Multigravida Mothers Research Articles

Determinants of short birth interval in Ethiopia: A multilevel analysis based on EDHS 2019, Ethiopia, 2023.

According to the World Health Organization and Ethiopian Demographic and Health Survey on birth spacing, there should be at least a two-year gap between conception and the first of two children born in quick succession. In poor nations like Ethiopia, resource issues were complex, making it difficult to get statistics for the entire country. However, by examining Ethiopian mini demographic and health survey data, we were able to provide data at the national level. The cross-sectional survey-based study was conducted in several of Ethiopia's administrative cities and nine regions. In the analysis, sampling weight was used to correct the survey's non-proportional sample distribution to strata and areas throughout the survey process and restore representative data. The study's household population was presented and described using descriptive statistics such as weighted frequencies and percentages. The statistically significant factors linked to frequent short birth intervals were found using a multivariable, multilevel logistic regression analysis. Overall, 4306 weighted multigravida mothers nested within 305 enumeration areas were included in the analysis. The respondents' mean (standard deviation) of the birth interval was 42.027(26.69). Higher-educated women had 12% lower odds of having a shorter pregnancy (AOR = 0.88; 95% CI: 0.35, 0.98) than women without higher education. The odds of a short birth interval were 3.04 times greater among women in the age category of 40-49 years at first marriage (AOR = 3.04; 95% CI: 1.08, 8.46) than among women in the age category of 15-19 years. This indicates that older women were most likely to have short birth intervals. In the multilevel logistic regression model, maternal age, maternal educational status, the wealth quintile index, use of contraceptives, duration of breastfeeding, and contextual regions were significantly associated with short birth intervals in Ethiopia.

Senam Birth Ball dalam Mengatasi Nyeri pada Persalinan Kala I

Physiologically, pain is generally felt by all mothers who face the birth process. Pain arises due to uterine contractions which are useful for opening the cervix. However, intense pain can disturb comfort and can affect psychological conditions. As many as 46% of primigravida mothers experienced severe pain, 64% experienced mild to moderate pain. In multigravida mothers, 37% experienced severe pain and 63% experienced moderate and mild pain. One way to overcome severe pain in the first stage is birth ball exercises. The aim of the research was to determine the effect of using a birth ball on first stage labor pain. The design of this research was a quasi-experimental one group with control group. The population in this study were all mothers giving birth at PMB Dewi Anggraini in March-April 2024, totaling 28 respondents. The sampling technique used is total sampling. Statistical tests use the Independent Sample T Test. The average pain in the intervention group was 3.52 and the average labor pain in the control group was 5.52, meaning there was a reduction in pain levels of 2.00. The significant value was found to be p: 0.001 < 0.05, meaning that there was a difference in the pain scale of the first stage of labor in the groups that used a birth ball and those that did not use a birth ball. It is hoped that health workers can improve maternal care during childbirth, one of which is by inviting mothers to use a birth ball.

Pemanfaatan Birth Ball dalam Kala Satu Persalinan untuk Mempercepat Penurunan Kepala Janin

The aim of this research plan is to determine the effectiveness of using a gym ball on lowering the head in pregnant women and speeding up the duration of labor. The method in this research is a case study using qualitative descriptive methods. The place of implementation is at PMB Rosita S.Tr Keb which is located at Citra Kencana Housing, Jl. Taman Karya No.17, Tuah Karya, Kec. Handsome, Pekanbaru City Riau 28293, Indonesia. The research was conducted on Mrs. The types of data used are primary data and secondary data. Other research results indicate that the Pelvick Rocking Exercise can speed up the first stage of the active phase of labor in multigravida mothers. This is similar to the results of research which also shows that the gym ball technique with pelvic rocking can speed up the length of labor in the first stage of the active phase by 52.61% and in terms of descent and rotation of the fetal head at the beginning of the active phase (dilatation: 3-5 cm) and the second stage.

