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Nel S, Pattinson RC, Vannevel V, Feucht UD, Mulol H, Wenhold FAM. Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework. Public Health Nutr 2023; 26:1523-1538. [PMID: 37170908 PMCID: PMC10410405 DOI: 10.1017/s1368980023000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. DESIGN A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. SETTING Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. PARTICIPANTS A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. RESULTS Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. CONCLUSIONS Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
| | - Robert C Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Friede AM Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
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Festo C, Vannevel V, Ali H, Tamrat T, Mollel GJ, Hlongwane T, Fahmida KA, Alland K, Barreix M, Mehrtash H, Silva R, Thwin SS, Mehl G, Labrique AB, Masanja H, Tunçalp Ӧ. Accuracy of a smartphone application for blood pressure estimation in Bangladesh, South Africa, and Tanzania. NPJ Digit Med 2023; 6:69. [PMID: 37069209 PMCID: PMC10107587 DOI: 10.1038/s41746-023-00804-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023] Open
Abstract
Undetected and unmonitored hypertension carries substantial mortality and morbidity, especially during pregnancy. We assessed the accuracy of OptiBPTM, a smartphone application for estimating blood pressure (BP), across diverse settings. The study was conducted in community settings: Gaibandha, Bangladesh and Ifakara, Tanzania for general populations, and Kalafong Provincial Tertiary Hospital, South Africa for pregnant populations. Based on guidance from the International Organization for Standardization (ISO) 81,060-2:2018 for non-invasive BP devices and global consensus statement, we compared BP measurements taken by two independent trained nurses on a standard auscultatory cuff to the BP measurements taken by a research version of OptiBPTM called CamBP. For ISO criterion 1, the mean error was 0.5 ± 5.8 mm Hg for the systolic blood pressure (SBP) and 0.1 ± 3.9 mmHg for the diastolic blood pressure (DBP) in South Africa; 0.8 ± 7.0 mmHg for the SBP and -0.4 ± 4.0 mmHg for the DBP in Tanzania; 3.3 ± 7.4 mmHg for the SBP and -0.4 ± 4.3 mmHg for the DBP in Bangladesh. For ISO criterion 2, the average standard deviation of the mean error per subject was 4.9 mmHg for the SBP and 3.4 mmHg for the DBP in South Africa; 6.3 mmHg for the SBP and 3.6 mmHg for the DBP in Tanzania; 6.4 mmHg for the SBP and 3.8 mmHg for the DBP in Bangladesh. OptiBPTM demonstrated accuracy against ISO standards in study populations, including pregnant populations, except in Bangladesh for SBP (criterion 2). Further research is needed to improve performance across different populations and integration within health systems.
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Affiliation(s)
- Charles Festo
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Valerie Vannevel
- South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
| | - Hasmot Ali
- The JiVitA Maternal and Child Health and Nutrition Research Project, Nasirabad, Keranipara, Rangpur, 5400, Bangladesh
| | - Tigest Tamrat
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Getrud J Mollel
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Tsakane Hlongwane
- South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa
| | - Kaniz A Fahmida
- The JiVitA Maternal and Child Health and Nutrition Research Project, Nasirabad, Keranipara, Rangpur, 5400, Bangladesh
| | - Kelsey Alland
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - María Barreix
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ronaldo Silva
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garrett Mehl
- Department of Digital Health and Innovations, World Health Organization, Geneva, Switzerland
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Digital Health and Innovations, World Health Organization, Geneva, Switzerland
| | - Honorati Masanja
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Ӧzge Tunçalp
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Bonell A, Vannevel V, Sonko B, Mohammed N, Vicedo-Cabrera AM, Haines A, Maxwell NS, Hirst J, Prentice AM. A feasibility study of the use of UmbiFlow™ to assess the impact of heat stress on fetoplacental blood flow in field studies. Int J Gynaecol Obstet 2023; 160:430-436. [PMID: 36165637 PMCID: PMC10092781 DOI: 10.1002/ijgo.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie Vannevel
- Maternal and Infant Healthcare Strategies Unit, SAMRC, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Healthcare strategies, University of Pretoria, Pretoria, South Africa
| | - Bakary Sonko
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Environment and Society, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - Jane Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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Nyofane M, Hoffman M, Mulol H, Botha T, Vannevel V, Pattinson R, Feucht U. Early Childhood Growth Parameters in South African Children with Exposure to Maternal HIV Infection and Placental Insufficiency. Viruses 2022; 14:v14122745. [PMID: 36560749 PMCID: PMC9782627 DOI: 10.3390/v14122745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (-0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (-0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (-1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (-0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.
