<div><h3>BACKGROUND</h3><div>Cesarean hysterectomy for placenta accreta spectrum disorder may be associated with severe hemorrhage because of placental invasion of the myometrium and the uterovesical space or parametrium. It leads to serious complications, such as massive hemorrhage requiring massive transfusion, coagulopathy, bladder and ureteric injuries, need for intensive care unit admission and prolonged hospital stay. To reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder, ongoing efforts are being made to develop different surgical approaches. In previous 12 cases upfront dissection of uterovesical space (bladder-first approach) before delivery of the neonate was observed to reduce hemorrhage arising from extensive neovascularization in this area and bladder injury.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess the efficacy of the bladder-first approach in a large sample to reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder.</div></div><div><h3>STUDY DESIGN</h3><div>This study presented data of 78 women (2017–2022) who underwent cesarean hysterectomy for placenta accreta spectrum disorder using the “bladder-first approach” from a tertiary care institute in Chandigarh, India. In this surgical approach, dissection of the uterovesical fold from the lower uterine segment to the cervix was performed before making the uterine incision for delivery. During this dissection, vascular areas were isolated and coagulated with bipolar electrosurgery or ligated with silk suture and then divided.</div></div><div><h3>RESULTS</h3><div>The 78 women with placenta accreta spectrum disorder underwent cesarean hysterectomy under general anesthesia. The mean gestational age was 35.0±2.5 weeks (range, 25.4–38.0), the mean blood loss was 1.56±1.06 L (range, 0.40–5.00 L), and the mean number of blood transfusions was 2.08±2.10 units (range, 0.00–9.00). Bladder injury occurred in 3 of 78 women (3.8%), and intensive care unit admission (for ≤24 hours) was needed by 3 of 78 women (3.8%). Histology was available in 73 of 78 women (19 with placenta percreta, 23 with placenta increta, and 31 with placenta accreta). There were 3 of 78 antenatal stillbirths. Of note, 75 women had live-born neonates, including 2 pairs of twins. The Apgar score of ≤7 at 5 minutes was seen in 6 of 77 neonates, and 20 of 77 neonates required neonatal intensive care unit care. There was 1 neonatal death on day 3 of life because of extreme prematurity and sepsis. In addition, 74 women went home with neonates, including 2 pairs of twins.</div></div><div><h3>CONCLUSION</h3><div>Our data support that up-front dissection of the uterovesical space or “bladder-first approach” reduces hemorrhage and bladder injury during cesarean hysterectomy in placenta accreta spectrum disorder, with no adverse effect on neonatal outcome. Achieving peripheral vascular control of the neovascularized uterovesical area before
{"title":"Up-front dissection of the uterovesical space or “bladder-first approach” reduces hemorrhage and bladder injury during hysterectomy for placenta accreta spectrum: reconfirmed in 78 more cases in a prospective single-center study","authors":"Pradip Kumar Saha MD, MAMS , Rashmi Bagga MD, DNB , Rimpi Singla MD , Aashima Arora MD , Vanita Jain MD , Vanita Suri MD , Kajal Jain MD , Parveen Kumar MD, DM , Nalini Gupta MD , Ashish Jain MD , Tulika Singh MD , Ravimohan S. Mavuduru MS, MCh","doi":"10.1016/j.xagr.2024.100425","DOIUrl":"10.1016/j.xagr.2024.100425","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Cesarean hysterectomy for placenta accreta spectrum disorder may be associated with severe hemorrhage because of placental invasion of the myometrium and the uterovesical space or parametrium. It leads to serious complications, such as massive hemorrhage requiring massive transfusion, coagulopathy, bladder and ureteric injuries, need for intensive care unit admission and prolonged hospital stay. To reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder, ongoing efforts are being made to develop different surgical approaches. In previous 12 cases upfront dissection of uterovesical space (bladder-first approach) before delivery of the neonate was observed to reduce hemorrhage arising from extensive neovascularization in this area and bladder injury.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess the efficacy of the bladder-first approach in a large sample to reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder.</div></div><div><h3>STUDY DESIGN</h3><div>This study presented data of 78 women (2017–2022) who underwent cesarean hysterectomy for placenta accreta spectrum disorder using the “bladder-first approach” from a tertiary care institute in Chandigarh, India. In this surgical approach, dissection of the uterovesical fold from the lower uterine segment to the cervix was performed before making the uterine incision for delivery. During this dissection, vascular areas were isolated and coagulated with bipolar electrosurgery or ligated with silk suture and then divided.</div></div><div><h3>RESULTS</h3><div>The 78 women with placenta accreta spectrum disorder underwent cesarean hysterectomy under general anesthesia. The mean gestational age was 35.0±2.5 weeks (range, 25.4–38.0), the mean blood loss was 1.56±1.06 L (range, 0.40–5.00 L), and the mean number of blood transfusions was 2.08±2.10 units (range, 0.00–9.00). Bladder injury occurred in 3 of 78 women (3.8%), and intensive care unit admission (for ≤24 hours) was needed by 3 of 78 women (3.8%). Histology was available in 73 of 78 women (19 with placenta percreta, 23 with placenta increta, and 31 with placenta accreta). There were 3 of 78 antenatal stillbirths. Of note, 75 women had live-born neonates, including 2 pairs of twins. The Apgar score of ≤7 at 5 minutes was seen in 6 of 77 neonates, and 20 of 77 neonates required neonatal intensive care unit care. There was 1 neonatal death on day 3 of life because of extreme prematurity and sepsis. In addition, 74 women went home with neonates, including 2 pairs of twins.</div></div><div><h3>CONCLUSION</h3><div>Our data support that up-front dissection of the uterovesical space or “bladder-first approach” reduces hemorrhage and bladder injury during cesarean hysterectomy in placenta accreta spectrum disorder, with no adverse effect on neonatal outcome. Achieving peripheral vascular control of the neovascularized uterovesical area before ","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eight or more antenatal care contact sessions are recommended as part of antenatal care to prevent pregnancy-related complications. However, studies across Ethiopia have shown discrepancies and inconsistent results.
OBJECTIVE
The goal of this study was to determine the pooled compliance to ≥8 antenatal care contact sessions and associated factors among Ethiopian healthcare providers.
