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The mechanism of paclitaxel induced damage on placental trophoblast cells. 紫杉醇对胎盘滋养层细胞的损伤机制
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-28 DOI: 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.

目的:妊娠期化疗具有一定的风险,可能引起流产、早产、胎儿生长受限等一系列并发症,但这些并发症与化疗的关系目前尚不明确。本实验主要研究化疗药物紫杉醇对胎盘滋养层细胞可能的损伤机制,探讨化疗是否会通过直接损伤胎盘组织而影响妊娠结局:本研究通过免疫荧光染色、Western blot实验、细胞流式细胞术、Seahorese细胞代谢实验和小鼠建模验证,探讨紫杉醇对胎盘滋养层细胞株JEG-3和BEWO的损伤机制:实验发现,紫杉醇能诱导JEG-3和BEWO细胞产生活性氧(ROS),并提高Bax/Bcl-2的表达比例。此外,紫杉醇还能降低JEG-3和BEWO细胞的线粒体膜电位,造成损伤,导致线粒体自噬和未折叠蛋白反应的发生。紫杉醇抑制 JEG-3 和 BEWO 细胞的糖酵解率,导致线粒体功能受损,包括基础呼吸值下降、呼吸储备能力下降和质子泄漏。在妊娠小鼠肿瘤模型中,紫杉醇可引起胎盘组织细胞的DNA损伤,并可能导致化疗小鼠胎盘组织细胞凋亡和正常生理功能受损:结论:紫杉醇可直接或间接影响胎盘滋养层细胞的正常生理功能,包括能量代谢和蛋白质合成障碍,这可能与紫杉醇化疗引起的不良妊娠结局有关。
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引用次数: 0
Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study. 与乌干达姆巴拉拉地区转诊医院剖腹产新生儿早发败血症相关的产妇因素:一项病例对照研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-28 DOI: 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.

背景:在低收入地区,剖腹产婴儿患早发新生儿败血症(EONS)的风险较高,其死亡率高于晚发败血症。然而,在包括乌干达在内的这些地区,导致剖腹产新生儿败血症的孕产妇因素并没有得到很好的记录。我们确定了乌干达西南部姆巴拉拉地区转诊医院(MRRH)剖腹产足月儿中与 EONS 相关的母体因素:2019年12月至2020年3月,我们在姆巴拉拉地区转诊医院开展了一项非匹配病例对照研究。病例为剖腹产的足月新生儿(72小时内)。对照组为剖腹产的足月儿,无EONS。我们对两组母婴进行了登记,并通过结构化问卷调查获得了母婴数据。病例是连续招募的,而对照组则通过简单随机抽样以 1:2 的比例招募。我们排除了母亲因病无法同意的新生儿。我们使用多变量逻辑回归分析来确定与EONS相关的母亲因素:我们共登记了 52 例病例和 104 例对照。母亲的平均年龄为 27 (± 5.5)岁。与非转诊母亲所生的新生儿相比,转诊母亲所生的新生儿发生 EONS 的几率更高(AOR = 6.2,95% CI:1.8-21)。此外,决定紧急剖腹产的分娩时间大于 1 小时(AOR = 16,95% CI:4.2-65)、产前出血(AOR = 8.0,95% CI:1.6-40)、初产妇(AOR = 4.8,95% CI:1.1-21)和破膜后阴道检查次数大于 3 次(AOR = 4.3,95% CI:1.5-12)与 EONS 相关:结论:在瑞金医院通过剖腹产分娩的足月儿中,孕早期、产前出血、破膜后多次阴道检查、从决定到分娩的时间过长以及转诊情况与EONS有关。为降低 EONS 风险,临床医生应限制膜破裂后的阴道检查,或在需要多次检查时考虑使用预防性抗生素。对初产妇、转诊者、产前出血者、胎膜破裂后多次阴道检查者以及从决定到分娩时间较长的产妇所生的婴儿进行筛查,有助于及时发现 EONS 并进行及时干预。实施标准程序以缩短剖腹产从决定到分娩的时间,可降低在这种情况下发生 EONS 的风险。
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引用次数: 0
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. 大流行期间初产妇体重指数、巨大儿和剖腹产的趋势:墨尔本 12 家公立医院的多中心回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-28 DOI: 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.