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Affiliation(s)
- Mothusi Nyofane
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa
- Department of Nutrition, National University of Lesotho, Maseru 100, Lesotho
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Correspondence: ; Tel.: +266-5775-1718
| | - Marinel Hoffman
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
| | - Helen Mulol
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria 0002, South Africa
| | - Tanita Botha
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
| | - Valerie Vannevel
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0002, South Africa
| | - Robert Pattinson
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0002, South Africa
| | - Ute Feucht
- Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Kalafong Provincial Tertiary Hospital, Pretoria 0001, South Africa
- Research Unit for Maternal and Infant Health Care Strategies, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria 0002, South Africa
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Adam S, Pheiffer C, Dias S, Hlongwane T, Vannevel V, Soma-Pillay P, Abdullah F. Coronavirus and Pregnancy: The Challenges of the 21st Century: A Review. Front Microbiol 2022; 13:923546. [PMID: 35910606 PMCID: PMC9326040 DOI: 10.3389/fmicb.2022.923546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Despite many advances in medicine we are still faced with emerging pathogens. Pregnant women have been disproportionately affected by previous coronavirus outbreaks. The COVID-19 pandemic has not affected pregnant women as greatly as SARS-CoV and MERS, but has posed other challenges such as the need for quarantine and isolation, limited access to antenatal care, use of personal protective equipment (PPE), vaccine hesitancy and inequities in vaccine access and therapeutics between rich countries and the global south. This review will describe the impact of the significant coronaviruses on pregnancy, with special focus on the challenges being encountered by the SARS-CoV-2 global pandemic.
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Affiliation(s)
- Sumaiya Adam
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- *Correspondence: Sumaiya Adam,
| | - Carmen Pheiffer
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
- Centre for Cardio-metabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
| | - Tsakane Hlongwane
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Feucht U, Hlongwane T, Vannevel V, Mulol H, Botha T, Pattinson R. Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening. Glob Health Sci Pract 2022; 10:GHSP-D-21-00692. [PMID: 36332066 PMCID: PMC9242613 DOI: 10.9745/ghsp-d-21-00692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
Continuous-wave Doppler ultrasound of the umbilical artery offers an inexpensive and scalable method of detecting undiagnosed fetal growth restriction. Using Doppler to screen low-risk pregnancies in low- and middle-income countries identifies fetuses at risk of stillbirth and, when managed appropriately, results in a step change reduction in the stillbirth rate. Identifying the high-risk fetus in the low-risk pregnant mother (LRM) is a neglected area of research. Fetal growth restriction (FGR) is a major cause of stillbirths, especially in low- and middle-income countries (LMICs). FGR is very poorly detected particularly in healthy pregnant women classified as low risk. Umbiflow is an inexpensive continuous-wave Doppler ultrasound (CWDU) apparatus that is suitable for use by low-level health care providers for screening low-risk pregnant populations. It can easily detect umbilical artery blood flow in the cord, which correlates well with placental function, and poor placental function correlates well with FGR. Use of CWDU to screen an LMIC population of more than 7,000 LRMs has demonstrated a high prevalence of abnormal umbilical artery flow of 13%, and absent end-diastolic flow, which is associated with end-stage placental disease, was found in 1.2%. This is 10 times higher than previously reported in high-income countries. Screening with CWDU together with a standard protocol managing those pregnancies with abnormal placental blood flow resulted in a 43% reduction in stillbirths (risk ratio: 0.57; 95% confidence interval=0.29, 0.85) in this LRM population. Further, follow-up of infants who had abnormal umbilical artery blood flow showed that these infants had significantly less fat-free mass at ages 6 weeks, 10 weeks, 14 weeks, and 6 months, than those with normal umbilical artery blood flow (P<.015), confirming that CWDU was able to detect true FGR. Thus, screening with CWDU can detect the fetus at risk of stillbirth, and infants likely to have suboptimal growth and development postnatally. Screening with CWDU in LRMs opens the door to a step change in preventing stillbirths in LMICs.
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Affiliation(s)
- Ute Feucht
- University of Pretoria, Pretoria, South Africa.
- South African Medical Research Council, Pretoria, South Africa
| | - Tsakane Hlongwane
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Valerie Vannevel
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Helen Mulol
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Tanita Botha
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Robert Pattinson
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Correspondence: J. B. Nachega, University of Pittsburgh School of Public Health, Department of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health 130 DeSoto Street, A532 Crabtree Hall, Pittsburgh, PA 15261 ()
| | | | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya,Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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8
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Vannevel V, Vogel JP, Pattinson RC, Adanu R, Charantimath U, Goudar SS, Gwako G, Kavi A, Maya E, Osoti A, Pujar Y, Qureshi ZP, Rulisa S, Botha T, Oladapo OT. Antenatal Doppler screening for fetuses at risk of adverse outcomes: a multicountry cohort study of the prevalence of abnormal resistance index in low-risk pregnant women. BMJ Open 2022; 12:e053622. [PMID: 35296477 PMCID: PMC8928296 DOI: 10.1136/bmjopen-2021-053622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Few interventions exist to address the high burden of stillbirths in apparently healthy pregnant women in low- and middle-income countries (LMICs). To establish whether a trial on the impact of routine Doppler screening in a low-risk obstetric population is warranted, we determined the prevalence of abnormal fetal umbilical artery resistance indices among low-risk pregnant women using a low-cost Doppler device in five LMICs. METHODS We conducted a multicentre, prospective cohort study in Ghana, India, Kenya, Rwanda and South Africa. Trained nurses or midwives performed a single, continuous-wave Doppler screening using the Umbiflow device for low-risk pregnant women (according to local guidelines) between 28 and 34 weeks' gestation. We assessed the prevalence of abnormal (raised) resistance index (RI), including absent end diastolic flow (AEDF), and compared pregnancy and health service utilisation outcomes between women with abnormal RI versus those with normal RI. RESULTS Of 7151 women screened, 495 (6.9%) had an abnormal RI, including 14 (0.2%) with AEDF. Caesarean section (40.8% vs 28.1%), labour induction (20.5% vs 9.0%) and low birth weight (<2500 g) (15.0% vs 6.8%) were significantly more frequent among women with abnormal RI compared with women with normal RI. Abnormal RI was associated with lower birth weights across all weight centiles. Stillbirth and perinatal mortality rates were similar between women with normal and abnormal RI. CONCLUSION A single Doppler screening of low-risk pregnant women in LMICs using the Umbiflow device can detect a large number of fetuses at risk of growth restriction and consequent adverse perinatal outcomes. Many perinatal deaths could potentially be averted with appropriate intervention strategies. TRIAL REGISTRATION NUMBER CTRI/2018/07/01486.
