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Polido, Carla Betina Andreucci 1969. "Morbidade materna grave e sexualidade = Severe maternal morbidity and sexual functioning". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312759.
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Orientadores: José Guilherme Cecatti, Rodolfo de Carvalho PacagnellaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Morbidade materna grave e near miss materno são indicadores de saúde mais abrangentes, quando comparados à razão de morte materna. Esse conceito recente permite não apenas a identificação do número de mulheres que morrem durante gestação e/ou parto, mas também o estudo da prevalência de condições potencialmente ameaçadoras de vida. No entanto, pouco se conhece sobre as possíveis consequências em longo prazo após esses episódios nos diversos aspectos da vida das sobreviventes. A gestação e o parto podem modificar a resposta sexual feminina, mas poucos estudos avaliaram esse desfecho após eventos de morbidade materna grave. Objetivos: Realizar uma revisão sistemática sobre aspectos de sexualidade, incluindo função sexual, em mulheres que apresentaram qualquer tipo de complicação durante gestação ou parto. Avaliar aspectos da resposta sexual feminina em mulheres com e sem morbidade materna grave. Métodos: Revisão sistemática nas bases de dados PubMed, EMBASE e SciELO, avaliando a associação de morbidade materna geral e grave com alterações da função e/ou resposta sexual feminina. A revisão seguiu o protocolo do método proposto para estudos observacionais (PRISMA). A resposta sexual feminina foi estudada como um dos desfechos da Coorte de Morbidade Materna Grave (COMMAG). O questionário Female Sexual Function Index (FSFI) foi aplicado às mulheres expostas (com antecedente de morbidade grave) e não expostas (com antecedente de gestação sem complicações). Além do FSFI, questões gerais sobre saúde geral e reprodutiva complementaram o estudo. Resultados: Lesões perineais maiores (terceiro e quarto graus) foram avaliadas como desfechos de morbidade geral em 12 estudos, e a morbidade materna grave foi analisada em 2 estudos. A morbidade geral e a grave foram associadas com maior tempo para a retomada da atividade sexual após o parto. A morbidade também se associou a uma maior frequência de dispareunia após o parto. Escores totais do FSFI não foram significativamente diferentes entre grupos de exposição e controle. Pela heterogeneidade entre eles, os estudos individuais permitiram apenas uma síntese qualitativa dos resultados, mas não metanálise. Para avaliação da resposta sexual feminina no COMMAG, foram incluídas 638 mulheres previamente internadas durante gestação ou parto na maternidade do CAISM/UNICAMP. Dessas, 315 tinham antecedente de morbidade materna grave, e 323 eram mulheres sem complicações durante gestação ou parto. Os escores totais médios do FSFI encontrados foram abaixo dos valores de ponto de corte para suspeita de disfunção, sem diferença entre os grupos estudados. Mulheres com antecedente de morbidade materna grave retomaram atividade sexual mais tardiamente após o parto do que as do grupo controle, porém sem diferença entre os grupos a partir do terceiro mês pós-parto. A análise múltipla identificou associação de valores mais baixos de FSFI com baixo de peso materno e ausência de parceria. Conclusões: Alterações da resposta sexual feminina podem ser consequências em longo prazo da ocorrência de episódios de morbidade materna grave. Com o crescimento da população de mulheres que sobrevivem a esses episódios, a abordagem da sexualidade no seguimento dessa população se faz premente
Abstract: Introduction: Severe maternal morbidity and maternal near miss currently are better health indicators than maternal mortality ratio. Together with the identification of women who died during pregnancy and/or childbirth, the new concept allows also to investigate the prevalence of potential life-threatening conditions. However, little is known about possible long-term consequences after those episodes over several aspects of the lives of survivors. It has already been described that uncomplicated pregnancy and childbirth might modify female sexual response. Notwithstanding, only few studies have evaluated aspects of sexuality of women after episodes of severe maternal morbidity. Objectives: To perform a systematic review of aspects of sexuality, including sexual function, in women who had had any kind of complication during pregnancy or childbirth. To evaluate aspects of female sexual response in women with and without severe maternal morbidity. Methods: Investigation included a systematic review through the databases PubMed, EMBASE, and SciELO, assessing general and severe maternal morbidity associated with altered female sexual response. The review followed the protocol method proposed for observational studies (PRISMA). The female sexual response has been studied as one of the outcomes at a retrospective cohort study on maternal severe morbidity (COMMAG). The Female Sexual Function Index questionnaire (FSFI) was applied at exposed women (severe morbidity) and unexposed (pregnancy without complications). Along with FSFI, the survey included also questions on general and reproductive health. Results: Major perineal injuries (3rd and 4th degree) were evaluated as general morbidity outcomes at 12 studies, and severe maternal morbidity was analyzed at 2 studies. Compared to control group, both women exposed to general and severe morbidity delayed resumption of sexual activity after childbirth. The exposed group had also more frequently dyspareunia after childbirth. The mean total FSFI scores were similar at both groups. The heterogeneity of the studies allowed only a qualitative synthesis, and meta-analysis was not feasible. To assess female sexual response at the cohort study, 638 women who delivered at UNICAMP's maternity unit were included. 315 of them were severe maternal morbidity cases, and 323 were women who had had uncomplicated pregnancy or childbirth. The mean total scores of FSFI were similar in both groups, though below cut-off values for suspected dysfunction. Women after severe maternal morbidity resumed sexual activity after birth later, when compared to control group. However, there was no significant difference at three months. Multivariate analysis showed association of lower FSFI scores with maternal low maternal weight and no partner. Conclusions: Altered female sexual response might be a long-term consequence after episodes of severe maternal morbidity. Since there is a growing population of women who survive these episodes, proper evaluation of sexual functioning among those women should be conducted
Doutorado
Saúde Materna e Perinatal
Doutora em Ciências da Saúde
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Mawani, Farah Naaz. "Cultural determinants of maternal morbidity among the Maasai". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22362.pdf.
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Ejidokun, Oluwatoyin Oyindamola. "Maternal anaemia and morbidity in South-Western Nigeria". Thesis, University College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338732.
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Marshall, Kathleen. "The first vaginal delivery and associated maternal morbidity". Thesis, University of Ulster, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286948.
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Monte, Alana Santos. "Severe maternal morbidity in a intensive care unit and maternal and perinatal repercussions". Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=18717.
