Pub Date : 2024-10-28DOI: 10.1186/s12884-024-06897-y
Yang Yu, Jia-Lei Zhu, Jun-Min Li, Jing Tang
Objective: Chemotherapy during pregnancy has a certain risk of causing a series of complications, such as miscarriage, premature birth, or fetal growth restriction, although the relationship between these complications and chemotherapy is currently unclear. This experiment focuses on the possible damage mechanism of the chemotherapeutic drug paclitaxel on placental trophoblast cells, and explores whether chemotherapy can affect pregnancy outcomes by directly damaging placental tissue.
Methods: This study explored the mechanism of paclitaxel induced damage on placental trophoblast cell lines JEG-3 and BEWO through immunofluorescence staining, Western blot experiments, cell flow cytometry, Seahorese cell metabolism experiments, and mouse modeling verification.
Results: The experiment found that paclitaxel could induce JEG-3 and BEWO cells to produce reactive oxygen species (ROS), and elevate the ratio of Bax/Bcl-2 expression. Besides, paclitaxel mediated the reduction of mitochondrial membrane potential in JEG-3 and BEWO cells, causing damage and leading to mitochondrial autophagy and the occurrence of unfolded protein response. Paclitaxel inhibited the glycolysis rate of JEG-3 and BEWO cells, and leaded to impaired mitochondrial function, including decreased basal respiratory values, decreased respiratory reserve capacity, and proton leakage. In pregnant mice with tumor modeling, paclitaxel could cause DNA damage in placental tissue cells, and might lead to apoptosis of chemotherapy mice placental tissue cells and impairment of normal physiological functions.
Conclusion: Paclitaxel may directly or indirectly affect the normal physiological functions of placental trophoblast cells, including energy metabolism and protein synthesis dysfunction, which may be related to the adverse pregnancy outcomes caused by paclitaxel chemotherapy.
{"title":"The mechanism of paclitaxel induced damage on placental trophoblast cells.","authors":"Yang Yu, Jia-Lei Zhu, Jun-Min Li, Jing Tang","doi":"10.1186/s12884-024-06897-y","DOIUrl":"10.1186/s12884-024-06897-y","url":null,"abstract":"<p><strong>Objective: </strong>Chemotherapy during pregnancy has a certain risk of causing a series of complications, such as miscarriage, premature birth, or fetal growth restriction, although the relationship between these complications and chemotherapy is currently unclear. This experiment focuses on the possible damage mechanism of the chemotherapeutic drug paclitaxel on placental trophoblast cells, and explores whether chemotherapy can affect pregnancy outcomes by directly damaging placental tissue.</p><p><strong>Methods: </strong>This study explored the mechanism of paclitaxel induced damage on placental trophoblast cell lines JEG-3 and BEWO through immunofluorescence staining, Western blot experiments, cell flow cytometry, Seahorese cell metabolism experiments, and mouse modeling verification.</p><p><strong>Results: </strong>The experiment found that paclitaxel could induce JEG-3 and BEWO cells to produce reactive oxygen species (ROS), and elevate the ratio of Bax/Bcl-2 expression. Besides, paclitaxel mediated the reduction of mitochondrial membrane potential in JEG-3 and BEWO cells, causing damage and leading to mitochondrial autophagy and the occurrence of unfolded protein response. Paclitaxel inhibited the glycolysis rate of JEG-3 and BEWO cells, and leaded to impaired mitochondrial function, including decreased basal respiratory values, decreased respiratory reserve capacity, and proton leakage. In pregnant mice with tumor modeling, paclitaxel could cause DNA damage in placental tissue cells, and might lead to apoptosis of chemotherapy mice placental tissue cells and impairment of normal physiological functions.</p><p><strong>Conclusion: </strong>Paclitaxel may directly or indirectly affect the normal physiological functions of placental trophoblast cells, including energy metabolism and protein synthesis dysfunction, which may be related to the adverse pregnancy outcomes caused by paclitaxel chemotherapy.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1186/s12884-024-06903-3
James M Maisaba, Richard Migisha, Asiphas Owaraganise, Leevan Tibaijuka, David Collins Agaba, Joy Muhumuza, Joseph Ngonzi, Stella Kyoyagala, Musa Kayondo
Background: Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.
Methods: We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.
Results: We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8-21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2-65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6-40), primiparity (AOR = 4.8, 95% CI: 1.1-21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5-12) were associated with EONS.
Conclusions: Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.
{"title":"Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study.","authors":"James M Maisaba, Richard Migisha, Asiphas Owaraganise, Leevan Tibaijuka, David Collins Agaba, Joy Muhumuza, Joseph Ngonzi, Stella Kyoyagala, Musa Kayondo","doi":"10.1186/s12884-024-06903-3","DOIUrl":"10.1186/s12884-024-06903-3","url":null,"abstract":"<p><strong>Background: </strong>Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.</p><p><strong>Methods: </strong>We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.</p><p><strong>Results: </strong>We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8-21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2-65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6-40), primiparity (AOR = 4.8, 95% CI: 1.1-21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5-12) were associated with EONS.</p><p><strong>Conclusions: </strong>Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1186/s12884-024-06908-y
Andrew J Goldsack, Melvin B Marzan, Daniel L Rolnik, Anthea C Lindquist, Joanne M Said, Kirsten R Palmer, Penelope M Sheehan, Stephanie Potenza, Natasha Pritchard, Clare L Whitehead, Jolyon Ford, Ben W Mol, Susan P Walker, Lisa Hui
Objective: To compare specific perinatal outcomes in nulliparas with a singleton infant in cephalic presentation at term, with and without exposure to the COVID-19 pandemic during pregnancy. We hypothesised that the pandemic conditions in Melbourne may have been an independent contributor to trends in maternal Body Mass Index ≥ 25 kg/m2, macrosomia and caesarean section.
