Maternal Causes Research Articles

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

BackgroundGlobally, a total of 13.6 million women have died due to maternal causes from 1990 to 2015. Majority of these deaths occurred in resource-limited countries. Among the causes of these deaths, obstructed and prolonged labor covers the highest percentage, which could be prevented by cost-effective and affordable health interventions like partograph use. Therefore, this systematic review and meta-analysis aimed to assess the level of partograph utilization among obstetric care providers and its associated factors in Ethiopia.MethodFor this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed/Medline, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. Microsoft Excel was used for data entry and Stata version 11.0 (Stata Corporation, College Station, TX, USA) for data analysis.ResultNineteen studies were included in this systematic review and meta-analysis with a total of 6237 obstetric care providers. The overall pooled prevalence of partograph utilization was 59.95% (95% CI 46.8–73.09, I2 = 99.4%, P < 0.001). Being in midwifery profession (adjusted odds ratio (AOR) 3.97; 95% confidence interval (CI) 2.63–5.99, I2 = 28.8%, P = 0.198), presence of supervision (AOR = 3.21; 95% CI 2.22–4.66, I2 = 0.0%, P = 0.742), Basic Emergency Obstetric and Newborn Care (BEmONC) training (AOR = 2.90; 95% CI 2.19–3.84, I2 = 36.9%, P = 0.13), knowledge of partograph (AOR = 2.5; 95% CI 1.6–3.8, I2 = 64.58%, P = 0.024), on-the-job refresher training on partograph (AOR = 5.7; 95% CI 2.5–12.9, I2 = 87.8%, P < 0.001), favorable attitude (AOR = 2.12; 95% CI 1.48–3.04, I2 = 0.0%, P = 0.58), and working at health center (AOR = 3.50; 95% CI 2.49–4.92, I2 = 49.1%, P = 0.08) were the determinant factors for partograph use among obstetric care providers in Ethiopia.ConclusionThe overall pooled prevalence of partograph utilization among obstetric care providers was low. Therefore, supportive supervision, providing Basic Emergency Obstetric and Newborn Care training, on-the-job refresher training on partograph, and promoting midwifery profession are strongly recommended to increase the use of partograph.

STUDY ON STILL BIRTH: A CATASTROPH FOR PATIENT AND NIGHTMARE FOR THE OBSTETRICIAN

Introduction: Still Birth is a catastrophic event for both treating doctor and the patient.World wide in 2015, for every 1000 total births, 18.4 babies were stillborn, mostly in low and middle income countries. India has the highest number of stillbirths, with an estimated 592 100 deaths per year Aim : To evaluate the still birth rate of our institution and to assess the sociodemographic factors contributing to it, and to predict the maximum risk period for still birth. Material and Methods: All patients who gave consent and delivered a baby either vaginally or by caeserian section after 28 weeks of gestation during the study period(july 2019-June 2020) were included in the study.Still Birth was defined as a baby born after 28 completed weeks of gestation or weighing more than 1 kg,with no signs of life .Total no of patients during the study period were 2629, with 5 sets of twins. So total no of birth during the study period was 2634. Epidemiological data were compared between still birth and total births.Causes of still births were analysed and period of maximum risk for still birth was predicted. Statistical Analysis :Descriptiveanalytes were expressed in proportion. Chi square test was used to assess the significance level and p value of &lt;.05 was taken as significant. Result: Total no. of births by either vaginal route or caesarean section during june 2019 to july 2020 were 2634 foetuses. among which,137 fetus were still born. So still birth rate was 52/1000 live births.Maximum no of still births were in the age group of 20-25 years 69(50.3%), were primigravida 46(33.5%), belonged to low socioeconomic status 95(69.3%), came from rural areas79(57.6%) and were unbooked 94(68.6%).There was statistically significant difference(p=.0012) in unbooked cases when still births and total births were compared. No cause could be attributable to still birth in 15(10.9%) of cases, whereas 81(59.1%) had maternal causes,17(12.4%) had fetal causes, 19(13.8%) had placental causes while 5(3.6%) had other reasons like acute infections or thermal burns. Major reason of StillBirth amongst the maternal causes, was labour complications 38(37.7%), whereas intra uterine growth restriction was the leading cause 8(5.8%) amongst the fetal factors.36-40 week was the gestational age during which maximum still births occured.95(69.31%) of still birth cases were delivered by vaginal route Conclusion:Majority of still births were in unbooked cases and labourcomplications were the leading cause of still births overall. Hence antenatal care and delivery by skilled attendant is of paramount importance. Routine antenatal care would also lead to early recognition of maternal and fetal high risk factors and their management.

Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †.

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child’s health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child–maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015–2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2–10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63–2.83), and very low birth weight (OR = 3.77; 95% CI 2.20–6.46); late preterm births (OR = 1.65; 95% CI 1.21–2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46–8.02) and 5th minutes (OR = 4.13; 95% CI 2.78–6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

Improving US maternal mortality reporting by analyzing literal text on death certificates, United States, 2016-2017.

Changes in data collection and processing of US maternal mortality data across states over time have led to inconsistencies in maternal death reporting. Our purpose was to identify possible misclassification of maternal deaths and to apply alternative coding methods to improve specificity of maternal causes. We analyzed 2016–2017 US vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We developed an alternative coding strategy to code the “primary cause of death” defined as the most likely cause that led to death. We recoded deaths with or without literal pregnancy mentions to maternal and non-maternal causes, respectively. Originally coded and recoded data were compared for overall maternal deaths and for a subset of deaths originally coded to ill-defined causes. Among 1691 originally coded maternal deaths, 597 (35.3%) remained a maternal death upon recoding and 1094 (64.7%) were recoded to non-maternal causes. The most common maternal causes were eclampsia and preeclampsia, obstetric embolism, postpartum cardiomyopathy, and obstetric hemorrhage. The most common non-maternal causes were diseases of the circulatory system and cancer, similar to the leading causes of death among all reproductive-age women (excluding injuries). Among 735 records originally coded to ill-defined causes, 94% were recoded to more specific, informative causes from literal text. Eighteen deaths originally coded as non-maternal mentioned pregnancy in the literals and were recoded as maternal deaths. Literal text provides more detailed information on cause of death which is often lost during coding. We found evidence of both underreporting and overreporting of maternal deaths, with possible overreporting predominant. Accurate data is essential for measuring the effectiveness of maternal mortality reduction programs.

Potential Gains in Reproductive-Aged Life Expectancy if Maternal Mortality were Eradicated from the Kintampo Districts of Central Ghana

Background: Almost 99 percent of pregnancy or childbirth-related complications globally is estimated to occur in developing regions. Yet, little is known about the demographic impact of maternal causes of death (COD) in low-and middle-income countries. Assuming that critical interventions were implemented such that maternal mortality is eradicated as a major cause of death, how would it translate to improved longevity for reproductive-aged women in the Kintampo districts of Ghana?Methods: The study used longitudinal health and demographic surveillance data from the Kintampo districts to assess the effect of hypothetically eradicating maternal COD on reproductive-aged life expectancy by applying multiple decrement and associated single decrement life table techniques.Results: According to the results, on the average, women would have lived an additional 4.4 years in their reproductive age if maternal mortality were eradicated as a cause of death, rising from an average of 28.7 years lived during the 2005-2014 period to 33.1 years assuming that maternal mortality was eradicated. The age patterns of maternal-related mortality and all-cause mortality depict that the maternal-related mortality is different from the all-cause mortality for women of reproductive age.Conclusion: This observation suggests that other COD are competing with maternal mortality among the WRA in the study area and during the study period.

A Survey on Leading Indications of Fetomaternal Therapeutic Abortions in Yazd: A Cross Sectional Study

Background: Congenital abnormalities are diseases that occur during fertilization of the egg or development of the fetus and lead to disability, illness or mortality. This study aimed to investigate the prevalence and the factors associated with fetomaternal abnormalities in therapeutic abortions. &#x0D; Methods: This cross-sectional study was performed on 391 mothers referred to Yazd legal medicine organization for pregnancy termination from March 2017 to March 2020. The data about their fetuses were extracted and recorded.&#x0D; Results:The most common fetal abnormalities observed in this study were central nervous system abnormalities (21.1%), subsequently chromosomal disorders (16.8%), hydropsfetalis, cystic hygroma (15.9%), syndromic disorders (10.1%), single-gene disorders (8.1%), dysmorphology (8.1%), musculoskeletal disorders (7.8%), and cardiovascular disorders (7.2%).&#x0D; Conclusion: The main maternal causes for therapeutic abortion were cardiovascular disease, kidney diseases and cancers, while the most common fetal disorders leading to therapeutic abortion were central nervous system disorders such as anencephaly.

