Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. ...Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. Objectives: Evaluate the rate of complications and medical interventions in “low-risk” pregnant women. Methods: This was a retrospective cohort study assessing the risk of obstetrical complications and medical interventions in low-risk patients from January 2010 to December 2020 at Philippe Maguilen Senghor Health Center in Dakar, Senegal. Results: There were 10,979 low-risk patients out of a total of 52,768, accounting for 20.8%. As medical interventions, episiotomy was performed in 27.5% and cesarean section in 8.7%. Acute fetal distress was observed in 4.1%. A low Apgar score at the fifth minute was observed in 1.89% (whereas it was 3.49% in high risk patients). Newborn-resuscitation was performed in 10.7%. Neonatal mortality was 5‰. Conclusion: Low-risk pregnancies are not without “risk”, and thus care-givers should prepare for risks even at dealing with low risk patients.展开更多
Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in ...Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in a region plagued by insecurity linked to armed groups. Method: This was an analytical cross-sectional study with prospective data collection over a 4-month period, from June 10 to October 10, 2020. Patients from precarious security areas were compared to those from safer areas. The Chi squared and Fisher tests were used for comparison of variables. Results: Obstetric emergencies accounted for 38.62% of admissions, from which 25.59% came from precarious security zones. Age was similar in both comparison groups. However, patients from unsafe areas were more likely to reside in rural areas (p 0.001) and more likely to be in unpaid occupations (p 0.001). Prenatal visits were less frequent (p 0.01) and women were more often multigravidae (p 0.01) in the precarious security group of patients. Apart from the more frequent uterine rupture (p = 0.02) in the group from precarious security zones, diagnosed complications and maternal mortality were similar in the 2 groups, while perinatal mortality was higher in the group of patients from precarious security zones (p 0.01). Conclusion: The precarious security situation has negative consequences on maternal and perinatal morbidity and mortality. Further studies are needed for better understanding of these consequences, and improvement of health system resilience strategies, to reduce related maternal and fetal morbidity and mortality.展开更多
Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control stu...Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control study was carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a single scarred uterus who presented with complications during delivery (cases) were compared to eighty nine others who had a successfully trial of scar (control) during the study period. Data were analyzed using the CSPro version 6.0 and SPSS version 20.0 softwares with statistical significance set at P Results: We recruited 2 groups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The majority of women with complications were married (50.6%) and unemployed (42.8%). Following univariate analysis, predictive factors of complications were: prematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on scarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months (five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic disproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal consultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted by a nurse (OR = 2.4;IC = [1.2 - 4.7]), referral from a different health unit (OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6 - 27.4), a meconium stained amniotic fluid (OR = 9.9;CI = [3.6 - 26.8]). After logistic regression, the retained factors associated with complications were post-term (aOR = 34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean section indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score less than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion: Predictive factors of complications can help anticipate negative obstetric outcomes.展开更多
An increasing number of childbearing agewomen undergo liver transplantation(LT)in the United States.Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility,parti...An increasing number of childbearing agewomen undergo liver transplantation(LT)in the United States.Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility,particularly in terms of immunosuppression and optimal timing of conception.Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus.On the other hand,the outcomes of pregnancy in LT recipients are favorable,and children born to LT recipients are relatively healthy.Counseling on pregnancy should start before LT and continue after LT up until pregnancy,while all pregnant LT recipients must be managed by amultidisciplinary team,including both an obstetrician and a transplant hepatologist.Additionally,an interval of at least 1-2 years after successful LT is recommended before considering pregnancy.Pregnancy-induced hypertension,pre-eclampsia,and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients.As adverse fetal outcomes,such asmiscarriage,abortion,stillbirth,or ectopic pregnancy,may occur more often than in the non-transplant population,early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications.No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.展开更多
Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted ...Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.展开更多