Design: Multi-centre retrospective cohort study and interrupted time-series analysis.
Setting: Metropolitan Melbourne, Victoria.
Population: Singleton infants ≥ 20 weeks gestational age born between 1 January 2019 and 31 March 2022.
Main outcome measures: Rates of maternal Body Mass Index ≥ 25 kg/m2, macrosomia (birthweight ≥ 4000 g) and caesarean section.
Results: 25 897 individuals gave birth for the first time to a singleton infant in cephalic presentation at term in the pre-pandemic cohort, and 25 298 in the pandemic-exposed cohort. Interrupted time-series analysis demonstrated no significant additional effect of the pandemic on pre-existing upward trends in maternal Body Mass Index ≥ 25 kg/m2, caesarean section or macrosomia. The rate of maternal Body Mass Index ≥ 25 kg/m2 was higher in the pandemic-exposed cohort compared with the pre-pandemic cohort, (45.82% vs. 44.58% respectively, p = 0.041) as was the overall rate of caesarean section (33.09% vs. 30.80%, p < 0.001). However, this increase in caesarean section was confined to individuals who had either an induction of labour or no labour. There was also a nonsignificant trend to higher rates of macrosomia in the pandemic-exposed cohort compared with the pre-pandemic cohort (8.55% vs. 7.99% respectively, p = 0.124).
Conclusions: While rates of Body Mass Index ≥ 25 kg/m2, pre-labour caesarean section, and caesarean section following induction of labour were higher among pandemic-exposed nulliparas, these findings represented a continuation of pre-existing upward trends, with no significant independent contribution from the pandemic. These trends are forecast to continue, with long term implications for population health.
{"title":"Trends in maternal body mass index, macrosomia and caesarean section in first-time mothers during the pandemic: a multicentre retrospective cohort study of 12 Melbourne public hospitals.","authors":"Andrew J Goldsack, Melvin B Marzan, Daniel L Rolnik, Anthea C Lindquist, Joanne M Said, Kirsten R Palmer, Penelope M Sheehan, Stephanie Potenza, Natasha Pritchard, Clare L Whitehead, Jolyon Ford, Ben W Mol, Susan P Walker, Lisa Hui","doi":"10.1186/s12884-024-06908-y","DOIUrl":"10.1186/s12884-024-06908-y","url":null,"abstract":"<p><strong>Objective: </strong>To compare specific perinatal outcomes in nulliparas with a singleton infant in cephalic presentation at term, with and without exposure to the COVID-19 pandemic during pregnancy. We hypothesised that the pandemic conditions in Melbourne may have been an independent contributor to trends in maternal Body Mass Index ≥ 25 kg/m<sup>2</sup>, macrosomia and caesarean section.</p><p><strong>Design: </strong>Multi-centre retrospective cohort study and interrupted time-series analysis.</p><p><strong>Setting: </strong>Metropolitan Melbourne, Victoria.</p><p><strong>Population: </strong>Singleton infants ≥ 20 weeks gestational age born between 1 January 2019 and 31 March 2022.</p><p><strong>Main outcome measures: </strong>Rates of maternal Body Mass Index ≥ 25 kg/m<sup>2</sup>, macrosomia (birthweight ≥ 4000 g) and caesarean section.</p><p><strong>Results: </strong>25 897 individuals gave birth for the first time to a singleton infant in cephalic presentation at term in the pre-pandemic cohort, and 25 298 in the pandemic-exposed cohort. Interrupted time-series analysis demonstrated no significant additional effect of the pandemic on pre-existing upward trends in maternal Body Mass Index ≥ 25 kg/m<sup>2</sup>, caesarean section or macrosomia. The rate of maternal Body Mass Index ≥ 25 kg/m<sup>2</sup> was higher in the pandemic-exposed cohort compared with the pre-pandemic cohort, (45.82% vs. 44.58% respectively, p = 0.041) as was the overall rate of caesarean section (33.09% vs. 30.80%, p < 0.001). However, this increase in caesarean section was confined to individuals who had either an induction of labour or no labour. There was also a nonsignificant trend to higher rates of macrosomia in the pandemic-exposed cohort compared with the pre-pandemic cohort (8.55% vs. 7.99% respectively, p = 0.124).</p><p><strong>Conclusions: </strong>While rates of Body Mass Index ≥ 25 kg/m<sup>2</sup>, pre-labour caesarean section, and caesarean section following induction of labour were higher among pandemic-exposed nulliparas, these findings represented a continuation of pre-existing upward trends, with no significant independent contribution from the pandemic. These trends are forecast to continue, with long term implications for population health.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-26DOI: 10.1186/s12884-024-06895-0
Elida Mwenebanda, Antonio Machado, Ajra Ilyas Patel, Alinane Linda Nyondo-Mipando, Isabel Kazanga Chiumia
Background: Maternal mortality in sub-Saharan Africa and Malawi remains high. Effective antenatal care (ANC) services can reduce maternal morbidity and mortality. However, attendance to ANC clinics and the quality of services provided remain a challenge. Malawi adopted the 2016 WHO antenatal care model and there is a need to assess factors that influence antenatal care attendance. The main objective of this study was to assess factors influencing attendance in the era of the eight ANC contact policy in Blantyre.