Fetal Autopsy-Categories and Causes of Death at a Tertiary Care Center.

A fetus is defined from 8 weeks after conception until term while in the uterus. Fetal death is defined as death of the fetus before the complete expulsion or extraction from the mother, irrespective of the duration of pregnancy that is not an induced termination of pregnancy. The causes of fetal death determined after fetal autopsy can be categorized according to the classification proposed by Cunningham and Hollier as fetal, placental, and maternal. All fetuses dying in utero, that is, prior to birth, regardless of the gestational age, to the mothers admitted in the Department of Obstetrics and Gynecology along with the respective placentas were received in the Department of Pathology, MGM Medical College, Aurangabad, after an informed and written consent from October 26, 2017, to October 30, 2019, and were included in this study. Clinical details along with obstetric history and antenatal ultrasonographic findings were also recorded. Anthropometric examination of the fetus was performed and evisceration was then done using the Rokitansky technique. Representative sections from each of the organs were taken and kept in tissue cassettes and processed for routine hematoxylin and eosin staining. This study was done on 33 cases of fetal death. Most fetal deaths occurred in the gestational age between 15 and 19 weeks (14 cases [42.42%]) and the least amount during 35 to 39 weeks (2 cases [6.06%]). The cause of death could not be ascertained in 6 cases (18.18%), whereas the maximum cases had fetal factor as the cause of death (15 cases [45.45%]). Maternal causes were seen in only 4 cases (12.12%). Gestational hypertension was seen to be the most common maternal factor associated with fetal death, which comprised 24.24% of cases (8 of 33). Thirteen of the total 33 cases did not have any associated obstetric complication. Of the total 33 fetal deaths, only 7 had associated placental defects on gross examination. Twenty-six placentas did not show any gross abnormality. Of these 7 cases, 5 were seen to have placental infarction. Fetal autopsy is a valuable and cost-effective modality for the confirmation of cause of fetal death. Fetal autopsy can also prove beneficial to the parents in planning for future pregnancies. Fetal autopsy can serve as the ultimate tool in diagnosing cause of fetal death in cases where no other diagnostic clue is available. Therefore, it should be encouraged and couples to be counseled regarding its importance and clinical utility.

A case-crossover study of short-term air pollution exposure and the risk of stillbirth in California, 1999–2009

BackgroundAssociations between ambient air pollution and stillbirth have recently been explored, but most studies have focused on long-term (trimester or gestational averages) rather than short-term (within one week) air pollution exposures. ObjectiveTo evaluate whether short-term exposures to criteria air pollutants are associated with increased risk of stillbirth. MethodsUsing air pollution and fetal death certificate data from 1999 to 2009, we assessed associations between acute prenatal air pollution exposure and stillbirth in California. In a time-stratified case-crossover study, we analyzed single day and/or cumulative average days (up to a 6 day lag) of exposure to fine (PM2.5) and coarse particles (PM10-2.5), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) for mothers estimated to reside within 10 km of a pollution monitor based on reported zip code. We also examined potential confounding by apparent temperature or co-pollutants, and effect modification by maternal demographic factors, fetal sex, gestational age, and cause of stillbirth. ResultsStillbirth cases in the primary analyses ranged between 1,203 and 13,018, depending on the pollutant. For an IQR increase in SO2 (lag 4), O3 (lag 4), and PM10-2.5 (lag 2), we found a 2.8% (95% confidence interval (CI) 0.2%, 5.5%), 5.8% (95% CI 1.6%, 10.1%), and 6.1% (95% CI 0.1%, 12.4%) increase in the odds of stillbirth, respectively. Additional adjustment by apparent temperature had little effect on the SO2 association but slightly attenuated O3 (adjusted % change: 4.2% (95% CI -0.2%, 8.9%) and PM10-2.5 (5.7% (95% CI -1.1%, 13.0%)) associations, while other co-pollutants had minimal impact. Associations were observed specifically for stillbirths from obstetric complications and in women with higher educational attainment. ConclusionsThis study provides evidence for associations between prenatal short-term air pollution exposure, specifically SO2, O3, and PM10-2.5, and stillbirth in California and warrants replication of findings in other settings.

