Maternal Index Research Articles

Prevalence and Factors Associated with Cesarean Section at UTH Women and Newborn Hospital Lusaka, Zambia

Background: Increase in cesarean section (CS) has been a source of public health concern globally. There is scanty updated information about cesarean section and associated factors in developing countries like Zambia. The aim of this study was to determine the prevalence of CS and associated factors at The University Teaching Hospital women and New-born in Lusaka Zambia. Methodology: The study design was cross sectional. It involved retrospective collection of data from birth registers of women who gave birth at the University Teaching Hospital-Women and Newborn from 1st January, 2018 to 31st December 2018. The total sample size was 6,965 women (15-49 years) after the inclusion and exclusion criteria were met. Statistical analysis was conducted using Binary Logistic Regression, level of significance was 0.05 and Confidence Interval of 95%. Goodness of fit was conducted using the likelihood ratio test. Data was analyzed using STATA version 14.2. Results: The Prevalence of Cesarean section was 44%. Factors significantly associated with Cesarean Section were maternal age (grouped), Birth weight (grouped), gestational age (grouped) and still birth (AOR=0.47 P<0.0001). There was an increased odds of having Cesarean Section among multipara (AOR= 1.10 P=0.73) and Multigravida (AOR=1.04, P=0.73). Common maternal indicators identified were repeat caesarean section (18%), obstructed labor (11%) and failure to progress (10%). The common fetal indicators identified were fetal distress (18%), big baby (10%) and mal presentation (7%). Conclusion: Prevalence is higher than the recommended WHO limit. There is need to reinforce health education, reinforce fetal monitoring and promote vaginal birth after caesarean. Keywords: Cesarean Section, Prevalence, Factors, Women and newborn, Zambia.

Maternal diet quality and associations with plasma lipid profiles and pregnancy-related cardiometabolic health

PurposeTo assess the relationship of early pregnancy maternal diet quality (DQ) with maternal plasma lipids and indicators of cardiometabolic health, including blood pressure (BP), gestational diabetes mellitus (GDM) and gestational weight gain (GWG).MethodsWomen (n = 215) aged 18–40 years with singleton pregnancies were recruited at 10–20 weeks gestation. Diet quality was assessed by the Dietary Guideline Index, calculated at early ([mean ± SD]) (15 ± 3 weeks) and late (35 ± 2 weeks) pregnancy. Lipidomic analysis was performed, and 698 species across 37 lipid classes were measured from plasma blood samples collected at early (15 ± 3 weeks) and mid (27 ± 3 weeks)-pregnancy. Clinical measures (BP, GDM diagnosis, weight) and blood samples were collected across pregnancy. Multiple linear and logistic regression models assessed associations of early pregnancy DQ with plasma lipids at early and mid-pregnancy, BP at three antenatal visits, GDM diagnosis and total GWG.ResultsMaternal DQ scores ([mean ± SD]) decreased significantly from early (70.7 ± 11.4) to late pregnancy (66.5 ± 12.6) (p < 0.0005). At a false discovery rate of 0.2, early pregnancy DQ was significantly associated with 13 plasma lipids at mid-pregnancy, including negative associations with six triglycerides (TGs); TG(54:0)[NL-18:0] (neutral loss), TG(50:1)[NL-14:0], TG(48:0)[NL-18:0], TG(52:1)[NL-18:0], TG(54:1)[NL-18:1], TG(50:0)[NL-18:0]. No statistically significant associations were found between early pregnancy DQ and BP, GDM or GWG.ConclusionMaternal diet did not adhere to Australian Dietary Guidelines. Diet quality was inversely associated with multiple plasma TGs. This study provides novel insights into the relationship between DQ, lipid biomarkers and cardiometabolic health during pregnancy.

