Obstetric Risk Factors Research Articles

Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors

The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR=1.72; 95% CI, 1.14-2.41; P=0.007), high birth weight (OR=4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR=1.36; 95% CI, 1.01-1.85; P=0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR=0.68; 95% CI, 0.51-0.94; P=0.02 and OR=0.51; 95% CI, 0.33-0.79; P=0.007). In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.

Prevalence of Antenatal Depression in a Teaching Hospital South/South Nigeria.

Background: Over 30 million people living in Africa suffer from depression which also contributes to global burden of diseases with a steady rise in prevalence, affecting all groups, including pregnant women. Factors which account for the psychological effects of pregnancy on mothers include; maternal age, planned pregnancy, previous experiences, spouse support, and partner violence. These risk factors may lead to antenatal depression which endangers the mother and the pregnancy. To safeguard mothers from depression during pregnancy, these factors need to be determined.&#x0D; Objective: To determine the prevalence, risk factors and predictors of antenatal depression.&#x0D; Methods: Pregnant women attending antenatal care, who met the study inclusion criteria were interviewed and screened for depression using the risk factor and socio-demographic questionnaire and Edinburgh Postnatal Depression Scale (EPDS). Data obtained was fed into the statistical package for social sciences (SPSS) version 23.0 and cross-tabulation of the relevant variables obtained using chi-squared and t-test. P values &lt;0.05 were statistically significant.&#x0D; Results: Of 500 respondents, 158 (31.6%) had depression. Risk factors of cohabiting with spouse, lack of financial support from spouse, fight with spouse, threat to life, history of still birth and child health challenges were determined, four of which turned out to be predictors of antenatal depression (AD).&#x0D; Conclusion: The high prevalence of 31.6% of antenatal depression calls for a review of obstetrics practice to include screening and diagnosis for antenatal depression.&#x0D; Keywords: Antenatal depression, socio-demographic factors, EPDS, Obstetrics risk factors, social support, predictors.

Changing Perspectives of Electronic Fetal Monitoring.

The delivery of healthy babies is the primary goal of obstetric care. Many technologies have been developed to reduce both maternal and fetal risks for poor outcomes. For 50 years, electronic fetal monitoring (EFM) has been used extensively in labor attempting to prevent a large proportion of neonatal encephalopathy and cerebral palsy. However, even key opinion leaders admit that EFM has mostly failed to achieve this goal. We believe this situation emanates from a fundamental misunderstanding of differences between screening and diagnostic tests, considerable subjectivity and inter-observer variability in EFM interpretation, failure to address the pathophysiology of fetal compromise, and a tunnel vision focus. To address these suboptimal results, several iterations of increasingly sophisticated analyses have intended to improve the situation. We believe that part of the continuing problem is that the focus of EFM has been too narrow ignoring important contextual issues such as maternal, fetal, and obstetrical risk factors, and increased uterine contraction frequency. All of these can significantly impact the application of EFM to intrapartum care. We have recently developed a new clinical approach, the Fetal Reserve Index (FRI), contextualizing EFM interpretation. Our data suggest the FRI is capable of providing higher accuracy and earlier detection of emerging fetal compromise. Over time, artificial intelligence/machine learning approaches will likely improve measurements and interpretation of FHR characteristics and other relevant variables. Such future developments will allow us to develop more comprehensive models that increase the interpretability and utility of interfaces for clinical decision making during the intrapartum period.

