Maternity Teaching Hospital Research Articles

Factors affecting success of trial of labour afterprevious one lower segment Caesarean section

Objective: The aim was to analyze the different factors associated with successful trial of labor after previous one lower segment cesarean delivery in our institution. Patients and methods: A Prospective case-series study was done at Al-Batool Maternity Teaching Hospital, Mosul on 476 women with previous one lower segment Caesarean delivery subjected to trial of labour between January 2009 and mid June 2009. Results: Successful trial of labour and vaginal delivery was reported in 82%. The factors that were found to be significantly associated with successful trial of labour are: parity of 2-4, history of previous vaginal delivery and particularly history of vaginal birth after Caesarean, fetal malpresentation as the indication of previous Caesarean, inter-pregnancy interval longer than 12 months, gestational age ≤ 40 weeks, cervical dilation ≥4 cm, cervical effacement ≥50%, station lower than –1 and intact membrane at time of admission, clear liquor and neonatal weight < 4000 grams. Conclusions: The factors present in woman's obstetric history and during her intrapartum course in the current pregnancy and birth weight that had significant differences in this study can be used as predictor of successful trial of labour and will help obstetrician to identify women who are more likely to attempt trial of labor and have a successful vaginal birth after previous one lower segment Caesarean delivery.

The relation between delivery type and tau protein levels in cord blood

The perinatal morbidity risk is higher in operative deliveries than normal vaginal deliveries. 'Tau protein' is a cytoskeletal component that is predominantly expressed in axons of neurons. The aim of this study was to investigate whether delivery type, particularly the forceps application, had any effect on cord blood tau levels. Ninety babies born in the Division of Maternal-Fetal Medicine of Ankara Etlik Maternity and Women's Health Teaching Hospital, Ankara, Turkey were involved in the study. The babies were divided into three groups according to delivery type: Group 1: normal vaginal delivery (NVD); Group 2: caesarean section; Group 3: forceps application. Cord blood samples were drawn from umbilical veins of the babies soon after the birth. The cord blood tau protein levels in the caesarean section group (79 pg/mL [45-223]) were found to be significantly lower than those of NVD (135 pg/mL [44-627]) and forceps (175 pg/mL [17-418]) groups (P = 0.001 and P < 0.001, respectively). We have shown that forceps applications uncomplicated with perinatal asphyxia did not affect the cord blood tau protein level significantly. Tau levels in caesarean section group were significantly lower than the other two groups. Caesarean section in this manner might be considered especially in conditions of risk of perinatal asphyxia to avoid hypoxia.

Comparison of Hysterosalpingography and Diagnostic Laparoscopy in the assessment of tubal patency for the investigation of subfertility

Background and objective: Infertility is common in our community . Infertility has become nowadays not only a medical, but a social problem as well .Fallopian tube problem is among one of the common causes of infertility. Hysterosalpingography and laparoscopy are used as a screening test for diagnosis of tubal patency . Hysterosalpingography is an out patient X-ray procedure, has for many years been an invaluable procedure for the assessment of tubal pathology and intra-uterine pathology. Laparoscopy is an invasive procedure used since 1944 by Raoul Palmer,of Paris for gynecological examination. We aimed in this paper to explore the role of hystrosalpingography in the evaluation of tubal patency in the diagnosis of the cause of female infertility in our society and to reduce the need for laparoscopy . Methods: One hundred fifty seven infertile women with fallopian tubes problem out of one thousand three hundred fifty patients who underwent HSG had given consent to undergo Laparoscopy in Sulaimaniea Maternity Teaching Hospital and in Hatwan Private Hospital during 2nd may. 2007 to 3rd may. 2008. For infertility not less than 2 years duration. Results: 1350 infertile patients with age range (20 – 39) years underwent HSG, 157 patients show pathology of the fallopian tubes. Diagnostic laparoscopy was performed for them after the HSG procedure to confirm the abnormalities diagnosed by HSG. ,The results showed non insignificant difference P value, the HSG gave 92,4% sensitivity and 100% specificity, while laparoscopy showed 100% sensitivity and 100% specificity. Conclusion: We conclude the feasibility of using HSG as a diagnostic method for investigating tubal patency in subfertile women when compared to the use of diagnostic laparoscopy.

