Childbirth experiences of women with a history of physical, sexual, and child abuse: a cross-sectional study of 2,575 Russian women

BACKGROUND

A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour.

METHODS

A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma.

RESULTS

Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(β) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(β) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth.

CONCLUSION

This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.

Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study

OBJECTIVES

Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH).

METHODS

The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis.

RESULTS

Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team.

CONCLUSION

The participants' experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.

Pulse perfusion index for predicting intrapartum fever during epidural analgesia

STUDY OBJECTIVE

To assess whether pulse perfusion index (PI) values could be employed to predict intrapartum fever and to provide a cut-off PI value for predicting intrapartum fever occurrence.

DESIGN

We conducted a single-center, prospective, observational study.

SETTING

Delivery room at the Department of Obstetrics, Affiliated Hospital of Jiangsu University.

PATIENTS

117 parturients who intended to have a vaginal delivery.

INTERVENTIONS

Each parturient received epidural analgesia.

MEASUREMENTS

We checked each parturient's tympanic temperature before analgesia (T₀), at 1 h (T₁) and 2 h (T₂) after analgesia, immediately at the end of the second (T₃) and third (T₄) stages of labor, and at 1 h postpartum (T₅). A temperature of ≥38°C was defined as fever. PI, measured on the right second toe, was recorded before analgesia (PI₀) and at 10 min (PI₁₀), 20 min (PI₂₀), and 30 min (PI₃₀) after analgesia. The PI change rate was calculated as the incremental change in PI₃₀ from PI₀, divided by the PI₀. Receiver operating characteristic (ROC) curves were used to verify the utility of the PI₃₀ and PI change rate values for predicting intrapartum fever.

MAIN RESULTS

We found that peak temperature (T_P) occurred at the end of the second or the third stage of labor. Within 30 min after analgesia, the PI showed a significant increase over time and there was a linear correlation between PI₃₀ and T_P values (P < 0.001, r = 0.544). The PI₁₀, PI₂₀, PI₃₀ and PI change rate in febrile parturients were higher than those in afebrile parturients (P < 0.001). The area under the ROC (AUROC) for PI₃₀ was 0.818 (P < 0.001) with a cut-off of 9.30. The AUROC of the PI change rate was 0.738 (P < 0.001) with a cut-off of 3.45.

CONCLUSIONS

PI₃₀ and PI change rate values could be used to predict intrapartum fever in parturients after epidural analgesia.

[Effect of induction on maternal and neonatal outcomes of vaginal birth after cesarean]

Objective: To investigate the effect of induction on maternal and neonatal outcomes of vaginal birth after cesarean section (VBAC). Methods: Retrospective cohort study. A total of 452 pregnant women who underwent trail of labor after cesarean section (TOLAC) from January 2015 to March 2019 of Beijing Obstetrics and Gynecology Hospital, Capital Medical University were enrolled. According to the mode of the onset of labor, those 331 women who underwent VBAC were divided into spontaneous labor group (n=280) and induction group(n=51). According to induction methods, the pregnant women in the induction group was divided into the low-dose oxytocin subgroup (n=35) and other method subgroup (n=16, 9 cases with cervical ripening by balloon and 7 cases combined with oxytocin). The effect of induction on labor duration and maternal and neonatal outcome in VBAC were analyzed. Results: No maternal and neonatal death occurred. There were 23.0% (76/331) with forceps, 15.1% (50/331) of postpartum hemorrhage, and 24.5% (81/331) of fetal distress. The gravidity, birth weight and the gestational weeks of delivery in the induction group were significantly higher than those in the spontaneous onset group [2.0 (2.0-3.0) vs 2.0(1.0-2.0) times, 39.0(38.0-40.0) vs 38.0(37.0-39.0) weeks, (3 467±372) vs (3 168±538) g, Z=-3.548,-3.892,-3.813, all P<0.01]. The duration of the second stage of labor was significantly longer than that of the spontaneous onset group [43(26-60) vs 30(17-49) min, Z=-2.145,P<0.05], but the duration of the first stage, the total duration of labor, the rate of forceps, the incidence of postpartum hemorrhage, the rate of perineal incision and the incidence of fetal distress were not obvious different (all P>0.05). The duration of the first stage and total duration in oxytocin group were significantly shorter than those other method group [260(210-435) vs 325(250-490) min, 450(355-620) vs 523(370-668) min, Z=-2.001,-1.913, all P<0.05]. There were not significantly different in the duration of second stage, mode of delivery, perineal injury, the rate of postpartum hemorrhage, and fetal distress in the two groups (all P>0.05). Conclusion: Pregnant women who have undergone TOLAC after caesarean section can be induced after fully evaluation. Although induction prolongs the labor duration, it does not affect the maternal and neonatal complication rate.

