Maternal Survival Research Articles

A clinical analysis of ectopic pregnancies in a tertiary care centre: A one year retrospective study

Following fertilization and fallopian tube transit, the blastocyst normally implants in the endometrial lining of the uterine cavity. An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. Fortunately, beta-human chorionic gonadotropin (β-hCG) assays and transvaginal sonography (TVS) aid earlier diagnosis, maternal survival, and fertility conservation. Ruptured ectopic is a surgical emergency.To study and analyse ectopic pregnancies in a tertiary care centre.To determine the incidence, risk factors, clinical presentation, management, morbidity and mortality of ectopic pregnancy.: A retrospective analysis of ectopic pregnancies was done in Gandhi hospital, Secunderabad from October 2021 to September 2022 (1 year duration) with a sample of 97 cases of suspected ectopic pregnancies observed and treated, out of total 11252 pregnant women admitted.The incidence of ectopic pregnancy was 8 per 1000(0.81%) pregnancies, majority between the age of 20-30yrs (87.5%) and in higher order pregnancies (3or>3 pregnancies) (50.4%). Risk factors were multiparity (50.5%), h/o infertility treatment (12.3%), tubal sterilisation (7.2%). The typical triad of amenorrhoea, pain abdomen and bleeding p/v was observed in 69% of cases. In 16.4% cases the haemoglobin was <7gm% at presentation. Among 97 suspected cases of ectopic pregnancies, 90(92.7%) cases were found to have ectopic pregnancy. 27.8% of cases were presented in class 2 or more haemorrhagic shock. 79% cases were ruptured ectopic pregnancies. Ampullary ectopic pregnancies were predominant(62.9%) followed by corneal (14.6%) > fimbrial(13.4%) > ovarian(4.4%)> isthmus (2.2%). 2 women among 97 cases of suspected ectopic pregnancies were found to have Heterotopic pregnancy {tubal+intrauterine [missed abortion]}. Unilateral salpingectomy was done in 90.5% cases. Medical management was done successfully with single dose of methotrexate in 1 case. Blood transfusions were given in 69.9% cases. Post op wound complications were observed in 3.1% cases. Mortality is zero in present study.Clinicians should be aware of the fact that any women in reproductive age group presenting with pain in lower abdomen or vaginal bleeding, ectopic pregnancy should be suspected irrespective of presence or absence of amenorrhoea, whether or not she has undergone sterilization, because early diagnosis is critical in reducing maternal morbidity and mortality and improving treatment success rates.

Trends in the utilisation of skilled birth attendance among pregnant women in Benin, from 2001 to 2017-2018, and projections to 2030

BackgroundSkilled birth attendance during childbirth is known to promote better pregnancy outcomes as well as contribute to maternal and newborn survival. The study aimed to analyse the progress in the use of skilled birth attendance by pregnant women over the last two decades (2001 to 2017–2018) in Benin, and then to make projections to 2030.MethodsA secondary analysis was made using Benin's Demographic and Health Survey (DHS) databases. The study population were i) women of 15–49 years of age who were successfully surveyed and usually resided in the households visited during DHS-II, DHS-III, DHS-IV and DHS-V, ii) and had had at least one live birth in the five years preceding each of these surveys. For each DHS, the corresponding proportion of births attended by skilled health personnel was determined. The study then generated the Annual Percent Change (APC) between each survey and globally, and projections were made to 2030.ResultsNationally, the percentage of women who gave birth attended by skilled health personnel was 67.39% in 2001, 76.10% in 2006, 80.87% in 2011–2012, and 79.12% in 2017–2018; this represents an APC = 0.98% between 2001 and 2017–2018. If the historical rate of progression is maintained, it is expected that by 2030, 89.35% of pregnant women will be using skilled birth attendance services.ConclusionEfforts are needed to understand the drivers of skilled birth attendance among pregnant women to adopt appropriate strategies.

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991-2015: An Ecological Systems Theory Perspective.

Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991-2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009-2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals.

Cardiac Arrest Due to out-of-Hospital Pulmonary Embolism During Pregnancy: Successful Thrombolysis.

Pulmonary embolism (PE) is a rare, severe complication in pregnancy, in which case thrombolysis can be lifesaving but has risks. We aim to highlight actions specific to pregnant women. A 24-week pregnant woman developed shortness of breath and experienced sudden cardiac arrest. Cardiopulmonary resuscitation (CPR) was begun immediately in the ambulance and a perimortem caesarean section was performed upon arrival at hospital, but the new-born died. After 55 minutes of CPR, bedside echocardiography revealed right ventricular strain and thrombolysis was given. The uterus was bandaged to minimize blood loss. After massive transfusions and correction of haemostasis, a hysterectomy was performed due to inability of the uterus to contract. After 3 weeks, the patient was discharged in good health and placed on continuous anticoagulant treatment with warfarin. Approximately 3% of all out-of-hospital cardiac arrest cases are due to PE. Among the few patients who survive at the scene, thrombolysis can be lifesaving and should be considered in pregnant women with unstable PE. Prompt collaborative diagnostic work-up in the emergency room is necessary. In a pregnant woman with cardiac arrest, a perimortem caesarean section improves the chances of both maternal and fetal survival. Thrombolysis should be considered for patients with PE in pregnancy with the same indications as in a non-pregnant woman. In case of survival, there is profuse bleeding with need for massive transfusions and haemostasis correction. Despite being in very poor condition, the above patient survived and was fully restored to health. In a young person with a non-shockable rhythm, pulmonary embolism should be kept in mind, especially if they have risk factors for thromboembolism, and pregnant women should be thrombolysed on the same indication as non-pregnant women.In cardiac arrest, a perimortem caesarean section improves the chances of both maternal and fetal survival, but after major surgery one should be prepared for the need for massive transfusions after thrombolysis. Bandaging the uterus might minimize bleeding. Despite 1-hour cardiac arrest with CPR, the patient survived and made a complete recovery.Lifestyle advice with exercise and sun exposure might help avoid rethrombosis and depression in both the short and long term.

Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health.

Environmental factors are important causes that impair global pregnancy outcomes and are, importantly, responsible for maternal morbidity and mortality. However, apart from the direct reasons for maternal deaths, mainly obstetric and neonatal complications, such factors are ignored or given less importance. The recent surge in research on the impact of various environmental factors on pregnancy outcomes suggests the need for immediate attention to such factors and device-specific policies to counter the situation. Moreover, the recent coronavirus disease of 2019 (COVID-19) pandemic, global warming, and climate change showed a lack of preparedness to counter the impact of such events on maternal survival and safe and successful pregnancy outcomes. In the present review, we have emphasized the specific factors responsible for increased maternal and neonatal deaths and their association with specific environmental factors. Increased attention on maternal healthcare, preparedness to counter sudden environmental challenges and improvement of the conventional requirement for better maternal healthcare access and nutrition at a global level may improve the scenario.

Comparative efficacy of sulphadoxine-pyrimethamine and dihydroartemisinin-piperaquine against malaria infection during late-stage pregnancy in mice.

