Instrumental Delivery Research Articles

Prevalence and associated factors of birth trauma in Ethiopia: A systematic review and meta-analysis.

Birth trauma is described as organ or tissue damage caused by physical pressure during birth. Birth trauma ranges from minor problems that go away on their own to significant wounds that might result in infant morbidity and mortality over the long term. It is one of the critical issues that have received the least attention globally. In Ethiopia, evidence regarding the pooled prevalence of birth trauma among neonates is scarce. Therefore, this study estimated the pooled prevalence of birth trauma and associated factors in Ethiopia over the last decade. The Preferred Items for Systematic Reviews and Meta-analysis (PRISMA-2009) guidelines were followed. The PubMed, Scopus, Web of Science, Google Scholar and Google databases were searched. Articles published in the English language in the last decade were included. Data were extracted by a pre-prepared Excel sheet, and analysis was conducted using STATA version 14. Subgroup analysis was also undertaken to evaluate how the prevalence of birth trauma differs across regions of Ethiopia. The pooled prevalence of birth trauma in Ethiopia was 10.57% (95% CI: 3.08, 18.07), with a heterogeneity index (I2) of 92.6% (p < 0.001). Presentation other than vertex AOR 11.94 (95% CI: 6.25-17.62), P = 0.001 and I2 = 53%, labor assisted by forceps AOR 6.25 (95% CI: 2.95-10.10), P = 0.002 with I2 = 51.8% and labor assisted with vacuum AOR 17.47 (95% CI: 4.25-39.46), P = 0.0001 with I2 = 92.9% were factors associated with the pooled prevalence of birth trauma in Ethiopia. The pooled prevalence of birth trauma in Ethiopia is considerable. Non-vertex presentation, use of instrumental delivery and prolonged labor were factors significantly associated with birth trauma. Strengthening neonatal improvement activities (thermal protection, hygienic umbilical cord and skin care, early and exclusive breastfeeding, assessment for signs of serious health problems or need for additional care and preventive treatment), is need.

Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia

BackgroundChild psychomotor development and factors affecting it today is the subject of interest of many studies, in particular by the experts involved in the protection and improvement of children’s health. There is limited evidence on developmental delay among under-five children in low-income countries like Ethiopia. The aim of this study was to assess gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia.MethodsFacility based cross sectional study design was used among under-five children attending under-five OPD in public health facilities of Dessie town from July 1, 2020 to August 15, 2021. A total of, 417 under-five children were systematically selected based on their average number of clients in a month. A pretested structured questionnaire was used for data collection, and data was entered into Epi-data 3.1 version and it was exported to STATA version 14 for analysis. Binary logistic regression analysis was used to identify factors associated with the outcome variable. Odds ratio with 95% confidence interval was used to show the strength and direction of association respectively and P-value less than 0.05 is used to declare statistical significance.ResultsThe overall proportion of gross motor developmental delay among under-five children attending health facilities of Dessie city, Ethiopia was 16.31%, 95% CI: (13.05, 20.19). Increased age of the child [AOR = 0.97, 95% CI: (0.96, 0.99)], increased gestational age during pregnancy [AOR = 0.47, 95% CI: (0.37, 0.65)], being male [AOR = 5.26, 95% CI: (1.76, 15.67)], having history of alcohol intake during pregnancy [AOR = 7.40, 95% CI: (2.36, 23.25)], taking iron during pregnancy [AOR = 0.04, 95% CI: (0.01, 0.15)], facing fetal and/or maternal complication [AOR = 4.98, 95% CI: (1.20, 20.62)], having instrumental delivery [AOR = 9.78, 95% CI: (2.48, 38.60)] were significantly associated with gross motor developmental delay.ConclusionsThe gross motor developmental delay among under-five children was higher as compared to other literatures. This study indicated that, age and sex of the child, iron and alcohol intake during pregnancy, gestational age, mode of delivery and any complication to her and or her neonate were independent variables which showed statistical significant association. The physicians should advise mothers to take iron-folic acid supplement properly and to avoid intake of alcohol during pregnancy. In addition, they should focus on those mothers who faced any complication to her and/or her neonate and better to discourage instrumental delivery unless there are no other options.