STUDY DESIGN
Studies were systematically searched from March 1, 2024, to April 2, 2024, using Embase, Web of Science, PubMed/MEDLINE, Science Direct, African Journal Online, and the Wiley Online Library. The data were subsequently transferred to Stata software, version 11, for further data analysis. Pooled effect sizes were calculated based on the prevalence of ≥8 antenatal care contact sessions, and the odds ratios and 95% confidence intervals to indicate statistical significance were determined for the associated factors. To evaluate statistical heterogeneity, the Cochrane Q test and I2 statistic were used.
RESULTS
In this systematic review and meta-analysis, a total of 492,000 articles were retrieved from various databases and registers. Finally, 16 studies with 7781 participants were included. The overall compliance to the guidelines that recommend ≥8 antenatal care contact sessions was 18.35% (95% confidence interval, 10.98–25.73). Healthcare providers who worked at hospital health facilities (adjusted odds ratio, 5.09; 95% confidence interval, 2.26–11.47) had knowledge of the importance of ≥8 antenatal care contact sessions for pregnant women (adjusted odds ratio 2.04; 95% confidence interval, 1.10–3.78). Those who were able to clearly differentiate between the guidelines recommending 8 antenatal care contact sessions and those recommending 4 antenatal care visits (adjusted odds ratio, 3.95; 95% confidence interval, 2.10–7.33) were more likely to record ≥8 antenatal care contact sessions, which was significantly associated with the outcome variable.
CONCLUSION
In this study, more than 80% of antenatal care healthcare providers did not comply with the modern and World Health Organization–recommended antenatal care contact guidelines for a variety of reasons. It is very important to address factors that prevent healthcare providers from complying with the recommended ≥8 antenatal care contact sessions. To improve compliance to the World Health Organization guidelines of ≥8 antenatal care contact sessions, training on these guidelines is recommended.
背景：8次或更多的产前保健接触会议被推荐作为产前保健的一部分，以防止妊娠相关并发症。然而，埃塞俄比亚各地的研究显示出差异和不一致的结果。目的：本研究的目的是确定埃塞俄比亚医疗保健提供者对≥8次产前保健接触的总体依从性及其相关因素。研究设计：使用Embase、Web of Science、PubMed/MEDLINE、Science Direct、African Journal Online和Wiley Online Library系统检索2024年3月1日至2024年4月2日的研究。这些数据随后被转移到Stata软件，版本11，进行进一步的数据分析。根据≥8次产前保健接触的流行率计算合并效应量，并确定相关因素的优势比和95%置信区间，以表明统计显著性。为了评估统计异质性，采用Cochrane Q检验和I2统计量。结果：在本系统综述和荟萃分析中，共从各种数据库和登记册中检索到492,000篇文章。最后，纳入了16项研究，7781名参与者。推荐≥8次产前保健接触的指南的总体依从性为18.35%（95%可信区间，10.98-25.73）。在医院卫生机构工作的卫生保健提供者(调整优势比5.09；95%可信区间，2.26-11.47)了解≥8次产前保健接触对孕妇的重要性(校正优势比2.04；95%置信区间为1.10-3.78)。那些能够清楚区分建议8次产前保健接触的指南和建议4次产前保健访问的指南的人(校正优势比，3.95；95%可信区间，2.10-7.33)记录≥8次产前护理接触的可能性更大，这与结局变量显著相关。结论：在本研究中，由于各种原因，超过80%的产前保健保健提供者没有遵守现代和世界卫生组织推荐的产前保健联系指南。解决阻碍医疗保健提供者遵守建议的≥8次产前保健接触的因素是非常重要的。为了更好地遵守世界卫生组织关于≥8次产前保健接触的指导方针，建议对这些指导方针进行培训。
{"title":"Use of eight or more antenatal care contacts and determinants among healthcare providers in Ethiopia: systematic review and meta-analysis","authors":"Agerie Mengistie Zeleke MSc , Yosef Aragaw Gonete MSc , Worku Chekol Tassew MSc , Yeshiwas Ayale Ferede MPH","doi":"10.1016/j.xagr.2024.100418","DOIUrl":"10.1016/j.xagr.2024.100418","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Eight or more antenatal care contact sessions are recommended as part of antenatal care to prevent pregnancy-related complications. However, studies across Ethiopia have shown discrepancies and inconsistent results.</div></div><div><h3>OBJECTIVE</h3><div>The goal of this study was to determine the pooled compliance to ≥8 antenatal care contact sessions and associated factors among Ethiopian healthcare providers.</div></div><div><h3>STUDY DESIGN</h3><div>Studies were systematically searched from March 1, 2024, to April 2, 2024, using Embase, Web of Science, PubMed/MEDLINE, Science Direct, African Journal Online, and the Wiley Online Library. The data were subsequently transferred to Stata software, version 11, for further data analysis. Pooled effect sizes were calculated based on the prevalence of ≥8 antenatal care contact sessions, and the odds ratios and 95% confidence intervals to indicate statistical significance were determined for the associated factors. To evaluate statistical heterogeneity, the Cochrane Q test and I<sup>2</sup> statistic were used.</div></div><div><h3>RESULTS</h3><div>In this systematic review and meta-analysis, a total of 492,000 articles were retrieved from various databases and registers. Finally, 16 studies with 7781 participants were included. The overall compliance to the guidelines that recommend ≥8 antenatal care contact sessions was 18.35% (95% confidence interval, 10.98–25.73). Healthcare providers who worked at hospital health facilities (adjusted odds ratio, 5.09; 95% confidence interval, 2.26–11.47) had knowledge of the importance of ≥8 antenatal care contact sessions for pregnant women (adjusted odds ratio 2.04; 95% confidence interval, 1.10–3.78). Those who were able to clearly differentiate between the guidelines recommending 8 antenatal care contact sessions and those recommending 4 antenatal care visits (adjusted odds ratio, 3.95; 95% confidence interval, 2.10–7.33) were more likely to record ≥8 antenatal care contact sessions, which was significantly associated with the outcome variable.</div></div><div><h3>CONCLUSION</h3><div>In this study, more than 80% of antenatal care healthcare providers did not comply with the modern and World Health Organization–recommended antenatal care contact guidelines for a variety of reasons. It is very important to address factors that prevent healthcare providers from complying with the recommended ≥8 antenatal care contact sessions. To improve compliance to the World Health Organization guidelines of ≥8 antenatal care contact sessions, training on these guidelines is recommended.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The gold standard for treating the placenta accreta spectrum (PAS) is a cesarean hysterectomy, which harms fertility. Another conservative surgical approach allows the uterus to be preserved: one-step conservative surgery. We will compare these two approaches through the “CMNT PAS” study. Before this main study, we conducted a pilot study to determine the required sample size.
