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Martins RIL, Novais JDSM, Reis ZSN. Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence. Rev Bras Ginecol Obstet 2024; 46:e-rbgo14. [PMID: 38765539 PMCID: PMC11075434 DOI: 10.61622/rbgo/2024ao14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/01/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.
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Affiliation(s)
- Raíssa Isabelle Leão Martins
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Jussara de Souza Mayrink Novais
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Zilma Silveira Nogueira Reis
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Gazeley U, Reniers G, Romero‐Prieto JE, Calvert C, Jasseh M, Herbst K, Khagayi S, Obor D, Kwaro D, Dube A, Dheresa M, Kabudula CW, Kahn K, Urassa M, Nyaguara A, Temmerman M, Magee LA, von Dadelszen P, Filippi V. Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries. BJOG 2024; 131:163-174. [PMID: 37469195 PMCID: PMC10952650 DOI: 10.1111/1471-0528.17606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum. DESIGN Open population cohort (Health and Demographic Surveillance Systems). SETTING Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. POPULATION 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. METHODS InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43-365 days postpartum adjusting for HDSS and time period (2000-2009 and 2010-2019). MAIN OUTCOME MEASURES Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). RESULTS Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000-2009 and 2010-2019. CONCLUSIONS Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.
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Affiliation(s)
- Ursula Gazeley
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Georges Reniers
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Clara Calvert
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Usher Institute, University of EdinburghEdinburghUK
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at LSHTMSerekundaThe Gambia
| | - Kobus Herbst
- Africa Health Research InstituteDurbanSouth Africa
- DSI‐MRC South African Population Research Infrastructure Network (SAPRIN)DurbanSouth Africa
| | - Sammy Khagayi
- Kenya Medical Research Institute – Centre for Global Health ResearchKisumuKenya
| | - David Obor
- Kenya Medical Research Institute – Centre for Global Health ResearchKisumuKenya
| | - Daniel Kwaro
- Kenya Medical Research Institute – Centre for Global Health ResearchKisumuKenya
| | - Albert Dube
- Malawi Epidemiology and Intervention Research InstituteKarongaMalawi
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
| | - Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Epidemiology and Global HealthUmeå UniversityUmeåSweden
| | - Mark Urassa
- The Tazama Project, National Institute for Medical ResearchMwanzaTanzania
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Children's HealthAga Khan UniversityNairobiKenya
| | - Laura A. Magee
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Science and MedicineKing's College LondonLondonUK
- Institute of Women and Children's Health, King's College LondonLondonUK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Science and MedicineKing's College LondonLondonUK
- Institute of Women and Children's Health, King's College LondonLondonUK
| | - Veronique Filippi
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
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Ye D, Li S, Ma Z, Ding Y, He R. Diagnostic value of platelet to lymphocyte ratio in preeclampsia: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2234540. [PMID: 37455131 DOI: 10.1080/14767058.2023.2234540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/27/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Using straightforward and accessible haematological parameters platelet/lymphocyte ratio (PLR) to diagnose preeclampsia (PE) early and precisely remains a challenge. Although several clinical studies suggested that PLR is able to diagnose PE, there has been no systematic evaluation of the diagnostic utility. OBJECTIVES To examine the diagnostic accuracy and potential applicability of PLR in the detection of PE. STUDY DESIGN Seven databases were searched using a combination of PLR and PE terms, and all potentially pertinent studies were systematically searched up to March 2023. All potentially relevant studies both prospective and retrospective were reviewed. To assess the diagnostic value of PLR for PE, pooled sensitivity (Sen), specificity (Spe), diagnostic odds ratio (DOR) and area under the summary receiver operating characteristic curve (SROC-AUC) were calculated. RESULTS Thirteen studies were enrolled in the meta-analysis. In the second and third trimesters, the PLR suggested a diagnostic value for PE with a pooled Sen of 54.7% [95% confidence interval (CI) (51.7, 57.6)], Spe of 77.8% [95% CI (75.5, 80.0)], + LR of 2.457 [95% CI (1.897, 3.182)], -LR of 0.584 [95% CI (0.491, 0.695)], DOR of 4.434 [95% CI (3.071, 6.402)], the SROC-AUC of 0.7296 and the standard error (SE) of 0.0370. CONCLUSION For the diagnosis of PE, PLR has a limited sensitivity but an acceptable specificity, and showed moderate accuracy. Further using complete blood count (CBC) indicators such as PLR alone or in combination to diagnose and predict PE could reduce healthcare costs and improve maternal and child prognosis.
