Total Live Births Research Articles

Decreasing the Newborn Birth Hospitalization Length of Stay.

This study aimed to determine our ability to shorten birth hospitalization length of stay (LOS) in which patient characteristics were associated with early discharge and had effects on early newborn readmission rate. Retrospective chart review of births from April 1, 2020 to December 31, 2020, was considered for this study. Delivery mode and maternal and newborn characteristics were evaluated for effect on discharge timing. Hospital readmissions within 7 days of discharge were reviewed. In total, 845 out of 1,077 total live births were included in the study population. Five hundred and eighty-nine (69.7%) newborns were discharged early (<48 hours after vaginal delivery [VD] and <72 hours after cesarean delivery [CS]). Factors associated with early discharge included 79.8% CS (p < 0.001), 84% birth after 2 p.m. (p < 0.001), 71.2% no diagnosis of maternal diabetes (p = 0.02), and 70.6% negative maternal coronavirus disease 2019 (p = 0.01). The overall 7-day readmission rate was 1.2 and 0.5% for newborns discharged early after VD. Most newborns can be discharged early without increasing newborn readmission. · Most patients were discharged <72 hours after CS.. · Most patients were discharged <48 hours after VD.. · Early discharge does not affect newborn readmissions..

COVID-19 induced birth sex ratio changes in England and Wales.

The sex ratio at birth (male live births divided by total live births) may be a sentinel health indicator. Stressful events reduce this ratio 3-5 months later by increasing male fetal loss. This ratio can also change 9 months after major population events that are linked to an increase or decrease in the frequency of sexual intercourse at the population level, with the ratio either rising or falling respectively after the event. We postulated that the COVID-19 pandemic may have affected the ratio in England and Wales. Publicly available, monthly live birth data for England and Wales was obtained from the Office for National Statistics up to December 2020. Using time series analysis, the sex ratio at birth for 2020 (global COVID-19 onset) was predicted using data from 2012-2019. Observed and predicted values were compared. From 2012-2020 there were 3,133,915 male and 2,974,115 female live births (ratio 0.5131). Three months after COVID-19 was declared pandemic (March 2020), there was a significant fall in the sex ratio at birth to 0.5100 in June 2020 which was below the 95% prediction interval of 0.5102-0.5179. Nine months after the pandemic declaration, (December 2020), there was a significant rise to 0.5171 (95% prediction interval 0.5085-0.5162). However, December 2020 had the lowest number of live births of any month from 2012-2020. Given that June 2020 falls within the crucial window when population stressors are known to affect the sex ratio at birth, these findings imply that the start of the COVID-19 pandemic caused population stress with notable effects on those who were already pregnant by causing a disproportionate loss of male fetuses. The finding of a higher sex ratio at birth in December 2020, i.e., 9 months after COVID-19 was declared a pandemic, could have resulted from the lockdown restrictions that initially spurred more sexual activity in a subset of the population in March 2020.

Isolated Vascular Rings Are Common Cardiovascular Malformations.

We investigated the prevalence of isolated vascular rings in the general population of Southern Nevada. We identified those prenatally and postnatally diagnosed with an isolated vascular ring between January 2014 and December 2021. We included only those with vascular or ligamentous structures completely encircling the trachea and esophagus. To investigate the prevalence of isolated vascular rings, we included only those with situs solitus, levocardia, and no significant intracardiac malformations. We identified 112 patients. Of the 112, 66 (59%) were female. There were approximately 211,000 total live births in Southern Nevada for the study period, for an overall prevalence of 5.3 isolated vascular rings per 10000 live births. However, for the years 2014 to 2017, the average prevalence figure was 3.5 per 10000 live births, and for the years 2018 to 2021, the average prevalence figure was 7.1 (range 6.5-8.0) per 10000 live births. Simultaneously, the prenatal detection rate rose from 66% to 86%. Isolated vascular rings are common cardiovascular malformations. As prenatal detection rates in the Southern Nevada general population approach 90%, the prevalence figures for isolated vascular rings appear to asymptote at about 7 per 10000 live births.

