Pub Date : 2026-02-01DOI: 10.1016/j.xagr.2025.100600
Edna Chacha MMED , Charles Muteshi MMED , Felix Oindi MMED , Elsie Wandera MBA
Background
Endometriosis affects up to 10% of reproductive-age women and significantly impairs quality of life including sexual function, intimate relationships, fertility, and psychological wellbeing. While its impact has been extensively studied in Western populations, there is limited Sub-Saharan African data exploring how the disease affects female sexual health and distress. This study aimed to assess sexual function and sexual distress among women with endometriosis at a tertiary hospital in Kenya.
Methods
A cross-sectional study was conducted involving 108 women aged 18 to 49 with confirmed endometriosis from January to June 2022. The study used validated self-administered questionnaires: Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Descriptive and inferential statistics were applied using SPSS v25.
Findings
Female sexual dysfunction (FSFI≤26.55) was observed in 76.9% of participants, with the most affected domains being arousal, orgasm, and pain. Sexual distress (FSDS-R≥11.5) was identified in 65.7%. Sociodemographic factors such as marital status, parity, residence, and prior live birth were significantly associated with dysfunction (P < 0.05).
Interpretation
Sexual dysfunction and distress are common among Kenyan women with endometriosis, underscoring the need for holistic care strategies that integrate medical and psychosocial support.
{"title":"Sexual dysfunction in women with endometriosis in a low-middle-income country","authors":"Edna Chacha MMED , Charles Muteshi MMED , Felix Oindi MMED , Elsie Wandera MBA","doi":"10.1016/j.xagr.2025.100600","DOIUrl":"10.1016/j.xagr.2025.100600","url":null,"abstract":"<div><h3>Background</h3><div>Endometriosis affects up to 10% of reproductive-age women and significantly impairs quality of life including sexual function, intimate relationships, fertility, and psychological wellbeing. While its impact has been extensively studied in Western populations, there is limited Sub-Saharan African data exploring how the disease affects female sexual health and distress. This study aimed to assess sexual function and sexual distress among women with endometriosis at a tertiary hospital in Kenya.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted involving 108 women aged 18 to 49 with confirmed endometriosis from January to June 2022. The study used validated self-administered questionnaires: Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Descriptive and inferential statistics were applied using SPSS v25.</div></div><div><h3>Findings</h3><div>Female sexual dysfunction (FSFI≤26.55) was observed in 76.9% of participants, with the most affected domains being arousal, orgasm, and pain. Sexual distress (FSDS-R≥11.5) was identified in 65.7%. Sociodemographic factors such as marital status, parity, residence, and prior live birth were significantly associated with dysfunction (<em>P</em> < 0.05).</div></div><div><h3>Interpretation</h3><div>Sexual dysfunction and distress are common among Kenyan women with endometriosis, underscoring the need for holistic care strategies that integrate medical and psychosocial support.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100600"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The burden of cervical cancer continues to grow in many limited-resource regions of the world. It is the third most common cancer in Ghana, and the second most common malignancy among women, with most cases detected at a late stage, leading to poor clinical outcomes. Cervical cancer is preventable through vaccination against human papillomavirus (HPV) infection and screening for precancerous lesions. However, preventive interventions in Ghana face several challenges, including limited infrastructure, financial constraints and human resource shortages. The uptake of HPV vaccination and cervical cancer screening remains low, with certain population groups, particularly women with disabilities being disproportionately affected by cervical cancer. Women with disabilities in Ghana encounter multiple systemic barriers to accessing cervical cancer screening services, including inaccessible healthcare facilities, the absence of disability-sensitive medical equipment and suboptimal communication with healthcare providers. These challenges contribute to markedly low screening uptake among this population, potentially leading to delayed diagnoses and poor clinical outcomes. The article highlights the critical need for focused research to inform the development of inclusive and equitable cervical cancer prevention and control strategies tailored to the needs of women with disabilities in Ghana.
{"title":"Cervical cancer screening in women with disabilities in Ghana: bridging the gap in access and equity","authors":"Yvonne Nartey PhD , Judith Osae-Larbi PhD , Joseph Daniels MD","doi":"10.1016/j.xagr.2025.100597","DOIUrl":"10.1016/j.xagr.2025.100597","url":null,"abstract":"<div><div>The burden of cervical cancer continues to grow in many limited-resource regions of the world. It is the third most common cancer in Ghana, and the second most common malignancy among women, with most cases detected at a late stage, leading to poor clinical outcomes. Cervical cancer is preventable through vaccination against human papillomavirus (HPV) infection and screening for precancerous lesions. However, preventive interventions in Ghana face several challenges, including limited infrastructure, financial constraints and human resource shortages. The uptake of HPV vaccination and cervical cancer screening remains low, with certain population groups, particularly women with disabilities being disproportionately affected by cervical cancer. Women with disabilities in Ghana encounter multiple systemic barriers to accessing cervical cancer screening services, including inaccessible healthcare facilities, the absence of disability-sensitive medical equipment and suboptimal communication with healthcare providers. These challenges contribute to markedly low screening uptake among this population, potentially leading to delayed diagnoses and poor clinical outcomes. The article highlights the critical need for focused research to inform the development of inclusive and equitable cervical cancer prevention and control strategies tailored to the needs of women with disabilities in Ghana.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.xagr.2025.100595
Emily Gray MD , Mary M. Brown PhD , Christy G. Woolcott PhD , John Fahey MMath , Victoria M. Allen MD, MSc , Heather M. Scott MD , Sarka Lisonkova MD, PhD , Azar Mehrabadi PhD
Background
Previous literature suggests that pregnant individuals with obesity have fewer planned and successful vaginal births following a previous cesarean delivery. Concern is growing that discrimination based on body mass index (BMI) and comorbidities associated with BMI, rather than BMI itself, are primarily responsible for these findings.