A STUDY OF DEMOGRAPHIC AND RISK FACTORS OF CHILDREN WITH AUTISM SPECTRUM DISORDER

Background of the study: Various risk factors have been reported in the development of Autism spectrum Disorder. The aim of our study is to explore the demographic and perinatal risk factors implicated in the development of ASD. A retrospective study was conducted with data of 49 children with ASD and found that total 71.3% of children were male 73.5% were in rst birth order. Out of 49 children 53.1% had history of Lower Segment Caesarean Section (LSCS). Indication of LSCS due to various obstetric or perinatal risk factors were reported in 17 cases. Three children had history of low birth weight with history of admission into Neonatal ICU. The study also explore the various co morbidity and found that ADHD (20.4%) was most common comorbidity followed by Mental retardation(18.4%), ADHD and MR(12.2%), seizure disorder and MR (8.2 %). This study found that male gender, rst birth order and perinatal risk factors are implicated in the development of Autism spectrum Disorder and majority of them have one or more another neuro developmental disorder as a comorbidity.

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

Background: Cesarean section delivery causes major risk factors in terms of intraoperative performance and blood loss while blood transfusion is a promising factor in emergency care in case of blood unavailability. Women undergoing cesarean section routinely require blood cross-matching. Aim: The present study aimed to evaluate the pattern of blood transfusion among women who underwent c/section at the tertiary care center. Materials and Methods: This cross-sectional study was conducted on 745 pregnant women who underwent cesarean section at Obstetrics &amp; Gynaecology department of Quaid-e-Azam International Hospital Islamabad and PAF hospital Masroor, Karachi for duration of six months from January 2021 to June 2021. The demographic details, incidence of cesarean section, blood transfusion indications and types were recorded. Antenatal intraoperative and pre-operative details were also noted. Complications regarding blood transfusion were analyzed using multivariable analysis and EPI-statistical software v 3.5.3. Results: Of the total 745 cesarean sections, the prevalence of blood transfusion was 10.1%. About 75 women transfused 216 units of blood with packed cells tailed by Fresh Frozen Plasma (FFP). The prevalence of emergency cesarean section was 61 (81.3%) while general anesthesia was utilized in 27 (44.3%) cases. Fetal distress and placenta praevia were the common indications of cesarean section. Placenta praevia Respiratory rate (RR) was 5.01 (p&lt;0.001). Other obstetric complications and risk factors were anemia, antepartum hemorrhage, hypertension, and previous cesarean section. The cross-matched transfusion ratio was 9.93 while the transfusion index and probabilities were 0.078 and 10.1 respectively. Conclusion: Our study found a higher prevalence of blood transfusion risks among pregnant women who underwent cesarean section. It has been observed that the risk of blood transfusion increased with placenta previa, preoperative maternal anemia, placenta abruption, and second stage cesarean section. During the antenatal period, the need for blood transfusion might be reduced with an increased concentration of maternal hemoglobin. Keywords: Blood transfusion, Complications, Caesarean delivery, Transfusion index

Recurrent preterm birth risk assessment for two delivery subtypes: A multivariable analysis.

The study sought to develop and apply a framework that uses a clinical phenotyping tool to assess risk for recurrent preterm birth. We extended an existing clinical phenotyping tool and applied a 4-step framework for our retrospective cohort study. The study was based on data collected in the Genomic and Proteomic Network for Preterm Birth Research Longitudinal Cohort Study (GPN-PBR LS). A total of 52 sociodemographic, clinical and obstetric history-related risk factors were selected for the analysis. Spontaneous and indicated delivery subtypes were analyzed both individually and in combination. Chi-square analysis and Kaplan-Meier estimate were used for univariate analysis. A Cox proportional hazards model was used for multivariable analysis. : A total of 428 women with a history of spontaneous preterm birth qualified for our analysis. The predictors of preterm delivery used in multivariable model were maternal age, maternal race, household income, marital status, previous caesarean section, number of previous deliveries, number of previous abortions, previous birth weight, cervical insufficiency, decidual hemorrhage, and placental dysfunction. The models stratified by delivery subtype performed better than the naïve model (concordance 0.76 for the spontaneous model, 0.87 for the indicated model, and 0.72 for the naïve model). The proposed 4-step framework is effective to analyze risk factors for recurrent preterm birth in a retrospective cohort and possesses practical features for future analyses with other data sources (eg, electronic health record data). We developed an analytical framework that utilizes a clinical phenotyping tool and performed a survival analysis to analyze risk for recurrent preterm birth.