Aromaterapi Lavender Untuk Mengurangi Intesitas Mual Muntah Pada Ibu Hamil Trimester I Di Wilayah Kerja Puskesmas Lubuk Alung

In the first trimester of pregnancy, expectant mothers may experience nausea and vomiting, known as emesis gravidarum. Nausea and vomiting occur in 60% to 80% of primigravida mothers and 40% to 60% of multigravida mothers. The aim of the study was to determine the effect of lavender aromatherapy on the intensity of nausea and vomiting in pregnant women in the Lubuk Alung Health Center Work Area. The study design was a quasi-experiment with a one-group pretest-posttest design. The population consisted of all pregnant women experiencing nausea and vomiting in the Lubuk Alung Health Center Work Area from June to December 2022, totaling 76 people. The sample for this study consisted of 15 individuals, selected through random sampling. The research instrument used the PUQE Score to assess the intensity of nausea and vomiting in pregnant women. The results showed that lavender aromatherapy had an effect on the intensity of nausea and vomiting in first-trimester pregnant women in the Lubuk Alung Health Center Work Area, with a P-value of 0.000 (P-value < 0.005). It is hoped that first-trimester pregnant women experiencing nausea and vomiting can implement lavender aromatherapy as an effort to reduce these symptoms.

Time, cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals, northwest Ethiopia: a prospective follow-up study.

Globally, 75% of neonatal deaths occur during the first weeks of life and more than 43% of deaths are covered by sub-Saharan Africa. Health-related policymakers and decision-makers need to use evidence-based treatments to reduce the time to early neonatal death and associated predictors. However, there are limited studies on median survival time, cause, incidence, and predictors in the study area as well as the country. Therefore, the aim of the present study was to assess time, the cause of early neonatal death, and its predictors among neonates admitted to neonatal intensive care units at Bahir Dar City public hospitals in northwest Ethiopia. An institution-based prospective follow-up study design was conducted among 387 early neonates selected by systematic sampling between 22 February and 22 April 2023. Statistical software, Epi Data version 4.6 and Stata version 14, was used for entry and analysis, respectively. Proportional hazard assumption and model fitness were checked by the Schoenfeld residual test and the Cox-Snell residual test, respectively. Descriptive statistics, the Kaplan-Meier curve, and the life table were used to describe variables. The Cox regression analysis model was fitted to identify the predictors of early neonatal death. During the follow-up time, 59 (15.25%) early neonates died, with an incidence of 31.79 per 1,000 early neonate days [95% confidence interval (CI): 0.024-0.041]. The leading causes of early neonatal death were prematurity complications, asphyxia, sepsis, meconium aspiration syndrome, and necrotizing enterocolitis. The mean survival time was 2.72 days. Being born from a multigravida mother [adjusted hazard ratio (AHR) 4.34; 95% CI: 1.63-11.55], a grand multigravida mother (AHR 3.50; 95% CI: 1.12-10.95), respiratory distress syndrome (AHR 2.60; 95% CI: 1.03-6.58), birth asphyxia (AHR 7.51; 95% CI: 2.30-24.51), a small gestational age (AHR 2.05; 95% CI: 1.08-4.92), and being unable to exclusively breastfeed (AHR 3.46; 95% CI: 1.52-7.88) were significantly associated predictors for time to early neonatal death. The incidence of early neonatal death was high, and the mean survival time was 2.72 days. Gravidity, respiratory distress syndrome, birth asphyxia, and being unable to exclusively breastfeed were identified as predictors of early neonatal death. Therefore, future research will consist of long-term prospective follow-up studies at a multicenter, nationwide level.

Rebozo Technique on Pain Intensity in the First Stage of the Active Phase and Length of Labor in Multigravida Mothers, Wanayasa District, Purwakarta Regency, Indonesia