A 20-year (1989–2008) audit of maternal mortality in Damascus, Syria

This article discusses a study that aimed to describe the causes of maternal deaths at the Maternity and Obstetric University Teaching Hospital in Damascus Syria the largest tertiary womans hospital in the city. During the 20-year audit all fatalities at the hospital were recorded by the consultant obstetrician responsible for patient care who cataloged both the cause of death and the case summary in the hospitals death register. The record was further categorized into direct causes (complications during and after pregnancy) and indirect causes (previously existing disease aggravated by pregnancy). Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Abordagem assistencial ao neonato portador de mielomeningocele segundo o modelo de adaptação de Roy

O objetivo deste estudo de caso foi identificar os diagnósticos de Enfermagem de um bebê portador de mielomeningocele, internado na Unidade de Terapia Intensiva Neonatal (UTIN), abordando os aspectos fisiológicos segundo a Teoria de Adaptação de Roy, e elaborar ações de enfermagem pertinentes a estes aspectos. O estudo foi desenvolvido na UTIN da Maternidade Escola Assis Chateaubriand, na cidade de Fortaleza, Ceará, Brasil, nos meses de dezembro de 2007 a março de 2008, quando foi utilizado um roteiro de levantamento de dados. Na análise, reconheceram-se os diagnósticos: padrão respiratório ineficaz; nutrição desequilibrada: menos do que as necessidades corporais; integridade da pele prejudicada; risco para infecção e percepção sensorial perturbada. A utilização desta teoria permitiu reconhecer que o RN pode desencadear respostas positivas ou negativas mediante estímulos, e que as metas e intervenções implementadas foram importantes para a substituição de respostas ineficazes por respostas adaptativas.

Impact of maternal risk factors on the outcome of pregnancy in Baghdad city

To find out the impact of maternal risk factors on the outcome of pregnancy in Baghdad city. A descriptive purposive study was carried out on 100 postpartum women who had delivered for 1 hr. to 24 hrs. ago . the study sample was selected from three hospitals in Baghdad city ( Baghdad teaching hospital ,Fatima Al-Zahra'a maternity and pediatric teaching hospital and Al-Yarmook teaching hospital),during the period from 25 Jan. to 25 Feb. 2006. The data were collected through the use of questionnaire format reviewing pregnants' records and personal interview and were analyzed by using descriptive and inferential statistical approaches. The finding revealed that maternal pregnancy complications had weak effects on pregnancy outcome , while maternal employment &amp; spouse's consanguinity were predictors for poor pregnancy outcome . The study recommended the necessity of establishing health education programs for pregnant to be self monitoring &amp; early detection of complications that associate the pregnancy . In addition promote the system of follow up care during antenatal ,perinatal,&amp; postnatal.

Avoidance of Routine Use of Episiotomy in Primigravida

Background and objective: The justification of the routine use of the episiotomy arouse at the beginning of 20th century. It was based on personal beliefs without scientific basis and this led to the incorporation of episiotomy in daily practice . High-quality methodological studies gave strong evidence that episiotomy should not be done routinely. The purpose of this study was to find out the rate and degrees of perineal tear in women with versus without episiotomy and to evaluate the severity of pain and complications including wound infection, wound dehiscence and dyspareunia. Methods: This is a prospective interventional study included 200 primigravida with term pregnancy, who attended the labor room at Maternity Teaching Hospital from 1st of January 2008 till 1st of July 2008. Episiotomy was done for a group and avoided in another group, then follow up was done to evaluate complications. Results: Perineal tears were significantly more in patients with episiotomy as episiotomy itself is regarded as second degree perineal tear. There was significant difference in the severity of pain, wound infection and dyspareunia among both groups but there was no significant difference in the Apgar score of the newborn in both group. Conclusion: This study does not supports maternal benefits of routine episiotomy.

