Referral Maternity Research Articles

Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.

Estimating fetal weight in gastroschisis: A 10 year audit of outcomes at the National Maternity Hospital.

To identify whether conventional methods of estimating fetal growth (Hadlock's formula), which relies heavily on abdominal circumference measurements, are accurate in fetuses with gastroschisis. A retrospective cohort study was performed between the period January 1, 2011 and December 31, 2021 in a tertiary referral maternity hospital identifying all pregnancies with a diagnosis of gastroschisis. Projected fetal weight was obtained using the formula (EFW [Hadlock's formula] + 185 g × [X/7]) where X was the number of days to delivery. During the study period 41 cases were identified. The median maternal age was 25. The median BMI was 25 and 63% were primiparous women (n = 26). Median gestation at diagnosis was 21 weeks. Median gestation at delivery was 36 weeks. A total of 4.8% of mothers had a history of drug use (n = 2). The rate of maternal tobacco use was 21.9% (n = 9). A total of 4.8% of fetuses had additional congenital anomalies including amniotic band syndrome and myelomeningocele (n = 2). Estimated fetal weight (EFW) and birth weight data were available for 34 cases. A Wilcoxon signed-rank test showed projected EFW using Hadlock's formula did not result in a statistically significant different birth weight (Z = -1.3, P = 0.169). Median projected weight and actual birth weight were 2241.35 and 2415 g respectively. Median difference was 0.64 g (95% CI: -148 to -28.5). Our data showed accuracy using standard formulae for EFW in fetuses with gastroschisis.

Effectiveness of photobiomodulation therapy on pain intensity in postpartum women with nipple or perineal trauma: protocol for a multicentre, double-blinded, parallel-group, randomised controlled trial

IntroductionPhotobiomodulation (PBM) using low-level laser can affect tissue repair mechanisms and seems promising in reducing pain intensity. However, few studies support the effectiveness of PBM on postpartum period complications, such...

Preconception care, prenatal care, and postpartum bonding in women with substance use

BackgroundThe status of care in the preconception and pregnancy periods in women who use substances can have an impact on maternal and neonatal health. This study aimed to assess the provision of preconception care, prenatal care, and postnatal mother-to-child bonding among pregnant women who use substances. MethodsAn ambidirectional cohort study was conducted, involving 69 pregnant women who reported substance use and had it confirmed using a ten-parameter panel kit (M10T) manufactured by Hannan Teb Pars Company. These women were selected from a referral maternity hospital between January and December 2020, using a convenience sampling method. Sociodemographic information, obstetric and medical history, and information about preconception and prenatal care were collected. All maternal and neonatal outcomes were recorded from the time of admission to the time of discharge for both the mothers and their neonates. Neonatal abstinence syndrome and mother-to-child bonding were assessed using modified Finnegan's neonatal abstinence tool and a postpartum bonding questionnaire, respectively. The data were analyzed using descriptive and inferential tests using SPSS software version 22. ResultThe mean age of the women was 32.8 ± 5.7 years. The mean duration of substance use was 5.1 ± 3.5 years. 48% of the pregnancies were reported as unwanted. A total of 94.2% and 50.7% of pregnant women did not receive preconception care and prenatal care, respectively. There was no association between pregnancy wantedness and receiving preconception care (P = 0.287), but a significant association was observed for prenatal care (P < 0.001). 31% of the mothers experienced a mother-to-child bonding disorder, with 75% of those who had unwanted pregnancies reporting such a disorder. ConclusionThe findings of this study indicate that the majority of pregnant women who use substances did not receive preconception care, and prenatal care was inadequate with fewer visits than recommended. One-third of the pregnant women who use substances experienced a mother-to-child bonding disorder. It was also observed that women with unwanted pregnancies had poorer perinatal care and mother-to-child bonding.