Maternal and Perinatal Outcome in Severe Pre-eclampsia in a Tertiary Care Center

Background: Pre-eclampsia is the leading reason for referrals to a specialized healthcare facility, as it represents a significant contributor to maternal and perinatal morbidity and mortality. Objective: The objective of this study is to examine the maternal and fetal outcomes associated with severe pre-eclampsia in a Tertiary Care Center. Design: Prospective observational study. Methodology: This prospective observational study took place at Dr. Prabhakar Kore Hospital and MRC, located in Belagavi and affiliated with KAHER's Jawaharlal Nehru Medical College, Belagavi. The study spanned from January 1, 2021, to December 31, 2021. Pregnant women diagnosed with severe Pre-eclampsia, which met the specified inclusion and exclusion criteria, and were admitted to the labor room at the tertiary care center, were enrolled in the study. Results: Participants in the study ranged in age from 19 to 41 years, with a mean gestational age at diagnosis of 35.32 weeks ±3.7 weeks. Among the participants, 73.4% underwent lower segment cesarean section (LSCS), while 22.4% had vaginal deliveries, including 3 cases with instrumental delivery (ventouse). The study observed increased incidences of Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome (32.4%), placental abruption (30%), postpartum hemorrhage (22%), partial HELLP syndrome (16.2%), pulmonary edema (11%), eclampsia and disseminated intravascular coagulation (DIC) (8.1%). The incidence of prematurity was 55%, and intrauterine fetal demise (IUFD) occurred in 7% of the cases. Conclusion: Maternal and perinatal problems are more common in eclampsia patients. Better prenatal care, early detection, and timely treatment of severe pre-eclampsia can lower the incidence of eclampsia.

Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.

There are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery. We performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia). We observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% vs 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 vs 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% vs 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy. We observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position.

Vulvovaginal Laceration and Pelvic Fracture With Symphisiolysis

Vulvovaginal laceration and pelvic fracture with symphysis disruption represent a complex and challenging clinical scenario in the field of obstetrics and gynecology. This study aims to examine the incidence, clinical characteristics, and management strategies for cases involving simultaneous vulvovaginal lacerations and pelvic fractures with symphysis disruption. A retrospective analysis was conducted on a cohort of patients presenting with these combined injuries over a specified period. Demographic data, obstetric history, mode of delivery, associated risk factors, clinical presentation, radiological findings, and management outcomes were systematically reviewed. Results revealed that the occurrence of vulvovaginal laceration and pelvic fracture with symphysis disruption is relatively rare but can lead to significant morbidity. The majority of cases were associated with traumatic childbirth, instrumental deliveries, or pelvic trauma. Prompt diagnosis through a multidisciplinary approach involving obstetricians, orthopedic surgeons, and radiologists is crucial for optimizing patient outcomes. In conclusion, vulvovaginal laceration and pelvic fracture with symphysis disruption present a complex clinical scenario that requires a comprehensive and multidisciplinary approach. Further research and collaborative efforts are warranted to enhance our understanding of risk factors, refine diagnostic protocols, and establish evidence-based guidelines for optimal management of this unique obstetric and gynecologic challenge.&#x0D; &#x0D;

Factors Associated With a Maternal Lower-limb Neurological Deficit After Vaginal Delivery

(Acta Obstet Gynecol Scand. 2023;102:51–58) Women experience lower-limb neurological deficit following vaginal delivery at a rate of 0.1% to 2%. The manifestation varies between transient with resolution within weeks to significant discomfort and prolonged disability. To better understand risk factors that contribute to this occurrence, maternal characteristics were assessed including neurological history, maternal obesity, nulliparity, gestational age &gt;41 weeks, labor positions, prolonged labor duration, large newborn weight, instrumental delivery, epidural analgesia, and cephalopelvic disproportion. Better understanding of the mechanism of this injury may allow for prevention.

