Risk Of Maternal Mortality Research Articles

Jaundice in pregnancy and its causes: A case report

Jaundice in pregnancy is an uncommon condition, affecting less than 5% of pregnant women globally and it carries a high risk of maternal and perinatal mortality. Although there are various causes of jaundice in pregnancy, viral hepatitis infection is the most common cause in India. This is a case of a 28-year old woman, in her third trimester who presented with severe nausea, vomiting and edema in her extremities. Laboratory tests revealed severe oligohydramnios with altered blood and electrolyte profile. A clinical diagnosis of jaundice in pregnancy was made and the patient underwent an emergency caesarean section due to the high-risk nature of her pregnancy. The causes of jaundice in pregnancy include acute fatty liver of pregnancy (AFLP), hyperemesis gravidarum, hemolysis and elevated liver enzymes and low platelets (HELLP) syndrome, viral hepatitis and intrahepatic cholestasis of pregnancy. Due to the acute onset of her condition and based on the principle of elimination, acute fatty liver of pregnancy was suspected as the cause of jaundice in this patient. After delivery, the patient received several blood transfusions and was placed on conservative treatment for a week. Both, mother and child, recovered well and were discharged without any complications.

Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study.

Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions. A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR). In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53). Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.

What Can Cardiologists Do to Reduce the High Risk of Maternal Mortality in the United States?

What Can Cardiologists Do to Reduce the High Risk of Maternal Mortality in the United States?

The application of a continuous partnership-based birth plan in China: A randomized controlled trial

BackgroundThe cesarean section rate is as high as 36.7% in China, much higher than the average cesarean section rate of 27% in Asia. With the implementation of the two-children and three-children policy, the primipara with cesarean will also face the choice of repeated or even multiple cesareans, which will increase the risk of maternal perinatal mortality and serious fetal pulmonary morbidity. To reduce the cesarean section rate, a series of midwifery service measures such as the birth plan have been taken in China and it has played a certain role in improving the birth outcome and maternal birth experience. However, the areas carrying out birth plan are often economically developed with advanced medical conditions. the application effect of birth plan in economically underdeveloped areas with limited medical conditions in China is unknown. ObjectiveTo evaluate the effects of a continuous partnership-based birth plan on local women's birth outcomes and experience in Haikou which is an economically underdeveloped city in China. DesignA randomized controlled trial study design was used. Participants90 primiparous women who received pregnancy service from the obstetrics clinic of one of tertiary hospitals in Haikou city, Hainan Province between July 2020 and December 2020 and planned to give birth in this hospital were recruited. MethodsAfter eligibility was determined, consents obtained and baseline surveys completed, 90 participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant and each group were 45 participants. Participants in control group received routine obstetric health service and nursing care, while participants in the experimental group received the continuous partnership service of midwives on the basis of routine care. At the same time, the birth plan was formulated and implemented, and the relevant indicators were recorded and analyzed during and after birth, including cesarean section rate, non-medical indication cesarean section rate, oxytocin use rate, perineal lateral resection rate and anxiety degree. ResultsThe cesarean rate in the experiment and control groups were 20.45% and 57.14%, of which the non-medical indication cesarean rate in the experiment and control groups were 22.22% and 50.00%, respectively, whereby the difference of cesarean rate and nonmedically indicated cesarean section rate between the groups was statistically significant (χ2 = 12.231, p < 0.001;χ2 = 9.101, p = 0.003). Besides, the differences in anxiety degree, neonatal NICU transfer rate and satisfaction of birth between the two groups were statistically significant (p < 0.05). While there was no significant difference in oxytocin use rate, perineal lateral resection rate, neonatal 1-min and 5-min Alzheimer's score between the two groups (P > 0.05). ConclusionThe birth plan based on continuous partnership can reduce medical intervention, improve birth outcomes, reduce anxiety and optimize maternal birth experience of women, which is worthy of promotion in economically underdeveloped areas of China.