The introduction of artemisinin combination therapies (ACTs) against malaria infections opened up a window of possibilities to combat malaria in pregnancy. However, the usefulness of ACTs in all stages of pregnancy must be critically assessed. This study was designed to evaluate dihydroartemisinin-piperaquine (DHAP) as a suitable alternative to sulphadoxine-pyrimethamine (SP) in the treatment of malaria during third-trimester pregnancy in mice. Experimental animals were inoculated with a parasitic dose of 1x106Plasmodium berghei (ANKA strain) infected erythrocytes and randomly allocated into treatment groups. The animals received standard doses of chloroquine alone (CQ)[10 mg/kg], SP [25 mg/kg] and [1.25 mg/kg] and DHAP [4 mg/kg] and [18 mg/kg] combinations. Maternal and pupil survival, litter sizes, pup weight and still-births were recorded, while the effect of the drug combinations on parasite suppression, recrudescence and parasite clearance time were evaluated. The day 4 chemo-suppression of parasitemia by DHAP in infected animals was comparable to SP, and CQ treatment (P > 0.05). The mean recrudescence time was significantly delayed (p = 0.031) in the DHAP treatment group compared to the CQ treatment group, while, there was no recrudescence in animals treated with SP. The birth rate in the SP group was significantly higher than in the DHAP group (P < 0.05). There was 100% maternal and pup survival in both combination treatments comparable with the uninfected gravid controls. The overall parasitological activity of SP against Plasmodium berghei in late-stage pregnancy appeared better than DHAP. In addition, SP treatment resulted in better birth outcomes assessed compared to DHAP treatment.

Institutional delivery service utilization and associated factors in fragile and conflict-affected situations in Sekota town, Northern Ethiopia, 2022: A community-based cross-sectional study

BackgroundConflict-affected areas are considered to contribute a substantial proportion of worldwide maternal deaths. However, research on maternal health care in conflict-affected countries is very limited. In the absence of recent data, it is impossible to monitor progress made in mitigating the effect of conflict on maternal survival. As a result, this study targeted to assess institutional delivery services usage and influencing factors in a fragile and conflict-affected situation in Sekota town, Northern Ethiopia. MethodsA community-based cross-sectional study was employed among 420 mothers in Sekota town, Northern Ethiopia from July 15th to 30th, 2022. The desired sample size was determined using a single population proportion formula. The data were collected by using interviewer administered structured questionnaire; entered via EpiData version 4.6 and analyzed using SPSS version 25 software. To identify the associated factors, a bivariable and multivariable logistic regression model was applied. The level of significance was declared at a p-value of <0.05. An adjusted odds ratio with a 95% confidence interval was considered to see the strength of the association between dependent and independent variables. ResultsOf the total respondent, 202 (48.1%), 95% CI: (43.0%, 53.0%) mothers utilized institutional delivery service. The use of institutional delivery services was associated with the maternal educational level of secondary school and above (AOR = 2.06, 95% CI: 1.08–3.93), antenatal care during the most recent pregnancy (AOR = 5.24, 95% CI: 3.01–9.11), being informed on birth preparedness and complication readiness (AOR = 1.93, 95% CI: 1.23–3.02) and displacement of the respondents from their usual place of residence due to conflict (AOR = 0.41, 95% CI: 0.21–0.68). ConclusionInstitutional delivery service utilization was very low in the study setting. Healthcare for women in conflict-prone areas requires critical attention and should be given priority during the conflict. More prospective research is needed to fully understand and reduce the impact of conflict on maternal and neonatal health care.

Levels and trends of maternal death in Baoan district, Shenzhen, China, 1999–2022

China had achieved impressive success in improving maternal health, while the progress of reducing maternal mortality ratio (MMR) varied across regions. Some studies had reported maternal mortality from national or provincial perspective, but researches of the MMR on long-term period at the city or county level rare been reported. Shenzhen has experienced significant socioeconomic and health changes, reflecting the typical development of China's coastal city. This study mainly introduced the levels and trends of maternal death in Baoan district, Shenzhen from 1999 to 2022. Maternal mortality data were extracted from registration forms and the Shenzhen Maternal and Child Health Management System. Linear-by-Linear Association tests were used to evaluate the trends of MMR among different groups. The study periods were divided into three stages by 8-year interval and χ2 test or Fisher's test was used to test the difference in maternal deaths of different periods. During 1999-2022, a total of 137 maternal deaths occurred in Baoan, the overall MMR was 15.91 per 100,000 live births, declined by 89.31% with an annualized rate of 9.26%. The MMR declined by 68.15% in migrant population, with an annualized rate of 5.07%, faster than that in permanent population (48.73%, 2.86%). The MMR due to direct and indirect obstetric causes shown a downward trend (P<0.001) and the gap between them narrowed to 14.29% during 2015-2022. The major causes of maternal deaths were obstetric hemorrhage (4.41 per 100,000 live births), amniotic fluid embolism (3.37 per 100,000 live births), medical complications (2.44 per 100,000 live births) and pregnancy-induced hypertension (1.97 per 100,000 live births), the MMR due to the above causes all shown decreasing trends (P < 0.01), pregnancy-induced hypertension became the leading cause of deaths during 2015-2022. The constituent ratio of maternal deaths with advanced age significantly increased by 57.78% in 2015-2022 compared with in 1999-2006. Baoan district had made encouraging progress in improving maternal survival, especially in migrant population. To further reduce the MMR, strengthening professional training to improve the capacity of obstetricians and physicians, increasing the awareness and ability of self-help health care among elderly pregnant women were in urgent need.