目的比较在妊娠期间接触过和未接触过 COVID-19 大流行的头足月单胎产妇的特定围产期结局。我们假设,墨尔本的大流行条件可能是导致孕产妇体重指数≥25 kg/m2、巨大儿和剖腹产趋势的一个独立因素:设计:多中心回顾性队列研究和间断时间序列分析:地点:维多利亚州墨尔本市:主要结果测量指标:主要结果测量指标:产妇体重指数≥25 kg/m2、巨大儿(出生体重≥4000 g)和剖腹产率。结果:大流行前队列中有25 897人首次分娩头足月单胎婴儿,大流行暴露队列中有25 298人首次分娩头足月单胎婴儿。间断时间序列分析表明,大流行对孕产妇体重指数≥ 25 kg/m2、剖腹产或巨大儿的上升趋势没有明显的额外影响。与大流行前队列相比,大流行暴露队列中孕产妇体重指数≥25 kg/m2 的比率更高(分别为 45.82% 对 44.58%,p = 0.041),剖腹产的总体比率也更高(33.09% 对 30.80%,p 结论:大流行暴露队列中孕产妇体重指数≥25 kg/m2 的比率更高(分别为 45.82% 对 44.58%,p = 0.041),剖腹产的总体比率也更高(33.09% 对 30.80%,p = 0.041):虽然体质指数≥ 25 kg/m2、产前剖腹产率和引产后剖腹产率在受大流行影响的非妊娠妇女中较高,但这些结果代表了先前存在的上升趋势的延续,大流行并没有造成显著的独立影响。预计这些趋势将持续下去,并对人口健康产生长期影响。
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引用次数: 0
Factors influencing antenatal care attendance in the eight contact era policy: a case of selected maternal health service facilities in Blantyre, Malawi. 影响八次接触政策下产前保健就诊率的因素:马拉维布兰太尔部分孕产妇保健服务机构的案例。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-26 DOI: 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":"24 1","pages":"704"},"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}
引用次数: 0
Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey. 埃塞俄比亚产后妇女分娩期间产科并发症的严重程度和预测因素:来自埃塞俄比亚 PMA 纵向调查的证据。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-26 DOI: 10.1186/s12884-024-06904-2
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
<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
导言大多数与妊娠有关的并发症都是可以预防的。然而,在撒哈拉以南非洲地区,妊娠和分娩并发症的发生率很高。有关埃塞俄比亚产后妇女分娩期间产科并发症的严重程度及其预测因素的证据有限:研究使用了基于埃塞俄比亚第二次队列纵向调查行动绩效监测的二手数据源。这是一项全国性调查,于 2021 年至 2023 年期间在埃塞俄比亚三个以农业为主的大区(奥罗莫、阿姆哈拉和南方各族自治省)和一个城市地区(亚的斯亚贝巴)进行。该项目旨在跟踪孕妇使用基本孕产妇和新生儿保健服务的情况。该项目包括孕妇登记和产后六周、六个月和一年的跟踪。调查开始时和产后六周收集的数据用于分析。对样本进行了加权处理,以考虑不同地区和城乡之间样本分配和回复率的差异。在拟合多层次模型之前,对多重共线性和组内相关性进行了评估,以确保估计值的准确性。多层次逻辑回归模型用于评估分娩过程中产科并发症发生的程度和预测因素。使用 Akaike 信息准则和贝叶斯信息准则对模型的拟合度进行了评估。本研究使用调整后的几率及其 95% 的置信区间来衡量相关性的强度:分娩期间产科并发症的发生率为 33.86%,95% 置信区间(31.56, 36.24)。在分娩过程中出现的产科并发症中,约 15.73% 的产妇出现出血,95% CI 为(14.02, 17.61);4.14% 的产妇胎膜破裂,95% CI 为(3.30, 5.17),但分娩没有在 24 小时内开始;2.29% 的产妇胎膜破裂,95% CI 为(1.67, 3.2.29%(95% CI:1.67, 3.13)的产妇在 9 个月前胎膜破裂;3.95%(95% CI:3.16, 4.93)的产妇面临胎位不正;12.70%(95% CI:11.18, 14.39)的产妇产程延长超过 12 小时;12.40%(95% CI:10.83, 14.17)的产妇出现抽搐。与来自食品安全家庭的妇女相比,来自严重食品安全家庭的妇女在分娩过程中发生产科并发症的几率要高出 1.88 倍 [AOR = 1.88;95% CI (1.22, 2.90)]。此外,与怀孕期间未发生并发症的妇女相比,怀孕期间发生并发症的妇女在分娩时出现产科并发症的几率要高出 2.39 倍 [AOR = 2.39;95% CI (1.81,3.16)]。另一方面,与之前没有活产经历的产妇相比,在此次分娩之前有过 1-4 次活产经历的产妇发生并发症的几率要低 0.61 倍 [AOR = 0.61; 95% (0.43, 0.88)]:埃塞俄比亚分娩过程中与分娩相关的产科并发症较多。埃塞俄比亚约有三分之一的产后妇女在分娩时出现产科并发症。根据这项研究,来自严重粮食不安全家庭的妇女、之前未生育过活产婴儿的妇女以及在怀孕期间出现并发症的妇女更有可能出现与分娩有关的产科并发症。因此,从事孕产妇和新生儿健康工作的政策制定者和计划实施者应特别关注来自严重粮食不安全家庭的妇女、之前没有活产经历的妇女以及在怀孕期间出现产科并发症的妇女,以减少分娩期间产科并发症的发生。在埃塞俄比亚,卫生部和农业部等多个政府组织致力于解决粮食不安全问题和改善营养获取。该国已启动了几项有效的营养计划,包括生产安全网计划、有针对性的补充营养餐计划和国家营养计划,旨在缓解粮食不安全问题并改善营养状况。持续的努力对于解决妇女的粮食不安全问题至关重要,这有助于减少妇女在分娩过程中与产科有关的并发症。参与孕产妇和新生儿保健的每个人都必须优先解决导致妇女分娩时产科并发症的因素,以实现到 2030 年消除所有可预防的孕产妇和新生儿死亡的目标。
{"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":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and materials: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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":"24 1","pages":"703"},"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}
引用次数: 0
The cultural adaptation and psychometric evaluation of the Mothers on Respect Index for Native Hawaiians and Pacific Islanders. 夏威夷原住民和太平洋岛民母亲受尊重指数的文化适应性和心理测量评估。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-25 DOI: 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.