Threats Related to Maternal Mortality in Kenya: A Systematic Review

Given the high level of MMR in Kenya, this systematic review set out to systematically review studies on hazard quotients for maternal mortality in Kenya. The end goal of the review was to identify relevant empirical evidence that were included in the final study synthesis and answered the set research question and objectives. The addressed research question was ‘which are the elements of danger for maternal mortality in Kenya?’ Objectives of the study were to assess the socio-demographic risk factors for maternal mortality in Kenya and to determine the hospital based threats for maternal mortality in Kenya. Formulation of research question was guided by the population, exposure and outcomes (PEO) format. A qualitative systematic review design was adopted. The population under review was pregnant women and sample of the study included was 7. PubMed and Google Scholar were the databases used to access the included studies. CASP 2018 was used to appraise the selected/included studies. A qualitative synthesis was used by the study to present the results from the selected studies narratively. Study findings showed that individual level key risks for maternal mortality in Kenya included age, distance to healthcare centres, anaemia and labour complications. The results also showed that nurses’ attitude and mistreatment were among risk factors for ANC non-attendance and adverse health outcomes among pregnant women in Kenya. The study concludes that socio-demographic and hospital based risk factors affect MMR in Kenya and urgent steps have to be taken if SDG 3 is to be attained by the 2030 end date.

Study of foetomaternal outcomes in COVID-19 afflicted parturients who underwent operative delivery - A retrospective analysis.

Parturients with coronavirus disease (COVID)-19 are increasingly presenting for operative delivery. The aim of this study was to outline the foetomaternal outcome in COVID-19-afflicted pregnant women who underwent lower segment caeserean section (LSCS). Data of all COVID-19 positive pregnant females who underwent caesarean section surgery between 1 April and 30 June 2021 was collected. Clinical parameters, including oxygen requirement, laboratory investigations, treatment measures, complications, length of hospital and intensive care unit/neonatal intensive care unit stay, and outcome of parturients and neonates, were collected and analysed. All patients were followed up either during their visits to the obstetric outpatient department or by making phone calls between 1 and 2 months of discharge. Statistical Package for the Social Sciences statistical software 16.0 was used for analysis. Independent group t-test or Mann-Whitney test was used for mean of continuous data. Chi-square test or Fisher's test was used for proportion of categorical data. A P value of <0.05 was considered significant. A total of 71 parturients delivered by caesarean section. 36.51% had mild COVID-19, and 87.5% had moderate COVID-19 at admission. One each with mild and moderate disease expired. The median (interquartile range) length of hospital stay was 7 (5-5.9) days for those with mild disease, and it was significantly longer for those with the moderate disease at 14 (9.5-17.5) days. Our study found that after a mean of 41.72 days of follow-up, of the 69 surviving mothers, 17 complained of fatigue, five complained of myalgia and one needed intermittent supplemental oxygen. Out of 74 babies born, seven died, which is 94.6 per 1000 live births. COVID-19 parturients delivered by LSCS stand a higher risk of maternal and neonatal mortality and adverse effects, including more hospital stay and increased mortality.