Analysis of the Factors leading to Severe Acute Maternal Morbidity and Maternal Mortality during COVID 19 Pandemic

Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic.&#x0D; Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21.&#x0D; Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality.&#x0D; Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.&#x0D;

Comparing neonatal outcome of late preterm: Intrauterine growth restricted (IUGR) average for gestational age infants

Comparing Neonatal outcome of late preterm -Intrauterine growth restricted (IUGR) vs Average for Gestational age (AGA) infants.Background: Individuals who had IUGR experience a range of poorer developmental outcomes, encompassing cognitive, socioemotional, and behavioral domains, compared with individuals who were born appropriate for gestational age (AGA).The primary aim was to evaluate neonatal outcome in late preterm IUGR and SGA infants and comparing them.Methods: Out of 3256 total live births, late preterm births are 341(10.4%). Incidence of IUGR in late preterm infants is 71/341(2.15%) and AGA is 170/341(8.25%). We analysed 100 singleton pregnancies, 50 infants with birth weight less than 10th percentile, control group with 50 infants with birth weight between 11-89 percentile at 34-36+6 weeks gestational age. The control group consisted of spontaneous preterm delivery at the same gestational age.Birth weight percentiles were based on the standard growth curve of Alexander et al. Results: There was a significant difference in mean birth weight between the two groups (IUGR: 1720g and AGA: 2495g). The frequency of cesarean sections was 64% in the IUGR group and 26% in the AGA group. 3 neonates of the IUGR group and one of the AGA infants presented Apgar scores <7 at 5 minutes. The length of stay of the newborn in the nursery, as well as the need for and duration of hospitalization in the NICU, differed significantly between the two groups. TTN, Neonatal sepsis and hyperbilirubinemia didnot differ between groups but phototherapy required for IUGR group is more.Conclusion: Late-preterm IUGR infants present a significantly higher risk of neonatal complications and a significantly longer NICU and hospital stay when compared to late-preterm AGA infants.

The clinical burden of extremely preterm birth in a large medical records database in the United States: complications, medication use, and healthcare resource utilization

Introduction Approximately 5% of global preterm births are extremely premature (EP), defined as occurring at less than 28 weeks gestational age. Advances in care have led to an increase in the survival of EP infants during the neonatal period. However, EP infants have a higher risk of developing complications such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). BPD and other respiratory morbidities are particularly prevalent among this population. To understand the healthcare resource utilization (HRU) of EP infants in the United States, the clinical and economic burden of extreme prematurity was examined in this retrospective study of data extracted from electronic medical records in the Kaiser Permanente Northern California (KPNC) health system. Methods The analysis included data from EP infants live-born between January 1997 and December 2016, and focused on complications and HRU up to 3 years corrected age (CA), covering the period up to December 2018. Stillbirths, infants born at <22 weeks gestational age, and infants with major congenital malformations were excluded. Complications of interest (BPD, IVH, and ROP) and medication use were compared by age group (≤1 year, >1 year and ≤2 years, and >2 years and ≤3 years CA). Analysis of HRU included hospital readmissions, ambulatory visits, and emergency room (ER) visits. Results A total of 2154 EP births (0.32% of total live births and 4.0% of preterm births that met the inclusion/exclusion criteria) were analyzed. The prevalence of EP birth showed a declining trend over time. ROP was the most commonly recorded complication during the birth hospitalization (37.1% any stage; 2.9% Stages 3 and 4). BPD was recorded in 34.3% of EP infants. IVH (any grade) was recorded in 22.7% of EP infants (6.4% Grades III and IV). A majority (78.7%) of EP infants were diagnosed with at least one respiratory condition during the first year CA, the most common being pneumonia (68.9%); the prevalence of respiratory conditions decreased over the second and third years CA. During the first 3 years CA, the most common medications prescribed to children born EP were inhaled bronchodilators (approximately 30% of children); at least 15% of children received systemic corticosteroids and inhaled steroids during this period. During the first 3 years CA, at least one hospital readmission was recorded for 16.4% of children born EP; 57.1% of these readmissions were related to respiratory conditions. At least one ER visit was recorded for 33.8% of children born EP, for which 53.1% were due to a respiratory condition. Ambulatory visits were recorded for 54.2% of EP children, for which 82.9% were due to a respiratory condition. Conclusions The short- and long-term clinical burden of EP birth was high. The onset of BPD, IVH, and ROP was common during the birth hospitalization for EP infants. Medication use, hospital readmission, and clinic visits (ER and ambulatory) occurred frequently in these children during the first 3 years CA, and were commonly due to respiratory conditions. Strategies prioritizing the reduction of risk and severity of respiratory conditions may alleviate the clinical burden of EP birth over the long term.

