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Wu C, Ling Z, Wang Y, Lv Y, Miao Z, Liu L, Ji X. Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features. Reprod Sci 2024:10.1007/s43032-024-01529-4. [PMID: 38575810 DOI: 10.1007/s43032-024-01529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
To analyze the differences in risk factors and pregnancy outcomes between recurrent and initial pre-eclampsia(PE) with severe features. Data from recurrent (n = 128) and initial (n = 904) PE with severe features who terminated their pregnancy or gave birth at 20 weeks of gestation or later at the tertiary teaching hospital (Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital) from January 2016 to December 2022 were collected. Risk factors for recurrent PE with severe features and differences in pregnancy outcomes between the two groups were assessed using the chi-square test, student t-test, or nonparametric test. Independent risk factors for recurrent PE with severe features were further analyzed by logistic regression. (1) Logistic regression analysis identified 3 independent risk factors for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. In addition, assisted reproductive technology (ART) is an independent risk factor for initial PE with severe features; (2) The incidence of oligohydramnios, chorioamnionitis, preterm birth, stillbirth, fetal growth restriction (FGR) and abnormal umbilical blood flow was higher in the recurrent PE with severe features group than in the initial PE with severe features group(P < 0.05). In contrast, the incidence of premature rupture of membrane (PROM) and postpartum hemorrhage (PPH) was higher in the group of initial PE with severe features(P < 0.05); (3) In the recurrent PE with severe features group, gestational age(GA) of birth and birth weight were lower than those in the initial PE with severe features group(P < 0.05). Also, the incidence of mild asphyxia, the rate of neonatal intensive care unit (NICU) hospitalization, length of stay in NICU, and the rate of abandoning treatment in the recurrent PE with severe features group were higher than those in the initial PE with severe features group(P < 0.05). 3 independent risk factors was identified for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. Women with recurrent PE with severe features are more likely to have adverse perinatal outcomes than those with initial PE with severe features.
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Affiliation(s)
- Chengqian Wu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhonghui Ling
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yixiao Wang
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Yan Lv
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Zhijing Miao
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China
| | - Lan Liu
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
| | - Xiaohong Ji
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210000, China.
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Franke MA, Nordmann K, Frühauf A, Ranaivoson RM, Rebaliha M, Rapanjato Z, Bärnighausen T, Muller N, Knauss S, Emmrich JV. Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis. BMJ Open 2024; 14:e081482. [PMID: 38569673 DOI: 10.1136/bmjopen-2023-081482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
CONTEXT There is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems that reduce preventable maternal and neonatal deaths are scarce. SETTING We aimed to determine the cost-effectiveness of a non-governmental organisation (NGO)-run inter-facility referral system for emergency obstetrical and neonatal care in rural Southern Madagascar by analysing the characteristics of cases referred through the intervention as well as its costs. DESIGN We used secondary NGO data, drawn from an NGO's monitoring and financial administration database, including medical and financial records. OUTCOME MEASURES We performed a descriptive and a cost-effectiveness analysis, including a one-way deterministic sensitivity analysis. RESULTS 1172 cases were referred over a period of 4 years. The most common referral reasons were obstructed labour, ineffective labour and eclampsia. In total, 48 neonates were referred through the referral system over the study period. Estimated cost per referral was US$336 and the incremental cost-effectiveness ratio (ICER) was US$70 per additional life-year saved (undiscounted, discounted US$137). The sensitivity analysis showed that the intervention was cost-effective for all scenarios with the lowest ICER at US$99 and the highest ICER at US$205 per additional life-year saved. When extrapolated to the population living in the study area, the investment costs of the programme were US$0.13 per person and annual running costs US$0.06 per person. CONCLUSIONS In our study, the inter-facility referral system was a very cost-effective intervention. Our findings may inform policies, decision-making and implementation strategies for emergency obstetrical and neonatal care referral systems in similar resource-constrained settings.
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Affiliation(s)
- Mara Anna Franke
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte für Madagaskar, Berlin, Germany
| | | | - Anna Frühauf
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Nadine Muller
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte für Madagaskar, Berlin, Germany
- Department of Infectious Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauss
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte für Madagaskar, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julius Valentin Emmrich
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte für Madagaskar, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Cozzi GD, Ye Y, Mbah R, Mbunwe DM, Pekwarake S, Yui Bunwi E, Fondzeyuf A, Ngong MG, Dionne JA, Harper LM, Jauk VC, Carlo WA, Halle-Ekane G, Tih PM, Szychowski JM, Tita AT, Subramaniam A. Predicting peripartum infection in laboring patients at high risk in Cameroon, Africa. Eur J Obstet Gynecol Reprod Biol 2024; 293:9-14. [PMID: 38096705 DOI: 10.1016/j.ejogrb.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To develop a predictive model for peripartum infection among high risk laboring patients in Cameroon, Africa. STUDY DESIGN We conducted a secondary analysis of the Cameroon Antibiotic Prophylaxis Trial (NCT03248297), a multicenter 3-arm double-blind randomized controlled trial of oral azithromycin ± amoxicillin among term pregnancies with prolonged labor or rupture of membranes in Cameroon 1/2018-5/2020. Patients with chorioamnionitis prior to randomization, study drug contraindications, or planned cesarean were excluded. The outcome of interest was a composite of maternal peripartum infection (chorioamnionitis, endometritis, sepsis by World Health Organization criteria, wound infection/abscess) diagnosed up to 6 weeks postpartum. Potential predictors were compared between patients with and without the composite outcome, and evaluated at a 0.05 alpha level. Statistically significant exposures were analyzed using multivariable regression (to generate adjusted odds ratios and 95 % confidence intervals) with backwards selection to generate a parsimonious model. Receiver operating characteristic curves with associated area under the curve assessed the model's predictive ability. A nomogram based on the final best fit multivariable model was constructed. RESULTS Of 756 patients in the parent trial, 652 were analyzed: 45 (7 %) had peripartum infection. Those with infection were more likely to be nulliparous, lower education level, higher gestational age, receive antibiotics per hospital protocols, and undergo cesarean. In our best-fit multivariable model, none/primary education (vs university), cesarean birth, and antibiotic receipt per physician discretion (vs for cesarean prophylaxis) were significantly associated with increased infection risk. This model was moderately predictive (AUC = 0.75, 95 % CI 0.67-0.82). When using this 3 factor model, for a patient with a cesarean birth, receipt of antibiotics per physician discretion, and university education, the probability of peripartum infection was 35 % (95 % CI 0.11-0.73). CONCLUSIONS While several variables such as parity are associated with infectious morbidity within 6 weeks among high risk laboring patients in Cameroon, only education level, antibiotic indication, and cesarean birth were independently associated, and a model including these 3 factors was moderately predictive. Validation of our findings in a larger population is warranted.