MODIFIED BIOPHYSICAL PROFILE IN HIGH RISK PREGNANCY AND ITS FETAL OUTCOME

Background: High risk pregnancies are at increased risk of maternal and neonatal morbidity and mortality. Modied biophysical prole (MBPP) is one of the best method used in antepartum fetal surveillance which comprises of Non stress test (NST) and Amniotic uid index (AFI). Our main aim is to evaluate the efcacy of modied biophysical prole in predicting perinatal outcome in high risk pregnancy &amp; to prevent perinatal morbidity &amp; mortality by intervention done in time. Methods: A prospective cohort study was conducted in our hospital from February 2021 to January 2022. In this study 200 high risk pregnant women with term pregnancy, attending the antenatal outpatient clinic or admitted in the ward were evaluated with the modied biophysical prole consisting of NST recording for 20 minutes, followed by ultrasound assessment of amniotic uid volume, using four quadrant technique. Results:Among 200 high risk pregnant women, Modied biophysical prole in high risk pregnancy showed amniotic uid index &lt; 5 in 4.5% cases, 26 % cases had AFI 6 to 8 and 69.5 % cases had AFI 8 to 24 ; CTG showed 23 % cases were found to have non-reactive &amp; 77% cases were reactive. When AFI &amp; CTG was combined, non-reactive CTG is more among cases with AFI &lt; 5 and it was statistically signicant (P Value =0.05). The rate of LSCS, Neonatal resuscitation and Admission was increased when there was abnormal MBPP. Conclusion: Modied biophysical prole is the best method for antepartum fetal surveillance. It can be used to predict perinatal outcome and provide timely intervention in high risk pregnancies

Relationship between serum selenium deficiency and preeclampsia among pregnant women at the Rivers State university teaching hospital, Port Harcourt, Nigeria

Background: Preeclampsia is a multi-system disorder of pregnancy. It is associated with a significantly increased risk of maternal and fetal morbidity and mortality. Oxidative stress has been implicated. Selenium is a very important trace element in the synthesis of endogenous antioxidants which help to balance the effects of oxidative free radicals. This study sought to determine the relationship between serum selenium deficiency and preeclampsia among pregnant women. Method: A prospective case-control study was carried out on consenting preeclamptic (135) and normotensive (135) pregnant women in their second half of pregnancy. Blood samples were taken for serum selenium estimation and analyzed using Atomic Absorption Spectrophotometry (AAS). Their Socio-demographic information was collected through a structured proforma. Data were analyzed using SPSS version 20. A P-value of &lt; 0.05 was considered to be statistically significant. Results: There was no significant difference in characteristics between the two groups. The mean selenium level of the preeclamptic women (0.52 ± 0.31µmol/l) was significantly (P=0.001) lower than that of the normotensive women (0.73 ± 0.24µmol/l). Bivariate analysis showed that preeclamptic women were 3.6 times more likely to have a deficiency in selenium compared to normotensive women (OR=3.61; P=0.001; 95%CI: 2.13-6.10). No significant difference was noted in the serum level of selenium in patients with mild versus severe preeclampsia. Conclusion: This study showed that pregnant women with selenium deficiency were 3.6 times more likely to develop preeclampsia compared to healthy normotensive pregnant women. However, there was no significant difference between levels in mild compared to severe preeclamptic women.

COVID-19 vaccination is effective at preventing severe illness and complications during pregnancy

COVID-19 vaccination is effective at preventing severe illness and complications during pregnancy

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study

In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. None.

A woman's lifetime risk disparities in maternal mortality in Ethiopia

AbstractBackgroundIn Ethiopia, a woman's lifetime risk (chance) of dying from maternal causes over a woman's reproductive lifespan continues to be a public health challenge. However, detailed evidence is scarce. This study aimed to assess woman's lifetime risk disparities in maternal mortality.MethodsNational data from the Ethiopian Demographic and Health Survey from 2000 to 2016 were used. To determine a woman's lifetime risk of dying, first, the maternal mortality ratio was calculated. Then, a woman's lifetime risk of dying was calculated. Four policy‐relevant socio‐economic factors were assessed: residence, education, regional states and economic status. To assess a woman's lifetime risk disparities in maternal mortality, the rate ratio (R) was used as per the World Health Organization's Health Equity Assessment Toolkit and software.ResultsFrom 61,610 respondents, 795 deaths were reported. A woman's lifetime risk of dying nearly halved from 4.6% in 2000 (1 in 22 women) to 1.9% in 2016 (1 in 52 women). In 2016, the highest woman's lifetime risk of dying was observed among rural women (1 in 111 women), in Oromiya regional state (1 in 71 women), women with secondary education (1 in 82 women) and women with middle income (1 in 77 women). The socioeconomic factors that drive a woman's lifetime risk disparities in maternal mortality include residence (1.3‐times higher among rural women), regional state (2‐times higher among women in Oromiya regional state), education (6‐times higher among women with lower educational status), and economic status (1.3‐times higher among the poorest women).ConclusionEthiopian women experienced a high lifetime risk of maternal mortality which varies across socioeconomic groups. Therefore, equity‐oriented maternal healthcare is recommended to reduce the effects of structural inequities, such as poverty, and the inequitable distribution of the socioeconomic factors of maternal health that sustain a woman's lifetime risk disparities in maternal mortality.

Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey.

Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.

Maternal Mortality in a Rural District of Pakistan and Contributing Factors.

Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.

Postpartum navigation decreases severe maternal morbidity most among Black women

Postpartum care is crucial for addressing conditions associated with severe maternal morbidity and mortality. Examination of programs that affect these outcomes for women at high risk, including disparate populations, is needed. This study aimed to examine whether a postpartum navigation program decreases all-cause 30-day postpartum hospitalizations and hospitalizations because of severe maternal morbidity identified using the US Centers for Disease Control and Prevention guidelines. The effect of this program was explored across patient demographics, including race and ethnicity. This was a retrospective cohort study that used health records of women who delivered at 3 large hospitals in the New York metropolitan area (Queens and Long Island) between April 2020 and November 2021 and who were at high risk of severe maternal morbidity. The incidence rates of 30-day postpartum all-cause hospitalization and hospitalization because of severe maternal morbidity were compared between women who were and were not enrolled in a novel postpartum transitional care management program. Navigation included standardized assessments, development of care plans, clinical management, and connection to clinical and social services that would extend beyond the postpartum period. Because the program prioritized enrolling women of the greatest risk, the risk-adjusted incidence was estimated using multivariate Poisson regression and stratified across patient demographics. Patient health records of 5819 women were included for analysis. Of note, 5819 of 19,258 deliveries (30.2%) during the study period were identified as having a higher risk of severe maternal morbidity. This was consistent with the incidence of high-risk pregnancies for tertiary hospitals in the New York metropolitan area. The condition most identified for risk of severe maternal morbidity at the time of delivery was hypertension (3171/5819 [54.5%]). The adjusted incidence of all-cause rehospitalization was 20% lower in enrollees than in nonenrollees (incident rate ratio, 0.80; 95% confidence interval, 0.67-0.95). Rehospitalization was decreased the most among Black women (incident rate ratio, 0.57; 95% confidence interval, 0.42-0.80). The adjusted incidence of rehospitalization because of indicators of severe maternal morbidity was 56% lower in enrollees than in nonenrollees (incident rate ratio, 0.44; 95% confidence interval, 0.24-0.77). Furthermore, it decreased most among Black women (incident rate ratio, 0.23; 95% confidence interval, 0.07-0.73). High-risk medical conditions at the time of delivery increased the risk of postpartum hospitalization, including hospitalizations because of severe maternal morbidity. A postpartum navigation program designed to identify and resolve clinical and social needs reduced postpartum hospitalizations and racial disparities with hospitalizations. Hospitals and healthcare systems should adopt this type of care model for women at high risk of severe maternal morbidity. Cost analyses are needed to evaluate the financial effect of postpartum navigation programs for women at high risk of severe maternal morbidity or mortality, which could influence reimbursement for these types of services. Further evidence and details of novel postpartum interventional models are needed for future studies.

Infant sex at birth and long-term maternal mortality.