Infant HIV Testing Amid the COVID-19 Pandemic and Evolving PMTCT Guidelines in Johannesburg, South Africa.

Background: The COVID-19 pandemic impacted HIV programmes with the diversion of resources and lockdown measures. We assessed the impact of COVID-19 on infant HIV diagnosis in the context of updated 2019 prevention of mother-to-child transmission of HIV (PMTCT) guidelines in Johannesburg, South Africa. Methods: HIV PCR data for children <2 years were extracted from the National Health Laboratory Service database from October 2018 to September 2021, inclusive. Trends in the total number of tests performed and the total number of children with HIV diagnosed, stratified by age, were determined to assess the effect of different COVID-19 lockdown levels and updated guidelines. Results: When comparing three 12-month periods ending September 2019–2021, respectively, the total number of HIV PCR tests performed increased (from 41 879 to 47 265 to 56 813), and the total number of children with HIV decreased (from 659 to 640 to 620), year-on-year. There was a substantial increase in 6-month testing in response to updated guidelines. Excluding 6-month testing, the year-on-year increase in total tests was maintained with birth and 10-week testing closely approximating total live births to women living with HIV. A decrease in the total number of children with HIV diagnosed was noted in Q2 2020, coinciding with the most restrictive lockdown, followed by a rebound in cases. Conclusions: Despite the restrictions and diversion of resources associated with COVID-19, there was a successful implementation of PMTCT guideline updates and minimal disruption to infant HIV testing. However, much work remains in order to achieve the elimination of mother-to-child transmission of HIV.

Estimates of Stillbirths, Neonatal Mortality, and Medically Vulnerable Live Births in Amhara, Ethiopia

Data on birth outcomes and early mortality are scarce, especially in settings with limited resources. Total births, both stillbirths and live births, are often not counted, yet such data are critical to allocate resources and target interventions to improve survival. To estimate the prevalence of stillbirths, neonatal deaths, and medically vulnerable phenotypes, such as preterm births, small-for-gestational-age (SGA), large-for-gestational-age (LGA), and low-birth-weight (LBW) births, in a setting where these key indicators remain largely unknown. This prospective pregnancy cohort study of women and their newborns was conducted between December 12, 2018, and November 5, 2020. The study was conducted in North Shewa Zone, Amhara, Ethiopia. Data were analyzed from July 2021 to May 2022. Pregnancy status, gestational age, birth weight, and vital status were measured to estimate the prevalence of stillbirths, live births, and medically vulnerable live births (ie, preterm, SGA, LGA, and LBW births). For mortality outcomes, the prevalence of neonatal (overall, early, and late) and perinatal mortality were estimated. Among the 2801 enrolled women, the median (IQR) age at conception was 26.5 (22.2-31.0) years, and the median (IQR) gestational age at enrollment was 24 (17-31) weeks. Of the 2628 women (93.8%) with outcome data, 101 pregnancies (3.8%) resulted in an early loss (<28 gestational weeks). Among the 2527 remaining pregnant women, there were 2518 births between 28 and less than 46 weeks' gestation; 2459 (97.7%; 95% CI, 97.0%-98.2%) were live births and 59 (2.3%; 95% CI, 1.8%-3.0%) were stillbirths. Many newborns (41.7%) were born preterm, SGA, LGA, or LBW. The estimated prevalence was 15.1% (95% CI, 13.7%-16.6%) for preterm births, 23.1% (95% CI, 21.3%-25.1%) for SGA births, 10.6% (95% CI, 9.3%-12.1%) for LGA births, and 9.4% (95% CI, 8.2%-10.8%) for LBW births. Among live births, the overall prevalence of neonatal mortality was 3.1% (95% CI, 2.5%-3.9%); mortality was higher among preterm births (7.2%; 95% CI, 4.9%-10.4%), LBW births (12.2%; 95% CI, 8.2%-17.7%), and SGA births (4.1%; 95% CI, 2.6%-6.5%). The prevalence of early neonatal mortality was almost twice as high as the prevalence of late neonatal mortality. The perinatal mortality prevalence was 4.3% (95% CI, 3.6%-5.2%), with a 1.2:1 ratio of stillbirths to first-week deaths. These findings have important implications for newborn health and survival. For policy makers and programmers, accurate data on key indicators of neonatal health provide information for resource allocation and to evaluate progress. For researchers, the findings underlie the importance for further research to develop and deliver interventions that improve health outcomes.