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Affiliation(s)
- Dan Ye
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Shuwen Li
- Department of Obstetrics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Zhenqin Ma
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Yi Ding
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Rongxia He
- Department of Obstetrics, Lanzhou University Second Hospital, Lanzhou, P.R. China
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Ali Egal J, Essa A, Osman F, Klingberg-Allvin M, Erlandsson K. Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland. Sex Reprod Healthc 2023; 37:100862. [PMID: 37269618 DOI: 10.1016/j.srhc.2023.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/01/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital. METHOD A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo. RESULTS From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital. CONCLUSION The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
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Affiliation(s)
- Jama Ali Egal
- School of Health and Welfare, Dalarna University, Sweden.
| | - Amina Essa
- Department of Midwifery, University of Hargeisa, Somaliland.
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Sweden.
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Hemingway-Foday J, Tita A, Chomba E, Mwenechanya M, Mweemba T, Nolen T, Lokangaka A, Tshefu Kitoto A, Lomendje G, Hibberd PL, Patel A, Das PK, Kurhe K, Goudar SS, Kavi A, Metgud M, Saleem S, Tikmani SS, Esamai F, Nyongesa P, Sagwe A, Figueroa L, Mazariegos M, Billah SM, Haque R, Shahjahan Siraj M, Goldenberg RL, Bauserman M, Bose C, Liechty EA, Ekhaguere OA, Krebs NF, Derman R, Petri WA, Koso-Thomas M, McClure E, Carlo WA. Prevention of maternal and neonatal death/infections with a single oral dose of azithromycin in women in labour in low-income and middle-income countries (A-PLUS): a study protocol for a multinational, randomised placebo-controlled clinical trial. BMJ Open 2023; 13:e068487. [PMID: 37648383 PMCID: PMC10471878 DOI: 10.1136/bmjopen-2022-068487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/15/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Maternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes. METHODS AND ANALYSIS This randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hypothesis will test whether this intervention will reduce intrapartum/neonatal death or sepsis. The intervention is a single, prophylactic intrapartum oral dose of 2 g azithromycin, compared with a single intrapartum oral dose of an identical appearing placebo. A total of 34 000 labouring women from 8 research sites in sub-Saharan Africa, South Asia and Latin America will be randomised with a one-to-one ratio to intervention/placebo. In addition, we will assess antimicrobial resistance in a sample of women and their newborns. ETHICS AND DISSEMINATION The study protocol has been reviewed and ethics approval obtained from all the relevant ethical review boards at each research site. The results will be disseminated via peer-reviewed journals and national and international scientific forums. TRIAL REGISTRATION NUMBER NCT03871491 (https://clinicaltrials.gov/ct2/show/NCT03871491?term=NCT03871491&draw=2&rank=1).
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Affiliation(s)
| | - Alan Tita
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Elwyn Chomba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | | | - Trecious Mweemba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Tracy Nolen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Adrien Lokangaka
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Antoinette Tshefu Kitoto
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Gustave Lomendje
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, Maharashtra, India
| | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Mrityunjay Metgud
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Sarah Saleem
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Shiyam S Tikmani
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | | | | | - Amos Sagwe
- Moi University School of Medicine, Eldoret, Kenya
| | - Lester Figueroa
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Sk Masum Billah
- The University of Sydney, Sydney, New South Wales, Australia
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Md Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Melissa Bauserman
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Richard Derman
- Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | - Waldemar A Carlo
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Tasew A, Melese E, Jemal S, Getachew L. Obstetrics mortality and associated factors in intensive care unit of Addis Ababa public hospital in, 2020/21: A hospital based case control study. Ann Med Surg (Lond) 2022; 81:104458. [PMID: 36147061 PMCID: PMC9486713 DOI: 10.1016/j.amsu.2022.