Treatment Of Obstetric Complications Research Articles

Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India

BackgroundExpansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time.MethodsUtilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel ‘Maternal Health Service Coverage Index’ (MHSI) for 29 states and 5 union territories of India for the base (2017–18) and reference (2019–20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year.ResultsIndia registered the highest mean percentage coverage (93.7%) for ‘institutional delivery’ and the lowest for ‘treatment for obstetric complications’ (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015—0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition.ConclusionOverall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Analisis Faktor Penyebab Asfiksia Pada Bayi Baru Lahir Di Rsud Siti Aisyah Kota Lubuklinggau

Background : Asphyxia neonatorum is an emergency in infants caused by a lack of oxygen supply and an increase in carbon dioxide in the lungs which results in death. Good antenatal care and delivery assistance by health workers are highly recommended for early detection and treatment of obstetric complications that may occur in pregnant women and newborns. The purpose of this research is Studi analysis of the factors causing asphyxia in newborns at the Siti Aisyah Hospital. Methods: This study uses an analytical survey method with a case control approach.The sampling technique in this study used systematic random sampling, the samples in this study was 206 Respondens. Analysis data used univariate and bivariate analysis. statistical test using chi square. Results: The results of the study showed that there was a relationship between preeclampsia, premature delivery, post-term delivery, and the second (two) long stage with the incidence of asphyxia in newborns with a value of 0.000, this value < 0.05. Conclusion: Asphyxia neonatorum is serious and threatens the baby's life, so good knowledge is needed for mothers in routinely carrying out antenatal care and assisting health workers for pregnant women who check their wombs.

Management and referral for high-risk conditions and complications during the antenatal period: knowledge, practice and attitude survey of providers in rural public healthcare in two states of India

BackgroundAppropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers’ perspectives on management and referrals of antenatal women with high obstetric risk, or with complications.MethodsWe surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications.ResultsStaff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers.ConclusionThe Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support.

Synthesis and in vitro characterization of oxytocin receptor targeted PEGylated immunoliposomes for drug delivery to the uterus

Targeted delivery of therapeutics to the uterus is an important goal in the treatment of obstetric complications, such as preterm labour, postpartum hemorrhage, and dysfunctional labour. Current treatment for these obstetric complications is challenging, as there are limited effective and safe therapeutic options available. We have developed a targeted drug delivery system for the uterus by conjugating anti-oxytocin receptor (OTR) antibodies to the surface of PEGylated liposomes (OTR-PEG-ILs). The functionality of the OTR-PEG-ILs has previously been evaluated on human and murine myometrial tissues as well as in vivo in a murine model of preterm labour. The aim of this study was to report the pharmaceutical synthesis and characterization of the OTR-PEG-ILs and investigate their specific cellular interaction with OTR-expressing myometrial cells in vitro. Immunoliposomes composed of 1,2-distearoyl-sn-glycero-2-phosphocholine (DSPC) and cholesterol were prepared using an optimized method for the coupling of low concentrations of antibody to liposomes. The liposomes were characterized for particle size, antibody conjugation, drug encapsulation, liposome stability, specificity of binding, cellular internalization, mechanistic pathway of cellular uptake, and cellular toxicity. Cellular association studies demonstrated specific binding of OTR-PEG-ILs to OTRs and significant cellular uptake following binding. Evaluation of the mechanistic pathway of cellular uptake indicated that they undergo internalization through both clathrin- and caveolin-mediated mechanisms. Furthermore, cellular toxicity studies have shown no significant effect of OTR-PEG-ILs or the endocytotic inhibitors on cell viability. This study further supports oxytocin receptors as a novel pharmaceutical target for drug delivery to the uterus.

