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Journal articles on the topic 'Health economics; Perinatal care'
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1
Pancholi, Nidhi. "Study of cases with perinatal mortality." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 5 (April 29, 2019): 1719. http://dx.doi.org/10.18203/2320-1770.ijrcog20191515.
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Background: Perinatal loss is one of the most traumatic life events. It is indeed a great psychological and emotional shock to not only the mother and father but the entire family and society as a whole. The perinatal mortality rate (PMR) is an important indicator of the quality of obstetric care during pregnancy. Perinatal deaths result largely from obstetric complications that can be prevented with proper antenatal care and quality neonatal services. The study was aims to study the factors related with perinatal loss and its prevention in future pregnancy.Methods: It was a prospective analytical study. All patients with IUFD, stillbirths and early neonatal loss were studied. Postpartum both mother and father were counselled. Detailed history and thorough physical examination were conducted. Data was recorded and tabulated, observation made and compared with results of various studies.Results: The results showed that the incidence of IUFD was 3.7% and early neonatal death was 10.8% per total admissions. The perinatal mortality rate was 63.62 per 1000 live births. Perinatal mortality rate was inversely related to the number of antenatal visits taken by the patient. Lack of antenatal care results in perinatal deaths probably due to failure of early identification and management of maternal problems that impact negatively on perinatal outcome. Even in advanced economies with sophisticated diagnostic and monitoring equipment, lack of antenatal care categorizes a pregnant woman as a high-risk pregnancy.Conclusions: There is a need for awareness regarding importance of antenatal care and institutional delivery. Perinatal mortality is an important indicator of maternal care, health and nutrition. It also reflects the quality of Obstetric and Pediatric care available. Every effort must be made to reduce perinatal mortality.
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Rai, Chanda, Latha V. Kharka, Sudip Dutta, and Nishant Kumar. "A retrospective analysis of the risk factors leading to perinatal mortality at a tertiary care hospital of Sikkim, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 6 (May 26, 2018): 2295. http://dx.doi.org/10.18203/2320-1770.ijrcog20182338.
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Background: This study helps to assess the burden of perinatal mortality at a tertiary referral hospital in Sikkim known for its hilly terrain which makes health services difficult to access. The aims and objectives were to determine the various causes and risk factors leading to perinatal mortality in order to formulate preventive strategiesMethods: All perinatal deaths over a year between August 2016-2017 were included and analysed in our study.Results: A stillbirth rate of 14 per 1000 total births and early neonatal death rate of 8 per 1000 live births was found in 1855 total births. Complications related to pregnancy like pre-eclampsia (16%), eclampsia (8%), ante-partum haemorrhage (15%) and medical disorders (13%) were major contributors to stillbirths while pre-maturity (53.3%), sepsis (20%), birth asphyxia due to meconium aspiration (13.3%) were notable factors leading to early neonatal deaths. In majority of the cases, factors like poor literacy, low socio-economic status, increased basal metabolic index and inadequate ante-natal care caused increased perinatal losses.Conclusions: Perinatal grief continues to surround women who have suffered perinatal deaths and serious efforts should be made to bring down the mortality rates by improving health , nutrition of all expecting mothers and increase their awareness to seek ante-natal health services in order to avoid any catastrophe in terms of maternal and fetal loss.
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Raine, Karen Hazell, Philip Boyce, and Karen Thorpe. "Antenatal interpersonal sensitivity as an early predictor of vulnerable mother–infant relationship quality." Clinical Child Psychology and Psychiatry 24, no. 4 (June 23, 2019): 860–75. http://dx.doi.org/10.1177/1359104519857217.
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Maternal mental health problems in the perinatal period incur significant human and economic costs attributable to adverse child outcomes. In response, governments invest in screening for perinatal depressive symptoms. Mother–infant relationship quality (MIRQ) is a key mechanism linking maternal perinatal mental health to child outcomes. Perinatal depressive symptoms are typically transient while personality style, including interpersonal sensitivity, is a more stable construct. We have demonstrated that antenatal interpersonal sensitivity independently predicted MIRQ at 12 months postpartum. Building on our previous work, the objective of this study was to examine the associations of antenatal interpersonal sensitivity and depressive symptoms with MIRQ 1 year postnatal. A sample of 73 women attending routine antenatal care, 61 (84%) from ethnically diverse populations, were studied across the perinatal period. At ⩽26 weeks, gestation interpersonal sensitivity and depressive symptoms were measured. At 12 months, postnatal mental health and MIRQ was assessed in 35 of the mother–infant dyads. We found no significant statistical association between antenatal interpersonal sensitivity and depressive symptoms with postnatal MIRQ. Interpersonal sensitivity ( r = –.24) showed weak association with MIRQ. Depressive symptom scores were not associated ( r =–.01). Maternal sensitivity assessment (MIRQ) using the CARE-Index identified low mean scores signifying low levels of maternal sensitivity (potential range 0–14; mean score = 6.3). We cautiously suggest that the findings raise questions about the presentation and assessment of perinatal mental health status among ethnically diverse populations and scoping of parenting support needs within this population.
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D’haenens, Florence, Bart Van Rompaey, Eva Swinnen, Tinne Dilles, and Katrien Beeckman. "The effects of continuity of care on the health of mother and child in the postnatal period: a systematic review." European Journal of Public Health 30, no. 4 (May 23, 2019): 749–60. http://dx.doi.org/10.1093/eurpub/ckz082.
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Abstract Background Continuity of care (COC) is essential for high-quality patient care in the perinatal period. Insights in the effects of COC models on patient outcomes are important to direct perinatal healthcare organization. To our knowledge, no previous review has listed the effects of COC on the physical and mental health of mother and child in the postnatal period. Methods A search was conducted in four databases (PubMed, Web of Knowledge, CENTRAL and CINAHL), from 2000 to 2018. Studies were included if: participants were healthy mothers or newborns with a gestational age between 37–42 weeks; they covered the perinatal period and aimed to measure breastfeeding or any outcome related to the maternal/newborn physical or mental health. At least one of the three COC types (management, informational and relationship) was identified in the intervention. The methodological quality was assessed. Results Ten articles were included. COC is mostly present in the identified care models. The effects of COC on the outcomes of mother and child in the postnatal period seem mostly to be positive, although not always significant. The relation between COC and the outcomes can be influenced by confounding factors, like the socio-economic status of the included population. Interventions with COC during pregnancy appear to be more effective for all the studied outcome factors. Conclusion COC as management, relational and informational continuity starting antenatal has the most impact on the postnatal outcomes of mother and child.
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Ogunfowora, O. B., and T. A. Ogunlesi. "Socio-clinical correlates of the perinatal outcome of severe perinatal asphyxia among referred newborn babies in Sagamu." Nigerian Journal of Paediatrics 47, no. 2 (August 6, 2020): 110–18. http://dx.doi.org/10.4314/njp.v47i2.10.
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Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred.Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia.Methods: A prospective crosssectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed.Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries tookplace at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). Hypoxic- Ischaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum careseeking behaviour and the commencement of feeding before admission .Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia.
Keywords: Asphyxia, Hypoxic-Ischaemic Encephalopathy, Intrapartum care, Perinatal mortality, Out-born
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Lewis, Celine, Melissa Hill, Owen J. Arthurs, John C. Hutchinson, Lyn S. Chitty, and Neil Sebire. "Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study." Archives of Disease in Childhood 103, no. 6 (February 8, 2018): 572–78. http://dx.doi.org/10.1136/archdischild-2017-314424.
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ObjectiveTo assess health professionals’ and coroners’ attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting.MethodsA qualitative study using semistructured interviews. Data were analysed thematically.ResultsTwenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers.ConclusionHealth professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.
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Rasskazova, V. N., Pavel F. Kiku, T. Yu Kurleeva, G. N. Bondar, O. A. Izmaylova, and A. V. Sukhova. "THE ANALYSIS OF THE EFFECTIVENESS OF THE PERINATAL CENTER IN PROVIDING QUALITY MEDICAL CARE." Health Care of the Russian Federation 62, no. 6 (May 24, 2019): 304–9. http://dx.doi.org/10.18821/0044-197x-2018-62-6-304-309.
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Introduction. Among the problems of health care during the reform period, the problem of quality management of medical care and effective management of the medical organization is particularly highlighted. The purpose of the study is to determine the main priorities of effective management of the medical organization of obstetric and gynecological profile to ensure the proper quality of medical care to the population. Materials and methods. We carried out quantitative and qualitative evaluation of the perinatal center in the period 2015-2017. Studied the efficiency of the administration of the human resources capacity of health organizations quality indicators of the hospital bed Fund and the financial-economic activity of enterprises. Results. The effective activity of the institution in the conditions of the established perinatal center is Shown due to the chosen strategy and tactics of the phased development of new obstetric, neonatal, inpatient-replacement technologies, the provision of highly specialized care with the use of modern equipment and medicines, which allowed to expand the range and volume of Advisory and diagnostic and treatment services, to reduce the level of perinatal and maternal losses. Discussion. The strengths of the organizational activities of the perinatal center management include: the inclusion of women’s consultation in the structure of the perinatal center, ensuring the continuity of care for gynecological and pregnant patients; state social support for motherhood and childhood, changing the conditions and procedure for the provision of free medical care to the population; functioning on the basis of the perinatal center of the Department of pathology of newborns, Department of resuscitation and intensive care of newborns, consultative and diagnostic and gynecological departments. The weak side of the organization can be attributed to the shortage of highly qualified personnel (doctors, nurses and Junior medical staff). Conclusion. In order to effectively use the resources of the institution, it is important to change the approach to the provision of material resources and their rational use in the process of the institution’s activities. The chosen strategy and tactics of management decision-making makes it possible to improve the quality and availability of medical care for pregnant women, mothers, maternity and newborn children.