Auditing cesarean section indications in women of Groups 1 to 4 of Robson's Ten-Group Classification System: A descriptive study at a university hospital in Thailand

Aim: To determine the appropriateness of indication for cesarean section in women at term with a single fetus in cephalic presentation without previous CS irrespective of parity and how labor started (Robson's Ten-Group Classification System [RTGCS] groups 1-4). Methods: This was a descriptive study assessing medical records of 311 women in RTGCS groups 1- 4, between 1st January 2020 and 31st December 2020 who underwent a CS in Srinagarind Hospital, a university hospital, Khon Kaen, Thailand. Appropriateness of CS indications was assessed using criteria developed by our institute. Indications were classified into three categories: cephalopelvic disproportion (CPD), fetal indications, and other maternal indications. Results: The overall appropriate rate of CS indications in RTGCS groups 1-4 was 32.5% (95% CI 26.8% – 38.7%). The appropriate rates of CS indications in RTCGS group 1, 2a, 2b, 3, 4a, and 4b were 43.0% (95% CI 35.2% - 51.2%), 10.6% (95% CI 0.0% - 24.9%), 11.7% (95% CI 0.0% - 25.0%), 50.0% (95% CI 32.1% - 68.6%), 0% (95% CI 0.0% - 100%), and 40.0% (95% CI 20.0% - 74.8%) respectively. Conclusion: Low appropriateness in CS indications in RTGCS groups 1-4 leads to high CS rates. Increasing appropriateness of CS indications in this population will reduce unnecessary CS. Interventions focusing on increasing appropriateness in CS indications are urgently required to achieve appropriate use of CS.

Health facilities preparedness to deliver maternal and newborn health care in Kilifi and Kisii Counties, Kenya

IntroductionHealth facility preparedness is essential for delivering quality maternal and newborn care, minimizing morbidity and mortality by addressing delays in seeking skilled care, reaching appropriate facilities, and receiving emergency care. A rapid assessment of 23 government health facilities in Kilifi and Kisii counties identified poor maternal and newborn indicators in 16 facilities. The Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project supported these facilities with training, equipment, and referral linkages. This study focuses on facility preparedness of the 16 facilities to deliver maternal and newborn health services, specifically delays two and three at the end of the project implementation.MethodsA descriptive cross-sectional study was carried-out on behalf of AQCESS project team by respective county ministry of health in-charge of reproductive maternal newborn and child health programs and trained nurses and medical doctors from Aga Khan health services in December 2019. The study evaluated the accessibility and reliability of drugs, commodities, equipment, personnel, basic necessities (such as water and electricity), and guidelines using validated World Health Organization service availability and readiness assessment tool. The findings of the assessment are presented through frequency and percentage analysis, along with a comparative analysis between the two counties.ResultsAll the 16 facilities assessed offered routine antenatal care (ANC) and normal delivery, but only two provided comprehensive emergency obstetric and newborn care (CEmONC). Most essential medicines, commodities, and required equipment were available. BEmONC and CEmONC guidelines were present in Kilifi, not in Kisii. One staff member was available 24/7 for cesarean section (CS) in each county, with one anesthetist in Kilifi. Electricity was accessible in all facilities, but only half had secondary power supply. Facilities offering CS had backup generators.ConclusionThe Facilities assessed had necessary drugs, commodities, equipment, and requirements, but staffing and guidelines were limited. Kilifi outperformed Kisii in most indicators. Additional support is needed for infrastructure and human resources to deliver quality maternal and newborn health services. Continuous monitoring will facilitate resource allocation based on facility needs.

Extracorporeal Membrane Oxygenation (ECMO): A Lifeline for Pregnant and Postpartum Women.