Amniotic fluid sludge is associated with earlier preterm delivery and raised cervicovaginal interleukin 8 concentrations

Preterm birth is the leading cause of global neonatal mortality. Amniotic fluid sludge, thought to indicate intra-amniotic infection, may have potential as a clinical biomarker of preterm birth risk. This study aimed to analyse whether the presence of amniotic fluid sludge in pregnant participants with a known short cervical length, can help improve understanding of aetiology and guide management choice. A retrospective cohort study analysing the effects of amniotic fluid sludge presence on risk of preterm birth in high-risk asymptomatic pregnant participants with a short cervical length (<25 mm) at a large tertiary referral maternity centre in London. Amniotic fluid sludge was detected on routine transvaginal ultrasound scan. 147 pregnant participants with short cervical length were identified, 54 of whom had amniotic fluid sludge. Pregnant participants with amniotic fluid sludge were more likely to have a short cervical length (14 vs 19 mm, p <0.0001), and increased cervicovaginal fetal fibronectin concentrations at diagnosis, compared to pregnant participants without AFS (125 vs 45 ng/mL, p=0.0006). Pregnant participants with amniotic fluid sludge were at increased risk of mid trimester loss and delivery before 24 gestational weeks (RR 3.4 [1.2-10.3]). Furthermore, we showed that pregnant participants with amniotic fluid sludge have increased cervicovaginal interleukin 8 concentrations supporting the concept of amniotic fluid sludge as an indicator of an inflammatory response to microbial invasion (p=0.03). Neonatal outcomes were similar between the two groups. In our cohort of high-risk asymptomatic pregnant participants with a short cervical length, the presence of amniotic fluid sludge is associated with increased risk of delivery before 24 weeks gestation. Pregnant participants with amniotic fluid sludge were also more likely to have raised fetal fibronectin levels and inflammatory cytokines, particularly interleukin 8, in the cervicovaginal fluid supporting the concept that AFS is associated with an infective or inflammatory process. Future research should aim to further establish the clinical significance of amniotic fluid sludge presence and guide subsequent management.

Newborn screening for sickle cell disease in Lubumbashi, Democratic Republic of the Congo: An update on the prevalence of the disease

Objectives: Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy. It affects about 2% of newborns in some sub-Saharan African countries. In most patients, the incidence of complications can be reduced if screening takes place at birth. This study was conducted to determine the prevalence of SCD among a population of newborns in Lubumbashi, in the Democratic Republic of the Congo (DRC). Material and Methods: This prospective and cross-sectional study was conducted among newborns in five referral maternity hospitals in Lubumbashi city, in the DRC. Newborns’ blood samples were examined by capillary electrophoresis. Results: Of a total of 588 newborns screened for SCD, 369 (68.59%; 95% confidence interval [CI]: 64.48%–72.49%) newborns were Hemoglobin AA (HbAA); 141 (26.21%; 95% CI: 22.54%–30.14%) newborns were HbAS; 27 (5.01%; 95% CI: 3.33%–7.22%) newborns were HbSS, and 1 (0.19%; 95% CI: 0.00%–1.03%) newborn was Hemoglobin AC (HbAC). Conclusion: The present study determined the prevalence of SCD during neonatal screening in Lubumbashi. The conduct of premarital counseling is essential to reduce the prevalence of this hemoglobinopathy which is high (5.01% of HbSS). Systematic newborn screening in all maternity wards in the country would help to assess the prevalence at the national level and improve the quality of life of SCD children.

Adverse pregnancy outcomes in women at increased risk of preterm pre-eclampsia on first-trimester combined screening.

Uteroplacental dysfunction may not only result in pre-eclampsia (PE) but also in preterm birth (PTB), small-for-gestational-age (SGA) birth and stillbirth. The aim of this study is to evaluate the positive predictive value (PPV) of first-trimester combined PE screening for all of these placenta-mediated adverse pregnancy outcomes. Retrospective cohort study. Tertiary referral maternity unit. A total of 13 211 singleton pregnancies. First-trimester combined screening for preterm PE using the Fetal Medicine Foundation (FMF) algorithm. Hypertensive disorders of pregnancy (HDP), PTB, SGA birth and stillbirth were combined to assess composite adverse and severe adverse pregnancy outcomes (CAPO and CAPO-S). The PPVs for CAPO and CAPO-S were calculated for women with a combined risk for preterm PE of ≥1 in 50 and ≥1 in 100. First-trimester combined screening identified 2215 women (16.8%) with a risk of ≥1 in 100 for preterm PE. The PPVs for a risk of ≥1 in 100 for CAPO and CAPO-S were 38.8% and 18.2%, respectively. The equivalent PPVs for a risk of ≥1 in 50 were 45.1% and 21.1%, respectively. Women identified at high risk of preterm PE are also at increased risk of other placenta-mediated adverse pregnancy outcomes, such as PTB, SGA birth and stillbirth. Women at high risk for preterm PE after first-trimester screening may benefit from a higher surveillance care pathway, with interventions to mitigate all the adverse outcomes associated with placental dysfunction.

Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study

BackgroundIt has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil.MethodsThis cross-sectional and comparative study analyzed preliminary data from the study “Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2”, which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study “Birth in Belo Horizonte: labor and birth survey”, conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, “Birth in Belo Horizonte: labor and birth survey”, data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson’s chi-square test, with a confidence level of 95%, and using Stata statistical program.ResultsWe found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001).ConclusionOur study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

Women's Perspectives on Cultural Sensitivity of Midwives During Intrapartum Care at a Maternity Ward in a National Referral Hospital in Zimbabwe.

Midwives attend intrapartum women of diverse ethnic backgrounds who each bring their cultural beliefs into the labor and delivery rooms. The International Confederation of Midwives has recommended providing culturally appropriate maternity care in its quest to increase skilled birth attendance and subsequently improve maternal and newborn health. This study aimed to examine midwives' cultural sensitivity during intrapartum care from women's perspectives, and how this relates to women's satisfaction with maternity care services. A qualitative phenomenological design was employed. Two focus group discussions were conducted with 16 women who had delivered in the labor ward of the selected national referral maternity unit. An interpretive phenomenological approach was used to analyze the data. This study revealed ineffective midwife-woman collaboration that excludes the incorporation of women's cultural beliefs in the design of maternity care plans. Emotional, physical, and informational support in the care provided to women during labor and childbirth was found to be incompetent. This suggests that midwives are not sensitive to cultural norms and do not provide woman-centered intrapartum care. Various factors implying midwives' lack of cultural sensitivity in their provision of intrapartum care were identified. Resultantly, women's expectations of labor are not met and this could negatively affect future maternity care-seeking behaviors. This study's findings provide policy makers, midwifery program managers and implementers with better insights for developing targeted interventions to improve cultural sensitivity for the delivery of respectful maternity care. Identifying factors that affect the implementation of culture-sensitive care by midwives could guide the adjustments required in midwifery education and practice.

Sexual Violence in the Zinder Region, about 441 Cases in Reference Motherhoods

Background: Niger is one of the countries that have the highest fertility rate in the world, with 7, 6 children per woman. Zinder is the most populated region of Niger with 5 million inhabitants that is 1/5 of Niger population. The demographic impact that has affected Niger the last 10 years: unemployment poverty and drug use, spawned violence of all kinds in Zinder region (physical and sexual violence). Sexual abuse is a major risk for poor psychiatric and physical outcomes. As sexual violence has serious consequences on the life and future of women and the community and it concerns our field of intervention, we initiated this study whose objective was to determine the socio-epidemiological and lesional aspects, the consequences and appropriate solutions of sexual violence in the Zinder. Methodology: This was a retrospective collection study of all cases of alleged sexual violence received over a 12-year period from 1 January 2009 to 30 June 2021 in Zinder’s referral maternity wards. Results: During the study period, 441 cases of sexual violence were collected; an annual average of 36 cases (441/12). The frequency is 1.29% on the 34,186 consultations. The mean age was 12.31 years with age extremes of 3 to 43 years. Students accounted for 25.39%. Street vendors were found in 224 cases or 50.79%. The predominant reason for admission is rape in 64.63%. The defloration was 52.15%. Pregnancy was found in 118 cases or 26.75%. HIV serology was positive in 1 victim. School dropout was 26.75%. Conclusion: The victims of sexual violence were minors, mostly street vendors and school children. The lack of means of repression at the time allowed the expansion of this violence. The consequences of sexual violence were severe. Advocacy has improved the phenomen on of sexual violence in Zinder.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study.

To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals. Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact. There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support. Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

Seroprevalence, Importance of Rapid Testing and Factors Associated with HBsAg Carriage in Pregnancy in Three Referral Maternity Hospitals in Mono (Benin), in 2020

Seroprevalence, Importance of Rapid Testing and Factors Associated with HBsAg Carriage in Pregnancy in Three Referral Maternity Hospitals in Mono (Benin), in 2020

Implementing an eHealth tool to improve referral services for obstetric emergencies in Sierra Leone

