Maternal Rate Research Articles

High reproductive potential of the commercially exploited shark Squalus suckleyi in the major fishing grounds of the western North Pacific.

The present study examined body length (precaudal length, PCL) and age at sexual maturity, as well as fecundity and maternal investment in the Pacific spiny dogfish Squalus suckleyi, a long-term commercially exploited shark in the western North Pacific, using samples caught in several fisheries and across seasons. The PCL and age at 50% sexual maturity of males were 60.6 cm and 9.4 years, respectively; and those of females were 73.1 cm and 17.8 years, respectively. The PCL and age at 50% maternity were 77.4 cm and 19.7 years, respectively. General or generalised linear models revealed that the fishing method was not significantly correlated with sexual maturity (both sexes), and the maternity rate and litter size were not correlated with female PCL. Other general linear models revealed an increase in offspring size with maternal size, but litter size was not affected by embryonic development. These findings indicate that the reproductive potential of Pacific spiny dogfish is relatively high throughout the whole North Pacific region because of a smaller size and earlier age at sexual maturation in both sexes. In addition, pregnant females displayed no resting phase and produced 0.45 more embryos per cm PCL in their lifetime after the onset of maturity, which is higher than in the eastern North Pacific. We suggest that these qualities are not a consequence of stock decline associated with the long-term exploitation of the species, but that its high reproductive potential has likely contributed to the long-term stability of the landings in Japan. This article is protected by copyright. All rights reserved.

The optimal induction timing in prelabor rupture of membranes: a retrospective study

Objective Term prelabour rupture of membrane (PROM) occurs in 8% of term deliveries, but it is unclear when to initiate induction. Our objective was to assess the optimal timing of oxytocin induction in the management of term PROM in terms of maternal and neonatal outcomes. Methods A retrospective cohort study was performed at a single tertiary care center from 2010 to 2020. All singleton pregnancies with PROM beyond 37 weeks gestation, without regular uterine contractions, were included. Eligible women were divided into three groups according to the timing of oxytocin induction (≤12; 12–24; ≥24 h) following PROM. Results Of 9,443 women presented with the term PROM, 1676 were included. They were classified according to the timing of oxytocin induction initiation following PROM: 1,127 within 12 h; 285 within 12–24 h; 264 after 24 h. There were no significant differences in baseline demographic characteristics between groups. Women who presented at our emergency department were induced earlier delivered significantly sooner than those who received oxytocin later (45 vs. 28.2 vs. 23.2 h, respectively, p < .001. Maternal infection rate was similar and unrelated to oxytocin starting time. Induction at <12 h from PROM was associated with reduced rate of antibiotic administration compared with other timings (26.8% vs. 38.6% vs. 33.33%, respectively; p < .001), and the same was found for neonatal composite adverse outcomes (RR = 1.27, p = .0307). Conclusion In term PROM, early induction (within 12 h of PROM) may be recommended to reduce the time-do-delivery interval and increase the delivery rate within 24 h. It may be of economic significance and improve women satisfaction. Furthermore, early induction may also improve neonatal outcomes, without worsening maternal outcomes.

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

(Anesth Analg. 2022;135:1153–1158) Neuraxial labor analgesia commonly results in maternal fevers, though the cause is unknown. Possible causes include infection, inflammation, and altered thermoregulation. An alternative pain management to epidural labor is continuous spinal analgesia, which has lower neuraxial and systemic bupivacaine levels and may decrease the rate of maternal fever. No studies to date have compared maternal fever rates between epidural labor and continuous spinal analgesia. The aim of this study is to compare 2 techniques and better understand the mechanism that drives maternal fevers in association with epidural labor analgesia.

Giving birth in a good way when it must take place away from home: Participatory research into visions of Inuit families and their Montreal-based medical providers.