A multicenter study of incidence, risk factors and outcomes of babies with birth asphyxia in Nepal

BackgroundPerinatal events which result in compromised oxygen delivery to the fetus can lead to Birth Asphyxia (BA). While the incidence, risk factors and outcomes of BA have been characterized, less is known in low resource settings.AimTo determine the incidence of Birth Asphyxia (BA) in Nepal and to evaluate associated risk factors and outcomes of this condition.MethodsA nested observational study was conducted in 12 hospitals of Nepal for a period of 14 months. Babies diagnosed as BA at ≥37 weeks of gestation were identified and demographics were reviewed. Data were analyzed using binary logistic regression followed by multiple logistic regression analysis.ResultsThe incidence of BA in this study was 6 per 1000 term livebirths and was higher among women 35 years and above. Predictors for BA were instrumented vaginal delivery (aOR:4.4, 95% CI, 3.1–6.1), fetal distress in labour (aOR:1.9, 95% CI, 1.0–3.6), malposition (aOR:1.8, 95% CI, 1.0–3.0), birth weight less than 2500 g (aOR:2.0, 95% CI, 1.3–2.9), gestational age ≥ 42 weeks (aOR:2.0, 95% CI, 1.3–3.3) and male gender (aOR:1.6, 95% CI, 1.2–2.0). The risk of pre-discharge mortality was 43 times higher in babies with BA (aOR:42.6, 95% CI, 32.2–56.3).ConclusionThe incidence of Birth asphyxia in Nepal higher than in more resourced setting. A range of obstetric and neonatal risk factors are associated with BA with an associated high risk of pre-discharge mortality. Interventions to improve management and decrease rates of BA could have marked impact on outcomes in low resource settings.

856A gestational age specific prognostic model for adverse perinatal events in obese women

Abstract Background Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors. Methods All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity. Results Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI. Conclusions Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes. Key messages Obese women require specific guidelines for timing of optimal delivery.

Towards stronger antenatal care: Understanding predictors of late presentation to antenatal services and implications for obstetric risk management in Rwanda.