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Miller, C. Arden. "Maternal and Infant Care: Comparisons between Western Europe and the United States." International Journal of Health Services 23, no. 4 (October 1993): 655–64. http://dx.doi.org/10.2190/rr4g-ntb1-l229-fvhg.
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A series of studies between 1986 and 1990 gathered data on maternal and infant care in ten Western European countries with lower infant mortality rates than the United States and compared the findings both within the European countries and in aggregate with the United States. Results from these studies reveal great variation among the study countries in how perinatal care is financed, staffed by professional and nonprofessional health workers, and provided by public clinics or private offices, and in the number of and locale of the recommended number of prenatal visits. Invariably consistent among the study countries is the nearly complete enrollment of childbearing women in early and continuous prenatal care, and the strong linkage of that care to a generous spectrum of social supports and financial benefits. None of the benefits generally pertains in the United States. The relevance of these observations for the United States suggests that current policies intended to lower economic barriers to a highly medicalized version of maternity care may yield disappointing results unless the perinatal sequence is linked to a more generous set of maternity-related social supports and financial benefits than is now contemplated.
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Wagner, Marsden G. "Health Services for Pregnancy in Europe." International Journal of Technology Assessment in Health Care 1, no. 4 (October 1985): 789–97. http://dx.doi.org/10.1017/s026646230000177x.
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In 1979, maternal and child health issues were discussed during the annual meeting of the 33 Member States of the European Region of the World Health Organization. During this discussion many countries expressed concern about the services offered for pregnancy, birth and the period following birth. The countries recognized that, as yet, unsolved problems remain which must be examined and they asked the European Regional Office of WHO to mount activities to study and report on these problems surrounding birth and birth care. In response to this request, the maternal and child health unit of the European Regional Office organized a Perinatal Study Group. The Group's 15 members came from 10 countries and spanned 10 professional disciplines: economics, epidemiology, health administration, midwifery, nursing, obstetrics, pediatrics, psychology, sociology, and statistics. For five years the Group conducted surveys, reviewed the literature and brought its own personal and professional experience to discussions of the health services for women and their babies, during pregnancy and birth, and after birth. The entire group met together at least once a year, at which time findings from the previous year's work were presented, followed by lengthy, sometimes heated, open and free discussions.
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Capik, Lynne Koehler. "Advocating Reimbursement for Family-Centered Childbirth Education in the 21st Century." Journal of Perinatal Education 7, no. 4 (October 1998): 1–8. http://dx.doi.org/10.1891/1058-1243.7.4.1.
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There are several positive socio-economic trends with implications for health care reimbursement of childbirth education. Despite the documented benefits and improved outcomes associated with receiving childbirth education, this service has not been regarded by most insurance plans as a reimbursable service for the childbearing family. Perinatal educators must become politically active in analyzing policy and issues of resource allocation. Perinatal educators must support policy and legislative efforts that guarantee access to and reimbursement for childbirth education.
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Jahja, Riawati. "Perinatal mortality in Indonesia: an unfinished agenda." Health, Culture and Society 1, no. 1 (October 11, 2011): 146–65. http://dx.doi.org/10.5195/hcs.2011.52.
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Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs) which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal. Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach) worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.
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Agrawal, Manish, and Kriti Bhatnagar. "Maternal determinants affecting perinatal mortality: a multivariate statistical approach." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 3 (February 19, 2017): 1052. http://dx.doi.org/10.18203/2320-1770.ijrcog20170583.
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Background: India has made considerable progress over the last two decades in the area of maternal and child health, through innovative and comprehensive health packages that covers the spectrum of Reproductive Child Health (RCH). Awareness of the special vulnerability of the cohort of mothers with ‘high risk factor’ has led to the popular recognition of ‘risk approach’, involving the optimal use of existing MCH services, providing essential obstetrical care for all with early detection of complications and emergency services for those who need it, thus reducing the need for intensive care along with reduction in perinantal mortality. The objective was to assess the prevalence of various maternal risk factors in pregnant women in hospital admissions and their correlation with perinatal mortality.Methods: The present study was carried out on 2050 consecutive deliveries from 1st April 2015 to 31st March 2016 at Department of Obstetrics and Gynecology and Department of Pediatrics, Muzaffarnagar Medical College, Muzaffarnagar Uttar Pradesh, India. All the pregnant women were interviewed and examined in detail at the onset of labor regarding various biosocio-economic characteristics, history of past and present medical and obstetrical complications.Results: The PNMR (93.66/1000 birth) observed in present study was still at a higher level and comparable to that in other studies done by various authors in past in this region. A significantly higher PNMR was observed with increase in maternal age and parity (3 times higher PNMR at >35 years and 2 ½ times higher PNMR at parity >5). Similarly, medical illnesses (3 times higher PNMR) and obstetrical complications (1.5 times higher PNMR) during present pregnancy were showing significant effect on perinatal outcome. In a multivariate analysis, residence (rural /urban), place and number of antenatal visits, gestational age and type of delivery remained as most significant maternal risk factors (p<0.005) after multiple logistic regression of other factors viz. maternal age, height, weight, parity, education, socio-economic status and antepartum anemia.Conclusions: It is heartening to observe that highest risk is associated with simple and easily identifiable factors like, unbooked cases, <3 antenatal visits, severe anemia, age >35 years, parity >5, weight <40 kg, height < 140cm , poor dietary calories, medical and obstetrical complications. These can identified from history only by grass root workers like traditional birth attendants and even elderly female family members. These risk determinants, labeled as simple but ‘high’ high risk are associated with poor perinatal outcome. If these factors are timely identified at community level and appropriately referred by grass root workers, it will significantly reduce perinatal mortality and improve neonatal survival.
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Chambers, Georgina M., Sean Randall, Cathrine Mihalopoulos, Nicole Reilly, Elizabeth A. Sullivan, Nicole Highet, Vera A. Morgan, Maxine L. Croft, Mary Lou Chatterton, and Marie-Paule Austin. "Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia." Australian Health Review 42, no. 5 (2018): 514. http://dx.doi.org/10.1071/ah17118.
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Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
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Antypkin, Y., T. Znamenska, R. Marushko, E. Dudina, V. Lapshin, and A. Vlasov. "STATUS OF MEDICAL CARE FOR NEWBORNS IN UKRAINE." Neonatology, surgery and perinatal medicine 10, no. 4(38) (December 31, 2020): 5–24. http://dx.doi.org/10.24061/2413-4260.x.4.38.2020.1.
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Introduction. In the context of continuing depopulation, and low birth rate, the formation and preservation of newborn generations’ health is the most important medical and social task and one of the main activities of the Ministry of Health of Ukraine and local health care institutions.
The aim of the study was to analyze and evaluate the effectiveness of medical care for newborns in Ukraine and its impact on the main indicators of newborns’ health.
Materials and research methods. A retrospective analysis and assessment of the dynamics of neonatal care in Ukraine was carried out according to state and industry statistics, perinatal audit according to the method of WHO “MATRIX - BABIES” for the period 2001-2019, monitoring and evaluation of the regionalization of perinatal care (for 2014-2017). Methods of a systematic approach, bibliographic, statistical data processing, and graphic representation were applied.
Results of the study: the study showed that during the period of the research a number of newborns born in the facilities of the Ministry of Health of Ukraine decreased from 387900 in 2000 to 294100 in 2019, with a negative trend in the generalized objective criterion of the generation’s health and socio-economic well-being of the population - frequency of premature newborns with low birth weight including those with extremely low birth weight. At the same time, the frequency of newborns with congenital diseases or those who got sick after birth, decreased from 280.8 per 1000 live births in 2000 to 172.14 in 2019 with the wave-like nature of its dynamics.
The existing state system of three-level neonatal care integrated into the perinatal service makes it possible to provide basic, qualified and highly qualified specialized medical care for newborns at all stages of its provision. During the observation period, the provision of newborns with pediatrician-neonatologists increased from 4.58 per 1000 live births to 5.34, and with hospital beds for premature and sick newborns - from 5.62 to 6.91, respectively.
A slight increasing trend of significant criterion of newborns’ health condition was achieved (99.36% in 2001 vs 99.7% in 2019) along with the activities of the neonatological service in survival of newborns in the first 168 hours of life mainly due to a 2.6-fold increase in the survival of newborns with a birth weight of 500-999g. Sufficient efficiency of medical care for newborns was confirmed by a positive trend in early neonatal mortality from 4.71 ‰ in 2000 to 3.04 ‰ in 2019 and neonatal mortality from 6.65 ‰ to 4.57 ‰, respectively.