Cashless Payment System Model at the Ministry of Cooperatives and Small and Medium Enterprises

To encourage the creation of effective and efficient APBN implementation, widely known by the public, and accountable, the payment mechanism in the APBN implementation process must be simplified but modern with the use of information technology that is increasingly optimal. One of the efforts made is to change shopping behavior, especially related to the use of the Money Supply mechanism which gradually shifts from fully using cash funds to cashless systems through the implementation of digital payments such as Government Credit Cards (KKP) and Cash Management System Virtual Accounts (CMS VA). This study aims to explore the factors that cause the low implementation of Cashless payment systems in the form of KKP and CMS VA within the Ministry of Cooperatives and SMEs, and find a model that can optimize it. Researchers use a qualitative approach with the case study method because they try to focus intensively on a particular object that studies it as a case, and cannot be generalized because the results of this study only apply to the case being studied. The results of this study show that leadership commitment is the factor that most influences the implementation of the cashless payment system, and also determines the influence of other factors such as human resource factors, the availability of SOPs, reward and punishment mechanisms, and the involvement of the Bank in the use of KKP and CMS VA. Satker must synergize with other parties so that in every stage of implementation starting from the signing stage of cooperation between Satker and the Bank, issuance and delivery of instruments, use transactions and accountability, until the supervision and monitoring evaluation stage can run better so that it can have an optimal impact on the implementation of Cashless payment systems within the Ministry of Cooperatives and SMEs

Abstract 17950: Atrial Fibrillation Impacts Mortality, Length of Stay, Resources Utilization and Need for Endotracheal Intubation in Patients Who Were Submitted to C-section or Natural Delivery: A Nationwide Analysis 2016-2020

Background: Atrial fibrillation (AF) is rare during pregnancy but the data on its impact during delivery is scaring. In this study, we aim to analyze the impact of AF in patients who underwent delivery via Cesarean section (CS), natural spontaneous delivery (NSD) or instrumental delivery (ID). Methods: We obtained the data from the National Inpatient Sample from 2016-2020. Our primary outcome was in-hospital mortality. Secondary outcomes included length of stay, total hospital charges and respiratory failure requiring intubation. Primary and secondary outcomes were adjusted to variables that had a p-value&lt;0.2 for that outcome. Results were considered statistically significant if p-value &lt;0.05. Results: There were 17,785,980 deliveries who underwent CS, NSD or ID. Of this, 6,000 patients had the secondary diagnosis of atrial fibrillation. The population had a mean age of 29.13 years. (See table 1) Patient with AF had almost twenty times more change of dying compared to those without AF odds ratio (OR) 19.12, 95% Confidence interval (CI) 4.33 - 84.45, p&lt;0.001. Furthermore, AF cohort stayed for one and a half day longer Coefficient 1.55, CI 1.16 - 1.94, p&lt;0.001, had a higher hospital charge Coefficient 19294.05, CI 14658.17 - 23929.93 and had a higher rate of respiratory complications requiring intubation OR 15.86, CI 7.83 - 32.15, p&lt;0.001. (See table 2) Conclusion: Atrial fibrillation has a substantial negative impact in inpatient outcomes on pregnant patients during delivery. Further research is needed to explore these disparities in maternal care.

Determinants of fetomaternal complication of instrumental vaginal delivery among women who gave childbirth in Southern Ethiopia: a facility-based cross-sectional study

BackgroundIn Ethiopia, one in five instrumental deliveries among women giving birth resulted in an unfavourable outcome. This study aimed to assess the determinants of feto-maternal complications of instrumental delivery in selected public hospitals of Gamo and Gofa zones, Southern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 399 women attending selected public hospitals in the Gamo and Gofa zones. Data were collected using data extraction tools using a systematic random sampling technique. The collected data was entered into Epi-data version 3.1 and then analyzed using SPSS version 25. Logistic regression analysis was conducted to determine an association.ResultsOne hundred eighty-three (45.9%, n = 183/399) instrumental deliveries were found to be complicated. Primigravida women (AOR: 95% CI: 2.21 (1.35, 3.63), infant birth weight (AOR: 95% CI: 2.56 (1.37, 4.77), post-term pregnancy (AOR: 95% CI: 12.77 (2.92, 55.78), and maternal age (AOR: 95% CI: 7.00 (2.16, 22.64) were associated with fetomaternal complications in instrumental delivery among women who gave birth.Conclusions and recommendationA high proportion of women developed fetomaternal complications when compared to local studies. Promotion of antenatal care services, increasing women’s education and empowerment as well as working on capacity building of health care professionals through education and training is cost-effective to reduce the occurrence of fetomaternal complications.