Extracorporeal membrane oxygenation (ECMO) is a life-saving technology that temporarily supports the heart and lungs in critical care situations. This review article examines the role of ECMO as a lifeline for pregnant and postpartum women facing severe maternal and fetal conditions. The review begins with an overview of the physiology and pathophysiology of ECMO, including its procedure and how it supports cardiopulmonary function. Unique considerations specific to pregnant and postpartum women, such as physiological changes during pregnancy, risks and complications associated with ECMO, and the need to balance maternal and fetal considerations, are discussed. The indications for ECMO in this population are explored, including common maternal indications such as cardiogenic shock, acute respiratory distress syndrome (ARDS), pulmonary embolism, and eclampsia, as well as fetal indications such as fetal distress, hypoxic-ischemic encephalopathy (HIE), and twin-to-twin transfusion syndrome (TTTS). The challenges and considerations in ECMO for pregnant and postpartum women, including ethical considerations and the decision-making process, are highlighted. The review further explores the multidisciplinary care and collaborative approach required, emphasizing the importance of a specialized ECMO team and collaboration between obstetricians, neonatologists, cardiologists, and other specialists. Additionally, patient selection, pre-ECMO assessment, and planning strategies are discussed. The review evaluates existing literature and studies on ECMO in pregnant and postpartum women, analyzing survival rates and maternal and fetal outcomes and comparing different ECMO modalities and strategies. Future directions and research opportunities are presented, including emerging technologies, areas for further research and clinical trials, and improved patient selection and management strategies. The conclusion emphasizes the importance of ECMO as a lifeline for pregnant and postpartum women and the potential impact on maternal and fetal health. The review highlights the need for ongoing research and advancements in ECMO to optimize outcomes and improve care for this unique and vulnerable patient population.

Inflammatory Biomarker Profiles in Very Preterm Infants within the Context of Preeclampsia, Chorioamnionitis, and Clinically Diagnosed Postnatal Infection.

Preterm delivery can be precipitated by preeclampsia or infection, and preterm infants are at heightened risk of postnatal infection. Little is known about the ontogeny of inflammatory biomarkers in extremely preterm infants. We hypothesized that suspected prenatal infection (clinical chorioamnionitis or spontaneous preterm labor) and clinically diagnosed postnatal infection would be associated with unique biomarker signatures, and those patterns would be influenced by the degree of prematurity. Venous blood was collected daily for the first week and weekly for up to 14 additional weeks from 142 neonates born at 22-32 weeks gestation. A custom array was utilized to measure monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6). C-reactive protein (CRP) levels were obtained from the electronic medical record. Independent of gestational age, MCP-1 was significantly increased (p < 0.001) in association with maternal preeclampsia, but MCP-1 was decreased (p < 0.01), and CRP was increased (p < 0.01) in the presence of chorioamnionitis with funisitis. IL-6 and CRP were both increased in infants diagnosed with postnatal infection, with peak levels observed on days 2 and 3, respectively. In conclusion, suspected prenatal and postnatal infections and non-infectious complications of pregnancy are associated with unique biomarker profiles, independent of gestational age, including over a 2-fold increase in MCP-1 among newborns of mothers with preeclampsia. Further, in those clinically diagnosed with a postnatal infection in the absence of antenatal infection concerns, IL-6 increases before CRP, emphasizing a potential role for expanded biomarker screening if antibiotics are initially avoided in infants delivered for maternal indications.

Individual and Systemic Factors of Under-five Mortality in Nigeria: A Cox Proportional Hazard Model

Despite considerable efforts to reduce under-five mortality nationwide, Nigeria has fallen short of achieving the Millennium Development Goals (MDGs) target of 67 deaths per 1,000 live births by 2015. Of all the documented factors of under-five mortality, little evidence exists on the impact of systemic barriers and individual factors (maternal health-seeking behaviour) on under-five mortality in Nigeria. The study used a nationally representative sample from Nigeria Demographic and Health Survey (NDHS) 2013 dataset. The target population was 20,192 women aged 15-59 years who had given birth to 31,480 children five years before the survey. Stata software was used for data analysis. The risk of death was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Findings from the overall Model I-IV revealed individual factors (maternal health-seeking indicators) as significant factors of under-five deaths (p &lt; 0.05). Children whose mothers received antenatal care coverage (ANC) outside health care facilities (HCF) (HR: 1.60, CI: 1.0-2.4, p &lt; 0.05); or delivered outside HCF (HR: 1.02, CI: 0.7-1.5, p &lt; 0.05) had elevated hazard risk of death before age five. Conversely, children who were presented for postnatal check within two weeks of delivery (HR: 0.60, CI: 0.5-0.8, p &lt; 0.05), or delivered within the longer birth interval (HR: 0.67, CI: 0.6-0.8, p &lt; 0.001) had significantly lower hazard risk of death before age five. As part of systemic factors, children whose mothers were covered by health insurance scheme had significantly (HR: 0.52, CI: 0.2-1.2, p &lt; 0.001) lower risk of death when compared with their counterparts without health insurance coverage. The study emphasized the need to revitalize strategies and programs to improve women health seeking behaviour and investment in the health sector through health insurance, infrastructure, and supplies.