Background: Pain during the first stage of the active phase is one of the main obstacles in the labor process. The rebozo technique, a traditional technique from Mexico, has been proven to be effective in reducing labor pain. This study aims to determine the effectiveness of the rebozo technique on the intensity of pain in the first stage of the active phase and the duration of labor in multigravida mothers in Wanayasa District, Purwakarta Regency.
 Methods: This research used a quasi-experimental design with a pre-test and post-test with a control group design. The research sample was 60 multigravida mothers who were divided into two groups: the intervention group (n=30), who received the rebozo technique, and the control group (n=30), who received standard care. Pain intensity was measured using the visual analogue scale (VAS) and duration of labor was calculated from 4 cm of cervical dilatation to complete dilation.
 Results: The results showed that there was a significant difference in the intensity of pain during the first active phase between the intervention group and the control group (p=0.001). The mean pain intensity in the intervention group was lower than the control group (VAS: 4.2 ± 1.5 vs. 6.1 ± 1.8). There was no significant difference in length of labor between the two groups (p=0.123).
 Conclusion: The rebozo technique is effective in reducing the intensity of pain during the first active phase in multigravida mothers but has no effect on the length of labor.

Factors associated with dietary patterns (DPS) and nutritional status among pregnant women in AM-HDSS, South Ethiopia.

Malnutrition during pregnancy increases the risk of chronic illness later in life and adverse birth outcomes in subsequent generations. In this regard, consumption of diets rich in adequate energy, protein, vitamins, and minerals from a variety of foods is essential. Evidence on the status of maternal dietary pattern is very crucial. Hence, the aim of this study was to assess factors associated with dietary patterns and nutritional status of pregnant women in South Ethiopia. A community-based cross-sectional study was conducted among 638 randomly selected pregnant women using a validated, a pre-tested, contextualized food frequency questionnaire using interviewer-administered structured questionnaire by digital open-source toolkit. Principal component factor analysis was employed to determine dietary patterns. Bivariable and multivariable ordinal logistic regression analyses were used to identify factors associated with dietary patterns and nutritional status, using STATA version 16. The dietary habits of pregnant women were best explained by three distinct dietary patterns. Urban dwellers (AOR = 2.18; 95% CI: 1.33, 3.59), from high socio-economic status (AOR = 2.43; 95% CI: 1.68, 3.51), from middle socio-economic status (AOR = 1.72; 95% CI: 1.19, 2.48), primigravida mothers (AOR = 1.72; 95% CI: 1.07, 2.78), and multigravida mothers (AOR = 2.08; 95% CI: 1.39, 3.10) were high likelihood to consume the highest tercile of "Cereals-Pulses and Dairy" compared to rural dwellers, from low socio-economic status and grand multigravida, respectively. Attending formal education (AOR = 1.60; 95% CI: 1.02, 2.51), from higher socioeconomic status (AOR = 1.56; 95% CI: 1.02, 2.38), not having food aversion (AOR = 1.98; 95% CI: 1.16, 3.39), and had good dietary knowledge (AOR = 2.16; 95% CI: 1.08, 4.32) were associated with a higher tercile consumption of "Nutrient-Dense" food compared to those without formal education, having food aversion and had poor dietary knowledge, respectively. Not attending formal education (AOR = 2.22; 95% CI: 1.48, 3.36), had decision-making autonomy (AOR = 1.91; 95% CI: 1.26, 2.90), and had good dietary knowledge (AOR = 1.86; 95% CI: 1.13, 3.08) were found to consume the highest tercile of "Leafy local food" compared to their counterpart. Consumption of lower terciles "Nutrient-Dense" food (AOR = 1.63; 95% CI: 1.07, 2.47) and "Leafy local food" (AOR = 2.32; 95% CI: 1.54, 3.51) were found to be factors associated with under nutrition during pregnancy. Three distinct dietary patterns were identified. Factors associated with these major dietary patterns included place of residence, socio-economic status, educational level, dietary knowledge, food aversion, number of pregnancies, and maternal decision-making autonomy. Under nutrition among pregnant women was found to be high and associated with the consumption of 'Nutrient-Dense' and 'Leafy local' foods. Therefore, concerned health authorities should strengthen dietary counseling during pregnancy, provide family planning services, and promote women's education.

