Maternal health, neonatology and perinatology最新文献

Background: Neonatal mortality remains a significant public health challenge in Ethiopia, often attributed to asphyxia at birth. Helping Babies Breathe (HBB), an evidence-based neonatal resuscitation program aims to address this issue. However, the sustainability of knowledge and skills acquired during pre-service training is less understood.

Objective: This study assessed the retention of knowledge and skills among midwives one year after completing the HBB pre-service training in Ethiopia.

Methods: A non-randomized quasi-experimental study was conducted involving a cohort of midwifery graduates who completed HBB training during their final year. Knowledge was assessed using a multiple-choice questionnaire, while skills were evaluated using Objective Structured Clinical Examinations (OSCEs). Data were collected immediately post-training, six months later, and one year later. Paired t-tests and Wilcoxon signed-rank tests were used to analyze changes over time.

Results: Of the 60 midwives initially trained, 50 (83.3%) participated in the follow-up assessment. The median knowledge score decreased significantly from 98% immediately post-training to 74% one year later (p < 0.01). Similarly, OSCE performance declined, with 36% of participants demonstrating proficiency compared to 62% at baseline (p < 0.05). A paired t-test was performed to evaluate whether students' psychomotor skills significantly declined 12 months after initial training. The results of the analysis showed a highly significant decline in psychomotor skills during this time, with a mean difference of -2.29 (SE = 0.29; p < 0.001). This negative mean difference, with pre-test scores averaging 27.59 (SD = 2.78) and post-test scores after 12 months averaging 25.31 (SD = 2.11), indicates a noticeable drop in skill levels following training.

Conclusion: While midwives retained moderate knowledge and skills one year after completing HBB training, significant attrition highlights the need for periodic refresher training and improved access to resuscitation tools. Strengthening these aspects may enhance the long-term impact of HBB in reducing neonatal mortality.

Background: Preventing infection in primary sutured perineal tears after childbirth is crucial to avoid systemic antibiotic use and potential complications from poor healing. This study aimed to investigate the efficacy of an antibacterial, triclosan-coated suture (VicrylPlus^®) in reducing infection in primary sutured childbirth-related perineal tears.

Methods: The PLUS study was a single-center, single-blinded, adaptive parallel-group randomized trial conducted at Lund University Hospital, Sweden. Women aged ≥ 18 years with a perineal tear at childbirth were randomly assigned in a 1:1 ratio to either the control group (conventional-absorbable suture, Vicryl^®) or the intervention group (triclosan-coated- absorbable suture, VicrylPlus^®).

Results: Out of 1921 eligible women, 1890 were randomized to either Vicryl^® (n = 953) or VicrylPlus^® (n = 937). There were no significant demographic differences between the groups. The most common type of tear in both groups was a second-degree tear (Vicryl^® 66.2% (n = 625), VicrylPlus^® 67.5% (n = 625)). Encompassing all types of deeper tears in the analysis there was a significantly decrease in infection after suturing with VicrylPlus^® 4% (n = 28) versus Vicryl^® 6.8% (n = 47); (OR 0.57, 95% CI 0.35-0.91, P = 0.024). When analyzing different tears separately, there was a non-significant increase in infection for first-degree tears with VicrylPlus^® 0.8% (n = 2) versus Vicryl^® 3.9% (n = 8); (OR 4.75, 95% CI 1.00-22.63, P = 0.050). However, for second-degree tears, the infection rate was significantly reduced with VicrylPlus^® 4.4% (n = 27) versus Vicryl^® 7.2% (n = 44); (OR 0.63, 95% CI 0.36-0.98, P = 0.05) and for third-degree and unclassified tears there was a non-significant decrease in infections with VicrylPlus^® 5.3% (n = 1) versus Vicryl^® 14.3% (n = 2); (OR 0.33, 95% CI 0.03-4.10, P = 0.561), respectively, VicrylPlus^® 0% versus Vicryl^® 1.7% (n = 1); (OR 0.98, 95% CI 0.95-1.02, P = 0.462).