Biomarkers of Neonatal Sepsis: Where We Are and Where We Are Going.

Neonatal sepsis is a bacterial bloodstream infection leading to severe clinical manifestations frequently associated with death or irreversible long-term deficits. Antibiotics are the drug of choice to treat sepsis, regardless of age. In neonates, the lack of reliable criteria for a definite diagnosis and the supposition that an early antibiotic administration could reduce sepsis development in children at risk have led to a relevant antibiotic overuse for both prevention and therapy. The availability of biomarkers of neonatal sepsis that could alert the physician to an early diagnosis of neonatal sepsis could improve the short and long-term outcomes of true sepsis cases and reduce the indiscriminate and deleterious use of preventive antibiotics. The main aim of this narrative review is to summarize the main results in this regard and to detail the accuracy of currently used biomarkers for the early diagnosis of neonatal sepsis. Literature analysis showed that, despite intense research, the diagnosis of neonatal sepsis and the conduct of antibiotic therapy cannot be at present decided on the basis of a single biomarker. Given the importance of the problem and the need to reduce the abuse of antibiotics, further studies are urgently required. However, instead of looking for new biomarkers, it seems easier and more productive to test combinations of two or more of the presently available biomarkers. Moreover, studies based on omics technologies should be strongly boosted. However, while waiting for new information, the use of the clinical scores prepared by some scientific institutions could be suggested. Based on maternal risk factors and infant clinical indicators, sepsis risk can be calculated, and a significant reduction in antibiotic consumption can be obtained.

Maternal preconception thyroid autoimmunity is associated with neonatal birth weight conceived by PCOS women undergoing their first in vitro fertilization/intracytoplasmic sperm injection

BackgroundThyroid autoimmunity and polycystic ovary syndrome (PCOS) are the most common endocrinopathies and have close relationships based on common etiology and pathogenesis, including genetic susceptibility, metabolic disorders, hormonal dysregulation, immune response, and inflammatory activation. The co-occurrence of both diseases is associated with adverse reproductive outcomes, but its effect on neonatal outcomes remains largely unknown. We aim to explore the effect of thyroid autoimmunity on neonatal birth weight in PCOS women undergoing IVF/ICSI.MethodsThis is a retrospective analysis of 486 PCOS women who underwent the first IVF/ICSI cycles and gave birth to 361 singletons and 125 twins during 2018 – 2020 at a reproductive center. The associations between maternal preconception serum thyroid function and autoimmunity indicators and birth weights of the singleton and twin groups were evaluated using generalized linear models (GLMs) and generalized estimate equations (GEEs), respectively. Analyses were further stratified by neonatal sex, maternal age, and maternal preconception BMI to assess the possible interaction effects.ResultsMaternal preconception serum TPOAb had a significant negative association with singleton birth weight (P for trends = 0.03). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in singleton birth weight of − 119.72 g (95% CI: − 222.68 g, − 16.70 g). Maternal preconception serum TPOAb had a significant positive association with twin birth weight (P for trends = 0.01). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in twin birth weight of 138.62 g (95% CI: 33.96 g, 243.30 g). Besides, maternal preconception serum TPOAb had a specific association with increased twin birth weight for female neonates, a specific association with decreased singleton birth weight for PCOS women under 35 years, and a specific association with decreased twin birth weight for overweight PCOS women (all P for interactions < 0.05).ConclusionsMaternal preconception thyroid autoimmunity may affect the birth weights of both singleton and twin neonates. Further large cohorts and experimental studies are required to confirm these findings and explore the underlying mechanisms.