<span style="font-family:Verdana;"><strong>Background:</strong> Herbal medicines use has prevailed over the past decades in both low-middle-income and high-income countries over the years. ...<span style="font-family:Verdana;"><strong>Background:</strong> Herbal medicines use has prevailed over the past decades in both low-middle-income and high-income countries over the years. The use among women has increased with increased risks of ill-health. There is extensive literature on herbal medicine use among women in pre/pregnancy, labour, and the postpartum periods. Therefore, this study aimed to understand women’s purposes, experiences, and motivation for using herbal medicines during pregnancy, childbirth and postpartum, and the experiences associated with the use. <strong>Methods:</strong> Four critical databases were predetermined and searched: CINAHL, Medline, Web of Science, and EMBASE. These databases were chosen for their comprehensiveness and relevance to the review aims. We considered peer-reviewed published articles from January 2000 to December 2018. We chose these databases because we found that they are dominant in the medical and healthcare-related literature. All references were pooled to Endnote reference management software for screening. Quality appraisal of articles was conducted using the Mixed-Method Assessment Tool (MMAT). Content analysis approach was used to extra the data from the articles. Globally, twenty-one articles met the inclusion criteria, and thus, formed the dataset for this review.<strong> Results:</strong> Most articles (n = 10, 47.6%) reported solely HM uses on only pregnancy whiles the rest evaluated HM uses in labour, pre-pregnancy, and the postpartum periods. The results have shown that the majority of women received information about HM from friends, family, the “black markets,” and drug outlets. Overall, the results were presented in seven broad themes: 1) sociodemographic characteristics of HM users, 2) perceived threat of health problem, 3) sources and quality of the information received, 4) susceptibility to health complications, 5) potential limitations to the use of HM, 6) the motivation for HM utilization, 7) concerns on the combined use of herbal and allopathic medicines. <strong>Conclusion:</strong> The study recommends the further research into the toxicity of herbal products, to ensure that accurate information can be provided to women before use.</span>展开更多
<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</stron...<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> Complications linked to postpartum & pregnancy are one of the major causes of female death. In order to understand the causes of complications and encourage women to take sufficient action in order to receive emergency treatment, a critical step should therefore be taken to minimize complications related to pregnancy, in order to ensure the safety of both women and newborns.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim of the work</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Evaluate the effectiveness of the education programs for pregnant women on obstetric danger signs in rural areas and help minimize the incidence of pregnancy loss and comorbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: A quasi-experimental design on 70 women from a population of through 372 women in six-month in antenatal clinics recruited from the previously mentioned settings with pre- and post-test was conducted at antenatal clinics (M.C.H centers) affiliated to the available geographical health zones in EL-fayoum rural area including: Al-sheikh hassan at sanorse. We collected the data of women characteristics by a self-administered interview questionnaire & a structured reported knowledge and practices checklist to evaluate pregnant women practices and knowledge. Follow up was done to the studied groups & histopathology assessments of the product of conception in cases of abortion secondary to the complications to compare between effect of antenatal care program on the woman who followed the program and those who did not.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: There is an improvement in 63% of pregnant women knowledge and practices after educational program in all aspects.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The most common danger signs that may occur during pregnancy were miscarriage and vaginal bleeding, intrauterine fetal death as reported by women</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">& confirmed by the histopathology reports. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The educational program had an efficient improving women knowledge and practice regarding danger signs for pregnant women in rural areas, with highly statically significant differences in all the tested items between pre/post program implementation (P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">0.001). </span><b><span style="font-family:Verdana;">Recommendations</span></b><span style="font-family:Verdana;">: Establishment of in-service training programs and continuous supervision in rural areas to a raise women knowledge and practice regarding educational pregnant women and developing antenatal classes for all pregnant women about obstetric danger signs.</span></span></span></span>展开更多
<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</str...<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> All pregnant women are at risk of obstetric complications </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Patient and Method</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: we conducted a prospective analytical survey for four months, from April 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> to July 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric com</span><span style="font-family:Verdana;">plications. Preruptive syndrome was the most common complication with</span><span style="font-family:Verdana;"> 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The mater</span><span style="font-family:Verdana;">nal mortality rate was 3%. Fetal complications were observed in 28.3% of cas</span><span style="font-family:Verdana;">es and the neonatal mortality rate was 24.6%.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: The maternal </span><span style="font-family:Verdana;">and fetal complications of evacuated parturients are a real public health</span><span style="font-family:Verdana;"> problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize </span><span style="font-family:Verdana;">obstetric emergencies will contribute to improve the maternal and fetal</span><span style="font-family:Verdana;"> prognosis of evacuated parturients.</span></span></span></span>展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Teenage pregnancy const...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Teenage pregnancy constitutes a high-risk pregnancy due to possible physical, psychological, socio-economic and increased obstetric risks associated with it. These risks though equally present in the older pregnant women </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">are</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> probably less when compared with teenagers. Thus perinatal outcome of pregnancies in these groups of patients varies.