BMC Pregnancy and Childbirth最新文献

Background: Histological chorioamnionitis (HCA) is a significant global threat to maternal and fetal health, with an increasing prevalence in resource-limited settings. However, data on its burden and predictors remain scarce in Africa, including Uganda. This study aimed to determine the prevalence and predictors of HCA among mothers with premature rupture of membranes (PROM) at three tertiary hospitals in Uganda.

Methods: This multicenter cross-sectional study was conducted over a three-month period, from July to October 2023, at three tertiary hospitals in Uganda. A total of 106 women diagnosed with PROM were consecutively enrolled. Data were collected using a structured questionnaire that captured routine history-taking and physical examinations. Key information gathered included the history of liquor drainage, clinical signs of chorioamnionitis (fever, uterine tenderness, and foul-smelling liquor), labor history, and placental samples obtained after delivery for histopathological analysis. Descriptive statistics and binary logistic regression analyses were performed using STATA version 14.2. Statistical significance was set at P < 0.05, with a 95% confidence interval. Results were presented using bar charts, pie charts, and tables.

Results: Among the 106 participants with PROM, 44 (41.5%) had histological chorioamnionitis. The most common histological finding was neutrophil infiltration in 22 cases (50.0%), followed by funisitis in 13 cases (29.6%). Referral status (aOR = 4.5, 95% CI: 1.511-13.315, p = 0.007) and lack of prenatal care (PNC) attendance (aOR = 9.8, 95% CI: 2.802-14.504, p = 0.000) were independently associated with histological chorioamnionitis.

Conclusions and recommendations: The prevalence of HCA in this study was notably higher than previously reported data from Uganda. Neutrophil infiltration was the most frequently observed histological lesion. Patients with PROM who were referred from other health facilities or had not attended PNC were at a higher risk of developing HCA. These findings highlight the critical need for early detection and management of HCA in mothers with PROM, particularly in resource-limited settings. Routine screening for HCA should be implemented for all women presenting with PROM, with special attention to referred cases and those without PNC. Early initiation of treatment should be considered until the diagnosis is definitively ruled out. Further research is needed to explore the underlying causes of HCA to inform targeted preventive measures.

Background: Induction of labour is an indispensable obstetric procedure, although associated with some complications. The World Health Organization recommends the use of low dose misoprostol to reduce adverse induction outcomes like uterine hyperstimulation and rupture. With the current availability of 25ug misoprostol tablets in Ghana, this study assesses the effectiveness and safety of 25ug intravaginal misoprostol among women with low risk postdate pregnancies (between 41 weeks and 43 weeks) induced at the premier tertiary healthcare facility in the country.

Methods: A cross-sectional study of low risk postdate pregnant women scheduled for induction of labour at Korle- Bu Teaching Hospital between 21st July 2022 and 30th April 2023. The primary outcome was the mode of delivery following induction of labour. The secondary outcomes included: induction to delivery interval, maternal complications, fetal complications and the predictors of successful vaginal delivery.

Results: Among 168 women analysed, 138/168 participants (82.1%) had vaginal delivery and 30/168 participants (17.9%) had caesarean section. The commonest indication for caesarean section was failure to progress, accounting for 40% of cases. The proportion of postdate women that had vaginal delivery within 24 h of induction was 117/168 (69.6%) with a CI of 62.1-76.5. The mean induction to vaginal delivery time was 17.39 (± 7.31) hours. There were no cases of uterine rupture, hyperstimulation, maternal mortality or still births recorded during the study. Fetal heart rate abnormalities occurred in 8.9% of participants, meconium staining of liquor occurred in twenty-five participants (14.9%). Eleven babies (6.5%) had low APGAR score (< 7) at five minutes and seventeen babies (10.1%) required NICU admission. Parity was the only significant predictor of vaginal delivery. (OR 3.14, 95% CI:1.38-7.13) CONCLUSION: The 25ug misoprostol induction protocol is effective and safe for the Ghanaian population with low risk postdate pregnancy.

Background: The study aimed to compare the pregnancy, prenatal, and postnatal outcomes between fresh and frozen embryo transfer (ET) in intracytoplasmic sperm injection (ICSI) cycles at Al-Zahra Referral Women's Hospital in northwest Iran.