Methods: This was an exploratory qualitative design in which 28 respondents participated using in-depth interviews and focus group discussions for the data collection process. The study sites included two healthcare facilities, namely Queen Elizabeth Central Hospital and Bangwe Health Centre, and a rural community (William Village Bangwe Rural) in Blantyre district. The 28 study participants included 11 ANC attendees, which comprised seven women in their final trimester and four postpartum women who attended ANC during their pregnancy, five midwives running the ANC clinics, and 12 non-users of ANC. The recordings were transcribed verbatim. The data were organized using Microsoft Excel and Microsoft word and analyzed using inductive content analysis.
Results: The factors promoting ANC attendance in the context of the eight ANC contact policy include; motivation from health workers, family, and spouses and the women's perceptions of ANC particularly the role it plays in preventing, detecting, and treating illness, but also preventing adverse pregnancy outcomes. On the other hand, the hindering factors to ANC attendance included lack of knowledge of the new ANC visit guidelines, financial constraints, quality of health services provided, attitude of healthcare workers, inadequate availability and training of healthcare workers, perceived poor quality of ANC services and personal beliefs.
Conclusion: It is essential to provide comprehensive training to healthcare workers in the antenatal department regarding the new WHO ANC recommendations. This will help improve the quality of services at the antenatal clinics, including ensuring the availability of all necessary resources to encourage attendance. Additionally, promoting comprehensive spousal support, encouraging participation in activities, and adequately planning scheduled visits can help overcome financial barriers and further support antenatal attendance.
背景:撒哈拉以南非洲和马拉维的孕产妇死亡率居高不下。有效的产前保健(ANC)服务可以降低孕产妇发病率和死亡率。然而,产前检查诊所的就诊率和服务质量仍是一项挑战。马拉维采用了 2016 年世界卫生组织产前护理模式,因此有必要评估影响产前护理就诊率的因素。本研究的主要目的是评估在布兰太尔实施八次产前检查接触政策期间影响就诊率的因素:本研究采用探索性定性设计,在数据收集过程中,28 名受访者参与了深度访谈和焦点小组讨论。研究地点包括两个医疗机构,即伊丽莎白女王中央医院和 Bangwe 健康中心,以及布兰太尔区的一个农村社区(William Village Bangwe Rural)。28 名研究参与者包括 11 名产前检查参加者(其中包括 7 名孕期最后三个月的妇女和 4 名产后妇女)、5 名产前检查诊所的助产士和 12 名未使用产前检查的妇女。录音被逐字转录。数据使用 Microsoft Excel 和 Microsoft word 进行整理,并使用归纳内容分析法进行分析:在八项产前保健接触政策的背景下,促进产前保健出席率的因素包括:卫生工作者、家人和配偶的激励,以及妇女对产前保健的看法,特别是产前保健在预防、检测和治疗疾病以及预防不良妊娠结局方面的作用。另一方面,阻碍妇女参加产前检查的因素包括缺乏对新的产前检查指南的了解、经济限制、所提供医疗服务的质量、医护人员的态度、医护人员的可用性和培训不足、认为产前检查服务质量差以及个人信仰:结论:为产前部门的医护人员提供有关世界卫生组织产前检查新建议的全面培训至关重要。这将有助于提高产前检查诊所的服务质量,包括确保提供所有必要的资源以鼓励孕产妇参加产前检查。此外,促进全面的配偶支持、鼓励参与活动以及充分规划预定的就诊时间,都有助于克服经济障碍,进一步支持产前检查的出席率。
{"title":"Factors influencing antenatal care attendance in the eight contact era policy: a case of selected maternal health service facilities in Blantyre, Malawi.","authors":"Elida Mwenebanda, Antonio Machado, Ajra Ilyas Patel, Alinane Linda Nyondo-Mipando, Isabel Kazanga Chiumia","doi":"10.1186/s12884-024-06895-0","DOIUrl":"10.1186/s12884-024-06895-0","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality in sub-Saharan Africa and Malawi remains high. Effective antenatal care (ANC) services can reduce maternal morbidity and mortality. However, attendance to ANC clinics and the quality of services provided remain a challenge. Malawi adopted the 2016 WHO antenatal care model and there is a need to assess factors that influence antenatal care attendance. The main objective of this study was to assess factors influencing attendance in the era of the eight ANC contact policy in Blantyre.</p><p><strong>Methods: </strong>This was an exploratory qualitative design in which 28 respondents participated using in-depth interviews and focus group discussions for the data collection process. The study sites included two healthcare facilities, namely Queen Elizabeth Central Hospital and Bangwe Health Centre, and a rural community (William Village Bangwe Rural) in Blantyre district. The 28 study participants included 11 ANC attendees, which comprised seven women in their final trimester and four postpartum women who attended ANC during their pregnancy, five midwives running the ANC clinics, and 12 non-users of ANC. The recordings were transcribed verbatim. The data were organized using Microsoft Excel and Microsoft word and analyzed using inductive content analysis.</p><p><strong>Results: </strong>The factors promoting ANC attendance in the context of the eight ANC contact policy include; motivation from health workers, family, and spouses and the women's perceptions of ANC particularly the role it plays in preventing, detecting, and treating illness, but also preventing adverse pregnancy outcomes. On the other hand, the hindering factors to ANC attendance included lack of knowledge of the new ANC visit guidelines, financial constraints, quality of health services provided, attitude of healthcare workers, inadequate availability and training of healthcare workers, perceived poor quality of ANC services and personal beliefs.