背景:在美国,夏威夷原住民和太平洋岛民(NHPI)在与妊娠相关的死亡中承受着过重的负担,与美国所有其他种族群体相比,他们参与产前护理的比例最低。除就医障碍外,研究表明,NHPI 在医疗保健环境中还面临着患者与医生沟通、歧视感和文化冲突等挑战。本文介绍了最初由 Vedam 等人(2017 年)针对加拿大不列颠哥伦比亚省不同社区开发的 14 项母亲尊重指数的文化适应性,并报告了适应性测量的初步心理测量评估结果:方法:对 26 名非高危人群妇女、专家和认知访谈者进行了访谈,为改编提供数据。对 90 名 NHPI 女性样本进行了在线调查,通过探索性和确认性因素分析来评估改编后测量方法的构建有效性、聚合有效性和内部可靠性:改编后的测量结果对原始测量结果做了很大改动,主要是增加了与 "感受到提供者的关怀和与提供者的联系 "和 "感知到的阻碍沟通的威胁 "相关的项目。心理测量分析确定了文化适应指数的三因素结构,并采用了确认因素分析来完善该测量。结果是,25 个项目的指数具有可接受的拟合指数、较高的内部信度(Cronbach's alpha 为 0.96,95% CI = .94-.97)以及与相关量表的趋同效度。总体而言,该样本中的参与者对尊重他人的护理表示出了较高的认可度;但是,接受 "结论 "的人对尊重他人的护理表示出了较低的认可度:我们的研究结果表明,现有的尊重孕产妇护理量表并没有完全反映出 NHPI 所重视的要素。针对不同文化和种族群体评估患者与医疗服务提供者关系的更多不同方面,有助于提高医疗服务质量,促进孕产妇和围产期健康边缘化社区的公平。
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引用次数: 0
The effect of nutrition education based on the Health Belief Model (HBM) on food intake in pregnant Afghan immigrant women: a semi-experimental study. 基于健康信念模式(HBM)的营养教育对阿富汗移民孕妇食物摄入量的影响:一项半实验研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-25 DOI: 10.1186/s12884-024-06728-0
Somaye Riazi, Vahid Ghavami, Seyyed Reza Sobhani, Nahid Jahani Shoorab, Kobra Mirzakhani

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.