Efektivitas Teknik Rebozo Shake the Apple (RSTA) Terhadap Intensitas Nyeri Dan Lama Kala 1 Fase Aktif Pada Persalinan Ibu Multigravida

Introduction: Pain during labor if not resolved will result in prolonged labor which is the cause of maternal death by 4,3%. Various efforts have been made to reduce the rate of prolonged labor, one of which is the rebozo shake the apple tree technique. Based on the results of a survey conducted at the Manis Jaya Health Center in April 2022, out of 33 mothers giving birth, 11 mothers experienced prolonged labor. Methods: This study was a quasi-experimental design with a pre-post test control group design. The research sample for multigravida mothers was 30 respondents using a purposive sampling technique. Data were analyzed using the dependent t-test and independent t-test. Results: The results of the univariate analysis revealed that the average pain intensity of the intervention group before was 6,27 after 1,67 and the control group before was 5,93 after 3,33. The average duration of the first active phase of the intervention group was 152,67 minutes and the control group was 215,13 minutes. The results of bivariate analysis of the intensity of labor pain with a value of p = 0,001 <0,005 and the duration of the first stage of the active phase with a value of p = 0,000 <0,005. Discussion: There is the effectiveness of the Rebozo Shake the Apple Tree (RSTA) technique on the intensity of labor pain and the length of the first active phase. It is hoped that health workers can provide the Rebozo Shake the Apple Tree (RSTA) technique to reduce labor pain and speed up the delivery process.

A CASE SERIES ON VARIED CLINICAL PRESENTATION IN LEIGHS SYNDROME IN A TERTIARY CARE HOSPITAL

Background:Leigh syndrome (LS) is a hereditary neurometabolic disease, also known as subacute necrotizing encephalomyelopathy, and was described by the British neuropathologist and psychiatrist Denis Leigh in 1951. It is a neurodegenerative disease with variable symptoms that occurs due to a mitochondrial dysfunction caused by a hereditary genetic defect, associated with bilateral central nervous system lesions. Although it is a rare disease, with an approximate incidence of 1: 40,000 live births, it is the most frequent mitochondrial disease in the first year of life. Clinical Scenario: Case 1 Baby Nikshitha, a 6-and-a-half-month old female child born to a multigravida mother in a non-consanguineous marriage with previous 2 abortions and 1 intrauterine death. The baby was born through LSCS (oligohydramnios) and cried immediately at birth with a weight of 2.5kgs with uneventful antenatal periods.Excessive Vomiting x 1 month, increased over 5 days, Inability to gain weight over the past 3 months, Abnormal Posturing - 2 days prior to admission Mri Brain: Symmetric areas of altered intensity in bilateral caudate nucleus relatively sparing Globus pallidi showing diffusion restriction. Clinical Scenario: Case 2 Baby of suhasini, a 3 months old female child born to a primi mother in a non-consanguineous marriage with previous 1 sibling death. The baby was born through NVD and cried immediately at birth with a weight of 2.5kgs with uneventful antenatal periods.Child presented to the hospital at 3months of life with the chief complaints of - FEVER x 4 days, Noisy breathing since 4 days, Abnormal Posturing – since yesterday nightInitial Septic workup to rule out meningitis – NORMAL. ABG done in view of failure to thrive with recurrent vomiting – Metabolic Acidosis.Mri Brain: Symmetric areas of altered intensity in bilateral caudate nucleus relatively sparing Globus pallidi showing diffusion restriction. No blooming to suggest haemorrhage or calcification. Myelination is consistent with age Clinical Scenario: Case 3 Shobhakumari, 2Y old female child born to a multigravida mother in a non-consanguineous marriage with h/o sibling death at 5 years of age (leighs disease). The baby was born through NVD and cried immediately at birth with a weight of 2.5kgs with uneventful antenatal periods.Child presented to the hospital at 2 years with the chief complaints of - Excessive Vomiting since 6daysInability to gain weight over the past 3 months MRI brain :T2/Flair hyperintense signal with restricted diffusion in deep grey matter of b/l cerebellar hemisphere and periaqueductal grey matter of midbrain caudate nucleus and putamen Clinical Scenario: Case 4 B/o Afreen 4 year male born to a primi mother through normal vaginal delivery in a non-consanguineousmarriage with birth weight of 2.7 kg . Child presented to a hospital with History of regression of milestones and rhythmic repetitive movement of upper limb since 15 months of age. Serum lactate was high and MRI brain showed symmetrical B/l T2/FLAIR caudate and putamen nucleus hyperintensity with restriction on DW1 images Discussion:Several studies showed significant heterogeneity in the clinical findings of Leigh syndrome. Sofou K et al., revealed in a study that 69% of the cases presented before 2 years of age, while three patients presented with ataxia or seizures at 8,10 and 21 years of age. Conclusion:The diagnosis of Leighs disease should be considered in appropriate clinical and laboratory settings whenever symmetrical hypo densities are encountered in the putamen and midbrain on.

