Mean Number Of Antenatal Visits Research Articles

Frequency and Factors Associated with Cesarean Section in a Tertiary Care Hospital of Southern Punjab, Pakistan

Background: There is a large variation in the frequency of cesarean section in different countries and in different regions of the same country. To reduce the country-wide disparity in this mode of delivery, WHO has set in an optimal range of 10–15%. In Pakistan, the rate of cesarean sections has increased over time. Rising rate of cesarean section may be associated with maternal age, antenatal care, parity, fetal lie and presentation, comorbidities, previous cesarean section, maternal choice, and clinical management policies. Objective: To determine the frequency and factors related to the cesarean section in females in a Tertiary Care Hospital in Southern Punjab of Pakistan. Methodology: It was a descriptive cross-sectional study, conducted from 1st March 2020 to 31st December 2020. Two hundred and five females fulfilling the inclusion criteria were enrolled applying the statistical formula. A predesigned questionnaire was applied to collect data at a Tertiary Care Hospital, Bahawalpur. The data were analyzed by using SPSS version 24. Results: The mean age of the respondents was 25.3±4.4 years; 45.4% of females belonged to the upper-middle class and 95.6% were housewives. The mean number of antenatal visits was 3.4±1. Overall, 72.7% of females had cesarean section deliveries. The risk factors associated with cesarean section were: previous cesarean section 34.6%, fetal distress 13.7%, cephalo-pelvic disproportion 12.7%, oligo-hydramnios 10.7%, low lying placenta 8.3%, abnormal lie presentation 6.8%, and failure to progress in labor 5.9%. Conclusion: The frequency of cesarean section was high. Major factors associated with cesarean section were previous cesarean section, education level, fetal distress, cephalo-pelvic disproportion, and oligo-hydramnios.

Maternal and fetal outcomes of unattended pregnancies in Lubumbashi, Democratic Republic of Congo

IntroductionLes grossesses non suivies se caractérisent par leur morbi-mortalité et maternelle et fœtale importante. Cette étude s'est fixée comme objectifs de déterminer la fréquence des grossesses non suivies, décrire le profil sociodémographique et évaluer la morbi-mortalité materno-fœtale lors de l'accouchement chez les femmes n'ayant pas suivi de consultations prénatales (CPN) dans la ville de Lubumbashi.MéthodesUne étude transversale analytique des accouchées d'une grossesse monofoetale de décembre 2013 à mai 2014 a été mené dans 10 maternités de référence à Lubumbashi. Les femmes n'ayant pas suivi les CPN ont été comparées aux femmes qui les avaient bien suivies (CPN≥4). Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. L'odds ratio et son intervalle de confiance ont été calculés. Le seuil de signification a été fixé à une valeur de p<0,05.RésultatsNous avons trouvé que la fréquence de l'absence de suivi de grossesses était de 21,23% et le nombre moyen de consultations prénatales était de 2,6 ± 1,9. L'analyse de la relation entre les consultations prénatales et les caractéristiques sociodémographiques des accouchées montre que l'absence de suivi était 2,29 fois plus élevée chez les adolescentes que chez les femmes adultes (OR=2,29 [1,54-3,41]), 4 fois plus élevée chez les femmes vivant seules que chez celles vivant en union (OR=4,00 [2,05-7,79]) et 4,08 fois plus élevée chez les femmes de bas niveau de scolarité (analphabète ou primaire) que chez celles ayant un niveau de scolarité élevé (OR=4,08 [3,08-5,40]). Comparées à celles les ayant bien suivis, nous avons constaté que les femmes n'ayant pas suivi de consultations prénatales présentaient un risque élevé d'évacuation obstétricale (OR=1,90 [1,26-2,95]), de rupture de membranes fœtales à l'admission (OR=1,31 [1,02-1,68]), de mal présentation fœtale (OR=1,89 [1,03-3,44]), d'accouchement par césarienne (OR=1,78 [1,21-2,63]), d'éclampsie (OR=3,00 [1,09-8,70]), de rupture utérine (OR=4,76 [1,00-47,19]) et d'anémie (OR=2,33 [1,06-5,13]). Les taux de prématurité (OR=1,93 [1,33-2,80]), de post-maturité (OR=1,47 [1,00-2,30]), de faible poids de naissance (OR=2,33 [1,56-3,46]), de dépression néonatale (OR=3,89 [2,52-6,02]), de transfert en néonatologie (OR=1,60 [1,11-2,32]) et de mortalité périnatale (OR=2,70 [1,59-4,57]) étaient significativement plus élevés chez les nouveau-nés issus des femmes n'ayant suivi de consultations prénatales que chez ceux de celles les ayant bien suivis.ConclusionIl ressort de notre étude que l'absence de suivi des consultations prénatales est associée à une forte morbidité maternelle et une morbi-mortalité périnatale élevée dans notre milieu.