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome.

Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support. Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO. Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32-49 and 8-11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge. Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study.

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study. A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021. The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart. The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

A Strategy for Reducing Maternal Mortality in Rural Kenya.

Migori County is categorized among regions with worst maternal survival rates in Kenya. The county's current maternal mortality ratio (MMR) is 673 deaths per 100000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.

Knowledge and Practices of Female Traditional Healthcare Givers to Mothers on Referral System for Care and Immunization against Childhood Killer Diseases in Hard-to-Reach Areas of Adamawa State - Nigeria

Female Traditional Healthcare Givers’ (FTHGs) knowledge, attitude, and practice on maternal and infant survival from pregnancy, delivery, and after birth has been a contextual matter throughout the globe, especially where the incidence of infant mortality rate is high. This often poses questions as to why, what happened, and where women of childbearing go for health seeking when pregnant, at birth, and after delivery? The impact of FTHGs activities to mothers and infants on their education and referral of mothers and children for treatment and immunization was studied in the three Senatorial Districts of Adamawa State. Self-structured questionnaires with both open and closed-ended responses and oral interviews were used for the purpose of the study and analyzed electronically on SPSS version 25.0. Approaches to improve the knowledge and practice of Female Traditional Healthcare Givers include seminars and workshops by Non-Governmental Organizations’, Antenatal Care at government health facilities, and health professionals’ effort in-home visits and formal education. These have improved FTHGs knowledge, skills, and acceptance of immunization programme against childhood killer diseases in most of the Senatorial District communities. Maternal and infant morbidity and mortality has experienced a great reduction in the process as FTHGs made referrals to health facilities on cases needing treatment and immunization. This underlies the need for training in epidemiological findings to prevent the incidence of infant morbidity and mortality since education is the key to a healthy live. Keywords: Childhood killer diseases, Epidemiological, Female Traditional Health care Givers, Healthcare, Immunization, Infant morbidity, Mortality, and Referral.

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Aim: To describe characteristics, etiological factors, maternal and perinatal outcome of perimortem Caesarean section. Design: Prospective study Setting: Emergency Room of Department of Obstetrics &amp; Gynecology Unit IDr.Ruth KM Pfau Civil Hospital &amp; Dow Medical College, Karachi. Methodology: This study was carried out in the Department of Obstetrics and Gynaecology, Civil Hospital Karachi from November 2020 to March 2021. All women who were presented in emergency in a collapsed state were included in the study and those women who were brought dead were excluded. Clinical details including age, gestational age, reason for perimortem Caesarean section, perinatal and maternal outcome were recorded on a predesigned proforma. Results: A total of 27 women underwent perimortem Cesarean section. The mean age of women who underwent PMCS was 266.5 years, and mean gestational age was 35±4weeks. Sixteen (59%) women were referred from either primary care or small clinics. Majority 15(55%), underwent PMCS within 5 minutes of maternal collapse and 12(44%) underwent PMCS, after 5 minutes of collapse. Septic shock 21(77%) was the main etiological factor for PMCS, followed by hypertension and cardiomyopathy 2(7%) each. Twenty three (85%) women survived, following PMCS, whereas 4(14%) died. Reasons for maternal death included hepatic encephalopathy(1), peripartum cardiomyopathy(2), eclampsia(1). The perinatal mortality was high, with only 14(51%) live birth and mean APGAR score at 1 and 5 minutes was 3. The mean stay in intensive care was 37 35 hours, whereas mean stay in ward was 5739 hours. Practical implications: This study suggests that if perimortem caesarean section accomplished in a timely manner, it can improve fetomaternal outcome. Conclusion: Perimortem Caesarean section can improve upon maternal survival. Greater awareness among doctors, multidisciplinary approach, proper documentation and information for family members are cornerstone of this emergency procedure. Keywords: Perimortem Cesarean section, septic shock,eclampsia,postpartumhaemorrhage, maternal mortality.

