BMC Pregnancy and Childbirth最新文献

Background: Caesarean section (CS) rates have increased globally, with substantial variations across healthcare settings. Monitoring CS rates using Robson's Ten Group Classification System (RTGCS) provides insights into obstetric practices. This study examines the variation in CS rates among women classified in Groups 1 to 4 of the RTGCS across hospitals in four low- and middle-income countries (LMICs) and explores hospital-level factors associated with these variations.

Methods: This observational study analyzed CS rates in 32 hospitals (8 per country) in Argentina, Burkina Faso, Thailand, and Vietnam. Data were collected from hospital records between January and December 2020. A meta-analysis assessed hospital-level heterogeneity in CS rates, and meta-regression models explored potential determinants, including hospital characteristics such as staffing levels, equipment availability, and birth volume.

Results: The overall CS rate in the 32 hospitals was 45.4%, with nearly half (46.5%) of CS performed on women in Groups 1 to 4. There was substantial heterogeneity in CS rates among hospitals (I² > 75%, p < 0.001). Factors associated with variations included country differences, staffing levels (midwife-to-delivery and doctor-to-delivery ratios at night), the presence of functional equipment (ultrasound and cardiotocograph), birth volume, and the possibility of labor companionship. Hospitals with higher birth volumes and greater staff availability had higher CS rates, while those permitting companionship during labor exhibited lower rates.

Conclusions: Hospital characteristics appear to influence CS rates among low-risk groups, highlighting the need to consider institutional factors when implementing CS reduction strategies. Routine monitoring using the RTGCS, alongside tailored interventions addressing hospital-specific challenges, could support efforts to optimize CS use in LMICs. Further research is needed to confirm the role of organizational factors and guide policy decisions.

Trial registration: The QUALI-DEC trial is registered with the Current Controlled Trials database (ISRCTN67214403), registration date: 30/03/2020.

Introduction: Maternal functioning in the first year after childbirth is vital for both mother and infant health. During this period, mothers often face various physical, psychological, and social challenges that may affect their ability to function effectively. Given the limited research on the status of maternal functioning and its predictors, particularly using a comprehensive instrument and within a 12-month postpartum period in Iran, this study aimed to assess maternal functioning status in the first year after childbirth and its predictors in Iranian mothers.

Methods: This cross-sectional study was conducted on 503 mothers in the first year after childbirth in the cities of Tehran and Semnan with two-stage stratified cluster sampling. The data was collected using questionnaire of demographic characteristics of mothers and newborns and the five-factor Persian version of Barkin Index of Maternal Functioning (BIMF) and analysed using SPSS version 25.

Findings: The mean and standard deviation of the general score of mothers' maternal functioning was (78.05 ±11.11). Mothers obtained the highest mean score in the infant care subscale (87.05 ± 16.52) and the lowest mean score in the maternal psychological well-being subscale (53.46± 27.45). The variable of postpartum maternal complications was the only predictive factor for the general state of maternal functioning after childbirth (P < 0.001, B = 3.709). This variable had a predictive role for all subscales of maternal functioning except the infant care subscale. Also, the mother's education level variable for the subscales of Maternal Psychological Well-being and Infant Care, the infant feeding method variable for the subscales of Infant Care and self-care, and the mother's job variable for the subscales of Satisfaction with Maternal Competence and self-care have been predictive factors.

Conclusion: In this study, Maternal functioning status after childbirth has been evaluated as strong, but this state is still far from its ideal level and requires interventions for improvement. Postpartum maternal complications, along with child feeding method, mother's level of education, and job, have a predictive role for maternal functioning status and its subscales. Therefore, special attention should be paid to these predictive factors to strengthen and improve the state of maternal function after childbirth.

Background: Extremely low birth weight (ELBW) infants, which weighing less than 1000 g, are at high risk of adverse neonatal outcomes, including intraventricular hemorrhage (IVH), respiratory distress syndrome, and long-term neurodevelopmental impairments. En caul cesarean section (ECCS) is often performed for delivery of ELBW infants to minimize potential damages to the skin, bones, and brain. Although a few studies reported that ECCS is a safe procedure for infants, there is limited research investigating the association between this procedure and neonatal IVH. This study aims to assess whether ECCS contributes to adverse effects during delivery, and association with the occurrence of neonatal IVH.

Methods: We retrospectively examined 252 ELBW infants delivered at our hospital from April 2015 to December 2023. Patients were divided into four groups according to delivery mode: successful ECCS, unsuccessful ECCS, non-trial ECCS, and vaginal delivery. The primary outcome was the incidence of IVH grade ≥ 3 during the neonatal period. The secondary outcomes were hemoglobin level of the infant, umbilical artery blood pH level, and maternal blood loss at delivery.

Results: No significant differences were observed in the median umbilical artery blood pH levels, Hb levels of infants at delivery, the amounts of maternal blood loss at delivery, incidence of IVH grade ≥ 3, intestinal perforation, or neonatal mortality between the group of patients who were attempted en caul cesarean delivery and the group of patients who were not. The incidence of IVH grade ≥ 3 was significantly lower in the group of successful ECCS compared with the other groups (4.8% vs. 15.8%, respectively; p < 0.05). The significant factors for IVH grade ≥ 3 identified on multivariate analysis were gestation week at delivery ≤ 24 weeks (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.33-6.62), steroid administration (OR 0.10, 95% CI 0.01-0.77) and successful ECCS (OR 0.29, 95% CI 0.09-0.87).

Conclusion: ECCS for ELBW infants may reduce the risk of neonatal IVH grade ≥ 3, and does not contribute to anemia and hypoxia of infants at delivery.

Background: Obstetric violence is an emerging health problem in maternal health services utilization. In the study context, there was limited evidence on obstetrics violence. Hence, the aim of this study to assess obstetric violence and its associated factors among HIV-positive women received birth care at public health facilities, Addis Ababa, Ethiopia.

Result: A total of 318 HIV-positive women had been participated in this study yielding 100% response rate. In this study 79% of HIV-positive women reported they had been subjected to at least one form of obstetric violence during birth care. The top three reported forms of obstetric violence: 249 (78.3%) failure to get informed consent, 227 (71.4%) unconsented medical procedure, 140 (44%) neglecting to suffer life-threatening complication. In the multivariable logistic regression analysis were identified that Female birth attendants (AOR = 2.85; 95% CI 1.57, 5.15), less than three times ANC-visitors (AOR = 2.99; 95% CI 1.39, 6.45), age > 35 years old (AOR = 2.47; 95% CI 1.25, 4.90) and primary school attendants (AOR = 2.13; 95% CI 1.08, 4.17) were significantly associated with obstetrics violence. This study identified that high prevalence of obstetric violence among HIV positive women. Hence, mitigation is needed to be undertaken by taking the reported forms of obstetrics violence, socio-demographic and obstetrics variables by ensuring a systematic and strategic intervention for quality birth care utilization through an inclusive involvement like families, communities, government and stakeholders.