Obstetrics and Gynecology International最新文献

Objective: To evaluate the maternal demographics, incidence, perinatal outcomes, and characteristics of babies born before arrival (BBAs) to hospitals.

Methods: A prospective, observational study was conducted at a large maternity unit in Durban, KwaZulu-Natal. A total of 200 mothers who attended the hospital within 24 hours of an out-of-hospital birth were recruited and interviewed, and 142 participants were eligible. A total of 128 mothers who delivered their babies in hospital (inborns) were used as the control group. Specific maternal and neonatal characteristics were analysed.

Results: The incidence of BBAs was 2.2%. The percentage of premature neonates in the BBA group was 54% vs 17.9% for inborns (p ≤ 0.001). A total of 33.8% of BBA mothers were unbooked vs 2.4% of inborns (p ≤ 0.001). The majority (59%) of inborns were primigravidas whereas the majority (73.9%) in the BBA group were multigravidas (p ≤ 0.001). Women in the BBA group were more prone to genital tears (p ≤ 0.001). There were no significant differences in respect of NICU admission and all-cause mortality; however, an increased risk for hypothermia and hypoglycaemia was found.

Conclusion: BBAs are at a significant risk of prematurity, low birth weight, hypothermia, and hypoglycaemia and are prone to longer hospital stays.

Background: Home delivery is childbirth in a nonclinical setting that takes place in a residence rather than in a health institution. Maternal morbidity and mortality are global health challenges, and developing countries contribute to most of the maternal deaths.

Objective: This study aimed to assess the extent and associated factors for home delivery in Serbo, Kersa Woreda, Jimma Zone, Southwest Ethiopia.

Method: A community-based cross-sectional study was employed among the 240 study participants. Data were collected by using systematic sampling technique from July 5 to 26, 2021, via a pretested semistructured questionnaire through face-to-face interview, and analyzed by a statistical package for the social sciences version 23.0. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with the extent of home delivery, and factors associated with the extent of home delivery were declared at a p value <0.05.

Result: In this study, the extent of home delivery was 28.7%. Identified factors statically associated with home delivery were low monthly income (AOR = 16.7, 95% CI: (2.028-13,83)), only the husband as the decision-maker (AOR = 5.0, 95% CI: (1.252-20.021)), never had a history of ANC follow-up (AOR = 5.7, 95% CI: (2.358-16.3)), poor knowledge toward delivery service (AOR = 3.0, 95% CI: (1.661-5.393)), negative attitude toward delivery service (AOR = 2.2, 95% CI: (1.054-4.409)), and large family size (AOR = 2.2, 95% CI: (1.187-4,119)).

Conclusion: When compared to the Ethiopian Demographic and Health Survey 2016, the prevalence of home delivery among women who gave birth in the last one year was low in this study. The study participants' identified factors that were significantly linked with home delivery were low monthly income, only husband as decision maker, no ANC follow-up, poor knowledge of delivery services, negative attitude toward delivery services, and large family size. Health professionals and health extension workers should raise awareness about institutional delivery and birth readiness so that women can give birth at a health facility even if labor begins unexpectedly.

Background: Annually, around 121 million unintended pregnancies occur in the world and more than 73 million encountered abortion. Ethiopia is also losing 19.6% of mothers due to unsafe abortion. Despite that postabortion contraceptive service is a climactic entry point for the prevention of unwanted pregnancy and associated deaths, the service magnitude and determinants immediately before discharge are not characterized well in Ethiopia. Hence, this study aimed to assess the magnitude of postabortion contraceptive utilization and associated factors among women receiving abortion care service before being discharged from health facilities in Harar, Eastern Ethiopia.

Methods: A facility-based cross-sectional study was conducted among 390 women receiving abortion care services. At discharge, data about contraceptive acceptance and related maternal characteristics were collected. A binary logistic regression model was used to assess the association between independent and dependent variables (postabortion contraceptive utilization). Analysis was done with SPSS 22. Statistical significance was considered at P < 0.05.

Result: The overall prevalence of postabortion contraceptive utilization was 81.5% (95% CI: 77.9, 85.4). Being unmarried (AOR, 0.05; 95% CI (0.02, 0.16)), having no history of previous abortion (AOR, 0.11; 95% CI (0.04, 0.34)), being multigravida (AOR 8.1; 95% CI (2.20, 13.40), lacking desire to have an additional child (AOR, 6.3; 95% CI (2.65, 15.34), and history of family planning use (AOR, 17.20; 95% CI (6.5, 38.60)) were determinants of postabortion contraceptive utilization before being discharged from the health facilities.