Objective
To describe disparities in planning and having a successful vaginal delivery after a previous cesarean delivery by BMI status.
Study Design
This population-based cohort study included all singleton pregnancies ≥37 weeks’ gestation from 2003 to 2021 in Nova Scotia, Canada, with one previous cesarean and without contraindications for a trial of labor. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, incorporating inverse probability weighting to account for confounding by demographic characteristics and co-morbidities.
Results
Among 12 646 deliveries, approximately 31% experienced pre-pregnancy obesity. Of those with obesity, 34% planned a vaginal birth compared to 44% of those without obesity (aRR: 0.82, 95% CI: 0.78, 0.86). Higher BMI classification was associated with a reduced likelihood of planned vaginal delivery: class I: 37%, aRR: 0.88 (95% CI: 0.82, 0.94); class II: 32%, aRR: 0.81 (95% CI: 0.74, 0.89); class III: 26%, aRR 0.65 (95% CI: 0.56, 0.75). Among those planning a vaginal delivery, those with obesity were less likely to have a vaginal birth compared to those without obesity (57% vs 69%; aRR: 0.87, 95% CI: 0.82, 0.92); successful vaginal birth was less likely as BMI increased.
Conclusion
Obesity was associated with reduced planned and successful vaginal delivery after a previous cesarean delivery and the association was most pronounced at higher BMI after accounting for demographic characteristics and co-morbidities. While discrimination based on BMI was unmeasured, notable disparities in planning and having a vaginal delivery by BMI suggest that training for health care providers and the availability of appropriate infrastructure may help optimize care for this population.
{"title":"Disparities in planned and successful vaginal delivery after a cesarean delivery by body mass index: a population-based cohort study","authors":"Emily Gray MD , Mary M. Brown PhD , Christy G. Woolcott PhD , John Fahey MMath , Victoria M. Allen MD, MSc , Heather M. Scott MD , Sarka Lisonkova MD, PhD , Azar Mehrabadi PhD","doi":"10.1016/j.xagr.2025.100595","DOIUrl":"10.1016/j.xagr.2025.100595","url":null,"abstract":"<div><h3>Background</h3><div>Previous literature suggests that pregnant individuals with obesity have fewer planned and successful vaginal births following a previous cesarean delivery. Concern is growing that discrimination based on body mass index (BMI) and comorbidities associated with BMI, rather than BMI itself, are primarily responsible for these findings.</div></div><div><h3>Objective</h3><div>To describe disparities in planning and having a successful vaginal delivery after a previous cesarean delivery by BMI status.</div></div><div><h3>Study Design</h3><div>This population-based cohort study included all singleton pregnancies ≥37 weeks’ gestation from 2003 to 2021 in Nova Scotia, Canada, with one previous cesarean and without contraindications for a trial of labor. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, incorporating inverse probability weighting to account for confounding by demographic characteristics and co-morbidities.</div></div><div><h3>Results</h3><div>Among 12 646 deliveries, approximately 31% experienced pre-pregnancy obesity. Of those with obesity, 34% planned a vaginal birth compared to 44% of those without obesity (aRR: 0.82, 95% CI: 0.78, 0.86). Higher BMI classification was associated with a reduced likelihood of planned vaginal delivery: class I: 37%, aRR: 0.88 (95% CI: 0.82, 0.94); class II: 32%, aRR: 0.81 (95% CI: 0.74, 0.89); class III: 26%, aRR 0.65 (95% CI: 0.56, 0.75). Among those planning a vaginal delivery, those with obesity were less likely to have a vaginal birth compared to those without obesity (57% vs 69%; aRR: 0.87, 95% CI: 0.82, 0.92); successful vaginal birth was less likely as BMI increased.</div></div><div><h3>Conclusion</h3><div>Obesity was associated with reduced planned and successful vaginal delivery after a previous cesarean delivery and the association was most pronounced at higher BMI after accounting for demographic characteristics and co-morbidities. While discrimination based on BMI was unmeasured, notable disparities in planning and having a vaginal delivery by BMI suggest that training for health care providers and the availability of appropriate infrastructure may help optimize care for this population.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100595"},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xagr.2025.100594
Benjamin David Habikigeni MD, Uwimana Muhuza Marie Parfaite MD, Emmanuel Edwar Siddig PhD, MBBS, Victor Mivumbi Ndicunguye MD
Adolescent sexual and reproductive health and rights (SRHR) are critical to ensuring the well-being and empowerment of young people, particularly in low-resource settings like Rwanda. Despite progressive policies and commitments aligned with global frameworks such as the Sustainable Development Goals, adolescents in Rwanda face persistent barriers including cultural stigma, gender inequalities, geographic disparities, and infra-structural limitations that hinder access to comprehensive SRHR services. This commentary critically examines Rwanda’s policy landscape, highlights key challenges in implementation, and explores disparities based on gender, location, and disability. It emphasizes the urgent need for multisectoral, community-engaged strategies, improved data systems, and targeted interventions to close critical gaps. Strengthening the operationalization of policies and fostering youth participation are essential to advancing adolescent SRHR and realizing their full rights in Rwanda’s journey toward health and development equity.