Screening of placenta accreta spectrum disorder using maternal serum biomarkers and clinical indicators: a case–control study

BackgroundPlacenta accreta spectrum (PAS) disorder is a major cause of postpartum hemorrhage-associated maternal and fetal death, and novel methods for PAS screening are urgently needed for clinical application.MethodsThe purpose of this study was to develop new methods for PAS screening using serum biomarkers and clinical indicators. A total of 95 PAS cases and 137 controls were enrolled in a case–control study as cohort one, and 44 PAS cases and 35 controls in a prospective nested case–control study were enrolled as cohort two. All subjects were pregnant women of Chinese Han population. Biomarkers for PAS from maternal blood samples were screened based on high-throughput immunoassay and were further validated in three phases of cohort one. Screening models for PAS were generated using maternal serum biomarkers and clinical indicators, and were validated in two cohorts. The expression levels of biomarkers were analyzed using histopathological and immunohistochemical (IHC) techniques, and gene expression was examined by QPCR in the human placenta. Binary logistic regression models were built, and the area under the curve (AUC), sensitivity, specificity, and Youden index were calculated. Statistical analyses and model building were performed in SPSS and graphs were generated in GraphPad Prism. The independent-sample t test was used to compare numerical data between two groups. For nonparametric variables, a Mann–Whitney U test or a X2 test was used.ResultsThe results demonstrated that the serum levels of matrix metalloproteinase-1 (MMP-1), epidermal growth factor (EGF), and vascular endothelial growth factor-A (VEGF-A) were consistently higher, while the level of tissue-type plasminogen activator (tPA) was significantly lower in PAS patients compared with normal term controls and patients with pre-eclampsia (PE) and placenta previa (PP). IHC and QPCR analysis confirmed that the expression of the identified biomarkers significantly changed during the third trimester in human placenta. The generated screening model combining serum biomarkers and clinical indicators detected 87% of PAS cases with AUC of 0.94.ConclusionsSerum biomarkers can be used for PAS screening with low expense and high clinical performance; therefore, it may help to develop a practicable method for clinical prenatal PAS screening.

The influence of the attending midwife on the occurrence of episiotomy: A retrospective cohort study

BackgroundEpisiotomy at the time of vaginal birth can result in short- and long-term complications for women. Therefore, it is important to study factors that influence the occurrence of episiotomy. AimTo examine to what extent the individual factors of clinical midwives in the same working conditions contribute to variations in episiotomy. MethodsA retrospective cohort study was performed at a secondary care hospital in Amsterdam, the Netherlands, using data from women who were assisted by a clinical midwife during birth in 2016. The clinical midwives filled out a questionnaire to determine individual factors. The predictive value of the individual factors of the clinical midwives was examined in a multiple logistic regression model on episiotomy. ResultsA total of 1302 births attended by 27 midwives were included. The mean episiotomy rate was 12.7%, with a range from 3.2% to 30.8% among midwives (p = 0.001). When stratified for parity, within the primipara group there was a significant variation in episiotomy among midwives with a range from 7.9% to 47.8% (p = 0.006). No significant variation was found in the occurrence of third/fourth degree tears or intact perineum. There was a significant difference in episiotomy for maternal indication among midwives (p = 0.041). Predictors for an episiotomy were number of years since graduation and place of bachelor education of the clinical midwife. ConclusionThis study shows that individual factors of clinical midwives influence the rate of episiotomy. Predictors for an episiotomy were the number of years since graduation and place of bachelor education. This shows that continuous training of clinical midwives could contribute to reducing the number of unnecessary episiotomies. Since suspected fetal distress is the only evidence based indication to perform an episiotomy, there is room for improvement given the variation in the number of episiotomies performed for maternal indication.