Study Design
This pilot study, conducted over 31 months, included patients who underwent surgery for suspected PAS based on imaging findings. Participants were divided into the conservative surgery group (CSG: 6 patients) and the Caesarean Hysterectomy Group (control group [CG]: 6 patients). For the CSG, our team adapted the approach described in previous research by Palacios-Jaraquemada.
Results
The primary objective of our study is to ascertain the appropriate sample size for our main investigation on the conservative surgical management of PAS. Concerning the primary outcome, the estimated amount of blood loss was lower in CSG compared to CG, although this difference was not statistically significant (1298.04±556 mL vs 891.051±348 mL, P=.159). The mean decrease in hemoglobin (Δ Hb) was 2.8±1.3251 g/dL in the CG group compared to 1.933±1.0614 g/dL in the CSG group (P=.240). The mean number of transfused red blood cell units was 3±3.2249 in the CG group and 1.5±1.64317 in the CSG group (P=.334).
Conclusion
The estimated blood loss between the two groups is not statistically significant. The required sample size is 22 patients.
治疗胎盘增生谱（PAS）的金标准是剖宫产子宫切除术，这损害了生育能力。另一种保守手术方法可以保留子宫：一步保守手术。我们将通过“CMNT PAS”研究对这两种方法进行比较。在本次主要研究之前，我们进行了一个试点研究，以确定所需的样本量。研究设计：这项初步研究进行了31个月，纳入了根据影像学发现接受手术治疗疑似PAS的患者。参与者分为保守手术组（CSG: 6例）和剖宫产切除术组（对照组[CG]: 6例）。对于CSG，我们的团队采用了Palacios-Jaraquemada先前研究中描述的方法。结果：我们研究的主要目的是为我们对PAS保守手术治疗的主要调查确定合适的样本量。关于主要结局，CSG组的估计失血量比CG组低，但差异无统计学意义（1298.04±556 mL vs 891.051±348 mL， P= 0.159）。CG组血红蛋白（Δ Hb）平均下降2.8±1.3251 g/dL， CSG组为1.933±1.0614 g/dL （P= 0.240）。CG组平均输血红细胞数为3±3.2249个，CSG组平均输血红细胞数为1.5±1.64317个（P= 0.334）。结论：两组患者估计失血量差异无统计学意义。所需的样本量为22例。
{"title":"New surgical technique for managing placenta accreta spectrum and pilot study of the “CMNT PAS” study","authors":"Hassine Saber Abouda MD , Haithem Aloui MD , Eya Azouz MD , Sofiene Ben Marzouk MD , Hatem Frikha MD , Rami Hammami MD , Sana Minjli MD , Rachid Hentati MD , Mehdi Khila MD , Badis Mohamed Chanoufi MD , Abir Karoui MD , Maghrebi Hayen MD","doi":"10.1016/j.xagr.2024.100430","DOIUrl":"10.1016/j.xagr.2024.100430","url":null,"abstract":"<div><h3>Introduction</h3><div>The gold standard for treating the placenta accreta spectrum (PAS) is a cesarean hysterectomy, which harms fertility. Another conservative surgical approach allows the uterus to be preserved: one-step conservative surgery. We will compare these two approaches through the “CMNT PAS” study. Before this main study, we conducted a pilot study to determine the required sample size.</div></div><div><h3>Study Design</h3><div>This pilot study, conducted over 31 months, included patients who underwent surgery for suspected PAS based on imaging findings. Participants were divided into the conservative surgery group (CSG: 6 patients) and the Caesarean Hysterectomy Group (control group [CG]: 6 patients). For the CSG, our team adapted the approach described in previous research by Palacios-Jaraquemada.</div></div><div><h3>Results</h3><div>The primary objective of our study is to ascertain the appropriate sample size for our main investigation on the conservative surgical management of PAS. Concerning the primary outcome, the estimated amount of blood loss was lower in CSG compared to CG, although this difference was not statistically significant (1298.04±556 mL vs 891.051±348 mL, <em>P</em>=.159). The mean decrease in hemoglobin (Δ Hb) was 2.8±1.3251 g/dL in the CG group compared to 1.933±1.0614 g/dL in the CSG group (<em>P</em>=.240). The mean number of transfused red blood cell units was 3±3.2249 in the CG group and 1.5±1.64317 in the CSG group (<em>P</em>=.334).</div></div><div><h3>Conclusion</h3><div>The estimated blood loss between the two groups is not statistically significant. The required sample size is 22 patients.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
About 5% to 13% of maternal mortality is directly related to unsafe abortion care. Despite the cultural stigmatization of abortions, Ghana has progressive abortion laws, healthcare guidelines, and clinical outcomes.
OBJECTIVE
Our study's primary aim was to characterize abortion outcomes in Ghana. Our secondary aims included investigating factors that led to abortion complications and the treatment of these complications.
STUDY DESIGN
We used data from the 2017 Ghana Maternal Health Survey. We examined questions that focused on the reasons for abortion, methods used for abortion, healthcare setting for abortion, and health issues after abortion. We performed descriptive and inferential statistics, including cross tabulation with chi-square analysis and logistic regression models.
RESULTS
Between 2012 and 2017, 1,425 women reported and completed the abortion-related questions. For those who obtained an abortion for health reasons, 69% had a surgical-based as opposed to herbal or medication-based abortion (P<.001), 94% had a medical facility–based as opposed to non-medical facility–based abortion (P<.001), and 21% had health problems related to the abortion within 1 month (P=.035). Women's reasons for undergoing an abortion did not affect the treatment rates after complications. There was no difference in the occurrence of an abortion-related complication or receipt of treatment for this complication within 1 month after the abortion among those who underwent medical facility–based and those who underwent nonmedical facility based abortion. Those with tertiary-level education or those who knew abortions were legal were more likely to have a surgical and medical facility–based abortion.
CONCLUSION
Although Ghana has room to improve the safety and accessibility of abortion services, our analysis suggests abortions in Ghana, regardless of reason given for seeking the service or method of abortion, seem to be safe. Translating Ghana's approach to abortion could minimize unsafe abortions globally.