{"title":"A critical evaluation of adolescent sexual and reproductive health and rights in Rwanda","authors":"Benjamin David Habikigeni MD, Uwimana Muhuza Marie Parfaite MD, Emmanuel Edwar Siddig PhD, MBBS, Victor Mivumbi Ndicunguye MD","doi":"10.1016/j.xagr.2025.100594","DOIUrl":"10.1016/j.xagr.2025.100594","url":null,"abstract":"<div><div>Adolescent sexual and reproductive health and rights (SRHR) are critical to ensuring the well-being and empowerment of young people, particularly in low-resource settings like Rwanda. Despite progressive policies and commitments aligned with global frameworks such as the Sustainable Development Goals, adolescents in Rwanda face persistent barriers including cultural stigma, gender inequalities, geographic disparities, and infra-structural limitations that hinder access to comprehensive SRHR services. This commentary critically examines Rwanda’s policy landscape, highlights key challenges in implementation, and explores disparities based on gender, location, and disability. It emphasizes the urgent need for multisectoral, community-engaged strategies, improved data systems, and targeted interventions to close critical gaps. Strengthening the operationalization of policies and fostering youth participation are essential to advancing adolescent SRHR and realizing their full rights in Rwanda’s journey toward health and development equity.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100594"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gestational trophoblastic disease is the term used to describe the heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. The clinical presentations of the gestational trophoblastic tumor include vaginal bleeding, uterine enlargement greater than expected for gestational age, hyperemesis, and secondary clinical hyperthyroidism. Less common presentations include pregnancy-induced hypertension in the first or second trimester of pregnancy and theca lutea cyst torsion. It is a rare incident to find uterine rupture because of a molar pregnancy. Most uterine ruptures reported so far were all malignant histologic types of the spectrum. This study presents a case of a ruptured uterus as a complication of complete molar pregnancy presenting with shock and severe anemia.
CASE PRESENTATION
A 37-year-old gravida 6, para 5 patient with a 5-month amenorrhea presented to the hospital with vaginal bleeding, abdominal pain, and symptoms of anemia. The patient’s hemoglobin level was 2.8 g/dL. Further assessment revealed a honeycomb-appearing endometrial mass and free fluid in the general peritoneum. The patient underwent emergency laparotomy, where a hysterectomy was performed for cornual uterine rupture. The patient was tested for serial serum human chorionic gonadotropin and declared cured after 6 months of observation.
CONCLUSION
Although rupture of the uterus is rare, a ruptured uterus in a molar pregnancy can be a catastrophic complication, presenting with massive hemoperitoneum and hemorrhagic shock. Hysterectomy, along with vascular filling with crystalloid and transfusion of blood products, can save a patient’s life. Patients can be followed by serial serum human chorionic gonadotropin (HCG) safely for any transformation to gestational trophoblastic neoplasia (GTN).
{"title":"Ruptured uterus: a rare and catastrophic complication of molar pregnancy","authors":"Ayalkibet Alemayehu Debele MD , Shimelis Fantu Gebresilasie MD , Solomon Elias Kefeni MD , Gelagay Zewudie Workineh MD , Eyerusalem Fissehatsion Dejene MD , Zekarias Dejene Adugna MD","doi":"10.1016/j.xagr.2025.100591","DOIUrl":"10.1016/j.xagr.2025.100591","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Gestational trophoblastic disease is the term used to describe the heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. The clinical presentations of the gestational trophoblastic tumor include vaginal bleeding, uterine enlargement greater than expected for gestational age, hyperemesis, and secondary clinical hyperthyroidism. Less common presentations include pregnancy-induced hypertension in the first or second trimester of pregnancy and theca lutea cyst torsion. It is a rare incident to find uterine rupture because of a molar pregnancy. Most uterine ruptures reported so far were all malignant histologic types of the spectrum. This study presents a case of a ruptured uterus as a complication of complete molar pregnancy presenting with shock and severe anemia.</div></div><div><h3>CASE PRESENTATION</h3><div>A 37-year-old gravida 6, para 5 patient with a 5-month amenorrhea presented to the hospital with vaginal bleeding, abdominal pain, and symptoms of anemia. The patient’s hemoglobin level was 2.8 g/dL. Further assessment revealed a honeycomb-appearing endometrial mass and free fluid in the general peritoneum. The patient underwent emergency laparotomy, where a hysterectomy was performed for cornual uterine rupture. The patient was tested for serial serum human chorionic gonadotropin and declared cured after 6 months of observation.</div></div><div><h3>CONCLUSION</h3><div>Although rupture of the uterus is rare, a ruptured uterus in a molar pregnancy can be a catastrophic complication, presenting with massive hemoperitoneum and hemorrhagic shock. Hysterectomy, along with vascular filling with crystalloid and transfusion of blood products, can save a patient’s life. Patients can be followed by serial serum human chorionic gonadotropin (HCG) safely for any transformation to gestational trophoblastic neoplasia (GTN).</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100591"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xagr.2025.100596