Conclusion: Postabortion contraceptive utilization in Harar health facilities still needs improvement as per the WHO and national recommendations. Therefore, the family planning provision strategies should be convincing and friendly, especially for unmarried mothers, and those who had no history of abortion should be counseled in friendly and systematically convincing schemes for enabling them to take the service before discharge from the health facility.

Purpose: We aim to determine the predictive value of endometrial thickness by transvaginal ultrasonography (TVS) in diagnosing endometrial pathology and to evaluate whether Doppler complements its diagnostic efficacy in perimenopausal women with abnormal uterine bleeding.

Methods: This cross-sectional observational study was conducted among 70 perimenopausal women with AUB who underwent TVS measurement of endometrial thickness (ET) and Doppler flow indices followed by endometrial sampling and histopathological examination (HPE).

Results: In HPE, 51 (73%) women had normal diagnosis while 19 (27%) women had neoplastic histology either benign or malignant. They were categorised into group I and group II, respectively. There was a significant difference in age (P=0.001) and incidence of obesity (P=0.01) between the two groups. The ETs measured in group I and group II were 7.89 ± 2.62 mm and 14.07 ± 3.96 mm, respectively, with significant difference (P < 0.001). A TVS-ET of 10.5 mm had the highest sensitivity and specificity of 89.5% and 86.3%, respectively, PPV of 70.68%, NPV of 95.68%, LR+ of 6.52, and LR- of 0.12. Doppler flow velocimetric study of endometrial and uterine vessels did not demonstrate a significant difference.

Conclusions: Women in perimenopause with AUB should be offered to undergo endometrial sampling for histopathological examination if TVS ET ≥10.5 mm. The coexisting risk factors especially higher age (>45 years) and obesity (BMI>30) significantly escalate the chances of developing endometrial pathology.

This investigation was performed in Kota Kinabalu, Sabah state, where the highest number of pregnancies is recorded. The purpose of this study was to determine variables associated with hazardous sexual activity and adolescent pregnancy in Sabah, Malaysia. The findings indicate that familial variables, peer interactions, self-esteem, psychiatric concerns, economic considerations, and sex knowledge all play a significant role in hazardous sexual conduct and adolescent pregnancy in Sabah, Malaysia. Information obtained from this study will help the Malaysian government and other officials to design and establish proper interventions that will help alleviate the challenge of high prevalence of teenage pregnancy. It is suggested that sex education be included in the high school curriculum, along with physical and health education in Sabah, Malaysia.

Background: Real-world evidence of the efficacy and safety of ferric carboxymaltose (FCM) infusion in Indian pregnant women with iron deficiency anemia (IDA) is lacking.

Objective: To assess the efficacy and safety of intravenous (IV) FCM in Indian pregnant women with IDA in 4 weeks in a real-life scenario.

Methods: This is a subgroup analysis of our previously conducted retrospective, multicenter, observational, real-world PROMISE study. Data on demographic and hematological parameters, patient-reported adverse events, and physicians' clinical impressions of efficacy and safety were analysed at 4 ± 1 week.

Results: This subgroup analysis included 1191 pregnant women in whom IV FCM resulted in a significant increase in hemoglobin (Hb) by 2.8 g/dL and serum ferritin by 30.03 μg/L at 4 weeks (P < 0.001 for both). In 103 pregnant women with severe IDA, there was a significant increase in Hb by 3.6 g/dL (P < 0.001), and serum ferritin by 16.96 μg/L (P=0.12). In 978 pregnant women with moderate IDA, significant improvement in Hb by 2.74 g/dL and serum ferritin by 33 μg/L (P < 0.001 for both) was noted. Similarly, there was a significant increase in red blood cell count, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin (P < 0.001 for all). In pregnant women with mild IDA (n = 26), Hb increased significantly by 1.99 g/dL (P < 0.001). Adverse effects were reported in 8.6% of pregnant women. No new safety signals or serious adverse effects were observed. Based on physicians' global assessment, good to very good efficacy and safety of IV FCM was noted in 99.2% and 98.6% of pregnant women, respectively.

Conclusions: IV FCM rapidly corrected anemia in a short period of 4 weeks with favorable safety in the second and third trimester of pregnancy with all severities of IDA (severe, moderate, and mild). The physicians' favorable global assessment of FCM's efficacy and safety in pregnant women with IDA supports its use in daily clinical practice. This trial is registered with CTRI/2021/12/039065.