Conclusion: The use of triclosan coated sutures significantly reduces the risk of infection in primary sutured childbirth-related perineal tears by 43%, except for first-degree tears. Further research is needed to determine whether their effectiveness remains consistent across the other specific types of deeper tears in a larger study population.

Trial registration: ClinicalTrials (NCT02863874), posted 11/08/2016, retrospectively registered. Approved by the regional ethical committee before start of enrollment (Dnr 2015/774).

Background: The global neonatal mortality rate is due to miss the third Sustainable Development Goal of 12 deaths per 100 live births by 2030. However, medical devices can play a crucial role in improving the quality of care given to neonates, helping to reduce the rate further.

Methods: This study focuses on quantifying the availability of syringe pumps to newborns at key hospital locations in Zambia. Inventories of syringe pumps on neonatal intensive care units (NICUs) were conducted at 7 different hospitals.

Results: Syringe pumps were only available on 3 of the 8 NICUs. Only 1 of the 13 syringe pumps were found in the Copperbelt region, despite 5 of the hospitals being located there. The largest syringe pump-to-bed ratio was 0.17 at Livingstone University Teaching Hospital.

Conclusions: In Zambia, there is a disproportionate availability of syringe pumps, for neonatal care, in the Lusaka and Southern regions compared to the Copperbelt region in the north.

Background: Umbilical vein catheterization is relatively straightforward procedure because the vein is easily recognized as a single, large, thin-walled vessel. However, anomalies of the umbilical vessels, such as the multivessel cord, which embeds more than two arteries or more than one vein, can result in catheter misplacement.

Case presentation: We present a unique case of a supernumerary patent umbilical artery in an asphyxiated term neonate, which resulted in the misplacement of the umbilical venous catheter in one of the three arteries. The diagnosis of artery cannulation was made through a comprehensive analysis of the patient's blood gases, the use of a pressure transducer to confirm the presence of a pulsatile arterial signal, and the interpretation of a chest X-ray. Subsequently, the catheter was removed without complication. A more detailed examination of the umbilical cord revealed the presence of three arteries and a vein, which was then successfully cannulated.

Conclusions: This case reinforces the notion that the umbilical cord may include more than three vessels, and that umbilical vein cannulation requires prior meticulous observation of the number of vessels to prevent misplacement of the catheter.

Background: Stillbirth is one of the biggest adverse pregnancy outcomes in countries with low and middle incomes. If current trends continue, 15.9 million babies will be stillborn; nearly half of these (7.7 million, or 48%) will occur in sub-Saharan Africa. Although stillbirth is one of the health care indicators, its prevalence and determinates are not well studied in low- and middle-income countries (LMIC). Therefore, this study aims to assess the prevalence and associated factors of stillbirth among people at extreme ages of reproductive life in Sub-Saharan Africa.

Methods: Data from the most recent Demographic and Health Surveys, which covered 23 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 76,451 women. STATA 14 was used to analyze the data. The associated factors of stillbirth were determined using a multilevel mixed-effects logistic retrogression model. Significant factors associated with stillbirth were declared significant at p- value < 0.05.

Results: The prevalence of stillbirth in Sub-Saharan Africa was 6.18% (95% CI: 6.01, 6.35). Higher odds of stillbirth were observed among women at advanced age (35-49 years) (AOR = 3.72, 95% CI: 2.57, 5.41), those who consumed alcohol during pregnancy (AOR = 1.58, 95% CI: 1.24, 2.00), and those who underwent cesarean section delivery (AOR = 1.23, 95% CI: 1.11, 1.37). Additionally, rural residence (AOR = 1.11, 95% CI: 1.01, 1.23), high community levels of illiteracy (AOR = 1.19, 95% CI: 1.07, 1.32), and residing in South sub-Saharan Africa (AOR = 1.19, 95% CI: 1.03, 1.38) were positively associated with stillbirth.

Conclusions: This study concludes that stillbirth among women at extreme ages of reproductive life is high compared to the UNICEF 2022 report. The study identified that both individual and community-level variables were associated factors of stillbirth. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women at the extreme ages of reproductive life and to women from rural areas while designing policies and strategies targeting reducing stillbirth rates.