Muhammad Ilham Aldika Akbar MD, PhD, MME , Ernawati MD, PhD , Manggala Pasca Wardhana MD, PhD , Ruth Widhiati Raharjo Putri MD , Anak Agung Gede Putra Wiradnyana MD, PhD , Dhanny Primantara Johari Santoso MD , Wiku Andonotopo MD, PhD , Gustaaf Dekker MD, PhD, FDCOG, FRANZCOG , Rozi Aditya Aryananda , HKFM Preeclampsia Research Group
<div><h3>Background</h3><div>Hypertension during pregnancy, including preeclampsia (PE) and its severe complication, eclampsia, remains a primary cause of maternal mortality globally. Eclampsia is a critical complication of PE that severely impacts maternal and neonatal health. Evidence regarding outcomes in pregnancies complicated by eclampsia, especially in developing nations, is limited.</div></div><div><h3>Objective</h3><div>This study aimed to compare the maternal and perinatal outcomes in patients with preeclampsia, both with and without eclampsia.</div></div><div><h3>Study Design</h3><div>This was a national, multicenter, observational, retrospective cohort study conducted in Indonesia. Data were gathered from medical records of patients who delivered at 30 hospitals across five principal islands in Indonesia between January 2022 and December 2023. The study included 1,808 cases with complete data who met the inclusion criteria, consisting of all pregnancies impacted by PE that culminated in delivery at the research sites. The sample was classified into 2 groups: the eclampsia group (n=151) and the non-eclampsia group (n=1657). Primary outcomes examined included maternal outcomes (eg, severe morbidity, maternal mortality), intrapartum management, labor complications, and perinatal outcomes (eg, preterm birth, neonatal morbidity, neonatal death). Statistical analysis utilized SPSS version 29, employing independent t-tests or Mann-Whitney U tests for continuous data, and Chi-square or Fisher's exact tests for categorical variables, with results expressed as numerical percentages, mean ± SD, or median (minimum-maximum).</div></div><div><h3>Results</h3><div>The overall incidence of PE during the study period was 5.3% (6763 out of 127,604 births). Among PE patients with complete data (n=1808), the incidence of eclampsia was 8.35% (151 cases). Pregnant women with eclampsia were significantly younger, more frequently nulliparous, and had elevated diastolic blood pressure compared to the noneclamptic cohort (<em>p</em><.05). Eclampsia was associated with markedly greater maternal morbidity, including HELLP syndrome (27.8% vs 10.7%; RR: 2.85), hypertensive emergencies (35.1% vs 21.4%; RR: 1.80), CVA (2.0% vs 0.1%; RR: 18.01), and ICU admission (34.4% vs 13.2%; RR: 2.86) (<em>p</em><.05). The eclampsia cohort also had a higher likelihood of cesarean section delivery (95.4% vs 83.7%) and a markedly elevated incidence of seizures during labor (31.3% vs 0.0%). Perinatal morbidity was also greater in the eclampsia cohort, with increased preterm birth rates (52.3% vs 42.5%; RR: 1.35), lower absolute and percentile birth weight, lower Apgar scores at 1 minute (<7: 76.2% vs 46.3%; RR: 1.80) and 5 minutes (<7: 38.4% vs 21.5%; RR: 1.96), increased NICU admissions (32.2% vs 22.8%; RR: 1.59), and a greater prevalence of respiratory distress syndrome (RDS) (32.2% vs 12.9%; RR: 2.80), necrotizing enterocolitis (NEC) (4.7% vs 0.8%; RR: 7.00), and neon
{"title":"THE INAPRES (Indonesia Preeclampsia Study): impact of eclampsia on maternal and perinatal outcomes among women with preeclampsia: findings from a National Multicenter Cohort","authors":"Muhammad Ilham Aldika Akbar MD, PhD, MME , Ernawati MD, PhD , Manggala Pasca Wardhana MD, PhD , Ruth Widhiati Raharjo Putri MD , Anak Agung Gede Putra Wiradnyana MD, PhD , Dhanny Primantara Johari Santoso MD , Wiku Andonotopo MD, PhD , Gustaaf Dekker MD, PhD, FDCOG, FRANZCOG , Rozi Aditya Aryananda , HKFM Preeclampsia Research Group","doi":"10.1016/j.xagr.2025.100596","DOIUrl":"10.1016/j.xagr.2025.100596","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension during pregnancy, including preeclampsia (PE) and its severe complication, eclampsia, remains a primary cause of maternal mortality globally. Eclampsia is a critical complication of PE that severely impacts maternal and neonatal health. Evidence regarding outcomes in pregnancies complicated by eclampsia, especially in developing nations, is limited.</div></div><div><h3>Objective</h3><div>This study aimed to compare the maternal and perinatal outcomes in patients with preeclampsia, both with and without eclampsia.