Relationship of Parity, Maternal Age and Birth Weight with the Duration of the Second Stage of Labor

Background: second stage of labor begins when the cervix is fully dilated and ends with the birth of a baby. The duration of second stage of labor commonly lasts 2 hours for primigravida mothers and one hour for multigravida mothers. Prolonged labor is one of complications experienced by mothers in second stage of labor. Prolonged labor can cause several complications for both mothers and infants. Prolonged labor can harm both the mother and the infant. The harmful effects of complications during second stage of labor for mothers include the incidence of uterine atony, laceration, bleeding, infection, fatigue and shock and improving the birth rate with the C-section incision. Whereas the harmful effects of complications during second stage of labor for infants include asphyxiated, cerebral trauma caused by pressure on the head of the fetus, the injury due to action, and premature rupture of membranes. The severity of the injury increases continuously along with the longer of the duration of the labor process, and the risk of which rises quickly after 24 hours. The longer the labor, the higher the morbidity as well as the mortality. The stage of labor affected by all such factors mentioned is called the second stage of laborObjective: to find out the relationship of parity, maternal age, and birth weight with the duration of the second stage of labor.Methods: this study applied a quantitative research design using an analytical survey method through a cross sectional approach. The sample in this study was chosen using total sampling method with the purposive sampling technique, namely, that the sample was all maternity mothers who were coincidentally present at the time of the study at UPTD Karya Mukti Public Health Center in August 2021. Then, Chi-square statistical test was used to determine the relationship between independent variables and dependent variable.Results: of the 30 respondents, 20 respondents whose parity was not at risk (95.2%) experienced normal duration of second stage of labor, while 5 respondents (55.6%) whose parity was at risk experienced normal duration of second stage of labor. 21 respondents whose maternal age was not at risk (95.5%) experienced normal duration of second stage of labor, while 4 respondents whose maternal age was at risk (50%) experienced normal duration second stage of labor. 23 respondents (92%) with normal birth weight babies experienced normal duration of second stage of labor, while 2 respondents (40%)with large birth weight babies experienced normal duration of second stage of labor. The results of the Chi-square statistical test showed that there was a significant relationship between parity and the duration of the second stage of labor with the p-value of 0.019 £ 0.05 and the OR value of 9.157. There was a significant relationship between maternal age and the duration of the second stage of labor with the p-value of 0.011 £ 0.05 and the OR value of 5.387, and there was a significant relationship between birth weight and the duration of the second stage of labor with the p-value of 0.022 £ 0.05 and OR value of 3.405.Conclusions: there was a relationship between parity and the duration of second stage of labor. There was a relationship between maternal age and the duration of second stage of labor, and there was a relationship between birth weight and the duration of second stage of labor. Suggestions: It is hoped that health workers will further improve IEC (Information, Education, and Communication) regarding safe gestational age, safe parity and balanced nutrition as a form of antenatal care for pregnant women which is very influential, especially during the second stage of labor. In addition, for pregnant women, it is better to perform quality ANC to predict whether mothers will be likely to experience prolonged labor or not and also to prevent prolonged labor and other complications of pregnancy and labor. Then, based on the results of ANC tests, the mothers immediately referred to a more adequate hospitals/maternity hospitals to monitor the condition of their pregnancy so as to prevent the risk that will be faced by the mothers and fetus during labor. Keywords: Parity, Maternal Age, Birth Weight, Duration of Second Stage Labor