Early antenatal care (ANC) reduces maternal and neonatal morbidity and mortality through identification of pregnancy-related complications, yet 44% of Rwandan women present to ANC after 16 weeks gestational age (GA). The objective of this study was to identify factors associated with delayed initiation of ANC and describe differences in the obstetric risks identified at the first ANC visit (ANC-1) between women presenting early and late to care. This secondary data analysis included 10,231 women presenting for ANC-1 across 18 health centers in Rwanda (May 2017-December 2018). Multivariable logistic regression models were constructed using backwards elimination to identify predictors of presentation to ANC at ≥16 and ≥24 weeks GA. Logistic regression was used to examine differences in obstetric risk factors identified at ANC-1 between women presenting before and after 16- and 24-weeks GA. Sixty-one percent of women presented to ANC at ≥16 weeks and 24.7% at ≥24 weeks GA, with a mean (SD) GA at presentation of 18.9 (6.9) weeks. Younger age (16 weeks: OR = 1.36, 95% CI: 1.06, 1.75; 24 weeks: OR = 1.33, 95% CI: 0.95, 1.85), higher parity (16 weeks: 1-4 births, OR = 1.55, 95% CI: 1.39, 1.72; five or more births, OR = 2.57, 95% CI: 2.17, 3.04; 24 weeks: 1-4 births, OR = 1.93, 95% CI: 1.78, 2.09; five or more births, OR = 3.20, 95% CI: 2.66, 3.85), lower educational attainment (16 weeks: primary, OR = 0.75, 95% CI: 0.65, 0.86; secondary, OR = 0.60, 95% CI: 0.47,0.76; university, OR = 0.48, 95% CI: 0.33, 0.70; 24 weeks: primary, OR = 0.64, 95% CI: 0.53, 0.77; secondary, OR = 0.43, 95% CI: 0.29, 0.63; university, OR = 0.12, 95% CI: 0.04, 0.32) and contributing to household income (16 weeks: OR = 1.78, 95% CI: 1.40, 2.25; 24 weeks: OR = 1.91, 95% CI: 1.42, 2.55) were associated with delayed ANC-1 (≥16 and ≥24 weeks GA). History of a spontaneous abortion (16 weeks: OR = 0.74, 95% CI: 0.66, 0.84; 24 weeks: OR = 0.70, 95% CI: 0.58, 0.84), pregnancy testing (16 weeks: OR = 0.48, 95% CI: 0.33, 0.71; 24 weeks: OR = 0.41, 95% CI: 0.27, 0.61; 24 weeks) and residing in the same district (16 weeks: OR = 1.55, 95% CI: 1.08, 2.22; 24 weeks: OR = 1.73, 95% CI: 1.04, 2.87) or catchment area (16 weeks: OR = 1.53, 95% CI: 1.05, 2.23; 24 weeks: OR = 1.84, 95% CI: 1.28, 2.66; 24 weeks) as the health facility were protective against delayed ANC-1. Women with a prior preterm (OR, 0.71, 95% CI, 0.53, 0.95) or low birthweight delivery (OR, 0.72, 95% CI, 0.55, 0.95) were less likely to initiate ANC after 16 weeks. Women with no obstetric history were more likely to present after 16 weeks GA (OR, 1.18, 95% CI, 1.06, 1.32). This study identified multiple predictors of delayed ANC-1. Focusing existing Community Health Worker outreach efforts on the populations at greatest risk of delaying care and expanding access to home pregnancy testing may improve early care attendance. While women presenting late to care were less likely to present without an identified obstetric risk factor, lower than expected rates were identified in the study population overall. Health centers may benefit from provider training and standardized screening protocols to improve identification of obstetric risk factors at ANC-1.

Oxidative stress and inflammation on neonatal outcomes. The role of smoke, traffic exposure and BMI

BACKGROUND AND AIM: Oxidative stress (OS) is known to play a role in pregnancy and neonatal outcomes, but the pathophysiology underlying such relationship is mostly unknown. Studies have confirmed this significant impact on pregnancy and neonatal life and the consequently adverse outcomes. The aim of this study is to evaluate how the living environment and some important maternal and obstetric risk factors (smoke, overweight, type of delivery) influence Oxidative Stress (OS) and inflammation in pregnancy and newborns. METHODS: Mothers and newborns were recruited at the Sant’Anna Hospital (Turin, Italy), strictly following these inclusion criteria: (1) full-term pregnancy; (2) uncomplicated pregnancy; (3) no pharmacological treatment during pregnancy; (4) no twin delivery; (5) healthy babies (APGAR score 1’/5’). Environmental and lifestyle information was obtained through a standardized questionnaire (PRAMS). OS and inflammation markers (Isoprostane, IL-1 and IL-6) were analysed in urine samples. RESULTS:Overall, 134 were recruited. Mothers and newborns OS and inflammation levels resulted to positively correlate (Spearman p0.01). Active and passive tobacco smoke during pregnancy (Spearman p0.01 and 0.02, respectively), traffic exposure (Spearman p: 0.02), and higher BMI (Spearman p: 0.05) resulted to significantly shape this relationship. Currently, we are calculating greenness and urbanization to analyse their association with OS and inflammation status. CONCLUSIONS:Our preliminary findings suggest that neonatal OS and inflammation are strongly influenced by 3 major risk factors: tobacco smoke exposure, high urbanization levels, and high BMI. Further analysis of each of those factors role is mandatory in order to understand the mechanisms underlying OS and neonatal outcomes relationship. Nevertheless, correct management and monitoring of these factors must be considered by preventive Public Health strategies, in order to improve neonatal health and outcomes. KEYWORDS: birth outcomes, oxidative stress imbalance, neonatal risk factors