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Affiliation(s)
- Valerie Vannevel
- Maternal and Infant Health Care Strategies Unit, SAMRC, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Joshua P Vogel
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Robert C Pattinson
- Maternal and Infant Health Care Strategies Unit, SAMRC, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Richard Adanu
- School of Public Health, University of Ghana, Legon, Ghana
| | - Umesh Charantimath
- Women's and Children's Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Avinash Kavi
- Women's and Children's Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Ernest Maya
- School of Public Health, University of Ghana, Legon, Ghana
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Yeshita Pujar
- Women's and Children's Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Zahida P Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), University of Rwanda, Kigali, Rwanda
| | - Tanita Botha
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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9
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Abstract
BACKGROUND Assisted vaginal births are carried out to expedite birth for the benefit of mothers and babies but are sometimes associated with significant morbidity for both. Various instruments are available, broadly divided into forceps and vacuum cups, and choice may be influenced by clinical circumstances, operator preference, experience and availability. OBJECTIVES: To evaluate the different instruments in terms of success in achieving a vaginal birth, and the risk of morbidity for mother and baby. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 May 2021), and reference lists of retrieved studies. SELECTION CRITERIA We selected randomised controlled trials of assisted vaginal birth using different instruments. The review did not include quasi-randomised trials, cluster-randomised trials or cross-over designs. The review included trials for which abstracts alone were available as long as there was sufficient information to assess eligibility. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We used the GRADE approach to assess the certainty of evidence. The main outcomes assessed included failed delivery with allocated instrument, any maternal trauma, third- and fourth-degree tears, postpartum haemorrhage, any neonatal trauma, low Apgar and low umbilical artery pH. MAIN RESULTS: We included 31 studies involving a total of 5754 women. Risk of bias criteria were largely assessed as 'unclear', due to a lack of detail in trial reports. Blinding would have been challenging for all trials due to their inability to conceal the type of instrument used from either the woman or the operator, which is reflected in the risk of bias assessment. Any type of forceps versus any type of vacuum cup (12 studies, 3129 women) Forceps may be less likely to fail in achieving vaginal birth: risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.88; 11 studies, 3080 women; low certainty. 'Any maternal trauma' may be slightly more likely with forceps: odds ratio (OR) 1.53, 95% CI 0.98 to 2.40; 5 studies, 1356 women; low certainty; and third- or fourth-degree tears may also be more likely with forceps: RR 1.83, 95% CI 1.32 to 2.55; 9 studies, 2493 women; low certainty. There is no evidence of a difference in the incidence of postpartum haemorrhage (PPH) between the two groups: RR 1.71, 95% CI 0.59 to 4.95; 2 studies, 523 women; low certainty, because the evidence is very imprecise due to a very wide CI. More women in the forceps group reported requiring pain relief. There is probably no evidence of difference in rates of low Apgar: RR 0.83, 95% CI 0.46 to 1.51; 7 studies, 1644 women; moderate certainty; or low umbilical artery pH in the forceps group compared to any vacuum: RR 1.33, 95% CI 0.91 to 1.93; 2 studies, 789 women; low certainty; both of these outcomes are imprecise and have wide CIs that include both benefit and harm. There were also lower rates of fetal trauma with 'any forceps' (cephalhematoma, retinal haemorrhage and jaundice). The composite outcome of 'any neonatal trauma' was not reported. Low-cavity forceps versus any vacuum cup (2 studies, 218 women) We included two small studies with 218 participants in this comparison, but we judged most of the evidence as very low certainty, hence it was not feasible to make judgements on the difference in the rates of failed delivery, any maternal trauma or third- and fourth- degree tears. PPH and low umbilical artery pH were not reported. Soft vacuum cup versus any rigid cup (9 studies, 1148 women) Failed delivery may be more likely in the soft vacuum cup group: RR 1.62, 95% CI 1.21 to 2.17; 9 studies, 1148 women; low certainty. There may be no difference in the rates of 'any maternal trauma': OR 0.63, 95% CI 0.24 to 1.67; 2 studies, 348 women; low certainty, but the confidence interval is