</div></div><div><h3>Study Design</h3><div>This was a national, multicenter, observational, retrospective cohort study conducted in Indonesia. Data were gathered from medical records of patients who delivered at 30 hospitals across five principal islands in Indonesia between January 2022 and December 2023. The study included 1,808 cases with complete data who met the inclusion criteria, consisting of all pregnancies impacted by PE that culminated in delivery at the research sites. The sample was classified into 2 groups: the eclampsia group (n=151) and the non-eclampsia group (n=1657). Primary outcomes examined included maternal outcomes (eg, severe morbidity, maternal mortality), intrapartum management, labor complications, and perinatal outcomes (eg, preterm birth, neonatal morbidity, neonatal death). Statistical analysis utilized SPSS version 29, employing independent t-tests or Mann-Whitney U tests for continuous data, and Chi-square or Fisher's exact tests for categorical variables, with results expressed as numerical percentages, mean ± SD, or median (minimum-maximum).</div></div><div><h3>Results</h3><div>The overall incidence of PE during the study period was 5.3% (6763 out of 127,604 births). Among PE patients with complete data (n=1808), the incidence of eclampsia was 8.35% (151 cases). Pregnant women with eclampsia were significantly younger, more frequently nulliparous, and had elevated diastolic blood pressure compared to the noneclamptic cohort (<em>p</em><.05). Eclampsia was associated with markedly greater maternal morbidity, including HELLP syndrome (27.8% vs 10.7%; RR: 2.85), hypertensive emergencies (35.1% vs 21.4%; RR: 1.80), CVA (2.0% vs 0.1%; RR: 18.01), and ICU admission (34.4% vs 13.2%; RR: 2.86) (<em>p</em><.05). The eclampsia cohort also had a higher likelihood of cesarean section delivery (95.4% vs 83.7%) and a markedly elevated incidence of seizures during labor (31.3% vs 0.0%). Perinatal morbidity was also greater in the eclampsia cohort, with increased preterm birth rates (52.3% vs 42.5%; RR: 1.35), lower absolute and percentile birth weight, lower Apgar scores at 1 minute (<7: 76.2% vs 46.3%; RR: 1.80) and 5 minutes (<7: 38.4% vs 21.5%; RR: 1.96), increased NICU admissions (32.2% vs 22.8%; RR: 1.59), and a greater prevalence of respiratory distress syndrome (RDS) (32.2% vs 12.9%; RR: 2.80), necrotizing enterocolitis (NEC) (4.7% vs 0.8%; RR: 7.00), and neon","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.xagr.2025.100598
Hoang Lam Vo MD, MSc , Lam Huong Le MD, PhD , Minh Phuong Nguyen MD, MSc , Tran Thao Nguyen Nguyen MD, PhD , Minh Tam Le MD, PhD , Vu Quoc Huy Nguyen MD, PhD
Background
Intra-abdominal adhesions are a common complication in repeat cesarean sections and can increase surgical risks and operative time. The ultrasound sliding sign is a non-invasive technique that may help predict adhesions by assessing the movement of the uterus relative to surrounding structures, offering a safer alternative to traditional diagnostic methods.
Objective
To evaluate the diagnostic accuracy of the transabdominal ultrasound sliding sign in predicting intra-abdominal adhesions and its association with maternal and neonatal outcomes in women undergoing repeat cesarean delivery in Vietnam.
Methods
This prospective observational study was conducted at the Obstetrics and Gynecology Center of Hue Central Hospital from April 2022 to December 2024. The study included 400 pregnant women with a previous cesarean section scar who underwent elective repeat cesarean delivery at or beyond 28 weeks of gestation. The sliding sign was assessed using transabdominal ultrasound during the third trimester. Intra-abdominal adhesions were classified intraoperatively by blinded surgeons according to Nair’s criteria as no (70.25%, 281/400), mild/moderate (13.25%,53/400), or severe (16.50%, 66/400) adhesions. A p-value of <.05 was considered statistically significant for all tests.
Results
The sliding sign showed strong diagnostic performance in predicting intra-abdominal adhesions. For adhesion, the area under the curve (AUC) was 79.29% (95% confidence interval [CI]: 73.91%–84.68%), sensitivity 68.91% (95% CI: 60.11–76.52), and specificity 89.68% (96% CI: 85.57–92.72). For severe adhesions, AUC was 83.48% (95% CI: 77.21–89.76), specificity was 89.68% (95% CI: 85.57–92.72) and the negative predictive value was 94.38% (95% CI: 91.96–96.80). The absence of the sliding sign was significantly more frequent in women with severe adhesions (51/66, 77.23%) compared to mild/moderate (31/53, 58.49%) and no adhesions (26/281, 10.32%) (p<.001). Operative time increasing with adhesion severity (p<.001). Intraoperative complications were infrequent but higher in adhesion group. Neonatal outcomes (birth weight, Apgar scores) showed no significant differences across groups (p=.605).
Conclusion
Transabdominal ultrasound assessment of the sliding sign provides a reliable, non-invasive method of predicting intra-abdominal adhesions prior to repeat cesarean delivery and is particularly useful for excluding severe adhesions. Its use can improve preoperative risk stratification, reduce maternal surgical risks, and maintain positive neonatal outcomes.