Transferring pregnant women out of their communities for childbirth continues to affect Inuit women living in Nunavik-Inuit territory in Northern Quebec. With estimates of maternal evacuation rates in the region between 14% and 33%, we examine how to support culturally safe birth for Inuit families when birth must take place away from home. A participatory research approach explored perceptions of Inuit families and their perinatal healthcare providers in Montreal for culturally safe birth, or "birth in a good way" in the context of evacuation, using fuzzy cognitive mapping. We used thematic analysis, fuzzy transitive closure, and an application of Harris' discourse analysis to analyze the maps and synthesize the findings into policy and practice recommendations. Eighteen maps authored by 8 Inuit and 24 service providers in Montreal generated 17 recommendations related to culturally safe birth in the context of evacuation. Family presence, financial assistance, patient and family engagement, and staff training featured prominently in participant visions. Participants also highlighted the need for culturally adapted services, with provision of traditional foods and the presence of Inuit perinatal care providers. Stakeholder engagement in the research resulted in dissemination of the findings to Inuit national organizations and implementation of several immediate improvements in the cultural safety of flyout births to Montreal. The findings point toward the need for culturally adapted, family-centered, and Inuit-led services to support birth that is as culturally safe as possible when evacuation is indicated. Application of these recommendations has the potential to benefit Inuit maternal, infant, and family wellness.

A Cross-Sectional Study of COVID-19 Pandemic Impact on Postpartum Women's Level of Anxiety, Depression and Breastfeeding Duration

Pregnancy and postpartum periods are known as sensitive periods in women’s life and COVID-19 pandemic seems to be worsening their mental health with major impacts on exclusive breastfeeding duration. Therefore, the present study aims to fill the gap in the literature by assessing the links between postpartum anxiety and depression symptoms and breastfeeding duration as well as the associated factors during the COVID-19 pandemic. A longitudinal prospective observational study was conducted between November and December 2020 at the Maternity ward of Vlore Regional Hospital, Albania. A total of 321 postpartum women were invited to participate in the study, resulting in 215 participants with a response rate of 66.9%. Along with modified questions from the Infant Feeding Practices Study II (IFPS II) Neonatal Questionnaire on breastfeeding follow-up from birth to third and sixth months, the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Edinburgh Postnatal Depression Scale (EPDS) were used to measure anxiety and depression levels. The binomial logistic regression model was applied to reflect the relationship between variables with the corresponding p-value ≤ 0.05. The mean age of participants was 27.4 ± 5.32 years old. 41% of them experienced postpartum anxiety and 51% showed symptoms of depression. Unemployment (69%; OR = 3.66), COVID-19 threat to their own life (89%; OR = 2.89), and feelings of isolation (62%), were all significant predictors of postpartum anxiety and depression disorders. Both anxiety and depression were significant barriers to unsuccessful breastfeeding duration, especially among primiparous women (p = 0.001). The findings revealed high anxiety and depression among postpartum women, which was linked to COVID-19 stressors and breastfeeding outcomes. The careful follow-up of perinatal mothers during a pandemic should be the priority of healthcare professionals to reduce maternal morbidity rates and improve the health of infants.

Analisis Faktor Maternal Terhadap Keluarga Berisiko Stunting Sebagai Upaya Peningkatan Analisis Data di BKKBN Kalimantan Timur

According to Riskesdas 2018, the prevalence of stunting in East Borneo is 30%. Based on data from East Borneo's Health Office 2017 states that number of children under five years of age who are stunting relatively high, that is 30,6% of the total toodlers. Maternal factors are risk factors for stunting especially in the first 1000 days of life. The maternal factor is the risk of 4 Too. Too young, too old, too close and too many. The condition of 4T will increase risks in pregnancy including the risk of stunting, morbidity and even death of mother and baby. Objective: To analyze the correlation of maternal risk factors with families at risk of stunting in East Borneo Province. Method: this research used secondary data of 508,351 families on the PK21 tabulation report (recapitulation of families at risk of stunting). Data analysis used the Pearson Correlation test which first found that the data were normally distributed. Results: PK21 data shows that there are 79.% of families at risk of stunting. The distribution of maternal risk factors is too young 0.8%, too old 53.4%, too close 3.2% and too many 33.1%. And the results of the correlation analysis show that there is a correlation between maternal factors too young (0.001), too old (0.001), too close (0.001) and too many (0.001) with families at risk of stunting. Conclusion: The prevalence of stunting in East Borneo is quite high, so it requires prevention to reduce the maternal factor 4T rate.