EVALUATION OF KNOWLEDGE, AWARENESS AND IMPLEMENTATION GAP OF HOMEBASED NEWBORN CARE AMONG ASHA WORKERS AND MOTHERS IN RURAL AREAS OF AMRITSAR, PUNJAB

Background: India contributes to 17.5% of the world's population, nearly 20% of the total live births, in spite of signicant steps that have been taken to reduce child and neonatal mortality, yet accounts for 26% of global neonate deaths. India has witnessed a signicant reduction in the number of neonatal deaths - from 1.35 million in 1990, to around 0.76 million in 2012. In an attempt to address the issue of high neonatal mortality, Government of India issued Home Based Newborn Care (HBNC) guidelines in 2011; and Accredited Social Health Activist (ASHA) workers were mobilized for providing maternal and immediate newborn care. Methods: This cross-sectional study was conducted in the rural areas of Amritsar District. The duration of study was 1 year (January 2020 to December 2020) and data was collected using a predesigned pretested semi-structured questionnaire. Total 400 subjects were recruited in the study in which 200 ASHA workers and 200 mothers were included.20-30 ASHA workers who had completed their NRHM training were selected from each block randomly. 20-30 mothers from each block of Amritsar were selected randomly. Results: In this cross-sectional study, 90% ASHA workers had knowledge on weighing, temperature measurement (78%), feeding frequency (63%), handwashing (2%) and Kangaroo Mother Care (KMC) positioning (12%) . Majority of ASHAs had knowledge about danger signs like bleeding stump (95%) ,distended abdomen (75%), fever (69.5%), chest indrawing (61.5%) and lethargy (35%).The study concluded that 54% of ASHA workers provided average quality and 46% ASHAs provided good quality care of newborn care. Out of 200 mothers, 74.5% mothers were aware of frequency of feeding, initiation of breastfeeding (32%), proper positioning of breastfeeding and attachment (21%), urine and stool frequency (44%), danger signs for which they should seek help (41%), temperature assessment (59%) and Kangaroo Mother Care positioning (2%). Conclusion: Present study concluded that majority of newborns get all the age-appropriate home visits but very less mothers had knowledge and awareness about HBNC provision.

Female’s Experience with Post-placental Intrauterine Contraceptive Device Use in a Tertiary Care Centre in Pakistan