The use of pain relief during labor among migrant obstetric populations

ObjectiveTo identify patterns in intrapartum analgesia use in the migrant obstetric population. MethodsA retrospective analysis included all deliveries with neonates above 500g in weight at a university hospital in Dublin, Ireland between 2009 and 2013. Analgesia was classified as neuraxial or non-neuraxial. Parturients were excluded owing to missing data, elective cesarean deliveries, and the use of analgesia during treatment for obstetric complications. ResultsThere were 36 689 deliveries included in the present study. Increased odds of not using neuraxial analgesia during delivery were observed among migrant parturients from North Africa, Sub-Saharan Africa, the Far East, India, and Eastern Europe compared with western Europe (all P<0.05). Increased odds of not receiving any analgesia during delivery were demonstrated among parturients from North Africa, Sub-Saharan Africa, the Far East, North America, Eastern Europe, and India compared with western Europe (all P<0.05). ConclusionsDisparities exist in the use of intrapartum analgesia between migrant and western European populations in Ireland. Migrants from Africa were the least likely to use any analgesia. The reasons for this are speculative but could be influenced by expectations of care in the region of origin.

Author's response to ‘Statins for the treatment of obstetric complications in Antiphospholipid Syndrome?’

Author's response to ‘Statins for the treatment of obstetric complications in Antiphospholipid Syndrome?’

Adolescents' Use of Maternal and Child Health Services in Developing Countries

Because of high levels of early childbearing in developing countries, pregnancy and childbirth are the leading causes of death among women aged 15-19. Use of skilled antenatal and delivery care improves maternal outcomes through the prevention, management and treatment of obstetric complications, and infant immunizations prevent many childhood diseases. Logistic regression analysis of Demographic and Health Survey data for 15 developing countries examined adolescents' use of antenatal care, delivery care and infant immunization services compared with use by older women. In general, the use of maternal and child health care did not vary by mother's age. In five of the 15 countries, women aged 18 or younger were less likely than women aged 19-23 to use either antenatal care or delivery care, or both (odds ratios, 0.5-0.9). Younger mothers in six countries were less likely than older mothers to have their infants immunized, particularly for diphtheria, pertussis and tetanus and for measles (0.5-0.8). The association of age and health care use was largely limited to Bangladesh, India, Indonesia, Nicaragua, Peru and Uganda. In Latin America, controlling for parity allowed differences between adolescents and older women to emerge. Except in Uganda, there were no differences in health care use by mother's age in the African countries. Country-specific investigations are needed in Asia to better understand the reasons for differences in service use by age. In general, further systematic evidence would help identify long-term interventions that will be most effective in increasing adolescents' use of maternal and child health services.

Combined retinal artery and vein occlusion in a patient with systemic lupus erythematosus and antiphospholipid syndrome

Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects women, particularly those of childbearing age. Consequently, pregnancy and its outcome are of particular importance in this condition. Despite recent advances in the treatment of obstetric complications in women with SLE, the disease remains associated with significant fetal and maternal morbidity. 1 Retinopathy is one of the most important manifestations of SLE, with a reported incidence of 7% 2 to 26%. 3 Histologic evidence of immune-mediated vasculitis has also been reported in lupus retinopathy. 4

Community education to improve utilization of emergency obstetric services in Ghana

Preliminary studies: Focus group studies in the Ashanti region showed that people avoided utilizing health facilities because of lack of confidence in the services and concern about the availability of drugs and supplies, among other reasons. Interventions: After services at the health center were upgraded, community education activities began in early 1994. These activities were carried out through existing mechanisms — e.g. Ministry of Health (MOH) outreach workers and village health workers, public health nurses and midwives, and village health committees. They addressed a variety of audiences, including women's and church groups, emphasizing early recognition and treatment of obstetric complications, and the improved availability of services. Results: The number of women with obstetric complications admitted to the health center rose from 26 in 1993 to 73 in 1995. It was the impression of the health center staff that women were also coming for treatment more promptly. Costs: The cost of this intervention was US$1950. This was mostly project funds, with the government and community together contributing approximately one-fifth. Conclusions: Once services are available, community education and information activities can enhance utilization. The cost of such activities can be reduced, and sustainability promoted, by involving MOH personnel and community groups.© 1997 International Federation of Gynecology and Obstetrics