Association between excessive fetal growth and maternal cancer in Shanghai, China: a large, population-based cohort study

The prevalence of high birth weight or large for gestational age (LGA) infants is increasing, with increasing evidence of pregnancy-related factors that may have long-term impacts on the health of the mother and baby. We aimed to determine the association between excessive fetal growth, specifically LGA and macrosomia, and subsequent maternal cancer by performing a prospective population-based cohort study. The data set was based on the Shanghai Birth Registry and Shanghai Cancer Registry, with medical records from the Shanghai Health Information Network as a supplement. Macrosomia and LGA prevalence was higher in women who developed cancer than in women who did not. Having an LGA child in the first delivery was associated with a subsequently increased risk of maternal cancer (hazard ratio [HR] = 1.08, 95% confidence interval [CI] 1.04–1.11). Additionally, in the last and heaviest deliveries, there were similar associations between LGA births and maternal cancer rates (HR = 1.08, 95% CI 1.04–1.12; HR = 1.08, 95% CI 1.05–1.12, respectively). Furthermore, a substantially increased trend in the risk of maternal cancer was associated with birth weights exceeding 2500 g. Our study supports the association between LGA births and increased risks of maternal cancer, but this risk requires further investigation.

Acceptance of recommended vaccinations during pregnancy: a cross-sectional study in Southern Italy.

Vaccine administration is a recommended, safe, and effective measure to protect pregnant women against vaccine-preventable diseases (VPDs). Despite available guidance, maternal immunization rates for vaccination against influenza and with the reduced antigen content tetanus-diphtheria-acellular pertussis vaccine (Tdap) in Italy remain incredibly low. The primary goal of the study was to explore what Italian pregnant women knew about VPDs and immunization during pregnancy and what factors affected their decision to be vaccinated. This cross-sectional study took place between October 2021 and April 2022 in the Southern part of Italy. All consecutive pregnant women, from those attending the selected facilities on randomly selected days, were approached to request participation. The inclusion criteria for participation were age ≥18 years, the ability to understand, speak, and read Italian, and being pregnant at any gestational age. The questionnaire, using a combination of checkboxes and free text answers, consisted of 32 items divided into five parts and lasted ~10 min. The results showed that 61% knew that the influenza vaccine is recommended and 48.7% knew that influenza could be risky during pregnancy; 74.1% wrongly reported that the Measles-Mumps-Rubella (MMR) vaccine is recommended during pregnancy. Seven out of 10 pregnant women believed that strong evidence supported the safety of vaccinations during pregnancy, and more than half (55.6%) thought they were at increased risk of severe illness with COVID-19. Women in the sample believed that vaccines received during pregnancy pose a risk of adverse events to the unborn child with a median value of 6 (IQR 3-9), on a scale ranging from 1 to 10. Similarly, the fear of contracting pertussis and influenza during pregnancy showed a median value of 6 (IQR 3-9) and 5 (IQR 3-8), respectively. Only 21.1% and 36.5% of women received influenza and Tdap vaccines during pregnancy. Unrealistic risk perception with a negative attitude toward vaccines in pregnancy and a low percentage of vaccinated pregnant women confirm the urgency of training women to make informed choices to increase overall vaccine uptake.

A 10-Year Retrospective Analysis of Uterine Rupture in a University Teaching Hospital in Nnewi, Nigeria

Background: One of the most serious obstetric emergencies that seriously endanger both mother and fetus and dramatically increase maternal and perinatal mortality in our community is uterine rupture. The aim of the study is to ascertain the prevalence of uterine rupture and the various aetiologies/predisposing factors associated with it. Methods: From January 1, 2007, to December 31, 2016, patients with ruptured uteruses were studied retrospectively and cross-sectionally at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Nigeria. Outcome measures included prevalence rate, surgical choices, maternal and fetal outcomes, and maternal case fatality rate. Stata 13.0 (StataCorp LP, Texas, USA) was used to analyze the data. Results: There were 10,777 deliveries and a total of 66 cases of ruptured uterus were treated, giving a ratio of 1 in 163 deliveries or prevalence of 6.0/1000 deliveries. Sixty four case notes were retrieved giving retrieval rate of 97.0% and prolonged obstructed labour was the commonest aetiologic factor identified (42.2%). Other associated factors were grand multiparity (36.0%), previous caesarean section (28.1%), previous myomectomy (3.1%), injudicious use of oxytocin (25.0%), use of misoprostol (3.1%) and abnormal lie (17.2%). Twenty of the patients (31.3%) had repair of the ruptured uterus alone, and 28(43.8%) had repair with bilateral tubal ligation. Six of the patients (9.4%) had total abdominal hysterectomies while 10(15.6%) had sub-total hysterectomies. There were a total of 4 maternal deaths giving a case fatality rate of 6.3%. The fetal outcome was poor with only 11 (17.2%) survivors. Conclusion: Only 17.2% of surviving fetuses had a good result, and 6.1 per 1000 deliveries involved uterine rupture. The rupture of gravid uterus will be decreased, if not completely eliminated, by adequate health education, widespread availability of comprehensive obstetric care facilities, enhanced antenatal care, a decline in the prevalence of primary caesarean sections, and population empowerment of women