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia.

BackgroundIn a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work.ResultsIn this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)).ConclusionsOur results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented.

Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria.

BackgroundIntermittent preventive treatment of malaria for pregnant women (IPTp) is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria.MethodsThis was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7.ResultsA total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516). Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367), and only 4.9% (18/367) took a third dose. Clinical malaria occurred in 85% (127/149) of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one dose of IPTp despite booking in the second trimester. Malaria in pregnancy occurred significantly more in women who failed to adhere to subsequent doses of IPTp than in those who adhered (24.6% versus 14.3%, respectively; risk ratio =2.5; 95% confidence interval 2.1, 3.0; P<0.001). Similarly, neonatal malaria occurred significantly more in neonates whose mothers did not receive IPTp compared to those whose mothers received at least one dose of IPTp (7.4% versus 3.4%; risk ratio =1.4; 95% confidence interval 0.9, 2.1; P=0.003).ConclusionMore than one half of parturients failed to adhere to prescribed intermittent preventive treatment for malaria in pregnancy in the major obstetric centers in Abakaliki, South East Nigeria. The very high prevalence of malaria among women who failed to adhere to IPTp and the associated adverse neonatal outcomes demands more pragmatic ways of improving access to, and acceptability of, malaria preventive measures in this area.

A Low-Cost Ultrasound Program Leads to Increased Antenatal Clinic Visits and Attended Deliveries at a Health Care Clinic in Rural Uganda

BackgroundIn June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics.Methods and FindingsRecords at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit) were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3–20.6, 95% CI) from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3–111.5, 95% CI) from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits.ConclusionsThe availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.

Healthcare Behavior and Expenditure in an Urban Slum in Relation to Birth Experience and Newborn Care

Newborn care practices and healthcare seeking are important determinants of neonatal morbidity and mortality in the resource-limited settings of the urban slums. To examine the current patterns of healthcare-seeking behavior and estimate out-of-pocket expenditure for delivery and common neonatal problems in the urban slums of Chandigarh. Community-based cross-sectional survey. Structured questionnaire was used to collect data from the clusters selected by the World Health Organisation (WHO) Expanded Program for Immunization's cluster survey method. Independent t-test, one-way ANOVA and Pearson's Chi-square tests were used to analyze the data. All tests were two-tailed and p < 0.05 was taken as significant. 31.7% of the mothers delivered at home with 4.18 ± 2.16 mean number of antenatal visits and 73.9% used prelacteals. Factors significantly predicting home deliveries were identified. About 44.7% of the neonates had problems after birth, with 40.3% requiring hospitalization. Choice of private healthcare providers governed the care seeking in the majority (61.4%). Out-of-pocket expenditure was significantly high for the private care providers in terms of the cost of delivery and the overall cost of neonatal illness though no gender-based differences were seen. Private sector emerged as the major healthcare provider in the urban slums resulting in higher out-of-pocket expenditure. A comprehensive health strategy comprising of health education, improvement in antenatal practices, institutional deliveries, behavior change communication activities and quality perinatal care is required for these urban slums.