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Objetivou-se avaliar as admissÃes em uma UTI materna de acordo com os critÃrios de morbidade materna grave estabelecidos e suas repercussÃes maternas e perinatais. Estudo epidemiolÃgico analÃtico, de corte transversal. A coleta de dados aconteceu no perÃodo de agosto a dezembro de 2015 na Maternidade Escola Assis Chateaubriand (MEAC). A populaÃÃo do estudo foi composta por todos os prontuÃrios das mulheres que tivessem se internado na UTI materna da MEAC entre os anos de 2010 a 2014, totalizando 882. Foram utilizados como critÃrios de exclusÃo: prontuÃrios de mulheres com mais de 42 dias pÃs-parto; prontuÃrios com dados incompletos ou nÃo encontrados; casos de complicaÃÃes ginecolÃgicas, sendo 322 prontuÃrios excluÃdos, totalizando uma amostra de 560 prontuÃrios. Os dados foram compilados e analisados por meio do programa Statistical Package for the Social Sciences (SPSS) versÃo 20.0. A maioria das mulheres que teve near miss materno (NMM) se associou à faixa etÃria entre 20 e 34 anos, nÃo trabalhava, multigesta, com histÃria de aborto anterior e com menos que seis consultas de prÃ-natal. O parto vaginal apresentou-se como fator de risco para Ãbito quando analisado isoladamente. PorÃm, na regressÃo logÃstica foi a cesÃrea que passou a apresentar maior chance. Os principais diagnÃsticos dessas mulheres foram as sÃndromes hipertensivas. No entanto foram as sÃndromes hemorrÃgicas que lideraram as causas bÃsicas da morte. O nÃmero de casos de NMM no critÃrio de Waterstone foi muito mais elevado do que nos outros critÃrios. Contudo, ao fazer a associaÃÃo com o Ãbito materno, ele foi o critÃrio que menos classificou as mulheres que evoluÃram para Ãbito, inferindo a necessidade de utilizar o CritÃrio da OMS. O baixo peso ao nascer, Apgar no 5 minuto menor que 7 e Idade Gestacional ao nascer menor que 30 semanas tiveram forte associaÃÃo com o Ãbito perinatal. As sÃndromes hipertensivas maternas e a insuficiÃncia respiratÃria foram as causas principais dos Ãbitos fetais e neonatais, respectivamente. Diante disso, recomenda-se que a morbidade materna grave seja investigada, pois permitirà uma anÃlise mais precisa dos fatores relacionados com a sua ocorrÃncia e tambÃm serà usada para auditar a qualidade do cuidado obstÃtrico do ponto de vista hospitalar e como grupo de comparaÃÃo em estudos de caso de morte materna e perinatal.The objective was to evaluate the admissions in a maternal ICU according to the established criteria of severe maternal morbidity and its maternal and perinatal repercussions. Analytical epidemiological study, cross-sectional. Data collection took place from August to December 2015 at the Maternity School Assis Chateaubriand (MEAC). The study population consisted of all the medical records of women who had been admitted to the maternal intensive care unit of MEAC from 2010 to 2014, totaling 882. Exclusion criteria were: records of women more than 42 days postpartum ; Charts with incomplete or missing data; Cases of gynecological complications, 322 of which were excluded, totaling a sample of 560 medical records. Data were compiled and analyzed using the Statistical Package for Social Sciences (SPSS) program version 20.0. The majority of women who had near miss maternal (NMM) were associated to the age group between 20 and 34 years, did not work, multigesta, with previous abortion history and with less than six prenatal consultations. Vaginal delivery was a risk factor for death when analyzed alone. However, in the logistic regression it was the cesarean section that presented a greater chance. The main diagnoses of these women were hypertensive syndromes. However, it was the hemorrhagic syndromes that led the basic causes of death. The number of NMM cases in the Waterstone criterion was much higher than in the other criteria. However, in association with maternal death, it was the criterion that less classified the women who died, inferring the need to use the WHO Criteria. Low birth weight, Apgar at 5 minutes less than 7 and Gestational Age at birth less than 30 weeks had a strong association with perinatal death. Maternal hypertensive syndromes and respiratory failure were the main causes of fetal and neonatal deaths, respectively. In view of this, it is recommended that serious maternal morbidity be investigated, as it will allow a more precise analysis of the factors related to its occurrence and will also be used to audit the quality of obstetric care from the hospital point of view and as a comparison group in studies Case of maternal and perinatal death.
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Siregar, Kemal Nazaruddin. "Social and programme factors influencing maternal morbidity in Indonesia". Thesis, University of Exeter, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297578.
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McCauley, M. E. "Assessing maternal morbidity in India, Pakistan, Kenya and Malawi". Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3022882/.
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Background: For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low- and middle-income countries. The PhD study sought to assess the extent and type of maternal morbidity in these settings. Methods: A descriptive observational cross-sectional study was conducted to assess physical (infectious and medical/obstetric), psychological and social morbidity. Socio-demographic factors, education, socioeconomic status, reported symptoms, clinical examination and laboratory investigations, quality of life, and satisfaction with health were assessed. Relationships between morbidity and maternal characteristics were investigated using logistic regression analysis. Findings: 11454 women were assessed in India (2099), Malawi (2923), Kenya (3145), and Pakistan (3287). Almost 3 out of 4 women had ≥1 symptom (73.5%), abnormalities on clinical examination (71.3%) or laboratory investigation (73.5%). In total, 9.0% of women had an identified infectious disease (HIV, malaria, syphilis or chest infection) and 23.1% had signs of early sepsis with an identifiable source of infection in 43%. HIV positive status was highest in Malawi (14.5%) as was malaria (10.4%). Overall, 47.9% of women were anaemic, 11.5% had other medical or obstetric conditions, 25.1% psychological and 36.6% social morbidity. Infectious morbidity was highest in Malawi (40.5%) and Kenya (38.5%), psychological and social morbidity was highest in Pakistan (47.3%, 60.2%). Morbidity was not limited to a core at risk group; only 1.2% had a combination of all four morbidities. Age, socioeconomic status, educational, previous pregnancies, and adverse maternal or neonatal outcomes were associated with different types of morbidity per country, but there was no consistent direction of strength of association. For each country, women with medical/obstetric morbidity was more likely to report psychological and infectious morbidity, apart from Malawi. Women with an infectious morbidity were more likely to report medical/obstetric, psychological and social morbidity in Pakistan and Malawi. Women with psychological morbidity were more likely to report social morbidity in Pakistan and Kenya. Conclusion: Despite women reporting that they have a good quality of life and are satisfied with their health, there is evidence of a significant burden of infectious, medical/obstetric, psychological, and social morbidity in women during and after pregnancy. At present available antenatal and postnatal care packages do not include comprehensive screening for all forms of ill-health. This study demonstrates that women have health needs, beyond simply the physical aspects of health and includes psychological and social well-being. To ensure all women have the right to the highest attainable standard of health and well-being, current antenatal and postnatal care packages need to be adapted and improved to provide comprehensive, holistic care in a way that meets a woman’s health needs.
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Boundy, Ellen O'Neal. "Determinants of Global Maternal and Neonatal Morbidity and Mortality". Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121139.
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In 2013, approximately 289,000 women died from pregnancy-related causes and 2.8 million newborns died within the first 28 days of life. The vast majority of these deaths occur in resource-limited settings. This work examines risk and protective factors for the development of several perinatal complications that put mothers and their infants at risk for adverse health outcomes. We explored determinants of preeclampsia and gestational hypertension among women in Dar es Salaam, Tanzania. We also examined the effects of pregnancy spacing intervals on perinatal outcomes in that group of women. We used log binomial regression to obtain risk ratios and 95% confidence intervals for the development of the adverse pregnancy outcomes of interest. We also looked at the efficacy of an intervention aimed at improving neonatal outcomes by conducting a systematic review and meta-analysis of the effects of kangaroo mother care on neonatal morbidity and mortality.
We found that nulliparity, history of hypertension, urinary tract infection, low calcium intake, history of preeclampsia, and history of preterm birth were associated with an increased risk of developing preeclampsia among women in Dar es Salaam. Risk factors for gestational hypertension included a history of diabetes, elevated blood pressure at study enrollment, increased mid-upper arm circumference, high hematocrit, low mean corpuscular volume, a history of miscarriage or stillbirth, and older age at first pregnancy. Twin gestation and increased body mass index were risk factors for both types of hypertensive disorders of pregnancy among women in Tanzania. After a live birth, inter-pregnancy intervals less than six months were associated with an increased the risk of having a low birth weight baby in the next pregnancy; while after a stillbirth, short inter-pregnancy intervals were associated with increased risk of stillbirth and perinatal death. Providing kangaroo mother care to infants after birth was associated with decreased neonatal morbidity and mortality and increased likelihood of exclusive breastfeeding when compared to conventional care.
These findings can help identify women and infants at increased risk for developing pregnancy-related complications and contribute to informing development of evidence-based maternal, newborn, and family planning programs and policies.Epidemiology
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Valentin, Dominique. "Reducing Maternal and Child Morbidity and Mortality Through Project Recommendations". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2588.
