile mechanisms to make their services women-friendly and accessible to the youth. Likewise, this study will also contribute to an in-depth understanding of the processes underlying social identities in shaping women's reproductive health-seeking behaviors. The study will be helpful for organizations that are working for maternal health and population welfare such as National Institute of Population Studies (NIPS) and also for policy-making bodies, including national health policymakers and Pakistan population policymakers. Keywords: Maternal health, Cultural Beliefs, Motherhood, Indigenous healing, Maternal food habits.

Prevalence of Teenage Pregnancy &amp; Its Outcome at Shaikh Zaid Women Hospital Larkana

Background: Teenage adolescent pregnancy is an important community health issue globally. Research shows that mothers in teenage period are at a higher risk of maternal death and complications related with pregnancy in comparison to the mothers who are adult. Therefore, this research was directed to examine the sociodemographic profile and fetal and maternal outcomes related with teenage pregnancy and their comparison with mothers of 20-30 years of age. Study Design: A comparative cross-sectional study. Place and Duration: In the obstetrics and Gynecology department of Sheikh Zaid Women Hospital Larkana for one-year duration from March 2021 to February 2022. Methods: A total of 60 teenage mothers ≤19 and 60 mothers who were 20-30 years of age respectively, were nominated as controls and cases. Data on the obstetric complications, fetal outcomes and sociodemographic profile were collected through face-to-face interviews using a pre-tested, pre-designed, partially structured questionnaire. The statistics were analyzed by entering data in the excel sheet of Microsoft. Results: In this study, 18.1 years was the mean age in teenage pregnant females and 24.3 years in the control group. 17.8 years was the mean age at which teenage mothers were married and for adults it was 20.1 years. 66.7% of teenage mothers and 61.7% of the control group are of high-low socioeconomic status. 80% of teenage pregnant females and 75% of control group were from rural areas. The mainstream of teenage mothers (70%) and control mothers (58.3%) are housewives by profession. The consanguineous marriages were observed in 33.3% of adolescent pregnant females and 41.7% in the control group. In this study, 38.3% and 46.7% of the mothers in adolescent and control group respectively had ante-natal checks during their pregnancy. Stillbirth / miscarriage were reported in 13.3% of adolescent mothers and 25% in the control group. 63.3% of teenage mothers had mild anemia and 53.3% in controls. The incidence of malnutrition (40% vs 15%, p &lt;0.05), PPH (25% vs 6.7%, p &lt;0.05), PROM (20% vs 3.3%, p &lt;0.05) was significant in teenage mothers in comparison to mothers who were adults. The incidence of PIH was lower significantly in mothers during adolescence in comparison to adult mothers (13.3% vs. 31.7%, p &lt;0.05). Conclusions: Complications such as PROM, maternal malnutrition, premature delivery, PPH and low birth weight occurred more frequently in adolescent mothers than in mothers who were adults. The adult mother’s higher proportion of PIH than in teenage mothers. Keywords: Adult pregnancy, teenage pregnancy, sociodemographic factors, adverse fetal and maternal outcomes.

Late initiation of antenatal care and associated factors among pregnant women in Jimma Zone Public Hospitals, Southwest Ethiopia, 2020

BackgroundLate antenatal care initiation is linked to a higher risk of maternal death. Women who do not start ANC at an early stage may experience the effects of pregnancy-related health difficulties, as well as long-term health issues and pregnancy complications. Therefore, our study aimed to determine the prevalence of late initiation of antenatal care and associated factors among pregnant women in Jimma Zone public Hospitals.MethodsA facility-based cross-sectional study design was employed in Jimma zone public hospitals from February 1 up to 30 March 2020 and 409 pregnant women were participated in the study by using a systematic random sampling method. Structured questionnaire was used to collect data that contain socio demographic variables, socio cultural variables, pregnancy related factors and predisposing factor related variables. The data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Binary and multivariable logistic regression analysis were performed by using 95%CI and significance was declared at P < 0.05.ResultForty-eight percent of pregnant women were initiated their first ANC late. Primary education (AOR = 0.242; 95% CI, 0.071–0.828) and college diploma and above was (AOR = 0.142; 95% CI, 0.040- 0.511), mothers with an unplanned pregnancy (AOR = 11.290; 95%CI, 4.109–31.023), time taken to arrive the health facility greater than sixty (60) minutes (AOR = 8.285; 95% CI, 2.794–24.564) and inadequate knowledge about ANC service (AOR = 4.181; 95%CI, 1.693–10.348) were associated with late first Antenatal care initiating.ConclusionThe prevalence of late initiation of ANC still remains a major public health concern in the study area. Level of education, unplanned pregnancy, distance from house to health facility, and lack of understanding about ANC services were all found to be significant variables in late ANC starting. As a result, healthcare workers can provide ongoing health education on the need of starting antenatal care visits early to avoid unfavorable pregnancy outcomes by considering all identified factors.

Robotic-Assisted Laparoscopic Resection of a Cornual Ectopic Pregnancy: Video Presentation

Study Objective A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Design Case Report. Setting Tertiary care center outside of a major city in the United States. Patients or Participants We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. Interventions The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. Measurements and Main Results The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Conclusion Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss. A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Case Report. Tertiary care center outside of a major city in the United States. We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss.