Assessing the Impact of Universal Healthcare Coverage on Maternal and Child Health Outcomes in Nigeria

The purpose of this research was to determine how universal healthcare coverage in Nigeria would affect maternal and infant health. 500 households across four states in Nigeria provided information for this cross-sectional research. Data analysis using descriptive statistics revealed that the NHIS has helped increase access to and use of maternal and child healthcare services, leading to a decrease in maternal and child death rates. Inadequate funding, infrastructure, and health workforce were also cited as obstacles to implementing the NHIS in the study. Maximizing the NHIS's effect and achieving further gains in maternal and child health outcomes will require addressing these challenges and social determinants of health, such as poverty, education, and access to clean water and sanitation. These results have substantial implications for healthcare policymakers and providers in Nigeria and other low-income nations. Improving maternal and child health outcomes and decreasing household healthcare expenses are two major goals of universal healthcare coverage initiatives like the NHIS.

Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133

INTRODUCTION: Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector. METHODS: Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. RESULTS: Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance. CONCLUSION: The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.

Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment.

Perinatal health outcomes are influenced by a variety of socioeconomic, behavioral, and economic factors that reduce access to health services. Despite these observations, rural communities continue to face barriers, including a lack of resources and the fragmentation of health services. To evaluate patterns in health outcomes, health behaviors, socioeconomic vulnerability, and sociodemographic characteristics across rural and nonrural counties within a single health system catchment area. Socioeconomic vulnerability metrics, health care access as determined by licensed provider metrics, and behavioral data were obtained from FlHealthCHARTS.gov and the County Health Rankings. County-level birth and health data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital between June 2011 and April 2017. The UFHPCA included 3 nonrural and 10 rural counties that represented more than 64,000 deliveries. Nearly 1 in 3 infants resided in a rural county, and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Maternal smoking rates (range 6.8%-24.8%) were above the statewide rate (6.2%). Except for Alachua County, breastfeeding initiation rates (range 54.9%-81.4%) and access to household computing devices (range 72.8%-86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3%-36.9%) were above the statewide rate (18.5%). Furthermore, risk ratios suggested negative health outcomes for residents of counties within the UFHPCA for each measure, except for infant mortality and maternal deaths, which lacked sample sizes to adequately test. The health burden of the UFHPCA is characterized by rural counties with increased maternal death, neonatal death, and preterm birth, as well as adverse health behaviors that included increased smoking during pregnancy and lower levels of breastfeeding relative to nonrural counties. Understanding perinatal health outcomes across a single health system has potential to not only estimate community needs but also facilitate planning of health care initiatives and interventions in rural and low-resource communities.

Promoting Best Practice in Obstetrics: Findings From a State-Based Perinatal Quality Collaborative Implementing the Obstetric Hemorrhage Maternal Safety Bundle [ID: 1377611