Background: Insertion of a post-placental intrauterine contraceptive device (PPIUCD) has been recommended by the World Health Organization (WHO) as one of the safe and effective methods of temporary contraception. In the immediate post-delivery period, females are highly driven and in need of an effective method for contraception so that child-rearing can be easy without unintended pregnancy. Objective: To assess the outcome of females accepting PPIUCD in terms of insertion, complications, and discontinuation rate at 6 weeks and 6 months. Methods: Retrospective, cross-sectional study conducted at the Department of Obstetrics and Gynecology, Lahore General Hospital, Pakistan, from May 2015 to August 2019. The data were collected and analysed after approval from the hospital ethical committee and were retrieved from the maternal and neonatal child health programme. Record of clinical visit and telephonic survey for miscellaneous complaints at 6 weeks and 6 months were evaluated from the medical records department and relevant data were extracted. The data were analysed using the IBM Statistical Package for the Social Sciences (SPSS® Statistics) V21.0 software (International Business Machines Corporation [IBM], New York, USA) and the results were expressed in descriptive statistics in frequencies and percentages. Results: Total live births during the study period were 43,065. PPIUCD was inserted in 5,275 females (12.24%). Only 13% presented for clinical follow-up; 87% had a telephonic conversation. Of these, 33% were advised to have a clinical visit; 83% reported no complaints. Reassurance was needed in 11% and threads were trimmed in 2%. Problems reported were displaced intrauterine contraceptive device (IUCD; 3.3%); spontaneous expulsion (24.0%); vaginal infections (4.7%); missing strings (3.0%); cramping (25.0%); dyspareunia (6.0%); spotting (52.0%); and vaginal discharge (16.0%). Ultrasound was advised (3.0%), as were symptomatic treatment (14.0%) and antibiotics and IUCD removal (0.7%). IUCD was discontinued by 6.7% of the females for various reasons: family pressure (0.3%); wanting a further child (0.7%); and opting for another method of family planning (14.0%). IUCD was removed and reinserted in 4.9%. Conclusion: PPIUCD has a low turnover rate of follow-up but has high compliance with devices and a low complication rate; however, complications can be reduced by improving patient selection and clinical follow-up. It provides an excellent window of opportunity for providing effective long-term contraception to the patients who need it the most.

The effect of female education on fertility: Evidence from China’s compulsory schooling reform

This paper examines the causal impact of women’s education on fertility by exploiting the cross-regional and cross-time variations in the enforcement of compulsory schooling reform in China. Using data from the 2010 Chinese Census, we find that increased women’s education permanently reduces fertility, which is different from the evidence in many countries where women compensate at later ages for the initial loss in births. We also find that increased education has a greater negative effect on the total live births of rural hukou women. When examining the potential channels underlying the relationship, we find that increased women’s education reduces child mortality, delays women entering the marriage market and childbirth, increases the opportunity costs of childrearing, and promotes positive assortative mating. Our research provides an additional explanation for the rapid decline in the total fertility rate in China.

A Study of Obstetric Patients Admitted in Intensive Care Unit of a Tertiary Care Hospital

Obstetric admissions to the intensive care units require special care and attention by a multidisciplinary team. Obstetric emergencies are a challenge to the intensivist as they have the potential for catastrophic complications. The aim of this study was to determine the admission indications, clinical characteristics and fetomaternal outcomes of obstetric patients admitted to intensive care units of a tertiary care hospital. According to our study, the most common diagnosis among obstetric patients who got admitted to intensive care units was hypertensive disorders complicating pregnancy. The most common indications for ICU admission were major blood loss followed by the need for administration of antihypertensive infusions. Among the total admissions to the ICUs, 93.5% of patients recovered completely and the maternal mortality rate was 4.8%. The neonatal mortality rate was 3.7% of total live births. A multidisciplinary team including obstetricians, neonatologists, anaesthetists and intensivists to lynchpin the correct diagnosis and to ensure timely delivery improves not only maternal outcome but also foetal outcome

Spectrum of Preterm Birth in Tertiary Care Hospital in Shimla District of Himachal Pradesh

Background: Globally, Prematurity or preterm birth is the leading cause of death in under the age of 5 years but this has been often overlooked and neglected problem. The present study aimed to study the trends of preterm birth in Shimla district of Himachal Pradesh, India. Methods: Retrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was conducted. The total number of preterm birth were retrieved. Results: A total of 34769 live birth took place in Kamla Nehru Hospital, Shimla from 2016 to 2020. Among the total live births, 5654(16.26%) were premature birth (&lt;37 weeks) while 29115(83.74%) were term birth. There was continuous decline in premature birth from 32.24% in 2016 to 17.41% in 2017and 10.84% in 2018, slightly rose to 10.87% in 2019 and 11.75% in 2020. Conclusions: The study concluded that over a period of 5 years there was continuous decrease in premature birth and now it reached almost near to the global average of preterm birth. Keywords: Trends, Preterm birth, Kamla Nehru Hospital, Shimla.