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Haiti is a Caribbean island with a humanitarian medical center providing healthcare services to 90,000 residents. Pregnant women visiting the medical clinic for prenatal care often do not return for delivery; instead, they return home to deliver alone or with the assistance of a traditional matron. Home-birth practices increase maternal-child health morbidity and mortality in an already fragile country. The purpose of this project was to gain a deeper understanding of Haitian pregnant women's preferences to deliver at home or at the healthcare clinic. The transtheoretical model for behavior change and the Johns Hopkins nursing evidence-based practice model guided the project. Two focus groups of 10 pregnant women total were recruited in the community of Delmas 32, Haiti. Group 1 was comprised of 5 women who delivered at home with matrons and Group 2 was comprised of 5 women who delivered at the clinic. Structured questions were asked to identify themes related to delivery location preferences. Focus group transcripts were analyzed guided by the Krueger and Casey strategy model. The thematic analysis was aligned with the peer-reviewed literature. Findings revealed that lack of access to care, lack of education and sensitization, and the attitude of healthcare personnel impacted women's preference for delivery at the clinic. Findings also supported a need to educate staff and the community in the best options for maternal-child care. A workshop was developed, based on the project findings, to share the recommendations with the clinic staff. The clinical leadership have indicated that they will implement the project recommendations. This project has the potential to support social change by reducing maternal-child deaths in Delmas 32 and across the Caribbean.
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Pfitscher, Lúcia Chaves 1981. "Morbidade materna grave por infecção e influenza H1N1 na Rede Brasileira de Vigilância de Morbidade Materna Grave = Severe maternal morbidity due to infection in the Brazilian Network for the Surveillance of Severe Maternal Morbidity". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311042.
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Orientadores: Maria Laura Costa do Nascimento, José Guilherme CecattiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A infecção representa importante causa de morbidade e mortalidade materna, sendo uma preocupação crescente no mundo todo. As doenças respiratórias, especialmente as virais, têm se destacado justamente pelo potencial de epidemia com que ameaçam a saúde da população mundial e pela vulnerabilidade identificada durante a gestação. Objetivo: Avaliar o impacto da morbidade materna grave (MMG) atribuível à infecção (sepse, meningite e doença respiratória) e os fatores associados ao pior resultado materno (near miss e óbito), entre mulheres da Rede Brasileira de Vigilância da Morbidade Materna Grave. Métodos: análise secundária de um estudo transversal, multicêntrico, que incluiu 27 centros de referência obstétrica das cinco regiões do Brasil no período de 2009 e 2010. A vigilância prospectiva dos casos de infecção grave foi realizada utilizando os critérios da OMS de condições potencialmente ameaçadoras da vida (CPAV) e near miss materno (NMM). Os principais focos de infecção foram identificados e comparados a outras causas de MMG. Mulheres com complicação devido à doença respiratória também foram avaliadas em dois grupos: com e sem suspeita de A(H1N1)pdm09 e também comparadas a outras causas de MMG. Casos com suspeita de A(H1N1)pdm09 foram revisados e separados em três grupos: não-testados, confirmados e não confirmados para A(H1N1)pdm09 e os seus resultados foram comparados. Complicações devidas à infecção e a doenças respiratórias foram comparadas com complicações devidas a outras causas de MMG. Os fatores associados com desfecho materno grave (DMG) foram avaliados para os casos de infecção e doença respiratória. Resultados: Dentre os 9555 casos de MMG, apenas 502 (5,3%) apresentaram infecção grave, entretanto foram responsáveis por cerca de um quarto dos casos de NMM e quase metade dos casos de morte materna (MM). Os indicadores de saúde avaliados demonstram maior gravidade dos casos complicados por infecção, com índice de mortalidade (IM) superior a 26% em comparação com 11% para as demais causas de MMG. Para doença respiratória, 206 mulheres apresentaram suspeita de A(H1N1)pdm09, cerca de 60% foram testados para a doença e 49 mulheres apresentaram resultado positivo. A gravidade dos desfechos maternos foi pior entre os casos de A(H1N1)pdm09 positivo, com uma taxa de NMM:MM abaixo de 1 (0,9:1), em comparação a 12:1 para outras causas de MMG. O IM para doença respiratória foi superior a 50% (7,4% outras causas de MMG). Demoras no atendimento foram associadas com pior prognóstico materno e estiveram presentes em mais de 50% entre os casos de infecção, aumentando em duas vezes o risco de DMG para doença respiratória. Resultados perinatais foram piores dentre os casos de doença respiratória, com aumento da prematuridade, morte fetal, baixo peso ao nascer e Apgar <7. HIV/AIDS, histerectomia, hospitalização prolongada, admissão em UTI e demoras no atendimento foram alguns fatores independentes associados DMG. Conclusão: complicações por infecção e em especial por influenza A(H1N1)pdm09 geram grande impacto sobre morbidade e mortalidade materna no Brasil e compreender os fatores associados à maior gravidade pode gerar medidas capazes de colaborar para a melhoria do cuidado obstétrico. Investir em intervenções específicas para gravidez, visando diagnóstico precoce e tratamento oportuno são essenciais para melhorar a saúde materna e reduzir o número de mortes maternas evitáveis no país
Abstract: Background: Infection represents the major cause of maternal morbidity and mortality, and a growing concern worldwide. Respiratory diseases, especially viral, have stood out because of their epidemic potential and the identified vulnerability towards infection during pregnancy. Objective: To assess the impact of severe maternal morbidity (SMM) due to infection (sepsis, meningitis and respiratory disease) and the factors associated with worse maternal outcome (near miss and death) among women of the Brazilian Network for the Surveillance of Severe Maternal Morbidity. Methods: secondary analysis of a cross-sectional, multicenter study that included 27 obstetric referral centers in five regions of Brazil between 2009 and 2010. Prospective surveillance of severe infection was performed using WHO criteria of potentially life threatening conditions (PLTC) and maternal near miss (MNM). The main sources of infection were identified and compared to other causes of SMM. Women with complications due to respiratory disease were also assessed in two groups: with and without suspected A(H1N1)pdm09 and also compared to other causes of SMM. Cases of suspected A(H1N1)pdm09 were reviewed and divided into three groups: non-tested, confirmed and unconfirmed for A(H1N1)pdm09 and their results were compared. Complications due to infection and respiratory disease were compared with complications due to other causes of SMM. Factors associated with SMO were assessed for cases of infection and respiratory disease. Results: Among the 9555 cases of SMM, only 502 (5.3%) had severe infection, however they were responsible for about a quarter of cases of MNM and almost half of the cases of maternal mortality (MM). The assessed health indicators demonstrate greater severity of cases complicated by infection, with a mortality index (MI) above 26% compared to 11% for other causes of SMM. For respiratory disease, 206 women had suspected A(H1N1)pdm09, about 60% were tested for the disease and 49 women were positive. The severity of the maternal outcomes was worse between the cases of A(H1N1)pdm09 positive, with a rate of MNM: MM below 1 (0.9: 1), compared to 12: 1 for other SMM causes. The MI among respiratory disease was superior to 50% (7.4% other causes SMM). Delays in care were associated with worse maternal prognosis and were present in over 50% of cases of infection. Perinatal results were worse in cases of respiratory disease, with increased prematurity, stillbirth, low birth weight and Apgar <7. HIV/AIDS, hysterectomy, prolonged hospitalization, ICU admission and delays in care were independent factors associated with severe maternal outcome. Conclusion: infections and especially those caused by A(H1N1)pdm09 presented great impact on maternal morbidity and mortality in Brazil and the identification of factors associated with the increased severity can contribute to the improvement of obstetric care. There is need for specific interventions during pregnancy, seeking early diagnosis and timely treatment of infections, which are essential for improving maternal health and to reducing the number of preventable maternal deaths in the country
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde
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Figueirêdo, Rudgy Pinto de. "O estudo da morbidade materna e do concepto em uma maternidade pública de João Pessoa, Paraíba". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-13032014-083803/.