Benefits of Investing on Mother and Child Healthcare in Tanzania

Purpose: Maternal and child healthcare play crucial role in reducing global mortality rates, with a significant impact on the overall burden of disease. The Sustainable Development Goal 3 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. Sub-Saharan Africa, including Tanzania, carries a high burden of mortality rates and experiences a significant share of maternal and child deaths, exacerbating the global figures. The average prevalence of below 5 years mortality in SSA between 2010 and 2018 was 4.10% according to Ahinkorah (2021). Recognizing the severity of this issue, the government of Tanzania through the Development Agenda 2025, Draft health policy 2020 and the current Health Sector strategic plan 2021-2026 plans to reduce infant and maternal mortality rates through mother and child healthcare investment. The Health Sector Strategic Plan focuses on strengthening the health systems in the country and aims to sustain the achievements made in enhancing the health of reproductive, maternal, newborn, children, and adolescent populations. This study sought to assess the benefits of investing on mother and child healthcare in Tanzania. The study was guided by the investment commodity theory developed by the economist John Maynard Keynes in 1936. The study evaluated the current status of mother and child health indicators, the benefits of investing in mother and child health on overall health outcomes and identified the existing gaps and challenges in the provision, access and utilization of mother and child healthcare services in Tanzania.&#x0D; Methodology: The study was a desktop review-based study which relied on existing published information, data, and literature.&#x0D; Findings: The study found out that there have been improvements in certain areas of mother and child health indicators but maternal and child mortality rates remain high. Health interventions such as vaccination programs, improved access to healthcare services, and the use of maternal and child health insurance cards showed positive effects on reducing child mortality, improving child health outcomes, and enhancing maternal healthcare utilization. The significant gaps and challenges in the provision, access, and utilization of mother and child healthcare services include disparities in access to healthcare services based on factors such as education level and wealth status, inadequate healthcare infrastructure, long distances to health facilities, sociocultural barriers, and financial constraints.&#x0D; Unique contribution to theory, practice and policy: The study recommends strengthening of healthcare infrastructure, enhancing access to maternal and child healthcare services, especially for vulnerable populations, promoting health education and raising awareness about maternal and child healthcare practices, addressing the shortage of skilled healthcare professionals, improving data collection and use and monitoring of maternal and child health indicators, addressing socio-cultural barriers that hinder access and utilization of healthcare services and increasing investment in mother and child health care programs through allocate adequate resources.

Affordable Care Act Medicaid expansions and maternal morbidity.

In this paper, we test whether the Affordable Care Act Medicaid expansions are associated with maternal morbidity. The ACA expansions may have affected maternal morbidity by increasing pre-conception access to health care, and by improving the quality of delivery care, through enhancing hospitals' financial positions. We use difference-in-difference models in conjunction with event studies. Data come from individual-level birth certificates and state-level hospital discharge data. The results show little evidence that the expansions are associated with overall maternal morbidity or indicators of specific adverse events including eclampsia, ruptured uterus, and unplanned hysterectomy. The results are consistent with prior research showing that the ACA Medicaid expansions are not statistically associated with pre-pregnancy health or maternal health during pregnancy. Our results add to this story and find little evidence of improvements in maternal health upon delivery.

Recent trends in maternal and child health inequalities in Latin America and the Caribbean: analysis of repeated national surveys

BackgroundAlthough most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time.MethodsWe identified LAC countries for which a national survey was available between 2011–2015 and a second comparable survey in 2018–2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality.ResultsProgress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits.ConclusionsAlthough LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely.

Correlates of higher anxiety scores reported by women admitted for elective caesarean section