At the same time, the increase of newborns’ incidence with diseases that have a direct impact on the development of chronic and disabling diseases is a cause for concern: cases of congenital pneumonia increased from 3.18 ‰ in 2000 to 5.46 ‰ in 2019, of neonatal sepsis - from 0.09 ‰ to 0.74 ‰, respectively. Also other disorders of newborns’ cerebral status increased from 18.5 ‰ in 2010 to 28.5 ‰, and neonatal jaundice - from 31.11 ‰ in 2015 to 43.65 ‰.
An excess in 1.5 times of the standard recommended by the WHO of the proportional indicator of early neonatal mortality was revealed among infants weighing more than 1500 g. The excess of the real indicator of early neonatal mortality over the actual one was 2.2-2.3 times, which meant underestimation of the total rate of neonatal and infant mortality.
Conclusions. Further improvement of the effectiveness of neonatal care and the decrease of early neonatal and neonatal mortality levels requires continued regionalization of perinatal care, completion of the perinatal care centers of the third level, revision and provision of patient routes, development and provision of state-guaranteed medical services/standards (such as a standard of child’s safety, safety of pregnant and postpartum woman), the reliability of determining body weight at birth, criteria for live birth and stillbirth, the introduction of follow-up monitoring of low-birth-weight newborns, the formation of a unified system for monitoring the activities of the maternal and child health services.
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Shawky, S. "Infant mortality in Arab countries: sociodemographic, perinatal and economic factors." Eastern Mediterranean Health Journal 7, no. 06 (December 15, 2001): 956–65. http://dx.doi.org/10.26719/2001.7.6.956.
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The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking-water and adequate sanitation facilities.
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Devi, Gayathrie, Kayalvizhi ., and Poovathi M. "Study of fetomaternal outcome of teenage pregnancy in a tertiary care hospital-MGMGH." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 1 (December 26, 2018): 303. http://dx.doi.org/10.18203/2320-1770.ijrcog20185444.
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Background: The objective is to study the fetomaternal outcome in teenage pregnancy at MGMGH for the study period of 6 months from April 2018 to September 2018. Teenage pregnancy is a worldwide health problem. WHO defined adolescence as the period from 10-19 years. It is a serious health problem in a developing country like India. Teenage pregnancy is associated with high risk of prematurity, low birthweight, preeclampsia and anaemia. The NHFS IV 2015 -2016 estimates that overall teenage pregnancy in India 7.9%.Methods: It is a retrospective study conducted in a tertiary care hospital at MGMGH, Trichy over a period of 6 months.251 teenage pregnant women delivered at our institution were selected for the study out of 4508 total deliveries during the study period. Parameters including incidence, age, parity, booking status, educational and socioeconomic status, medical disorders, antepartum, intrapartum, postpartum complications, mode of delivery and neonatal outcome were studied.Results: Study showed the incidence of teenage pregnancy at our MGMGH is 5.56%. Among these teenage pregnant women 47.1% had anaemia, 23.1% had gestational hypertension,4.8% of women had eclampsia, 22.3% % had preterm delivery. Lscs rate was 27.1%,70.29 % had Normal vaginal delivery,1.6% had instrumental deliveries, 31.5% had low birth weight babies,28.2 % NICU admissions, 2.9% perinatal deaths.Conclusions: Teenage pregnancy is associated with increased incidence of anaemia, pre-eclampsia, eclampsia, preterm delivery, instrumental delivery, low birth weight and perinatal death. By improving socio economic status, education, nutrition, good antenatal care, public awareness, institutional delivery and postnatal care help in reducing maternal and perinatal morbidity and mortality in adolescent pregnancy.
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Longombe, Ahuka Ona, K. M. Lusi, and P. Nickson. "Obstetric Uterine Ruptures in a Rural Area in Zaïre." Tropical Doctor 24, no. 2 (April 1994): 90–93. http://dx.doi.org/10.1177/004947559402400226.
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Uterine ruptures with their deplorable sequelae constitute a major obstetrical problem in the rural areas of Africa. The maternal and perinatal mortality remain high as a result, mainly due to the lack of early and adequate care for these patients. Grandemultiparity is one of the major predisposing factors. Prevention must necessarily include the availability of family planning advice, improved organization of and access to maternal care, and good supervision during delivery and the post-partum period. The general improvement of the overall socio-economic condition is a pre-condition to the improvement of access to care.
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Schwank, Simone Eliane, Qiongjie Zhou, Yanling He, and Ganesh Acharya. "Perinatal mental health around the world: priorities for research and service development in China." BJPsych International 17, no. 3 (February 18, 2020): 50–53. http://dx.doi.org/10.1192/bji.2020.5.
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China's healthcare is improving together with rapid economic growth. Yet, mental healthcare is lagging behind. Prevalence of perinatal depression is high among women of the one-child generation, but access to qualified care is limited. Chinese healthcare professionals, policy makers and patients alike express concerns about insufficient knowledge among the public as well as healthcare providers regarding mental disorders. There appears to be a general lack of help-seeking behaviour for mental disorders owing to perceived risk of social stigmatisation. Social support through family and friends, use of online resources and community healthcare services are preferred, rather than seeking help from mental health specialists.
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Sutter-Dallay, A. L. "Maternal Mental Illness and Early Parenting Interventions." European Psychiatry 41, S1 (April 2017): S64. http://dx.doi.org/10.1016/j.eurpsy.2017.01.062.
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The importance of the “1001 critical days” (conception to age 2) underlies the need to act early in life to enhance children's developmental outcomes. Lack of intervention is likely to affect the children of today but also the generations to come. For adults, transition to parenthood is a major stressful life event. The strong emotional load of this experience can make this transitional period much more challenging for adults with psychological, social and economic vulnerabilities, and lead to unadjusted interactions.Then, applying the “transactional model of development” (Sameroff, 2009) to the early perinatal period helps us to understand how the needs of infants can easily affect a parent's mental state and induce inadequate parenting behaviors. These in turn make the infant's interactions more difficult and the infant's development more likely to be impaired. Perinatal mental health is thus an important public health challenge for it is essential to provide services to enhance maternal and infant emotional well-being at a moment that is simultaneously when the mother's social and emotional vulnerabilities are at their height and a critical time in the child's development.Perinatal mental health policies, including joint care of parents and infants, must provide positive support for the potential virtuous circle between the skills and vulnerabilities of the infant and the parents.This presentation will explore the different types of joined perinatal care for parents and infants that cover a range of services, from parent-infant psychotherapies to joint mother-baby hospitalizations.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Kandeel, Wafaa A., Thanaa M. Rabah, Dina Abu Zeid, Ebtissam M. Salah El Din, Ammal M. Metwally, Ashraf Shaalan, Lobna A. El Etreby, and Sanaa Y. Shaaban. "Determinants of Exclusive Breastfeeding in a Sample of Egyptian Infants." Open Access Macedonian Journal of Medical Sciences 6, no. 10 (October 2, 2018): 1818–23. http://dx.doi.org/10.3889/oamjms.2018.359.
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BACKGROUND: Breastfeeding is an optimum, healthy, and economical mode of feeding an infant. However, many preventable obstacles hinder exclusive breastfeeding in the first six months of life.
AIM: We aimed to assess the social-, maternal- and infant-related factors disturbing exclusive breastfeeding in the first six months of life.
METHODS: It is a retrospective study included 827 dyads of mothers and infants older than 6 months (411 exclusively breastfed, 311 artificially-fed and 105 mixed feds). Mothers were interviewed to obtain sociodemographic information, maternal medical history and perinatal history and a detailed history of infant feeding.
RSULTS: Many factors were found to support the decision for artificial feeding rather than exclusive breastfeeding, including maternal age < 25 years (OR = 2.252), child birth order > 3rd (OR = 2.436), being a primi-para (OR = 1.878), single marital status (OR = 2.762), preterm infant (OR = 3.287) and complicated labor (OR = 1.841). Factors in favor of mixed feeding included cesarean section (OR = 2.004) and admission to the Neonatal Intensive Care Unit (OR = 1.925).
CONCLUSIONS: Although it isn’t a community-based study and its results can’t be generalised, plans to improve health and development of children are preferable to include the following: health education and awareness programs about the importance of exclusive breastfeeding should be directed for young and first-time mothers. Improved antenatal care to reduce perinatal and neonatal problems; and training, monitoring, and supervising community health care workers to recognise labour complications and provide support and knowledge to lactating mothers.
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Davis, Jonathan, and Lori Devlin. "A Practical Approach to Neonatal Opiate Withdrawal Syndrome." American Journal of Perinatology 35, no. 04 (November 3, 2017): 324–30. http://dx.doi.org/10.1055/s-0037-1608630.
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AbstractPerinatal opioid misuse and neonatal opioid withdrawal syndrome (NOWS) are a significant public health problem that has grown exponentially over the past decade. In the United States, a woman seeks emergency room care for prescription opioid misuse every 3 minutes and approximately every 25 minutes, a child is born with signs of drug withdrawal. The economic impact of perinatal opioid misuse is significant with annual hospital charges for NOWS in 2012 as $1.5 billion dollars. Perinatal opioid misuse is a complex, multifaceted problem that demands a multidisciplinary cross specialty approach. This article will review the current state of NOWS and provide medical practitioners with a practical guide to enhance evidence based practice.