Significance of cord blood nucleated red blood cell count in pregnancies complicated by preeclampsia as a marker for intra uterine growth restriction

Background: Preeclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation which is typically characterized by hypertension, proteinuria, edema and fetal compromise which is a leading cause of intra uterine growth restriction (IUGR). Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) hence determination of NRBC counts is essentially helpful in predicting short term neurodevelopment outcome. Objective of the study Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) in term babies born to preeclamptic mothersMethods: A cross sectional study conducted in a tertiary care hospital to evaluate the significance of cord blood NRBC count in term neonates born with pregnancy complicated by preeclampsia. It included 60 healthy mothers (control group) and 60 mothers with PIH. Collected data was analysed with SPSS software.Results: The nucleated red blood cell in cord blood of newborns in preeclampsia group was significantly higher than in the control group (p value 0.013). IUGR is significantly higher in PIH group (p value 0.008).Conclusions: From the observed data it is concluded that IUGR is an important cause of perinatal morbidity and mortality. The commonest maternal cause for IUGR was pregnancy induced hypertension. The other contributing factors were anemia, lack of awareness (unregistered, unbooked cases) among mothers, poor maternal nutrition and poor weight gain during pregnancy. Infants of preeclamptic women have higher nucleated red blood cell count at birth than control which means that preeclampsia may produce an erythropoietic response in the fetus. The positive correlation between cord nucleated red blood cell counts in preeclamptic patients and control group indicates that may be the hypoperfused placenta plays a role in this correlation.

Applying the WHO ICD-PM classification system to stillbirths in a major referral Centre in Northeast Nigeria: a retrospective analysis from 2010-2018

BackgroundLack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system.MethodsThis was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths’ records. Cause of death was assigned via consensus using the ICD-PM classification system.ResultsThere were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000 births (95% CI: 53, 71)], and 2015 [65 per 1000 births (95% CI, 55, 76)]. Antepartum and intrapartum stillbirths were almost equally prevalent (48% vs 52%). Maternal medical and surgical conditions (M4) were the commonest (69.3%) cause of antepartum stillbirths while complications of placenta, cord and membranes (M3) accounted for the majority (45.8%) of intrapartum stillbirths and the trends were similar between 2010 and 2018. Antepartum and intrapartum fetal causes of stillbirths were mainly due to prematurity which is a disorder of fetal growth (A5 and I6).ConclusionsMost causes of stillbirths in our setting are due to preventable causes and the trends have remained unabated between 2010 and 2018. Progress toward global SBR targets are off-track, requiring more interventions to halt and reduce the high SBR.

Direct maternal deaths attributable to HIV in the era of antiretroviral therapy: evidence from three population-based HIV cohorts with verbal autopsy.

To assess whether HIV is associated with an increased risk of mortality from direct maternal complications. Population-based cohort study using data from three demographic surveillance sites in Eastern and Southern Africa. We use verbal autopsy data, with cause of death assigned using the InSilicoVA algorithm, to describe the association between HIV and direct maternal deaths amongst women aged 20-49 years. We report direct maternal mortality rates by HIV status, and crude and adjusted rate ratios comparing HIV-infected and uninfected women, by study site and by ART availability. We pool the study-specific rate ratios using random-effects meta-analysis. There was strong evidence that HIV increased the rate of direct maternal mortality across all the study sites in the period ART was widely available, with the rate ratios varying from 4.5 in Karonga, Malawi [95% confidence interval (CI) 1.6-12.6] to 5.2 in Kisesa, Tanzania (95% CI 1.7-16.1) and 5.9 in uMkhanyakude, South Africa (95% CI 2.3-15.2) after adjusting for sociodemographic confounders. Combining these adjusted results across the study sites, we estimated that HIV-infected women have 5.2 times the rate of direct maternal mortality compared with HIV-uninfected women (95% CI 2.9-9.5). HIV-infected women face higher rates of mortality from direct maternal causes, which suggests that we need to improve access to quality maternity care for these women. These findings also have implications for the surveillance of HIV/AIDS-related mortality, as not all excess mortality attributable to HIV will be explicitly attributed to HIV/AIDS on the basis of a verbal autopsy interview.

Risk factors of perinatal asphyxia at Nishtar Hospital Multan.