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Affiliation(s)
- Gabriella D Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Yuanfan Ye
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rahel Mbah
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Doreen M Mbunwe
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | | | - Edwan Yui Bunwi
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | | | - Mary G Ngong
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Jodie A Dionne
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Department of Women's Health, Division of Maternal Fetal Medicine, University of Texas at Austin, Dell School of Medicine, Austin, TX, USA
| | - Victoria C Jauk
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Halle-Ekane
- Cameroon Baptist Convention Health Services, Cameroon, Africa; University of Buea, Cameroon, Africa
| | - Pius M Tih
- Cameroon Baptist Convention Health Services, Cameroon, Africa
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
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Arowosegbe AO, Dedeke IO, Shittu OB, Ojo DA, Amusan JS, Iwaloye O, Ekpo UF. Can Clean Delivery Kits Prevent Infections? Lessons from Traditional Birth Attendants in Nigeria. Ann Glob Health 2023; 89:85. [PMID: 38077261 PMCID: PMC10705026 DOI: 10.5334/aogh.4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Background In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria. Methods The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests. Results CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 -1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively. Conclusion CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information.
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Affiliation(s)
| | | | - Olufunke Bolatito Shittu
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - David Ajiboye Ojo
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Joy Stephen Amusan
- Department of Public Health, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Opeoluwa Iwaloye
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Uwemedimo Friday Ekpo
- Department of Pure and Applied Zoology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
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Muteke K, Musaba MW, Mukunya D, Beyeza J, Wandabwa JN, Kiondo P. Postpartum resolution of hypertension, proteinuria and acute kidney injury among women with preeclampsia and severe features at Mulago National Referral Hospital, Uganda: a cohort study. Afr Health Sci 2023; 23:27-36. [PMID: 38357176 PMCID: PMC10862643 DOI: 10.4314/ahs.v23i3.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The resolution of hypertension, proteinuria and AKI postpartum among women with preeclampsia is not well documented in Uganda. Objective To determine the time to resolution of hypertension, proteinuria and AKI postpartum until 6 weeks among women with preeclampsia in Mulago Hospital, Uganda. Methods Between August 2017 and April 2018, we measured blood pressure, urine protein and serum creatinine on days 1,7,21 and 42 postpartum among 86 women with preeclampsia. The primary outcomes were time to the resolution of hypertension, proteinuria and AKI. We fitted accelerated failure models using Stata 17's stintreg. command with a log normal distribution and obtained time ratios of selected exposures on time to resolution of hypertension, proteinuria and AKI intervals. Results The median time to resolution of hypertension, proteinuria and AKI was seven (7) days (Inter quartile range, IQR 1-21). The time to resolution of hypertension among primiparous women was 3.5 times that of multiparous women [TR 3.5, 95%CI 1.1, 11.3]. No differences were observed in resolution of hypertension, proteinuria and acute kidney injury. Conclusion The time to resolution of hypertension, proteinuria and AKI was seven days. We recommend larger studies with longer follow-up beyond six-weeks postpartum to inform revision of our guidelines.
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Affiliation(s)
- Kasereka Muteke
- Department of Obstetrics and gynecology, College of Health Sciences, Makerere University, P.O BOX 7072, Kampala, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - David Mukunya
- Department of Public and Community Health, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - Jolly Beyeza
- Department of Obstetrics and gynecology, College of Health Sciences, Makerere University, P.O BOX 7072, Kampala, Uganda
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - Paul Kiondo
- Department of Obstetrics and gynecology, College of Health Sciences, Makerere University, P.O BOX 7072, Kampala, Uganda
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda
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Wanduru P, Hanson C, Waiswa P, Kakooza-Mwesige A, Alvesson HM. Mothers' perceptions and experiences of caring for sick newborns in Newborn Care Units in public hospitals in Eastern Uganda: a qualitative study. Reprod Health 2023; 20:106. [PMID: 37474965 PMCID: PMC10360301 DOI: 10.1186/s12978-023-01649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Mothers' participation in the care of their sick newborns in Newborn Care Units (NCUs) has been linked to several advantages including earlier discharge, fewer complications, better mother-baby bonding, and an easier transition to home after discharge. This study aimed to understand mothers' perceptions and experiences while participating in the care of their sick newborns in the NCUs to inform interventions promoting mothers' participation in public health facilities in Uganda. METHODS We conducted an exploratory qualitative study comprised of 18 in-depth interviews with mothers caring for their newborns in two NCUs at a Regional Referral and General hospital in Eastern Uganda between April and May 2022. The interviews were audio-recorded and then transcribed. For analysis, we used a thematic analysis approach. RESULTS The fear of losing their baby was an overarching theme that underlay mothers' perceptions, actions, and experiences in the NCU. Mothers' confidence in the care provided to their babies was based on their baby's outcomes. For example, when mothers saw almost immediate improvement after treatment, they felt more confident in the care than when this was not the case. Furthermore, mothers considered it essential that health care providers responded quickly in an emergency. Moreover, they expressed concerns about a lack of control over their personal space in the crowded NCU. Additionally, caring for babies in these settings is physically and financially taxing, with mothers requiring the combined efforts of family members to help them cope. CONCLUSION This study shows that for mothers of sick newborns in the NCU, the baby's survival is the first concern and the basis of mothers' confidence in the quality of care provided. Efforts to improve parental participation in NCUs must focus on lowering the costs incurred by families in caring for a baby in the NCU, addressing privacy and space concerns, leveraging the family's role, and avoiding compromising the quality of care in the process of participation.