wide, indicating possible benefit or harm. There may be no difference in the rates of third- or fourth-degree tears: RR 0.93, 95% CI 0.35 to 2.44; 4 studies, 619 women; low certainty. There is probably no difference in the rates of PPH: RR 0.89, 95% CI 0.49 to 1.61; 5 studies, 737 women; moderate certainty between the soft and rigid cup groups. There may be little or no difference in the incidence of low Apgar scores: RR 0.82, 95% CI 0.49 to 1.37; 9 studies, 1148; low certainty; or low umbilical artery pH: RR 0.80, 95% CI 0.47 to 1.36; 1 study, 100 women; low certainty. Handheld vacuum versus any vacuum cup (4 studies, 968 women) There may be no difference in the rates of failures with allocated instrument: RR 1.35, 95% CI 0.81 to 2.25; 4 studies, 962 women; low certainty, any maternal trauma: OR 1.16, 95% CI 0.71 to 1.88; 2 studies; 394 women; low certainty, PPH: RR 0.31, 95% CI 0.03 to 2.92; 1 study, 164 women; low certainty, low umbilical artery pH: RR 1.06, 95% CI 0.71 to 1.59; 1 study, 164 women; low certainty, or low Apgar scores: RR 1.25, 95% CI 0.34 to 4.61; 3 studies, 784 women; low certainty) between the two groups. There is probably no difference in the rates of third- or fourth-degree tears between the 'handheld vacuum' and 'any vacuum cup' groups: RR 1.15, 95% CI 0.62 to 2.12; 4 studies, 962 women; moderate certainty. AUTHORS' CONCLUSIONS This review provides low-certainty evidence that forceps may be more likely to achieve vaginal birth and have lower rates of fetal trauma, but at a greater risk of perineal trauma and higher pain relief requirements compared with vacuum cups. There was low-certainty evidence that rigid vacuum cups may be more likely to achieve a vaginal birth than soft cups but with more fetal trauma, whilst handheld vacuum cups had similar success rates compared to other cups. There was no evidence of a difference in the rates of third- or fourth-degree tears or postpartum haemorrhages between types of cups, but wide confidence intervals around the estimates indicate further research is needed in this area.
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Affiliation(s)
- Ganga L Verma
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK
| | - Jessica J Spalding
- Department of Obstetrics and Gynaecology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Marc D Wilkinson
- Department of Obstetrics and Gynaecology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - G Justus Hofmeyr
- Walter Sisulu University, University of Fort Hare, University of the Witwatersrand, Eastern Cape Department of Health, East London, South Africa & Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - Valerie Vannevel
- SAMRC Maternal and Infant Health Care Strategies Unit/University of Pretoria, Pretoria, South Africa
| | - Fidelma O'Mahony
- Keele University & Department of Obstetrics and Gynaecology, University Hospitals of North Midlands, Stoke-on-Trent, UK
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10
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Budhram S, Vannevel V, Botha T, Chauke L, Bhoora S, Balie GM, Odell N, Lombaard H, Wise A, Georgiou C, Ngxola N, Wynne E, Mbewu U, Mabenge M, Phinzi S, Gubu-Ntaba N, Goldman G, Tunkyi K, Prithipal S, Naidoo K, Venkatachalam S, Moodley T, Mould S, Hlabisa M, Govender L, Maistry C, Habineza JP, Israel P, Foolchand S, Tsibiyane NV, Panday M, Soma-Pillay P, Adam S, Molokoane F, Mojela MS, van Rensburg EJ, Mashamba T, Matjila M, Fawcus S, Osman A, Venter M, Petro G, Fakier A, Langenegger E, Cluver CA, Bekker A, de Waard L, Stewart C, Ngene NC, Lunda O, N Cebekhulu S, Moodley S, Koranteng-Peprah MA, Ati EMC, Maswime S, Yates LM. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynaecol Obstet 2021; 155:455-465. [PMID: 34499750 PMCID: PMC9087659 DOI: 10.1002/ijgo.13917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Objective To describe risk factors and outcomes of pregnant women infected with SARS‐CoV‐2 admitted to South African healthcare facilities. Methods A population‐based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS‐CoV‐2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed. Results A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID‐19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID‐19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care. Maternal tuberculosis, but not HIV co‐infection or other co‐morbidities, was associated with admission for COVID‐19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID‐19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications. Conclusion The maternal mortality rate was high among women admitted with SARS‐CoV‐2 infection and higher in women admitted primarily for COVID‐19 illness with tuberculosis being the only co‐morbidity associated with admission. A multicenter, observational study describing the risk factors and pregnancy outcomes of women admitted with SARS‐CoV‐2 infection in South Africa, a low‐ and middle‐income country.
