Risk factors in puerperal endometritis-myometritis. An incident case-referent study

Predictors of perinatal mortality in rural population of Northwest Ethiopia: a prospective longitudinal study

Background

Perinatal mortality is one of the serious challenges in meeting maternal and child Millennium Development Goals in developing countries. Identifying its predictors is an important step to develop focused and appropriate health interventions for reducing perinatal deaths. This study therefore aims at identifying predictors of perinatal mortality in a rural setting in northwest Ethiopia.

Methods

A prospective longitudinal study was conducted at Dabat Health and Demographic Surveillance site, northwest Ethiopia, from November 2009 to August 2011. Data were collected by interviewing the mothers or guardians of eligible children. Multiple logistic regressions were employed to identify potential predictors.

Results

A total of 1752 eligible children were included in the study. Perinatal mortality rate in the study population was 50.22 per 1000 (95% CI: 39.99, 60.46) total births. In multiple logistic analysis, previous still birth [(AOR = 8.38, 95% CI: 3.94, 17.83)], twin birth [(AOR = 7.09, 95% CI: (3.22, 15.61)], not receiving tetanus toxoid vaccine during the index pregnancy [(AOR = 3.62, 95% CI: 1.57, 8.34)], short birth interval of less than 24 months [(AOR = 2.58, 95% CI: (1.61, 4.13)], maternal illiteracy [(AOR = 4.83, 95% CI: (1.45, 16.05)] and mothers’ running own business [(AOR = 5.40, 95% CI: 1.40, 27.96)] were the main predictors associated with increased risk of perinatal death.

Conclusions

Predictors of perinatal death in the study area are easily recognizable and potentially preventable with the existing maternal health programs. Efforts need to be intensified in expanding maternal and newborn health services to significantly reduce perinatal mortality in rural settings.

J. Complicações perinatais em gestantes infectadas pelo vírus da imunodeficiência humana

OBJETIVOS: analisar as complicações perinatais em gestantes infectadas pelo HIV. MÉTODOS: estudo do tipo coorte, realizado em centro perinatal terciário, no período de 1 de janeiro de 1996 a 31 de março de 2003. Foram selecionadas para o estudo 7698 gestações, cujos critérios de inclusão foram: gestação única e idade gestacional superior a 22 semanas. A infecção pelo HIV foi confirmada pelos testes ELISA e Western Blot. Estudou-se a associação entre a presença da infecção pelo HIV e as seguintes variáveis: ruptura prematura de membranas, parto prematuro, muito baixo peso ao nascimento, infecção puerperal, Apgar baixo no primeiro e quinto minutos, crescimento intra-uterino restrito (CIUR) e pequeno para a idade gestacional (PIG). RESULTADOS: do total de gestantes estudadas, 228 (2,96%) estavam infectadas pelo HIV. Os resultados dos testes estatísticos indicam que a infecção pelo HIV não é fator de risco para a ruptura prematura de membranas (RR = 0,48, p <0,01), parto prematuro (RR = 0,92, p = 0,01), muito baixo peso ao nascimento (RR = 0,69, p = 0,54), infecção puerperal (RR = 0,00, p = 0,31), Apgar menor do que sete no primeiro minuto (RR = 0,81, p = 0,40) e no quinto minuto (RR = 0,36, p = 0.19). Entre as variáveis estudadas, a hipótese de homogeneidade das proporções foi rejeitada para crescimento intra-uterino restrito (RR = 5,27, p <0,01) e pequeno para a idade gestacional (RR = 1,73, p < 0,01). CONCLUSÕES: a ocorrência de complicações maternas e fetais em gestantes infectadas pelo HIV não é diferente da observada em mulheres não infectadas, com exceção CIUR e PIG.

Intrauterine infection after delivery: a marker of HIV-1 seropositivity among puerperal women in Uganda?

A case controlled study about HIV seroprevalence among women with post-partum endometritis-myometritis (PPEM) matched with two controls. Each was performed in a non-governmental organization hospital in Kampala, Uganda. All participants were offered HIV pre- and post-test counselling. Personal and clinical information was obtained and HIV-1 ELISA tests performed on blood samples and discordant results resolved by Western blot test. HIV-1 seroprevalence was significantly higher among women with PPEM than controls, 26 (42.3%) and 26 (21.3%) respectively (P = 0.002). Women with PPEM were two-and-a-half times more likely to be HIV-positive than controls, odds ratio 2.74 (95% CI 1.34-5.65). Single or cohabiting women and low salaried women were also significantly more among PPEM cases than controls. In conclusion, PPEM cases had significantly higher seroprevalence of HIV-1 infection than controls and this needs further elucidation for purposes of management strategies.

Infection-related morbidities in the mother, fetus and neonate

Only partially understood host defense mechanisms operate against infections affecting maternal and fetal morbidity. Subclinical ascending infections through the lower female genital tract are predominant worldwide. Important micronutrient deficiencies may prevail in low-income countries where these infections are much more common than in high-income countries. Important morbidities related to poor perinatal outcome both for the mother and for the fetus and newborn comprise preterm birth, prelabor rupture of membranes, placental abruption (predelivery detachment of the placenta), postpartum sepsis and maternal anemia. In the fetus, sepsis and intrauterine growth retardation are suspected to be consequences of ascending maternal infections. In the newborn, septicemia and respiratory disorders as well as some neurological disorders seem to be consequences of such ascending genital infections in the pregnant woman. It is concluded that much more attention should be given to efforts to elucidate the host defense mechanisms and antimicrobial barriers from the vagina through the cervix, fetal membranes and amniotic fluid including the early fetal immunocompetence in the second and the third trimester of pregnancy.

Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study

OBJECTIVE

To study the impact of interpregnancy interval on maternal morbidity and mortality.

DESIGN

Retrospective cross sectional study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Montevideo, Uruguay.

SETTING

Latin America and the Caribbean, 1985-97.

PARTICIPANTS

456 889 parous women delivering singleton infants.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios of the effects of short and long interpregnancy intervals on maternal death, pre-eclampsia, eclampsia, gestational diabetes mellitus, third trimester bleeding, premature rupture of membranes, postpartum haemorrhage, puerperal endometritis, and anaemia.

RESULTS

Short (<6 months) and long (>59 months) interpregnancy intervals were observed for 2.8% and 19.5% of women, respectively. After adjustment for major confounding factors, compared with those conceiving at 18 to 23 months after a previous birth, women with interpregnancy intervals of 5 months or less had higher risks for maternal death (odds ratio 2.54; 95% confidence interval 1.22 to 5.38), third trimester bleeding (1.73; 1.42 to 2.24), premature rupture of membranes (1.72; 1.53 to 1.93), puerperal endometritis (1.33; 1.22 to 1.45), and anaemia (1.30; 1.18 to 1.43). Compared with women with interpregnancy intervals of 18 to 23 months, women with interpregnancy intervals longer than 59 months had significantly increased risks of pre-eclampsia (1.83; 1.72 to 1.94) and eclampsia (1.80; 1.38 to 2.32).

CONCLUSIONS

Interpregnancy intervals less than 6 months and longer than 59 months are associated with an increased risk of adverse maternal outcomes.