{"title":"Transabdominal ultrasound sliding sign for predicting intra-abdominal adhesions in repeat cesarean delivery: a prospective observational study from Vietnam","authors":"Hoang Lam Vo MD, MSc , Lam Huong Le MD, PhD , Minh Phuong Nguyen MD, MSc , Tran Thao Nguyen Nguyen MD, PhD , Minh Tam Le MD, PhD , Vu Quoc Huy Nguyen MD, PhD","doi":"10.1016/j.xagr.2025.100598","DOIUrl":"10.1016/j.xagr.2025.100598","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal adhesions are a common complication in repeat cesarean sections and can increase surgical risks and operative time. The ultrasound sliding sign is a non-invasive technique that may help predict adhesions by assessing the movement of the uterus relative to surrounding structures, offering a safer alternative to traditional diagnostic methods.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic accuracy of the transabdominal ultrasound sliding sign in predicting intra-abdominal adhesions and its association with maternal and neonatal outcomes in women undergoing repeat cesarean delivery in Vietnam.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted at the Obstetrics and Gynecology Center of Hue Central Hospital from April 2022 to December 2024. The study included 400 pregnant women with a previous cesarean section scar who underwent elective repeat cesarean delivery at or beyond 28 weeks of gestation. The sliding sign was assessed using transabdominal ultrasound during the third trimester. Intra-abdominal adhesions were classified intraoperatively by blinded surgeons according to Nair’s criteria as no (70.25%, 281/400), mild/moderate (13.25%,53/400), or severe (16.50%, 66/400) adhesions. A <em>p</em>-value of <.05 was considered statistically significant for all tests.</div></div><div><h3>Results</h3><div>The sliding sign showed strong diagnostic performance in predicting intra-abdominal adhesions. For adhesion, the area under the curve (AUC) was 79.29% (95% confidence interval [CI]: 73.91%–84.68%), sensitivity 68.91% (95% CI: 60.11–76.52), and specificity 89.68% (96% CI: 85.57–92.72). For severe adhesions, AUC was 83.48% (95% CI: 77.21–89.76), specificity was 89.68% (95% CI: 85.57–92.72) and the negative predictive value was 94.38% (95% CI: 91.96–96.80). The absence of the sliding sign was significantly more frequent in women with severe adhesions (51/66, 77.23%) compared to mild/moderate (31/53, 58.49%) and no adhesions (26/281, 10.32%) (<em>p</em><.001). Operative time increasing with adhesion severity (<em>p</em><.001). Intraoperative complications were infrequent but higher in adhesion group. Neonatal outcomes (birth weight, Apgar scores) showed no significant differences across groups (<em>p</em>=.605).</div></div><div><h3>Conclusion</h3><div>Transabdominal ultrasound assessment of the sliding sign provides a reliable, non-invasive method of predicting intra-abdominal adhesions prior to repeat cesarean delivery and is particularly useful for excluding severe adhesions. Its use can improve preoperative risk stratification, reduce maternal surgical risks, and maintain positive neonatal outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear.</div></div><div><h3>Objective</h3><div>The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH.</div></div><div><h3>Results</h3><div>One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500–1000 mL) occurred in 34 cases (44.7%), >1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (<em>r</em>=0.365, <em>P</em><.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, <em>P</em>=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07–1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (<em>n</em>=19) and after 30 gestational weeks (<em>n</em>=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in wh
几乎10%的孕妇被诊断为胎盘位置异常（PLA），包括前置胎盘和低位胎盘；然而，大多数PLA溶解为妊娠过程。尽管胎盘迁移，产后出血（PPH）往往经历在这些情况下。胎盘迁移时间与PPH风险之间的关系尚不清楚。目的探讨胎盘迁移时间与PPH的关系，并建立一个临界值，以准确预测妊娠期发生胎盘迁移的患者发生PPH的风险。研究设计：这是一项使用日本大阪大学医院电子病历的回顾性队列研究。22孕周后经阴道超声诊断为PLA的患者符合纳入条件。所有2009年至2022年间在我院分娩的患者。在观察到胎盘迁移（距宫颈内腔超过2cm）的情况下，仅在阴道分娩中使用多变量分析收集可能影响PPH的协变量，研究胎盘迁移时间与PPH之间的关系。根据结果，生成受试者工作特征曲线，以确定胎盘迁移周数的最佳截止时间，以预测PPH。结果2009年至2022年，我院共收治45例妊娠22周后诊断为PLA的产妇。分析了76例胎盘迁移后阴道分娩成功的病例。胎盘迁移的中位胎龄为32周，分娩时中位出血量为777 mL。PPH (500-1000 mL) 34例（44.7%），1000 mL 26例（34.2%）。在单因素分析中，胎盘迁移时间与出血量呈正相关（r=0.365, P< 0.01）。此外，多变量分析显示，胎盘迁移时间是预测出血量最重要的协变量（标准化偏回归系数：0.31，P= 0.0036）。此外，胎盘迁移的时间是PPH（超过500 mL）的重要风险因素（调整单位OR为1.26 [95% CI: 1.07-1.49]）。受试者工作特征曲线显示，预测PPH（大于500 mL）风险的胎盘迁移时间的中等截止时间为29妊娠周。29周前胎盘迁移组（n=19）和30周后胎盘迁移组（n=57）比较，30周后胎盘迁移组PPH（大于500 mL）的发生率显著高于30周后胎盘迁移组（52.6% vs 87.7%， P= 0.0012）。结论胎盘迁移时间与PPH的发生呈正相关。特别是，在妊娠30周后确认胎盘迁移的病例应仔细监测PPH的高风险，因为PPH的风险并未消除。
{"title":"The migration of placenta even after 30 gestational weeks is a risk factor for postpartum hemorrhage","authors":"Gaku Yamamoto MD , Kosuke Hiramatsu MD, PhD , Yoko Kawanishi MD, PhD , Mamoru Kakuda MD, PhD , Koji Nakamura MD, PhD , Tatsuya Miyake MD, PhD , Kazuya Mimura MD, PhD , Toshihiro Kimura MD, PhD , Masayuki Endo MD, PhD , Tadashi Kimura MD, PhD , Michiko Kodama MD, PhD","doi":"10.1016/j.xagr.2025.100593","DOIUrl":"10.1016/j.xagr.2025.100593","url":null,"abstract":"<div><h3>Background</h3><div>Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear.</div></div><div><h3>Objective</h3><div>The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH.</div></div><div><h3>Results</h3><div>One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500–1000 mL) occurred in 34 cases (44.7%), >1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (<em>r</em>=0.365, <em>P</em><.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, <em>P</em>=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07–1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (<em>n</em>=19) and after 30 gestational weeks (<em>n</em>=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in wh","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100593"},"PeriodicalIF":0.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.xagr.2025.100592
Josef Alexander Locher MBChB, MMED , Amy Wise MBBCh, MMED , Renate Strehlau MBBCh, PhD