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Affiliation(s)
- Phillip Wanduru
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Peter Waiswa
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Symonds NE, Vidler M, Wiens MO, Omar S, English LL, Ukah UV, Ansermino JM, Ngonzi J, Bebell LM, Hwang B, Christoffersen-Deb A, Kissoon N, Payne BA. Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth 2023; 23:303. [PMID: 37120529 PMCID: PMC10148415 DOI: 10.1186/s12884-023-05459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 02/20/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. METHODS A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. RESULTS Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. CONCLUSIONS Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. TRIAL REGISTRATION PROSPERO registration number: CRD42018103955.
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Affiliation(s)
- Nicola E Symonds
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Matthew O Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Walimu, Kampala, Uganda
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - L Lacey English
- Department of Internal Medicine and Pediatrics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - U Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Mark Ansermino
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lisa M Bebell
- Infectious Diseases Division, and Center for Global Health, Massachusetts General Hospital Medical Practice Evaluation Center, Boston, MA, USA
| | - Bella Hwang
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Niranjan Kissoon
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Beth A Payne
- School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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Marandu LE, Masika GM. Healthcare workers' level of adherence to infection prevention and control and its impact on puerperal and neonatal sepsis among delivering women and neonates in Central Tanzania: a protocol for a prospective cohort study. BMJ Open 2023; 13:e066701. [PMID: 36918240 PMCID: PMC10016239 DOI: 10.1136/bmjopen-2022-066701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Delivering women and neonates are at a great risk of acquiring infections due to a lack of adherence to infection prevention and control (IPC), a low level of immunity and extended exposure to care procedures that can lead to infections. This prospective cohort study aims to assess the level of adherence to IPC among healthcare workers and its impact on puerperal and neonatal sepsis in the Dodoma region. METHODS AND ANALYSIS The level of adherence to IPC is examined cross-sectionally among healthcare workers (HCWs) in contact with delivering women and their neonates. A prospective cohort approach is used to assess the level of exposure of 294 delivering women and their neonates to poor hygienic practices of HCWs through an observation checklist. Outcomes, including the incidence of puerperal and neonatal sepsis, are evaluated clinically 2 days later before discharge. Laboratory culture and sensitivity confirmatory tests of blood samples are done on positive cases. Data analysis for level of adherence to IPC practices, incidence of puerperal and neonatal sepsis, and relative risk among the exposed women and neonates will be performed. ETHICS AND DISSEMINATION The University of Dodoma Research Ethics Committee approved this study (ref no. MA.84/261/'A'/25). Findings of this study will be published in international peer-reviewed journals and disseminated at international conferences to the participating hospitals, the University of Dodoma and the Tanzanian Ministry of Health for informing practice and policy.
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Affiliation(s)
- Laura Edward Marandu
- Department of Clinical Nursing, The University of Dodoma, Dodoma, Tanzania, United Republic of
- Department of Health Quality Assurance, Ministry of Health, Dodoma, Tanzania, United Republic of
| | - Golden Mwakibo Masika
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania, United Republic of
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Jaén-Sánchez N, González-Azpeitia G, Carranza-Rodriguez C, Muianganisso AJ, Torres LV, Pérez-Arellano JL. Effects of HIV infection and/or malaria on maternal and neonatal health in a high-prevalence setting. Trop Med Int Health 2023; 28:98-106. [PMID: 36579677 DOI: 10.1111/tmi.13848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE HIV infection and malaria have been associated with different complications during pregnancy and delivery. HIV-positive pregnant women are at increased risk for all adverse outcomes of malaria during pregnancy. The main objective was to analyse the obstetric and perinatal consequences of malaria, HIV infection and HIV/malaria co-infection in pregnant women and newborns, which has been less well evaluated. METHODS A cross-sectional study was carried out in the Maternity Service of the Provincial Hospital of Tete Mozambique, involving completion of a structured questionnaire that included demographic data, and information on the current pregnancy, delivery and the newborn. In total, 819 women (13-45 years old) in the immediate postpartum period were enrolled between 1 March and 31 October 2016. RESULTS The overall prevalence of HIV and malaria, considered separately, in pregnant women was ~12% (103 women with HIV and 101 with malaria). Only one-fifth of HIV-infected women knew their HIV status before pregnancy. A significantly higher proportion of women with HIV attended four or more antenatal care visits than women without HIV. Caesarean section was less frequent in HIV patients, and peripartum urinary infection was more frequent than in seronegative women (13/103 [12.6%] vs. 34/716 [4.7%]). HIV/malaria co-infection were 17/819 (2%) and was significantly associated with the development of pre-eclampsia when HIV-infected patients received anti-retroviral treatment, and with an increase in urinary tract infections around delivery. With respect to the newborn, co-infection increased the frequency of early neonatal death, as well as neonatal asphyxia and jaundice. CONCLUSIONS In Mozambique, the prevalence of malaria and HIV infection in women of childbearing age continues to be high and contributes additively to complications during pregnancy and childbirth, and in the newborn. Therefore, integrating HIV, malaria and reproductive health services is essential if maternal and foetal outcomes are to improve.
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Affiliation(s)
- Nieves Jaén-Sánchez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria González-Azpeitia
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.,Pediatric Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Cristina Carranza-Rodriguez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Laura Vallejo Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José Luis Pérez-Arellano
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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10
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Bishaw KA, Sharew Y, Beka E, Aynalem BY, Zeleke LB, Desta M, Kassie B, Amha H, Eshete T, Tamir W, Bantigen K, Mulugeta H, Ferede AA, Bitewa YB. Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study. Front Glob Womens Health 2023; 4:966942. [PMID: 36760237 PMCID: PMC9902590 DOI: 10.3389/fgwh.2023.966942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
Background Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital. Methods A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis. Results The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09-11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79-11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08-9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85-12.43)], being referred [AHR: 2.90; 95% CI: (1.10-7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08-10.50)] were statistically significant predictors of puerperal sepsis. Conclusion The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis.
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Affiliation(s)
- Keralem Anteneh Bishaw
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia,Correspondence: Keralem Anteneh Bishaw
| | - Yewbmirt Sharew
- Department of Midwifery, Injibara University, Injibara, Ethiopia
| | - Endihnew Beka
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | | | | | - Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kassie
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department Health Informatics, Debre Markos University, Debre Markos, Ethiopia
| | - Workineh Tamir
- Department of Laboratory, Injibara University, Injibara, Ethiopia
| | - Kerebih Bantigen
- School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henok Mulugeta
- Department of Midwifery, Injibara University, Injibara, Ethiopia
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11
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Odogwu NM. Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1082199. [PMID: 36685092 PMCID: PMC9845938 DOI: 10.3389/frph.2022.1082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.