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Affiliation(s)
- Samantha Budhram
- Maternal Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shastra Bhoora
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Maternal Critical Care, Baylor College, Houston, Texas, USA
| | - Gaynor M Balie
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Natalie Odell
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Hennie Lombaard
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Chrysanthi Georgiou
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Ngxola
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Emma Wynne
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Unati Mbewu
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Mfundo Mabenge
- Department of Obstetrics and Gynecology, Dora Nginza Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Sibusiso Phinzi
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Nontsikelelo Gubu-Ntaba
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Gareth Goldman
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kay Tunkyi
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sudhir Prithipal
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Keshree Naidoo
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Santhi Venkatachalam
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Terence Moodley
- Department of Obstetrics and Gynecology, Prince Mshiyeni Memorial Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sean Mould
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mzuvele Hlabisa
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Logie Govender
- Department of Obstetrics & Gynecology, Queen Nandi Regional Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Charlene Maistry
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - John P Habineza
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - Priya Israel
- Department of Obstetrics and Gynecology, Edendale Hospital, Pietermaritzburg, South Africa.,University of Kwazulu Natal, Durban, South Africa
| | - Serantha Foolchand
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Nomandla V Tsibiyane
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mala Panday
- Department of Obstetrics and Gynaecology, King Dinizulu Hospital Complex, University of Kwazulu Natal, Durban, South Africa
| | - Priya Soma-Pillay
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Sumaiya Adam
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Felicia Molokoane
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Matthew S Mojela
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Elizabeth J van Rensburg
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tshililo Mashamba
- Department of Obstetrics and Gynecology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa.,MRC/UCT Receptor Biology Unit, Division of Medical Biochemistry, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Sue Fawcus
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mareli Venter
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory Petro
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Ahminah Fakier
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Eduard Langenegger
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Catherine A Cluver
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa.,Translational Obstetrics Group, Mercy Perinatal, Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Chantal Stewart
- Department of Obstetrics and Gynecology, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
| | - Nnabuike C Ngene
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Ongombe Lunda
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Sylvia N Cebekhulu
- Department of Obstetrics and Gynecology, Bongani Regional Hospital, University of Free State, Bloemfontein, South Africa
| | - Siva Moodley
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mama-Asu Koranteng-Peprah
- Department of Obstetrics and Gynaecology, Midlands/Eden Gardens private Hospital, Pietermaritzburg, South Africa
| | - Emmanuel M C Ati
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, South Africa
| | - Laura M Yates
- Clinical Genetics Unit, Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa.,KwaZulu-Natal Research and Innovation Sequencing Platform, University of Kwazulu-Natal, Durban, South Africa
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11
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Feucht U, Mulol H, Vannevel V, Pattinson R. The ability of continuous-wave Doppler ultrasound to detect fetal growth restriction. PLoS One 2021; 16:e0255960. [PMID: 34370790 PMCID: PMC8351973 DOI: 10.1371/journal.pone.0255960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fetal growth restriction (FGR), defined as a fetus failing to reach its genetic growth potential, remains poorly diagnosed antenatally. This study aimed to assess the ability of continuous-wave Doppler ultrasound of the umbilical artery (CWD-UmA) to detect FGR in healthy women with low-risk pregnancies. METHODS AND FINDINGS This prospective longitudinal descriptive cohort study enrolled infants born to low-risk mothers who were screened with CWD-UmA between 28-34 weeks' gestation; the resistance index (RI) was classified as normal or abnormal. Infants were assessed at 6, 10, 14 weeks, and 6 months postnatally for anthropometric indicators and body composition using the deuterium dilution method to assess fat-free mass (FFM). Neonates in the abnormal RI group were compared with those in the normal RI group, and neonates classified as small-for-gestational age (SGA) were compared with appropriate-for-gestational age (AGA) neonates. Eighty-one term infants were included. Only 6 of 26 infants (23.1%) with an abnormal RI value would have been classified as SGA. The abnormal RI group had significantly reduced mean FFM and FFM-for-age Z-scores at 6, 10, 14 weeks, and 6 months compared with the normal RI group (P<0.015). The SGA group's FFM did not show this consistent trend when compared to AGA FFM, being significantly different only at 6 months (P = 0.039). The main limitation of the study was the small sample size of the infant follow-up. CONCLUSIONS Abnormal RI obtained from CWD-UmA is able to detect FGR and is considered a useful addition to classifying the neonate only by SGA or AGA at birth.
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Affiliation(s)
- Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Robert Pattinson
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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12
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Hofmeyr GJ, Bernitz S, Bonet M, Bucagu M, Dao B, Downe S, Galadanci H, Homer C, Hundley V, Lavender T, Levy B, Lissauer D, Lumbiganon P, McConville FE, Pattinson R, Qureshi Z, Souza JP, Stanton ME, Ten Hoope-Bender P, Vannevel V, Vogel JP, Oladapo OT. WHO next-generation partograph: revolutionary steps towards individualised labour care. BJOG 2021; 128:1658-1662. [PMID: 33686760 PMCID: PMC9291293 DOI: 10.1111/1471-0528.16694] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- G J Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.,Effective Care Research Unit, University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - S Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - M Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - M Bucagu
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - B Dao
- Jhpiego, Baltimore, MD, USA
| | - S Downe
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, UK
| | - H Galadanci
- Africa Centre of Excellence for Population Health and Policy, Bayero University, Bayero, Nigeria
| | - Cse Homer
- Maternal, Child and Adolescent Health Programme, Burnet Institute, Melbourne, Vic., Australia
| | - V Hundley
- Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, UK
| | - T Lavender
- Department of International Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Levy
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - D Lissauer
- Malawi-Liverpool-Wellcome Trust Research Institute, Queen Elizabeth Central Hospital, College of Medicine, Chichiri, Blantyre, Malawi
| | - P Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - F E McConville
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - R Pattinson
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - Z Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J P Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - M E Stanton
- Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
| | | | - V Vannevel
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - J P Vogel
- Maternal, Child and Adolescent Health Programme, Burnet Institute, Melbourne, Vic., Australia
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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13
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Vogel JP, Vannevel V, Robbers G, Gwako G, Lavin T, Adanikin A, Hlongwane T, Pattinson RC, Qureshi ZP, Oladapo OT. Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review. Reprod Health 2021; 18:38. [PMID: 33579315 PMCID: PMC7881445 DOI: 10.1186/s12978-021-01088-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF. Methods We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow > 20 weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. Results A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries. Conclusions Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia.