</span><b><span style="font-family:Verdana;"> Objective: </span></b><span style="font-family:Verdana;">To compare the socio-demographic characteristics, pattern of pregnancy complications and perinatal outcome of pregnancy among primigravid teenagers and older primigravid women.</span><b><span style="font-family:Verdana;"> Method: </span></b><span style="font-family:Verdana;">A comparative study was carried out among 58 primigravid teenagers and equal numbers of adult primigravidae at Federal Teaching Hospital, Ido Ekiti, Nigeria over five year period between January 2008 and December, 2012. Their socio-demographic characteristics, booking status, pregnancy complications, estimated gestational age at delivery, mode of delivery, post-partum morbidities, neonatal birth weight and perinatal mortalities were obtained from their case notes. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Deliveries by teenagers accounted for 2.48% of all deliveries during the period under review. Teenage age was significantly associated with unmarried status (P < 0.001). Two-third (67.2%) of the teenagers were unbooked for antenatal care whereas less than one-quarter of the adult were unbooked. Pregnancy related complications such as, hypertensive disorders of pregnancy, cephalopelvic disproportion/obstructed labour and anaemia were more among the teenagers compared with the older women. There were also more preterm deliveries among the teenagers compared with the older women (17.2% VS 5.2%). Perinatal mortality rate was 155/1000 birth among the teenagers. The incidence of Low birth weight and perinatal mortality were significantly higher among the teenage mothers (P < 0.05). However, there was no statistical difference in the occurrence of morbidity and maternal mortality</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">in both groups (P > 0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Pregnancy and deliveries in teenagers are high risk. Therefore, sex education as well as access to reproductive health information and care will help reduce the occurrence of unwanted pregnancies and their lasting impact on teenagers, their families, and the society.</span></span></span></span>展开更多
<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</stron...<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> Maternal obesity and its associated health complications increase;however, area-specific data is lacking in Ghana. We attempted to assess the prevalence and adverse effects of maternal obesity in Ghana.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Study population were women booking to, and gave birth to infants in Cape Coast Metropolitan Hospital, Ghana, during February 2018 to January 2019 (n = 510). Body mass index (BMI) during the first trimester w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> identified and analyzed in relation with outcomes/complications.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Incidence of maternal obesity (overweight/obese, BMI ≥</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">25) was 37.3%. Of them, 34.4% had maternal complications such as postpartum haemorrhage, foetal distress, and cephalo-pelvic disproportion (in this order). The caesarian rate was 20.5%. Among the non obese women only 20% had maternal complications and the caesarian section rate was 16.2%. Obesity was positively correlated with maternal age and parity but was not with low socio-economic status. Obese women were more likely to have obstetric complications.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusions</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Obese women were more likely to suffer obstetric complications and to have cesarean. Although present data was a confirmation of the existing data in other part</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of the world, we believe that these data may be useful in making area-specific health policy.</span></span></span>展开更多
文摘Background: “Low-risk” pregnancy is defined as a pregnancy that develops physiologically in a healthy woman and remains healthy. In practice, “low-risk” pregnancies are defined by excluding high-risk pregnancies. Objectives: Evaluate the rate of complications and medical interventions in “low-risk” pregnant women. Methods: This was a retrospective cohort study assessing the risk of obstetrical complications and medical interventions in low-risk patients from January 2010 to December 2020 at Philippe Maguilen Senghor Health Center in Dakar, Senegal. Results: There were 10,979 low-risk patients out of a total of 52,768, accounting for 20.8%. As medical interventions, episiotomy was performed in 27.5% and cesarean section in 8.7%. Acute fetal distress was observed in 4.1%. A low Apgar score at the fifth minute was observed in 1.89% (whereas it was 3.49% in high risk patients). Newborn-resuscitation was performed in 10.7%. Neonatal mortality was 5‰. Conclusion: Low-risk pregnancies are not without “risk”, and thus care-givers should prepare for risks even at dealing with low risk patients.
文摘Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in a region plagued by insecurity linked to armed groups. Method: This was an analytical cross-sectional study with prospective data collection over a 4-month period, from June 10 to October 10, 2020. Patients from precarious security areas were compared to those from safer areas. The Chi squared and Fisher tests were used for comparison of variables. Results: Obstetric emergencies accounted for 38.62% of admissions, from which 25.59% came from precarious security zones. Age was similar in both comparison groups. However, patients from unsafe areas were more likely to reside in rural areas (p 0.001) and more likely to be in unpaid occupations (p 0.001). Prenatal visits were less frequent (p 0.01) and women were more often multigravidae (p 0.01) in the precarious security group of patients. Apart from the more frequent uterine rupture (p = 0.02) in the group from precarious security zones, diagnosed complications and maternal mortality were similar in the 2 groups, while perinatal mortality was higher in the group of patients from precarious security zones (p 0.01). Conclusion: The precarious security situation has negative consequences on maternal and perinatal morbidity and mortality. Further studies are needed for better understanding of these consequences, and improvement of health system resilience strategies, to reduce related maternal and fetal morbidity and mortality.