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Affiliation(s)
- Nkechi Martina Odogwu
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States,School of Public Health, University of Minnesota, Minneapolis, MN, United States,Correspondence: Nkechi Martina Odogwu ,
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12
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Yuan H, Zhang C, Maung ENT, Fan S, Shi Z, Liao F, Wang S, Jin Y, Chen L, Wang L. Epidemiological characteristics and risk factors of obstetric infection after the Universal Two-Child Policy in North China: a 5-year retrospective study based on 268,311 cases. BMC Infect Dis 2022; 22:878. [PMID: 36418982 PMCID: PMC9682668 DOI: 10.1186/s12879-022-07714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obstetrical infection is one of the causes of maternal death and a difficult problem for many clinicians. Changes in the demographic and obstetric background of pregnant women following the Universal Two-Child Policy may have an impact on some fertility phenomena. And with the increase in the number of deliveries, the limited medical resources become more scarce. How will China's health system quickly adapt to the growing needs and expectations for maternal health and ensure the provision of qualified and accessible medical services? In addition, what social support measures should be provided to reduce preventable obstetric complications? Given the relatively low per capita share of medical resources in China, how should China deal with the impact of the Universal Two-Child Policy? Therefore, more studies based on the change of fertility policy are needed. We try to analyze the epidemiological characteristics and risk factors of obstetric infection before and after the Universal Two-Child Policy, with a view to providing reference for the prevention and control of obstetric infection in regions after the change of fertility policy, and also hope to make corresponding contributions to the solution of the above problems through relevant studies. METHODS The subjects of the survey were 268,311 pregnant women from Hebei Province Maternal Near Miss Surveillance System (HBMNMSS) of Hebei Women and Children's Health Center from January 1, 2013 to December 31, 2017. We analyzed the region, time and population distribution characteristics of obstetric infection, compared the epidemiological factors of obstetric infection before and after the Universal Two-Child Policy, and analyzed the relevant risk factors of obstetric infection. RESULTS The incidence of obstetric infection increased nearly twice after the Universal Two-Child Policy. The incidence of obstetric infection was highest in Chengde (1.9%), a city with a northward geographical distribution, Baoding (1.6%), Cangzhou (1.5%) followed; The higher the hospital grade, the higher the incidence; The incidence of obstetric infections in hospitals at all levels has increased; The age of onset before the Universal Two-Child Policy was (27.82 ± 5.047) years old, and the age after the Universal Two-Child Policy was (28.97 ± 4.880) years old; The incidence of obstetric infections is higher in winter. The rate of abortion-related infection (increased from 0.61 to 1.65%) and the rate of pregnant women with high school education (increased from 0.35 to 0.74%) increased significantly. The results of multivariate Logistic regression analysis after the Universal Two-Child Policy showed that anemia (OR = 1.249, 95%CI: 1.071-1.458), chronic hypertension (OR = 1.934, 95%CI: 1.375-2.722), mild preeclampsia (OR = 2.103, 95%CI: 1.323-3.344) and severe preeclampsia (OR = 2.228, 95%CI: 1.703-2.916) were independent risk factors for obstetric infection. Gestational age ≥ 37 weeks was a protective factor. CONCLUSION After the Universal Two-Child Policy, the prevention and control of obstetric infections should be strengthened, especially for abortion-related infections and elderly maternal with obstetric complications and complication in high-grade hospitals in winter. Educational background is also one of the factors that should be considered in the prevention of obstetric sensation. Prolonging gestational age is helpful to reduce the incidence of obstetric infection.
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Affiliation(s)
- Huiqing Yuan
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China ,grid.256883.20000 0004 1760 8442Graduate School of Hebei Medical University, Shijiazhuang, 050071 China
| | - Cui Zhang
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China
| | - Ei Ni Tar Maung
- grid.452859.70000 0004 6006 3273Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000 Guangdong China
| | - Songli Fan
- Hebei Women and Children’s Health Center, Shijiazhuang, 050000 China
| | - Zijia Shi
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China ,grid.256883.20000 0004 1760 8442Graduate School of Hebei Medical University, Shijiazhuang, 050071 China
| | - Fang Liao
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China ,Graduate School of North China University of Technology, Tangshan, 063000 China
| | - Shuo Wang
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China ,Graduate School of North China University of Technology, Tangshan, 063000 China
| | - Ying Jin
- grid.440208.a0000 0004 1757 9805Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051 China
| | - Le Chen
- grid.452859.70000 0004 6006 3273Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000 Guangdong China
| | - Li Wang
- grid.452859.70000 0004 6006 3273Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000 Guangdong China
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13
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Rahim NE, Ngonzi J, Boatin AA, Bassett IV, Siedner MJ, Mugyenyi GR, Bebell LM. The interaction between antenatal care and abnormal temperature during delivery and its relationship with postpartum care: a prospective study of 1,538 women in semi-rural Uganda. BMC Pregnancy Childbirth 2022; 22:860. [PMID: 36411419 PMCID: PMC9677695 DOI: 10.1186/s12884-022-05207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Postnatal care (PNC) is an important tool for reducing maternal and neonatal morbidity and mortality. However, what predicts receipt and maintenance in PNC, particularly events during pregnancy and the peripartum period, is not well understood. We hypothesized that fever or hypothermia during delivery would engender greater health consciousness among those attending antenatal care, leading to greater PNC engagement after hospital discharge and our objective was to evaluate this relationship. METHODS Women were prospectively enrolled immediately postpartum at Mbarara Regional Referral Hospital (MRRH). We collected postpartum vital signs and surveyed women by telephone about PNC receipt, fever, and infection at two and six weeks postpartum. Our outcome of interest was receipt of PNC post-discharge, defined as whether a participant visited a health facility and/or was hospitalized in the postpartum period. Our explanatory variables were whether a participant was ever febrile (> 38.0˚C) or hypothermic (< 36.0˚C) during delivery stay and whether a participant attended at least 4 antenatal care (ANC) visits. We used logistic regressions to estimate the association between ANC and fever/hypothermia with PNC, including an interaction term between ANC and fever/hypothermia to determine whether there was a modifying relationship between variables on PNC. Regression models were adjusted for age, marital status, parity, HIV serostatus, Mbarara residency, and whether the participant was referred to MRRH, RESULTS: Of the 1,541 women, 86 (5.6%) reported visiting a health facility and/or hospitalization and 186 (12.0%) had an abnormal temperature recorded during delivery stay. Of those who reported at least one visit, 59/86 (68.6%) delivered by cesarean, 37/86 (43.0%) reported post-discharge fever, and 44/86 (51.2%) reported post-discharge infection. Neither ANC attendance, abnormal temperature after delivery, nor their interaction term, were significantly associated with post-discharge PNC. The included covariates were not significantly associated with the outcome. CONCLUSIONS While the overall proportion of women reporting post-discharge PNC was low, those who reported visiting a health facility and/or hospitalization had high proportions of post-discharge fever, post-discharge infection, and cesarean delivery, which suggests that these visits may have been related to problem-focused care. No significant associations between ANC and PNC were observed in this cohort. Further research assessing ANC quality and PNC visit focus is needed to ensure ANC and PNC are optimized to reduce morbidity and mortality.