| | - Valerie Vannevel
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Gianna Robbers
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Tina Lavin
- School of Population and Global Health, University of Western Australia, Hackett Drive, Crawley, Perth, Australia.,UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abiodun Adanikin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Tsakane Hlongwane
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Robert C Pattinson
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria, 0007, South Africa
| | - Zahida P Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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14
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Dornan JC, Feucht U, Dornan SS, Mulol H, Vannevel V, Hlongwane T, Pattinson R. Re: Next steps to prevent stillbirth associated with growth restriction: Continuous-wave Doppler, fetal growth restriction and small-for-gestational-age babies. BJOG 2021; 128:940. [PMID: 33524242 DOI: 10.1111/1471-0528.16643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- James C Dornan
- Obstetrics and Gynaecology School Medicine, Royal College Surgeons Institute, Manama, Bahrain
| | - Ute Feucht
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - Samina S Dornan
- Maternal Fetal Medicine, King's College Hospital London, Dubai, UAE
| | - Helen Mulol
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - Valerie Vannevel
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - Tsakane Hlongwane
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
| | - Robert Pattinson
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
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15
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Hlongwane TM, Bozkurt B, Barreix MC, Pattinson R, Gülmezoglu M, Vannevel V, Tunçalp Ö. Implementing antenatal care recommendations, South Africa. Bull World Health Organ 2021; 99:220-227. [PMID: 33716344 PMCID: PMC7941100 DOI: 10.2471/blt.20.278945] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
Despite progress in reduction in maternal deaths in South Africa, deaths due to complications of hypertension in pregnancy remain high at 26 deaths per 100 000 live births in 2016. The South African health ministry modified its existing four-visit antenatal care model to align with the World Health Organization’s (WHO) 2016 recommendations for the number and content of antenatal care contacts. Implementation of the eight-contact antenatal care recommendations began in April 2017, after adaptation to the national context and nationwide trainings. In this article, we describe the stages of implementation and the monitoring of key indicators. We share lessons, particularly from the important early stages of nationwide scale-up and an analysis of the early results. We analysed samples of maternity case records in four catchment areas in the first year of the updated care model. The mean number of antenatal care contacts among five monthly samples of 200 women increased steadily from 4.76 (standard deviation, SD: 2.0) in March 2017 to 5.90 (SD: 2.3) in February 2018. The proportion of women with hypertension detected who received appropriate action (provision of medical treatment or referral) also increased from 83.3% (20/24) to 100.0% (35/35) over the same period. South Africa’s experiences with implementation of the updated antenatal care package shows that commitment from all stakeholders is essential for success. Training and readiness are key to identifying and managing women with complications and developing an efficient antenatal care system accessible to all women.
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Affiliation(s)
- Tsakane Mag Hlongwane
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa
| | - Burcu Bozkurt
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Maria C Barreix
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Robert Pattinson
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa
| | - Metin Gülmezoglu
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Valerie Vannevel
- South African Medical Research Council/University of Pretoria Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Unit Private Bag X323 Arcadia, Pretoria 0007, South Africa
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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16
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Nachega JB, Sam-Agudu NA, Budhram S, Taha TE, Vannevel V, Somapillay P, Ishoso DK, Tshiasuma Pipo M, Bongo-Pasi Nswe C, Ditekemena J, Ayele BT, Machekano RN, Gachuno OW, Kinuthia J, Mwongeli N, Sekikubo M, Musoke P, Agbeno EK, Umar LW, Ntakwinja M, Mukwege DM, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Kayembe JMN, Mavungu Landu DJ, Muyembe Tamfum JJ, Zumla A, Langenegger EJ, Mofenson LM. Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration. Am J Trop Med Hyg 2020; 104:461-465. [PMID: 33372651 PMCID: PMC7866362 DOI: 10.4269/ajtmh.20-1553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.
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Affiliation(s)
- Jean B. Nachega
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie Vannevel
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Daniel Katuashi Ishoso
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Tshiasuma Pipo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
| | - Christian Bongo-Pasi Nswe
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - John Ditekemena
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Birhanu T. Ayele
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick N. Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W. Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
| | - Lawal W. Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Eduard J. Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean-Marie N. Kayembe
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Don Jethro Mavungu Landu
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Eduard J. Langenegger
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - for the AFREhealth COVID-19 Research Collaboration Working Group
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
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17
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Vannevel V, Swanepoel C, Pattinson RC. Global perspectives on operative vaginal deliveries. Best Pract Res Clin Obstet Gynaecol 2018; 56:107-113. [PMID: 30392949 DOI: 10.1016/j.bpobgyn.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/25/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
Operative vaginal delivery (OVD) refers to the use of an instrument (forceps or vacuum device) to assist with the delivery of the fetus from the vagina. This can help improve maternal and fetal outcomes and has to be weighed up against the risks and benefits of performing second-stage cesarean deliveries. OVD forms an integral part of basic emergency obstetric care and a skilled birth attendant's duties. Outlet forceps and vacuum extraction should be used to shorten the second stage of labor and to improve maternal and fetal outcomes associated with delayed second stage. Despite the known benefit of OVD, available data on the use of OVDs in low- and middle-income countries show very low rates, mostly due to the lack of skilled healthcare workers and equipment shortages. Increased use of OVD can safely reduce the number of second-stage cesarean deliveries with its associated morbidity and mortality. We recommend implementing training programs to increase the number of skilled healthcare workers and strengthening health systems to provide birthing facilities with the equipment required to perform OVD.