Methods: A prospective study was conducted among all infertile women (N = 469) who underwent embryo transfer between 2018 and 23 at Al-Zahra referral infertility center. Patients in cycles with fresh embryo transfer and patients for whom frozen embryos were transferred were compared in terms of live birth rate and fetal outcomes. Multiple logistic regression analysis was used to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results: The majority of the participants were primary infertility 83.3%. The rate of chemical and clinical pregnancy was (21.8% vs. 17.2%) and (19% vs. 13.4%) in the fresh embryo and the frozen embryo transfers, respectively. Likewise, the rate of live births was (14.1% vs. 9.1%), respectively. The number of retrieved oocytes was significantly higher in frozen ET compared to fresh ET (P = 0.001). In the final analysis, after adjusting for potential confounders, no significant associations were found for clinical pregnancy (AOR = 1.51; 95% CI: 0.90-2.5; P = 0.125) and chemical pregnancy (AOR = 1.31; 95% CI: 0.81-2.3; P = 0.238) rates between fresh and frozen ETs. Similarly, there were no significant differences in live birth rate (AOR = 1.6; 95% CI: 0.54-12.4), preterm birth (AOR = 0.62; 95% CI: 0.33-5.5), and primary infertility (AOR = 0.73; 95% CI: 0.34-1.6) between fresh and frozen ETs. The incidence of multiple pregnancies and spontaneous abortion was (5% vs. 13.8%) and (22.2% vs. 30.2%) in the fresh embryo and frozen embryo groups, respectively.

Conclusion: No significant differences in perinatal and postnatal outcomes were found between fresh and frozen embryo transfers.

Background: A birth interval of less than 33 months was considered short, and in low- income countries like Ethiopia, a short birth interval is the primary cause of approximately 822 maternal deaths every day. Due to that this study aimed to predict short birth interval and associated factors among women (15-49) in Ethiopia using ensemble learning algorithms.

Methods: A secondary data analysis of Ethiopian demographic health servey from 2016 to 2019 was performed. a total of weighted sample of 12,573 women in the reproductive age group was included in this study. Data have been extracted and processed with Stata version 17. The dataset was then imported into a Jupyter notebook for further detailed analysis and visualization. An ensemble Machin learning algorithm using different classification models were implemented. All analysis and calculation were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, and xgboost pakages.

Results: Random forest demonstrated the best performance with an accuracy 97.84%, recall of 99.70%, F1-score of 97.81%, 98.95% precision on test data and AUC (98%). Region, residency, age of women, sex of child, respondent education, distance health facility, husband education and religion were top predicting factors of short birth interval among women in Ethiopia.

Conclusion: Random forest was best predictive models with improved performance. "The most significant features that contribute to the accuracy of the top-performing models, notably the Random Forest should be highlighted because they outperformed the other model in the analysis.In general, ensemble learning algorithms can accurately predict short birth interval status, making them potentially useful as decision-support tools for the pertinent stakeholders.

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. Intrauterine hemostatic devices are recommended when PPH does not respond to medical treatment. The objective of this study was to assess the factors leading to unsuccessful intrauterine therapy with a chitosan-covered tamponade (CT) for the treatment of PPH and to evaluate clinical outcomes based on real-world data.

Methods: This registry-based cohort study included all women treated with CT for PPH between January 2017 and June 2022 at a university clinic's perinatal department. The endpoint was defined as the failure of CT, indicated by the requirement of further invasive procedures for ongoing hemorrhage after CT application. Medical records were reviewed and binary logistic regressions used to evaluate delivery mode, placenta previa, and placenta accreta spectrum as potential risk factors for CT treatment failure.

Results: The cohort consisted of 230 women, with successful CT treatment in 91.3%. The success rate for mild PPH was 100.0%, for moderate 95.5%, and for severe 84.2%. Five hysterectomies were performed in total. Placenta previa in cesarean sections was identified as the primary risk factor for CT treatment failure, increasing the odds about 7.5-fold (Odds Ratio: 7.48; 95% CI: 1.87-33.15) compared to cesarean sections without placenta previa. Furthermore, delays in CT insertion may also contribute to treatment failure.

Conclusion: CT serves as an intrauterine treatment for medically intractable PPH. Placenta previa significantly increases the risk of CT treatment failure in cesarean sections. Obstetricians should be particularly vigilant in managing patients with placenta previa and consider early use of CT or a combination of procedures.