Cold Weather as a Risk Factor for Late Diagnosis and Surgery for Developmental Dysplasia of the Hip.

Newborn hip screening aims to prevent the late diagnosis of and subsequent surgical procedures for developmental dysplasia of the hip (DDH). Weather may affect how parents swaddle their babies in early life, but weather has never been formally regarded as a risk factor in hip screening. This study investigates the association between the incidence of surgically treated DDH and the outdoor temperature. Surgical procedures for late-diagnosed DDH were investigated in 12 birth-year cohorts (1999 to 2010) using the Taiwan National Health Insurance Research Database. The number of children who underwent a DDH-related surgical procedure between 6 months and 5 years of age per total live births was evaluated as an outcome of hip screening. Trend and regression analyses were used to determine the association between the incidence of surgically treated DDH and birth year, birth month, and the temperature during the birth month and first 3 months of life. The mean incidence of surgically treated DDH was 0.48 per 1,000 live births (1,296 surgically treated patients per 2,712,002 live births). The incidence of surgically treated DDH among babies born in winter months (0.70 per 1,000) was significantly higher than that among babies born in summer months (0.32 per 1,000), and it was significantly correlated with mean temperature in the first 3 months of life (r2 = 0.91; p < 0.0001) and birth month (r2 = 0.68; p < 0.001). Multivariable regression revealed that external temperature in the first 3 months of life was the most significant factor (β = -0.034 [95% confidence interval, -0.042 to -0.022]; p < 0.001) for the incidence of surgically treated DDH (adjusted r2 = 0.485). The trend of seasonal differences remained the same throughout the study years following implementation of the hip-screening policy. As the incidence of surgically treated DDH is the ultimate outcome of newborn hip screening, cold weather should be regarded as a risk factor and should be incorporated into future screening programs. Weather patterns of different geographical areas should be studied to determine if children born in the winter are at an increased risk for requiring a surgical procedure for DDH, and newborn hip-screening programs should be revised accordingly. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic.

Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic.Methods: Participants were 2,237 pregnant and postpartum women (aged 19–47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) “anxiety only,” (c) “depression only,” and (d) “no depression or anxiety.” After estimating the prevalence of CAD, “anxiety only,” and “depression only,” we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women.Results: Comorbid anxiety and depression, “anxiety only,” and “depression only,” occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). “Poor family support” (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30–2.78; p = 0.0009) and “no birth” (OR: 1.91; 95% CI: 1.32–2.75; p = 0.0006) remained significant factors for the CAD group, while “poor family support” (OR: 2.16; 95% CI: 1.34–3.47; p = 0.0015) remained a significant factor for the “depression only” group when their results were compared to those of the “no depression or anxiety” group in the multiple logistic regression analysis.Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.

Evaluating maternal characteristics and DNA polymerase chain reaction birth testing of neonates born with HIV in a KwaZulu-Natal referral hospital – missed opportunities?

Background. Congenital HIV infection has declined in South Africa with an expanded programme to decrease perinatal HIV transmission. Understanding the challenges within this programme can identify opportunities for improvements. There is an opportunity with birth HIV DNA polymerase chain reaction testing to expedite very early treatment of neonates born with HIV in referral hospitals. Objectives. This study was aimed at describing the characteristics of mothers of neonates born with HIV as well as the evaluation of the access and availability of birth HIV DNA PCR results within a referral hospital. Method. This study was a retrospective chart review of all documented neonates born with HIV delivered between 1 January 2017 and 30 June 2019 at King Edward VIII Hospital, Durban, KwaZulu-Natal. The birth HIV DNA PCR results provided through institutional programmes were analysed, and the clinical characteristics of mothers of neonates born with HIV were described. Results. Review of hospital-based records, during the 30-month study period, identified 6 902 (40.02% of 17 243 total live births) birth HIV DNA PCR tests having been done. During the sample period, documented positive, rejected or indeterminate results were analysed. These results indicated only 37 (0.54%) of known HIV-exposed neonates who were tested, to have a documented positive birth HIV DNA PCR result. Fifty-nine neonates had either indeterminate or rejected results. Negative HIV DNA PCR results could not be verified. Analysis of the mothers of neonates with documented HIV-positive results indicated high mean viral loads of these mothers (52 343 copies/mL) and most were diagnosed in the current pregnancy or at delivery. Conclusion. Review of the characteristics of mothers of neonates born with HIV within a public referral hospital reiterates that late HIV diagnosis is common in this high-risk group. Birth HIV DNA PCR results may fail to adequately identify all positive neonates timeously for very early initiation of antiretroviral treatment.