</p><p><strong>Conclusion: </strong>It is essential to provide comprehensive training to healthcare workers in the antenatal department regarding the new WHO ANC recommendations. This will help improve the quality of services at the antenatal clinics, including ensuring the availability of all necessary resources to encourage attendance. Additionally, promoting comprehensive spousal support, encouraging participation in activities, and adequately planning scheduled visits can help overcome financial barriers and further support antenatal attendance.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Introduction: </strong>The majority of pregnancy-related complications were preventable. However, the magnitude of complications during pregnancy and childbirth was high in sub-Saharan Africa. There was limited evidence on the magnitude of obstetric complications during childbirth and its predictors among postpartum women in Ethiopia.</p><p><strong>Methods and materials: </strong>The research used secondary data sources based on performance monitoring for action in Ethiopia's second cohort longitudinal survey. It was a national survey that was conducted in three large, predominantly agrarian regions (Oromia, Amhara, and SNNP) and one urban region (Addis Ababa) of Ethiopia between 2021 and 2023. It was conducted to track pregnant women's use of essential maternal and newborn health services. It involved the enrollment of pregnant women and tracking them at six weeks, six months, and one year after giving birth. The data collected at the beginning of the survey and six weeks after childbirth were used for the analysis. Sample weights were applied to account for differences in sample allocation and response rates across regions and urban/rural areas. Multi-collinearity and intra-cluster correlation were assessed before fitting the multilevel models to ensure the accuracy of the estimates. A multi-level logistic regression model was used to assess the magnitude and predictors for the occurrence of obstetric complications during delivery. The model fit was evaluated using Akaike's Information Criterion and Bayesian Information Criterion. Adjusted odds ratio with its 95% confidence interval was used to measure the strength of association for this study.</p><p><strong>Results: </strong>The magnitude of obstetric complications during delivery was found to be 33.86% with 95% CI (31.56, 36.24. Among the obstetric complications that occurred during delivery, about 15.73%with 95% CI(14.02, 17.61) of women experienced bleeding, 4.14% with 95% CI (3.30, 5.17) had their membrane rupture but labor did not start within 24 h, 2.29% with 95% CI(1.67, 3.13) had their membrane rupture before 9 months, 3.95% with 95% CI(3.16, 4.93) had faced malpresentation or malposition of the baby, 12.70% with 95% CI (11.18, 14.39) had prolonged labor lasting more than 12 h, and 12.40% with 95% CI (10.83,14.17) had convulsions. The odds of occurrence of obstetric complication during delivery among women from severely food insecure households were 1.88 times [AOR = 1.88; 95% CI (1.22, 2.90)] more likely to occur than women from food secure households. Moreover, the odds of occurrence for obstetric complications during delivery among women who had complications during their pregnancy were 2.39 times [AOR = 2.39; 95% CI (1.81, 3.16)] more likely to occur as compared to those women who had no complication during their pregnancy. On the other hand, women's who had 1-4 live births given before this delivery were 0.61 times [AOR = 0.61; 95% (0.43, 0.88)] less likely to develop
{"title":"Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey.","authors":"Amare Mebrat Delie, Mihret Melese, Liknaw Workie Limenh, Dereje Esubalew, Nigus Kassie Worku, Eneyew Talie Fenta, Mickiale Hailu, Alemwork Abie, Molla Getie Mehari, Tenagnework Eseyneh Dagnaw","doi":"10.1186/s12884-024-06904-2","DOIUrl":"10.1186/s12884-024-06904-2","url":null,"abstract":"<p><strong>Introduction: </strong>The majority of pregnancy-related complications were preventable. However, the magnitude of complications during pregnancy and childbirth was high in sub-Saharan Africa. There was limited evidence on the magnitude of obstetric complications during childbirth and its predictors among postpartum women in Ethiopia.