Maternal Health Care Utilization Among Ever Married Youths in Kyimyindaing Township, Myanmar

This study aimed to identify maternal care services utilization among ever married female youths (15-24 years) in Kyimyindaing Township, Yangon, Myanmar. A quantitative cross-sectional survey was conducted. A total of 196 ever married females who had delivered at least one child were included. Multistage sampling was employed. Face to face interviews using a structured questionnaire were carried out. Respondents were asked about their maternal care services utilization at the last pregnancy. Bivariate and logistic regression analyses were applied to determine the factors associated with utilization of maternal care services. Overall 96% of respondents received antenatal care (ANC) at least once and 79% had at least 4 ANC visits. The mean number of antenatal visits increased with women's education level. The majority received late ANC regardless of residence, age, education and family income. Nearly 39% delivered at home, especially in rural areas and 79% of home deliveries were attended by traditional birth attendants (TBAs). Only 56.6% of women received at least one postnatal care visit. Inadequate postnatal care (<6 times) was identified (82.6%). Place of residence, women's education and ANC frequency were the key determinants for a delivery place and postnatal care. Despite relatively high antenatal care attendance, most women practiced home deliveries and received inadequate postnatal care. Maternal health services need to be focused on rural women and women with little or no education. Quality ANC should be the entry point of safe delivery and postnatal care. Further intensification of information, education and communication activities on "safe motherhood" is needed.

Clinical Audit of Antenatal Service Provision in Nigeria

We audited records of 365 pregnant women whose mean age was 25.6 ± 5.6 years. Their mean gestational age at booking was 29.3 ± 2.7 weeks; their mean number of antenatal visits was 4.2 ± 2.3. Weight, blood pressure, and urine were checked on 97.3%, 95.1%, and 86.3% of the women respectively. Hemoglobin estimation was done on 19.2% of women; 34.8% received two doses of tetanus toxoid. Malaria prophylaxis and iron and folate supplements were provided to 263 (72.1%) and 293 (80.3%), respectively. Late booking was common, and antenatal service was inadequately equipped. Early booking and full implementation of preventive treatments are recommended. Support for detection of anaemia and immunization service is desirable.

Risk factors and consequences of congenital Chagas disease in Yacuiba, south Bolivia

To determine the risk factors of congenital Chagas disease and the consequences of the disease in newborns. Study of 2712 pregnant women and 2742 newborns in Yacuiba, south Bolivia. Chagas infection was determined serologically in mothers and parasitologically in newborns. Consequences of congenital Chagas disease were assessed clinically. The prevalence of Chagas disease in pregnant women was 42.2%. Congenital transmission was estimated at 6% of infected mothers leading to an incidence rate of 2.6% among newborns. Main risk factors of congenital transmission were mothers' seropositivity and maternal Trypanosoma cruzi parasitaemia. Parity was higher in infected than in non-infected mothers, but it was not associated with the risk of congenital transmission. The rate of congenital infection was significantly higher in newborns from multiple pregnancies than in singletons. However, we did not observe statistically significant consequences of Chagas disease in newborns from single pregnancies or among twins. The main risk factors for congenital transmission were infection and parasitaemia of mothers. Consequences of the disease seemed mild in newborns from single pregnancies and perhaps more important in multiple births.