{"title":"Ghana abortion care—a model for others: analysis of the 2017 Ghana Maternal Health Survey","authors":"Dhanalakshmi Thiyagarajan MD, MPH , Kwaku Asah-Opoku MBChB, MPH , Sarah Compton PhD, MPH","doi":"10.1016/j.xagr.2024.100419","DOIUrl":"10.1016/j.xagr.2024.100419","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>About 5% to 13% of maternal mortality is directly related to unsafe abortion care. Despite the cultural stigmatization of abortions, Ghana has progressive abortion laws, healthcare guidelines, and clinical outcomes.</div></div><div><h3>OBJECTIVE</h3><div>Our study's primary aim was to characterize abortion outcomes in Ghana. Our secondary aims included investigating factors that led to abortion complications and the treatment of these complications.</div></div><div><h3>STUDY DESIGN</h3><div>We used data from the 2017 Ghana Maternal Health Survey. We examined questions that focused on the reasons for abortion, methods used for abortion, healthcare setting for abortion, and health issues after abortion. We performed descriptive and inferential statistics, including cross tabulation with chi-square analysis and logistic regression models.</div></div><div><h3>RESULTS</h3><div>Between 2012 and 2017, 1,425 women reported and completed the abortion-related questions. For those who obtained an abortion for health reasons, 69% had a surgical-based as opposed to herbal or medication-based abortion (<em>P</em><.001), 94% had a medical facility–based as opposed to non-medical facility–based abortion (<em>P</em><.001), and 21% had health problems related to the abortion within 1 month (<em>P</em>=.035). Women's reasons for undergoing an abortion did not affect the treatment rates after complications. There was no difference in the occurrence of an abortion-related complication or receipt of treatment for this complication within 1 month after the abortion among those who underwent medical facility–based and those who underwent nonmedical facility based abortion. Those with tertiary-level education or those who knew abortions were legal were more likely to have a surgical and medical facility–based abortion.</div></div><div><h3>CONCLUSION</h3><div>Although Ghana has room to improve the safety and accessibility of abortion services, our analysis suggests abortions in Ghana, regardless of reason given for seeking the service or method of abortion, seem to be safe. Translating Ghana's approach to abortion could minimize unsafe abortions globally.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.xagr.2024.100415
José Morales-Roselló , Blanca Novillo-Del Álamo , Alicia Martínez-Varea
Objective
The incidence of cesarean section (CS) for failure to progress (FP) has progressively increased; thus, knowing the factors that increase this incidence has become of crucial importance. This study aimed to find the true determinants of CS for FP within 2 weeks of delivery, proposing strategies to reduce its incidence.
Material and Methods
A group of 957 term and late preterm (≥34 weeks) singleton pregnancies with a complete gestational follow-up and an ultrasound examination within 2 weeks of delivery were included in a retrospective observational study. Epidemiological, sonographic, and perinatal data were recorded, and multivariable logistic regression analyses were applied to create models to predict the importance of different variables in the explanation of FP.
Results
Induction of labor was by far the most important modifiable factor, followed by smoking and maternal weight, while parity was the most important nonmodifiable factor, followed by maternal age and estimated fetal weight. The difference in days from the actual due date exerted no influence.
Conclusions
To reduce the incidence of CS for FP, inductions of labor should be performed only under evidence-based medicine indications and kept to a minimum. In addition, maternal overweight reduction and maternal smoking cessation should be promoted before the initiation of gestation.
{"title":"Determinants of failure to progress within 2 weeks of delivery: results of a multivariable analysis approach","authors":"José Morales-Roselló , Blanca Novillo-Del Álamo , Alicia Martínez-Varea","doi":"10.1016/j.xagr.2024.100415","DOIUrl":"10.1016/j.xagr.2024.100415","url":null,"abstract":"<div><h3>Objective</h3><div>The incidence of cesarean section (CS) for failure to progress (FP) has progressively increased; thus, knowing the factors that increase this incidence has become of crucial importance. This study aimed to find the true determinants of CS for FP within 2 weeks of delivery, proposing strategies to reduce its incidence.</div></div><div><h3>Material and Methods</h3><div>A group of 957 term and late preterm (≥34 weeks) singleton pregnancies with a complete gestational follow-up and an ultrasound examination within 2 weeks of delivery were included in a retrospective observational study. Epidemiological, sonographic, and perinatal data were recorded, and multivariable logistic regression analyses were applied to create models to predict the importance of different variables in the explanation of FP.</div></div><div><h3>Results</h3><div>Induction of labor was by far the most important modifiable factor, followed by smoking and maternal weight, while parity was the most important nonmodifiable factor, followed by maternal age and estimated fetal weight. The difference in days from the actual due date exerted no influence.</div></div><div><h3>Conclusions</h3><div>To reduce the incidence of CS for FP, inductions of labor should be performed only under evidence-based medicine indications and kept to a minimum. In addition, maternal overweight reduction and maternal smoking cessation should be promoted before the initiation of gestation.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.xagr.2024.100411
Zayël Z. Frijmersum MD , Eva Van der Meij MD, PhD , Esther V.A. Bouwsma MD, PhD , Corine J.M. Verhoeven PhD , Johannes R. Anema MD, PhD , Judith A.F. Huirne MD, PhD , Petra C.A.M. Bakker MD, PhD
BACKGROUND
Evidence suggests that postpartum recovery takes longer than 6 weeks. However, evidence-based recommendations regarding postpartum recovery are lacking. Current research mainly focuses on shortening hospital stay after childbirth, neglecting outpatient recovery.
OBJECTIVE
This study aimed to develop multidisciplinary recommendations on convalescence after vaginal and cesarean delivery using a modified Delphi method to improve recovery after childbirth.
STUDY DESIGN
Multidisciplinary experts employed in different medical organizations involved in care and guidance of patients during postpartum recovery participated in the study. The panel included 16 experts (5 gynecologists, 2 senior residents, 4 midwives, 2 maternity nurses, 2 general practitioners, and 1 pelvic floor physical therapist) and representatives from medical organizations. Detailed recommendations on convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery were developed. In addition, a list with 35 potential affecting factors that could delay recovery was presented to identify circumstances in which the convalescence recommendation should be adapted. Recommendations were based on a literature review and a modified Delphi procedure among 16 experts. Multidisciplinary consensus of at least 67% was achieved on convalescence recommendations for 27 relevant functional activities after childbirth.
RESULTS
Multidisciplinary consensus on convalescence recommendations was reached for 26 of 27 functional activities for uncomplicated vaginal and cesarean delivery after 6 Delphi rounds and 2 group discussions. In total, 7 out of 32 affecting factors were deemed as independent factors that may delay recovery and therefore change the convalescence recommendations. The recommendations were deemed feasible by representatives from the same medical organizations as the panel.