</p><p><strong>Methods and materials: </strong>The research used secondary data sources based on performance monitoring for action in Ethiopia's second cohort longitudinal survey. It was a national survey that was conducted in three large, predominantly agrarian regions (Oromia, Amhara, and SNNP) and one urban region (Addis Ababa) of Ethiopia between 2021 and 2023. It was conducted to track pregnant women's use of essential maternal and newborn health services. It involved the enrollment of pregnant women and tracking them at six weeks, six months, and one year after giving birth. The data collected at the beginning of the survey and six weeks after childbirth were used for the analysis. Sample weights were applied to account for differences in sample allocation and response rates across regions and urban/rural areas. Multi-collinearity and intra-cluster correlation were assessed before fitting the multilevel models to ensure the accuracy of the estimates. A multi-level logistic regression model was used to assess the magnitude and predictors for the occurrence of obstetric complications during delivery. The model fit was evaluated using Akaike's Information Criterion and Bayesian Information Criterion. Adjusted odds ratio with its 95% confidence interval was used to measure the strength of association for this study.</p><p><strong>Results: </strong>The magnitude of obstetric complications during delivery was found to be 33.86% with 95% CI (31.56, 36.24. Among the obstetric complications that occurred during delivery, about 15.73%with 95% CI(14.02, 17.61) of women experienced bleeding, 4.14% with 95% CI (3.30, 5.17) had their membrane rupture but labor did not start within 24 h, 2.29% with 95% CI(1.67, 3.13) had their membrane rupture before 9 months, 3.95% with 95% CI(3.16, 4.93) had faced malpresentation or malposition of the baby, 12.70% with 95% CI (11.18, 14.39) had prolonged labor lasting more than 12 h, and 12.40% with 95% CI (10.83,14.17) had convulsions. The odds of occurrence of obstetric complication during delivery among women from severely food insecure households were 1.88 times [AOR = 1.88; 95% CI (1.22, 2.90)] more likely to occur than women from food secure households. Moreover, the odds of occurrence for obstetric complications during delivery among women who had complications during their pregnancy were 2.39 times [AOR = 2.39; 95% CI (1.81, 3.16)] more likely to occur as compared to those women who had no complication during their pregnancy. On the other hand, women's who had 1-4 live births given before this delivery were 0.61 times [AOR = 0.61; 95% (0.43, 0.88)] less likely to develop ","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1186/s12884-024-06856-7
Rebecca Delafield, Eunjung Lim, Ann Chang, Crystal VangTung, Jocelyn Howard, Adrienne Dillard, Sunny Chen, Princess Lei Ebbay, Joseph Keawe'aimoku Kaholokula
Background: Native Hawaiian and Pacific Islanders (NHPI) are disproportionately burdened by pregnancy-related deaths in the United States and have the lowest engagement in prenatal care compared to all other US racial groups. Aside from access barriers, studies suggest that NHPI face challenges with patient-clinician communication, perceived discrimination, and cultural conflicts within healthcare settings. This paper describes the cultural adaptation of the 14-item Mothers On Respect index for NHPI, originally developed by Vedam et al. (2017) for diverse communities in British Columbia, Canada, and reports the findings of the preliminary psychometric assessment of the adapted measure.
Methods: Data from 26 interviews with NHPI women, expert, and cognitive interviews were conducted to inform the adaptation. An online survey was administered to a sample of 90 NHPI women to assess construct validity, convergent validity, and internal reliability of the adapted measure using exploratory and confirmatory factor analyses.
Results: The adaptation resulted in substantial changes to the original measure, mainly by the addition of items related to 'feeling cared for by and connected to the provider' and 'perceived threats hindering communication.' The psychometric analyses identified a three-factor structure for the culturally adapted index and confirmatory factor analyses were employed to refine the measure. The result was a 25-item index with acceptable goodness of fit indices, high internal reliability (Cronbach's alpha of 0.96, 95% CI = .94-.97) and convergent validity with a related scale. Overall, participants in this sample indicated high levels of respectful care; however, people who received < 8 prenatal care visits had significantly lower ratings on average.
Conclusions: Our findings suggest that the elements valued by NHPI are not fully captured in existing measures of respectful maternity care. Efforts to assess more discrete aspects of the patient-provider relationship for culturally distinct and racialized groups could help improve the quality of care and advance equity in maternal and perinatal health marginalized communities.