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Affiliation(s)
- V Vannevel
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa.
| | - C Swanepoel
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa
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18
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Abstract
Obstetric medicine as a speciality is yet to be developed in South Africa. South Africa is regarded as a developing country. The burden of HIV and metabolic syndrome creates a need for advanced maternal care. An increase has been noted in hypertension and gestational diabetes due to increasing maternal age and increasing prevalence of obesity. The South African National Committee on Confidential Enquiry into Maternal Deaths' 2015 Saving Mothers Report identified non-pregnancy-related infections as the leading cause of maternal deaths. Obstetric medicine care includes pre-conception, antepartum and postpartum care. This article aims to highlight the importance of obstetric medicine, even in a resource-poor setting. The current internal medicine and obstetrics and gynaecology training is discussed and emphasis is placed on the opportunity to create an obstetric medicine programme.
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Affiliation(s)
- Lizemarie Wium
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Gauteng, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynaecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Salome Bothma
- Department of Internal Medicine, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
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19
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Schvartzman JA, Krupitzki H, Merialdi M, Betrán AP, Requejo J, Nguyen MH, Vayena E, Fiorillo AE, Gadow EC, Vizcaino FM, von Petery F, Marroquin V, Cafferata ML, Mazzoni A, Vannevel V, Pattinson RC, Gülmezoglu AM, Althabe F, Bonet M. Odon device for instrumental vaginal deliveries: results of a medical device pilot clinical study. Reprod Health 2018. [PMID: 29526165 PMCID: PMC5846255 DOI: 10.1186/s12978-018-0485-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A prolonged and complicated second stage of labour is associated with serious perinatal complications. The Odon device is an innovation intended to perform instrumental vaginal delivery presently under development. We present an evaluation of the feasibility and safety of delivery with early prototypes of this device from an early terminated clinical study. Methods Hospital-based, multi-phased, open-label, pilot clinical study with no control group in tertiary hospitals in Argentina and South Africa. Multiparous and nulliparous women, with uncomplicated singleton pregnancies, were enrolled during the third trimester of pregnancy. Delivery with Odon device was attempted under non-emergency conditions during the second stage of labour. The feasibility outcome was delivery with the Odon device defined as successful expulsion of the fetal head after one-time application of the device. Results Of the 49 women enrolled, the Odon device was inserted successfully in 46 (93%), and successful Odon device delivery as defined above was achieved in 35 (71%) women. Vaginal, first and second degree perineal tears occurred in 29 (59%) women. Four women had cervical tears. No third or fourth degree perineal tears were observed. All neonates were born alive and vigorous. No adverse maternal or infant outcomes were observed at 6-weeks follow-up for all dyads, and at 1 year for the first 30 dyads. Conclusions Delivery using the Odon device is feasible. Observed genital tears could be due to the device or the process of delivery and assessment bias. Evaluating the effectiveness and safety of the further developed prototype of the BD Odon Device™ will require a randomized-controlled trial. Trial registration ANZCTR ACTRN12613000141741 Registered 06 February 2013. Retrospectively registered.
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Affiliation(s)
- Javier A Schvartzman
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Hugo Krupitzki
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Mario Merialdi
- 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, CH-1211, Geneva 27, Switzerland.,Becton Dickinson and Company (BD), Franklin Lakes, NJ, USA
| | - Ana Pilar Betrán
- 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, CH-1211, Geneva 27, Switzerland
| | - Jennifer Requejo
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - My Huong Nguyen
- 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, CH-1211, Geneva 27, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, ETH Zurich, Auf der Mauer 17, 8092, Zurich, Switzerland
| | - Angel E Fiorillo
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Enrique C Gadow
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Francisco M Vizcaino
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Felicitas von Petery
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - Victoria Marroquin
- Department of Obstetrics and Gynecology, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC-IUC - CONICET), University Hospital, Av. Galván 4102 1431FWO, Buenos Aires, Argentina
| | - María Luisa Cafferata
- Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Dr Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Dr Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Valerie Vannevel
- SAMRC Maternal and Infant Health Care Strategies, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Robert C Pattinson
- SAMRC Maternal and Infant Health Care Strategies, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - A Metin Gülmezoglu
- 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, CH-1211, Geneva 27, Switzerland
| | - Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria (IECS - CONICET), Dr Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina
| | - Mercedes Bonet
- 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, CH-1211, Geneva 27, Switzerland.