CONCLUSION
Multidisciplinary consensus on recommendations regarding convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery was achieved.
{"title":"The development of multidisciplinary convalescence recommendations after childbirth: a modified Delphi study","authors":"Zayël Z. Frijmersum MD , Eva Van der Meij MD, PhD , Esther V.A. Bouwsma MD, PhD , Corine J.M. Verhoeven PhD , Johannes R. Anema MD, PhD , Judith A.F. Huirne MD, PhD , Petra C.A.M. Bakker MD, PhD","doi":"10.1016/j.xagr.2024.100411","DOIUrl":"10.1016/j.xagr.2024.100411","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Evidence suggests that postpartum recovery takes longer than 6 weeks. However, evidence-based recommendations regarding postpartum recovery are lacking. Current research mainly focuses on shortening hospital stay after childbirth, neglecting outpatient recovery.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to develop multidisciplinary recommendations on convalescence after vaginal and cesarean delivery using a modified Delphi method to improve recovery after childbirth.</div></div><div><h3>STUDY DESIGN</h3><div>Multidisciplinary experts employed in different medical organizations involved in care and guidance of patients during postpartum recovery participated in the study. The panel included 16 experts (5 gynecologists, 2 senior residents, 4 midwives, 2 maternity nurses, 2 general practitioners, and 1 pelvic floor physical therapist) and representatives from medical organizations. Detailed recommendations on convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery were developed. In addition, a list with 35 potential affecting factors that could delay recovery was presented to identify circumstances in which the convalescence recommendation should be adapted. Recommendations were based on a literature review and a modified Delphi procedure among 16 experts. Multidisciplinary consensus of at least 67% was achieved on convalescence recommendations for 27 relevant functional activities after childbirth.</div></div><div><h3>RESULTS</h3><div>Multidisciplinary consensus on convalescence recommendations was reached for 26 of 27 functional activities for uncomplicated vaginal and cesarean delivery after 6 Delphi rounds and 2 group discussions. In total, 7 out of 32 affecting factors were deemed as independent factors that may delay recovery and therefore change the convalescence recommendations. The recommendations were deemed feasible by representatives from the same medical organizations as the panel.</div></div><div><h3>CONCLUSION</h3><div>Multidisciplinary consensus on recommendations regarding convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery was achieved.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.xagr.2024.100412
Sanjay K. Agarwal MD, FACOG , Michael Stokes MPH , Rong Chen MA , Cassandra Lickert MD
<div><h3>Background</h3><div>Historically, the clinical characteristics and treatment pathways for patients with uterine fibroids and heavy menstrual bleeding have differed between White and Black women.</div></div><div><h3>Objective</h3><div>To provide a contemporary comparison of patient characteristics and treatment patterns among White and Black women with uterine fibroids and heavy menstrual bleeding in the United States.</div></div><div><h3>Study Design</h3><div>This retrospective cohort study included administrative claims data from 46,139 White and 17,297 Black women with uterine fibroids and heavy menstrual bleeding from the Optum Clinformatics database (January 2011–December 2020) and 7353 White and 16,776 Black women from the IBM MarketScan Multi-State Medicaid Insurance database (January 2010–December 2019). Patients were indexed at their initial uterine fibroid diagnosis claim and were required to have a claim for heavy menstrual bleeding and ≥12 months of continuous enrollment pre- and postindex. Patients were followed until the earliest of death, disenrollment, hysterectomy date, or end of study database. Outcomes were stratified by race and included patient demographics, clinical characteristics, pharmacologic treatment patterns, and surgeries/procedures. Pearson's Chi-square test for categorical variables and Student's t-test for continuous data were used to evaluate differences in baseline characteristics. Descriptive statistics were used to characterize treatment pathways for hormonal contraceptive use in women with ≥24 months of follow-up. Kaplan–Meier survival analysis was used to estimate time until hysterectomy, with log-rank testing to assess between-group differences.</div></div><div><h3>Results</h3><div>The mean (standard deviation) duration of follow-up was 44.6 (27.9) and 41.0 (24.9) months in the commercial and Medicaid databases, respectively. Mean (standard deviation) age at uterine fibroid diagnosis was lower for Black than White women in both databases (commercial: 42.3 [6.5] vs 44.4 [6.3] years; <em>P</em><.0001; Medicaid: 39.6 [7.1] years vs 40.2 [7.2] years; <em>P</em><.0001). Anemia was more prevalent in Black vs White women in both databases (commercial: 5.9% [1028/17,297] vs 3.6% [1648/46,139]; <em>P</em><.0001; Medicaid: 7.0% [1180/16,776] vs 4.5% [331/7353]; <em>P</em><.0001). In the commercial database, approximately one-half of women had claims for ≥1 bulk symptom, with no significant differences between groups. In the Medicaid database, significantly more White than Black women had claims for bulk symptoms (77.0% [5665/7353] vs 68.4% [11,477/16,776]; <em>P</em><.0001). Approximately 40% of all patients received hormonal drug therapies as initial treatment, most commonly hormonal contraceptives. However, discontinuation of hormonal contraceptive therapy was nearly universal, with one-half discontinuing within a median treatment duration of ∼5 months. Most women stopped treatment after 1 or