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Introdução - O estudo da morbidade materna contribui para um melhor entendimento do quadro da saúde materna, no Brasil, e para o conhecimento dos problemas obstétricos que podem levar (ou não) ao internamento das gestantes. Os dados de morbidade materna são vitais para os gestores de políticas públicas de saúde, os quais precisam saber quantas mulheres necessitam de cuidados obstétricos básicos para tornar a gestação e o parto mais seguros. Objetivos - Estudar a morbidade materna e os conceptos de puérperas numa maternidade da rede pública de João Pessoa, Paraíba, e identificar mulheres com diagnósticos considerados potencialmente graves e sugestivos de morbidade materna near miss. Método - Trata-se de um estudo transversal que fez parte de uma pesquisa maior sobre a morbimortalidade materna. Foi selecionada uma amostra de 414 puérperas por um processo de amostragem aleatória sistemático, cujos dados foram coletados, prospectivamente, de setembro a novembro de 2011, a partir dos prontuários clínicos e entrevistas complementares, numa maternidade pública de referência e acentuada demanda no município. Resultados - Foram estudadas 383 gestações que terminaram em parto e 391 conceptos. Entre as puérperas, predominou a faixa etária dos 20 aos 34 anos, cor parda, baixa escolaridade, baixa renda e sem ocupação formal no mercado de trabalho. Metade delas tiveram parto cesariano e 17 por cento dos recém-nascidos apresentaram problemas de saúde. Foram identificadas as seguintes intercorrências no parto: lacerações do períneo, hematomas, traumatismos, hemorragias e hipertensões. No puerpério, destacaram-se os transtornos hipertensivos, as hemorragias do pós-parto e as infecções. Entre os 64 diagnósticos sugestivos de near miss, estão as síndromes hipertensivas (58 por cento ) e as síndromes hemorrágicas (32,8 por cento ). Na análise comparativa entre os grupos de puérperas com morbidades sugestivas e não sugestivas de near miss, as seguintes variáveis apresentaram diferenças estatisticamente significantes (p<0,001): problemas de saúde na gestação anterior e atual, hipertensão, gestação de risco e uso de anti-hipertensivos. Não foram encontradas diferenças estatísticas entre as características dos neonatos e a morbidade materna, sugestiva ou não de near miss. Conclusão - O estudo permitiu conhecer as características maternas e a prevalência (15,5 por cento ) de morbidades sugestivas de near miss que ocorrem, seja no parto seja no puerpério. Ampliar o conhecimento sobre os aspectos que envolvem a morbidade materna torna-se crucial para o adequado enfrentamento de complicações no ciclo gravídico-puerperal, além de apoiar o Plano de Ação para acelerar a redução da mortalidade materna e morbidade materna grave.Introduction The study of maternal morbidity contributes to a better understanding of the maternal health scene in Brazil and to the fuller knowledge of obstetric problems that may lead (or not) to the hospitalization of pregnant women. Maternal morbidity data are vital for the administrators of public health policies, who need to know how many women are expected to need basic obstetric care so as to make pregnancy and delivery safer. Objectives To study maternal morbidity and the conceptuses of puerperae in a public maternity hospital in João Pessoa, Paraíba, and identify women with a diagnosis considered potentially threatening and suggestive of being possible near misses. Method - This is a transverse study that is part of a larger project on maternal morbimortality. A sample of 414 puerperae was selected by a process of systematic random sampling, the data on whom were collected, prospectively, from September to November 2011, on the basis of clinical case notes and complementary interviews, at a public maternity hospital of reference in great demand in the municipality. Results - A total of 383 pregnancies which were carried through to delivery and 391 conceptuses were studied. There predominated, among the puerperas: the 20 - 34 year age-group, of brown skin color, low level of schooling, low income and no formal professional occupation. Half of them underwent caesarian section and 17 per cent of the new-born presented health problems. The following incidents were identified during labour: lacerations of the perineum, haematomas, traumatisms, haemorrhages and hypertensions. During the puerperium, hypertensive disorders, post-partum hemorrhage and other puerperal infections were noteworthy. The most frequent mention in the case notes of maternal causes was of hypertensive disturbances of pregnancy. Among the 64 diagnoses suggestive of near-miss, are the hypertensive (58 per cent ) and the haemorrhagic syndromes (32.8 per cent ). In the comparative analysis of the groups of puerperae with morbidities suggestive of near-miss, the following variables presented statistically significant differences (p<0.001): health problems during the previous and present pregnancy, hypertension, risk pregnancy and use of hypertensive medications. No statistical differences between the characteristics of the newborn and those of maternal morbidity (whether suggestive of near miss or not) were found. Conclusion - The study allowed the identification of maternal characteristics and the prevalence (15.5 per cent ) of the morbidities suggestive of maternal near-miss which occur either during labour or puerperium. It is crucial that our knowledge of the aspects of maternal mortality should be expanded so that the complications of the pregnancy-puerperal cycle may be adequately treated and to provide support for the Action Plan to speed up the reduction of maternal mortality and severe maternal morbidity.
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McBride, Carole Anne. "Maternal Hypertension Influences Mortality and Severe Morbidity in Infants Born Extremely Preterm". ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/598.
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Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within the lowest 10th percentile). Within this high risk population, SGA infants have increased risk of mortality compared to appropriate for gestational age infants. Therefore the impact of maternal HTN on neonatal outcome might be presumed to be negative. Previous studies however, have been contradictory, with both higher and lower rates of infant mortality reported in infants born to mothers with HTN, as well as differing reports analyzing the relationship between serious morbidity and maternal HTN.
Utilizing the Vermont Oxford Network Very Low Birth Weight database, a collaborative database of Level III Neonatal Intensive Care Units across the world, 88,275 North American infants born between 22+0 and 29+6 weeks gestational age between 2008 and 2011 were identified. This dissertation explores the relationship between maternal HTN and gestational age at time of birth within this population, and the reported rates of morbidity and mortality in infants born prior to 30 weeks gestation. The independent contributions of maternal HTN with neonatal morbidity and mortality in our population were estimated using logistic regression and adjusting for factors previously known to be associated with risk, including birth weight, antenatal steroid exposure, infant sex, maternal race/ethnicity, prenatal care, inborn/outborn status, and birth year. We hypothesized that mortality rates would be lower for infants born to mothers with HTN compared to those born due to other factors, when corrected for the noted confounding variables and surviving infants would have better prognoses, as evidenced by lower rates of severe morbidity, including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and infection. Within the higher-risk SGA population, we hypothesized that mortality rates would be higher than observed in appropriately grown infants, but decreased in those born to mothers with HTN, despite the association between maternal HTN and SGA.
This dissertation begins with an explanation of current knowledge about preterm birth, maternal HTN, and their associations. Chapter 2 focuses on the relationship between maternal HTN and infant mortality in extremely preterm infants. Chapter 3 examines the risk associated with severe morbidities in surviving infants. In addition, we also use a combined morbidity risk assessment score which has previously been used to determine future risk of long term disability. In Chapter 4, SGA infants are separately evaluated for their risk of mortality and the association with maternal HTN.
These analyses support the high mortality and morbidity rates seen in extremely preterm infants. Maternal HTN, after adjustment, results in reduced risk of both mortality and severe morbidities in infants compared to infants born to mothers with other underlying contributors to preterm birth. This suggests that clinical practices and parental counseling should reflect differing risk profiles in sub-populations of extremely preterm infants.
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Lima, Hesly Martins Pereira. "Factors associated with severe morbidity and maternal near miss in tertiary centre of attention to maternal and newborn". Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16482.