Ochsner Obstetrics and Gynecology Simulation Program: A Review of the Literature and Description of a Multidisciplinary Simulation Program Targeting Management of Obstetric Emergencies

Background: Simulation training improves the response to obstetric emergencies. Methods: We review the current literature regarding simulation training for provider education, team training, and obstetric outcomes and describe the implementation of a multidisciplinary obstetric simulation program. Results: A review of literature available at PubMed reveals many studies focused on provider education but few studies detailing the direct impact on patients. We review simulation reports that demonstrate improved clinical outcomes after obstetric emergencies-such as shoulder dystocia, postpartum hemorrhage, delivery of the second twin, operative vaginal delivery, urgent cesarean delivery, and neonatal resuscitation-as these studies formed the basis of the Ochsner Obstetrics and Gynecology Simulation Program in New Orleans, LA. We discuss the 3 principal simulation formats at Ochsner: a half-day course at the simulation training center, in-situ simulation on clinical care floors, and just-in-time training in the classroom. We also present detailed examples of simulation scenarios to assist others in creating a robust simulation program to ensure staff and providers are well trained to respond to obstetric emergencies. Conclusion: The Ochsner Obstetrics and Gynecology Simulation Program was formulated on published literature and incorporates a variety of clinical settings, scenarios, and approaches to improve educational opportunities and response to obstetric emergencies.

Incidence of catastrophic expenditures linked to obstetric and neonatal care at 92 facilities in Lubumbashi, Democratic Republic of the Congo, 2015

Background

In the Democratic Republic of the Congo (DRC), more than 93% of users must pay out of pocket for care. Despite the risk of catastrophic expenditures (CE), 94% of births in Lubumbashi are attended by skilled personnel. We aimed to identify risk factors for CE associated with obstetric and neonatal care in this setting, to document coping mechanisms employed by households to pay the price of care, and to identify consequences of CE on households.

Methods

We used mixed methods and conducted both a cross-sectional study and a phenomenological study of women who delivered at 92 health care facilities in all 11 health zones of Lubumbashi. In April and May 2015 we followed 1,627 women and collected data on their health care and household expenses to determine whether they experienced CE, defined as payments that reached or exceeded 40% of a household’s capacity to pay. Two months after discharge, we conducted semi-structured interviews with 58 women at their homes to assess the consequences of CE.

Results

In all, 261 of 1,627 (16.0%) women experienced CE. Whether a woman or her infant experienced complications was an important contributor to her risk of CE; poverty, younger age, being unmarried, and delivering in a parastatal facility or with more highly trained personnel also increased risk. Among a subset of women with CE interviewed 2 months after discharge, those who were in debt or who had lost their trading income or goods were unable to pay their rent, their children’s school fees, or were obliged to reduce food consumption in the household; some had become victims of mistreatment such as verbal abuse, disputes with in-laws, denial of paternity, abandonment by partners, financial deprivation, even divorce.

Conclusions

We found a higher proportion of CE than previously reported in the DRC or in other urban settings in Africa. We suggest that the government and funders in DRC support initiatives to put in place mutual-aid health risk pools and health insurance and introduce and institutionalize free maternal and infant care. We further suggest that the government ensure decent and regular payment of providers and improve the financing and functioning of health care facilities to improve the quality of care and alleviate the burden on users.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7260-9) contains supplementary material, which is available to authorized users.

Health-related quality of life after obstetric intensive care admission: Comparison with the general population

PURPOSE

To examine health-related quality of life (HRQoL) in obstetric patients after intensive care discharge, with comparison to age-appropriate reference values from the general Finnish female population.

MATERIAL AND METHODS

Retrospective register-based study. Four multidisciplinary intensive care units at Finnish university hospitals participated.

RESULTS

A total of 291 obstetric patient were admitted to the ICU, of whom 114 (39%) completed follow-up measurements. At baseline (pre-intensive care admission), patients showed lower physical (mobility, self-care, pain/discomfort) and social (usual activities) dimensions compared to reference values. Baseline overall health status (EQsum) was lower than reference values. However EQsum increased over six months (mean, 0.907 to 0.946) such that follow-up values were similar to reference values. At follow-up, 18.4% of patients showed poorer HRQoL (mean, 0.764; range, 0.638-0.885) compared to reference values. Multiparous patients showed lower scores than primiparous patients. EQ VAS scores were lower at baseline, but increased over six months (72.12 to 87.5) such that follow-up values were similar to reference values.

CONCLUSIONS

The baseline HRQoL of study population was lower than that of the general population, but after six months, the mean values were comparable to reference value. However, one in five patients still experienced impaired QOL at follow-up.

Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011

Background

While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi.

Methods

This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards.

Results

The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one.

In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities.

Conclusion

Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1224-9) contains supplementary material, which is available to authorized users.