Background: World Health Organization strongly recommends that every obstetrical provider at birth needs to have knowledge and skills on active management of the third stage of labor and use it routinely for all women. However, implementation of this lifesaver intervention by skilled birth attendants is questionable because 3% to 16.5% of women still experience postpartum hemorrhage. Even though coverage of giving births at health facilities in Ethiopia increases, postpartum hemorrhage accounts for 12.2% of all maternal deaths occurring in the country. Lack of the necessary skills of birth attendants is a major contributor to these adverse birth outcomes.

Objectives: This study aimed to assess the active management of the third stage of labor practice and associated factors among obstetric care providers.

Methods: An institution-based cross-sectional study design was applied from March 15 to April 15, 2020. Multistage sampling techniques were used to get 254 participants, and data were collected using self-administered structured questionnaires and an observation checklist. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. The multivariable logistic regression model was used at 95% confidence interval with P value <0.05. Among the 232 providers participating in the study, only 75 (32.3%) of respondents had a good practice. The practice of the provider was significantly associated with work experience (adjusted odd ratio 0.206 (95% confidence interval, 0.06-0.63)), knowledge (adjusted odd ratio (2.98 (95% confidence interval, 1.45-6.14)), the presence of assistance (adjusted odd ratio 2.04 (95% confidence interval, 1.06-3.93)), and time of uterotonic drug preparation (adjusted odd ratio 4.69 (95% confidence interval, 2.31-9.53)).

Conclusion: Only one-third of obstetric care providers had good practice during active management of third stage of labor. Practice was significantly associated with work experience, knowledge, the presence of assistance during third-stage management, and time of uterotonic drug preparation. Consistent and sustainable on job training and clinical audit should be applied in all facilities with regular supportive supervision and monitoring. Furthermore, team work and adequate preparation should be done to facilitate the management of active third stage of labor.

Objectives: The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation.

Materials and methods: This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute.

Results: Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31-36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8-21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58-17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38-15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20-14.3).

Conclusion: Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.

Background: Poor maternal health indices, including high maternal mortality, are among Nigeria's major public health problems. Most of these deaths can be prevented by timely access and utilization of maternity healthcare services by women. Aim/Objective. This study seeks to identify factors affecting the utilization of health facilities for the delivery of babies among mothers in Calabar, Cross River State, Nigeria. Methodology. The study was a community-based cross-sectional study. A structured questionnaire was administered to 422 women of reproductive age residents in the study area who had given birth at least once within the last five years prior to the survey using a multistage random sampling technique. Data generated were entered, coded, and analyzed using Statistical Packages for Social Sciences (SPSS version 22.0), and results were presented in tables and charts. Chi-squared tests and multiple logistic regression were used for the identification of variables associated with health facility-based delivery.

Result: The mean age of respondents was 27.3 years (SD = 8.4). Fifty-two percent of the respondents utilized the health facility for delivery, 89.6% attended at least one antenatal clinic (ANC), and 18.9% completed at least 3 ANC sessions. There was a statistically significant association between health facility delivery and marital status (P=0.007), education (P=0.042), and family size (P=0.002). Older women (OR = 0.7, CI = 0.169-3.714), Christians (OR = 1.9, CI = 0.093-41.1), divorcees (OR = 3.7, CI = 0.00-0.00), and respondents who registered early (first trimester) for ANC (OR = 4.9, CI = 0.78-31.48) were found to be higher users of delivery services at the health facility.

Conclusion: Community health intervention focusing on improving the knowledge and awareness of the significance of utilizing available delivery services at the healthcare facility should be developed and implemented.

This study is a retrospective cohort review carried out at a single, private tertiary center. We included 190 female patients who underwent surgery for acute appendicitis between January 2016 and December 2018. Two groups of patients were analyzed based on the pregnancy. The main outcome measures were complication rate and risk of abortion during or after surgery. Out of 190 female patients, eight of them were pregnant (4.2%). The pregnant group more significantly underwent ultrasound investigation compared to the nonpregnant group. Complicated appendicitis present in two pregnant patients at advanced gestational age was not statistically significant from nonpregnant. Laparoscopic appendectomy was performed in 6/8 (75%) of pregnant compared to 158/182 (87%) in nonpregnant (p = 0.415). Compared to the nonpregnant, the pregnant group has a more fecolith, positive peritoneal fluid culture, and wound infection, with E. coli more frequently isolated in 25%. None of the pregnant patients had an abortion, preterm labor, or mortality during or after surgery. In conclusion, laparoscopic appendectomy is a low-risk operation for pregnant with acute appendicitis.