背景从历史上看，子宫肌瘤和大量月经出血患者的临床特征和治疗途径在白人和黑人妇女之间存在差异。研究目的对美国患有子宫肌瘤和大量月经出血的白人和黑人妇女的患者特征和治疗模式进行当代比较。研究设计这项回顾性队列研究纳入了来自 Optum Clinformatics 数据库（2011 年 1 月至 2020 年 12 月）的 46,139 名白种女性和 17,297 名黑种女性子宫肌瘤和大量月经出血患者的管理索赔数据，以及来自 IBM MarketScan 多州医疗补助保险数据库（2010 年 1 月至 2019 年 12 月）的 7353 名白种女性和 16,776 名黑种女性的管理索赔数据。患者在首次子宫肌瘤诊断索赔时被纳入索引，并要求有月经大量出血索赔，且索引前后连续参保时间≥12 个月。对患者进行随访，直至死亡、退出、子宫切除日期或研究数据库结束（以最早者为准）。研究结果按种族分层，包括患者人口统计学特征、临床特征、药物治疗模式和手术/程序。对分类变量采用皮尔逊卡方检验，对连续数据采用学生 t 检验，以评估基线特征的差异。描述性统计用于描述随访时间≥24个月的妇女使用激素避孕药的治疗途径。采用 Kaplan-Meier 生存分析估计子宫切除术前的时间，并用对数秩检验评估组间差异。结果商业数据库和医疗补助数据库的平均（标准差）随访时间分别为 44.6 (27.9) 个月和 41.0 (24.9) 个月。在两个数据库中，黑人妇女确诊子宫肌瘤时的平均年龄（标准差）均低于白人妇女（商业数据库：42.3 [6.5] 岁 vs 44.4 [6.3]岁；P< .0001；医疗补助数据库：39.6 [7.1] 岁 vs 40.2 [7.2]岁；P< .0001）。在两个数据库中，黑人妇女与白人妇女的贫血发生率更高（商业数据库：5.9% [1028/17,297] vs 3.6% [1648/46,139]；P<；.0001；医疗补助数据库：7.0% [1180/16,776] vs 4.5% [331/7353]；P<；.0001）。在商业数据库中，约有二分之一的妇女报销了≥1 项大宗症状，组间无显著差异。在医疗补助（Medicaid）数据库中，因大量症状而索赔的白人妇女明显多于黑人妇女（77.0% [5665/7353] vs 68.4% [11,477/16,776]; P<.0001）。所有患者中约有 40% 接受了激素药物疗法作为初始治疗，其中最常见的是激素避孕药。然而，几乎所有患者都停止了激素避孕药物治疗，二分之一的患者在中位 5 个月的治疗时间内停止了治疗。大多数妇女在使用了 1 或 2 种药物后就停止了治疗（商业避孕药）：白人，89.9% [9757/10857]；黑人，90.0% [3594/3993]；医疗补助：白人，92.2% [1635/1773]；黑人，94.2% [4454/4726]）。子宫切除术是最常见的手术，在白人妇女与黑人妇女中更为常见（商业：43.9% [20,235/46,139] vs 37.8% [6536/17,297]；医疗补助：46.8% [3444/7353] vs 32.0% [5364/16,776]）。UF-HMB患者还高度依赖激素避孕药，随后几乎普遍停止治疗。
{"title":"Uterine fibroids with heavy menstrual bleeding stratified by race in a commercial and Medicaid database","authors":"Sanjay K. Agarwal MD, FACOG , Michael Stokes MPH , Rong Chen MA , Cassandra Lickert MD","doi":"10.1016/j.xagr.2024.100412","DOIUrl":"10.1016/j.xagr.2024.100412","url":null,"abstract":"<div><h3>Background</h3><div>Historically, the clinical characteristics and treatment pathways for patients with uterine fibroids and heavy menstrual bleeding have differed between White and Black women.</div></div><div><h3>Objective</h3><div>To provide a contemporary comparison of patient characteristics and treatment patterns among White and Black women with uterine fibroids and heavy menstrual bleeding in the United States.</div></div><div><h3>Study Design</h3><div>This retrospective cohort study included administrative claims data from 46,139 White and 17,297 Black women with uterine fibroids and heavy menstrual bleeding from the Optum Clinformatics database (January 2011–December 2020) and 7353 White and 16,776 Black women from the IBM MarketScan Multi-State Medicaid Insurance database (January 2010–December 2019). Patients were indexed at their initial uterine fibroid diagnosis claim and were required to have a claim for heavy menstrual bleeding and ≥12 months of continuous enrollment pre- and postindex. Patients were followed until the earliest of death, disenrollment, hysterectomy date, or end of study database. Outcomes were stratified by race and included patient demographics, clinical characteristics, pharmacologic treatment patterns, and surgeries/procedures. Pearson's Chi-square test for categorical variables and Student's t-test for continuous data were used to evaluate differences in baseline characteristics. Descriptive statistics were used to characterize treatment pathways for hormonal contraceptive use in women with ≥24 months of follow-up. Kaplan–Meier survival analysis was used to estimate time until hysterectomy, with log-rank testing to assess between-group differences.</div></div><div><h3>Results</h3><div>The mean (standard deviation) duration of follow-up was 44.6 (27.9) and 41.0 (24.9) months in the commercial and Medicaid databases, respectively. Mean (standard deviation) age at uterine fibroid diagnosis was lower for Black than White women in both databases (commercial: 42.3 [6.5] vs 44.4 [6.3] years; <em>P</em><.0001; Medicaid: 39.6 [7.1] years vs 40.2 [7.2] years; <em>P</em><.0001). Anemia was more prevalent in Black vs White women in both databases (commercial: 5.9% [1028/17,297] vs 3.6% [1648/46,139]; <em>P</em><.0001; Medicaid: 7.0% [1180/16,776] vs 4.5% [331/7353]; <em>P</em><.0001). In the commercial database, approximately one-half of women had claims for ≥1 bulk symptom, with no significant differences between groups. In the Medicaid database, significantly more White than Black women had claims for bulk symptoms (77.0% [5665/7353] vs 68.4% [11,477/16,776]; <em>P</em><.0001). Approximately 40% of all patients received hormonal drug therapies as initial treatment, most commonly hormonal contraceptives. However, discontinuation of hormonal contraceptive therapy was nearly universal, with one-half discontinuing within a median treatment duration of ∼5 months. Most women stopped treatment after 1 or","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100412"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.xagr.2024.100416
Klea Atallah BBiomed(Hons) , Serena Moon MD , I-Lynn Lee MBBS, BMedSc, FRACP, PhD , Rosalynn Pszczola MBChB, BMedSci(Hons), FRACP , Joanne M. Said MBBS, PhD, CMFM
Objective
To examine the current literature surrounding the administration of antenatal corticosteroids in pregnancies complicated by diabetes and summarize the reported neonatal and maternal outcomes in exposed and unexposed groups.
Data sources
A systematic search was performed in November 2023 using Ovid Medline and Embase databases to identify relevant studies.
Study Eligibility Criteria
Articles that reported on the maternal or neonatal outcomes in pregnancies complicated by pre-gestational or gestational diabetes after exposure to antenatal corticosteroids were included in this review. Articles were excluded if they did not separately report on the outcomes experienced by women with diabetes.