Thyroid disorders rank as the second most common endocrine abnormalities during pregnancy, posing significant challenges for clinical diagnosis due to overlapping symptoms with normal pregnancy. Thyroid hormones play a critical role in fetal growth and neurocognitive development, necessitating precise interpretation of maternal thyroid function tests, which differ from non-pregnant states. Proper management of thyroid dysfunction can significantly reduce morbidity in both mothers and their fetuses.This review explores the physiological changes in thyroid function during pregnancy, the epidemiology of thyroid disorders, and current guidelines for diagnosis and management. Pregnancy induces anatomical and physiological changes in the thyroid gland, including an increase in gland size and alterations in hormone levels influenced by factors such as hCG and estrogen. These changes necessitate trimester-specific reference ranges for thyroid function tests, as the American Thyroid Association and the American College of Obstetricians and Gynecologists recommended. Hyperthyroidism, primarily caused by Graves' disease and gestational transient thyrotoxicosis, can lead to complications like preeclampsia, preterm birth, and fetal hyperthyroidism. Management includes antithyroid drugs, with careful monitoring to balance maternal and fetal risks. Hypothyroidism, including subclinical and overt forms, is predominantly due to autoimmune thyroiditis and poses risks such as spontaneous abortion, preterm delivery, and impaired neurodevelopment in offspring. The review discusses the debated benefits of levothyroxine treatment for subclinical hypothyroidism, highlighting the need for further research to establish clear guidelines.Given the complex interplay between thyroid function and pregnancy outcomes, this comprehensive review underscores the importance of tailored, evidence-based approaches to managing thyroid disorders in pregnant women.

Introduction: Stillbirth is still a major public health problem in middle- and low-income countries. However, there has been limited research conducted to identify determinants of stillbirth in Ethiopia. Therefore, this study aimed to identify the determinants of stillbirth among women who gave birth in public hospitals in the West Gojjam Zone, Northwest Ethiopia.

Methods: An unmatched case-control study was conducted among 418 mothers who gave birth from March 1-30, 2022. Consecutive and systematic sampling techniques were used to select the cases and controls, respectively. The collected data were entered into Epidata and exported into SPSS version 16 for analysis. Numerical descriptive statistics were expressed by using the mean with standard deviation (SD) and/or median with interquartile range (IQR), whereas categorical variables were expressed by proportions. Bivariable and multivariable binary logistic regression analyses were used to identify determinants of stillbirth. The model goodness of fit test was checked using the Hosmer-Lemeshow test. Variables having a P-value ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis model. Adjusted odds ratio with 95% confidence intervals (CIs) was used to report the strength of association, and variables with a P-value < 0.05 were considered statistically significant.

Results: A total of 105 cases and 313 controls were included in this study. The odds of having stillbirth were higher among women who were illiterate (AOR: 1.6, 95% CI: 1.34, 7.55), had first ANC visit in the second trimester (AOR: 11.4, 95% CI: 2.99, 43.71), had an induced mode of delivery (AOR: 8.7, 95% CI: 2.10, 36.03), history of stillbirth (AOR: 1.5, 95% CI: 1.45, 4.90), bad obstetric history (AOR: 4.8, 95% CI: 1.44, 15.89), history of preterm (AOR: 7.6, 95% CI: 1.57, 37.21), not vaccinated for TT (AOR: 8.8, 95% CI: 2.23, 35.17), labor not followed by using partograph (AOR: 3.1, 95% CI: 1.10, 8.42), and history of abortion (AOR: 11, 95% CI: 2.91, 41.31).

Conclusion: The determinants of stillbirth included women who were illiterate, started ANC visits in the second trimester, had an induced mode of delivery, history of stillbirth, bad obstetric history, history of preterm, history of abortion, not vaccinated for TT, and not followed by partograph. It is better to improve partograph utilization during intrapartum care and screen mothers who had a higher risk of adverse birth outcomes during their pregnancy to avert the problem.