Prevalência de Staphylococcus spp resistentes à meticilina isolados em uma maternidade escola da Cidade de Natal, Estado do Rio Grande do Norte

Analyses on 1,576 clinical specimens from hospitalized patients were performed with the aim of determining the prevalence of methicillin-resistant Staphylococcus spp isolated in the Januário Cicco Teaching Maternity Hospital in Natal, Rio Grande do Norte, in 2002 and 2003. The samples were collected, processed and identified according to standard procedures, for each clinical specimen. In vitro susceptibility profiles were obtained using the Kirby-Bauer method. 188 strains of Staphylococcus spp were isolated: 105 were identified as Staphylococcus aureus and 83 as coagulase-negative Staphylococcus. Staphylococcus aureus was isolated most often in secretions, whereas coagulase-negative Staphylococcus was most prevalent in blood cultures. The high (41.5%) prevalence of methicillin-resistant Staphylococcus spp shows the need for immediate prophylactic measures aimed at impeding the dissemination of this phenomenon.

A qualitative study of mild to moderate psychological distress during pregnancy

Background Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild–moderate psychological distress. Objective This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care. Design A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis. Setting A large teaching maternity hospital in North West England. Participants Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care. Results Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements. Conclusions Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.

Using standard primipara method to compare the quality of maternity care in Cairo and London

SummaryThere is no universally agreed definition of quality of care (QoC). However, we assumed that the QoC in a London teaching hospital is high and could be used as a benchmark QoC with which to compare the practice in Cairo. We aim to highlight differences in the frequency of adverse outcomes attributable to differences in the QoC between two maternity teaching hospitals in Cairo and London, in low risk, standard primiparae (SP) delivered in 1999. In Ain Shams Maternity Hospital in Cairo and St Mary's Maternity Hospital in London, the caesarean section rate was 9.1% and 22.5%, respectively (OR = 0.34, p < 0.0001); the instrumental delivery rate was 4.1% and 26.8%, respectively (OR = 0.12, p < 0.0001), and the induction of labour (IOL) rate was 1.1% and 16.7%, respectively (OR = 0.06, p < 0.0001). Third degree perineal tears occurred in 0.3% and 8.2%, of the vaginal deliveries (OR = 0.14, p = 0.002) and the still birth rate was 0.78% and 0.1%, (OR = 7.96, p < 0.01) in the Cairo and London hospitals, respectively. This is the first time the SP method has been used to compare similar institutions in developed and developing countries. Intervention rates were significantly higher at St Mary's and so was the improved fetal outcome. A trade-off of improved fetal outcomes for more interventions is difficult to establish. Residual differences in case mix and patient preferences may explain some of the results.

O REFLEXO DA ORIENTAÇÃO NA PRÁTICA DO ALEITAMENTO MATERNO

Objetivamos identificar o conhecimento das mães acerca da amamentação, visando investigar sentimentosmaternos a respeito dessa prática. Estudo exploratório-descritivo com abordagem qualitativa, realizado na Maternidade-Escola Assis Chateaubriand–MEAC, em Fortaleza-CE. Os sujeitos foram 10 mães assistidas por profissionais da MEAC.A coleta de dados foi de julho a agosto de 2005, com a observação participante e entrevista semi-estruturada. O conteúdofoi agrupado nas categorias: Orientações recebidas do serviço; Vantagens x desvantagens; Duração do aleitamentomaterno; Sentimento ao amamentar. Os dados obtidos permitiram compreender que as mulheres são conscientes dosbenefícios, mas se queixam de que a amamentação é difícil, contribuindo para a introdução de alimentos complementares,podendo haver um desvio no crescimento e desenvolvimento das crianças. Concluímos que estratégias de educação emsaúde são importantes, pois permitem desenvolver atividades de educar, facilitando a sensibilização das mulheres para atomada de consciência destes valores.