Maternal adaptations may vary by foetal sex. Whether male infants influence long-term mortality in mothers remains uncertain. The objective of the study was to examine whether male infants increase the risk of maternal mortality. This study included pregnant women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project (CPP). Collaborative Perinatal Project records were linked to the National Death Index and the Social Security Master Death File to ascertain deaths until 2016. Foetal sex was determined by infant sex at birth, defined as the total number of male or female infants in pregnancies prior to or during enrolment in the CPP. In secondary analyses, exposure was defined as infant sex at the last CPP delivery. Outcomes included all-cause and underlying causes of mortality. We used Cox proportional hazards models weighted by the number of prior live births and stratified our models by parity and race/ethnicity. Among 48,188 women, 50.8% had a male infant at their last registered CPP pregnancy and 39.0% had a recorded death after a mean follow-up of 47.8 years (SD 10.5 years). No linear association was found between the number of liveborn males and all-cause mortality (primipara women: HR 1.02, 95% CI 0.95, 1.09, multipara women, 1 prior live birth: HR 0.96, 95% CI 0.89, 1.03, multipara women, ≥2 prior live births: HR 0.97, 95% CI 0.85, 1.11). A similar trend was noted for cardiovascular- and cancer-related mortality. At the last delivery, women with a male infant did not have an increased risk of all-cause or cause-specific mortality compared to women with a female infant. These findings were consistent across racial/ethnic groups. Women who give birth to male infants, regardless of number, are not at increased risk of all-cause and cause-specific mortality. These findings suggest that giving birth to male infants may not independently influence the long-term health of women.

Maternal and fetal/neonatal outcomes of pregnancies complicated by pulmonary hypertension: a retrospective study of 154 patients

ObjectivesTo determine the main clinical and demographic outcomes related to Pulmonary Hypertension (PH) and adverse obstetric and fetal/neonatal outcomes. MethodsThis study retrospectively analyzed the medical record data of 154 patients with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2011 and December 2020. ResultsAccording to the severity of elevated Pulmonary Artery Systolic Pressure (PASP), 82 women (53.2%) were included in the mild PH group, 34 (22.1%) were included in the moderate PH group, and 38 (24.7%) were included in the severe PH group. There were significant differences in the incidence of heart failure, premature delivery, Very-Low-Birth-Weight (VLBW) infants, and Small-for-Gestational-Age (SGA) infants among the three PH groups (p < 0.05). Five (3.2%) women died within 7-days after delivery, 7 (4.5%) fetuses died in utero, and 3 (1.9%) neonates died. The authors found that PASP was an independent risk factor for maternal mortality. After adjustment for age, gestational weeks, systolic blood pressure, Body Mass Index (BMI), mode of delivery, and anesthesia, the risk of maternal mortality in the severe PH group was 20.21 times higher than that in the mild-moderate PH group (OR = 21.21 [95% CI 1.7∼264.17]), p < 0.05. All 131 (85.1%) patients were followed up for 12 months postpartum. ConclusionsThe authors found that the risk of maternal mortality in the severe PH group was significantly higher than that in the mild-moderate group, highlighting the importance of pulmonary artery pressure screening before pregnancy, early advice on contraception, and multidisciplinary care.

New Rule-Based Model to Predict Maternal Mortality Risk

Most maternal deaths occur by preventable means [1]. This could be addressed by finding better ways to track the vitals of mothers and better ways of determining maternal mortality risk. This paper uses an association rule mining (ARM) algorithm called Apriori to generate human readable rules to better classify maternal mortality risk. The Waikato Environment for Knowledge Analysis (WEKA) was used to apply the Apriori algorithm to the data set and python was used to clean the data set. The data set that was used consisted of real maternal health vitals that were then converted into categorical data to apply the Apriori algorithm.