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background In low-income nations like Ethiopia, the rate of obstetric death in intensive care units is significant. The indications of admission are Preeclampsia/Eclampsia, postpartum hemorrhage, and puerperal sepsis but, patient outcomes subsequent to intensive care unit admission are sparse. The aim of this study is to assess factors associated with obstetrics mortality in Intensive Care unit. Methods A hospital based unmatched case control study was conducted on obstetrics patients admitted to Addis Ababa Public hospital's intensive care unit from October 2018 to November 2020. Multivariable logistic regression analysis was done; Odds Ratio and Confidence Interval (OR and 95% CI) were computed using SPSS version 26. P value < 0.05 was taken as statistically significant. Result Obstetrics mortality in intensive care unit was high and accounts 27% from the total intensive care unit admission. Severe pre-eclampsia AOR: 6.33; 95% CI: 2.25–17.79, puerperal sepsis AOR: 4.51; 95% CI: 1.68–12.15, age ≥35 years AOR: 4.09; 95% CI: 1.42–11.77, absence of antenatal care: AOR: 3.74; 95% CI: 1.03–13.5, maternal coexisting diseases AOR: 5.2; 95% CI: 2.22–12.16, and severely decrease of consciousness at admission AOR: 3.78; 95% CI: 1.21–11.79 were significantly associated with obstetrics mortality in Addis Ababa Public Hospitals intensive care unit. Conclusion and Recommendation: Maternal age ≥35 years, loss of antenatal care, puerperal sepsis, severe pre-eclampsia, pre-existing medical comorbidities and severe decrease level of consciousness during ICU admission were the most significant factors associated with obstetrics mortality. It is recommended that all pregnant women should have antenatal care so that preeclampsia and maternal comorbidities will be early diagnosed and treated. Obstetrics mortality in intensive care unit (ICU) is high in low-income countries. The indications of admission are Preeclampsia/Eclampsia, postpartum hemorrhage, and puerperal sepsis. Obstetrics mortality in intensive care unit was high and accounts 27% from the total intensive care unit admission. The aim of this study is to assess factors associated with obstetrics mortality in ICU.
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Affiliation(s)
- Asaminew Tasew
- Department of Anesthesia, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Eyayalem Melese
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Corresponding author. Department of Anesthesia, School of Medicine, College Of Health Sciences, Addis Ababa University, Ethiopia.
| | - Suleman Jemal
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemlem Getachew
- Department of Anesthesia, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Sitaula S, Basnet T, Agrawal A, Manandhar T, Das D, Shrestha P. Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study. BMC Pregnancy Childbirth 2021; 21:471. [PMID: 34210273 PMCID: PMC8247237 DOI: 10.1186/s12884-021-03920-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality. Methods This is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year’s study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics. Results There was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%). Conclusions Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.
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Affiliation(s)
- Sarita Sitaula
- Department of Obstetrics and Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Tulasa Basnet
- Department of Obstetrics and Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ajay Agrawal
- Department of Obstetrics and Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Tara Manandhar
- Department of Obstetrics and Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dipti Das
- Department of Obstetrics and Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Prezma Shrestha
- Department of Obstetrics and Gynecology, Maharajgunj Medical Campus, TUTH, Kathmandu, Nepal
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Kodan LR, Verschueren KJC, McCaw-Binns AM, Tjon Kon Fat R, Browne JL, Rijken MJ, Bloemenkamp KWM. Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees. Reprod Health 2021; 18:46. [PMID: 33608026 DOI: 10.1186/s12978-020-01051-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022] Open
Abstract
Plain English summary The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. Background Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods The classification of pregnancy-related deaths in Suriname during 2010–2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. Results Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). Conclusions Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.
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Tang Q, Wang L, Cai R, Zhang L, Zhang X, Liu X, Liu S. The association of MOV10 polymorphism and expression levels with preeclampsia in the Chinese Han population. Mol Genet Genomic Med 2021; 9:e1564. [PMID: 33269545 PMCID: PMC7963431 DOI: 10.1002/mgg3.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To assess the relationship between MOV10 rs2932538 polymorphism and susceptibility to preeclampsia (PE) in the Chinese Han population and to investigate whether the placental expression of MOV10 have association with PE. METHODS We enrolled 1021 pregnant women with PE and 1594 normotensive pregnant women to analyze genotyping of MOV10 rs2932538. Clinical data and related test results of all subjects were collected and analyzed. For volunteers providing placentas, real-time PCR, Western blot, and immunohistochemistry were applied to assess the expression level of MOV10. RESULTS There was significant statistical difference between preeclamptic patients and healthy subjects in genotype distributions and alleles. The frequencies of genotypes TT+CT were significantly associated with the increased risk of preeclampsia. Besides, T alleles were found to be related to a higher risk of PE. Significant statistical difference was also observed on distributions of genotype in PE without/with severe features group compared or early onset/late onset versus controls. The placental expression of MOV10 was lower in preeclamptic women, however, no relationship was found between MOV10 expression level and MOV10 rs2932538 genotypes. CONCLUSION This study suggests that MOV10 rs2932538 polymorphism may be associated with PE susceptibility in the Chinese Han population. The placental expression of MOV10 decrease in PE but have no relationship with rs2932538 polymorphism.