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Vu, Huyen, and Fadia T. Shaya. "Predicting Factors of Depression, Antidepressant Use and Positive Response to Antidepressants in Perinatal and Postpartum Women." Clinical Practice & Epidemiology in Mental Health 13, no. 1 (June 30, 2017): 49–60. http://dx.doi.org/10.2174/1745017901713010049.
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Background: In the United States, there is a disparity in knowledge of nationwide depression prevalence, the antidepressant use and the antidepressant responses during perinatal/postpartum periods. Objective: This study investigated the predicting factors of depression, antidepressant use and positive antidepressant response during the perinatal/postpartum periods. Method: The 2007-2012 National Health and Nutrition Examination Surveys (NHANES) were combined to identify adult pregnant women, those within the 18-month postpartum period (n=492) and their depression statuses via demographics, health care accessibility, antidepressant use and illicit drug use information. The characteristics of different study groups were compared (depression versus no-depression groups, antidepressant users versus non-antidepressant users, and antidepressant responders versus antidepressant non-responders). Multivariable logistic regression analysis was used to predict factors of perinatal depression (PND)/ postpartum depression (PPD), antidepressant use and antidepressant positive response in PND/PPD. Results: PND/PPD individuals had higher rates of mental health visits. No predicting factor for developing PND/PPD was shown. Antidepressant users were significantly older with insurance and recent health checkups/ mental visits. Being below the poverty level and having some health care accessibility are predictors for being on antidepressants. Recent non-illicit drug use is a predictor for PND/PPD symptom improvement while on antidepressants. Conclusion: The group of those with social-economic disadvantages was more likely to be on antidepressants for PND/PPD. Illicit drug users were less likely to show improvement with antidepressants. The safety and efficacy of antidepressant use during this period is controversial. More studies need to focus on the barriers involving antidepressant treatments, the safety and outcomes of antidepressants for PND/PPD management.
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D., Rita, Kiran Naik, R. M. Desai, and Sphurti Tungal. "Study of feto maternal outcome of teenage pregnancy at tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 7 (June 24, 2017): 2841. http://dx.doi.org/10.18203/2320-1770.ijrcog20172610.
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Background: Teenage pregnancy due to changing social conditions, it’s important to study the implications of the maternal and fetal health. It is a serious health problem, more so in developing countries like India. Young mothers and newborns are at increased risk of anaemia, pre-eclampsia, increased rate of LSCS, PTVD, LBW, prematurity, NICU care, RDS, sepsis, IUGR. Hence, study is directed to identify the problems and their outcome.Methods: Teenage pregnant ladies between 18 to 20 years were taken up for the study. Study duration was 1 year from January to December 2016, at SDM Medical College Dharwad. During this period, all cases were included in the study, irrespective of their booking and unbooking statuses after 28 weeks of pregnancy are taken.Results: Study showed the incidence of teenage pregnancy is 10.26%. 79.2% of teenage mothers have varying grades of anaemia, 13.6% of women had eclampsia, 16.01% had preterm deliveries, LSCS rate were as high as 52%, 17.4% had instrumental deliveries, 12.5% were low birth weight neonates, 8.4% requiring NICU care and 2% were perinatal deaths due to prematurity, respiratory distress, sepsis.Conclusions: As teenage pregnancy is associated with high risk of anaemia, pre-eclampsia, eclampsia, PTVD, instrumental delivery, high rate of LSCS, prematurity, low birth weight, perinatal death. It’s important to reduce the teenage pregnancy by improving the socio-economic condition, education, public awareness, strict implementation of law, good ANC care, nutrition, access to contraceptive services, sex education.
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Camacho, Elizabeth M., and Gemma E. Shields. "Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review." BMJ Open 8, no. 8 (August 2018): e022022. http://dx.doi.org/10.1136/bmjopen-2018-022022.
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ObjectivesAnxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression (PAD) were systematically reviewed with the aim of guiding researchers and commissioners of perinatal mental health services towards potentially cost-effective strategies.MethodsElectronic searches were conducted on the MEDLINE, PsycINFO and NHS Economic Evaluation and Health Technology Assessment databases in September 2017 to identify relevant economic evaluations published since January 2000. Two stages of screening were used with prespecified inclusion/exclusion criteria. A data extraction form was designed prior to the literature search to capture key data. A published checklist was used to assess the quality of publications identified.ResultsOf the 168 non-duplicate citations identified, 8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment. Where the cost per quality-adjusted life year (QALY) gained was reported, interventions ranged from being dominant (cheaper and more effective than usual care) to costing £39 875/QALY.ConclusionsUncertainty and heterogeneity across studies in terms of setting and design make it difficult to make direct comparisons or draw strong conclusions. However, the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective. Many gaps were identified in the economic evidence, such as the cost-effectiveness of interventions for perinatal anxiety, antenatal depression or interventions for fathers.PROSPERO registration numberCRD42016051133.
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Bchir, A. "[The birth register as an evaluation tool of maternal and child health activities at district level]." Eastern Mediterranean Health Journal 2, no. 3 (September 2, 2021): 418–24. http://dx.doi.org/10.26719/1996.2.3.418.
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Relevant epidemiological data are essential to improving management of maternal and child health services at district level. In public maternity hospitals of the health region of Monastir, Tunisia, a perinatal register has been established recording information related to pregnancy, childbirth and the condition of the newborn. During 1994, 7750 deliveries were registered, of which 46% took place in the university teaching hospital. Use of peripheral maternity hospitals varies according to the resources of the hospital;the university teaching hospital is highly attractive, especially for women from neighbouring districts. These findings raise the problem of the cost-effectiveness and relevance of opening new health facilities, particularly in times of economic crisis in the health care system
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Dassios, Theodore, Mazen Refaey, Nick Kametas, Ravindra Bhat, and Anne Greenough. "Adverse neonatal outcomes and house prices in London." Journal of Perinatal Medicine 47, no. 1 (December 19, 2018): 99–105. http://dx.doi.org/10.1515/jpm-2017-0397.
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Abstract Objective To explore whether the average price of houses per postcode sector [sector house average prices (SHAP)] is related to perinatal outcomes and whether gestational age would be lower and mortality higher in the least expensive areas compared to the most expensive. Methods All neonatal unit admissions at King’s College Hospital from 1/1/2012 to 31/12/2016 were reviewed. The SHAP was retrieved from the Land Registry and the population was divided in equal quintiles with quintiles 1 and 5 representing the most and least expensive areas, respectively. Gestational age and birth weight z-score were collected. Mortality was defined as death before discharge from neonatal care. Results Three thousand three hundred and sixty infants were included and divided in quintiles consisting of 672 infants. Gestational age was lower in quintile 5 compared to all other quintiles (adjusted P<0.001). Birthweight z-score was not significantly different between the quintiles. The SHAP was lower in the infants who died before discharge (n=92) compared to the SHAP of the infants who were alive at discharge (n=3268) (P<0.001). Infants of quintile 5 had 6 times higher risk of death before discharge from neonatal care compared to infants of quintile 1. Conclusion Low SHAPs were associated with poorer perinatal outcomes suggesting SHAP could potentially be used in perinatal populations to determine socio-economic status and associated outcomes.
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Littlewood, Elizabeth, Shehzad Ali, Lisa Dyson, Ada Keding, Pat Ansell, Della Bailey, Debrah Bates, et al. "Identifying perinatal depression with case-finding instruments: a mixed-methods study (BaBY PaNDA – Born and Bred in Yorkshire PeriNatal Depression Diagnostic Accuracy)." Health Services and Delivery Research 6, no. 6 (February 2018): 1–210. http://dx.doi.org/10.3310/hsdr06060.