Background: Mevalonate kinase deficiency is an inherited autoinflammatory disorder that can present with a wide clinical spectrum, ranging from mild forms with recurrent episodes of fever, lymphadenopathy, splenomegaly and skin rash to the much rarer severe form, which is characterized by additional occurrences of psychomotor impairment, cholestatic jaundice, ophthalmological symptoms, and failure to thrive. The few cases described with perinatal onset often showed a very severe clinical course.

Case presentation: Here, we report the case of a preterm infant born at 30 + 2 weeks of gestation with a prenatal genetic diagnosis of mevalonate kinase deficiency presenting with intrauterine bowel dilatation, mild hydrops fetalis, and microcephaly. Laparotomy on the second day of life revealed intestinal obstruction necessitating partial ileum resection and ileostomy. The neonate had recurrent inflammatory reactions with elevated C-reactive protein levels, severe cholestasis, a progressive liver dysfunction, and an increasingly distended abdomen with subsequent respiratory insufficiency. Urinary mevalonic acid was highly elevated. The patient received anti-inflammatory therapy with prednisone and anakinra. Unfortunately, the patient died at the age of 77 days due to cardiorespiratory failure.

Conclusions: This case shows that intestinal obstruction with dilated fetal bowel loops can be an initially leading clinical symptom of severe mevalonate kinase deficiency. Diagnostics should be considered at an early stage, especially in the presence of other anomalies such as hydrops fetalis, growth restriction, or microcephaly. Data on the neonatal course of severe mevalonate kinase deficiency are still scarce and further studies are needed, particularly on treatment in neonates and young infants.

Increasing heat events, due to human induced climate change have shown to affect vulnerable populations such as pregnant and postpartum women and their mental health. Moreover, consequences of heat events can be unevenly distributed, affecting communities with existing structural discrimination and socially and economically disadvantaged populations. The risk of perinatal depression might be higher in pregnant and postpartum women. In this commentary, we argue, based on the review of literature, that there is a quintessential need for scientific research to investigate the interlinkage between heat events and perinatal depression.

Background: Preterm infants experience excessive insensible water loss in postnatal period. Established practices like cling film might not be sufficient alone in reducing this loss. Being expensive, humidified incubators might not be affordable in developing countries. Hence, we tried to explore double plastic wrap (cling film attached to the bassinet wall and occlusive plastic wrap covering the baby) as a low-cost solution of increased insensible water loss in postnatal period.

Methods: In this pilot trial 63 inborn infants of less than 32 weeks of gestation or birth weight less than 1200 g were enrolled and randomized to either single wrap (only cling film attached to the bassinet wall) or double wrap (cling film covering the bassinet and occlusive plastic wrap covering the baby) group after birth. This practice was allowed in addition to radiant warmer care and other routine thermoregulatory measures followed in the unit. Intervention was continued till first 7 days of life unless they met any pre-specified withdrawal criteria. The primary outcome was a difference in total insensible water loss (g/m2) in first seven days of life between two groups. The secondary outcomes were difference in cumulative insensible water loss (g/m2) in the first 72 h of life, 4-7 days of life, average daily insensible water loss in the first week (g/m2/h), neonatal morbidities, mortality and time to event analysis.

Results: Of 63 randomized infants, 32 were allocated to single wrap and 31 to double wrap groups. Cumulative insensible water loss in first 72 h and first week were significantly lower in the double wrap group (2786.5 ± 576 g/m2 in single wrap and 2376.8 ± 626 g/m2 in double wrap, p value 0.012 for 0-3 days and 6225.48 ± 951 g/m2 in single wrap and 5260.61 ± 1091 in double wrap, p value 0.034 for 0-7 days of life respectively). Apart from increased incidence of patent ductus arteriosus in double wrap group (41.94% vs. 15.62%, p 0.027) no other clinically significant outcomes were different between 2 groups. Median times to wean off respiratory support, regain birth weight and discharge from health facility were also similar between the two groups.

Conclusion: Double plastic wrap has been found to reduce cumulative insensible water loss in first week of life compared to cling film alone in the setting of a low-to-middle income-country.

Trial registration number: CTRI/2024/03/063749.

Trial registration date: 07.03.2024. LINK TO CTRI: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTAwMzk5&Enc=&userName=CTRI/2024/03/063749 .