文摘Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control study was carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a single scarred uterus who presented with complications during delivery (cases) were compared to eighty nine others who had a successfully trial of scar (control) during the study period. Data were analyzed using the CSPro version 6.0 and SPSS version 20.0 softwares with statistical significance set at P Results: We recruited 2 groups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The majority of women with complications were married (50.6%) and unemployed (42.8%). Following univariate analysis, predictive factors of complications were: prematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on scarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months (five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic disproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal consultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted by a nurse (OR = 2.4;IC = [1.2 - 4.7]), referral from a different health unit (OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6 - 27.4), a meconium stained amniotic fluid (OR = 9.9;CI = [3.6 - 26.8]). After logistic regression, the retained factors associated with complications were post-term (aOR = 34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean section indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score less than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion: Predictive factors of complications can help anticipate negative obstetric outcomes.
文摘An increasing number of childbearing agewomen undergo liver transplantation(LT)in the United States.Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility,particularly in terms of immunosuppression and optimal timing of conception.Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus.On the other hand,the outcomes of pregnancy in LT recipients are favorable,and children born to LT recipients are relatively healthy.Counseling on pregnancy should start before LT and continue after LT up until pregnancy,while all pregnant LT recipients must be managed by amultidisciplinary team,including both an obstetrician and a transplant hepatologist.Additionally,an interval of at least 1-2 years after successful LT is recommended before considering pregnancy.Pregnancy-induced hypertension,pre-eclampsia,and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients.As adverse fetal outcomes,such asmiscarriage,abortion,stillbirth,or ectopic pregnancy,may occur more often than in the non-transplant population,early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications.No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.
文摘Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.
文摘<span style="font-family:Verdana;"><strong>Background:</strong> Herbal medicines use has prevailed over the past decades in both low-middle-income and high-income countries over the years. The use among women has increased with increased risks of ill-health. There is extensive literature on herbal medicine use among women in pre/pregnancy, labour, and the postpartum periods. Therefore, this study aimed to understand women’s purposes, experiences, and motivation for using herbal medicines during pregnancy, childbirth and postpartum, and the experiences associated with the use. <strong>Methods:</strong> Four critical databases were predetermined and searched: CINAHL, Medline, Web of Science, and EMBASE. These databases were chosen for their comprehensiveness and relevance to the review aims. We considered peer-reviewed published articles from January 2000 to December 2018. We chose these databases because we found that they are dominant in the medical and healthcare-related literature. All references were pooled to Endnote reference management software for screening. Quality appraisal of articles was conducted using the Mixed-Method Assessment Tool (MMAT). Content analysis approach was used to extra the data from the articles. Globally, twenty-one articles met the inclusion criteria, and thus, formed the dataset for this review.<strong> Results:</strong> Most articles (n = 10, 47.6%) reported solely HM uses on only pregnancy whiles the rest evaluated HM uses in labour, pre-pregnancy, and the postpartum periods. The results have shown that the majority of women received information about HM from friends, family, the “black markets,” and drug outlets. Overall, the results were presented in seven broad themes: 1) sociodemographic characteristics of HM users, 2) perceived threat of health problem, 3) sources and quality of the information received, 4) susceptibility to health complications, 5) potential limitations to the use of HM, 6) the motivation for HM utilization, 7) concerns on the combined use of herbal and allopathic medicines. <strong>Conclusion:</strong> The study recommends the further research into the toxicity of herbal products, to ensure that accurate information can be provided to women before use.</span>
文摘<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> Complications linked to postpartum & pregnancy are one of the major causes of female death. In order to understand the causes of complications and encourage women to take sufficient action in order to receive emergency treatment, a critical step should therefore be taken to minimize complications related to pregnancy, in order to ensure the safety of both women and newborns.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim of the work</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">:</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Evaluate the effectiveness of the education programs for pregnant women on obstetric danger signs in rural areas and help minimize the incidence of pregnancy loss and comorbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: A quasi-experimental design on 70 women from a population of through 372 women in six-month in antenatal clinics recruited from the previously mentioned settings with pre- and post-test was conducted at antenatal clinics (M.C.H centers) affiliated to the available geographical health zones in EL-fayoum rural area including: Al-sheikh hassan at sanorse. We collected the data of women characteristics by a self-administered interview questionnaire & a structured reported knowledge and practices checklist to evaluate pregnant women practices and knowledge. Follow up was done to the studied groups & histopathology assessments of the product of conception in cases of abortion secondary to the complications to compare between effect of antenatal care program on the woman who followed the program and those who did not.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: There is an improvement in 63% of pregnant women knowledge and practices after educational program in all aspects.