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Affiliation(s)
- Qian Tang
- Medical Genetic Departmentthe Affiliated Hospital of Qingdao UniversityQingdaoChina
- Prenatal Diagnosis Centerthe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ling Wang
- Department of Nephrologythe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Renmei Cai
- Prenatal Diagnosis CenterQingdao Municipal HospitalQingdaoChina
| | - Lu Zhang
- Medical Genetic Departmentthe Affiliated Hospital of Qingdao UniversityQingdaoChina
- Prenatal Diagnosis Centerthe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xiaoxiao Zhang
- Department of Nephrologythe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xuemei Liu
- Department of Nephrologythe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Shiguo Liu
- Medical Genetic Departmentthe Affiliated Hospital of Qingdao UniversityQingdaoChina
- Prenatal Diagnosis Centerthe Affiliated Hospital of Qingdao UniversityQingdaoChina
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11
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Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB, Hibberd PL, Garces AL, Figueroa L, Krebs NF, Esamai F, Nyongesa P, Liechty EA, Carlo WA, Chomba E, Goudar SS, Kavi A, Derman RJ, Saleem S, Jessani S, Billah SM, Koso-Thomas M, McClure EM, Goldenberg RL, Bose C. Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reprod Health 2020; 17:173. [PMID: 33334343 PMCID: PMC7745363 DOI: 10.1186/s12978-020-00990-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION The MNHR is registered at NCT01073475 .
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Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | | | | | - Jackie Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India
- Adjunct Faculty Medical Research, Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | | | | | | | - Sk Masum Billah
- Maternal and Child Health Division (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
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12
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Farhat S, Zafar MU, Sheikh MA, Qasim CM, Urooj F, Fatima SS. Association of resolvin level in pregnant women with preeclampsia and metabolic syndrome. Taiwan J Obstet Gynecol 2020; 59:105-108. [PMID: 32039775 DOI: 10.1016/j.tjog.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Preeclampsia (PE) and Metabolic syndrome (MetS) are multifactorial conditions and are major causes of maternal and neonatal morbidity and mortality worldwide. Both conditions are pro-inflammatory and can be causative factor for vascular damage. Anti-inflammatory mediators such as Resolvin also called resolution-phase interaction products may help to reduce the effect. Therefore, this study aimed to measure the serum Resolvin level in mild pre-eclamptic women with and without metabolic syndrome. MATERIAL AND METHODS A total of 293 pregnant females were recruited in this case control study. They were grouped as: Group A [pre-eclamptic patients with MetS (n = 140)] and Group B [pre-eclamptic patients without MetS (n = 153)]. Preeclampsia was diagnosed according to the ACOG criteria and metabolic syndrome according the NCEP-ATP III guidelines. Anthropometric data, lipid profile, Resolvin, VEGFR and PlGF levels were tested as per manufacturer's guidelines. Data was analyzed by using SPSS version 23. In all instances, a p value of <0.05 was considered significant. RESULTS All females were aged matched so no difference was observed in any group. Blood pressure and triglyceride levels were significantly higher in Group A; whereas VEGFR and PlGF were lower as compared to Group B. Higher Resolvin levels were observed in Group A subjects as compared to Group B [105.19 ± 42.29 pg/ml; 46.74 ± 20.16 pg/ml; p < 0.01 respectively]. Resolvin levels were found to have a weak correlation with BMI (r = 0.264; p = 0.11), while a positive strong correlation with systolic BP (r = 0.722; p < 0.001), diastolic BP (r = 0.664; p < 0.001) and a negative correlation with VEGFR (r = -0.639; p < 0.01) and PlGF (r = -0.523; p < 0.01). CONCLUSION Higher resolvin levels were observed in PE subjects with metabolic syndrome and showed a significant strong positive correlation with blood pressure. Further longitudinal studies are required to identify the causal link.
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Affiliation(s)
- Sabah Farhat
- Department of Biological and Biomedical Sciences, Aga Khan University, Pakistan
| | | | | | | | - Faiza Urooj
- Medical College, Aga Khan University, Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Pakistan.
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13
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Gage AD, Carnes F, Blossom J, Aluvaala J, Amatya A, Mahat K, Malata A, Roder-DeWan S, Twum-Danso N, Yahya T, Kruk ME. In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible? Health Aff (Millwood) 2020; 38:1576-1584. [PMID: 31479351 DOI: 10.1377/hlthaff.2018.05397] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.