Novel genomic markers and genes related to reproduction in prolific Chios dairy sheep: a genome-wide association study.

Genetic architecture of sheep reproduction is increasingly gaining scientific interest due to the major impact on sheep production systems. In the present study, we conducted pedigree-based analyses and genome-wide association studies using the Illumina Ovine SNP50K BeadChip to explore the genetic mechanisms underlying the reproduction of the highly prolific Chios dairy sheep. First lambing age, total prolificacy and maternal lamb survival were selected as representative reproductive traits and estimated as significantly heritable (h2 = 0.07-0.21) with no evident genetic antagonism among traits. We identified novel genome-wide and suggestive significant single-nucleotide polymorphisms (SNPs) on chromosomes 2 and 12 associated with age at first lambing. The new variants detected on chromosome 2 span a region of 357.79 kb with high pairwise linkage disequilibrium estimates (r2 = 0.8-0.9). Functional annotation analysis revealed candidate genes, such as the collagen-type genes and the Myostatin gene, that participate in osteogenesis, myogenesis, skeletal and muscle mass development resembling the functionality of major genes affecting the ovulation rate and prolificacy. Additional functional enrichment analysis associated the collagen-type genes with multiple uterine-related disfunctions, such as cervical insufficiency, uterine prolapse and abnormalities of the uterine cervix. Several genes (e.g., KAZN, PRDM2, PDPN, LRRC28) localised close to the SNP marker on chromosome 12 were grouped in annotation enrichment clusters majorly involved in developmental and biosynthetic pathways, apoptosis, and nucleic acid-templated transcription. Our findings may further contribute to unravel the genomic regions that are important for sheep reproduction and could be incorporated into future selective breeding programmes.