Abstract Background Maternal health remains a major issue of concern in Sierra Leone. In the main referral maternity institution, Princess Christian Maternity Hospital (PCMH), up to 25% of maternal deaths occur during or shortly after transit from another health facility. There is an urgent need to improve referral systems between peripheral health units (PHUs) and PCMH. Our aim was to pilot and evaluate an eHealth tool facilitating referral of obstetric emergency cases through effective teleconsultation between PHUs and PCMH. Methods A web application was designed to capture unclear or complicated delivery cases at PHUs and request respective telemedical counselling from the referral institution PCMH. The eHealth tool was piloted at 10 PHUs in Western area urban and rural in August 2021. Necessary devices were provided and delivery staff was trained to use the app. In December 2021, we conducted focus group discussion with 3-6 delivery staff at five PHUs and at PCMH to evaluate utilization and outcomes of the tool. Results All participants perceived the eHealth tool as an improvement of referral procedures. Response time from PCMH after a request for counselling from a PHU was mostly &amp;lt;30 minutes. The main perceived advantage of the tool was the systematic documentation of obstetric complications and procedures. This relieved staff from fear of wrong treatment accusations, and recorded communication with PCMH made processes and responsibilities transparent. Another important benefit was PCMH staff being already prepared to receive a specific emergency case after use of the app, thus reducing the ‘third delay’ within the referral facility. As a major obstacle to smooth referral despite the eHealth tool, a lacking ambulance system was mentioned as a critical gap. Conclusions Exceedingly positive user experiences with this simple tool seem to make an expansion to more PHUs worthwhile. Benefits of using the app in more remote districts in Sierra Leone should be further investigated. Key messages • Delivery staff in Sierra Leone was capable of using a web app for telemedical counselling in a useful and effective manner. • The eHealth tool was perceived as very helpful in systematically and transparently documenting emergency delivery cases and treatment procedures.

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia.

Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes. A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia). The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830). Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Maternal plasma diacylglycerols and triacylglycerols in the prediction of gestational diabetes mellitus.

To define the lipidomic profile in plasma across pregnancy, and identify lipid biomarkers for gestational diabetes mellitus (GDM) prediction in early pregnancy. Case-control study. Tertiary referral maternity unit. Plasma samples from 100 GDM and 100 normal glucose tolerance (NGT) women, divided into a training set (GDM first trimester=50, GDM second trimester=40, NGT first trimester=50, NGT second trimester=50) and a validation set (GDM first trimester=45, GDM second trimester=34, NGT first trimester=44, NGT second trimester=40). Plasma samples were collected in the first (11+0 to 13+6 weeks), second (19+0 to 24+6 weeks), and third trimesters (30+0 to 34+6 weeks), and tested by ultra-high-performance liquid chromatography coupled with electrospray ionisation-quadrupole-time of flight-mass spectrometry; The GDM prediction model was established by the machine-learning method of random forest. Gestational diabetes mellitus. In both the GDM and NGT group, lyso-glycerophospholipids were down-regulated, whereas ceramides, sphingomyelins, cholesteryl ester, diacylglycerols (DGs) and triacylglycerols (TGs) and glucosylceramide were up-regulated across the three trimesters of pregnancy. In the training dataset, seven TGs and five DGs demonstrated good performance in the prediction of GDM in the first and second trimesters (area under the curve [AUC]=0.96 with 95% confidence interval [CI] of 0.93-1 and AUC=0.97 with 95% CI of 0.95-1, respectively), independent of maternal body mass index (BMI) and ethnicity. In the validation dataset, the predictive model achieved an AUC of 0.88 and 0.94 at the first and second trimesters, respectively. Our results have proposed new lipid biomarkers for the first trimester prediction of GDM, independent of ethnicity and BMI.

O8 - Re-defining Antenatal Care - development and implementation of IMAP in a Large Tertiary Referral Maternity Service