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Affiliation(s)
- Anna D Gage
- Anna D. Gage ( ) is a student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Fei Carnes
- Fei Carnes is a geographic information systems (GIS) specialist in the Center for Geographic Analyses, Harvard University, in Cambridge, Massachusetts
| | - Jeff Blossom
- Jeff Blossom is the GIS service manager in the Center for Geographic Analyses, Harvard University
| | - Jalemba Aluvaala
- Jalemba Aluvaala is a research fellow in the Department of Paediatrics and Child Health, University of Nairobi School of Medicine, in Kenya
| | - Archana Amatya
- Archana Amatya is an assistant professor of community medicine and public health at the Tribhuvan University Teaching Hospital, in Kathmandu, Nepal
| | - Kishori Mahat
- Kishori Mahat is an advisor in Quality Assurance and Regulation, Nepal Health Sector Support Programme, Department for International Development, in Kathmandu
| | - Address Malata
- Address Malata is principal of the College of Nursing, Malawi University of Science and Technology, in Limbe
| | - Sanam Roder-DeWan
- Sanam Roder-DeWan is a researcher in the Ifakara Health Institute, in Dar es Salaam, Tanzania
| | | | - Talhiya Yahya
- Talhiya Yahya is head of the Quality Management Unit, Ministry of Health, Community Development, Gender, Elderly, and Children, in Dar es Salaam
| | - Margaret E Kruk
- Margaret E. Kruk is an associate professor in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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Dahabiyeh LA, Mansour RSH, Saleh SS, Kamel G. Investigating the molecular structure of placenta and plasma in pre-eclampsia by infrared microspectroscopy. J Pharm Biomed Anal 2020; 184:113186. [PMID: 32105942 DOI: 10.1016/j.jpba.2020.113186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
Abstract
Pre-eclampsia (PE) is a serious hypertensive disorder with unclear etiology and lack of reliable diagnostic tests. In this study, IR microspectroscopy was applied to identify molecular changes associated with the pathogenesis of PE in placental tissues and plasma samples from pre-eclamptic women and normotensive matched controls. The obtained spectra were analyzed by multivariate analysis in the spectral ranges of 3050-2800 cm-1 and 1855-1485 cm-1 corresponding to lipid and protein-carbonyl components, respectively. In the lipid region, an increase in CH2/CH3 ratio was noticed and higher level of unsaturation index in placenta was evident. New lipid species emerged as a consequence of oxidative stress. The more intense peak at 1740 cm-1 in PE reflected higher level of LDL and VLDL. In the protein region, a decrease in the α-helix structure associated with gain in β-sheet and β-turn structures was detected. Our results revealed significant conformational changes in the protein secondary structure in PE illustrated by peak shifts and intensity alterations, particularly in amide I component. Variations in lipid order, membrane integrity, fatty acid saturation and plasma lipid profile were also detected in PE. The ROC curve generated from plasma samples yielded AUC values of 98.4% and 99.9% for lipid and protein-carbonyl regions, respectively. The current study shed light on the promising role of IR microspectroscopy as a new analytical tool that can aid in providing better diagnosis and understanding of the pathophysiology of PE.
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Affiliation(s)
- Lina A Dahabiyeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Queen Rania St, Amman, 11942, Jordan.
| | | | - Shawqi S Saleh
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | - Gihan Kamel
- SESAME Synchrotron (Synchrotron-light for Experimental Science and Applications in the Middle East), 19252, Allan, Jordan; Department of Physics, Faculty of Science, Helwan University, Cairo, Egypt
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15
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Mönckeberg M, Arias V, Fuenzalida R, Álvarez S, Toro V, Calvo A, Kusanovic JP, Monteiro LJ, Schepeler M, Nien JK, Martinez J, Illanes SE. Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index and Maternal Risk Factors in Routine Clinical Use. Diagnostics (Basel) 2020; 10:E182. [PMID: 32225087 DOI: 10.3390/diagnostics10040182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 01/18/2023] Open
Abstract
Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.
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Aden JA, Ahmed HJ, Östergren PO. Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach. Glob Health Action 2020; 12:1672314. [PMID: 31599213 PMCID: PMC6792038 DOI: 10.1080/16549716.2019.1672314] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a post-conflict era. Very little is known about the effects that these contextual factors can have on maternal mortality. Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia. Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths. Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays. Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.