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Affiliation(s)
- Nicholas E. Rahim
- grid.32224.350000 0004 0386 9924Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, USA
| | - Joseph Ngonzi
- grid.33440.300000 0001 0232 6272Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A. Boatin
- grid.32224.350000 0004 0386 9924Department of Obstetrics and Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, USA
| | - Ingrid V. Bassett
- grid.32224.350000 0004 0386 9924Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mark J. Siedner
- grid.32224.350000 0004 0386 9924Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, USA ,grid.33440.300000 0001 0232 6272Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey R. Mugyenyi
- grid.33440.300000 0001 0232 6272Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lisa M. Bebell
- grid.38142.3c000000041936754XDepartment of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRJ-504, Boston, MA 02114 USA
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14
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Sirilak T, Kanjanarat P, Nochaiwong S, Katip W. Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth. Front Med (Lausanne) 2022; 9:939421. [PMID: 36148454 PMCID: PMC9485810 DOI: 10.3389/fmed.2022.939421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.
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Affiliation(s)
| | - Penkarn Kanjanarat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Penkarn Kanjanarat,
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Pharmacy, Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Wasan Katip
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Wasan Katip,
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Li W, Jiang M, Lu R. The impact of shared governance on the adverse mood of parturients with gestational hypertension and perinatal indicators of newborns. J OBSTET GYNAECOL 2022; 42:1823-1828. [PMID: 35465804 DOI: 10.1080/01443615.2022.2039909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wenyan Li
- Nursing Department, Ganzhou Maternal and Child Health Hospital, Ganzhou, China
| | - Manxiang Jiang
- Trauma Center, Ganzhou People's Hospital, Ganzhou, China
| | - Ruiying Lu
- Department of Obstetrics, Ganzhou Maternal and Child Health Hospital, Ganzhou, China
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Providing education and tools increases nurses’ and midwives’ assessment for puerperal sepsis in a regional referral hospital in South Western Uganda. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Malmir M, Boroojerdi NA, Masoumi SZ, Parsa P. Factors affecting postpartum infection: A systematic review. Infect Disord Drug Targets 2021; 22:e291121198367. [PMID: 34844548 DOI: 10.2174/1871526521666211129100519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Puerperal infection is used to describe any bacterial infection of the reproductive tract after delivery. Identifying the factors affecting postpartum infections can reduce the risk and complications of such factors and postpartum maternal mortality. OBJECTIVE This structured study was designed to evaluate factors affecting postpartum infections. METHODS In this study, after selecting Scopus, PubMed, SID, and Web of Science electronic databases, all observational studies (cohort and case-control) available and published in Farsi and English to investigate factors affecting postpartum infections were searched. The search was performed using the terms postpartum, infection, wound infection, puerperium, reason, risk factor, and their equivalent Persian words from 2010 to November 2019 regardless of publication status. RESULTS Out of the 3227 studies obtained, 19 were reviewed after removing irrelevant articles, duplicates (shared in databases), and animal samples. Age, level of education, delivery method, presence of episiotomy, anemia due to postpartum hemorrhage, interventions and manipulations during childbirth, prenatal hygiene, Povidone Iodine usage before delivery to wash the vagina, antibiotic prevention, increased labor duration, obesity, and the presence of bacteria were common symptoms affecting postpartum infection. CONCLUSION In this study, the factors affecting postpartum infection have been identified, some of which are avoidable. Identifying these factors helps reduce postpartum infections and their complications.
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Affiliation(s)
- Maryam Malmir
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan. Iran
| | | | - Seyedeh Zahra Masoumi
- Mother and Child Care Research Center, Midwifery Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Paarisa Parsa
- , School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
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Zamarano H, Musinguzi B, Kabajulizi I, Manirakiza G, Guti W, Muhwezi I, Hussein AA, Baweera A, Kabahinda B, Itabangi H, Bazira J, Kabanda T. Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda. BMC Microbiol 2021; 21:303. [PMID: 34736415 PMCID: PMC8567569 DOI: 10.1186/s12866-021-02367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths. Objective(s) To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital. Methods We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher’s exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis. Results Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation. Conclusion Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.