Characteristics of induced labors at Marqués de Valdecilla University Hospital

OBJECTIVE

Induction of labor (IOL) is a common obstetric practice which has increased in recent decades. The main objective of this study is to describe the characteristics of induced labor at Marqués de Valdecilla University Hospital.

METHOD

A descriptive, retrospective study was performed between January 1st and April 30t^h of 2014, by reviewing medical histories. A standardised registration has been used to collect data.

RESULTS

There were a total of 376 IOL, the incidence was 35.1%. The most frequent indications were premature rupture of membranes (33.9%) and gestational age of 41 completed weeks or more (16.7%). Oxytocin was used to start 66.8% of the IOL. Of all births, 61.4% were spontaneous vaginal births and 25.3% caesarean sections. An increase in the rate of caesarean sections was observed in the group of gestational age of 41 completed weeks or more (27.3%) and hypertensive disorders of pregnancy (29.8%). The main cause of dystocia was suspected fetal compromise (36.4%). Adaptation to extrauterine life was within the parameters of normality in 94% of the newborn infants.

CONCLUSIONS

Comparing the IOL with spontaneous labor, a decrease in spontaneous vaginal births and an increase in caesarean sections and operative vaginal births was observed in the inductions. This study provides relevant information to the professionals in the fields of gynaecology and obstetrics, and opens the way for future research to obtain results transferable to the clinical practice.

[Caesarean section: History, epidemiology, and ethics to diminish its incidence]

Cesarean section has become the most performed surgery and it has been enhanced with the use of antibiotics and improvement in surgical techniques. The aim of this systematic review is to describe and clarify some historical and ethical characteristics of this surgery, pointing out some aspects about its epidemiological behavior, becoming a topic that should be treated globally, giving priority to the prevention and identification of factors that may increase the incidence rates. Today, this "epidemic" reported rates higher than fifty percent, so it is considered a worldwide public health problem. Consequently, in Mexico strategies aimed at its reduction have been implemented. However, sociocultural, economic, medicolegal and biomedical factors are aspects that may difficult this goal. As we decrease the percentage of cesarean section in nulliparous patients, we diminish the number of iterative cesarean and its associated complications. This aim must be achieved through the adherence to the guidelines which promote interest in monitoring and delivery care in health institutions of our country.

Birth weight and obstetric complications determine age at onset in first episode of psychosis

BACKGROUND

Earlier age at onset of psychosis (AOP) has been associated with poor social adjustment and clinical outcome. Genetic and environmental factors such as obstetric complications, parental history of psychosis, advanced paternal age at time of birth, low birth weight and gestational age, and use of drugs have been described as bringing AOP forward. This study aims to evaluate the relationship between AOP and these factors in a sample of first episode of psychosis (FEP) patients.

METHODS

Clinical and sociodemographic data, age at FEP, age of parents at birth, parental history of psychosis, drug-use habits of the mother during pregnancy and of the patient before psychotic onset, and Lewis and Murray obstetric complication scale were obtained from 90 patients with FEP. Statistical analysis was performed by means of Pearson correlations, Chi-square tests, Student T-test analyses and a linear regression model using SPSS version 22.

RESULTS

Pre-eclampsia, need for incubator at birth, use of forceps, parental history of psychosis, and low birth weight were associated with an earlier AOP. Use of forceps and birth weight are the variables which best predict AOP in FEP. Stimulant drugs, which were mostly used together with cannabis and cocaine, were the only substances associated with an earlier AOP.

CONCLUSIONS

Our findings are consistent with previous study results and underline the role of the prenatal period in the development of psychosis and the importance of careful monitoring of pregnancy and delivery, especially in cases with familial history.

Uterine compression sutures for management of severe postpartum haemorrhage: five-year audit

OBJECTIVES

To audit the use of compression sutures for the management of massive postpartum haemorrhage and compare outcomes to those documented in the literature.

DESIGN

Retrospective study.

SETTING

A regional obstetric unit in Hong Kong.

PATIENTS

Patients with severe postpartum haemorrhage encountered over a 5-year period from January 2008 to December 2012, in which compression sutures were used for management.

MAIN OUTCOME MEASURES

Successful management with prevention of hysterectomy.

RESULTS

In all, 35 patients with massive postpartum haemorrhage with failed medical treatment, for whom compression sutures were used in the management, were identified. The overall success rate for the use of B-Lynch compression sutures alone to prevent hysterectomy was 23/35 (66%), and the success rate of compression sutures in conjunction with other surgical procedures was 26/35 (74%). This reported success rate appeared lower than that reported in the literature.

CONCLUSION

Uterine compression was an effective method for the management of massive postpartum haemorrhage in approximately 70% of cases, and could be used in conjunction with other interventions to increase its success rate in terms of avoiding hysterectomy.