Low-birthweight babies in Eastern Nigeria

In this study low birth weight is defined as a birth weight of less than 2500 g. Maternal antenatal complications such as antepartum haemorrhage multiple pregnancy malaria sepsis pregnancy induced hypertension and anaemia which are known to predispose to low-birthweight babies are common in Nigerian obstetric practice possibly due to the inadequate antenatal care that these women receive. Sixty-one percent of mothers of low-birthweight babies booked after 16 weeks of gestation and 78% of mothers of low-birthweight babies were booked by the time of delivery compared with 86% for all deliveries in this hospital. The mean number of antenatal visits was 6±2 for mothers of low-birthweight babies compared with 10±3 for all other deliveries. Neonatal care at the University Teaching Hospital is poor as a consequence of the severe scarcity of skilled manpower modern technology and drugs. (excerpt)

Overutilization of antenatal care in Norway

It has long been a common belief in Norway that all pregnant women attend antenatal care, but no documentation has been provided. In 1984, official guidelines were issued recommending a reduction of the number of routine visits. However, no studies have been performed in order to monitor whether the recommendations are followed. Utilization review of antenatal care in Norway. A national cross-sectional study, comprising all deliveries in all obstetrical units in the country during a two-week registration period in June 1996. Information on onset of antenatal care, the number of visits, parity and gestational age at the time of delivery was collected. The study comprised 1,557 deliveries; 45 of the 60 obstetrical units in the country participated. The mean number of antenatal visits was 12.2. Only two of the 1,557 women (0.1%) delivered without any previous antenatal care. A total of 80% started antenatal care in the first trimester, 0.4% had their first antenatal visit in the third trimester. The mean number of antenatal visits was substantially higher than the recommended number. Antenatal care-providers do not comply with the official guidelines.

Review: the risk of neonatal mortality is increased in pregnant women who continue to use heroin while receiving methadone

Hulse GK, Milne E, English DR , et al. Assessing the relationship between maternal opiate use and neonatal mortality. Addiction1998 Jul; 93 : 1033 –42 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Question Is...

Changing to ‘new style’ antenatal care

This study describes the effects of introducing ‘new style’ antenatal care into South Bedfordshire; a reduced schedule of routine visits and an increased emphasis on community care. During the planning stage, professionals and new mothers were consulted. Guidelines for antenatal care were jointly developed by midwives, GPs and obstetricians. A significant reduction was achieved in the mean number of antenatal visits from 11.7 to 10 after the new system had been in operation for 21 months. Mothers' acceptance of the reduced visits schedule was low, but increased after it had been introduced. Initially, 80% of women were against the change; later this propotion had fallen to 46%. The care of women who developed hypertension in pregnancy was also audited; the proportion of women who managed according to the guidelines increased from 58% to 93% in those with borderline raised blood pressure, and from 57% to 95% in those with diastolic pressures above 100mmHg.

Improving antenatal care for pregnant adolescents in southern Malawi

This paper considers why antenatal care (ANC) programs for adolescents may need to be improved in areas where a high proportion of first pregnancies are to young girls. Descriptive data on the characteristics of 615 adolescents (aged 10-19 years) who attended for a first antenatal care visit at two rural hospitals in southern Malawi are given. For the 41.5% who came for a supervised delivery, details of their pregnancy care and delivery outcome are provided. The Chi-square test is used for determining significant differences between age and parity groups and logistic regression for an analysis of low birthweight. Fifty-two percent of girls were nulliparous, 24.5% were < or =16 years and 73.3% were illiterate. Prevalence of anemia, malaria and HIV infection was high. Girls who were nulliparous, illiterate, made early antenatal care visits or gave a history of stillbirth or abortion were less likely to attend for delivery. Few primiparae required an assisted vaginal delivery or cesarean section but primiparae had more adverse birth outcomes. Forty percent of primiparae <17 years gave birth to low birthweight babies as did 28.3% of multiparae. In a logistic regression (all adolescents) low birthweight was correlated with literacy (p=0.03) and number of antenatal care visits (p=0.01). Pregnancy morbidity and adverse birth outcomes were common in spite of antenatal care attendance. This partly reflects poor management of malaria during pregnancy. In areas like Malawi, where childbearing starts early, girls in their first pregnancy need good quality care and careful monitoring if problems are not to be perpetuated to a second pregnancy. Many girls start pregnancy with HIV and schistosomal infections which indicates the need for programs before girls become pregnant.