背景:根据世界卫生组织的报告,移民营养不良的风险增加。孕妇营养不良是一个公共卫生问题,全世界约有 20%至 30%的孕妇营养不良。目前还没有任何调查显示任何干预措施对改善阿富汗移民孕妇营养摄入的效果。因此,本研究旨在确定基于健康信念模式(HBM)的营养教育对阿富汗移民孕妇食物摄入量的影响:本研究对符合纳入标准的 116 名阿富汗移民孕妇进行了半实验研究,这些孕妇于 2022 年 6 月至 2023 年 2 月被转诊至伊朗马什哈德市第 2 卫生中心,并被随机分配至干预组(56 人)和对照组(56 人)。研究工具包括人口统计学问卷、HBM问卷和标准24小时食物提醒问卷。干预措施包括根据健康信念模式进行四次45-60分钟的营养教育,每组8-10人。各研究单位分别在干预前、干预后和干预后一个月完成问卷调查。数据采用 SPSS 21 版软件进行分析:结果:与干预前相比,干预组的能量、蛋白质、碳水化合物以及铁、钙、锌和维生素 D 等微量营养素的摄入量在干预前、干预后和干预后一个月都有显著增加(P 结论:与干预前相比,干预组的能量、蛋白质、碳水化合物以及铁、钙、锌和维生素 D 等微量营养素的摄入量都有显著增加(P):基于健康信念模式的营养教育对阿富汗移民孕妇的营养摄入很有效。鉴于孕期摄入足够营养的重要性及其对母亲和胎儿健康的影响,建议对这些母亲开展基于健康信念模式的营养教育:该项目已在伊朗临床试验数据库注册,代码为IRCT20220629055312N1,首次注册日期:2022 年 7 月 25 日。
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引用次数: 0
Influence of prenatal aquatic activities on fetal outcomes and maternal physical and mental outcomes: a systematic review and meta-analysis. 产前水上活动对胎儿和产妇身心健康的影响:系统综述和荟萃分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-25 DOI: 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.

背景:水上活动作为一种孕期锻炼方式正变得越来越流行。然而,这些活动对孕妇怀孕期间和怀孕后的身心健康以及胎儿的影响仍不清楚。这项荟萃分析评估了有关孕期水上活动对新生儿和孕产妇预后影响的现有证据:方法:在三个数据库(PubMed、Cochrane Central 电子数据库、Embase)中搜索了从开始到 2024 年 7 月 17 日的随机对照试验(RCT),比较水上活动与标准产前护理或不做运动对新生儿和孕产妇结局的影响。采用随机效应模型确定汇总结果:10项研究(包括1949名患者)符合荟萃分析的纳入标准。结果显示,产前水中活动可显著改善产妇体重控制(平均差 [MD]= -0.91,95% 置信区间 [CI]= -1.64 至 -0.18,P = 0.01,I2 = 0.00%)、改善产妇生活质量(标准平均差 [SMD] = 0.16,95%CI = 0.03 至 0.28,P = 0.01,I2 = 0.00%)和延长胎儿出生长度(MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I2 = 0.00%),而在胎儿出生体重、1 分钟阿普加评分、5 分钟阿普加评分、脐带血 pH 值、胎龄、早产率、产后抑郁发生率和分娩方式方面,与标准产前护理或不运动相比无显著差异:结论:产前水上活动可明显改善孕妇体重控制和孕期生活质量,并可促进产程延长。然而,还需要更多的研究来证实这些发现。
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引用次数: 0
Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study. 产前风险因素与选择性剖腹产大量输血的结果:一项全国性回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12884-024-06875-4
Xiaohan Xu, Yuelun Zhang, Xuerong Yu, Yuguang Huang

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。
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引用次数: 0
Lived experiences of women with uterine rupture who were managed at Nekemte specialized hospital: a qualitative study. 在 Nekemte 专科医院接受治疗的子宫破裂妇女的生活经历:一项定性研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-24 DOI: 10.1186/s12884-024-06890-5
Mitiku Getachew Kumara, Gurmesa Tura Debelew, Beyene Wondafrash Ademe

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。
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BMC Pregnancy and Childbirth
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