Trial registration: This study was approved by the local Ethics Committee on 11/10/2021 (EA4/231/21).

Background: Globally, intimate partners are the most common perpetrators of violence against women. Sub-Saharan Africa (SSA) contributes significantly to the burden of intimate partner violence (IPV) in Africa, with four of every 10 women in SSA having experienced IPV. When IPV occurs in pregnancy, it is significantly associated with adverse outcomes. This study sought to assess the prevalence, determinants and complications of IPV in pregnancy in Nigeria and Ghana, two SSA countries.

Methods: A descriptive, cross-sectional study, conducted between February-July 2022, amongst pregnant women attending antenatal care clinics in 17 health facilities across the six geopolitical zones in Nigeria, and three hospitals in three regions in Ghana. The women were screened for IPV using an adaptation of the 'HARK' (Humiliation, Afraid, Rape, Kick) questions. Data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Associations between IPV and sociodemographic characteristics of the women and their spouses/partners were tested using Pearson's Chi square. Factors found to be statistically significant were subjected to binary logistic regression modelling to determine the predictors of IPV. The level of statistical significance was set at a p-value of < 0.05.

Results: The prevalence of IPV was 26.2%. Predictors of IPV included the women's marital status (p = 0.001), educational status (p = 0.040), rural residence (p = 0.034), occupation (p = 0.040), spouse's/partner's occupation (p = 0.021), use of illicit drugs by spouse/partner (p = 0.014), history of psychiatric illness in spouse/partner (p = 0.030), experience of IPV in previous relationship(s) by spouse/partner (p = 0.011), and witness of parental IPV by spouse/partner (p < 0.001). The most common complication of IPV in pregnancy were the mental health complications of anxiety (54.7%) and depression (46.9%). Miscarriages (15.6%) and preterm birth (9.5%) were the most common pregnancy complications.

Conclusions: One in every four pregnant women in Nigeria and Ghana experience IPV, with significant mental health and pregnancy complications. Routine IPV screening in pregnancy and prompt referral of screen-positive women to support services is recommended. Policies and interventions that promote gender equality and women's economic and educational empowerment are beneficial.

Background: Taking a sufficient number of skilled antenatal care (SANC) visits is incontrovertibly connected to safe motherhood. This study aims to shed light on the prevalence and potential factors associated with disparities in the SANC taking behavior of pregnant mothers in rural and urban Bangladesh.

Methods: For this purpose, a nationally representative secondary dataset from the Bangladesh Demographic and Health Survey (BDHS, 2017-18) has been considered. The information regarding the last birth of mothers who delivered within three years preceding the survey has been analyzed. We have applied the Conway-Maxwell-Poisson regression model (CMPRM) to deal with the overdispersion in skilled ANC count data, as this model shows the least AIC compared to the classical negative-binomial regression model (NBRM) and the generalized Poisson regression model (GPRM).

Results: Significant disparity (p-value < 0.001) has been observed in the mean number of SANC taken by rural (3.17) and urban (4.52) women. The analysis revealed that covariates have significantly different effects on SANC visits in rural areas compared to urban areas. For instance, women aged 35 and above in rural settings exhibited a 37% higher incidence rate of SANC visits (IRR = 1.37) compared to those under 20. Educational attainment had a pronounced impact, with rural women showing a 39% (IRR = 1.39) increase in SANC visits for primary education, 57% (IRR = 1.57) for secondary education, and 64% (IRR = 1.64) for higher education, compared to uneducated women. In contrast, in urban areas, higher education resulted in only a 35% (IRR = 1.35) increase.

Conclusion: Our findings from this study indicate that the concerned authority should come forward, and policymakers should emphasize various factors that are mainly responsible for the noteworthy different SANC status of pregnant women living in rural and urban areas in Bangladesh. Doing so, it can be hoped that the required number of ANC visits (eight or more) in both types of residences in Bangladesh, recommended by the World Health Organization (WHO), will be satisfied to ensure safer motherhood.

Background: The study aims to adapt the validity and reliability of the Pregnancy Quality of Life Scale in Turkish society.

Methods: The study was carried out methodologically between April 2021 and April 2022 at Bayburt State Hospital, the only public hospital operating in the city center of Bayburt. In the study, a total of 355 pregnant women who met the research criteria and volunteered to participate were examined without selecting a sample. Validity and reliability analysis of language and content validity, explanatory and confirmatory factor analysis, and Cronbach- α coefficient were used.