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nÃo hÃA pregnancy can be composed of a range of clinical conditions, ranging from a healthy pregnancy to another limit that is maternal death. Between these two extremes are the conditions described as severe maternal morbidity and near miss, which is a more severe condition than the maternal morbidity. In 2009, the WHO standardized maternal near miss approach, as an important tool to uniformly identify cases and evaluate the quality of care for women with serious complications. It is worth emphasizing that women who fall into these situations share many characteristics with maternal deaths, but represent a rich source of details about the determinant factors of their maternal health condition, since they are alive. Participated in this research 941 women who had severe maternal morbidity criteria and/or near miss during the period of July 2009 to June 2010, at the Maternity School Assis Chateaubriand - UFC. They were identified 61 cases of maternal near miss and 880 of severe maternal morbidity non-near miss. The incidence of maternal morbidity non-near miss was 190.6 and near miss was 10.8/1,000 live births. The mortality rate of maternal near miss was 18%. The variables significantly different between the two groups were: color (p = 0.002) and number of prenatal visits (p <0.001). Among the severe maternal morbidity conditions, it was found that eclampsia and the need for ICU admission were the defining of the risk of progressing to death, while the use of magnesium sulfate acted as a protective factor. It was found, also, that have criteria of near miss is statistically significant for maternal death (p <0.001; ORB = 3.94; 95% CI: 1.66 - 9.37). Among the defining criteria of near miss, the more directly associated with maternal death was the presence of management criteria: all the 11 cases that resulted in death had some management discretion. It was concluded that based health policies and actions in cases of maternal near miss is the most effective means of improving maternal health.
Uma gravidez pode ser constituida por uma gama de condiÃÃes clÃnicas, que vÃo desde uma gravidez saudÃvel atà o outro limite que à a morte materna. Entre os extremos encontram-se as condiÃÃes descritas como morbidade materna grave e near miss, que à uma condiÃÃo mais grave do que a morbidade materna. Em 2009, a OMS padronizou a abordagem near miss materno, como uma ferramenta importante para identificar uniformemente os casos e avaliar a qualidade dos cuidados prestados Ãs mulheres com complicaÃÃes graves. Vale enfatizar, que as mulheres que se enquadram nestas situaÃÃes compartilham muitas caracterÃsticas com os Ãbitos maternos, porÃm representam uma fonte rica de detalhes acerca dos fatores determinantes da sua condiÃÃo de saÃde materna, uma vez que estas estÃo vivas. Participaram da presente pesquisa 941 mulheres que possuÃam critÃrios de morbidade materna grave e/ou near miss durante o perÃodo de julho de 2009 a junho de 2010, na Maternidade-Escola Assis Chateaubriand-UFC. Foram identificados 61 casos de near miss materno e 880 de morbidade materna grave nÃo-near miss. A incidÃncia de morbidade materna nÃo-near miss foi de 190,6 e near miss foi de 10,8/1.000 nascidos vivos. A taxa de mortalidade de near miss materno foi de 18%. As variÃveis significativamente diferente entre os dois grupos foram: cor (p=0,002) e nÃmero de consultas de prÃ-natal (p<0,001). Dentre as condiÃÃes de morbidade materna grave, verificou-se que a eclÃmpsia e a necessidade de internaÃÃo em UTI foram os definidores do risco de evoluir ao Ãbito, enquanto a utilizaÃÃo do sulfato de magnÃsio atuou como fator de proteÃÃo. Constatou-se que ter critÃrio de near miss à estatisticamente siginificante para a morte materna (p < 0,001; ORB= 3,94; IC95%:1,66-9,37). Entre os critÃrios definidores de near miss, o mais diretamente associado ao Ãbito materno foi à presenÃa de critÃrios de manejo: todos os 11 casos que culminaram em Ãbito apresentaram algum critÃrio de manejo. Concluiu-se que basear polÃticas e aÃÃes de saÃde nos casos de near miss materno à o meio mais eficaz de melhorar a saÃde materna.
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Oliveira, Júnior Fernando Cesar de 1952. "Morbidade materna grave e near miss nos extremos da vida reprodutiva : Severe maternal morbidity and near miss in extremes of reproductive life". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309270.
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Orientadores: Fernanda Garanhani de Castro Surita, João Luiz Pinto e SilvaTese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: conhecer a prevalência e fatores associados à morbidade materna grave (MMG), nas formas de condições potencialmente ameaçadoras da vida (CPAV) ou near miss (NM), e à mortalidade materna (MM) em mulheres nos extremos da idade reprodutiva. Métodos: foram realizadas duas abordagens: a primeira, uma análise secundária do banco de dados da Pesquisa Nacional de Demografia e Saúde (PNDS) brasileira de 2006, através de um questionário para avaliar a ocorrência de complicações maternas. Utilizou-se a definição pragmática em que qualquer mulher relatando a ocorrência de eclâmpsia, histerectomia, transfusão de sangue ou internação em unidade de terapia intensiva era considerada como um caso de near miss. Associações entre os extremos da idade reprodutiva (adolescentes e mulheres com 35 a 49 anos) e morbidade materna grave foram avaliados. Para a análise foram realizadas proporções e razões das complicações e intervenções relacionadas definidas como near miss e o risco estimado para morbidade materna. A segunda abordagem foi à análise secundária do estudo de corte transversal multicêntrica, implementado em 27 unidades obstétricas de referência nas cinco regiões geográficas do Brasil e criado para identificação dos casos de morbidade materna grave. Realizou-se vigilância prospectiva das mulheres internadas durante o período de 12 meses. Foram analisados os dados relativos à ocorrência de MM, NM e CPAV na faixa etária da adolescência (10 a 19 anos) e nas gestantes mais velhas (com 35 anos ou mais) usando como referencia mulheres entre 20 e 34 anos. Calcularam-se as razões de prevalência (RP) e os intervalos de confiança a 95%, ajustados por conglomerados para as variáveis maternas epidemiológicas, obstétricas, clínicas e de demoras. Realizou-se análise múltipla por regressão de Poisson. Resultados: Na primeira abordagem foram encontradas 6833 gestações sendo, 73,7% em mulheres entre 20 e 34 anos, 17,9% em mulheres com 35 anos ou mais e 8,4% em adolescentes. A única variável diferente entre os grupos foi à necessidade de transfusão sanguínea, mais prevalente entre os controles. Houve tendência de aumento nas razões de NM com o aumento da idade materna. O único fator de risco identificado foi menor escolaridade entre as mulheres com 35 anos ou mais. Na segunda abordagem foram encontrados 17% de adolescentes e 17% de mulheres com 35 anos ou mais. As prevalências de NM e MM foram maiores entre as mulheres com 35 anos ou mais. NM e MM aumentaram com o aumento da idade da mulher, mas também foram muito elevados no extremo inferior da idade, ou seja, entre as adolescentes com 10 a 14 anos. Na análise multivariada, a adolescência não foi um fator de risco independente, enquanto a idade de 35 anos ou mais o foi (RP 1.25; 1.07-1.45). Conclusões: NM e MM aumentaram com o aumento da idade maternal, com exceção do grupo de adolescentes entre 10 e 14 anos, que também apresentou maiores riscos de NM e MM
Abstract: Objective: to assess the prevalence and factors associated with severe maternal morbidity (SMM), considering the definitions: potentially life-threatening conditions (PTLC), maternal near miss (MNM) and maternal mortality (MM) in women at the extremes of reproductive age. Methods: Two methodological approaches were programmed: the first was a secondary analysis of the 2006 Brazilian Demographic Health Survey (DHS) database that was conducted through a previously validated questionnaire to evaluate the occurrence of maternal complications. We used a pragmatic definition in which any woman reporting the occurrence of eclampsia, hysterectomy, blood transfusion, or hospitalization in the intensive care unit was considered as a case of near miss. Associations between the extremes of reproductive age (adolescents and women aged 35 to 49 years) and SMM were assessed. For this analysis proportions and ratios related to complications and interventions defined as near miss and the estimated risk for maternal morbidity were performed. The second approach was a secondary analysis of a cross-sectional multicenter study, implemented in 27 referral obstetric units in all five geographic regions of Brazil, created to identify cases of SMM, using prospective surveillance of hospitalized women during twelve months. We analyzed the data on the occurrence of MM, MNM and PTLC in teenagers (10 to 19 years) and in older pregnant women (aged 35 or more) using as reference women between 20 and 34 years. We calculated prevalence ratios (PR) with confidence intervals of 95% adjusted for conglomerates. Maternal variables, epidemiological, obstetric, and clinical and delays were considered. Statistical Analysis was performed by multiple Poisson regression. Results: In the first approach 6833 pregnancies were considered, 73.7% in women aged 20-34 years, 17.9% in women 35 years or older and 8.4% in adolescents. The only difference between groups was the need for blood transfusion, more prevalent among controls. There was a tendency of increase in the ratios of MNM with increasing maternal age. The only risk factor identified was lower education among women aged 35 years or more. In the second approach we found 17% of adolescents and also 17% of women aged 35 or more. The prevalence of MNM and MM was higher among women with 35 years or more. MNM and MM increased with increasing age, but were also very high at the lowest end of the age, among adolescents aged 10-14 years. In multivariate analysis. Adolescence was not an independent risk factor while age of 35 years or more was (PR 1.25; CI 1:07 to 1:45). Conclusions: MNM and MM increases with increasing maternal age, exception made to the group of adolescents aged 10-14 that also has a higher risk of NM and MM
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
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Bique, Osman Nafissa. "The impact of maternal morbidity on fetal growth and pregnancy outcome in Mozambique /". Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-3971-3/.