Maternal Prenatal Anxiety and the Fetal Origins of Epigenetic Aging

BackgroundThe fetal origins of mental health is a well-established framework that currently lacks a robust index of the biological embedding of prenatal adversity. The Pediatric-Buccal-Epigenetic (PedBE) clock is a novel epigenetic tool that associates with aspects of the prenatal environment, but additional validation in longitudinal datasets is required. Likewise, the relationship between prenatal maternal mental health and the PedBE clock has not been described. MethodsLongitudinal cohorts from the Netherlands (Basal Influences on Baby Development [BIBO] n = 165) and Singapore (Growing Up in Singapore Towards Healthy Outcomes [GUSTO] n = 340) provided data on prenatal maternal anxiety and longitudinal assessments of buccal cell–derived genome-wide DNA methylation assessed at 6 and 10 years of age in BIBO, and at 3, 9, and 48 months of age in GUSTO. Measures of epigenetic age acceleration were calculated using the PedBE clock and benchmarked against an established multi-tissue epigenetic predictor. ResultsPrenatal maternal anxiety predicted child PedBE epigenetic age acceleration in both cohorts, with effects largely restricted to males and not females. These results were independent of obstetric, socioeconomic, and genetic risk factors, with a larger effect size for prenatal anxiety than depression. PedBE age acceleration predicted increased externalizing symptoms in males from mid- to late childhood in the BIBO cohort only. ConclusionsThese findings point to the fetal origins of epigenetic age acceleration and reveal an increased sensitivity in males. Convergent evidence underscores the societal importance of providing timely and effective mental health support to pregnant individuals, which may have lasting consequences for both mother and child.

Obstetric venous thromboembolism prophylaxis, risk factors and outcomes.

Risk factors for obstetric venous thromboembolism (VTE), a leading cause of maternal mortality in the United States, are increasing on a population basis. This review provides the obstetrician with an update of current issues related to obstetric VTE risk, prophylaxis, outcomes, anaesthesia considerations and future research opportunities. Obstetric VTE affects approximately 1 per 1000 pregnancies and accounts consistently for 9-10% of maternal deaths in the United States. In industrialized countries, risk factors for VTE, including overweight/obesity, caesarean delivery and obstetrical complications such postpartum haemorrhage and infection continue to increase. VTE prophylaxis is central to reducing maternal mortality. However, recommendations for prophylaxis from leadership societies vary widely. In the UK, maternal mortality risk from VTE has decreased significantly in the setting of broader heparin prophylaxis. In the United States where mechanical VTE prophylaxis is used more commonly, mortality risk has remained constant. Obstetric VTE is a leading cause of maternal mortality in the United States. The incidence of risk factors for obstetric VTE continues to increase. Currently, recommendations for obstetric VTE prophylaxis vary substantially. Opportunities for research in this area exist to optimize prophylaxis and improve maternal outcomes.

Gestational Age at Term and Educational Outcomes at Age Nine.

To estimate associations between gestational age (GA) and teacher-reported academic outcomes at age 9 years among children born at term (37-41 weeks). A secondary data analysis of 1405 children participating in a national US birth cohort study was conducted. At age 9 years, students were evaluated by their teachers in the areas of mathematics, science and social studies, and language and literacy. Unadjusted and adjusted logistic regression models of associations between GA and teacher-reported academic outcomes were estimated and neonatal morbidities were explored as potential pathways. A continuous measure of GA in weeks was significantly associated with above-average rankings in all areas. The associations were similar across outcomes (eg, mathematics [odds ratio (OR): 1.13; confidence interval (CI): 1.02-1.25], science and social studies [OR: 1.13; CI: 1.01-1.26], and language and literacy [OR: 1.16; CI: 1.05-1.28]) in a model that adjusted for child sex, maternal characteristics, and obstetric risk factors and delivery complications. Other specifications indicate a positive association between late term (41 weeks) and mathematics and a negative association between early term (37-38 weeks) and language and literacy, compared with term (39-40). The associations did not appear to operate through neonatal morbidity. The findings highlight the importance of GA, even at term. Whereas current guidelines suggest waiting until at least 39 weeks to deliver when possible, our findings add to a small group of studies suggesting that GA through 41 weeks is associated with improvements in some educational outcomes.