Differential diagnosis of bulging scalp: beyond cephalohematoma and subgaleal hematoma

A 30-day-old infant was brought to the pediatric emergency room with a bulge in the scalp in the parieto-occipital region, mobile and without associated phlogistic signs. He had no history of fever or any other complaints. The mother reported that the bulge appeared at 20 days of life and showed progressive growth. There was no history of trauma. The boy was born at term by cesarean delivery due to cephalopelvic disproportion.&#x0D; For initial evaluation, skull X-ray and cerebral ultrasound were performed (Figure 1). A magnetic resonance imaging and tomography of the brain were also performed (Figure 1). &#x0D; Faced with the diagnostic challenge, neurosurgery proceeded with drainage of the collection and biopsy of the galea. No malignant cells were found and the biopsy only found an inflammatory change. Given these findings, the diagnosis of delayed subaponeurotic fluid collection (DSFD) was made. There was no recurrence of the collection and the patient had a good evolution.&#x0D; DSFD are a rare condition, which occurs spontaneously between the 4th and 18th week of life, and makes the differential diagnosis with cephalohematoma, caput succedeneum and subgaleal hematoma [1]. Its pathophysiology is not fully elucidated; however, most reports share a similar history of prolonged or instrumented delivery [1,2]. Patients are otherwise healthy and with no history of trauma [2].&#x0D; The management of DSFD is conservative and the natural history is spontaneous resolution within 1 to 2 months [1,2].

Increasing trends in a low 5-min Apgar score among (near) term singletons: a Dutch nationwide cohort study.

To investigate trends in low Apgar scores in (near) term singletons using the Dutch Perinatal Registry. In a cohort of 1,583,188 singletons liveborn ≥35 weeks of gestation in the period 2010-2019, we studied trends in low 5-min Apgar scores (<7 and <4) using Cochrane Armitage trend tests. The proportion of infants with low Apgar scores <7 and <4 increased significantly between 2010-2019 (1.04-1.42% (p < 0.001), 0.17-0.19% (p = 0.009), respectively). Neonatal mortality remained unchanged. Induction of labour, epidural analgesia and planned caesarean section showed an increasing trend. Instrumental vaginal delivery and emergency caesarean section were performed less frequently over time, but these intervention subgroups showed the highest relative increase in infants with low Apgar scores. In the Netherlands, the risk of a low 5-min Apgar score increased over the last decade. The highest relative increase was observed in subgroups of instrumental vaginal delivery and emergency caesarean section.

Relationship Between Neonatal Brain Injury and Objective Measures of Head Trauma: A Case-Control Study.

Neonatal brain injury is a common and devastating diagnosis conferring lifelong challenges for children and families. The role of mechanical forces applied to the head, often referred to as "birth trauma," are often considered although evidence for this association is lacking. The objective of this study was to investigate the association between common types of neonatal brain injury and scalp swelling using a novel method to quantify scalp swelling as an unbiased proxy for mechanical forces applied to the head. Case-control study using population-based, prospectively collected tertiary care center databases and healthy controls from the Human Connectome Development Project. Included were infants born 32-42 weeks gestational age and MRI in the first 9 days. Outcomes categories included healthy neonates, hypoxic ischemic encephalopathy (HIE) with or without brain injury, or stroke (ischemic or hemorrhagic). Volume of scalp swelling was objectively quantified by a novel imaging method blinded to brain injury. Variables included mode of delivery and use of instrumentation. Statistical tests included Kruskal-Wallis test, chi square, and multivariable and multinomial logistic regression. There were 309 infants included (55% male): 72 healthy controls, 77 HIE without brain injury on MRI, 78 HIE with brain injury, and 82 with stroke (60 ischemic, 22 hemorrhagic). Scalp swelling was present in 126 (40.8%, 95% confidence interval [CI] 35.2%-46.5%) with no difference in proportions between outcome groups. Compared to healthy controls, median volume was higher in those with HIE without brain injury (17.5 mL, 95% CI 6.8-28.2), HIE with brain injury (12.1 mL, 95% CI 5.5-18.6), but not ischemic stroke (4.7 mL, 95% CI -1.2-10.6) nor hemorrhagic stroke (8.3 mL, 95% CI -2.2-18.8). Scalp swelling was associated with instrumented delivery (OR 2.1, 95% CI 1.0-4.1), but not associated with increased odds of brain injury in those with HIE (OR 1.5, 95% CI 0.76-3.30). Scalp swelling measures were highly reliable (ICC = 0.97). "Birth trauma" quantified by scalp swelling volume was more common in infants with difficult deliveries, but not associated with greater odds of brain injury due to hypoxia or stroke. These results may help parents and practitioners to dissociate the appearance of trauma with the risk of brain injury.