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Kabagambe, Agaba Daphine. "Analysing human rights accountability towards ending preventable maternal morbidity and mortality in Uganda". University of the Western Cape, 2018. http://hdl.handle.net/11394/6311.
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Doctor Legum - LLDThe persistence of preventable Maternal Morbidity and Mortality (hereafter MMM), in the developing world, despite ground breaking technological and scientific advances, is unacceptable. There is no cause of death and disability for men between ages 15 and 44 that comes close to the large scale of maternal mortality and morbidity.1 Thus, the prevalence of high MMM ratios indicates the side-lining of women's rights. Surprisingly, the causal factors of preventable MMM and interventions needed to reverse the pervasively high numbers are now well known. Yet, hundreds of women continue to die daily and to suffer lifelong illnesses while giving birth. In Uganda, despite various regulatory, policy and programmatic strategies, the most recent survey revealed that the maternal mortality ratios were at a staggering 438 per 100,000 live births.2 This study attributes the continued prevalence of high MMM rates to lack of accountability that would ensure services and resources are being maximized and redistributed equitably. Lack of effective accountability mechanisms in place encourages unbridled financial, human and technical resource wastage, diversion, non-utilization and embezzlement of funds. It is not enough that medical equipment, personnel and finances are increasingly being allocated to the health sector by the Government. Without effective tracking and supervisory mechanisms, these additional financial, technical and human resource allocation will most likely not translate into reduced MMM rates. Sadly, in Uganda, the role of accountability towards the operationalization of human rights is underappreciated. In fact, many health sector practitioners are unaware of the ways in which accountability can be implemented. Despite the recent infiltration of the term 'accountability' into laws and policies, it remains an elusive and fuzzy concept. Further still, as demonstrated throughout the study, accountability has been popularized by international and regional human rights monitoring mechanisms such as the UN treaty bodies, African Commission but at the domestic level, great strides have yet to be made in infusing human rights accountability into laws, policies, programs and practices in a way that will reverse the high MMM. The domestication of accountability is vital because human rights ideals are only turned into actual implementable strategies at the national level. A direct focus on Uganda would allow for the undertaking of the country's own specific challenges within its domestic context.
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Kabagambe, Agaba Daphine. "Analysing human rights accountability towards ending preventable maternal morbidity and morality in Uganda". University of the Western Cape, 2017. http://hdl.handle.net/11394/6304.
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Doctor Legum - LLDThe persistence of preventable Maternal Morbidity and Mortality (hereafter MMM), in the developing world, despite ground breaking technological and scientific advances, is unacceptable. There is no cause of death and disability for men between ages 15 and 44 that comes close to the large scale of maternal mortality and morbidity. Thus, the prevalence of high MMM ratios indicates the side-lining of women's rights. Surprisingly, the causal factors of preventable MMM and interventions needed to reverse the pervasively high numbers are now well known. Yet, hundreds of women continue to die daily and to suffer lifelong illnesses while giving birth. In Uganda, despite various regulatory, policy and programmatic strategies, the most recent survey revealed that the maternal mortality ratios were at a staggering 438 per 100,000 live births.
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Gilbert, Ann, i Dr Erin Harmeyer. "White-Black Disparity in Maternal Mortality and Morbidity: An Exploration of Risk Factors". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/secfr-conf/2020/schedule/25.
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Black expectant mothers are more likely to die from pregnancy-related complications than white expectant mothers. While researchers have long documented this disparity, the gap persists. The purpose of this literature review is to describe the white-black disparity in maternal mortality and morbidity, identify racism and discrimination across multiple ecological systems as a primary driver of this disparity, and suggest implications of this for social work practice. This review presents basic statistics and means of data collection regarding this disparity, acknowledges known risk factors for pregnancy-related deaths, and identifies the association between racism and discrimination in healthcare settings and this white-black disparity. A bioecological framework will be used to further analyze the implications of racism on multiple ecological systems. The conclusion presents existing interventions and provides recommendations for social workers regarding this healthcare disparity.
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Womack, Lindsay Shively. "Severe Maternal Morbidity in Florida: Risk Factors and Determinants of the Increasing Rate". Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6783.
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Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011. In an effort to reduce these increasing complication rates, clinicians and researchers have emphasized the need to identify potential modifiable risk factors for severe maternal morbidity, and the need to study the relationships between these risk factors and severe maternal morbidity. The overall goal of this study is to improve the understanding of the increasing rates of severe maternal morbidity.
The objective of the first study is to examine the association between prepregnancy BMI and severe maternal morbidity in women residing in Florida who had a live birth during 2007-2014. Additionally, the specific association between prepregnancy BMI and the most common individual conditions that comprise the composite measure of severe maternal morbidity will also be examined. We conducted a population-based retrospective cohort study using Florida’s linked birth certificate and maternal hospital discharge data for the years 2007-2014. The risk of severe maternal morbidity associated with BMI was then estimated by odds ratios (OR) and 95% confidence intervals (CI) derived using generalized estimating equations (GEE) for logistic regression. This final model was rerun separately for the most common conditions that comprise severe maternal morbidity as the outcome measure to assess differences by type of condition. Unadjusted rates of severe maternal morbidity increased with increasing BMI; however, after risk adjustment overweight and obese women had slightly protective odds of severe maternal morbidity when compared with normal weight women. The association between prepregnancy BMI and severe maternal morbidity differs by types of severe maternal morbidity. A protective dose-response relationship was seen for blood transfusion and disseminated intravascular coagulation, with the odds of morbidity decreasing with increasing BMI. The odds of heart failure, adult respiratory distress syndrome, and ventilation all increased with increasing BMI. This study shows that severe maternal morbidity is a complex measure and not just a single condition. In future studies, it will be imperative to analyze severe maternal morbidity as a composite measure and as individual conditions to identify modifiable risk factors to focus on for interventions.
The objective of the second study is to identify potential determinants of the increase in the rate of severe maternal morbidity among women residing in Florida who had a live birth during 2005-2014. We examined severe maternal morbidity rates and related risk factors in live births to Florida women between 2005 and 2014, using Florida’s linked birth certificate and hospital discharge data. We initially conducted a Kitagawa analysis to evaluate the components of the increased rate of severe maternal morbidity between 2005 and 2014. Additionally, we performed a multivariable regression analysis to estimate the contribution of the multiple factors to differences in the rate of severe maternal morbidity in 2005 and 2014. The rate of severe maternal morbidity in 2014 was 19.3 per 1,000 live births, which was 1.65 times higher than the rate in 2005. Nearly all of the excess severe maternal morbidity and blood transfusions in 2014 can be explained by differences in the rate of severe maternal morbidity and blood transfusion between the two time periods. In total, sociodemographic factors, medical factors, and individual and hospital health service factors explained 9.1% of the overall severe maternal morbidity increase in 2014 compared with 2005, and only explained 2.5% of the increase in blood transfusions during this time period. Our study findings indicate that the increase in the rate of severe maternal morbidity is comprised almost entirely by an increase in the rate of blood transfusions. Further research will need to be conducted to explain the increase in the rate of severe maternal morbidity and blood transfusions.