Ashley Judd to Speak at APA Annual Meeting

Back to table of contents Previous article Next article Annual MeetingFull AccessAshley Judd to Speak at APA Annual MeetingKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:25 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.66AbstractGolden Globe winner and Emmy-nominated actress Ashley Judd has long been a devoted activist and humanitarian, championing women’s rights and public health issues. She has also written about the need to ensure privacy for families following the death of a loved one to suicide.Actor and mental health advocate Ashley Judd is the keynote speaker at the Opening Session of APA’s 2023 Annual Meeting. The Opening Session will be held Saturday, May 20, at 5:30 p.m. in the Moscone Center.Known for her roles in “De-Lovely,” “Ruby in Paradise,” and “Double Jeopardy,” actress, writer, and humanitarian Ashley Judd, M.P.A., will be a plenary speaker at the 2023 APA Annual Meeting in San Francisco.Judd has also gained worldwide acclaim as an avid advocate of human rights, with a focus on gender equality and public health. Since 2004 she has worked with numerous NGOs and traveled the world in support of public health efforts related to maternal health, child survival, HIV prevention, and malaria prevention and treatment.She currently serves as a Global Goodwill Ambassador for the United Nations (UN) Population Fund, the UN’s sexual and reproductive health agency. She is also the chair of the Women’s Media Center Speech Project: Curbing Abuse, Expanding Freedom; a Global Ambassador for both Population Services International and Polaris Project; and a member of the leadership council of the International Center for Research on Women.Judd earned her master’s degree from Harvard’s Kennedy School of Government. In 2017, she was the recipient of the Muhammad Ali Kentucky Humanitarian Award. Her undergraduate alma mater, the University of Kentucky, established the Ashley T. Judd Distinguished Graduate Fellowship in the Office for Policy Studies on Violence Against Women.She was also featured on the cover of TIME Magazine’s 2017 Person of the Year issue, which honored the thousands of individuals across the world who spoke out about their experiences of sexual harassment and assault, dubbed “The Silence Breakers.”Judd has written about her family experiences with mental illness. In August 2022, she penned a guest essay in the New York Times about her family’s effort to keep police reports related to the suicide of her mother, Naomi Judd, private. Naomi Judd was a well-respected musician who dealt with mental illness for much of her life.Tennessee law allows police reports from closed investigations, including family interviews, to be made public. “Naomi lost a long battle against an unrelenting foe that in the end was too powerful to be defeated,” Ashley Judd wrote. “I could not help her. I can, however, do something about how she is remembered.”She wrote that she intends to make the invasion of privacy following an individual’s death by suicide “a personal as well as a legal cause.” She also called for a reformation of law enforcement procedures related to such cases. “Though I acknowledge the need for law enforcement to investigate a sudden violent death by suicide, there is absolutely no compelling public interest in the case of my mother to justify releasing the videos, images, and family interviews that were done in the course of that investigation.”Last August, Naomi Judd’s family filed for injunctive relief in Williamson County, Tenn., to keep the police records related to her death private. Last December, the Associated Press reported that the family had filed a notice to voluntarily dismiss the lawsuit, due in part to the fact that journalists who requested the police records were not requesting photographs or body cam footage. The notice also said a Tennessee state lawmaker is introducing legislation to make death investigation records private when the death is not the result of a crime.“I hope that leaders in Washington and in state capitals will provide some basic protections for those involved in the police response to mental health emergencies,” Ashley Judd wrote in her essay, adding that her mother “should be remembered for how she lived, which was with goofy humor, glory onstage, and unfailing kindness off it—not for the private details of how she suffered when she died.” ■ ISSUES NewArchived

Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort

Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. Maternal death. A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.

Pregnancy after Kidney Transplantation—Impact of Functional Renal Reserve, Slope of eGFR before Pregnancy, and Intensity of Immunosuppression on Kidney Function and Maternal Health

Women of childbearing age show increased fertility after kidney transplantation. Of concern, preeclampsia, preterm delivery, and allograft dysfunction contribute to maternal and perinatal morbidity and mortality. We performed a retrospective single-center study, including 40 women with post-transplant pregnancies after single or combined pancreas-kidney transplantation between 2003 and 2019. Outcomes of kidney function up to 24 months after the end of pregnancy were compared with a matched-pair cohort of 40 transplanted patients without pregnancies. With a maternal survival rate of 100%, 39 out of 46 pregnancies ended up with a live-born baby. The eGFR slopes to the end of 24 months follow-up showed mean eGFR declines in both groups (-5.4 ± 14.3 mL/min in pregnant versus -7.6 ± 14.1 mL/min in controls). We identified 18 women with adverse pregnancy events, defined as preeclampsia with severe end-organ dysfunction. An impaired hyperfiltration during pregnancy was a significant risk contributor for both adverse pregnancy events (p < 0.05) and deterioration of kidney function (p < 0.01). In addition, a declining renal allograft function in the year before pregnancy was a negative predictor of worsening allograft function after 24 months of follow-up. No increased frequency of de novo donor-specific antibodies after delivery could be detected. Overall, pregnancies in women after kidney transplantation showed good allograft and maternal outcomes.