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Background Perinatal depression is well recognised as a mental health condition but < 50% of cases are identified in routine practice. A case-finding strategy using the Whooley questions is currently recommended by the National Institute for Health and Care Excellence. Objectives To determine the diagnostic accuracy, acceptability and cost-effectiveness of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to identify perinatal depression. Design A prospective diagnostic accuracy cohort study, with concurrent qualitative and economic evaluations. Setting Maternity services in England. Participants A total of 391 pregnant women. Main outcome measures Women completed the Whooley questions, EPDS and a diagnostic reference standard (Clinical Interview Schedule – Revised) during pregnancy (20 weeks) and postnatally (3–4 months). Qualitative interviews were conducted with health professionals (HPs) and a subsample of women. Results Diagnostic accuracy results: depression prevalence rates were 10.3% during pregnancy and 10.5% postnatally. The Whooley questions and EPDS (cut-off point of ≥ 10) performed reasonably well, with comparable sensitivity [pregnancy: Whooley questions 85.0%, 95% confidence interval (CI) 70.2% to 94.3%; EPDS 82.5%, 95% CI 67.2% to 92.7%; postnatally: Whooley questions 85.7%, 95% CI 69.7% to 95.2%; EPDS 82.9%, 95% CI 66.4% to 93.4%] and specificity (pregnancy: Whooley questions 83.7%, 95% CI 79.4% to 87.4%; EPDS 86.6%, 95% CI 82.5% to 90.0%; postnatally: Whooley questions 80.6%, 95% CI 75.7% to 84.9%; EPDS 87.6%, 95% CI 83.3% to 91.1%). Diagnostic accuracy of the EPDS (cut-off point of ≥ 13) was poor at both time points (pregnancy: sensitivity 45%, 95% CI 29.3% to 61.5%, and specificity 95.7%, 95% CI 93.0% to 97.6%; postnatally: sensitivity 62.9%, 95% CI 44.9% to 78.5%, and specificity 95.7%, 95% CI 92.7% to 97.7%). Qualitative evaluation: women and HPs were supportive of screening/case-finding for perinatal depression. The EPDS was preferred to the Whooley questions by women and HPs, mainly because of its ‘softer’ wording. Whooley question 1 was thought to be less acceptable, largely because of the terms ‘depressed’ and ‘hopeless’, leading to women not revealing their depressive symptoms. HPs identified a ‘patient-centred’ environment that focused on the mother and baby to promote discussion about mental health. Cost-effectiveness results: screening/case-finding using the Whooley questions or the EPDS alone was not the most cost-effective strategy. A two-stage strategy, ‘Whooley questions followed by the Patient Health Questionnaire’ (a measure assessing depression symptomatology), was the most cost-effective strategy in the range between £20,000 and £30,000 per quality-adjusted life-year in both the prenatal and postnatal decision models. Limitations Perinatal depression diagnosis was not cross-referenced with women’s medical records so the proportion of new cases identified is unknown. The clinical effectiveness and cost-effectiveness of screening/case-finding strategies was not assessed as part of a randomised controlled trial. Conclusions The Whooley questions and EPDS had acceptable sensitivity and specificity, but their use in practice might be limited by low predictive value and variation in their acceptability. A two-stage strategy was more cost-effective than single-stage strategies. Neither case-finding instrument met National Screening Committee criteria. Future work The yield of screening/case-finding should be established with reference to health-care records. The clinical effectiveness and cost-effectiveness of screening/case-finding for perinatal depression needs to be tested in a randomised controlled trial. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Katuwal, Neeta, A. Rana, G. Gurung, and J. Baral. "Air Transfer of Obstetric Emergencies to a Tertiary Care Center in Nepal." Nepal Journal of Obstetrics and Gynaecology 11, no. 2 (June 3, 2017): 16–19. http://dx.doi.org/10.3126/njog.v11i2.17454.
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Aims: This study was performed to review the places, indications, maternal-perinatal outcomes requiring emergency air transfer to a tertiary level referral center.Methods: A hospital based descriptive study of one year duration, conducted in Tribhuvan University Teaching Hospital (TUTH), over a period of twelve months. All the women who were air transferred for pregnancy complications were enrolled.Results: There were total 19 airlifted obstetric emergencies to TUTH over one year period: majority (68%) from hilly areas and others (32%) from mountain region. Out of them, referred cases were 11 [district hospital (5), healthpost (4); Primary Health Center (PHC) (2)]; and rest were from home (8). Two cases were abortion related; septic abortion (1) and incomplete abortion (1). There were three antepartum cases: pregnancy with meningoencephalitis (1), eclampsia (1) and bleeding placenta previa (1); maximum, eleven intrapartum cases, obstructed labor (6),labor dystocia (3), breech in labor (1) and undelivered second twin (1). Rest three were postpartum cases, one each of eclampsia, puerperal sepsis and retained placenta. Maternal morbidities were one each case of uterine rupture, acute kidney injury, retained placenta with PPH and vesicovaginal fistula that developed in the case of shoulder dystocia. Maternal mortality occurred in 2 cases, first women with antepartum eclampsia who had intracerebral bleed and second was a case of pregnancy with meningoencephalitis who later developed brain death. Regarding perinatal outcome 12/14 (86%) had live birth and 2/14 (14%) had IUFD upon arrival.Conclusion: Air lift on personal expenditure, despite economic constraints has proven beneficial in our country’s context with difficult geographical terrain and inadequate health services, whereas anticipation of any critical condition right in the beginning and timely transfer however could have been more advantageous.
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Neri Mini, Fernanda, Jaclyn A. Saltzman, Meg Simione, Man Luo, Meghan E. Perkins, Brianna Roche, Tiffany Blake-Lamb, et al. "Expectant Fathers’ Social Determinants of Health in Early Pregnancy." Global Pediatric Health 7 (January 2020): 2333794X2097562. http://dx.doi.org/10.1177/2333794x20975628.
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This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner’s first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers’ unmet needs during pregnancy and providing father-specific perinatal information.
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Stock, Sarah J., Helga Zoega, Meredith Brockway, Rachel H. Mulholland, Jessica E. Miller, Jasper V. Been, Rachael Wood, et al. "The international Perinatal Outcomes in the Pandemic (iPOP) study: protocol." Wellcome Open Research 6 (February 2, 2021): 21. http://dx.doi.org/10.12688/wellcomeopenres.16507.1.
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Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread “natural experiment” of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide critical new information to shape prenatal care strategies throughout (and well beyond) the pandemic.
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Dudhrejia, Kavita, Zalak V. Karena, and Rahul P. Patel. "A prospective study of maternal factors and perinatal outcome of preterm birth." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 1 (December 26, 2019): 129. http://dx.doi.org/10.18203/2320-1770.ijrcog20195571.
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Background: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality, henceforth being a major concern for the obstetricians and paediatricians as well being a major health care issue. Preventing and treating the associated risk factors could play a major role in curbing the perinatal morbidity and mortality.Methods: A total 100 women with preterm labour or an indicated preterm termination of pregnancy were enrolled in the study. They were evaluated by history taking, clinical examination, and ultrasonography. Corticosteroids were given to all the patients. Maternal risk factors, obstetric outcome and perinatal outcome till discharge were studied.Results: Of the 100 women studied, mean age of the cases was 27 years, 60% of the cases belonged to lower socio-economic class, 74% of the cases were under 55 kgs weight group and 77% of cases were anaemic. 34% cases were below 34 weeks of gestation, 58% were multigravida, and 2% grand multipara with 35% labour being induced labour because of presence of various risk factors such as preterm premature rupture of membranes (PPROM), pre-eclampsia, eclampsia and chorioamnionitis. 6% cases had multiple pregnancies and 8% had history of preterm delivery in previous pregnancy. Out of 107 babies, 73% neonates required neonatal intensive care unit (NICU) admission and there was 12.14% neonatal mortality rate.Conclusions: Anaemia, malnutrition, infection, high order pregnancy are the preventable causes of preterm birth which can be prevented, screened and treated by specialised antenatal programs.
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Rivero-Arias, Oliver, Oya Eddama, Denis Azzopardi, A. David Edwards, Brenda Strohm, and Helen Campbell. "Hypothermia for perinatal asphyxia: trial-based resource use and costs at 6–7 years." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 3 (July 11, 2018): F285—F292. http://dx.doi.org/10.1136/archdischild-2017-314685.
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ObjectiveTo assess the impact of hypothermic neural rescue for perinatal asphyxia at birth on healthcare costs of survivors aged 6–7 years, and to quantify the relationship between costs and overall disability levels.Design6–7 years follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial.SettingCommunity study including a single parental questionnaire to collect information on children’s healthcare resource use.Patients130 UK children (63 in the control group, 67 in the hypothermia group) whose parents consented and returned the questionnaire.InterventionsIntensive care with cooling of the body to 33.5°C for 72 hours or intensive care alone.Main outcome measuresHealthcare resource usage and costs over the preceding 6 months.ResultsAt 6–7 years, mean (SE) healthcare costs per child were £1543 (£361) in the hypothermia group and £2549 (£812) in the control group, giving a saving of −£1005 (95% CI −£2734 to £724). Greater levels of overall disability were associated with progressively higher costs, and more parents in the hypothermia group were employed (64% vs 47%). Results were sensitive to outlying observations.ConclusionsCost results although not significant favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. Estimates were however sensitive to the care requirements of two seriously ill children in the control group. A quantification of the relationship between costs and levels of disability experienced will be useful to healthcare professionals, policy makers and health economists contemplating the long-term economic consequences of perinatal asphyxia and hypothermic neural rescue.Trial registration numberThis study reports on the follow-up of the TOBY clinical trial: ClinicalTrials. gov number NCT01092637.
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Dayyabu, Aliyu Labaran, Yusuf Murtala, Amos Grünebaum, Laurence B. McCullough, Birgit Arabin, Malcolm I. Levene, Robert L. Brent, et al. "Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa." Journal of Perinatal Medicine 47, no. 1 (December 19, 2018): 16–21. http://dx.doi.org/10.1515/jpm-2018-0066.
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Abstract Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.
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Farrar, Diane, Mark Simmonds, Susan Griffin, Ana Duarte, Debbie A. Lawlor, Mark Sculpher, Lesley Fairley, et al. "The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation." Health Technology Assessment 20, no. 86 (November 2016): 1–348. http://dx.doi.org/10.3310/hta20860.