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The most common danger signs that may occur during pregnancy were miscarriage and vaginal bleeding, intrauterine fetal death as reported by women</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">& confirmed by the histopathology reports. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The educational program had an efficient improving women knowledge and practice regarding danger signs for pregnant women in rural areas, with highly statically significant differences in all the tested items between pre/post program implementation (P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">0.001). </span><b><span style="font-family:Verdana;">Recommendations</span></b><span style="font-family:Verdana;">: Establishment of in-service training programs and continuous supervision in rural areas to a raise women knowledge and practice regarding educational pregnant women and developing antenatal classes for all pregnant women about obstetric danger signs.</span></span></span></span>
文摘<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> All pregnant women are at risk of obstetric complications </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Patient and Method</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: we conducted a prospective analytical survey for four months, from April 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> to July 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric com</span><span style="font-family:Verdana;">plications. Preruptive syndrome was the most common complication with</span><span style="font-family:Verdana;"> 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The mater</span><span style="font-family:Verdana;">nal mortality rate was 3%. Fetal complications were observed in 28.3% of cas</span><span style="font-family:Verdana;">es and the neonatal mortality rate was 24.6%.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: The maternal </span><span style="font-family:Verdana;">and fetal complications of evacuated parturients are a real public health</span><span style="font-family:Verdana;"> problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize </span><span style="font-family:Verdana;">obstetric emergencies will contribute to improve the maternal and fetal</span><span style="font-family:Verdana;"> prognosis of evacuated parturients.</span></span></span></span>
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Teenage pregnancy constitutes a high-risk pregnancy due to possible physical, psychological, socio-economic and increased obstetric risks associated with it. These risks though equally present in the older pregnant women </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">are</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> probably less when compared with teenagers. Thus perinatal outcome of pregnancies in these groups of patients varies.</span><b><span style="font-family:Verdana;"> Objective: </span></b><span style="font-family:Verdana;">To compare the socio-demographic characteristics, pattern of pregnancy complications and perinatal outcome of pregnancy among primigravid teenagers and older primigravid women.</span><b><span style="font-family:Verdana;"> Method: </span></b><span style="font-family:Verdana;">A comparative study was carried out among 58 primigravid teenagers and equal numbers of adult primigravidae at Federal Teaching Hospital, Ido Ekiti, Nigeria over five year period between January 2008 and December, 2012. Their socio-demographic characteristics, booking status, pregnancy complications, estimated gestational age at delivery, mode of delivery, post-partum morbidities, neonatal birth weight and perinatal mortalities were obtained from their case notes. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Deliveries by teenagers accounted for 2.48% of all deliveries during the period under review. Teenage age was significantly associated with unmarried status (P < 0.001). Two-third (67.2%) of the teenagers were unbooked for antenatal care whereas less than one-quarter of the adult were unbooked. Pregnancy related complications such as, hypertensive disorders of pregnancy, cephalopelvic disproportion/obstructed labour and anaemia were more among the teenagers compared with the older women. There were also more preterm deliveries among the teenagers compared with the older women (17.2% VS 5.2%). Perinatal mortality rate was 155/1000 birth among the teenagers. The incidence of Low birth weight and perinatal mortality were significantly higher among the teenage mothers (P < 0.05). However, there was no statistical difference in the occurrence of morbidity and maternal mortality</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">in both groups (P > 0.05). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Pregnancy and deliveries in teenagers are high risk. Therefore, sex education as well as access to reproductive health information and care will help reduce the occurrence of unwanted pregnancies and their lasting impact on teenagers, their families, and the society.</span></span></span></span>
文摘<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong> Maternal obesity and its associated health complications increase;however, area-specific data is lacking in Ghana. We attempted to assess the prevalence and adverse effects of maternal obesity in Ghana.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Study population were women booking to, and gave birth to infants in Cape Coast Metropolitan Hospital, Ghana, during February 2018 to January 2019 (n = 510). Body mass index (BMI) during the first trimester w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> identified and analyzed in relation with outcomes/complications.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Incidence of maternal obesity (overweight/obese, BMI ≥</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">25) was 37.3%. Of them, 34.4% had maternal complications such as postpartum haemorrhage, foetal distress, and cephalo-pelvic disproportion (in this order). The caesarian rate was 20.5%. Among the non obese women only 20% had maternal complications and the caesarian section rate was 16.2%. Obesity was positively correlated with maternal age and parity but was not with low socio-economic status. Obese women were more likely to have obstetric complications.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusions</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Obese women were more likely to suffer obstetric complications and to have cesarean. Although present data was a confirmation of the existing data in other part</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of the world, we believe that these data may be useful in making area-specific health policy.</span></span></span>