Many perinatal deaths follow birth asphyxia that occurs in babies of women who are referred on developing life-threatening obstetric complications. Objectives: To determine the antenatal and intrapartum risk factors for perinatal asphyxia among babies delivered by women admitted as emergency obstetric referrals. Study Design: Cross-sectional study. Setting: Pediatric Unit 1, Nishtar Hospital Multan, Pakistan. Period: From May 2017 to April 2018. Material &amp; Methods: A total of 150 newborn term babies (and their mothers) with a 1, 5, &amp; 10-minutes Apgar score 4 or less (perinatal asphyxia) were considered for the study. Antepartum and intraparturn risk factors were noted among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. Results: Out of150 neonates, 57(38%) were presented with perinatal asphyxia at the age of 1 minute, 62(41.3%) at the age of 5 minutes and 31(20.1%) neonates were presented at the age of 10 minutes. In these cases, 45(30%) were related to maternal causes, 71(47.3%) to placental causes and 34(22.7%) to fetal cause. Conclusions: Early recognition of antepartum and intraparturn risk factors for perinatal axphyxiaamong emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from perinatal asphyxia.

Sociodemographic and health care profile of maternal death in Recife, PE, Brazil, 2006-2017: a descriptive study.

to describe the sociodemographic and health care characteristics of women dying due to maternal causes in Recife, Pernambuco, Brazil. this was a descriptive study using the Mortality Information System, case investigation sheets and summary sheets of early and late maternal deaths occurring between 2006 and 2017, with avoidability assessed by the Municipal Maternal Mortality Committee. we identified 171 deaths, of which 133 were in the puerperium; most deaths occurred among Black women (68.4%), women without partners (60.2%), women who had prenatal care (77.2%), during maternity hospital/general hospital delivery (97.1%), women attended to by obstetricians (82.6%);10.4% of women with puerperal complications had no health care; avoidable/probably avoidable deaths corresponded to 81.9%, for indirect causes (n=80), and direct causes (n=79). deaths occurred mainly in the postpartum period, among Black women; care failures were frequent; improved health service surveillance and follow-up is needed in the pregnancy-puerperal period, in Recife.

A review of socio-demographic and clinical correlates of stillbirth at a teaching hospital with limited advanced fetal surveillance

Background: Stillbirth has a heavy burden of psychosocial and economic cost on women, families and nations. The study aimed at determining the rate of stillbirth and identifying the factors contributing to stillbirths in Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti over the study period. Materials and Methods: The study was a retrospective descriptive one carried out at the Obstetric Unit of Obstetrics, Gynaecology and Perinatology Department of Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from 1st of January, 2012 to 31st of December, 2016. The data obtained were processed using Statistical Package for Social Sciences (SPSS) computer software version 20. Descriptive statistics was utilized to analyze the data; continuous variables were summarized with mean and discrete variables were summarized using numbers and percentages. Results: There were 532 stillbirths out of a total of 9,364 deliveries during the study period. This gave a stillbirth rate of 56.8/1000 total births. Macerated stillbirths accounted for 232 (43.6%) while fresh stillbirths accounted for 300 (56.4%) of the cases; with majority of the bereaved mothers (86.8%) being unbooked. Stillbirth rate was highest among women aged 15 to 19 years followed by those aged 40 years and above. Infections (chorioamnionitis), 69 (13.0%), obstructed labour. 59 (11.1.%) and antepartum haemorrhage 38 (7.1%) were the leading maternal causes of stillbirth. Prematurity 81 (15.2%) and multiple gestation 38 (7.1%) were the leading fetal causes. In 43 cases (8.1%), there were unexplained causes of stillbirth.Conclusion: As stillbirth remains a largely preventable condition, more aggressive measures should be instituted to ensure comprehensive maternity care for pregnant women; with more emphasis on advanced fetal surveillance arm of antenatal/intrapartum care. Appropriate evidence based post-delivery management, especially in the areas of conduct of baby autopsy and handling of bereavement, should be given to the mothers of the deceased.

In-hospital management of elderly patients undergoing myocardial perfusion scintigraphy.