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BackgroundGestational diabetes mellitus (GDM) is associated with a higher risk of important adverse outcomes. Practice varies and the best strategy for identifying and treating GDM is unclear.AimTo estimate the clinical effectiveness and cost-effectiveness of strategies for identifying and treating women with GDM.MethodsWe analysed individual participant data (IPD) from birth cohorts and conducted systematic reviews to estimate the association of maternal glucose levels with adverse perinatal outcomes; GDM prevalence; maternal characteristics/risk factors for GDM; and the effectiveness and costs of treatments. The cost-effectiveness of various strategies was estimated using a decision tree model, along with a value of information analysis to assess where future research might be worthwhile. Detailed systematic searches of MEDLINE®and MEDLINE In-Process & Other Non-Indexed Citations®, EMBASE, Cumulative Index to Nursing and Allied Health Literature Plus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database, Maternity and Infant Care database and the Cochrane Methodology Register were undertaken from inception up to October 2014.ResultsWe identified 58 studies examining maternal glucose levels and outcome associations. Analyses using IPD alone and the systematic review demonstrated continuous linear associations of fasting and post-load glucose levels with adverse perinatal outcomes, with no clear threshold below which there is no increased risk. Using IPD, we estimated glucose thresholds to identify infants at high risk of being born large for gestational age or with high adiposity; for South Asian (SA) women these thresholds were fasting and post-load glucose levels of 5.2 mmol/l and 7.2 mmol/l, respectively and for white British (WB) women they were 5.4 and 7.5 mmol/l, respectively. Prevalence using IPD and published data varied from 1.2% to 24.2% (depending on criteria and population) and was consistently two to three times higher in SA women than in WB women. Lowering thresholds to identify GDM, particularly in women of SA origin, identifies more women at risk, but increases costs. Maternal characteristics did not accurately identify women with GDM; there was limited evidence that in some populations risk factors may be useful for identifying low-risk women. Dietary modification additional to routine care reduced the risk of most adverse perinatal outcomes. Metformin (Glucophage,®Teva UK Ltd, Eastbourne, UK) and insulin were more effective than glibenclamide (Aurobindo Pharma – Milpharm Ltd, South Ruislip, Middlesex, UK). For all strategies to identify and treat GDM, the costs exceeded the health benefits. A policy of no screening/testing or treatment offered the maximum expected net monetary benefit (NMB) of £1184 at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY). The NMB for the three best-performing strategies in each category (screen only, then treat; screen, test, then treat; and test all, then treat) ranged between –£1197 and –£1210. Further research to reduce uncertainty around potential longer-term benefits for the mothers and offspring, find ways of improving the accuracy of identifying women with GDM, and reduce costs of identification and treatment would be worthwhile.LimitationsWe did not have access to IPD from populations in the UK outside of England. Few observational studies reported longer-term associations, and treatment trials have generally reported only perinatal outcomes.ConclusionsUsing the national standard cost-effectiveness threshold of £20,000 per QALY it is not cost-effective to routinely identify pregnant women for treatment of hyperglycaemia. Further research to provide evidence on longer-term outcomes, and more cost-effective ways to detect and treat GDM, would be valuable.Study registrationThis study is registered as PROSPERO CRD42013004608.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Akter, Shaheen, Rubiya Parvin, and B. H. Nazma Yasmeen. "Admission Hypothermia Among Neonates Presented to Neonatal Intensive Care Unit." Journal of Nepal Paediatric Society 33, no. 3 (December 14, 2013): 166–71. http://dx.doi.org/10.3126/jnps.v33i3.8312.
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Introduction: In developing countries, thermal protection of the newborn is not properly addressed. Neonates presented to Neonatal intensive care unit (NICU) for admission with various problems are frequently found to be hypothermic. The objective of this study was to determine the incidence and associated risk factors for neonatal hypothermia on admission to NICU. Materials and Methods: This was a prospective observational study carried over a period of three years at Enam Medical College and Hospital (EMCH) among the newborns admitted to NICU. Hypothermia has been defined as axillary temperature <36.5°C (<97.7° F). Temperature was measured at admission. Data were collected regarding perinatal and socio economic factors. Bivariate and multivariate analysis has been done to see the association of risk factors. Result: A total of 2310 babies between 0 and 680 h of age (mean 43± 12 hours) were studied. Thirty four percent (785) of the neonates had hypothermia. Mean gestation was 34±3 weeks and 42.5% were inborn. Significant determinants of neonatal hypothermia at admission included factors like preterm (p=0.03), low birth weight (p=0.005), normal delivery (p=0.012), birth asphyxia (p=0.001) below average socioeconomic status (p=0.001) and long distance (>10 km) travelled by the neonate (p=0.03). Independent variables are resuscitation at birth [p=.001, Odds Ratio (OR), 2.43; Confidence Interval (CI), 1.47 to 4.00], (p=0.001), age less than 24 hours (p=.02; OR 2.25; CI, 1.13 to 4.47), low birth weight (p=0.03; OR,2.0; CI, 1.06 to 3.82), caesarean section(C/S) delivery (p=.006; OR 1.35; CI, 1.18-2.12) and below average economic status (p=0.001; OR, 2.76; CI, 1.56 to 5.90). Conclusion: Incidence of admission hypothermia among neonates in our NICU was 34%. Independent risk factors are resuscitation at birth, very low birth weight, C/S delivery, age less than 24 hours and poor socio-economic condition. Proper thermal care should be provided for neonates both at home and hospitals. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8312 J. Nepal Paediatr. Soc. 2013;33(3):166-171
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Bhimani, Nishant R., Pushti V. Vachhani, and Girija P. Kartha. "Intranatal and postnatal care practices among married women of reproductive age group: a community based cross- sectional study in the rural area of Surendranagar district." International Journal Of Community Medicine And Public Health 4, no. 4 (March 28, 2017): 1289. http://dx.doi.org/10.18203/2394-6040.ijcmph20171364.
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Background: Intra natal care means care taken during delivery. This consists of taking care of not only the mother but also the newborn at the time of child-birth. Appropriate delivery care is crucial for both maternal and perinatal health. Increasing skilled attendance at birth is a central goal of the safe motherhood and child survival mission. Postpartum care aimed at complication-free puerperium and a healthy baby. There is a high risk of mortality for both the mother and her baby in the immediate period around birth. High quality intranatal and postnatal care is the important way to reduce the maternal morbidity and mortality. Utilization of intranatal and postnatal services is poor in the rural areas, which ultimately lead to increased maternal & child morbidity and mortality.Methods: The study was carried out among married women of reproductive age group. Pre-designed and pretested Performa was used to obtain the information from participants. It was community based cross - sectional study. All the collected data were analysed by applying appropriate statistical tests. The data were analysed by statistical package for social sciences (SPSS).Results: A total of 353 women were included in the study. Majority (86.97%) of women utilized health facility either government or private for their deliveries. Significant difference was observed between literacy status as well as socio economic class and utilization of institutional facility for the place of delivery. More than half women i.e. nearly 56% had not availed postnatal care services.Conclusions: Percentage of institutional deliveries as well as deliveries attended by skilled birth attendant was quite better. The most common reason for not availing the intra natal and postnatal services was found to be lack of knowledge regarding importance of these services on the outcome of delivery.
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Jain, Sapna B., and Rashmi Tripathi. "Antipartum surveillance by scoring system for pregnancy outcome of cesarean section in a tertiary referral centre of Madhya Pradesh, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 9 (August 27, 2018): 3558. http://dx.doi.org/10.18203/2320-1770.ijrcog20183432.
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Background: It is imperative to find out high risk pregnancy for providing apt care to the needy mother and fetus, so application of risk scoring system helps in pin pointing the at-risk patient and also gives a notion about the prognosis of fetal and maternal wellbeing. This study aims to evaluate the clinical application of risk scoring system in cesarean delivery for identification and management of risk pregnancies appropriately to improve perinatal and maternal morbidity and mortality.Methods: LNMC Bhopal M.P. a tertiary referral centre with approximately 2100 delivery / year and cesarean rate of 33%, serving primarily rural population. This prospective analytical study conducted from July 2017 till June 2018. Focused on the combination of the principal predictors of obstetric outcome taken from the previously published scoring system were applied on 120 cases of unplanned at risk caesarean section and summed up to identify risk-pregnancy and its predictive value for maternal and perinatal outcome.Results: It was determined by birth weight, APGAR score, birth asphyxia and NICU admission, Perinatal and maternal morbidity and mortality. Out of 120 caesarean cases 25% grouped in high risk, 58.3% low risk and 16.6%moderate group and their perinatal outcome was compared. 90% and 15% of the high risk and moderate group respectively had high risk neonates. In the high-risk group 2% had neonatal death, while no mortality in low risk cases. Maternal outcome was analysed by HDU admission 3% mothers were admitted in HDU with eclampsia and multi organ failure with one maternal mortality due to HELLP syndrome other recovered well, while one patient left against medical advice due to high expenses.Conclusions: Risk evaluation by simplified scoring system is an easy and economical way to identify high risk pregnancy to provide quick, comprehensive and quality health services to needy mother and neonate at right time, thus help in lowering the perinatal and maternal mortality and morbidity even at PHC level.