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Affiliation(s)
- Henry Zamarano
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Benson Musinguzi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Muni University, P.O. Box 725, Arua, Uganda.,Department of Microbiology and Immunology, College of Health, Medicine and Life Sciences, King Ceasor University, P.O. Box 88, Kampala, Uganda
| | - Immaculate Kabajulizi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Godfrey Manirakiza
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Walker Guti
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ivan Muhwezi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ayan Ahmed Hussein
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Agnes Baweera
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Boaz Kabahinda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Herbert Itabangi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.,Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - Joel Bazira
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Taseera Kabanda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Yang W, Fan X, Du X, Wang Z, Wang M, Cao N. The value of inflammatory factors and red blood cell immune indices in predicting perinatal infection in hypertensive women after cesarean section. Am J Transl Res 2021; 13:2990-2996. [PMID: 34017466 PMCID: PMC8129257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was conducted to explore the predictive value of inflammatory factors and red blood cell (RBC) immune indices in perinatal infection of women with pregnancy-induced hypertension after cesarean section. METHODS Eighty women with pregnancy-induced hypertension and perinatal infection after cesarean section were enrolled as the study group. Another 80 pregnant women with hypertension but without perinatal infection during cesarean section were included as the control group. The two groups were compared in terms of interleukin-1β (IL-1β), IL-6, IL-10, transformation growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), immune adhesion inhibitor (FEIR), immune adhesion promotion factor (FEER), and immune complex rosette (RBC-ICR) levels. The mothers in the study group were grouped according to the level of white blood cells, and the differences in related indicators of women in different inflammatory states were compared. Finally, the correlation between inflammatory factors and RBC-related immune indices was calculated. The differences in inflammatory factors and RBC-related immune indices were evaluated among different infection types. The ROC curve of IL-1β, IL-6, IL-10 and FEIR, FEER, RBC-ICR for infection prediction was plotted. RESULTS The study group showed significantly higher maternal levels of inflammatory factors and FEIR and lower FEER and RBC-ICR than the control group (P<0.05). There was a significant correlation between inflammatory factors and RBC-related immune indices (P<0.05), and there was little difference in inflammatory factors and RBC-related immune indices among different infection types (P>0.05). Inflammatory factors and RBC-related immune indices exhibited good predictive value for perinatal infection of women with pregnancy-induced hypertension. CONCLUSION Prior to perinatal infection, the inflammatory factors and the RBC indices of women with hypertension and cesarean section are significantly altered. Monitoring these indicators can be used to evaluate maternal prognosis.
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Affiliation(s)
- Wenju Yang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Xiaocui Fan
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Xia Du
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Zhen Wang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Min Wang
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
| | - Ningning Cao
- Obstetrics Department, Liaocheng Dongchangfu District Maternity and Child Health Hospital Liaocheng 252000, Shandong Province, China
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Wen Y, Chen H, Ming X, Chen X, Zhou W. Analysis of risk factors, pathogenic bacteria of maternal sepsis in term pregnant women with positive blood culture during hospitalization. Medicine (Baltimore) 2021; 100:e24847. [PMID: 33607856 PMCID: PMC7899873 DOI: 10.1097/md.0000000000024847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.
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Anger HA, Durocher J, Dabash R, Hassanein N, Ononge S, Burkhardt G, Frye LJ, Diop A, Beye Diop SBM, Darwish E, Ramadan MC, Kayaga J, Charles D, Gaye A, Eckardt M, Winikoff B. Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade. PLoS One 2021; 16:e0245988. [PMID: 33556104 PMCID: PMC7869979 DOI: 10.1371/journal.pone.0245988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective We aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women’s opinions on their overall experience of PPH care. Methods This prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0–10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported. Results Among women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45–3.35). A high postpartum pain score of 8–10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30–10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable. Conclusion UBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women’s satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.
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Affiliation(s)
- Holly A. Anger
- Gynuity Health Projects, New York, New York, United States of America
- * E-mail:
| | - Jill Durocher
- Gynuity Health Projects, New York, New York, United States of America
| | - Rasha Dabash
- Gynuity Health Projects, New York, New York, United States of America
| | | | - Sam Ononge
- Makerere University School of Health Sciences, Kampala, Uganda
| | - Gillian Burkhardt
- Gynuity Health Projects, New York, New York, United States of America
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Laura J. Frye
- Gynuity Health Projects, New York, New York, United States of America
| | - Ayisha Diop
- Gynuity Health Projects, New York, New York, United States of America
| | | | - Emad Darwish
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Dyanna Charles
- Gynuity Health Projects, New York, New York, United States of America
| | - Alioune Gaye
- Obstetrician/Gynecologist Consultant, Dakar, Senegal
| | - Melody Eckardt
- Global Health Innovation Lab, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Beverly Winikoff
- Gynuity Health Projects, New York, New York, United States of America
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22
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McDiehl RP, Boatin AA, Mugyenyi GR, Siedner MJ, Riley LE, Ngonzi J, Bebell LM. Antenatal Care Visit Attendance Frequency and Birth Outcomes in Rural Uganda: A Prospective Cohort Study. Matern Child Health J 2020; 25:311-320. [PMID: 33201450 DOI: 10.1007/s10995-020-03023-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Antenatal care (ANC) is designed to improve pregnancy outcomes by providing screening and treatment for preventable and treatable diseases. However, data are lacking on whether ANC affects stillbirth risk. We hypothesized stillbirth risk in Uganda is lower in women attending the recommended ≥ 4 ANC visits compared to those attending ≤ 3. METHODS We performed a secondary analysis of subset of 1,785 women enrolled in a prospective cohort of postpartum infection who presented to a regional referral hospital for delivery. Our primary outcome was documented stillbirth; a secondary composite poor birth outcome included stillbirth, early neonatal death, low birth weight (< 2500 g), and 5-min APGAR score < 7. We performed multivariable logistic regression analyses to identify independent correlates of stillbirth and poor birth outcome. RESULTS Of 1,785 participants, 58 (3%) pregnancies resulted in stillbirth and 198 (11%) had a poor birth outcome. Of 1,236 women attending ≥ 4 ANC visits, 31 (2.5%) had a stillbirth, compared to 27/510 (5.2%) attending ≤ 3. In multivariable analyses controlling for age, parity, distance traveled, referral status to hospital, malaria prophylaxis, and syphilis infection; attending ≥ 4 ANC visits was associated with significantly reduced odds of stillbirth (aOR 0.5, 95% CI 0.3-0.9, P = 0.02) and poor birth outcome (aOR 0.66, 95% CI 0.4-0.96, P = 0.03). Malaria prophylaxis was also independently associated with reduced odds of stillbirth (aOR 0.05, 95% CI 0.2-1.0, P = 0.04). CONCLUSIONS Attending ≥ 4 ANC visits was associated with reduced odds of stillbirth and poor birth outcomes in this Ugandan cohort, which may be related to more comprehensive infection screening, treatment, and prevention services.