“Safer Births Bundle of Care” Implementation and Perinatal Impact at 30 Hospitals in Tanzania—Halfway Evaluation

Safer Births Bundle of Care (SBBC) consists of innovative clinical and training tools for improved labour care and newborn resuscitation, integrated with new strategies for continuous quality improvement. After implementation, we hypothesised a reduction in 24-h newborn deaths, fresh stillbirths, and maternal deaths by 50%, 20%, and 10%, respectively. This is a 3-year stepped-wedged cluster randomised implementation study, including 30 facilities within five regions in Tanzania. Data collectors at each facility enter labour and newborn care indicators, patient characteristics and outcomes. This halfway evaluation reports data from March 2021 through July 2022. In total, 138,357 deliveries were recorded; 67,690 pre- and 70,667 post-implementations of SBBC. There were steady trends of increased 24-h newborn and maternal survival in four regions after SBBC initiation. In the first region, with 13 months of implementation (n = 15,658 deliveries), an estimated additional 100 newborns and 20 women were saved. Reported fresh stillbirths seemed to fluctuate across time, and increased in three regions after the start of SBBC. Uptake of the bundle varied between regions. This SBBC halfway evaluation indicates steady reductions in 24-h newborn and maternal mortality, in line with our hypotheses, in four of five regions. Enhanced focus on uptake of the bundle and the quality improvement component is necessary to fully reach the SBBC impact potential as we move forward.

Maternal social position and survival to weaning in arid‐country vervet monkeys

AbstractObjectivesWe consider the relative contributions of maternal rank and sociability to the survival of infant vervet monkeys (Chlorocebus pygerythrus) to nutritional independence (~210 days) in a generally resource‐poor environment.MethodsWe analyzed survival data from 153 infants born to 60 mothers across three free‐ranging troops and 10 yearly birth cohorts at a South African research site experiencing general but variable resource scarcity.ResultsThe population was characterized by a pre‐weaning mortality of 30% (Range: 9%–85%), with a median age at death of 50 days. In addition to the consequences of resource availability, increased infant survival was independently and equivalently positively associated with higher maternal rank and a greater number of maternal spatial partners.DiscussionWe use this outcome to suggest that apparent discrepancies across sites and species in the relative importance of different maternal attributes in determining reproductive outcomes may be resolved by considering more closely local sources of infant mortality.

Evaluation of aglepristone and oxytocin on induction of parturition in guinea pig.

Induction of parturition in guinea pigs appears to be essential because these animals have a higher rate of reproductive problems than rabbits and small rodents. Since aglepristone (AGL) is a competitive progesterone antagonist acting through binding to progesterone receptors while oxytocin (OT) is a powerful constituent of uterine smooth muscle, the aim of this study was to evaluate the clinical and ultrasonographic impacts of AGL and OT on guinea pig parturition induction. In this study, guinea pigs were allocated into five groups; each included five animals on the 61st day of pregnancy. In the aglepristone group (Agle), AGL was administrated subcutaneously (SC) once daily on 2 consecutive days (Days 61 and 62 post mating). Oxytocin (OT) was administered subcutaneously once and twice at 4-h intervals on Day 62 post mating in oxytocin 1 (Oxy1) and oxytocin 2 (Oxy2) groups, respectively. The animals in the aglepristone-oxytocin group (Agle-Oxy) received AGL subcutaneously once daily on 2 consecutive days (Days 61 and 62 post mating) and OT on Day 62 post mating. The remaining sows received saline solution (0.9% NaCl) in the control group. According to the results, fetal heart rate, temperature, neonatal and maternal survival rates were not significantly different between the treatment and control groups (p > 0.05). Biparietal diameter of head and body weight of neonates in the Agle, Oxy2 and Agle-Oxy groups showed a significant decline, compared to the control group (p < 0.05). The time interval between injection and delivery and the duration of pregnancy was significantly reduced in Agle, Oxy2, Agl-Oxy groups, compared to the control and Oxy1 groups. In conclusion, it seems that treatment Oxy2 can induce parturition in guinea pigs without side effects and lower pain during induction of parturition.