Methods
Maternal and neonatal outcomes of interest included neonatal respiratory distress syndrome, neonatal hypoglycemia, and maternal hyperglycemia. Key words in this search included combinations of the terms related to pre-gestational and gestational diabetes, antenatal corticosteroids, respiratory distress syndrome, hypoglycemia, and hyperglycemia. Title and abstract screening was conducted in duplicate.
Results
There were 19 studies that met the inclusion criteria. There were 13 studies that presented results pertaining to neonatal respiratory distress syndrome, 14 studies discussed neonatal hypoglycemia and 5 studies discussed maternal hyperglycemia. Only 2 included studies were randomized controlled trials with the remaining 17 studies being observational. There was heterogeneity in clinical settings, study populations, type of corticosteroid administered and timing of administration across the included studies. This review found that there is no clear evidence of beneficial effect of corticosteroid administration on neonatal respiratory outcomes in pregnancies complicated by diabetes. Additionally, there was discrepancy between studies reporting on neonatal hypoglycemia with 6 studies reporting an increased incidence in this outcome after antenatal corticosteroid exposure whilst 4 studies found no difference between exposed and unexposed groups. This review identified a specific gap in the reporting of maternal hyperglycemia following antenatal corticosteroids. The limited number of studies that did report this outcome unanimously reported an increased incidence of maternal hyperglycemia after corticosteroid exposure. The majority of studies had small sample sizes of pregnancies both complicated by diabetes and exposed to corticosteroids and therefore lacked sufficient power to make robust conclusions about the influence of antenatal corticosteroids in this group.
Conclusion
This review concludes that there are insufficient data regarding the risks and benefits of antenatal corticosteroid administration in pregnancies complicated by diabetes.
{"title":"Maternal and neonatal outcomes following antenatal corticosteroids in pregnancies complicated by diabetes: a scoping review","authors":"Klea Atallah BBiomed(Hons) , Serena Moon MD , I-Lynn Lee MBBS, BMedSc, FRACP, PhD , Rosalynn Pszczola MBChB, BMedSci(Hons), FRACP , Joanne M. Said MBBS, PhD, CMFM","doi":"10.1016/j.xagr.2024.100416","DOIUrl":"10.1016/j.xagr.2024.100416","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the current literature surrounding the administration of antenatal corticosteroids in pregnancies complicated by diabetes and summarize the reported neonatal and maternal outcomes in exposed and unexposed groups.</div></div><div><h3>Data sources</h3><div>A systematic search was performed in November 2023 using Ovid Medline and Embase databases to identify relevant studies.</div></div><div><h3>Study Eligibility Criteria</h3><div>Articles that reported on the maternal or neonatal outcomes in pregnancies complicated by pre-gestational or gestational diabetes after exposure to antenatal corticosteroids were included in this review. Articles were excluded if they did not separately report on the outcomes experienced by women with diabetes.</div></div><div><h3>Methods</h3><div>Maternal and neonatal outcomes of interest included neonatal respiratory distress syndrome, neonatal hypoglycemia, and maternal hyperglycemia. Key words in this search included combinations of the terms related to pre-gestational and gestational diabetes, antenatal corticosteroids, respiratory distress syndrome, hypoglycemia, and hyperglycemia. Title and abstract screening was conducted in duplicate.</div></div><div><h3>Results</h3><div>There were 19 studies that met the inclusion criteria. There were 13 studies that presented results pertaining to neonatal respiratory distress syndrome, 14 studies discussed neonatal hypoglycemia and 5 studies discussed maternal hyperglycemia. Only 2 included studies were randomized controlled trials with the remaining 17 studies being observational. There was heterogeneity in clinical settings, study populations, type of corticosteroid administered and timing of administration across the included studies. This review found that there is no clear evidence of beneficial effect of corticosteroid administration on neonatal respiratory outcomes in pregnancies complicated by diabetes. Additionally, there was discrepancy between studies reporting on neonatal hypoglycemia with 6 studies reporting an increased incidence in this outcome after antenatal corticosteroid exposure whilst 4 studies found no difference between exposed and unexposed groups. This review identified a specific gap in the reporting of maternal hyperglycemia following antenatal corticosteroids. The limited number of studies that did report this outcome unanimously reported an increased incidence of maternal hyperglycemia after corticosteroid exposure. The majority of studies had small sample sizes of pregnancies both complicated by diabetes and exposed to corticosteroids and therefore lacked sufficient power to make robust conclusions about the influence of antenatal corticosteroids in this group.</div></div><div><h3>Conclusion</h3><div>This review concludes that there are insufficient data regarding the risks and benefits of antenatal corticosteroid administration in pregnancies complicated by diabetes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.xagr.2024.100417
Endale Tamiru Burayu MSc, Bekem Dibaba Degefa MSc
BACKGROUND
Anemia is a major problem in Ethiopia, affecting a large part of the population. Despite the importance of the problem, the causes of anemia, especially iron deficiency anemia, among pregnant women attending antenatal care (ANC) in the study area have been little studied. Therefore, the aim of this study was to investigate iron deficiency anemia and its associated factors in pregnant women seeking antenatal care in public health facilities in Southwest Ethiopia in 2023.
METHODS AND MATERIALS
A mixed facility-based cross-sectional study was conducted involving 364 pregnant women from selected health facilities in Ilubabor and Buno Bedele zones. Backward multiple logistic regression was used to analyze the relationship between dependent and independent variables, with statistical significance set at a P value less than .05.
RESULTS
In this study, the prevalence of iron deficiency anemia was found to be 21.4%. Several factors have been significantly associated with iron deficiency anemia including; presence of malaria parasite [AOR=15.8, CI=5.1–48.4], presence of Helminthes [AOR=8.1, CI=2.8–23.9], consumption of leafy vegetables less than once a day [AOR=3.4, CI = 1.5–13.3] and not taking iron supplements/consumption [AOR=2.2, CI=1.1–4.4].
CONCLUSION AND RECOMMENDATIONS
The overall prevalence of iron deficiency anemia in the study area suggests that, it is a moderate public health problem. In order to improve the nutritional status of women, routine and consistent nutritional advice, the establishment of regular preventive systems and the implementation of feedback mechanisms are recommended.