An Audit of Maternal Mortality at a Tertiary Care Hospital

Objective:To find causes of maternal deaths and to calculate maternal mortality ratio at tertiary care hospital Karachi. Study Design and setting:An observational study was conducted from1st January 2019 to 31stDecember 2020 at theDepartment of Obstetrics &amp; Gynecology Unit 1, JPMC Karachi. Methodology:Patients were selected according to inclusion criteria after ethical approval through non probability consecutivesampling technique. Details of patients were obtained from filesand record registers. Their demographic feature like age,parity, gestational age, booking status and presence or absence of medical disorders, their status of delivery and direct andindirect reasons of maternal deaths were noted and their frequency and percentages were calculated. Brought dead patientsand those who died accidently were excluded from the study. Results:During the period of two years the total numbers of deaths certified in the department were 90. Total number ofchild birth and live births were 19084 and 17892 respectively. The maternal mortality ratio was estimated as 503.01 per100,000 live births. Most of the patients 74(82.3%) were un booked. Direct Causes were about 67(74.5%). Haemorrhagewas found to be most common reason of maternal deaths in about21(23.3%). Eclampsia among18(20%) deaths. Anemia, cardiac disease, hepatic failure were the indirect causes of maternal deaths responsible for 23 (25.5%) of maternal deaths. Conclusion:Maternal Death rate is persistently elevated in JPMC, being tertiary care hospital mostly due to serious and referred complicated cases. Haemorrhage and eclampsia are still major killers of mothers as before.

A retrospective review of low-birth-weight cases in a tertiary care hospital in Shimla district of Himachal Pradesh

Background: Low birth weight (LBW) is a serious public health problem and a leading cause of death in the first month of life. The present study aimed to study the trends of low birth weight in Shimla district of Himachal Pradesh, India.Methods: Retrospective review of records of Kamla Nehru Hospital, Shimla covering the period January 2016 to December 2020 was done. The total number of low-birth-weight babies each year were retrieved.Results: A total of 34769 live births took place in Kamla Nehru Hospital, Shimla from 2016 to 2020. Among the total live births, 8479 (24.39%) were having low birth weight (&lt;2500 gm) while 26290 (75.61%) were having normal birth weight (&gt;2500 gm). Out of total 8479 LBW Babies, 7148 (84.3%) were LBW (&lt;2500 gm),1167 (13.76%) were very low birth weight (1000-1500 gm) and 164 (1.93%) were of extremely low birth weight There was continuous decrease in low birth weight from 35.14% in 2016 to 17.51% in 2019. After that it start increasing slightly to 18.9% in 2020.Conclusions: Over the span of five years, there was continuous decrease in incidence of LBW. Nutritional education during pregnancy and proper Antenatal care (ANC) services needs to be addressed to reduce prevalence of LBW in Himachal Pradesh