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Panda, Sandhyasri, Sai Sunil Kishore M., Durga Devi M., Mahalakshmi G., Sirisha S., and Maneesha Kiran. "Risk factors and perinatal outcome associated with low birth weight in a prospective cohort: is there a shift towards sustainable developmental goal 3." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 10 (September 26, 2019): 3858. http://dx.doi.org/10.18203/2320-1770.ijrcog20194210.
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Background: Low birth weight is a socio, economic, cultural and community based health issue which reflects responsibility and commitment of local and national administrative authorities. It continues to be a cause of short and long term adverse perinatal outcome with a bearing on adult non communicable health risks.Methods: This is a prospective observational and analytic study to know the prevalence, risk factors and perinatal outcome of LBW, from July 2017 to December 2018 in department of Obstetrics and Gynecology, MIMS Medical College, Andhra Pradesh, India. Maternal risk factors and outcomes associated with LBW were defined through risk ratios.Results: 721 infants including 116 LBW and 605 NBW born during study period were included in the study. Prevalence of LBW was 16%. Preterm birth accounted for 35%, FGR for 13.8% and SGA for 51.2% of them. Maternal factors like age <20 years and >35years, social status II to IV, below higher secondary education, house maker, primi gravida, grand multi para, BMI <18.5kg/M2 or >24.9kg/M2, Hb<11 gm% were having higher RR for LBW. LBW infants showed frequent association with oligo or polyhydramnious and hemorrhagic or turbid amniotic fluid. They had higher risks for non reassuring fetal heart rate changes, for induced delivery or an elective caesarean section. More often they needed NICU care for longer duration and showed a higher risk for malformations and neonatal mortality. Overall perinatal mortality was 5.54 per 1000 live birth.Conclusions: LBW is a risk factor for neonatal morbidity and mortality; which can be minimised by institutional delivery. High prevalence PTB (35%) warrants obstetricians to be more vigilant about indentifying the risk factors and adequate management planning. Constitutionally small baby at birth probably needs redefining normal birth weight for different ethnicity.
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Maji, Baisakhi, Sumana Samanta, Sreetama Banerjee, Tanjib Hassan Mullick, Sudhanshu Saharay, and Debjit Sarkar. "Clinico-epidemiological profile of eclampsia patients admitted in an urban tertiary care hospital of West Bengal: a record based study." International Journal Of Community Medicine And Public Health 5, no. 6 (May 22, 2018): 2416. http://dx.doi.org/10.18203/2394-6040.ijcmph20182169.
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Background: Eclampsia is a multi–system disorder with complex pathogenesis, causing 12% of global maternal deaths. It is a major public health problem specially in developing countries, contributing to maternal and perinatal morbidity as well as mortality. Majority of them are preventable if managed timely, promptly and with expertise. The objectives of the study were to identify the incidence of eclampsia in R G Kar Medical College and Hospital as well to identify the determinants of feto-maternal outcome.Methods: A retrospective, record-based cross-sectional study was conducted in an urban tertiary care teaching hospital. There were 354 pregnant women with eclampsia admitted and delivered during the study period which was 1st January-31st December’2015. Complete enumeration was done to get the sample for the study. Data were retrieved from eclampsia registers and log books of delivery kept in the labour room and hospital record section. After wards it was analysed with the help of SPSS 20.0 version to get different inferential statistics.Results: Incidence of eclampsia in that hospital in 2015 was18.4/1000 deliveries. Almost 72% patients had ante-partum eclampsia and rest had post-partum eclampsia. Emergency caesarean section was the most common (62.14%) mode of delivery. Perinatal mortality was found in 5.6% of the eclampsia patients. Majority (65%) of the babies delivered belonged to low birth weight. Muslim patients and the patients of gestational age more than 36 weeks had unfavourable outcome.Conclusions: There is need to educate and encourage the general public for antenatal care and institutional delivery. Along with this the socio-economic, cultural and educational status are to be uplifted for the improvement of the present scenario regarding eclampsia in our country.
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Bone, Jeffrey N., Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, et al. "Economic and cost-effectiveness analysis of the Community-Level Interventions for Pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique." BMJ Global Health 6, no. 5 (May 2021): e004123. http://dx.doi.org/10.1136/bmjgh-2020-004123.
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BackgroundThe Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014–2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.MethodsIncluded were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1–3, 4–7, ≥8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision tree model was built to determine the cost-effectiveness of the intervention (vs usual care), based on the primary clinical endpoint of years of life lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes.ResultsThe incremental per pregnancy cost of the intervention was US$12.66 (India), US$11.51 (Pakistan) and US$13.26 (Mozambique). As implemented, the intervention was not cost-effective due largely to minimal differences in YLL between arms. However, among women who received ≥8 CLIP contacts (four in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries).ConclusionThe intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting WHO guidance on antenatal contact frequency.Trial registration numberNCT01911494.
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Pelaez Freire, Julian A., Mauricio Hernández Carillo, Liliana Arias Castillo, Jorge A. Holguin Ruiz, and Julian A. Herrera Murgueitio. "Social Determinants and Ethnic Factors Associated with a New Spatial Distribution of Maternal Mortality for a City of Colombia (2000-2019)." European Journal of Medical and Health Sciences 3, no. 4 (July 4, 2021): 1–5. http://dx.doi.org/10.24018/ejmed.2021.3.4.916.
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Introduction: Maternal mortality in our region observed a significative reduction, however, it continues to be a a public health problem. In Cali-Colombia was traditionally concentrated in the eastern and hillside areas and with high prevalence of afroamerican patients.
Materials and methods: To analyze the behavior of maternal mortality during the last twenty years in the city, an ecological analytical study of spatial correlation was carried out including in the analysis, economic, sociocultural and health care factors. Univariate, bivariate and multivariate analyzes were performed.
Results: The spatial analysis showed clusters of maternal mortality in the northern and central areas of the city. As a risk factor for maternal mortality, it was observed that in pregnant women belonging to the mixed ethnic backgrounds and spanic white ethnicity from low socioeconomic income (IRR: 1.13, 95% CI 1.03-1.24). Access to basic education (OR: 0.66, 95% CI 0.53-0.83), attendance at prenatal care (OR: 0.95 95% CI 0.93-0.98) and access to health institutions (OR: 0.96, 95% CI: 0.95-0-97) identified as protective factors for maternal mortality.
Conclusion: The clusters for maternal-perinatal mortality in the city during the last two decades had a significant spatial change with a new pattern of risk factors associated to maternal mortality.
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Victora, Cesar Gomes, and Fernando Celso Barros. "Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions." Sao Paulo Medical Journal 119, no. 1 (January 4, 2001): 33–42. http://dx.doi.org/10.1590/s1516-31802001000100009.
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CONTEXT: Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. TYPE OF STUDY: Review paper. METHODS: Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. RESULTS: The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57% of all infant deaths, and congenital malformations are responsible for 11.2% of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. CONCLUSIONS: A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8% reduction in infant mortality but the efficacy of available interventions is low.
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Nazarenko, L. G., L. A. Hook, and N. S. Nestertsova. "Basic aspects of assessing the condition of the fetus and predicting the health of the newborn." HEALTH OF WOMAN, no. 5-6(151-152) (July 30, 2020): 8–14. http://dx.doi.org/10.15574/hw.2020.151-152.7.
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Negative processes in modern society - economic and environmental crisis, psycho-emotional tension due to military confrontation, migration, deformation of the family value system – cause changes in medical and social «portrait» of pregnant women, and therefore adversely affect the fetus. This should motivate the modern physician to improve the professional level of clinical informative instrumental methods of assessing the condition of the fetus when choosing a method of delivery, the correct use of modern methods of fetal monitoring, based on skills development, error assessment, updating knowledge of pathophysiology of fetal oxygen supply. Perinatal encephalopathy due to hypoxic-ischemic lesions of the nervous system plays a leading role in the development of disorders of neonatal adaptation, neurological morbidity and disability of newborns. The article schematically presents modern ideas about the triggers of fetal hypoxia in physiological childbirth, as well as in pathological conditions with impaired gas exchange between mother and fetus. The main vectors for assessing the condition of the fetus during full-term pregnancy are determined: registration of cardiac activity, identification of patterns of pathological condition of the nervous system, identification of the consequences of fetoplacental vascular disorders, determination of oxygen markers. The actual data and basic aspects of the use of modern technologies for assessing the condition of the fetus are given: cardiotocography (CTG), electrocardiography of the fetus, blood samples from the present head. Particular attention is paid to the CPC as the «gold standard» for assessing the condition of the fetus. The main points of the computer system of CTG Dawes–Redman are covered. Emphasis is placed on the need for a modern physician to have a visual assessment of CTG samples. Information on invasive technologies used to identify the state of gas exchange in the fetus is presented. The role of regular training of medical staff on technologies of intranatal assessment of fetal condition using the classification criteria of CTG and FIGO recommendations is emphasized, which is a necessary condition for achieving positive results in perinatal care of the fetus. Keywords: fetal condition, intranatal evaluation, hypoxemia, cardiotocography, lactate.
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Weber, Ashley, Tondi M. Harrison, Deborah Steward, and Susan Ludington-Hoe. "Paid Family Leave to Enhance the Health Outcomes of Preterm Infants." Policy, Politics, & Nursing Practice 19, no. 1-2 (February 2018): 11–28. http://dx.doi.org/10.1177/1527154418791821.