背景 贫血是埃塞俄比亚的一个主要问题，影响着大部分人口。尽管这一问题很重要，但对研究地区接受产前护理（ANC）的孕妇贫血（尤其是缺铁性贫血）的原因却研究甚少。因此，本研究旨在调查 2023 年在埃塞俄比亚西南部公共医疗机构接受产前检查的孕妇中存在的缺铁性贫血及其相关因素。方法和材料本研究以医疗机构为基础，对伊鲁巴博尔区（Ilubabor）和布诺贝德尔区（Buno Bedele）选定医疗机构中的 364 名孕妇进行了横断面混合研究。采用后向多元逻辑回归分析因变量和自变量之间的关系，统计显著性设定为 P 值小于 .05。有几个因素与缺铁性贫血明显相关，包括：疟原虫的存在[AOR=15.8，CI=5.1-48.4]、螺旋体的存在[AOR=8.1，CI=2.8-23.9]、每天食用叶菜少于一次[AOR=3.结论和建议该研究地区缺铁性贫血的总体患病率表明，缺铁性贫血是一个中等程度的公共卫生问题。为了改善妇女的营养状况，建议提供常规和持续的营养建议，建立定期预防系统并实施反馈机制。
{"title":"Exploration of iron deficiency anemia and its associated factors among pregnant women seeking antenatal care in public health facilities of southwestern Ethiopia. A mixed study","authors":"Endale Tamiru Burayu MSc, Bekem Dibaba Degefa MSc","doi":"10.1016/j.xagr.2024.100417","DOIUrl":"10.1016/j.xagr.2024.100417","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Anemia is a major problem in Ethiopia, affecting a large part of the population. Despite the importance of the problem, the causes of anemia, especially iron deficiency anemia, among pregnant women attending antenatal care (ANC) in the study area have been little studied. Therefore, the aim of this study was to investigate iron deficiency anemia and its associated factors in pregnant women seeking antenatal care in public health facilities in Southwest Ethiopia in 2023.</div></div><div><h3>METHODS AND MATERIALS</h3><div>A mixed facility-based cross-sectional study was conducted involving 364 pregnant women from selected health facilities in Ilubabor and Buno Bedele zones. Backward multiple logistic regression was used to analyze the relationship between dependent and independent variables, with statistical significance set at a <em>P</em> value less than .05.</div></div><div><h3>RESULTS</h3><div>In this study, the prevalence of iron deficiency anemia was found to be 21.4%. Several factors have been significantly associated with iron deficiency anemia including; presence of malaria parasite [AOR=15.8, CI=5.1–48.4], presence of Helminthes [AOR=8.1, CI=2.8–23.9], consumption of leafy vegetables less than once a day [AOR=3.4, CI = 1.5–13.3] and not taking iron supplements/consumption [AOR=2.2, CI=1.1–4.4].</div></div><div><h3>CONCLUSION AND RECOMMENDATIONS</h3><div>The overall prevalence of iron deficiency anemia in the study area suggests that, it is a moderate public health problem. In order to improve the nutritional status of women, routine and consistent nutritional advice, the establishment of regular preventive systems and the implementation of feedback mechanisms are recommended.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mistreatment in healthcare is defined by the set of behaviors, acts, and omissions committed by the healthcare providers on patients. Pregnant women can be exposed to this behavior during pregnancy, childbirth, and the postpartum period. It can have several aspects and affects the women's mental health, social and professional life, and also their newborns and families.
Objective
This study was made to estimate the frequency of mistreatment during the peripartum period in a Tunisian maternity unit, determine its impact on the parturient and her entourage, and draw up recommendations for the prevention of this public health problem.
Study Design
We conducted a cross-sectional survey in Department C of the Tunis Maternity and Neonatology Center from July 2022 to September 30, 2022. Our questionnaire encompassed verbal and physical abuse, patient information, consent, unprofessional conduct, poor communication, and discrimination.
Results
This study included 400 patients. The average age was 29.3+–5.65. Single women represented 12.3% of the cases. Seventy-five percent of women reported having been victims of at least one type of violence during childbirth. Verbal abuse was the most frequent type observed. Eighty-two percent of women reported verbal abuse, while 23.25% underwent physical violence. After the delivery, 391 women (97.8%) stated that the delivery was a source of anxiety and that they were not ready to repeat the experience. Six of them were followed up in psychiatry. Mistreatment was expressed by a lack of information and/or respect for consent, unprofessional conduct, or poor communication between the caregiver and the patient.
Conclusion
This study emphasizes the significance of including women in decision-making processes regarding their care. Establishing systematic approaches for providing information and obtaining consent is crucial, ensuring a dynamic approach that promotes women's freedom of choice.
{"title":"Mistreatment in healthcare: peripartum experience in a Tunisian maternity","authors":"Haithem Aloui MD, Hatem Frikha MD, Rami Hammami MD, Amal Chermiti MD, Hassine Saber Abouda MD, Mohamed Badis Channoufi PhD, Abir Karoui PhD","doi":"10.1016/j.xagr.2024.100410","DOIUrl":"10.1016/j.xagr.2024.100410","url":null,"abstract":"<div><h3>Background</h3><div>Mistreatment in healthcare is defined by the set of behaviors, acts, and omissions committed by the healthcare providers on patients. Pregnant women can be exposed to this behavior during pregnancy, childbirth, and the postpartum period. It can have several aspects and affects the women's mental health, social and professional life, and also their newborns and families.</div></div><div><h3>Objective</h3><div>This study was made to estimate the frequency of mistreatment during the peripartum period in a Tunisian maternity unit, determine its impact on the parturient and her entourage, and draw up recommendations for the prevention of this public health problem.</div></div><div><h3>Study Design</h3><div>We conducted a cross-sectional survey in Department C of the Tunis Maternity and Neonatology Center from July 2022 to September 30, 2022. Our questionnaire encompassed verbal and physical abuse, patient information, consent, unprofessional conduct, poor communication, and discrimination.</div></div><div><h3>Results</h3><div>This study included 400 patients. The average age was 29.3+–5.65. Single women represented 12.3% of the cases. Seventy-five percent of women reported having been victims of at least one type of violence during childbirth. Verbal abuse was the most frequent type observed. Eighty-two percent of women reported verbal abuse, while 23.25% underwent physical violence. After the delivery, 391 women (97.8%) stated that the delivery was a source of anxiety and that they were not ready to repeat the experience. Six of them were followed up in psychiatry. Mistreatment was expressed by a lack of information and/or respect for consent, unprofessional conduct, or poor communication between the caregiver and the patient.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the significance of including women in decision-making processes regarding their care. Establishing systematic approaches for providing information and obtaining consent is crucial, ensuring a dynamic approach that promotes women's freedom of choice.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100410"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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