ANXIETY AND READINESS DIFFERENCES BETWEEN PRIMIGRAVIDA AND MULTIGRAVIDA MOTHERS TOWARDS CHILDBIRTH IN THE COVID-19 PANDEMIC

Background and Purpose : Corona Virus Disease 2019 (COVID-19) has now become a global pandemic, even in Indonesia. Pregnant women feel more and more anxious during the current COVID-19 pandemic, especially for 3rd trimester pregnant women who will give birth soon. Parity is one of the factors that can affect the level of anxiety of pregnant women in addition to the factors of the epidemic situation that can increase maternal anxiety. Childbirth readiness is one of the benchmarks for the success of the delivery process and this can indirectly contribute to the increase in MMR in Indonesia. Objective: Analyzing the differences in the level of anxiety and readiness towards childbirth in the COVID-19 pandemic between primigravida and multigravida mothers in their third trimester of pregnancy at the Duren Sawit District Health Center. Methods : This type of research is an observational study with a cross sectional design. Sampling was done by proportional random sampling method. The research instrument is a questionnaire. The method used in data analysis is the Mann-Whitney U test with the help of SPSS. Result : The sample of this study was 99 pregnant women in their third trimester of pregnancy. The level of anxiety in primigravida mothers is Severe level of anxiety (80.9%). Meanwhile, multigravida mothers have a Moderate level of anxiety (56.1%). The level of readiness of primigravida mothers is in the Inadequate category (57.1%). Meanwhile, multigravida mothers have a Good level of readiness (63.3%). The results of the Mann Whitney test showed that there was a significant difference between primigravida and multigravida mothers on the level of anxiety and readiness towards childbirth in the COVID-19 pandemic with a p value (0.000). Conclusion : There is a significant difference in the level of anxiety and readiness towards childbirth in the COVID-19 pandemic between primigravida and multigravida mothers in their third trimester of pregnancy at the Duren Sawit District Health Center.

Level of Knowledge, Attitude, and Practice of Pregnant Women on Antenatal Care in Amatere Health Center, Massawa, Eritrea: A Cross-Sectional Study, 2019.

Proper antenatal care is one of great means of reducing maternal and child morbidity and mortality. However, determining level of knowledge and practice is vital, and the objective of this study was to evaluate this gap among pregnant women in Amatere Health Center, Massawa city, Eritrea, 2019. A cross-sectional study with systematic sampling was conducted. All pregnant mothers who were resident of Massawa city and visiting Amatere Health Center for their current pregnancy were included in the study. An interviewer-administered structured questionnaire was used as data collection tool. Results were presented using descriptive statistics, percent, and frequencies. A total of 289 pregnant mothers were enrolled in the study with a mean age of 27.7 years. Most mothers reported that high blood pressure (92.4%), maternal smoking (97.6%), alcohol consumption (97.2%), infection (92.7%), and medicines (98.3%) had affected fetal growth during pregnancy. Practically, two-thirds (59.4%) of the mothers were visiting the health facility during the first three months of their pregnancy. Majority of mothers had good knowledge (84.1%) and attitude (99%), but they had low level of practice (45%). Marital status, occupation, gravidity, and parity had showed statistically significant association to their comprehensive knowledge (p < 0.001). And their gravidity (p < 0.003) and parity (p < 0.001) had also showed statistically significant association to their level of practice. Even though majority of the pregnant mothers had high level of knowledge and attitude, their practice towards ANC was relatively low. Age, marital status, and occupation showed statistically significant association to their comprehensive knowledge. Moreover, multiparous and multigravida mothers were having higher level of knowledge and practice on antenatal care. Enhancing community awareness on early starting of antenatal care and improving their practice through proper counseling are highly recommended.