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20
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Abstract
BACKGROUND Pelvimetry assesses the size of a woman's pelvis aiming to predict whether she will be able to give birth vaginally or not. This can be done by clinical examination, or by conventional X-rays, computerised tomography (CT) scanning, or magnetic resonance imaging (MRI). OBJECTIVES To assess the effects of pelvimetry (performed antenatally or intrapartum) on the method of birth, on perinatal mortality and morbidity, and on maternal morbidity. This review concentrates exclusively on women whose fetuses have a cephalic presentation. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2017) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (including quasi-randomised) assessing the use of pelvimetry versus no pelvimetry or assessing different types of pelvimetry in women with a cephalic presentation at or near term were included. Cluster trials were eligible for inclusion, but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Five trials with a total of 1159 women were included. All used X-ray pelvimetry to assess the pelvis. X-ray pelvimetry versus no pelvimetry or clinical pelvimetry is the only comparison included in this review due to the lack of trials identified that examined other types of radiological pelvimetry or that compared clinical pelvimetry versus no pelvimetry.The included trials were generally at high risk of bias. There is an overall high risk of performance bias due to lack of blinding of women and staff. Two studies were also at high risk of selection bias. We used GRADEpro software to grade evidence for our selected outcomes; for caesarean section we rated the evidence low quality and all the other outcomes (perinatal mortality, wound sepsis, blood transfusion, scar dehiscence and admission to special care baby unit) as very low quality. Downgrading was due to risk of bias relating to lack of allocation concealment and blinding, and imprecision of effect estimates.Women undergoing X-ray pelvimetry were more likely to have a caesarean section (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.19 to 1.52; 1159 women; 5 studies; low-quality evidence). There were no clear differences between groups for perinatal outcomes: perinatal mortality (RR 0.53, 95% CI 0.19 to 1.45; 1159 infants; 5 studies; very low-quality evidence), perinatal asphyxia (RR 0.66, 95% CI 0.39 to 1.10; 305 infants; 1 study), and admission to special care baby unit (RR 0.20, 95% CI 0.01 to 4.13; 288 infants; 1 study; very low-quality evidence). Other outcomes assessed were wound sepsis (RR 0.83, 95% CI 0.26 to 2.67; 288 women; 1 study; very low-quality evidence), blood transfusion (RR 1.00, 95% CI 0.39 to 2.59; 288 women; 1 study; very low-quality evidence), and scar dehiscence (RR 0.59, 95% CI 0.14 to 2.46; 390 women; 2 studies; very low-quality evidence). Again, no clear differences were found for these outcomes between the women who received X-ray pelvimetry and those who did not. Apgar score less than seven at five minutes was not reported in any study. AUTHORS' CONCLUSIONS X-ray pelvimetry versus no pelvimetry or clinical pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types or pelvimetry (other radiological examination or clinical pelvimetry versus no pelvimetry). There is not enough evidence to support the use of X-ray pelvimetry for deciding on mode of delivery in women whose fetuses have a cephalic presentation. Women who undergo an X-ray pelvimetry may be more likely to have a caesarean section.Further research should be directed towards defining whether there are specific clinical situations in which pelvimetry can be shown to be of value. Newer methods of pelvimetry (CT, MRI) should be subjected to randomised trials to assess their value. Further trials of X-ray pelvimetry in cephalic presentations would be of value if large enough to assess the effect on perinatal mortality.
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Affiliation(s)
- Robert C Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Kalafong Hospital, Private Bag X396, Pretoria, Gauteng, South Africa, 0001
| | - Anna Cuthbert
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS
| | - Valerie Vannevel
- Kalafong Hospital/University of Pretoria, Klipspringer Street, Atteridgeville, South Africa, 0008
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21
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Vannevel V, Brouckaert O, Leunen K, Amant F, Berteloot P, Dieudonne AS, Laenen A, Wildiers H, Paridaens R, Van LE, Weltens C, Moerman P, Smeets A, Lambrechts D, Christiaens MR, Vergote I, Neven P. P1-08-20: Parity Interferes with the Effect of Age at Diagnosis on the Frequency Breast Cancers Are Triple-Negative. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-08-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Epidemiologic studies show an age related decrease in the frequency that breast cancers are triple negative (TN) (estrogen receptor, progesterone receptor and HER-2 negative). Parity increases the risk of TN breast cancer as a previous full-term pregnancy mainly protects against ER+ breast cancer. It is unknown whether this protective affect appears at all ages of breast cancer diagnosis. We study the frequency of triple negative breast cancers by parity and age at breast cancer diagnosis.
Methods We performed a retrospective case-case analysis including 1583 consecutive female patients with primary diagnosis of invasive breast cancer, < 51 years at diagnosis. We compared the frequency of TN tumors between parous (N = 1271) and nulliparous (N = 312) women in three age categories (21 to 30 yrs, 31 to 40 yrs and 41 to 50 yrs). For statistical analysis we used a logistic regression model.
Results We confirmed a decrease of TN breast cancer with age (p < 0.0001). This decrease is stronger pronounced in the nulliparous group. Parity favors TN tumors only in women > 40 years at breast cancer diagnosis.
Discussion: Although several other factors may affect the frequency breast cancers are TN, age at breast cancer diagnosis interacts with the effect of a previous pregnancy on the frequency breast cancers are TN. Breast cancers in young women (< age 40) may have been initiated long before pregnancy can induce a protective effect against ER-positive cases. The international BCAC has recently accepted to validate our UZ Leuven findings.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-20.
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