THE RELATIONSHIP BETWEEN IVF CLINIC VOLUME AND SUCCESS RATES IN SART REPORTING CLINICS

To determine if the volume of IVF cycles performed by a clinic affects the live birth rate Individual clinic reports on the SART.com site were reviewed from the finalized annual report for 2017, and data on IVF cycle volume and success rates were extracted. Clinics reporting more than one location were aggregated into a single report, yielding 341 clinic reports for 248,086 cycles. We explored whether there was a relationship between the clinic size and the outcomes of live births for first embryo transfer, live births for all embryo transfers, singleton births for first embryo transfer, and singleton births for all embryo transfers. For analysis, we fit 4 linear regression models with the birth outcomes for women under 35 in 286 clinics that had greater than 20 cycle starts and had fewer than 2000 total cycles. Due to the non-normality of the data, we performed Box Cox transformations on the percent live birth when necessary. Using clinic volumes as the predictor and a sandwich estimator for the variance to account for decreasing residual variance with increasing clinic volume, as well as an optimal , we found that there were slight but statistically significant positive associations between clinic size and percentage live births for singleton live births for all transfers (=1.3939,) and for singleton births for the first transfer (, but clinic size was not significant for live births for all transfers ( or for live births for the first transfer. Using an illustrative example for the Box Cox transformed outcomes, an increase from 500 to 1500 in clinic volume would correspond a non statistically significant ∼2.25% increase in total live births on average (from 53.72% to 55.97%) and to a statistically significant ∼5.61% increase in singleton live births (from 45.04% to 50.66%). The R2 values are very low for all models (< 0.1), implying low predictive power of clinic size for birth rates. Scatterplots revealed an increased variability of success rates among smaller clinics. Live birth rates from IVF, on average, are not affected by increasing volume of cycles per clinic, but there is greater variability in success rates and a slightly higher multiple pregnancy rate among smaller clinics than larger clinics.

ACCESS TO WORK LEAVE AND IN VITRO FERTILIZATION (IVF) OUTCOMES

BackgroundAssisted Reproductive Technology (ART) including IVF is the most expensive method of infertility treatment, at a median cost of $19,000/cycle (1). It is also the most time intensive, resulting in an average of 8.74 days taken off work per cycle (2). In 2009, only an estimated 24% of ART need was being met in the U.S. ART is responsible for 1.5% of total live births in the U.S., compared to 3% in Europe despite no difference in incidence (1). The financial burden of care has been researched extensively, and state mandated insurance coverage improves access and outcomes associated with IVF. States with mandated coverage have fewer embryos transferred and fewer multiple births per cycle (3). There is less research examining the amount of time off work that is required during treatment. Existing literature suggests that increased time off from work is associated with increased stress and early termination of care (4,5). However, to our knowledge, there is no research examining access to employment leave during IVF and how this influences outcomes.ObjectiveTo examine the current state of access to employment leave during IVF cycles, evaluate the relationship between access to employment leave during IVF treatment and IVF outcomes as measured by number of embryos transferred, live birth rate, and multiple pregnancy rate in an academic infertility clinic located in a state with no insurance mandate.Materials and MethodsWomen who underwent IVF with a fresh embryo transfer from 2016-2018 were asked to complete an email survey with questions about their access to work leave, type of work leave, ease of requesting leave, and impact of taking leave on their work. IVF outcomes were collected from the clinic’s SART data set and demographics were collected from both the SART data and clinic records.ResultsOf the 409 cycles identified during the study period, 335 had email addresses and were contacted. 69 responses were received (20.5% response rate). 46 patients reported having access to leave during IVF, 17 patients reported not having access, and 6 patients did not require leave (unemployed or self-employed). Patients without leave transferred 1.4 embryos per cycle, had a live birth rate of 52.9%, and 17.6% of cycles resulted in multiple pregnancies. In patients with leave, 1.6 embryos were transferred per cycle, the live birth rate was 50%, and the rate of multiple pregnancies was 13%. There are no statistically significant differences between the groups for any of the outcomes. There is a significant difference (0.0342) in the percentage of patients that believe time off for IVF affected their work, 65% of patients in the group without access to leave felt time off affected their work compared to 35% of the group with leave.ConclusionsThe present study found no difference in IVF outcomes based on patient access to work leave during treatment, however it suggests that limited access to leave could be a barrier, preventing people from receiving appropriate fertility treatment. Research investigating the barriers that limit access to care serves as an important tool to help address the socioeconomic discrepancies that exist with infertility treatment.