Prenatal diagnosis of congenital heart defects: echocardiography.

Congenital heart defects (CHD) are the most common congenital anomaly, and the majority can be diagnosed during prenatal life. Prenatal detection rates remain highly variable, as most CHD occur in low risk pregnancies and therefore depend on the maternal obstetric provider to recognize fetal cardiac abnormality on obstetric screening anatomic ultrasound. Fetuses with abnormal findings on obstetric screening anatomic ultrasound and/or risk factors for cardiac disease should be referred for evaluation with fetal echocardiography. Fetal echocardiography should be performed by specialized sonographers and interpreted by physicians with knowledge of evolving fetal cardiac anatomy and physiology throughout gestation. A fetal echocardiography examination, which can be done from the late first trimester onward, utilizes a standardized and systemic approach to diagnose fetuses with CHD or other forms of primary or secondary cardiac disease. The field of fetal cardiology has advanced past the accurate prenatal diagnosis of simple and complex CHD, as fetal echocardiography enables understanding of dynamic fetal cardiac physiology and consideration of potential fetal/neonatal treatment. The greatest impact of fetal echocardiography remains identification of critical CHD before birth to allow immediate cardiac management after delivery to decrease neonatal morbidity and mortality. Analyzing the severity of abnormal cardiac physiology in various forms of CHD before birth allows the fetal cardiologist to prognosticate effects on the developing fetus, predict risk of postnatal hemodynamic instability, guide delivery planning through multidisciplinary collaboration, and anticipate how the disease will impact the neonate after delivery.

Maternal Heart Failure.

Heart failure (HF) remains the most common major cardiovascular complication arising in pregnancy and the postpartum period. Mothers who develop HF have been shown to experience an increased risk of death as well as a variety of adverse cardiac and obstetric outcomes. Recent studies have demonstrated that the risk to neonates is significant, with increased risks in perinatal morbidity and mortality, low Apgar scores, and prolonged neonatal intensive care unit stays. Information on the causal factors of HF can be used to predict risk and understand timing of onset, mortality, and morbidity. A variety of modifiable, nonmodifiable, and obstetric risk factors as well as comorbidities are known to increase a patient's likelihood of developing HF, and there are additional elements that are known to portend a poorer prognosis beyond the HF diagnosis. Multidisciplinary cardio‐obstetric teams are becoming more prominent, and their existence will both benefit patients through direct care and increased awareness and educate clinicians and trainees on this patient population. Detection, access to care, insurance barriers to extended postpartum follow‐up, and timely patient counseling are all areas where care for these women can be improved. Further data on maternal and fetal outcomes are necessary, with the formation of State Maternal Perinatal Quality Collaboratives paving the way for such advances.

Estimating the Prevalence and Risk Factors of Obstetric Fistula in Ethiopia: Results from Demographic and Health Survey.