BackgroundAn elective caesarean section (CS) has been associated with high anxiety scores, and there are associations between higher anxiety scores and younger age, primigravidae, higher educational level, and previous experience with anaesthesia. In this study, the aim is to measure anxiety scores associated with an elective CS using two measuring scales and identify women's characteristics and obstetrics variables that are associated with higher scores. MethodsA cross-sectional study was conducted between Nov 15, 2019 and Nov 15, 2020. Women were included if they were 18 years of age or more, had viable pregnancies, and were admitted for an elective CS. Anxiety scores were measured on admission using the visual analogue scale for anxiety (VASA) and then the State-Trait Anxiety Inventory (STAI-Y). Associated factors were studied using logistic regression analyses. ResultsThree hundred women were recruited. Means (SD) for the participant's age and gestation age were 30.5 (5.7) years and 37.6 (1.4) weeks, respectively. Additionally, 29.3% of the participants having a CS were primigravidae and 62.3% were for maternal indications. Furthermore, 55%, 59%, and 61% of the women had scores above the means of VASA and STAI-S components 1 and 2, respectively.Variables that showed statistically significant associations with higher anxiety scores were that the woman's age was 25–34, the CS was for foetal indications, the choice of anaesthesia was general, and the source of information for the choice of anaesthesia was a layperson. ConclusionHigher anxiety scores are prevalent among women admitted for an elective CS. STAI-Y and VASA correlated well, and the short VASA may replace the lengthy STAI-Y in clinical practice. Identification of women with risk factors may help in implementing strategies to reduce anxiety.

Breastfeeding initiation and duration through the COVID-19 pandemic, a linked population-level routine data study: the Born in Wales Cohort 2018–2021

ObjectivesThe WHO recommends exclusive breastfeeding for the first 6 months of life. This study aimed to examine the impact the pandemic had on breastfeeding uptake and duration, and whether intention...

FETOMATERNAL OUTCOME IN EARLY ONSET SEVERE PRE ECLAMPSIA

Introduction:Preeclampsia is a multisystem disorder occurring exclusively during pregnancy whose exact etiology is yet unknown. It occurs in approximately 5-7% of pregnancies. Early onset preeclampsia (&lt;34 weeks gestational age) occurs in less than 1% of pregnancies and is often associated with maternal morbidity as the riskof progres­sionto severe maternal disease is inversely related with gestational age at onset. Material And Methods:100 pregnant women admitted to labor room in the department of OBG, Govt. medical college,Kota Rajasthan between 1 February 2021 – 31 January 2022who fulfilled the criteria ( Gestational age ≥ 24 weeks &amp;&lt; 34 weeks , diastolic BP ≥ 110 mm Hg, with any features of severe pre eclampsia ) were included in this study . Results:In the present study, Out of 100 patients of early onset severe preeclampsia was more common in Primigravida 59(59%)in the age group of 21-30 years. Mean gestational age at diagnosis was 31weeks 3 days ± 2weeks 3 days. Most underwent termination of pregnancy after 32 weeks. Maternal indication was found to be the most common cause for termination. 31(31%) patients of the total experienced complication like imminent eclampsia, HELLP syndrome ,Acute renal failure and abruption placentae . 65 (65%) delivered by caesarean section. Mean birthweight was 1.59 kg ± 0.5kgand neonatal complication rate was 71(71%). Conclusion:Early onset severe preeclampsia is associated with significant maternal and fetal complications. Decision regarding termination of pregnancy has to be taken based on both maternal and fetal factors.

Evaluation of Caesarean Expenditures of Households in Benin

After years of effort, sub-Saharan Africa has seen little improvement in maternal and neonatal health indicators. Providing all women with access to emergency obstetric care is an accepted effective strategy to reduce maternal and neonatal mortality. In many African countries such as Benin, the cost of health care is a major obstacle to access obstetric care. The aim of this study was to evaluate the caesarean section expenditures of households in Benin and to determine the strategies for obtaining the necessary resources to meet the caesarean section expenditures of the households. Three hospitals and 505 households in the Littoral region were sampled, and data were collected by applying a questionnaire to the people accompanying the woman to the hospital. The socioeconomic status of the households was evaluated using a wealth index created by principal component analysis. Factors significantly associated with expenditure were determined using multivariate linear regression analysis. Despite the free caesarean section policy in effect, households spend a median of US$180.60 (IQR: 148.13–222.35) for a caesarean section, of which 76.0% are direct costs, 17.0% are indirect costs, and 7.0% are opportunity costs. Expenditures vary considerably depending on the residence area of the household, the presence of complications, the presence of health insurance, the socioeconomic class of the households, the education level, and working status of the woman. Finally, households use 11 strategies to obtain funds to pay for the caesarean costs. While poor households resort to foreign aid, asset sales, and/or current spending cuts, the rich use their income and/or savings to cover their caesarean section expenses. The results favour the adoption of a mechanism for direct exemption of the costs of caesarean sections payable by the poorest households, in addition to the current free caesarean policy.