INTRODUCTION: The Perinatal Neonatal Quality Improvement Network (PNQIN) of Massachusetts engaged hospital teams in a statewide improvement initiative to address maternal morbidity from obstetric hemorrhage (OB HEM) through support of implementation and adherence to best practices in screening for and diagnosis of OB HEM. METHODS: The Alliance for Innovation on Maternal Health (AIM) OB HEM bundle was adapted and implemented across hospitals in Massachusetts from June to December 2021. Each month, participating hospital teams joined educational webinars, learned quality improvement strategies, received access to resources for the intervention, and submitted data on six structure and five process measures. Severe maternal morbidity rates were provided using state hospital discharge data. Reliability of implementation was monitored by structure and process measure submission. Aggregate data were shared statewide. RESULTS: Fifty-three percent of birthing hospitals in the state (21 of 40) voluntarily participated. Baseline risk screening for OB HEM was 93% and quantitative blood loss measurement (QBL) was 60% in aggregate for all teams. Six participating hospitals reported all 11 measures monthly across the 6-month period. Half of these sites had all six structure measures in place at baseline and 83% reported completion of structure measures by the end of the study period. Among these six sites, the cumulative proportion QBL utilization increased 178% from 28% to 78% and documented OB HEM risk assessment during labor admission increased 8.4% from 83% to 90%. CONCLUSION: Implementation of the OB HEM bundle was effective in increasing adherence to evidence-based care among participating birth hospitals through a collaborative, quality improvement approach.

Maternal and Neonatal Outcomes After Monoclonal Antibody Use [ID: 1376620

INTRODUCTION: The study aimed to evaluate whether the administration of monoclonal antibodies (MABs) in mildly symptomatic unvaccinated COVID-19-positive pregnant patients reduced the need for maternal hospitalization and to evaluate whether this medication affected the rate of adverse neonatal outcomes and severe maternal disease. We hypothesized that MAB use would reduce the need for hospitalization. METHODS: This retrospective cohort study was completed by obtaining electronic medical record data of all pregnant patients between August 2020 and January 2022 who met criteria for MAB therapy. The two comparison groups were patients who received outpatient MAB therapy during pregnancy and those who were eligible for therapy but declined. Demographic and hospitalization data were obtained. Exclusion criteria included severe illness upon diagnosis requiring hospitalization, or patients for whom delivery and neonatal data were not available. RESULTS: During the study period, 49 patients qualified for MAB therapy, of which delivery data were available for 39 patients. Twenty patients (51%) elected to receive MAB therapy and 19 (49%) declined. Among those who received MAB therapy, 10 (26% of the population) were vaccinated, and among those who declined, 6 (15% of the population) were vaccinated. The two groups were similar in gestational age at delivery (38 weeks 4 days versus 37 weeks 5 days) and gestational age at diagnosis (19 weeks 0 days versus 22 weeks 6 days). Among patients who did not receive MABs, both absolute and relative maternal hospitalization rate was higher (26.3% versus 5%, 12.8% versus 3%, P&gt;.05). When stratified by vaccination status, those who were vaccinated had a 5% probability of hospitalization regardless of MAB therapy. The probability of hospitalization was highest among unvaccinated women who did not receive MAB therapy (67%) and lowest among unvaccinated women who received MAB therapy (0%). CONCLUSION: Unvaccinated patients who declined MAB therapy had a higher rate of hospitalization, although not statistically significant. These preliminary findings warrant further study with a larger cohort.

Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561

INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.

Race and Ethnicity Misclassification in Hospital Discharge Data and the Impact on Differences in Severe Maternal Morbidity Rates in Florida.

Hospital discharge (HD) records contain important information that is used in public health and health care sectors. It is becoming increasingly common to rely mostly or exclusively on HD data to assess and monitor severe maternal morbidity (SMM) overall and by sociodemographic characteristics, including race and ethnicity. Limited studies have validated race and ethnicity in HD or provided estimates on the impact of assessing health differences in maternity populations. This study aims to determine the differences in race and ethnicity reporting between HD and birth certificate (BC) data for maternity hospitals in Florida and to estimate the impact of race and ethnicity misclassification on state- and hospital-specific SMM rates. We conducted a population-based retrospective study of live births using linked BC and HD records from 2016 to 2019 (n = 783,753). BC data were used as the gold standard. Race and ethnicity were categorized as non-Hispanic (NH)-White, NH-Black, Hispanic, NH-Asian Pacific Islander (API), and NH-American Indian or Alaskan Native (AIAN). Overall, race and ethnicity misclassification and its impact on SMM at the state- and hospital levels were estimated. At the state level, NH-AIAN women were the most misclassified (sensitivity: 28.2%; positive predictive value (PPV): 25.2%) and were commonly classified as NH-API (30.3%) in HD records. NH-API women were the next most misclassified (sensitivity: 57.3%; PPV: 85.4%) and were commonly classified as NH-White (5.8%) or NH-other (5.5%). At the hospital level, wide variation in sensitivity and PPV with negative skewing was identified, particularly for NH-White, Hispanic, and NH-API women. Misclassification did not result in large differences in SMM rates at the state level for all race and ethnicity categories except for NH-AIAN women (% difference 78.7). However, at the hospital level, Hispanic women had wide variability of a percent difference in SMM rates and were more likely to have underestimated SMM rates. Reducing race and ethnicity misclassification on HD records is key in assessing and addressing SMM differences and better informing surveillance, research, and quality improvement efforts.