Assessing the maternal risks associated with short stature in ancient Southeast Asia

AbstractThe maternal experience in ancient Southeast Asia has been an area of study not yet addressed in bioarchaeological research due to the challenges associated with evaluating it and the lack of tools available. This study aims to better our knowledge of the maternal experience in ancient Southeast Asia by investigating whether there is a relationship between maternal mortality rates and a known maternal risk factor, stature, which can be estimated from archaeologically derived skeletal remains. This is performed by applying an adapted maternal mortality rate estimator and undertaking analyses based on stature estimates from ancient Southeast Asian archaeological samples. By investigating estimated stature and maternal mortality rates, we are able to look at whether the modern risks associated with pregnancy in short statured females were also seemingly applicable in the past in Southeast Asia. This study identified that, at the population level, a decrease in average stature coincided with an increase in maternal mortality rates. These results emulate modern trends, with shorter statured females being at a higher risk of maternal death and often requiring medical intervention due to complications caused by their short stature and associated small pelvis. These findings contribute to our understanding of the maternal risk associated with short stature in ancient Southeast Asia.

Risk factors of maternal death in preeclampsia

Aim. To determine the factors contributing to maternal death due to preeclampsia.Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study.

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score ≥ 8 points but also those with fibrinogen levels ≤ 1.5g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels ≤ 1.5g/L as predictors of a Japanese obstetrical DIC score of ≥ 8. We included 595 participants with blood loss ≥ 1000mL during vaginal delivery or ≥ 2000mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of ≥ 8 and fibrinogen levels of ≤ 1.5g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of ≥ 3 was associated with RBC or fibrinogen administration and a score of ≥ 5 was associated with PC transfusion. Fibrinogen levels ≤ 1.89g/L and ≤ 2.44g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels ≤ 1.5g/L may have similar potential to a DIC score of ≥ 8 points for detecting obstetrical DIC in Japan.

Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis

ObjectivesTo systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes.DesignSystematic review and meta-analysis of observational data searched from inception until 1...

Prevalence, Associated Factors and Consequences of Unwanted Pregnancy in Iran.

Background:Unwanted pregnancy is a type of unplanned pregnancy that can endanger health of mother and child. This study aimed to determine the prevalence of unwanted pregnancy and its associated factors and consequences in Iran.Methods:This cross-sectional study was conducted in regions with low, moderate and high risk of maternal death. Two provinces were randomly selected in each region and 24 public health centers in each province during 2007–2012. Thereafter, 15–20 mothers, received at least one session of pregnancy care, were selected from each healthcare center. Data were gathered from both health records and interview with the mothers.Results:Of 2714 participants, 86.4% and 13.6% had respectively wanted and unwanted pregnancies. The underlying factors of unwanted pregnancy were determined as low distance with previous and next pregnancy, economic problems and have enough children. Moreover, there were significant relationships between unwanted pregnancy and place of residence, mother’s age and education, father’s education, pre-pregnancy care and number of previous pregnancies and children. There were also significant association between unwanted pregnancy and pregnancy care, anemia, exposure to risk factors and disease, intake of folic acid and iron, domestic violence, bitter memories and men’s participation.Conclusion:Although the prevalence of unwanted pregnancy has had a significant decrease in Iran, these mothers still require a higher level of educational, counseling and supportive services due to their low access to pregnancy care services and high exposure to associated risk factors.

The Effect of Socioeconomic Status on All-Cause Maternal Mortality: A Nationwide Population-Based Cohort Study

Improving maternal health is one of the 13 targets of Sustainable Development Goal 3; consequently, preventing maternal death, which usually occurs in women’s prime productive years, is an important issue that needs to be addressed immediately. This study examines the association between socioeconomic status and all-cause maternal mortality in South Korea and provides evidence of preventable risk factors for maternal death. For this population-based retrospective cohort study, data on 3,334,663 nulliparous women were extracted from the Korean National Health Insurance Service database between 2003 and 2018. The outcome variables were all-cause maternal mortality within six weeks and a year after childbirth. A log-binomial regression model determined the association between maternal mortality and income-level adjusted covariates. Women with lower income levels had higher risk of maternal death within six weeks (risk ratio (RR) = 2.42, 95% confidence interval (CI) = 1.65–3.53) and within one year (RR = 1.83, 95% CI = 1.47–2.28), especially those who were aged 35–39 years, lived in rural areas, delivered via cesarean section, and had maternal comorbidities. The study identifies a significant relationship between South Korean primiparas’ socioeconomic status and maternal death within six weeks or one year after childbirth, suggesting interventions to alleviate the risk of maternal death.

Pregnancy-Related Acute Kidney Injury in Preeclampsia: Risk Factors and Renal Outcomes.

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 μmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6-11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8-2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21-4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.

THE EQUITY OF ANTENATAL CARE STANDARD IN DIFFERENT AGES

Background: Antenatal care standard ensures the health of pregnant woman with early detection of risk factors, prevention and treatment provided by competent health practitioners. Health equality does not always mean improving the same service for everyone, but the services are provided according to everyone's needs.Aim: This research was to examine the antenatal standards based on patients’ needs in the Public Health Centre of Medokan Ayu.Methods: This research was observational by using cross-sectional design. The population in this study was 518 pregnant women who gave birth from June 2011 to May 2012 in the Primary Healthcare Center of Medokan Ayu. There were 88 mothers as samples obtained by a cluster random sampling.Results: This study determines the need for antenatal care standards can be fulfilled more for the age of &lt;20 years and &gt;30 years to avoid the high risk of maternal death and needs and equity based on the standards. There were no differences in the acceptance standard of antenatal care (5T and 7T) based on the age group between &lt;20 years, 20-30 years, and&gt; 30 years.Conclusions: Reproductive women need to recognize the importance of antenatal care. The availability and quality of antenatal care need to be further maintained by the healthcare providers, and they need to be more aware to the importance of antenatal care. Women in later reproductive period need to be aware of the prevailing risks in circumstances. Keywords: Equity, Antenatal care standard, Age.