Initial Maternity Assessment and Planning – IMAP The staged roll out of a project to offer all women planning to birth at a large tertiary referral maternity service publicly funded first trimester screening had only just begun when the COVID19 pandemic hit in early 2020. What quickly became apparent was the urgent need for change in the way services were delivered and what ensued was the early implementation of First Trimester Screening Service (FTSS) and the development of policy to support the safety of our women, our staff and the wider community. The early implementation of the FTSS saw a number of further developments: 1. Increased rates of reported Domestic violence and or psychosocial vulnerabilities 2. Highlighted duplication of midwifery and obstetric assessments in the FTSS and a traditional booking in visit. 3. Highlighted lack of information available to women regarding models of care and maternity service in general A clinical redesign project, Initial Maternity Assessment and Planning (IMAP) commenced in November 2020 and was implemented in November 2021. The project delivered: 1. A universal entry into the Service via a single electronic referral 2. Detailed patient information regarding the IMAP visit, FTS, pathways and options for models of maternity care provided prior to initial appointment 3. IMAP visit – comprehensive, holistic, multidisciplinary screening assessment of the pregnant woman and baby in the early pregnancy period, detailed risk assessment and risk appropriate management plan and allocated model of care 4. Elements of antenatal care, Low and high risk pathways – schedule of antenatal visits, recommended content and supporting education and resource for women and families. 5. Focussed visits at 16-18 weeks – welcome to your model of care and 36 weeks – Review pregnancy and recommended timing, model and place of birth 6. Comprehensive suite of educational resources accessed via QR code. At this stage the project evaluation is just commencing. We expect to be able to present preliminary outcomes at the conference.

The prevalence of perioperative iron deficiency anaemia in women undergoing caesarean section—a retrospective cohort study

BackgroundCaesarean section is a common surgery, with almost 23 million procedures performed globally each year. Postpartum haemorrhage, in association with caesarean section surgery, is a leading global cause of maternal morbidity and mortality. Perioperative iron deficiency anaemia is a risk factor for intraoperative bleeding. Therefore, anaemia is an important and modifiable risk factor for bleeding during caesarean section surgery. Recent recommendations advise that all preoperative patients with anaemia (defined as haemoglobin concentration (Hb) < 130 g/L), regardless of sex, be assessed and treated to normalise haemoglobin levels. It is unclear how this recommendation translates to pregnant women where the World Health Organization (WHO) defines anaemia at a much lower threshold (Hb < 110 g/L). We aimed to determine the prevalence, and characterization, of Hb levels < 130 g/L perioperatively in women undergoing caesarean section.MethodWe conducted a retrospective cohort study of 489 consecutive women who underwent caesarean section over a 12-week period, in a single-centre tertiary referral maternity unit in Australia. We calculated the proportion of women who were anaemic (Hb < 130 g/L) at four time points—first hospital appointment, third trimester, preoperatively and on discharge from hospital. The proportion of women who were iron deficient (ferritin level < 30 μg/L) at their first hospital appointment was determined.ResultsHaemoglobin was measured in 479 women. Ferritin was measured in 437 of these women. The mean (SD) Hb at the first hospital appointment, third trimester, preoperatively, and postoperatively on discharge was 126.7 (11.4) g/L, 114.6 (10.6) g/L, 124.1 (12.4) g/L, and 108.0 (13.6) g/L respectively. Iron deficiency was present in 148 (33.9%) women at their first hospital appointment; 107 of 248 (43.1%) women with anaemia and 41 of 189 (21.7%) with no anaemia. 29 women were found to have moderate anaemia (Hb 80−109 g/L) with 18 of these 29 (62.1%) women having iron deficiency. Only 68 (45.9%) women with iron deficiency at their first hospital appointment received treatment. The prevalence of anaemia classified as Hb < 130 g/L versus the WHO classification of Hb < 110 g/L from all causes was 57.4% versus 6.1% at first hospital appointment, 94% versus 26.1% in third trimester, and 66.0% versus 12.2% preoperatively. Postoperatively at least 40% of women had Hb < 130 g/L on hospital discharge versus at least 23% of women using WHO definition of Hb < 110 g/L. Of the 112 women with hospital discharge Hb < 110 g/L, 35 (31.3%) women were iron deficient at their first hospital appointment.ConclusionOver one in three women were iron deficient at their first hospital appointment. 62% of women with moderate anaemia (Hb 80–109 g/L) also had iron deficiency. At least four in 10 women were anaemic (Hb < 130 g/L) on hospital discharge. Less than half of the women with anaemia were treated. Our data suggests that 30% of postoperative anaemia may be prevented with intensive treatment of iron deficiency in early pregnancy. Large prospective studies, are needed to determine outcomes after caesarean section in women, stratified by preoperative Hb and ferritin levels. The prevalence of anaemia in our data suggests it is a moderate public health problem.