Prevalence and factors associated with neonatal acute respiratory distress syndrome among neonates admitted to the neonatal intensive care units of Gurage zone public hospital, South West Ethiopia.

Respiratory distress syndrome (RDS) is the leading cause of respiratory failure and death of a neonate in today's world, especially in developing countries like Ethiopia. We used an institutional-based cross-sectional study in the selected hospitals of the Gurage zone admitted from June 2019 to June 2021. The data were collected using a structured questionnaire. Data were entered into Epi data 3.1 and exported to SPSS version 25 for analysis. The prevalence of respiratory distress syndrome (RDS) in the study area was 45.1%. The odds of RDS in neonates from mothers with gestational age between 35 &37 were 3.99 times higher compared to term gestation. The odds of RDS among neonates with jaundice and sepsis are 4.33- and 1.92-times higher odds compared to their counterparts. The odds of RDS in neonates born via Caesarean section were 1.7 times higher compared with those delivered via spontaneous and instrumental delivery. RDS was also higher in neonates born to mothers <20 years of age and >=35 years old. the prevalence of RDS in the study area was high. Thus, healthcare providers should act on those factors with appropriate follow-up for early detection of the problem and prevent the risk.

Postdate Pregnancy Maternal and Fetal Outcomes among Sudanese Women

Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses. Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018. An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded. Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%). Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and &gt; 7 in 86.9%. Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week. Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection.

Impact of Maternal Body Mass Index (BMI) and Age on Pregnancy Outcomes at a Tertiary Care Hospital

Objectives: To analyze the role of maternal BMI and age on pregnancy outcomes. Study design and Setting: A retrospective cohort study CMH, Abbottabad from 1st August 2022 to 31st January 2023 Methodology:A retrospective cohort study was done over a period of 6 months in 500 post-natal women whose BMI were calculated and recorded at first trimester during their booking visit and eventually delivered at combined military hospital, Abbottabad. Data related to age, BMI, gestational age at the time of delivery, spontaneous or induction of labour and mode of delivery were evaluated. Results: The study included 500 female patients. The mean age and BMI were 32±11.5 years and 28.8±8 respectively. 140 (28%) females had normal weight, 310(62%) and 50(10%) were overweight and obese respectively. The variable age at the time of booking was divided into three groups = 20 years, 21-35 years, and 36-42 years which included 80(16.4%), 275(55%) and 145(29%) patients respectively. Multigravida were 285(57%) and prim gravida were 215(43%). Induction was given to 275(55%) and those who went into spontaneous labour were 225(45%). Delivery at term that is = 37 weeks was 455(91%) and only 45(9%) were delivered before 37 weeks. Percentage of women having a spontaneous vaginal delivery was 230(46%) and 250(50%) had LSCS and 20(4%) underwent instrumental delivery. Conclusion: It was evident that raised BMI and maternal age had confounding effects on pregnancy outcomes. The incidence of LSCS was more in patients with higher BMI and age.

FIGO opinion paper: Drivers and solutions to the cesarean delivery epidemic with emphasis on the increasing rates in Africa and Southeastern Europe.

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress.