IntroductionObstetric fistula is the most common obstetric problem in low- and middle-income countries where maternal care is inaccessible. Obstetric fistula has serious social and economic consequences resulting in devastating health problems for women. There is a lack of national studies that show the burden of obstetric fistula and risk factors; as a result, this study aimed to estimate the prevalence of obstetric fistula, its symptoms, and risk factors in Ethiopia.MethodsA population-level cross-sectional study was conducted with a total of 7590 women who gave birth in the last 5 years, using data from the 2016 Ethiopian Demographic and Health Survey. Complex sample analysis and normalized weighting were used to compensate for the disproportionate sampling in the survey. A multivariable logistic regression model was fitted to find a significant association between obstetric fistula and covariates. Both odds ratios (crude and adjusted) with their corresponding 95% confidence intervals (CI) were reported.ResultsAmong the 7590 women having given birth in the last 5 years, 32 (0.42%) women with obstetric fistula were identified. Of these, 64% developed obstetric fistula after live birth and 23.1% developed obstetric fistula after stillbirth. More than 72.8% were associated with prolonged and very difficult labor. No history of contraceptive use (AOR = 3.43; 95% CI: 1.05–11.21), having a big problem of distance from the health facility (AOR = 3.7; 95% CI: 1.05–11.21), early marriage (AOR = 1.52; 95% CI: 1.12–3.5), and being a rural resident (AOR = 1.5; 95% CI:1.2–5.05) were risk factors associated with obstetric fistula.ConclusionThis study finding revealed that obstetric fistula is the most common devastating obstetric problem in Ethiopia. Early marriage, early initiation of sexual intercourse, distance from the health facility, no history of contraceptive use, and rural residence were the predisposing factors to develop an obstetric fistula. Thus, interventions should focus on creating community awareness regarding early marriage and its consequences, early seeking of health facility visiting, and avoiding unintended pregnancy to minimize the subsequent complications.

Prevalence and associated risk factors of antenatal depression among Brazilian pregnant women: A population-based study

• Antenatal depression (AD) is a common maternal mental health disorder that affects women globally and is considered a public health concern, especially in developing countries. • Overall, there is a lack of population-based studies assessing the prevalence and the relationship between sociodemographic and obstetric variables with AD. • Among 22.621 women (18–49 years old) from the Brazilian National Health Survey (PNS−2013) there was 800 pregnant women. The AD prevalence was 11.4% (95%CI: 8.5% - 14.9%). • AD was associated with lower education, a non-white skin color and living alone. • In Brazil, AD is prevalent and its associated with a vulnerable sociodemographic profile. An equitable mental health assistance for pregnant women should consider risks factors such as race, education and partner status. Antenatal depression is frequently prevalent but results may vary among studies. We aim to estimate the prevalence of antenatal depression and its associated sociodemographic and obstetric risk factors. We used data from the Brazilian National Survey (PNS 2013), a population-based study, with complex and probabilistic sampling method. Of the 22.445 women at reproductive age (18 to 49 years old) participants in the PNS 2013, there were 800 women reported being pregnant at the time of interview. All participants answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic, obstetric and clinical data. Pregnant women with a PHQ-9 score ≥ 10 were classified as “Depressed”. All variables were categorized. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for the association between explanatory variables and antenatal depression. Among 800 pregnant women, 95 (11.4%; 95%CI: 8.5%:14.9%) were classified as depressed. In the adjusted analysis, the following variables were associated with higher risk of AD: an elementary school degree (adjusted OR 5.22, 95% CI 2.10:12.9), a non-white skin color (aOR 2.67, 95% CI 1.44 - 4.94) and living alone (aOR 2.16, 95% CI 1.12:4.18). In Brazil, antenatal depression is prevalent and its associated with a vulnerable sociodemographic profile. An equitable mental health assistance for pregnant women should consider risks factors such as race, education and partner status.

Impact of Maternal Body Mass Index on Obstetric Outcomes in Women Attending Labor in Al-Basra Hospitals