Effect of Posterior Tibial Nerve Stimulation on Overactive Bladder among Multigravida Mothers

Background and objective:To evaluate the efficiency of posterior tibial nerve stimulation on multigravida mother’s overactive bladder.Urine urgency, excessive urination, and urinary urgency in nightsare the hallmarks of overactive bladder syndrome (OAB), a urological condition that may or may not be followed by urinary incontinence (UI).This is a chronic disease that affects millions of women worldwide, with the risk of death increasing as they become older.Despite the fact that there is no immediate danger to life, it significantly impacts the health. In multigravida mothers, the lower urinary system, which includes the bladder and urethra, functions as a single functional unit.A technique for symptom evaluation called theoveractive bladder symptom scoreOABSS aims to sum up all OAB symptoms into a single score.Method:Thispilot study was conducted at Saveetha medical college and hospital. Using inclusion and exclusion criteria samples wereselected for the period of 4 weeks. Before and after the conclusion of treatment, the patients' OABSSwere evaluated.Then thepatients weretreated with transcutaneous electric nerve stimulation for 4 weeks.Results:Comparingpre-test and post-test values in the experiment group revealed a statistically significant difference, according to statistical analysis of quantitative data, (P&lt;0.0001) inOAB symptom score wasrecorded in multigravida women.Conclusion:Thisstudy concludes that posterior tibial nerve stimulation is effective in overactive bladder among multigravida mothers measured using OAB symptom score.

Neonatal Sotos Syndrome: A Novel Frameshift Mutation of the NSD1 Gene Associated with Neonatal Encephalopathy Presenting without Overgrowth

AbstractSotos syndrome type I is one of the more common genetic overgrowth disorders. It presents classically with macrocephaly, distinctive facial gestalt, and acromegalic features, along with neonatal complications including hypotonia, feeding difficulties, and hypoglycemia with other minor feature inconstancies. The phenotypical overlap of features of this syndrome, more so in neonatal age, thwarts an easy diagnosis. In this case report, a neonate of a nonconsanguineous marriage to a multigravida mother with insignificant obstetric history, presented primarily with respiratory difficulty, central hypotonia, and hypoglycemia. Sparse hair, tall forehead, pointed chin, and lax skin were accompanied by persistent encephalopathy and refractory myoclonic jerks. However, the quintessential features of pre- and postnatal overgrowth were lacking, making the line of diagnosis difficult. On neuroimaging, atypical diffuse pachygyria was found. Clinical exome sequencing revealed heterozygous single base pair deletion in exon 21 of the NSD1 gene on chromosome 5q35, resulting in an unreported frameshift and premature truncation of the protein 19 amino acids downstream to codon 2065, confirming the genetic diagnosis of autosomal dominant Sotos syndrome 1. The neonate later succumbed to death after withdrawal of ventilatory support.

Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial.

BackgroundThe exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions.ObjectiveThis study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state.MethodsThis study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention.ResultsThe response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47).ConclusionsFace-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes.Trial RegistrationThaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004

EFEKTIFITAS PEMERIKSAAN KADAR GULA DARAH RUTIN TERHADAP PENCEGAHAN DIABETES MELLITUS TYPE II PADA IBU-IBU MULTIGRAVIDA

Diabetes Mellitus (DM) is a disorder of carbohydrate, protein and fat metabolism characterized by hyperglycemia or an increase in blood glucose levels that occurs due to insulin secretion abnormalities or decreased insulin action (American Diabetes Association, 2012). The results of statistical analysis using t-test showed that the p-value was 0.323, meaning that there was no difference between the prevention of type II diabetes mellitus in the control group before and before treatment in multigravida mothers. While the intervention group before treatment was mostly ineffective, namely as many as 34 respondents (85%) after showing a very large change, most of them were classified as effective, namely as many as 32 respondents (80%), The results of the analysis using the t-test showed that the p-value the intervention group was 0.000, meaning that there was a difference between the prevention of type II diabetes mellitus in the intervention group before and before treatment in multigravida mothers.