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Affiliation(s)
- Rachel P McDiehl
- Emory University School of Medicine Department of Gynecology and Obstetrics, Glenn Building, 4th Floor - 412B, 69 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Adeline A Boatin
- Massachusetts General Hospital Department of Obstetrics and Gynecology, 55 Fruit St, Boston, MA, 02114, USA.,Massachusetts General Hospital Center for Global Health, Suite 722, 125 Nashua St, Boston, MA, 02114, USA
| | - Godfrey R Mugyenyi
- Mbarara University of Science and Technology Department of Obstetrics and Gynaecology, P.O. Box 1410, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital Center for Global Health, Suite 722, 125 Nashua St, Boston, MA, 02114, USA.,Massachusetts General Hospital Division of Infectious Diseases and Medical Practice Evaluation Center, 55 Fruit St and 100 Cambridge St, Boston, MA, 02114, USA
| | - Laura E Riley
- Weill Cornell Medical Center Department of Obstetrics and Gynecology, New York, NY, USA
| | - Joseph Ngonzi
- Mbarara University of Science and Technology Department of Obstetrics and Gynaecology, P.O. Box 1410, Mbarara, Uganda
| | - Lisa M Bebell
- Massachusetts General Hospital Center for Global Health, Suite 722, 125 Nashua St, Boston, MA, 02114, USA.,Massachusetts General Hospital Division of Infectious Diseases and Medical Practice Evaluation Center, 55 Fruit St and 100 Cambridge St, Boston, MA, 02114, USA
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23
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Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis. Obstet Gynecol Int 2020; 2020:1582653. [PMID: 32934656 PMCID: PMC7479451 DOI: 10.1155/2020/1582653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue. Methods A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019. Results The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear. Conclusion Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.
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Ngunyi YL, Halle-Ekane G, Tendongfor N, Mbivnjo EL, Evouna Mbarga A, Nembulefack D, Lo-oh CA, Egbe TO. Determinants and aetiologies of postpartum pyrexia; a retrospective analysis in a tertiary health facility in the Littoral Region of Cameroon. BMC Pregnancy Childbirth 2020; 20:167. [PMID: 32183728 PMCID: PMC7079534 DOI: 10.1186/s12884-020-02867-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/09/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Postpartum febrile morbidity is relatively common, occurring in approximately 5-7% of births. Differentiating between potentially serious and benign causes of postpartum pyrexia (PP) is fundamental in curbing the mortality rate from sinister causes such as sepsis. The paucity of data on PP in Cameroon makes it difficult to access its actual burden. This study was aimed at determining the prevalence, risk factors and aetiologies of PP at a tertiary hospital in Douala, Cameroon. METHODS This was a 2 - year hospital - based retrospective cohort study carried out at the Douala General Hospital (DGH), during which medical records of all postpartum admissions between January 1st 2017 and December 31st 2018 were reviewed. The review consisted of collecting data on socio-demographic characteristics, clinical profile, investigations and final diagnoses. The collected data was analysed in SPSS 23.0. Chi-squared test was used to test the association between variables and a logistic regression analysis was fitted to identify risk factors associated to PP. RESULTS A total of 1520 postpartum files were reviewed. The prevalence of PP was 8.82%. The most frequent causes of PP were: malaria (46.7%), urinary tract infections (18.7%), puerperal sepsis (17.9%) and pneumonia (8.7%). E. coli was the most (49.3%) cultured germ isolated in positive cultures. Onset of PP was more common (85%) within the first 3 days postpartum and malaria (60%) was the leading aetiology within this period. Five or more vaginal examinations prior to delivery (OR 59.151, 95% CI: 21.463-163.019; p < 0.001), perineal tears (OR 45.157, 95% CI: 2.266-899.722; p < 0.001), and duration of labour > 18 h (OR 26.760, 95% CI: 7.100-100.862; p < 0.001) were the most significant risk factors associated with PP. CONCLUSION Approximately 1 in every 12 postpartum cases in the DGH presents with PP. Malaria was the leading cause of PP at DGH especially for cases registered within 3 days postpartum. The risk factors identified were mostly associated to perinatal events, such as frequent vaginal examinations, perineal tears and prolonged labour. Efforts towards preventing identified risk factors thus becomes paramount in order to curb this high rate of PP in the DGH.
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Affiliation(s)
- Yannick Lechedem Ngunyi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Bebetta Memorial Community Clinic, Buea, Cameroon
| | - Gregory Halle-Ekane
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Obstetrics and Gynaecology Service, Douala General Hospital, Douala, Cameroon
| | | | | | - Armel Evouna Mbarga
- Cameroon Field Epidemiology Training Programme/Ministry of Public Health, Yaounde, Cameroon
| | | | | | - Thomas Obinchemti Egbe
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Obstetrics and Gynaecology Service, Douala General Hospital, Douala, Cameroon
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Kajeguka DC, Mrema NR, Mawazo A, Malya R, Mgabo MR. Factors and Causes of Puerperal Sepsis in Kilimanjaro, Tanzania: A Descriptive Study among Postnatal Women who Attended Kilimanjaro Christian Medical Centre. East Afr Health Res J 2020; 4:158-163. [PMID: 34308233 PMCID: PMC8279318 DOI: 10.24248/eahrj.v4i2.639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Puerperal sepsis is the major cause of maternal morbidity and mortality worldwide. About 94% of maternal mortality occur in low and middle-income countries including Tanzania. Objective: To estimate the prevalence, document factors and causes of puerperal sepsis among postnatal women who attended postnatal care in Kilimanjaro Christian Medical Centre Hospital in the year 2015. Methodology: A descriptive cross-sectional study was carried out at Kilimanjaro Christian Medical Centre, Tanzania. A total of 183 medical records of attendance in 2015 were used for the study. Information about the isolated organism in culture was retrieved from the Laboratory Information System. Results: The prevalence of puerperal sepsis was 11.5% (21/183). The most common factors and causes of puerperal sepsis included caesarean section 66.7% (14/21), postpartum haemorrhage 57.1% (12/21), moderate to severe anaemia 61.9% (13/21), prolonged labour 76.2% (16/21) and bacterial infection 90.5% (19/21). The difference was significant at p<.05. The most bacteria species isolated among women with puerperal sepsis was Staphylococcus spp 50.0% (7/14), Escherichia 28.6% (4/14) and Streptococcus spp 21.4% (3/14). Conclusion: Puerperal sepsis is prevalent (11.5%) at Kilimanjaro Christian Medical Centre. Staphylococcus spp was found to be a predominant isolate which causes puerperal sepsis followed by E. coli and Streptococcus spp.