Kardiyovasküler hastalığı olan kadınlarda kontrasepsiyon ve danışmanlık

The risk of maternal and neonatal morbidity and mortality is high in pregnancies of women that they have cardiovascular disease (CVD). Unplanned pregnancies are very risky if health cannot be optimized before conception. Despite the known risks of unplanned pregnancies, 25% to 54% of women with cardiovascular heart disease continue to have unplanned pregnancies. It is important to provide reliable contraception counseling and pregnancy planning before pregnancy to optimize the health of both mother and baby in this population. Early and accurate contraceptive counseling for women of reproductive age with cardiovascular heart disease is must to prevent unplanned pregnancies in this population. The purpose of this review; To define contraceptive method options in women with cardiovascular heart disease, to examine the risks, benefits and contraceptive method medical eligibility criteria within the scope of counseling in line with the literature. Keywords: cardiovascular disease, pregnancy, contraception, medical eligibility criteria, consultancy

Knowledge, Attitude, and Practice towards Family Planning among Married Women in ALTI city, Alkamlin locality, AL-Gezira State, Sudan from February – March 2023

Background: Researches have shown highest awareness but low utilization of contraceptives making the situation a serious challenge. Most of women in reproductive age group know little or have incorrect information about family planning methods. Even when they know the name of some of the contraceptives, they do not know where to get them or how to use it. These women have negative attitude about family planning, whereas some have heard false and misleading information, the current study aimed in assessing the knowledge, attitude, and practice of family planning among married women in ALTI city. Justification: Considering the high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, this study aims to explore the knowledge, attitude, and practice (KAP) of family planning (FP) and associated factors among married women living in ALTI city February – 2023. Methods: Cross sectional study. 45 women were interviewed. Data were collected using a structured and pretested questionnaire, which included study participants’ socio-demographic characteristics, access to FP services, knowledge, attitude, and practice of FP. Study population: This study targeted married women in childbearing age in ALTI city February-2023.

Platelet Count and Platelet Distribution Width: Potential Predictive Biomarkers for Preeclampsia and Eclampsia

Introduction: Hypertensive disorders of pregnancy are one of the most common obstetric pathologies, affecting approximately 8-10% of all pregnancies worldwide, including entities like preeclampsia and eclampsia. Preeclampsia increases the risk of maternal morbidity and mortality, foetal mortality, and preterm birth. Early identification of preeclampsia and eclampsia helps in the effective management and favourable outcome of pregnancy. Aim: To determine the relationship between platelet parameters, namely Platelet Count (PC) and Platelet Distribution Width (PDW), with preeclampsia and eclampsia. Materials and Methods: A hospital-based analytical crosssectional study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, including 100 pregnant women attending the antenatal clinic in Jorhat Medical College and Hospital, Jorhat, Assam, India, for a duration of one year (from June 2021 to July 2022). Pregnant women meeting the inclusion criteria were selected and divided into two broad groups: a comparison group comprising normotensive pregnant women (n=50) and a study group (n=50), which further included subgroups of preeclamptic women (n=35) and eclamptic women (n=15). A 5 mL venous blood sample was drawn and collected in an Ethylenediaminetetracetic acid (EDTA) vial from both groups and analysed using a six-part fully automated haematology cell counter (SYSMEX XN-550) for PC and PDW. Changes in PC and PDW were compared between the two groups using a student t-test with GraphPad software. A p-value of &lt;0.05 was considered statistically significant. Results: The mean PC in preeclampsia was 185.714±69.56×103 / μL, while in eclampsia, it was 147.53±56.927×103 /μL. The mean value of PDW in preeclampsia was 18.4314±4.184 fL, while in eclampsia, it was 14.86±3.854 fL. A decrease in PC was found to be statistically significant in eclampsia (p-value &lt;0.001). PDW was statistically significantly different among normotensive, preeclamptic, and eclamptic participants (p-value &lt;0.001). The increase in PDW was higher in eclamptic patients compared to preeclamptic patients. Conclusion: Hence, the estimation of PC and PDW can be used as a screening test for the early identification of preeclampsia and eclampsia. Platelet parameters may act as an indicator of preeclampsia and eclampsia. The prognosis of preeclampsia and eclampsia in pregnant women can also be assessed, making them effective prognostic markers as PDW correlates with disease severity. Moreover, these indices are cost-effective and easily available.