Contemporary Trends in Cesarean Delivery Rates and Indications.

This study aimed to describe cesarean delivery rates and indications at a single center in order to assess the impact of the guidelines published by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine on trends in labor management. This is a retrospective cohort study of patients ≥23 weeks' gestation delivering at a single tertiary care referral center from 2013 to 2018. Demographic characteristics, mode of delivery, and main indication for cesarean delivery were ascertained by individual chart review. Cesarean delivery indications (mutually exclusive) were the following: repeat cesarean delivery, nonreassuring fetal status, malpresentation, maternal indications (e.g., placenta previa or genital herpes simplex virus), failed labor (any stage labor arrest), or other (i.e., fetal anomaly and elective). Polynomial (cubic) regression models were used to model rates of cesarean delivery and indications over time. Subgroup analyses further examined trends in nulliparous women. Of the 24,637 patients delivered during the study period, 24,050 were included in the analysis; 7,835 (32.6%) had a cesarean delivery. The rates of overall cesarean delivery were significantly different over time (p < 0.001), declining to a minimum of 30.9% in 2014 and peaking at 34.6% in 2018. With regard to the overall cesarean delivery indications, there were no significant differences over time. When limited to nulliparous patients, the rates of cesarean delivery were also noted to be significantly different over time (p = 0.02) nadiring at 30% in 2015 from 35.4% in 2013 and then rising up to 33.9% in 2018. As for nulliparous patients, there was no significant difference in primary cesarean delivery indications over time except for nonreassuring fetal status (p = 0.049). Despite changes in labor management definitions and guidelines encouraging vaginal birth, the rates of overall cesarean delivery did not decrease over time. The indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have not significantly changed over time. · The rates of overall cesarean deliveries did not decrease despite the 2014 published recommendations for the reduction in cesarean deliveries.. · There were no significant differences in the indications of cesarean deliveries among nulliparous or multiparous women.. · Despite the adoption of strategies to reduce the overall and primary cesarean delivery rates, these trends remain unchanged.. · Indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have also not significantly changed over time.. · Additional strategies to encourage and increase vaginal delivery rates must be adopted..

Perceptions of health care workers on maternal and child health services in Pakistan during COVID-19: A cross-sectional study

BackgroundMaternal and child healthcare service delivery in vulnerable and fragile health systems has suffered a tremendous impact owing to the shift in focus to curtail the COVID-19 pandemic. We aimed to evaluate the impact of the COVID-19 pandemic on maternal and child healthcare services to inform policy advice for a more resilient maternal and child healthcare service delivery in Pakistan. MethodsA descriptive cross-sectional study was conducted. A structured and validated questionnaire was transformed into an online version and a link was first sent to about 300 healthcare professionals to achieve a sample size of 203, including medical doctors, nurses, and other paramedical staff working in public sector health facilities of the four provinces of Pakistan. The questionnaire was responded to by 195 participants. The Chi-Square test was used to determine the statistical differences between the categorical variables. ResultsAlthough about two-thirds of the participants reported a moderate adherence to protocols and procedures to prevent COVID-19 in their health facilities, the maternal and child health service delivery-related indicators declined during the pandemic. For instance, 66.8% and 62.4% of the participants, respectively, did not agree that a Neonatal Intensive Care Unit and an Intensive Care Unit to admit sick newborns and women with obstetric complications during the COVID-19 pandemic were available during the COVID-19 pandemic. In addition, 23% and 20% of the participants, respectively, reported that staff availability and the provision of cesarean section were moderate to extremely affected. The association between job designation and the impact of COVID-19 was statistically significant (χ2 p = 0.038). ConclusionsThe study suggests that maternal and child healthcare services including C-Section, perinatal care, and inpatient care of newborns in Pakistan may have been moderately affected by the COVID-19 pandemic.