A Case Report On Prune Belly Syndrome

Eagle-Barrett syndrome’ is the other name for prune belly syndrome. The classical triad of urinary tract anomalies,deficient abdominal musculature, and bilateral cryptorchidism. It is a congenital anomaly of unknown aetiology, most commonlyseen in males. It is seen in one and 30,000 live births.96% of them are males. In this case report, we present a boy child born toA 38-year-old multigravida mother with a previous history of three vaginal deliveries. On examination of the baby, the followingfeatures are to be found-hypotonia, deficiency of abdominal muscle, undescended testis, a palpable bladder and kidney. Radiologicalimaging showed gross hydronephrosis on both sides and big ureter. The baby was diagnosed with Prune Belly syndrome.Ultrasound investigations done during the antenatal period, helps in directing anomalies of the kidney which is to be followed inthe postnatal period. The aim of the writing this case report is to establish the importance of antenatal diagnosis of congenitalmalformations including Eagle-Barrett Syndrome among many others. Prenatal diagnosis of PBS should be considered wheneverthe following ultra- sound anomalies are clearly identified: oligohydramnios, urinary abnormalities (dilatation of the urinary tract,megacystis, bilateral hydroureteronephrosis), and the absence of abdominal musculature. Routine screening during the antenatalperiod with ultrasound helps in detecting anomalies of the kidney at an earlier stage . This help in initiating optimal treatment toavoid the fatal cause of Prune Belly Syndrome

Novel Genetic Diagnoses in Septo-Optic Dysplasia.

Septo-optic dysplasia (SOD) is a developmental phenotype characterized by midline neuroradiological anomalies, optic nerve hypoplasia, and pituitary anomalies, with a high degree of variability and additional systemic anomalies present in some cases. While disruption of several transcription factors has been identified in SOD cohorts, most cases lack a genetic diagnosis, with multifactorial risk factors being thought to play a role. Exome sequencing in a cohort of families with a clinical diagnosis of SOD identified a genetic diagnosis in 3/6 families, de novo variants in SOX2, SHH, and ARID1A, and explored variants of uncertain significance in the remaining three. The outcome of this study suggests that investigation for a genetic etiology is warranted in individuals with SOD, particularly in the presence of additional syndromic anomalies and when born to older, multigravida mothers. The identification of causative variants in SHH and ARID1A further expands the phenotypic spectra associated with these genes and reveals novel pathways to explore in septo-optic dysplasia.

Antenatal Anxiety towards Gender Preference and Social Acceptance among Primi and Multi Gravida Antenatal Mother attending Sadar Hospital, Sasaram

Antenatal Anxiety towards Gender Preference and Social Acceptance among Primi and Multi Gravida Antenatal Mother attending Sadar Hospital, Sasaram

Awareness of the mothers about Expanded Programme on Immunization and relation of immunization coverage with maternal education and Covid-19 Pandemic Lockdown

Background: Expanded Programme on Immunization (EPI) prevents childhood fatal illnesses, and better coverage will raise herd immunity. Objective: To assess the knowledge of the mothers about Expanded Programme on Immunization of childhood vaccinations and relationship of the immunization coverage with mother's education and Covid-19 pandemic lock-down. Methodology: It was a cross-sectional study, conducted by using a pretested questionnaire. Settings: Paediatric outpatient department and EPI centre, Sadiq Abbasi Hospital Bahawalpur from 1st September to 15th November 2021. A total of 200 multigravida mothers having children &lt;5 years, were included by convenient sampling technique. Data were collected through a proforma, containing information about demographic characteristics, EPI coverage of the child, and mothers' knowledge and attitude towards the EPI program. Data were analyzed with the help of SPSS version 21. Results: Among the total of 200 mothers, more than 90% were housewives and only 20% with more than 12 years of formal education. Only 3% of mothers answered correctly about the exact number of EPI vaccines. The awareness about the individual vaccine was 28% to 33%, except in the polio vaccine it was 70%, and in measles, it was 95%. Half of the mothers answered that EPI vaccines are safe, and half believe that they are effective as well. Working women and mothers with higher education status vaccinated themselves against covid-19 and also vaccinated their children according to the EPI schedule. Conclusion: Awareness regarding EPI is poor and maternal education status significantly affects EPI knowledge and practices, additionally covid-19 pandemic also affected the EPI practices.