<div><h3>Background</h3><div>Intimate hygiene practices during pregnancy can influence maternal and neonatal health outcomes. Limited data exist on these practices among South African women. This study aimed to characterize intimate hygiene practices among pregnant women in Johannesburg and examine associations with demographic factors and preterm birth.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted on data from 18,076 pregnant women enrolled in the Group B Streptococcus Correlates of Protection Cohort Study in Johannesburg, South Africa. Participants completed questionnaires detailing their intimate hygiene practices, including frequency, methods, and products used. Statistical analyses assessed the prevalence of these practices, their association with demographic characteristics (age, race, education, occupation, dwelling type, parity, and HIV status), and preterm birth outcomes.</div></div><div><h3>Results</h3><div>The mean age was 28.4 years (range 18–49). Most participants were Black (93.0%), single (80.4%), unemployed (64.7%), and resided in urban areas (70.7%). They reported a median intimate cleaning frequency of 14 times per week (IQR 8–14). Over half (53.3%) practiced douching, and 48.4% added products to their bathwater.</div><div>Race was significantly associated with adding bathwater products (<em>P</em><.00001). White women (44.3%) had the highest proportion adding products. Tertiary-educated mothers were more likely to add products (27.0%, <em>P</em>=.0041). Students had the highest rate of product use (28.7%, <em>P</em>=.0018). Urban participants were more likely to add products (25.2%) than semi-urban women (23.2%, <em>P</em>=.025).</div><div>Douching was also significantly associated with race (<em>P</em><.00001), with the “Other” category (65.1%) reporting the highest rate. Women with no schooling had the highest douching rate (53.2%, <em>P</em>=.0006). Semi-urban mothers douched the most frequently (53.4%, <em>P</em><.00001). Marital status was significantly associated with douching (<em>P</em><.00001), with the highest prevalence among single women (45.8%). Occupation was also significantly associated with douching (<em>P</em>=.016), with students having the highest douching prevalence (28.7%).</div><div>A significant association was observed between gestational age and the addition of products to bathwater for deliveries between 34 and <37 weeks compared to term deliveries (<em>P</em>=.045). Women who did not add products were more likely to deliver at term, while those who added products had a higher likelihood of delivering preterm. For deliveries <34 weeks compared to 34–<37 weeks, women who did not add products were more likely to deliver at 34–<37 weeks (<em>P</em>=.02).</div><div>For deliveries at <34 weeks compared to 34–<37 weeks, women who douched were less likely to deliver at <34 weeks, while those who did not douche had lower proportions of deliveries at
{"title":"Intimate hygiene practices during pregnancy with demographic and preterm birth associations: a large cohort study","authors":"Josef Alexander Locher MBChB, MMED , Amy Wise MBBCh, MMED , Renate Strehlau MBBCh, PhD","doi":"10.1016/j.xagr.2025.100592","DOIUrl":"10.1016/j.xagr.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Intimate hygiene practices during pregnancy can influence maternal and neonatal health outcomes. Limited data exist on these practices among South African women. This study aimed to characterize intimate hygiene practices among pregnant women in Johannesburg and examine associations with demographic factors and preterm birth.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted on data from 18,076 pregnant women enrolled in the Group B Streptococcus Correlates of Protection Cohort Study in Johannesburg, South Africa. Participants completed questionnaires detailing their intimate hygiene practices, including frequency, methods, and products used. Statistical analyses assessed the prevalence of these practices, their association with demographic characteristics (age, race, education, occupation, dwelling type, parity, and HIV status), and preterm birth outcomes.</div></div><div><h3>Results</h3><div>The mean age was 28.4 years (range 18–49). Most participants were Black (93.0%), single (80.4%), unemployed (64.7%), and resided in urban areas (70.7%). They reported a median intimate cleaning frequency of 14 times per week (IQR 8–14). Over half (53.3%) practiced douching, and 48.4% added products to their bathwater.</div><div>Race was significantly associated with adding bathwater products (<em>P</em><.00001). White women (44.3%) had the highest proportion adding products. Tertiary-educated mothers were more likely to add products (27.0%, <em>P</em>=.0041). Students had the highest rate of product use (28.7%, <em>P</em>=.0018). Urban participants were more likely to add products (25.2%) than semi-urban women (23.2%, <em>P</em>=.025).</div><div>Douching was also significantly associated with race (<em>P</em><.00001), with the “Other” category (65.1%) reporting the highest rate. Women with no schooling had the highest douching rate (53.2%, <em>P</em>=.0006). Semi-urban mothers douched the most frequently (53.4%, <em>P</em><.00001). Marital status was significantly associated with douching (<em>P</em><.00001), with the highest prevalence among single women (45.8%). Occupation was also significantly associated with douching (<em>P</em>=.016), with students having the highest douching prevalence (28.7%).</div><div>A significant association was observed between gestational age and the addition of products to bathwater for deliveries between 34 and <37 weeks compared to term deliveries (<em>P</em>=.045). Women who did not add products were more likely to deliver at term, while those who added products had a higher likelihood of delivering preterm. For deliveries <34 weeks compared to 34–<37 weeks, women who did not add products were more likely to deliver at 34–<37 weeks (<em>P</em>=.02).</div><div>For deliveries at <34 weeks compared to 34–<37 weeks, women who douched were less likely to deliver at <34 weeks, while those who did not douche had lower proportions of deliveries at ","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>BACKGROUND</h3><div>Postpartum hemorrhage continues to be a leading cause of maternal mortality globally. Although the E-MOTIVE bundle is an innovative approach for the early detection and management of postpartum hemorrhage that reduces maternal mortality by as high as 60%, its universal implementation in clinical practice in low-middle-income countries remains low.