Influence of IUD perceptions on method discontinuation

Objective The study was conducted to assess how misbeliefs and fears about intrauterine contraceptive devices (IUDs) can influence the rate of early discontinuation of this method. Study Design This is a prospective survey conducted at the Family Planning Clinic at Al-Habibia Maternity Teaching Hospital (Baghdad, Iraq). Two hundred women presenting to the family planning clinic with requests for premature IUD removal were administered a structured questionnaire to ascertain demographic information and reasons for removal request. Careful and sympathetic questioning was essential in order to obtain correct information. The data were analyzed using descriptive and inferential statistics. Results Slightly over half of the women (52.8%) gave only one reason for requesting removal, while the remaining (47.5%) women had two or three complaints. Side effects were the principal reason for request for removal in both groups (45.7% and 42.6%). In the group that offered only one reason, IUD side effects, device-related issues, fears about the device and pregnancy or seeking pregnancy were the reported reasons. In the group that offered more than one reason, each had two or three complaints. IUD side effects and fears about the device were the most prevalent (42.6% and 41.8%, respectively); these fears and perceptions were reported more frequently among younger users and among those requesting early removal. Conclusion Fears and misbeliefs about IUD contributed to discontinuation of use in almost half of the women requesting IUD removal. These elements were more common among younger women and, noticeably, among those who requested early removal.

La cesárea del milenio: técnica de Misgav Ladach modificada

IntroductionMany gynecological interventions have been replaced by medical and surgical alternatives. Nevertheless, Cesarean section has no alternative and consequently efforts should be made to make the procedure simpler, more effective and less costly. MethodWe performed a prospective case-control study of the results of the modified Misgav-Ladach technique in Cesarean sections performed over a 5-year period at the provincial maternity teaching hospital of Camagüey (Cuba). A total of 284 patients were divided into two groups. Odds ratios (OR) and 95% confidence intervals were determined. ResultsThe indications for surgery, surgical risk, newborn extraction time, and newborn status at birth showed no significant differences between the 2 groups. However, the mean surgical time was 9 minutes lower in the study group (p<0.05). Complications such as abscesses, abdominal wall hematomas and paralytic ileus were more frequent in the control group and were reduced in the study group to 0.08%. Hospitalization was significantly reduced in the study group with a marked decline in costs. ConclusionRoutine application of the Misgav-Ladach procedure is feasible and has significant benefits.

Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study

The Valsalva pushing technique is used routinely in the second stage of labor in many countries, and it is accepted as standard obstetric management in Turkey. The purpose of this study was to determine the effects of pushing techniques on mother and fetus in birth in this setting. This randomized study was conducted between July 2003 and June 2004 in Bakirkoy Maternity and Children's Teaching Hospital in Istanbul, Turkey. One hundred low-risk primiparas between 38 and 42 weeks' gestation, who expected a spontaneous vaginal delivery, were randomized to either a spontaneous pushing group or a Valsalva-type pushing group. Spontaneous pushing women were informed during the first stage of labor about spontaneous pushing technique (open glottis pushing while breathing out) and were supported in pushing spontaneously in the second stage of labor. Similarly, Valsalva pushing women were informed during the first stage of labor about the Valsalva pushing technique (closed glottis pushing while holding their breath) and were supported in using Valsalva pushing in the second stage of labor. Perineal tears, postpartum hemorrhage, and hemoglobin levels were evaluated in mothers; and umbilical artery pH, Po(2) (mmHg), and Pco(2) (mmHg) levels and Apgar scores at 1 and 5 minutes were evaluated in newborns in both groups. No significant differences were found between the two groups in their demographics, incidence of nonreassuring fetal surveillance patterns, or use of oxytocin. The second stage of labor and duration of the expulsion phase were significantly longer with Valsalva-type pushing. Differences in the incidence of episiotomy, perineal tears, or postpartum hemorrhage were not significant between the groups. The baby fared better with spontaneous pushing, with higher 1- and 5-minute Apgar scores, and higher umbilical cord pH and Po(2) levels. After the birth, women expressed greater satisfaction with spontaneous pushing. Educating women about the spontaneous pushing technique in the first stage of labor and providing support for spontaneous pushing in the second stage result in a shorter second stage without interventions and in improved newborn outcomes. Women also stated that they pushed more effectively with the spontaneous pushing technique.