To investigate the impact of myocardial perfusion scintigraphy results on the decision for invasive coronary angiography in elderly patients (≥75 years) with suspected coronary artery disease hospitalized in a single tertiary medical center. In the retrospective study, data of 276 (136 elderly) consecutive hospitalized patients referred to myocardial perfusion imaging were analyzed. The clinical characteristics, myocardial perfusion scintigraphy results, invasive coronary angiography and revascularization rates and in-hospital adverse events were identified by manually reviewing the patients' records. Ischemia was found in 40.2% of patients. There was no significant difference in the proportion of ischemia between elderly and younger patients (38.2% vs. 42.1%, P=0.508). Invasive coronary angiography was performed in 64.0% of patients with ischemia and in 6.8% of patients with normal myocardial perfusion imaging (P<0.001). The referral rate for invasive coronary angiography was not different between elderly and younger patients with ischemia (63.5% vs. 64.4%, P=0.848). Ischemia on myocardial perfusion imaging was the most predictive variable for a referral to invasive coronary angiography (odds ratio 31.8, 95% confidence interval 14.6-69.5, P<0.001). There was no significant difference between the younger and elderly patients in revascularization rate and adverse events until discharge (39% vs. 40%, P=0.99 and 7.1% vs. 8.8%, P=0.6, respectively). Ischemia on myocardial perfusion scintigraphy is a powerful predictor for in-hospital invasive coronary angiography independent of the patient's age. Elderly patients with ischemia received invasive coronary angiography equally as their younger counterparts and have similar rates of adverse events until discharge.

Common causes of death in childbearing age women in AL Diwanyia governorate/Iraq

Background&#x0D; Women in the reproductive age group comprise a dangerous part of ur population because they face a double burden of communicable and non communicable diseases in addition to high risk of pregnancy complication. Thus an expected death of women in reproductive age had big trauma to family in psychological and social level of other member in family.&#x0D; Objective&#x0D; 1-To find out the unrecorded maternal death in health institution&#x0D; 2- To throw alight on most common causes of death in reproductive age groups woman&#x0D; Methods&#x0D; A cross sectional description type study was carried out from 1st june to 28thjune 2013 at Diwanyia city. The study enrolled data about dead women of child bearing age 12-49 year that occurred in period from January 2011 to December of 2012. Studied different types of variables age, residence, cause of death.Data were analyzed by (SPSS) like proportion. &#x0D; Result&#x0D; A total of 450 deaths in reproductive age group women were reported, of which 18 (4%) were maternal death while 432 (96%) were due to non maternal cause. Majority of the deaths occurred in the age group of 40 – 49 years 169 (37.6%), and the most cause of death are ischemic heart disease 97 (21.6%) follow by cancer 81(18%).&#x0D; Conclusion:&#x0D; Control of modern life styles such as increase in weight, proper management of pregnancy complications might be decrease death rate in child bearing age women.

Application of the International Classification of Diseases for Perinatal Mortality (ICD-PM) to vital statistics records for the purpose of classifying perinatal deaths in Antioquia, Colombia

To describe perinatal mortality in the Department of Antioquia based on the WHO International Classification of Diseases (ICD-PM) and determine the feasibility of applying this classification system to the official records on vital statistics. Descriptive study of the causes of perinatal death according to the time of death in relation to the time of delivery and associated maternal conditions. The primary source was the official database of vital statistics for the period between 2013 and 2016. The variables measured were maternal age, gestational age and weight at the time of birth, area of residence, type of delivery, and causes of death, including direct and associated causes, and other pathological conditions. A descriptive analysis is performed, causes are presented in terms of absolute numbers and percentages, and distributed according to the timing of death in relation to childbirth and birthweight. Of 3901 perinatal deaths occurring in fetuses 22 weeks or more of gestational age or a minimum weight of 500 g, and up to 28 days of life, 1404 (36.0%) occurred before delivery, 378 (9.7%) during the intrapartum period, 1760 (45.1%) during the neonatal period, and 359 (9.2%) cases had no information regarding the time of death in relation to the time of delivery. The main causes of death of the neonates weighing 1000 g or more were congenital malformations, deformities and chromosomal abnormalities (30.2%), antepartum and intrapartum hypoxia (29.3%), and infection (12.3%). In 69.5% of cases, no associated maternal causes were identified and in those in which there were related causes, the most frequent was placenta, cord and membrane complications (16.8%). The ICD-PM is a system globally applicable to records of vital statistics, enabling the characterization of perinatal mortality in the Department.