Results: The factor structure of the Turkish form of the scale was consistent with the original form. As a result of the explanatory appropriate. The internal consistency coefficient was calculated as the total Cronbach-α coefficient of the scale was 0.628 for the first trimester, and 0.628 for the II. trimester 0.727 for trimester, III. Trimester it is 0.698 for a trimester.

Conclusion: As a result of the validity and reliability study, the Turkish version of the Pregnancy Quality of Life Scale can be used as a valid and reliable measurement tool.

Background: Haemolytic disease of the foetus and newborn (HDFN) is an immune disorder driven by maternal alloimmunisation against foetal/newborn red blood cell antigens. HDFN can cause significant morbidity and mortality, with symptoms in the foetus ranging from mild anaemia to hydrops fetalis. While in newborns, HDFN can lead to severe forms of neonatal hyperbilirubinaemia and kernicterus. This systematic review (SR) aimed to identify and summarise real-world evidence (RWE) related to the patient burden/experience and economic burden of HDFN.

Methods: Electronic database searches supplemented by handsearching of grey literature, were conducted to identify studies that reported the clinical patient burden/experience, and economic burden of HDFN in Europe, the Middle East, and Africa (EMEA). Data from eligible studies were summarised in a narrative synthesis due to heterogeneity between studies.

Results: A total of 26 relevant publications were identified for inclusion in the SR, consisting of one study that directly measured Health Related Quality of Life, 9 studies reporting on proxy outcomes for patient burden and 18 studies reporting on economic burden (this includes two double-counted studies reporting more than one outcome type). Neurodevelopment, academic development, behaviour and personality were assessed as proxy outcomes for patient burden given the limited identification of patient-reported outcome data. These studies suggested potential neurodevelopmental impairments in children with HDFN. Despite these indirect insights into patient burden, identified data were limited and results should be interpreted with consideration of the inherent heterogeneity in design and endpoints assessed across RWE studies. Economic burden data were primarily limited to healthcare resource use outcomes, with limited reported data on healthcare costs, it is difficult to draw notable conclusions on the true economic burden of HDFN.

Conclusions: The current SR provides a clear summary of the available evidence for the patient experience and economic burden of HDFN. While the limited evidence indicates that HDFN does confer a significant burden on patients, the review identifies the need for further well-powered and representative observational studies using well-defined outcome measures to aid a greater understanding of the burden and experience of HDFN.

Trial registration: The protocol for this systematic review was registered in PROSPERO CRD42022328444.

Background: Three million babies die in the early neonatal period while 2.6 million are stillborn per year worldwide, and one of three deaths can be prevented. The perinatal mortality rate in Nepal is around 31 per 1000 births. Although the perinatal and neonatal death rates have decreased recently, it still poses a major challenge to the health system of Nepal. The objective of the study is to determine the causes of perinatal deaths by integrating Minimally Invasive Tissue Sampling (MITS) in hospital perinatal deaths and incorporating verbal autopsy in community deaths in Kaski district of Nepal.

Methods: The study will be conducted among the perinatal deaths reported in the five hospitals implementing the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Kaski district of Nepal. We will also conduct verbal autopsy (VA) among community perinatal deaths reported in the district. All the perinatal deaths reported in the study sites will be enrolled in the first stage of the study. Minimally Invasive Tissue Sampling (MITS) will be conducted among the consenting cases of perinatal deaths to retrieve relevant tissue samples and specimens. The specimens will undergo standard histopathological, microbiological, biochemical, and molecular tests. The "Cause of Death Panel" will finalize MITS informed cause of death following the customized protocol for the project and the cause so derived will be compared with that obtained by the review of deaths by the MPDSR committees of the hospitals. The Female Community Health Volunteers will be trained and mobilized to identify community perinatal deaths and trained personnel will conduct VA. Community engagement activities will be conducted to provide awareness to prevent perinatal deaths.

Discussion: The mechanism of counting and accounting for deaths in a systematic manner is important and it can provide evidence to determine changes in clinical practice and to develop guidelines and training packages for preventive measures. The outcome will be helpful to standardize methods to establish the accurate causes of perinatal deaths and develop strategies to minimize the deaths. The selected pathological investigations can be integrated into the existing death surveillance system in order to effectively determine the causes of death.