Diabetes during Labour: Types, Mode of Delivery and Fetal Outcome in Erbil Maternity Teaching Hospital

A field study on 54 pregnant women during labor with pre gestational and gestational diabetes in&#x0D; Erbil Maternity Teaching Hospital ,Erbil city , Kurdistan region Iraq from 1st of January to the 1st of&#x0D; March 2005 was carried out to determine the types of diabetes, mode of delivery and neonatal out come .&#x0D; Total deliveries in this period were 2891, making the rate of diabetes during labor 1.9%. Mean maternal&#x0D; age was33.65±5.35 years, mean maternal weight was 79.50±13.5 kg, 3.7% of patients were primigraivid&#x0D; while 57.41 % were grandmultiparus.63% of diabetic patients in our study were Gestational diabetes&#x0D; while 37% were pregestational diabetes (Type 1 and Type 2 Diabetes).There was no statistically&#x0D; significant correlations between the types of diabetes and maternal age, weight, and parity.61.1% of the&#x0D; patients delivered by Caesarean Section (Emergency and Elective) while 29.6% of cases delivered&#x0D; spontaneously vaginally .The most common indication for Caesarean Section was Cephalo pelvic&#x0D; Disproportion .The perinatal mortality in the study group was 6 (2 macerated stillbirth, 2 fresh stillbirth&#x0D; and 2 early neonatal deaths), there were 5cases (9.2%) of congenital fetal malformations (4 congenital&#x0D; heart disease and one case of club foot (all were newborns of pregestational diabetic mothers).

How does a concomitant surgery effect the outcomes of Burch colposuspension?

To evaluate the outcomes of 90 Burch colposuspension procedures with or without concomitant surgery after a 6-year follow-up period. The study was carried out in the urogynecology department of Ankara Etlik Women's and Maternity Teaching Hospital, Turkey. Ninety women who were diagnosed as having genuine stress urinary incontinence (GSI) were enrolled in this study. The Burch colposuspension procedure was performed for the treatment of genuine stress urinary incontinence with or without a concomitant surgery After a 6-year follow-up, it has been noted that concomitant surgeries have no effect on the outcome of continence (P>0.05). Pelvic prolapse incidence was 7%. No voiding difficulty was observed. The study shows that concomitant surgeries have no effect on the outcome of continence. However, concomitant surgery can increase operational morbidity. Modified McCall culdoplasty does not seem to be a preventive measure for pelvic organ prolapse.

Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia

Objective to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative (BFHI) Ten steps to successful breast feeding and the duration of breast feeding in first-time mothers. Design a prospective study to assess the duration of breast feeding up to 6 months postpartum. Survival analysis techniques (Kaplan–Meier curves and Cox proportional hazard models) were used to interpret the data. Participants 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November 2003. Findings ignoring all other factors, we found that women whose babies received a bottle feed, used a pacifier or dummy, or who used a nipple shield during their postnatal stay, were at significantly greater risk of weaning ( p⩽0.05). After adjusting for socio-demographic variables, self-efficacy, intended duration of breast feeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breast feeding on demand. However, a composite variable indicating use of one or more of nipple shields, a dummy or bottle feeds while in hospital resulted in a significantly greater risk of weaning ( p=0.05). Implications for practice socio-demographic and cultural factors may be more important determinants of the duration of breast feeding than some of the very specific hospital practices targeted in the Ten steps to successful breast feeding. From a public health perspective, we may influence the duration of breast feeding through better post-discharge support services, or through interventions that improve attitudes to breast feeding in specific socio-cultural and economic groups.