Hypertension during pregnancy and risk of stillbirth: challenges in a developing country

Objective To explore the factors associated with hypertensive disorders of pregnancy (HDP) in women experiencing stillbirth (SB). Material and methods It was an observational, analytical case-control study, done as part of the World Health Organization South-East Asian Region Office SB project. The epidemiological profile, history, clinical features, and investigations of stillborn cases having HDP were noted, an equal number of age and parity matched subjects with HDP having livebirth were taken as controls. Results Out of 46,816 deliveries, 1239 (26.2/1000) were stillborn. The maternal causes contributed 374/1239 (30.2%) stillbirths according to the CODAC classification, HDP was the most common maternal cause (304/1239, 24.9%). Subjects with HDP were included as cases. On comparing the cases with controls it was found that significantly more number of cases had inadequate antenatal visits (p < .001, OR −4.8), two or more abortions (p < .001, OR −1.9), early onset of hypertension (p < .0001, OR −5.6) and complications such as fetal growth restriction (FGR) (p < .001, OR −2.3) and abruption (p < .001, OR −4.0). Women with preeclampsia were less likely to have SB compared to those with gestational or chronic hypertension (p = .0001, OR −2.3). The birth weight/placental weight ratio of more than eight had the highest odds ratio regarding contribution to SB among hypertensive women (p = .0001 OR −6.7). Conclusion In women with HDP, adequate antenatal care would lead to the prevention of complications such as anemia, abruption, and FGR, and thus prevent SB. The high BW/PW ratio is a potential marker of risk of SB.

PENGARUH PELAKSANAAN PELVIC ROCKING DENGAN BIRTH BALL TERHADAP KEMAJUAN PERSALINAN PADA IBU BERSALIN DI KLINIK PRATAMA TANJUNG DELI TUA TAHUN 2018

SDKI (2012) noted that 38.2% of prolonged labor is a maternal and perinatal cause of death. Efforts to prevent prolonged childbirth such as pelvic rocking with birth balls that support labor to run physiologically. This study aims to determine the effect of pelvic rocking implementation with birth ball on the progress of childbirth in women giving birth at the Tanjung Pratama Clinic of Deli Tua in 2018.&#x0D; This study uses pre-experimental research using static group comparison&#x0D; design with accidental sampling technique. The sample was divided into 2 groups, the intervention group conducted pelvic rocking with birth ball for mothers during the active phase for 30 minutes as much as 2 sessions and observed the progress of labor in the control group conducted in April-July 2018. Data analysis using the independent samples test.&#x0D; The results show there was an influence of pelvic rocking with birth ball to the progress of labor where the average progress of labor for the birth ball status was done and was not done was different from the p-value of 0.00001 &lt;0.05. Birth ball status was 138.2 minutes faster than birth ball status was not performed.&#x0D; Pelvic rocking with birth ball helps the baby to rotate to the optimal position and shorten the first stage of labor so as to reduce pain and provide comfort to the mother in the face of childbirth. It is expected that health workers can become facilitators for maternal mothers and support labor in a physiological way.

Fetoplacental ratios in stillbirths and second trimester miscarriages.

An abnormal fetoplacental (F/P) ratio is a risk factor for poor pregnancy outcomes including fetal death, but studies of F/P ratio among stillbirths are limited. In the Wisconsin Stillbirth Service Program cohort of second and third trimester fetal deaths, 1,022 were at ≥24 weeks with data on fetal and placental weight. Comparison with data for viable infants of the same gestational ages (GAs) showed that the F/P ratio increases more rapidly with GA for stillbirths than for viable infants. While placentas of stillborn infants are small at all GA, weights of deceased fetuses are lowest early in the second trimester, becoming nearly normal by term. Excess high F/P ratios are noted at all GAs, increasing toward term, while low ratios are frequent at early gestation but rare near term. Analysis by cause of death shows that F/P ratios are markedly elevated for placental and maternal causes (about 50% above the 90th centile), somewhat elevated for cord accidents, non-hydropic fetal, and unknown causes (about 1/3 above the 90th centile), and variable with 40% below the 10th centile for hydropic stillbirths. Across all causes and GAs, placental weights are more abnormal than fetal weights, suggesting that diminished placental function may contribute to fetal demise even when non-placental causes (e.g., premature membrane rupture, cord accidents, and chromosomal disorders) are identified. About half of all stillbirths have abnormal F/P ratios, suggesting that improvements in prenatal assessment of placental size and function might aid in identifying pregnancies at risk for demise; unfortunately, therapeutic options for ongoing pregnancies with diminished placental function remain limited.