Consistent with national trends, the rates of severe maternal morbidity have been increasing in Florida. This increase is driven almost entirely by blood transfusions and cannot be explained by traditional factors that are readily available in current datasets. In addition to the differences between the trends of blood transfusions and the 20 severe maternal morbidity conditions, there are also differences in risk factors associated with these different conditions. Prepregnancy overweight and obesity is associated with a protective effect with blood transfusions and disseminated intravascular coagulation that is not seen in the other conditions. Therefore, initiatives to decrease the rates of severe maternal morbidity will need to take these differences into account.
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Giordano, Juliana Camargo 1980. "A carga da eclampsia : resultados de um estudo multicêntrico de vigilância da morbidade materna grave no Brasil = The burden of eclampsia : results from a multicenter study on surveillance of severe maternal morbidity in Brazil". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309202.
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Orientador: Mary Angela ParpinelliDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A mortalidade materna (MM) é um forte indicador de disparidades nos direitos das mulheres. O estudo dos casos de Near Miss (NM) é estratégico para identificar falhas no atendimento obstétrico. Em números absolutos, tanto MM quanto a ocorrência de eclâmpsia são eventos raros. Objetivo: avaliar os principais preditores de desfecho maternal grave (DMG: NM materno e MM) para eclâmpsia. Métodos: análise secundária de um estudo transversal, multicêntrico, incluindo 27 unidades obstétricas de referência de todas as cinco regiões do Brasil, entre 2009/2010. Foram identificados 426 casos de eclâmpsia e classificados de acordo com os resultados: DMG e não-DMG. As regiões brasileiras foram divididas em regiões de menor e maior renda e calculados os indicadores de cuidados obstétricos pela OMS. SPSS® e Stata® softwares foram utilizados para avaliar as características maternas, história clínica e obstétrica e o acesso aos serviços de saúde como preditores para a DMG, e correspondentes resultados perinatais, através do cálculo das razões prevalência (RP), respectivos intervalos de confiança de 95% (IC) e ainda aplicada à análise de regressão múltipla de Poisson (ajustada para o efeito cluster). Resultados: a prevalência e o índice de mortalidade por eclâmpsia em regiões de menor e maior renda foram de 0,8% / 0,2% e 8,1% / 22%, respectivamente. Dificuldades no acesso aos serviços de saúde: internação em UTI (RP ajustada 3,61, IC 95% 1,77-7,35) e monitorização inadequada (RP ajustada 2,31, IC 95% 1,48-3,59) foram associadas com DMG, também a morte perinatal foi maior neste grupo (RP ajustada 2,30; IC de 95% 1,45-3,65). Conclusão: a morbidade / mortalidade associada com eclâmpsia foi elevada no Brasil, especialmente nas regiões de baixa renda. A qualificação do atendimento à saúde materna e melhorias nos atendimentos das emergências são essenciais para aliviar a carga de eclâmpsia
Abstract: Background: Maternal mortality (MM) is a core indicator of disparities in women rights. Studying Near Miss cases is strategic to identify breakdowns in obstetrical care. In absolute numbers, both MM and the occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). Methods: secondary analysis of a multicentre cross-sectional study, including 27 referral obstetric units from all five regions of Brazil, from 2009/2010. 426 cases of eclampsia were identified and classified according to outcomes: SMO and non-SMO. We divided Brazilian regions in lower and higher income regions and calculated the obstetric care indicators by WHO. SPSS® and Stata® softwares were used to assess the maternal characteristics, clinical and obstetrical history, access to health services as predictors for SMO, and correspondent perinatal outcomes, by calculating the prevalence ratios (PR), respective 95% confidence interval (CI) and also applying Poisson multiple regression analysis (adjusted for cluster effect). Results: prevalence and mortality index for eclampsia in lower and higher income regions were0.8%/ 0.2% and 8,1%/ 22%, respectively. Difficulties on access health care: ICU admission (adjPR 3.61; 95%CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95%CI 1.48-3.59) were associated with SMO, also perinatal death was higher in this group (adjPR 2.30; 95%CI 1.45-3.65). Conclusions: morbidity/mortality associated with eclampsia were high in Brazil, especially in lower income regions. Qualifying maternal health and improvements in emergency care are essential to relieve the burden of eclampsia
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde
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Chaves, Solange da Cruz 1957. "Transição obstétrica e os caminhos da redução da mortalidade materna = Obstetric transition and the pathways for maternal mortality reduction". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312735.
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Orientadores: João Paulo Dias de Souza, José Guilherme CecattiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivos: Avaliar se as características propostas da Transição Obstétrica ¿ um modelo conceitual criado para explicar as mudanças graduais que os países apresentam ao eliminar a mortalidade materna evitável ¿ são observadas em um grande banco de dados multipaíses sobre a saúde materna e perinatal.Métodos: Trata-se de análise secundária de um estudo transversal da OMS que coletou informações de todas as mulheres que deram à luz em 359 unidades de saúde de 29 países da África, Ásia, América Latina e Oriente Médio, durante um período de 2 a 4 meses entre 2010 e 2011. As razões de Condições Potencialmente Ameaçadoras da Vida (CPAV), Resultados Maternos Graves (RMG), Near Miss Materno (NMM), e Mortalidade Materna (MM) foram estimadas e estratificadas por estágio de transição obstétrica. Resultados: Dados de 314.623 mulheres incluídas neste estudo demonstram que a fecundidade das mulheres, indiretamente estimada pela paridade, foi maior nos países que estão em estágio menor da transição obstétrica, variando de uma média de 3,0 crianças por mulher no Estágio II para 1,8 crianças por mulher no Estágio IV. O nível de medicalização do nascimento nas instituições de saúde dos países participantes, avaliada pelas taxas de cesárea e de indução de trabalho de parto, tendeu a aumentar à medida que os estágios de transição obstétrica aumentam. No Estágio IV, as mulheres tiveram 2,4 vezes a taxa de cesáreas (15,3% no Estágio II e 36,7% no Estágio IV) e 2,6 vezes a taxa de indução de trabalho de parto (7,1% no Estágio II e 18,8% no Estágio IV) que as mulheres de países no Estágio II. À medida que os estágios da transição obstétrica aumentaram, a média de idade das primíparas também aumentou. A ocorrência de ruptura uterina apresentou uma tendência decrescente, caindo aproximadamente 5,2 vezes, de 178 para 34 casos para 100 000 nascidos vivos à medida que os países transicionaram do Estágio II para o Estágio IV. Conclusões: Esta análise corroborou o modelo da Transição Obstétrica utilizando um banco de dados de grande porte e multipaíses. O modelo da Transição Obstétrica pode justificar a individualização da estratégia de redução da mortalidade materna de acordo com os estágios da transição obstétrica de cada país
Abstract: Objectives: To test whether the proposed features of the Obstetric Transition Model¿a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality¿are observed in a large, multicountry, maternal and perinatal health database. Methods: This was a secondary analysis of a WHO cross-sectional study that collected information on all women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2¿4-month period in 2010 ¿ 2011. The ratios of Potentially Life-threatening Conditions (PLTC), Severe Maternal Outcomes (SMO), Maternal Near Miss (MNM) and Maternal Death (MD) were estimated and stratified by stages of obstetric transition. Results: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. The level of medicalization in health facilities in participating countries, defined by the number of caesarean deliveries and number of labor inductions, tended to increase as the stage of obstetric transition increased. In Stage IV, women had 2.4 times the caesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) than women in Stage II. As the stages of obstetric transition increased, the mean age of primiparous women also increased. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. Conclusions: This analysis supports the concept of obstetric transition using multicountry data. The obstetric transition model could provide justification for customizing strategies for reducing maternal mortality according to a country¿s stage in the obstetric transition
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde
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Lomalisa, Litenye. "Causes of maternal deaths and severe acute maternal morbidity in a regional hospital in the Northwest Province of South Africa". Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7030_1254736307.