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Affiliation(s)
- Debora C Kajeguka
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Neema Reuben Mrema
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Akili Mawazo
- Faculty of Medicine, Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rosemary Malya
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maseke R Mgabo
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Population Studies, Institute of Rural Development Planning
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Rouse CE, Eckert LO, Muñoz FM, Stringer JSA, Kochhar S, Bartlett L, Sanicas M, Dudley DJ, Harper DM, Bittaye M, Meller L, Jehan F, Maltezou HC, Šubelj M, Bardaji A, Kachikis A, Beigi R, Gravett MG. Postpartum endometritis and infection following incomplete or complete abortion: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2019; 37:7585-7595. [PMID: 31783980 PMCID: PMC6891249 DOI: 10.1016/j.vaccine.2019.09.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C E Rouse
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - L O Eckert
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - F M Muñoz
- Department of Pediatrics, Section on Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - J S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - S Kochhar
- Global Healthcare Consulting; University of Washington, Seattle, USA; Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L Bartlett
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - M Sanicas
- Sanofi Pasteur, Asia and JPAC Region, Singapore
| | - D J Dudley
- University of Virginia, Department of Obstetrics and Gynecology, Charlottesville, VA, USA
| | - D M Harper
- University of Michigan, Departments of Family Medicine and Obstetrics and Gynecology, Department of Epidemiology, Ann Arbor, MI, USA
| | - M Bittaye
- Edward Francis Small Teaching Hospital/University of The Gambia and Medical Research Council, The Gambia at London School of Hygiene and Tropical Medicine, USA
| | - L Meller
- Safety & Pharmacovigilance, Syneos Health, Raleigh, NC, USA
| | - F Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - H C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - M Šubelj
- National Institute of Public Health, Ljubljana, Slovenia
| | - A Bardaji
- Barcelona Institute for Global Health, Barcelona, Spain
| | - A Kachikis
- Department of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - R Beigi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M G Gravett
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA.
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de Souza HCC, Perdoná GSC, Marcolin AC, Oyeneyin LO, Oladapo OT, Mugerwa K, Souza JP. Development of caesarean section prediction models: secondary analysis of a prospective cohort study in two sub-Saharan African countries. Reprod Health 2019; 16:165. [PMID: 31727102 PMCID: PMC6854746 DOI: 10.1186/s12978-019-0832-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background Caesarean section is recommended in situations in which vaginal birth presents a greater likelihood of adverse maternal or perinatal outcomes than normal. However, it is associated with a higher risk of complications, especially when performed without a clear medical indication. Since labour attendants have no standardised clinical method to assist in this decision, statistical tools developed based on multiple labour variables may be an alternative. The objective of this paper was to develop and evaluate the accuracy of models for caesarean section prediction using maternal and foetal characteristics collected at admission and through labour. Method This is a secondary analysis of the World Health Organization’s Better Outcomes in Labour Difficulty prospective cohort study in two sub-Saharan African countries. Data were collected from women admitted for labour and childbirth in 13 hospitals in Nigeria as well as Uganda between 2014 and 2015. We applied logistic regression to develop different models to predict caesarean section, based on the time when intrapartum assessment was made. To evaluate discriminatory capacity of the various models, we calculated: area under the curve, diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity. Results A total of 8957 pregnant women with 12.67% of caesarean births were used for model development. The model based on labour admission characteristics showed an area under the curve of 78.70%, sensitivity of 63.20%, specificity of 78.68% and accuracy of 76.62%. On the other hand, the models that applied intrapartum assessments performed better, with an area under the curve of 93.66%, sensitivity of 80.12%, specificity of 89.26% and accuracy of 88.03%. Conclusion It is possible to predict the likelihood of intrapartum caesarean section with high accuracy based on labour characteristics and events. However, the accuracy of this prediction is considerably higher when based on information obtained throughout the course of labour.
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Affiliation(s)
- Hayala C C de Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Gleici S C Perdoná
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Alessandra C Marcolin
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Lawal O Oyeneyin
- Department of Obstetrics & Gynaecology, University of Medical Sciences Teaching Hospital, Medical Village, Laje Road, Ondo City, Ondo State, Nigeria
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 27, CH-1211, Geneva, Switzerland
| | - Kidza Mugerwa
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
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Faure K, Dessein R, Vanderstichele S, Subtil D. Endométrites du post-partum. RPC infections génitales hautes CNGOF et SPILF. ACTA ACUST UNITED AC 2019; 47:442-450. [DOI: 10.1016/j.gofs.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Outcomes among Mothers Who Gave Birth in the Health Facility: Does Birth Preparedness and Complication Readiness Have a Role? Obstet Gynecol Int 2019; 2019:5147853. [PMID: 31182963 PMCID: PMC6515023 DOI: 10.1155/2019/5147853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/17/2019] [Indexed: 12/01/2022] Open
Abstract
Background Giving childbirth is a natural reward for human beings to replace themselves to exist in the world. Despite all the efforts made to improve maternal health, maternal morbidity and mortality continue during childbirth. Hence, this study aimed to determine the proportion of maternal birth outcomes and identify their predictors among mothers who gave birth in hospitals. Method A hospital-based cross-sectional study was conducted from April 9 to June 7, 2016, among 384 postnatal mothers in Debre Tabor Hospital. Randomly selected mothers were interviewed by trained data collectors. Data were checked for completeness, entered using Epi Info version 7, and analyzed using STATA 14 software. A multivariate logistic regression model was used to control confounders and identify predictors of maternal birth outcomes. Statistical significance was declared by adjusted odds ratio with a 95% confidence interval and a p value ≤0.05. Result About 77% (95% CI: 72.9, 81.3) of the mothers had good maternal birth outcomes. Antenatal care utilization (AOR: 2.60; 95% CI: 1.16, 5.83); BPCR practice (AOR: 2.10; 95% CI: 1.12, 3.96); self-preference of health institution (AOR: 2.34; 95% CI: 1.11, 4.50); and mode of delivery: caesarean (AOR: 0.46; 95% CI: 0.23, 0.87), assisted breech (AOR: 0.17; 95% CI: 0.04, 0.69), and instrumental (AOR: 0.27; 95% CI: 0.09, 0.79) were associated with good maternal birth outcome. Conclusion In this study, the maternal birth outcome among postnatal mothers was good in more than three-fourth of the cases. Hence, encouraging mothers to utilize health-care services and counseling and supporting them on BPCR practice are recommended.
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