Maternal and Neonatal Mortality in Fana Health District, Koulikoro, Mali

The aim was to assess maternal and neonatal deaths. Materials and Methods: This was a cross-sectional retro-prospective study on the evolution of the trend of maternal and neonatal deaths in the fana health district from 01 January 2018 to 31 December 2022. Results: We recorded the following assisted delivery rates: 69.19% in 2018; 74.44% in 2019; 73.35% in 2020; 80.47% in 2021 and 79.13% in 2022. The maternal death rates in the fana health district from 2018 to 2022 are 0.20, 0.26, 0.44, 0.43 and 0.47 per 1000 live births, respectively. Theneonatal death rate in the Fana Health District from 2018 to 2022 is 1.9; 1.7; 1.1; 1.4 and 1.0 per 1,000 live births. Maternal death rates in the Koulikoro region and Mali from 2018 to 2022 evolved as follows: 0.28; 0.26; 0.32; 0.32 and 0.32 costs 0.48; 0.43; 0.48; 0.49 and 0.42 per 1000 live births, respectively. Neonatal death rates in the Koulikoro region and Mali from 2018 to 2022 evolved as follows: 1.8, 1.6, 1.6; 2.2 and 2.4 co n tre 2.4; 2.3; 2.2; 2.3 and 2.2 per 1000 live births, respectively. Conclusion: Maternal and neonatal mortality rates remain a priority problem in developing countries, including ours, but we believe that the creation of the SO NUB and SONUC structures and the recruitment of qualified personnel could really reduce the rates obtained.

Impact of COVID-19 mandatory lockdown on maternal gestational weight gain and neonatal macrosomia rate at an academic medical center in Israel

Background In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals’ eating habits and physical activity. Objective To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. Method A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. Results A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p = .048; OR: 1.29; 95% CI: 1.002– 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p < .01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p = .26; OR: 1.12; 95% CI: 0.92–1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p = .003, OR: 1.36; 95% CI: 1.11–1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p = .042; OR: 1.32; 95% CI: 1.02–1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p = .02; OR: 1.40; 95% CI: 1.06–1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p = .001; OR: 1.65; 95% CI: 1.25–2.19). Neonatal condition at delivery was comparable. Conclusion COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined.

Maternal and Perinatal Outcome in a Contemporary Cohort of Patients with Portal Hypertension: A Single-Center Experience.

Portal hypertension in pregnancy is characterized by an increased perinatal and maternal complication rate. The purpose of this study was to evaluate the perinatal and maternal outcomes of these high-risk pregnancies at our tertiary center. We identified pregnancies with portal hypertension in our departmental database for the years 2013 to 2021. The medical history and perinatal and maternal data were extracted from medical records. Eleven cases were identified. In pregnancy, delivery and postpartum, complications occurred in 72.7% of cases and included among others ascites, subclavian thrombosis, variceal-ligation-induced ulcer bleeding and postoperative hemorrhage. The cesarean delivery rate was 72.7% (n = 8); five of these were done for obstetric or fetal indications. The rate of preterm birth and admissions to neonatal intensive care unit were high (54.5% and 45.5%, respectively). Our case series substantiates the high maternal and perinatal complication rates seen in portal hypertension. The prevention of thromboembolic and bleeding complications was the main challenge. Care by an interdisciplinary team of experts is crucial for a successful perinatal and maternal outcome.

Chagas Disease Maternal Seroprevalence and Maternal–Fetal Health Outcomes in a Parturition Cohort in Western El Salvador

Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.