{"title":"The cultural adaptation and psychometric evaluation of the Mothers on Respect Index for Native Hawaiians and Pacific Islanders.","authors":"Rebecca Delafield, Eunjung Lim, Ann Chang, Crystal VangTung, Jocelyn Howard, Adrienne Dillard, Sunny Chen, Princess Lei Ebbay, Joseph Keawe'aimoku Kaholokula","doi":"10.1186/s12884-024-06856-7","DOIUrl":"10.1186/s12884-024-06856-7","url":null,"abstract":"<p><strong>Background: </strong>Native Hawaiian and Pacific Islanders (NHPI) are disproportionately burdened by pregnancy-related deaths in the United States and have the lowest engagement in prenatal care compared to all other US racial groups. Aside from access barriers, studies suggest that NHPI face challenges with patient-clinician communication, perceived discrimination, and cultural conflicts within healthcare settings. This paper describes the cultural adaptation of the 14-item Mothers On Respect index for NHPI, originally developed by Vedam et al. (2017) for diverse communities in British Columbia, Canada, and reports the findings of the preliminary psychometric assessment of the adapted measure.</p><p><strong>Methods: </strong>Data from 26 interviews with NHPI women, expert, and cognitive interviews were conducted to inform the adaptation. An online survey was administered to a sample of 90 NHPI women to assess construct validity, convergent validity, and internal reliability of the adapted measure using exploratory and confirmatory factor analyses.</p><p><strong>Results: </strong>The adaptation resulted in substantial changes to the original measure, mainly by the addition of items related to 'feeling cared for by and connected to the provider' and 'perceived threats hindering communication.' The psychometric analyses identified a three-factor structure for the culturally adapted index and confirmatory factor analyses were employed to refine the measure. The result was a 25-item index with acceptable goodness of fit indices, high internal reliability (Cronbach's alpha of 0.96, 95% CI = .94-.97) and convergent validity with a related scale. Overall, participants in this sample indicated high levels of respectful care; however, people who received < 8 prenatal care visits had significantly lower ratings on average.</p><p><strong>Conclusions: </strong>Our findings suggest that the elements valued by NHPI are not fully captured in existing measures of respectful maternity care. Efforts to assess more discrete aspects of the patient-provider relationship for culturally distinct and racialized groups could help improve the quality of care and advance equity in maternal and perinatal health marginalized communities.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: According to the World Health Organization report, immigrants are at increased risk of malnutrition. Nutritional deficiencies in pregnancy are a public health concern and around 20 to 30 percent of pregnant women suffer from it worldwide. There has not been any investigation about the effect of any intervention on improving nutritional intake in pregnant Afghan immigrant women. Therefore, the present study was conducted to determine the effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women.
Methods: A semi-experimental study study was conducted on 116 Afghan immigrant pregnant women who have the inclusion criteria, were referred to health center No. 2 in Mashhad, Iran in June 2022 until February 2023, and were randomly assigned to the intervention (56) and control (56) groups. The demographic, HBM questionnaire and the standard 24-h food reminder questionnaire were the research tools. The intervention consisted of four sessions of 45-60 min of nutrition education based on the Health Belief Model in groups of 8-10 people. The questionnaires were completed before, immediately, and one month after the intervention by the research units. Data were analyzed with SPSS version 21 software.
Results: The intake of energy, protein, carbohydrates, and micronutrients such as iron, calcium, zinc, and vitamin D increased in the intervention group immediately and one month after the intervention significantly compared to before the intervention (P < 0.05). Although all these nutrients intake had a significant decrease in control group women (P < 0.05).
Conclusions: Nutrition education based on the health belief model is effective in the nutritional intake of Afghan immigrant pregnant women. According to the importance of getting enough nutrients in pregnancy and its effects on the mother and fetus's health, nutrition education based on the Health Belief Model model is suggested for these mothers.
Trial registration: It is registered in the Iranian clinical trials database under the code: IRCT20220629055312N1, Date of first registration: 25/07/2022.
{"title":"The effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women: a semi-experimental study.","authors":"Somaye Riazi, Vahid Ghavami, Seyyed Reza Sobhani, Nahid Jahani Shoorab, Kobra Mirzakhani","doi":"10.1186/s12884-024-06728-0","DOIUrl":"10.1186/s12884-024-06728-0","url":null,"abstract":"<p><strong>Background: </strong>According to the World Health Organization report, immigrants are at increased risk of malnutrition. Nutritional deficiencies in pregnancy are a public health concern and around 20 to 30 percent of pregnant women suffer from it worldwide. There has not been any investigation about the effect of any intervention on improving nutritional intake in pregnant Afghan immigrant women. Therefore, the present study was conducted to determine the effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women.</p><p><strong>Methods: </strong>A semi-experimental study study was conducted on 116 Afghan immigrant pregnant women who have the inclusion criteria, were referred to health center No. 2 in Mashhad, Iran in June 2022 until February 2023, and were randomly assigned to the intervention (56) and control (56) groups. The demographic, HBM questionnaire and the standard 24-h food reminder questionnaire were the research tools. The intervention consisted of four sessions of 45-60 min of nutrition education based on the Health Belief Model in groups of 8-10 people. The questionnaires were completed before, immediately, and one month after the intervention by the research units. Data were analyzed with SPSS version 21 software.</p><p><strong>Results: </strong>The intake of energy, protein, carbohydrates, and micronutrients such as iron, calcium, zinc, and vitamin D increased in the intervention group immediately and one month after the intervention significantly compared to before the intervention (P < 0.05). Although all these nutrients intake had a significant decrease in control group women (P < 0.05).</p><p><strong>Conclusions: </strong>Nutrition education based on the health belief model is effective in the nutritional intake of Afghan immigrant pregnant women. According to the importance of getting enough nutrients in pregnancy and its effects on the mother and fetus's health, nutrition education based on the Health Belief Model model is suggested for these mothers.</p><p><strong>Trial registration: </strong>It is registered in the Iranian clinical trials database under the code: IRCT20220629055312N1, Date of first registration: 25/07/2022.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1186/s12884-024-06870-9
Kun Zhao, Junmiao Xu, Jingting Zhao, Rongrong Chen, Yuhan Wang, Xiangming Ye, Feifei Zhou
Background: Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes.
Methods: Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models.