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Affiliation(s)
- Jamila Ahmed Aden
- Faculty of Medicine and Health Sciences, East Africa University , Bosaso , Puntland State of Somalia, Somalia.,Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University , Lund , Sweden.,Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Hinda Jama Ahmed
- Faculty of Medicine and Health Sciences, East Africa University , Bosaso , Puntland State of Somalia, Somalia
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University , Lund , Sweden
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Yoshihara T, Zaitsu M, Kubota S, Arima H, Sasaguri T. Pool walking may improve renal function by suppressing the renin-angiotensin-aldosterone system in healthy pregnant women. Sci Rep 2020; 10:2891. [PMID: 32076019 DOI: 10.1038/s41598-020-59598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
This study aimed to examine the effect of pool walking on renal function in pregnant women. Fifteen pregnant women (mean gestational age, 37.8 weeks) walked in a pool (depth 1.3 m) for 1 h. A few days later, they walked on a street for 1 h. Within each activity, the starting and ending levels of plasma renin activity were measured. The total urine volume, creatinine clearance, and change in plasma renin activity levels between each activity were compared by Wilcoxon rank-sum test. The renin-angiotensin-aldosterone level was suppressed during pool walking: the mean starting and ending values of plasma renin activity and serum aldosterone were 6.8 vs. 5.5 ng/mL/h (p = 0.002) and 654 vs. 473 pg/mL (p = 0.01), respectively. The decreases in plasma renin activity and serum aldosterone levels were more evident in pool walking than in land walking (plasma renin activity, -1.27 vs. 0.81 ng/mL/h, p = 0.002; serum aldosterone, -180.9 vs. 3.1 ng/mL/h, p = 0.03), resulting in higher total urine volume (299 vs. 80 mL, p < 0.001) and creatinine clearance (161.4 vs. 123.4 mL/min, p = 0.03) in pool walking. Pool walking may improve renal function in pregnant women partly through the suppressed renin-angiotensin-aldosterone system.
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18
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Dahabiyeh LA, Tooth D, Kurlak LO, Mistry HD, Pipkin FB, Barrett DA. A pilot study of alterations in oxidized angiotensinogen and antioxidants in pre-eclamptic pregnancy. Sci Rep 2020; 10:1956. [PMID: 32029819 PMCID: PMC7004983 DOI: 10.1038/s41598-020-58930-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/20/2020] [Indexed: 11/09/2022] Open
Abstract
The oxidation status of angiotensinogen (AGT) may have a critical role in pre-eclampsia. We used a validated, quantitative, mass spectrometry-based method to measure the oxidized and total AGT levels in plasma of pre-eclamptic women (n = 17), normotensive-matched controls (n = 17), and healthy non-pregnant women (n = 10). Measurements of plasma glutathione peroxidase (GPx) activity and serum selenium concentrations were performed as markers of circulating antioxidant capacity. Higher proportions of oxidized AGT in plasma from pre-eclamptic women compared to matched normotensive pregnant controls (P = 0.006), whilst maintaining a similar total plasma AGT concentration were found. In the pre-eclamptic group, blood pressure were correlated with the proportion of oxidized AGT; no such correlation was seen in the normotensive pregnant women. Plasma GPx was inversely correlated with oxidized AGT, and there was an inverse association between serum selenium concentration and the proportion of oxidized AGT. This is the first time that oxidized AGT in human plasma has been linked directly to antioxidant status, providing a mechanism for the enhanced oxidative stress in pre-eclampsia. We now provide pathophysiological evidence that the conversion of the reduced form of AGT to its more active oxidized form is associated with inadequate antioxidant status and could indeed contribute to the hypertension of pre-eclampsia.
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Affiliation(s)
- Lina A Dahabiyeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, Amman, Jordan.,Centre for Analytical Bioscience, Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - David Tooth
- BBSRC/EPSRC Synthetic Biology Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Lesia O Kurlak
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine; University of Nottingham, Nottingham, UK
| | - Hiten D Mistry
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine; University of Nottingham, Nottingham, UK.
| | - Fiona Broughton Pipkin
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine; University of Nottingham, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
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Duffy CR, Moore JL, Saleem S, Tshefu A, Bose CL, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Wallace DD, McClure EM, Goldenberg RL. Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network. Acta Obstet Gynecol Scand 2018; 98:300-308. [PMID: 30414270 DOI: 10.1111/aogs.13502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
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Affiliation(s)
- Cassandra R Duffy
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ana L Garces
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India
| | | | | | | | | | | | - Dennis D Wallace
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Abstract
This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone.
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