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Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies.
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Chandrasekharan, Praveen, Maximo Vento, Daniele Trevisanuto, Elizabeth Partridge, Mark A. Underwood, Jean Wiedeman, Anup Katheria, and Satyan Lakshminrusimha. "Neonatal Resuscitation and Postresuscitation Care of Infants Born to Mothers with Suspected or Confirmed SARS-CoV-2 Infection." American Journal of Perinatology 37, no. 08 (April 8, 2020): 813–24. http://dx.doi.org/10.1055/s-0040-1709688.
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The first case of novel coronavirus disease of 2019 (COVID-19) caused by severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. Key Points
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Garg, Shaveta, Tajinder Kaur, Ajayveer Singh Saran, and Monu Yadav. "A study of etiology and outcome of preterm birth at a tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 10 (September 23, 2017): 4488. http://dx.doi.org/10.18203/2320-1770.ijrcog20174429.
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Background: Preterm births are still the leading cause of perinatal mortality and morbidity. It is a major challenge in the obstetrical health care.Methods: This study was conducted over a period of eight months from September 2016 till April 2017 at a tertiary care hospital. All patients who delivered a live baby before 37 weeks of gestation were included in the study.Results: Present study was conducted on 100 eligible women out of which 7 delivered before 30 weeks but majority of them (55%) delivered after 34 weeks of gestation. In our study, most of the patients (66%) presented in active phase of labor which resulted in preterm birth of baby. The most common risk factor of preterm labor was genitourinary tract infections (34%) followed by Preterm Premature rupture of membranes (22%). Past obstetric history of preterm delivery and abortions also had a significant impact on the present pregnancy outcome.Conclusions: Preterm labour and birth still have a high incidence causing significant neonatal mortality and morbidity as well as economic burden on family and hospital. The causes of preterm birth are multifactorial and modifiable. This incidence can be reduced by early identification of established risk factors, as revisited and reemphasized in our study, with the help of universal and proper antenatal care.
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Rehman, Bilal Ur, Javid Ahmad, Rauf Ur Rashid Kaul, and Mohammad Kaleem ul Haque. "An epidemiological study to assess the mental health status of pregnant women in a tertiary care hospital, Srinagar, Jammu and Kashmir, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 6 (May 25, 2017): 2580. http://dx.doi.org/10.18203/2320-1770.ijrcog20172355.
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Background: Pregnancy is a major psychological, as well as physiological event; women may find themselves unable to cope with additional demands of pregnancy. Mental illness during pregnancy-whether anxiety, depression or more severe psychiatric disorders-can have a significant negative impact on a mother and her baby. Poor psychological health has been associated with low birth weight, premature birth, perinatal and infant death, postnatal depression, as well as long term behavioural and psychological impacts on the child. Depressive disorders are a common source of disability among women. Mental health problems during pregnancy and postpartum periods are one of the alarming health issue among women. Community-based epidemiological data on antenatal depression from developing countries is scarce. This study was conducted to assess the mental health status of pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar (J and K).Methods: A cross sectional study was conducted over a period of six months from 1stSeptember 2016 to 28th February 2017 among randomly selected pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar. A total of 200 pregnant women formed the study subjects. Data was collected by interviewing the pregnant women using pre-designed, pre-tested, semi-structured questionnaire. Data was analysed using Statistical Programme for the social science (SPSS) version 19.0.Results: Amongst the study population, prevalence of depressive disorder was 26%. The depression was significantly increasing with advancing pregnancy and advancing age. Socio-economic status and depression was associated statistically significant (p=0.024). Women with bad relationship with in laws had significantly more depression compared to those who had good relationship with in laws (P=0.0037). The association between parity and depressive disorder was statistically insignificant(P=0,7144).Conclusions: When we care for mother we care for two live and live without psychological consideration is completely materialistic. A depressive symptom occurs commonly during 2nd and 3rd trimester of pregnancy, drawing attention to a need to screen for depression during antenatal care. Maternal health policies, a priority in developing countries, must integrate maternal depression as a disorder of public health importance. Intervention should target women in the early antenatal period.
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Cooly, Vijayalakshmi, Sailaja Bandaru, Bhuvaneswari Salicheemala, and Sailaja Surayapalem. "Prevalence and associated risk factors of asymptomatic bacteriuria among antenatal women attending a health care center: one year study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 12 (November 23, 2017): 5472. http://dx.doi.org/10.18203/2320-1770.ijrcog20175263.
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Background: Asymptomatic bacteriuria is defined as presence of persistent and actively multiplying bacteria in urine in significant numbers, ≥105/ml but without clinical symptoms. Detection of ASB is important during pregnancy as it leads to 25% of symptomatic urinary tract infection in pregnant mothers, pyelonephritis, hypertension in pregnancy, postpartum UTI, anemia, preterm labour, low birth weight and perinatal death of the foetus. The objective of the present study is to identify the prevalence of ASB among pregnant women, epidemiological pattern, risk factors associated with it, type of pathogens and their antimicrobial susceptibility.Methods: A prospective cross-sectional study was conducted on 500 asymptomatic antenatal women who fulfilled the inclusion criteria attending the department of Obstetrics and Gynecology. Mid stream urine specimen was collected from all the cases and subjected to microscopic analysis and culture and sensitivity.Results: Our study showed the prevalence of ASB as 7.6% among antenatal women.78.8% of sterile cases and 13.6% as contaminants. 21-25 years was the common age group of ASB cases in our study. ASB was common among multiparous women, during 3rd trimester. Statistically significant association was observed with low socio-economic status, increases sexual activity and among illiterate cases. Escherichia coli (42.11%) was the most common isolate in the study. Other isolates were Klebsiella, Staphylococcus aureus, CONS, Citrobacter and Enterococcus sp. Imipenem, Meropenem exhibited 100% sensitivity for gram negative isolates and clindamycin for gram positive isolates.Conclusions: All the cases of ASB diagnosed should be treated based upon the culture and sensitivity report to prevent unnecessary prescription of antibiotics which can economically burden the patient as well pave a way in development of resistant strains. Hence, further initiatives should be undertaken to include urine culture sensitivity as a part of national screening programme to prevent maternal and foetal complications.
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Singh, Arpita, and Ambujam K. "Maternal socio-demographic determinants and fetal outcome of intrauterine growth restriction." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 9 (August 27, 2018): 3843. http://dx.doi.org/10.18203/2320-1770.ijrcog20183805.
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Background: Intrauterine Growth Restriction is a major neonatal health issue. It is associated with increased risk of perinatal morbidity and mortality. Maternal factors are the major contributing factors of IUGR and studying these factors can help in preventing IUGR and reducing perinatal mortality. The objective is to study the maternal sociodemographic risk factors associated with Intra uterine growth restriction.Methods: This is a Case-control study conducted in the Department of Obstetrics and Gynaecology, GMC Thrissur. 115 cases of Intra Uterine Growth Restriction were compared to 115 controls. Data was collected by interviewing the mother using structured questionnaire which is pretested and by persual of antenatal records. Intra Uterine Growth Restriction is defined as occurring if the sonographic estimated fetal weight <10th percentile for that gestational age. Chi Square test was used for the analysis of data.Results: Low socio-economic status and malnutrition (BMI<18.5) were significant socio-demographic factors associated with fetal growth restriction. Mean birth weight in IUGR group was 1.8kg compared to 2.9kg in control group. Female fetuses were more commonly associated with IUGR. Intra Uterine Growth Restricted babies had lower Apgar scores (<7) and had more chances for NICU admission.Conclusions: By studying the maternal risk factors associated with Intra Uterine Growth Restriction, we could identify the high-risk group. Early predictive studies could be done in these high-risk pregnancies with focus on good antenatal care to reduce the problem of IUGR in the community.
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Bi, Peng, Shilu Tong, and Kevin Parton. "Neonates' Birth Weight and Attitudinal Status of Primiparous Women in Hefei, China." Australian Journal of Primary Health 8, no. 2 (2002): 54. http://dx.doi.org/10.1071/py02027.
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To examine the maternal attitudinal status among primiparous women, to explore the potential risk factors of their neonates' birth weight and to provide suggestions to improve the quality of perinatal health care, a survey was conducted in a medium city of China. Using a cluster sampling method, four hospitals were selected from Hefei City, China. Social and biomedical information was collected on 394 primiparous women and their neonates over the period of 10 May to 9 June, 1995 both from their medical records and from the mothers' responses to a questionnaire. Data analyses including univariate analysis, F test and multiple linear regression analysis were conducted. It was found that the primiparous women who had a high educational level, an occupation with a stable income and an optimal delivery age (23-29 years old) had a more stable maternal attitudinal status, and their neonates tended to have a higher birth weight. The parents' height, mother's weight, maternal nutritional status, neonate's gender, vagina bleeding history, location of the family home, whether the mother had regular check-ups and mother's negative feeling during pregnancy were also significantly correlated with the neonates' birth weight. The results suggested that the improvement of educational levels, raising economic status, particularly maternal nutrition status during pregnancy and the choice of an optimal delivery age among primiparous women might be helpful in reduction lower birth weight incidence.