Clinical and epidemiological aspects of SARS-CoV-2 infection among pregnant and postpartum women in Mozambique: a prospective cohort study

BackgroundAlthough there is a significant increase of evidence regarding the prevalence and impact of COVID-19 on maternal and perinatal outcomes, data on the effects of the pandemic on the obstetric population in sub-Saharan African countries are still scarce. Therefore, the study aims were to assess the prevalence and impact of COVID-19 on maternal and neonatal outcomes in the obstetric population at Central Hospital of Maputo (HCM), Mozambique.MethodsProspective cohort study conducted at teaching and referral maternity, HCM, from 20 October 2020 to 22 July 2021. We collected maternal and perinatal outcomes up to 6 weeks postpartum of eligible women (pregnant and postpartum women—up to the 14th day postpartum) screened for COVID-19 (individual test for symptomatic participants and pool testing for asymptomatic). The primary outcome was maternal death, Severe Acute Respiratory Syndrome (SARS) and Intensive Care Unit (ICU) admission. We estimated the COVID-19 prevalence and the unadjusted RR (95% CI) for maternal and perinatal outcomes. We used the chi-square or Fisher's exact test to compare categorical variables (two-sided p-value < 0.05 for statistical significance).ResultsWe included 239 participants. The overall prevalence of COVID-19 was 9.2% (22/239) and in the symptomatic group was 32.4% (11/34). About 50% of the participants with COVID-19 were symptomatic. Moreover, the most frequent symptoms were dyspnoea (33.3%), cough (28.6%), anosmia (23.8%), and fever (19%). Not having a partner, being pregnant, and alcohol consumption were vulnerability factors for SARS-CoV-2 infection. The risk of adverse maternal and neonatal outcomes (abortion, foetal death, preterm birth, Apgar, and NICU admission) was not significantly increased with COVID-19. Moreover, we did not observe a significant difference in the primary outcomes (SARS, ICU admission and maternal death) between COVID-19 positive and COVID-19 negative groups.ConclusionThe prevalence of COVID-19 in the obstetric population is higher than in the general population, and fifty percent of pregnant and postpartum women with COVID-19 infection are asymptomatic. Not having a partner and alcohol consumption were factors of greatest vulnerability to SARS-COV-2 infection. Moreover, being pregnant versus postpartum was associated with increased vulnerability to COVID-19. Data suggest that pregnant women with COVID-19 may have a higher frequency of COVID-19 infection, reinforcing the need for universal testing, adequate follow-up for this population, and increasing COVID-19 therapy facilities in Mozambique. Moreover, provide counselling during Antenatal care for COVID-19 preventive measures. However, more prospective and robust studies are needed to assess these findings.

Seroprevalence of SARS-CoV-2 virus antibodies and sociodemographic features of pregnant women in Mogadishu, Somalia: a cross-sectional survey study

ObjectiveRecent investigations have revealed that COVID-19 during pregnancy substantially increases the risk of harmful outcomes for mothers and neonates, including preterm death and stillbirth as well as severe maternal morbidity...

Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study.

The aim of this study was to investigate the relationships between maternal vascular malperfusions (MVM) and second trimester uterine arteries pulsatility index (UtA-PI) in cases of stillbirth (SB), compared to live-birth (LB) matched controls. This was a multicentre, observational, matched case-control study performed at five referral maternity centres over a 4-year period including SB and LB control pregnancies at high-risk for preeclampsia (PE) and/or fetal growth restriction (FGR), matched and stratified for UtA-PI MoM quartiles values of the SB cases. Logistic regression was used to assess the rates of each MVM finding, within each increasing MoM quartile subcategory in SB and matched LB controls. 82 SB and 82 LB matched high-risk pregnancies were included. Placental hypoplasia, placental infarction, retroplacental hematoma, distal villous hypoplasia and accelerated villous maturation showed a significant correlation with UtA-PI. At univariable analysis, placental infarction and distal villous hypoplasia were more highly associated with the increasing quartile uterine Doppler measurements (odds ratio 2.24 and 2.23, respectively). Logistic regressions showed a significant positive and independent association between rates of retroplacental hematoma or distal villous hypoplasia and stillbirth within corresponding UtA-PI MoM quartiles (odds ratio 5.21 and 2.28, respectively). We are providing evidence for characterization of two major etiological stillbirth categories, characterized by a positive or absent association with UtA-PI impairment and specific histopathological placental MVM lesions. Our results support a strict third trimester follow-up of cases with increased second trimester UtA-PI, in order to improve the reproductive chances of these pregnant patients.