Maternal and Newborn Morbidity in Federal Teaching Hospital Gombe, North-East, Nigeria

Background: Efforts are being made to promote mother and child survival by reducing the high rate of maternal and newborn morbidities in developing nations, particularly in sub-Sahara Africa. The study was designed to find the pattern and associated factors of maternal and newborn morbidities in Gombe, northeast Nigeria test. Materials and Methods: Patients were prospectively interviewed with the use of a structured questionnaire and medical case records were also reviewed. Data obtained was entered into SPSS version 21 for analysis. Results: A total of 250 women were studied. Most (53.6%) were aged 26–35 years. The majority (97.2%) were married. Most (40.0%) were unemployed and of the Fulani ethnicity (36.4%). Urban dwellers were in the majority (55.2%). Approx. 78% had at least a secondary level of education. Most (64.4%) were multiparous, had 2 or more living children (72%), and 76% with less than 8 ANC visits. Distribution of MOD showed C/S (52.4%), SVD (36%), and Instrumental delivery (1.6%). Maternal morbidity was recorded in 22% with PPH (47.3%), Genital injury (30.5%), and Genital sepsis (16.4%) most common. Newborn morbidity was recorded in 23.6% with neonatal asphyxia (25.4%), neonatal jaundice (25.4%), and LBW (22%) most common. Women who had less than 8 ANC visits (p = 0.05) and underwent instrumental delivery (p = 0.002) were more likely to suffer morbidity. Those who had Caesarean Section were less likely to have a maternal morbidity (p = 0.002). Whereas, neonates born to primiparous women were more likely to suffer a morbidity (p = 0.042). There was no significant relationship between number of ANC visits (p = 0.512) and MOD (p = 0.680). Conclusion: PPH, genital injuries, and genital sepsis were the commonest maternal morbidities while Neonatal asphyxia, jaundice, and LBW were commonest in the newborn. Less than eight ANC visits and instrumental delivery increased the likelihood of maternal morbidity, while delivery to primiparous mothers increased the likelihood of newborn morbidity. Campaign for adequate antenatal care clinic visits should be sustained and when indicated cesarean delivery should not be denied to women. Accouchers must be trained in the usage of instrumental deliveries to reduce morbidities associated with it.

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies.

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.

Prevalence of pelvic floor disorder and associated factors among women in Arba Minch Health and Demographic Surveillance Site, Gamo Zone, Southern Ethiopia, 2021

BackgroundGlobally, millions of women develop pelvic floor disorder. It imposes a considerable emotional, social, and financial burden on women’s lives. Despite this, in developing countries, nearly half of women with pelvic floor disorder do not seek any help due to feelings of isolation, depression, shame, and loss of control. Thus, the magnitude of the problem is largely unknown. The aim of this study was to assess the prevalence of pelvic floor disorder and associated factors among women at Arba Minch Health and Demographic surveillance site.MethodsA cross-sectional study with a simple random sampling technique was employed on a community basis. The data were entered into EpiData version 3.1 and then exported to Statistical Package for Social Sciences version 25 for data cleaning and analysis. Bivariate and multivariable analyses using binary logistic regressions were carried out to identify factors associated with pelvic floor disorder. The level of significance was declared at a p-value of &amp;lt; 0.05.ResultsThe prevalence of pelvic floor disorder was 31.4% (95% CI = 26.9% to 35.8%). Being grand multiparous (AOR = 3.919, 95% CI = 1.495–10.276), having a history of instrumental delivery (AOR = 3.042, 95% CI = 1.483 to 6.241), having a history of perianal tearing (AOR = 2.972, 95% CI = 1.491 to 5.927), and having a medical disease (AOR= 2.698, 95% CI = 1.526 to 4.770) were factors associated with pelvic floor disorder.Conclusions and recommendationsThe prevalence of pelvic floor disorder was high in the study area. Parity, instrumental delivery, perianal tears, and medical problems were factors affecting the prevalence of pelvic floor disorder. There is a need for an improvement of policies and strategies focusing on prevention and treatment services to alleviate the problem.

Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders.

Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses. A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found. Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED. We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.