Results: Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I2 = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I2 = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I2 = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery.
Conclusions: Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.
{"title":"Influence of prenatal aquatic activities on fetal outcomes and maternal physical and mental outcomes: a systematic review and meta-analysis.","authors":"Kun Zhao, Junmiao Xu, Jingting Zhao, Rongrong Chen, Yuhan Wang, Xiangming Ye, Feifei Zhou","doi":"10.1186/s12884-024-06870-9","DOIUrl":"10.1186/s12884-024-06870-9","url":null,"abstract":"<p><strong>Background: </strong>Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes.</p><p><strong>Methods: </strong>Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models.</p><p><strong>Results: </strong>Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I<sup>2</sup> = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I<sup>2</sup> = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I<sup>2</sup> = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery.</p><p><strong>Conclusions: </strong>Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.
Methods: We conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.
Results: A total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10-1.48], anemia (aOR 1.66; 95% CI 1.34-2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39-5.05), coagulopathy (aOR 25.92; 95% CI 8.59-69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86-4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04-2.47), uterine scar (aOR 1.39; 95% CI 1.15-1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74-4.38), polyhydramnios (aOR 2.52; 95% CI 1.19-4.68) and placenta previa (aOR 25.03; 95% CI 21.04-29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.
Conclusions: Ten risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.
背景:产后出血是导致产妇死亡和发病的主要原因之一。产后出血的病因与分娩方式有关,因此,择期剖宫产产妇大量输血的风险因素可能与阴道分娩或急诊剖宫产产妇大量输血的风险因素不同。本研究的主要目的是调查择期剖宫产产前大量输血的风险因素:方法:我们根据全国范围内三级医院住院病历系统的数据进行了一项回顾性队列研究。我们纳入了 2013 年 1 月至 2018 年 8 月期间接受择期剖宫产手术的产妇。主要结果是大量输血,定义为分娩当天输血超过8个单位的红细胞。候选风险因素由第十版《国际疾病分类》入院诊断代码确定。采用多变量逻辑回归法评估了每个因素与大量输血之间的关系:结果:共纳入 294,695 名产妇,其中 572 人接受了大量输血(发生率:每 100,000 例选择性剖宫产 194 人)。产妇年龄[调整赔率(aOR)1.22;95% 置信区间(CI)1.10-1.48]、贫血(aOR 1.66;95% CI 1.34-2.05)、血小板减少(aOR 3.54;95% CI 2.39-5.05)、凝血功能障碍(aOR 25.92;95% CI 8.59-69.50)、低白蛋白血症(aOR 2.97;95% CI 1.86-4.53)、肝功能障碍(aOR 1.65;95% CI 1.04-2.47)、子宫疤痕(aOR 1.39;95% CI 1.15-1.67)、多胎妊娠(aOR 2.84;95% CI 1.74-4.38)、多羊水(aOR 2.52;95% CI 1.19-4.68)和前置胎盘(aOR 25.03;95% CI 21.04-29.77)与选择性剖宫产大量输血有关。在接受大量输血的产妇中,7 人(1.2%)在住院期间死亡,126 人(22.0%)需要切除子宫,25 人(4.4%)需要子宫填塞术,57 人(10.0%)需要子宫动脉结扎术:结论:在接受择期剖宫产手术的妇女中发现了十种导致大量输血的风险因素。我们的研究结果可能有助于血液制品的准备工作,并为剖宫产术前对大量输血高危产妇采取预防性策略提供了机会。
{"title":"Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study.","authors":"Xiaohan Xu, Yuelun Zhang, Xuerong Yu, Yuguang Huang","doi":"10.1186/s12884-024-06875-4","DOIUrl":"10.1186/s12884-024-06875-4","url":null,"abstract":"<p><strong>Background: </strong>Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10-1.48], anemia (aOR 1.66; 95% CI 1.34-2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39-5.05), coagulopathy (aOR 25.92; 95% CI 8.59-69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86-4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04-2.47), uterine scar (aOR 1.39; 95% CI 1.15-1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74-4.38), polyhydramnios (aOR 2.52; 95% CI 1.19-4.68) and placenta previa (aOR 25.03; 95% CI 21.04-29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.</p><p><strong>Conclusions: </strong>Ten risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Uterine rupture is a rare but severe obstetric complication that poses significant risks to maternal and fetal health. Understanding the lived experiences of individuals who have undergone uterine rupture is crucial for improving care and support for those affected by this condition. This qualitative phenomenological study aimed to explore the experiences of individuals who have experienced uterine rupture.
Method: The study employed a qualitative phenomenological approach, conducting 12 in-depth interviews and four key informant interviews with individuals who had experienced uterine rupture. Data analysis was conducted thematically using Atlas ti software to identify patterns and themes within the participants' narratives.
Results: The analysis of the interviews highlighted six key themes: experience during diagnosis and initial symptoms, perceived predisposing factors of uterine rupture, challenges faced by individuals with uterine rupture, impacts on their lives, and coping and resilience strategies. The findings revealed that women often failed to recognise the initial symptoms of uterine rupture due to a lack of preparation, a preference for home deliveries, husband refusal, and a general lack of awareness. This delay in seeking care resulted in severe consequences, including the loss of their babies, infertility, fistula, psychological trauma, and disruptions to daily life and relationships. To cope, many women resorted to accepting their situation, isolating themselves, and using traditional healing techniques.