Background: Maternal obesity is significant risk for both mother and fetus, it is considering an obstetrical risk factor leading to high frequency of completions during prenatal period and increases the risk of several adverse outcomes of pregnancy .therefor, there is a substantial need for the development of preventive actions .body mass index is the most commonly used method to estimate the degree of obesity. Objectives: To determine of abnormal body mass index in pregnant women are attending labor. To detect the effect of body mass index on Women’s health, Neonatal health. To find out relationship between the body mass index and Demographic variables. Reproductive variables and nutritional status. Methodology: A descriptive analytic study was conducted from 28th February to 25th May 2013 at-Basra General hospital and Basra Hospital for Maternity and Children on (400) pregnant women who attending in the labor room. These clients were in labor pain, singleton pregnancy, and all pregnant women underwent a trail of vaginal delivery. A non–probability (Purposive sample) was use to select the participants of study sample a questionnaire was used a tool to collected data content validity was determined through reviewing it by (14) experts in different fields. Descriptive and inferential statistics were used to analyze the data. Results: The result of study revealed that most of the study sample aged (21-30) years with mean age and standard division (26.39 ± 7.65). The highest percentage (40%) of study sample were overweight pregnant women group (25-29.9) body mass index, with Primary level education, housewives, and low socioeconomic status. (53.5%) of them were had (2-4) pregnancies and (42.5%) of them were delivered (2-4) deliveries. Women with high body mass index for study sample had a higher incidence of several complications during pregnancy such as anemia, hypertension, diabetic mellitus and urinary tract infection. There were many complications of pregnant women

Analysis of Risk Factors with the Degree of Pelvic Organs Prolapse at Dr. Mohammad Hoesin General Hospital Palembang

Background. Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs (consisting of the uterus, vaginal cuff, bladder, intestines, and rectum) or more are still in or out of the vagina. Risk factors that influence the incidence of POP consist of obstetric risk factors (number of parity and birth method) and non-obstetric risk factors (age, menopause, BMI, comorbid disease, and hypertension). The purpose of this study was to analyze the risk factors associated with the degree of POP.&#x0D; Methods. This study is an observational study with a cross-sectional approach to 111 patients examined at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin general hospital Palembang on January 2017 to December 2019, who was diagnosed with pelvic organ prolapse.&#x0D; Results. The results showed the effect of variables with the degree of POP using the chi-square test, consisting of parity (p=0.007), birth method (p=&lt;0.001), age (p=0.016), menopause (p=0.001), BMI (p =0.005), indicates that there is a significant effect on the degree of POP. Meanwhile, comorbid factors (p=0.481) and hypertension (p=0.415) did not show a significant relationship with the degree of POP. The results of the binary logistic regression analysis of all risk factors, the number of parity &gt;4, overweight, and age 40 years, will have a 99.85% chance of experiencing grade 3 or 4 prolapse.&#x0D; Conclusion. Age is the most dominant risk factor affecting the degree of pelvic organ prolapse, with 19 times the chance of developing POP 3 or 4 degrees.

Analysis of Risk Factors with the Degree of Pelvic Organs Prolapse at Dr. Mohammad Hoesin General Hospital Palembang

Background. Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs (consisting of the uterus, vaginal cuff, bladder, intestines, and rectum) or more are still in or out of the vagina. Risk factors that influence the incidence of POP consist of obstetric risk factors (number of parity and birth method) and non-obstetric risk factors (age, menopause, BMI, comorbid disease, and hypertension). The purpose of this study was to analyze the risk factors associated with the degree of POP.&#x0D; Methods. This study is an observational study with a cross-sectional approach to 111 patients examined at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin general hospital Palembang on January 2017 to December 2019, who was diagnosed with pelvic organ prolapse.&#x0D; Results. The results showed the effect of variables with the degree of POP using the chi-square test, consisting of parity (p=0.007), birth method (p=&lt;0.001), age (p=0.016), menopause (p=0.001), BMI (p =0.005), indicates that there is a significant effect on the degree of POP. Meanwhile, comorbid factors (p=0.481) and hypertension (p=0.415) did not show a significant relationship with the degree of POP. The results of the binary logistic regression analysis of all risk factors, the number of parity &gt;4, overweight, and age 40 years, will have a 99.85% chance of experiencing grade 3 or 4 prolapse.&#x0D; Conclusion. Age is the most dominant risk factor affecting the degree of pelvic organ prolapse, with 19 times the chance of developing POP 3 or 4 degrees.