Outcome of vasectomies performed at a Turkish metropolitan maternity hospital

Objective To determine prospectively the outcome of vasectomies performed by two trained surgeons over a 9-month period at the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital Family Planning Centre.Methods The demographic data, source of information concerning the method, sexual function before and after voluntary no-scalpel vasectomy, compliance with the post-vasectomy follow-up program of men applying for a vasectomy were analyzed. All patients were contacted by telephone and invited for follow-up visits for counseling, inquiry regarding sexual dysfunction, and performance of a semen analysis.Results The patients were married men, mostly primary school graduates, with more than one child. Sources of information were health services and/or health personnel for 89% of the patients. Of the 279 men who underwent a vasectomy and who were later contacted by phone, 131 (47%) came for a follow-up assessment. There was only one post-vasectomy pregnancy (0.8%). The incidence of reported sexual problems did not change after the procedure. Vasectomy did not affect the sexual function of men in our study.Conclusion Compliance with follow-up after vasectomy, which is extremely important for assessment of its successful outcome, is low.

MICROBIOLOGICAL STUDY OF BACTERIAL VAGINOSIS AMONG PREGNANT WOMEN IN AL-DIWANIYA CITY

The study was designed in across-sectional pattern, on 335 pregnant women who attended the department of obstetrics and gynaecology at Maternity and Child Teaching Hospital, and some private clinics in AL-Diwaniya city. They were examined for bacterial vaginosis in the period from September 2002 to the end of February 2003. The present study showed that 96(28.6%) women affected by bacterial vaginosis, 109(32.6%) women presented with abnormal vaginal discharge due to other causes and 130 (38.8%) women without any signs and symptoms of vaginitis G.vaginalis were isolated from 89(93.7%), 3(2.7%) and 45(34.6%)of the above mentioned groups respectively. The main age group of bacterial vaginosis occurrence was (25-35%) years, and was more common among pregnant women in the third trimester of pregnancy (40.7%), where the economic status and parity of patient appeared to play no role on the disease prevalence. It was found that the bacterial vaginosis plays an important and significant role in the causation of preterm delivery (Odds ratio 2.9). It was found that Amsel's criteria are good and valid screening tests in the early diagnosis than the cultural technique, because of their high sensitivity and specificity, which yielded (96%, 95%) respectively. Other microorganisms are mainly Candida albicans (11.9%), Staphylococcus aureus (7.4%), Staphylococcus saprophyticus (4.8%), Beta haemolytic streptococcal (3.6%) and to a less prevalence rates for Neisseria gonorrhea (2.6%) and Trichomonas vaginalis (2.08%).

Breast feeding self-efficacy and other determinants of the duration of breast feeding in a cohort of first-time mothers in Adelaide, Australia

Objective to assess the ability of a Breast-Feeding Self-Efficacy Scale (BSES) score measured at 1 week postpartum to predict the duration of breast-feeding in first-time mothers, and to develop a minimal set of potential confounders, including the BSES and demographic variables, for comparing the apparent effect of other influences on the duration of breast-feeding. Design a prospective cohort study, with primary outcome the duration of breast feeding up to 6 months postpartum. Participants 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November, 2003. Findings the BSES at 1 week postpartum was a strong predictor of the duration of breast-feeding in these first-time mothers. Its ability to predict the duration of breast-feeding was largely independent of the other factors (intended duration of breast-feeding, mother's level of education, country of birth, housing situation, smoking status and method of delivery), which were also found to be significant predictors of breast-feeding duration. Implications for practice the BSES (including a new short form version) has been confirmed by our study as an important instrument for identifying women at risk of early cessation of breast-feeding. Together with other demographic variables, it should be useful for targeting limited resources to those most in need.