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine the effectiveness and acceptability of the E-MOTIVE bundle intervention in Ethiopia.</div></div><div><h3>STUDY DESIGN</h3><div>This was an implementation research on the E-MOTIVE bundle intervention for the early detection and treatment of postpartum hemorrhage using a mixed-method study design (pre- and postintervention quantitative study and cross-sectional qualitative study) in Ethiopia for over 22 months (June 2023 to February 2025). The primary outcome of the study was the rate of severe postpartum hemorrhage. The secondary outcomes were the detection of postpartum hemorrhage complications (such as blood transfusion, maternal death, admission to a high-dependency unit, and estimated blood loss) and the acceptability of the E-MOTIVE bundle approach. The participants of the quantitative study included pregnant women who delivered vaginally at St. Paul’s Hospital during the study period. Participants of the qualitative data were postpartum women who had the E-MOTIVE bundle approach applied during delivery, obstetrical care providers, maternity care coordinators, and representatives of nongovernmental organizations who focused on maternal care delivery. Quantitative data (including the characteristics of the E-MOTIVE bundle approach, occurrence of postpartum hemorrhage, and postpartum hemorrhage complication) were collected using a structured questionnaire, and qualitative data were collected using key informant interviews and focus group discussions (in-depth interviews and focused discussions focusing on the E-MOTIVE experience, attitude, and practice were conducted). Quantitative data were analyzed using simple descriptive statistics on IBM SPSS Statistics (version 23; IBM Corporation, Armonk, NY), and qualitative data were analyzed using thematic analysis on Scientific Software (ATLAS.ti.9.Ink; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).</div></div><div><h3>RESULTS</h3><div>There were a total of 2500 and 2225 vaginal deliveries during the preintervention and postintervention periods, respectively. Compared with the preintervention period, there was a significant reduction in severe postpartum hemorrhage (25.0% in the preintervention period vs 13.5% in the postintervention period) and complications of postpartum hemorrhage, including maternal death (laparotomy: 5.0% in the preintervention period vs 1.0% in the postintervention period; maternal death: one maternal death in the preintervention period vs no encounter of maternal death in the postintervention period) in the postinterven
{"title":"Feasibility, acceptability, and effectiveness of the E-MOTIVE bundle intervention for early detection and management of postpartum hemorrhage in a low-middle-income country: implementation research","authors":"Wondimu Gudu MD , Felagot Taddese Tefera MD , Aida Tilahun MD , Abrham Getachew MPH , Delayehu Bekele MD , Malede Birara MD , Mekitie Wondafrash MD , Kidist Lemma MD , Saron Teka MD , Yemisrach Mulugeta MD , Bethelhem Birhanu Tefera MD , Lemi Belay Tolu MD , Mebratu Abraha MPH , Abraham Fessehaye Sium MD","doi":"10.1016/j.xagr.2025.100588","DOIUrl":"10.1016/j.xagr.2025.100588","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum hemorrhage continues to be a leading cause of maternal mortality globally. Although the E-MOTIVE bundle is an innovative approach for the early detection and management of postpartum hemorrhage that reduces maternal mortality by as high as 60%, its universal implementation in clinical practice in low-middle-income countries remains low.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine the effectiveness and acceptability of the E-MOTIVE bundle intervention in Ethiopia.</div></div><div><h3>STUDY DESIGN</h3><div>This was an implementation research on the E-MOTIVE bundle intervention for the early detection and treatment of postpartum hemorrhage using a mixed-method study design (pre- and postintervention quantitative study and cross-sectional qualitative study) in Ethiopia for over 22 months (June 2023 to February 2025). The primary outcome of the study was the rate of severe postpartum hemorrhage. The secondary outcomes were the detection of postpartum hemorrhage complications (such as blood transfusion, maternal death, admission to a high-dependency unit, and estimated blood loss) and the acceptability of the E-MOTIVE bundle approach. The participants of the quantitative study included pregnant women who delivered vaginally at St. Paul’s Hospital during the study period. Participants of the qualitative data were postpartum women who had the E-MOTIVE bundle approach applied during delivery, obstetrical care providers, maternity care coordinators, and representatives of nongovernmental organizations who focused on maternal care delivery. Quantitative data (including the characteristics of the E-MOTIVE bundle approach, occurrence of postpartum hemorrhage, and postpartum hemorrhage complication) were collected using a structured questionnaire, and qualitative data were collected using key informant interviews and focus group discussions (in-depth interviews and focused discussions focusing on the E-MOTIVE experience, attitude, and practice were conducted). Quantitative data were analyzed using simple descriptive statistics on IBM SPSS Statistics (version 23; IBM Corporation, Armonk, NY), and qualitative data were analyzed using thematic analysis on Scientific Software (ATLAS.ti.9.Ink; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).</div></div><div><h3>RESULTS</h3><div>There were a total of 2500 and 2225 vaginal deliveries during the preintervention and postintervention periods, respectively. Compared with the preintervention period, there was a significant reduction in severe postpartum hemorrhage (25.0% in the preintervention period vs 13.5% in the postintervention period) and complications of postpartum hemorrhage, including maternal death (laparotomy: 5.0% in the preintervention period vs 1.0% in the postintervention period; maternal death: one maternal death in the preintervention period vs no encounter of maternal death in the postintervention period) in the postinterven","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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