Conclusions: This study's findings provide valuable insights into the complex and multifaceted nature of uterine rupture, shedding light on the experiences of those affected by this condition. To address the challenges, it is essential to enhance awareness and education through community education programs and comprehensive antenatal classes. Additionally, improving access to healthcare by strengthening health infrastructure and deploying mobile health clinics can ensure better prenatal care. Furthermore, encouraging hospital deliveries through incentives and the support of community health workers can reduce risks. Providing psychological counselling and establishing support groups can help affected women cope with the consequences. Moreover, engaging men in maternal health through educational programs and involving them in antenatal care can foster better support. Finally, promoting safe traditional practices by integrating traditional healers and respecting cultural sensitivities can increase acceptance and adherence.
背景:子宫破裂是一种罕见但严重的产科并发症,对产妇和胎儿的健康构成重大风险。了解子宫破裂患者的生活经历对于改善对患者的护理和支持至关重要。这项定性现象学研究旨在探索子宫破裂患者的经历:本研究采用定性现象学方法,对经历过子宫破裂的患者进行了 12 次深度访谈和 4 次关键信息提供者访谈。使用 Atlas ti 软件对数据进行了主题分析,以确定参与者叙述中的模式和主题:对访谈的分析突出了六个关键主题:诊断期间的经历和初期症状、子宫破裂的诱发因素、子宫破裂患者面临的挑战、对其生活的影响以及应对和复原策略。研究结果显示,由于缺乏准备、倾向于在家分娩、丈夫拒绝以及普遍缺乏认识,妇女往往无法识别子宫破裂的初期症状。这种延误就医的情况导致了严重的后果,包括失去婴儿、不孕、瘘管、心理创伤以及日常生活和人际关系的中断。为了解决这些问题,许多妇女不得不接受自己的处境,与世隔绝,并使用传统的治疗方法:这项研究的结果为了解子宫破裂的复杂性和多面性提供了宝贵的见解,同时也揭示了受这种疾病影响的人的经历。为了应对这些挑战,必须通过社区教育计划和综合产前课程来加强宣传和教育。此外,通过加强医疗基础设施和部署流动医疗诊所来改善医疗服务的可及性,可以确保更好的产前护理。此外,通过激励措施和社区卫生工作人员的支持来鼓励住院分娩也能降低风险。提供心理咨询和建立支持小组可以帮助受影响的妇女应对后果。此外,通过教育计划让男性参与到孕产妇保健中来,并让他们参与到产前护理中来,可以促进更好的支持。最后,通过结合传统医士和尊重文化敏感性来推广安全的传统做法,可以提高接受度和坚持度。
{"title":"Lived experiences of women with uterine rupture who were managed at Nekemte specialized hospital: a qualitative study.","authors":"Mitiku Getachew Kumara, Gurmesa Tura Debelew, Beyene Wondafrash Ademe","doi":"10.1186/s12884-024-06890-5","DOIUrl":"10.1186/s12884-024-06890-5","url":null,"abstract":"<p><strong>Background: </strong>Uterine rupture is a rare but severe obstetric complication that poses significant risks to maternal and fetal health. Understanding the lived experiences of individuals who have undergone uterine rupture is crucial for improving care and support for those affected by this condition. This qualitative phenomenological study aimed to explore the experiences of individuals who have experienced uterine rupture.</p><p><strong>Method: </strong>The study employed a qualitative phenomenological approach, conducting 12 in-depth interviews and four key informant interviews with individuals who had experienced uterine rupture. Data analysis was conducted thematically using Atlas ti software to identify patterns and themes within the participants' narratives.</p><p><strong>Results: </strong>The analysis of the interviews highlighted six key themes: experience during diagnosis and initial symptoms, perceived predisposing factors of uterine rupture, challenges faced by individuals with uterine rupture, impacts on their lives, and coping and resilience strategies. The findings revealed that women often failed to recognise the initial symptoms of uterine rupture due to a lack of preparation, a preference for home deliveries, husband refusal, and a general lack of awareness. This delay in seeking care resulted in severe consequences, including the loss of their babies, infertility, fistula, psychological trauma, and disruptions to daily life and relationships. To cope, many women resorted to accepting their situation, isolating themselves, and using traditional healing techniques.</p><p><strong>Conclusions: </strong>This study's findings provide valuable insights into the complex and multifaceted nature of uterine rupture, shedding light on the experiences of those affected by this condition. To address the challenges, it is essential to enhance awareness and education through community education programs and comprehensive antenatal classes. Additionally, improving access to healthcare by strengthening health infrastructure and deploying mobile health clinics can ensure better prenatal care. Furthermore, encouraging hospital deliveries through incentives and the support of community health workers can reduce risks. Providing psychological counselling and establishing support groups can help affected women cope with the consequences. Moreover, engaging men in maternal health through educational programs and involving them in antenatal care can foster better support. Finally, promoting safe traditional practices by integrating traditional healers and respecting cultural sensitivities can increase acceptance and adherence.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}