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Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006.
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Mgonja, Miriam Lucy. "Integrated studies addressing the incidence of severe maternal morbidity (SMM) in Kilombero district, Tanzania". Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/28620.
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Severe maternal morbidities (SMM) are a diverse range of serious complications which occur during pregnancy, childbirth and the post-natal period (six weeks after childbirth). They can affect any of the body organ systems, and their severity means that if untreated, or wrongly treated, maternal death is likely to result. Therefore prevention of maternal death requires better understanding of the epidemiology and outcome of the various forms of SMM . Tanzania is among developing countries in the world having a high maternal mortality ratio (454 per 100,000 live births), but there are few published evidence addressing all major forms of SMM in Tanzania. Not all pregnant Tanzanian women use health facilities for antenatal care or delivery, not even for treatment in the event of a complication. Therefore ascertaining the level of SMM in health facilities will not give a true estimation of the incidence among all pregnant women. While ascertaining SMM in the community would therefore seem to be a preferable approach, there are considerable practical barriers to executing such research in rural areas of developing countries. Furthermore previous studies have raised concerns about the reliability and validity of women's self report of obstetric complications, especially when such report is retrospective. This PhD research has therefore taken two complementary approaches: (1) At St Francis Referral Hospital, Kilombero, Tanzania, using hospital routine data with case note review of all admissions experiencing complications, it has ascertained over the course of a full calendar year, the incidence and outcome of SMM, and associated risk factors (N = 5500 total admissions, n=1723 with case note review); (2) By undertaking a community interview survey in that hospital's rural catchment area, to determine the incidence of SMM via women's self reporting of symptoms. This survey attempted to interview all women in selected villages that are subject to the Ifakara Centre Demographic Surveillance System (IC-DSS), and who were recorded by IC-DSS as having given birth over the same time-frame (690 were interviewed, while 663 had given birth during study period). Validation of self-reporting of SMM was undertaken using interview response data of the subset of 173 interviewees who had attended St Francis hospital for obstetric delivery/treatment during the study interval, and for whom hospital diagnosis made at that time were therefore also available. In the hospital study, the incidence of both intrapartum (IP) and postpartum (PP) SMM (among all women delivering there or admitted postpartum) was 19.2% , with a case fatality rate of 1.7%. The incidence of solely intrapartum SMM was 17.2%, the rate being higher among primigravida than among multigravid (28% v 8% , p < 0.001), among teenagers than older women (23% v 14%, p < 0.001) and single women than among other women (68.1% v 48.7% , p < 0.001). Among 909 intrapartum SMM, the three commonest conditions were obstructed labour (69%), eclampsia (14%) and severe preeclampsia (9%) while in the 258 postpartum SMM, the three commonest conditions were postpartum eclampsia (26%), puerperal sepsis (24%) and postpartum haemorrhage (23%). Neonatal death was more common among women with intrapartum SMM than among other deliveries (4.7 % v 1.1%, p < 0.001). There were no intra partum maternal deaths, but across all antenatal, intra partum and postpartum admissions, maternal mortality was four-fold greater among women admitted in critical condition than among other women (2.1% v 0.5%, p = 0.006). The majority of the women who became maternal deaths were admitted in critical condition (11/17). Among Ifakara IC-DSS women interviewed, the majority had used health facilities at some level for obstetric care (64.7%), and affirmed prior birth and emergency complication readiness plans (97.6% & 81.5%). The incidence of any SMM (antenatal to postnatal, derived from self reported symptoms by interviewees) was 16.7% ; while for both intra partum and postpartum SMM, the incidence was 15.4%, lower than that of the hospital study (19.2%). Considering solely intra partum (interview-ascertained) SMM, the rate was 8.1% (n=54), lower than the corresponding estimate of 17.2% from the hospital study. Validation interview-ascertained intra partum SMM classification could be undertaken in the subset of 173 who had delivered in St Francis hospital. Of these, 48 could be matched with the list of names of hospital admissions subjected to case note-review (i.e. all deliveries with any evidence of complications), while the remainder had no hospital-ascertained complication even (and hence must be presumed to be 'normal deliveries'). In this group, interview-ascertained IP SMM rate was 21.4%, and the sensitivity and specificity for interview-ascertained IP SMM were 59.3% (16/27) and 85.6% (125/146) respectively. This is the first study in Tanzania to address the incidence of all intra partum and postpartum severe morbidities, using both retrospective review of referral hospital data/records and an interview survey in the surrounding rural community. The research findings have described the relative frequency of various subtypes of SMM, and the relationship of SMM to sociodemographic and obstetric factors and to maternal-foetal outcome. Such information will be helpful for clinicians and maternity staff to understand the pattern of SMM and how the hospital is performing in treating SMM cases. The finding that maternal death is so strongly associated with admission in critical condition emphasises the importance of addressing factors that delay admission of pregnancies that develop complications. In the thesis the findings from the research studies will be elaborated and the challenges of such research will be discussed. While the sample size for validation of intra partum SMM was too small to be able to make conclusive remarks, the finding of borderline sensitivity will be discussed in relation to specific morbidities and the reliability of the hospital data 'gold standard' comparator. With a pragmatic approach one can undertake research on SMM that enhances understanding of the complexities of SMM and its measurement, while also imparting knowledge on the epidemiology of the condition and potential actions that could be considered to improve outcome for SMM.
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Okong, Pius. "Maternal morbidity in Uganda : studies on life-threatening pregnancy complications in low-income settings /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-127-X/.
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Strand, Roland T. "Severe maternal morbidity in Angola : studies on postpartum haemorrhage, jaundice and clinic-based audit /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-356-6/.
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Patel, Roshni Raman. "Operative delivery : its associations and subsequent maternal and infant morbidity : analyses from the ALSPAC Cohort". Thesis, University of Bristol, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432939.
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Meyer, Laurence. "Maternal and neonatal morbidity in instrumental deliveries with the Kobayashi vacuum extractor and low forceps". Master's thesis, Université Laval, 1985. http://hdl.handle.net/20.500.11794/33570.
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335941 La ventouse obstétricale facilite l'extraction du foetus dans les accouchements difficiles. Récemment une nouvelle ventouse en Silastic a été introduite en Amérique du Nord. L'objectif de cette recherche était de documenter les risques maternels et néonataux associés à l'utilisation, comme premier instrument, de la ventouse en Silastic de Kobayashi ou de forceps bas. L'étude concernait les femmes ayant accouché à l'Hôpital Saint-Sacrement de Québec entre juillet 1982 et novembre 1984. Les sujets éligibles devaient avoir eu une grossesse unique et un accouchement, à 37 semaines de gestation ou plus, ayant nécessité une instrumentation vaginale sur un vertex en station basse. Etaient exclues les instrumentations avec manoeuvres de rotation de 45 degrés ou plus. Deux cent quatre-vingt-treize accouchements par ventouse ont été comparés à 468 accouchements par forceps bas. Vingt-neuf instrumentations par ventouse avaient nécessité l'application de forceps bas pour compléter l'accouchement. Ces 29 observations ont été incluses dans le groupe des ventouses, selon le premier instrument utilisé. Le groupe des forceps constituait le groupe de référence. Les risques relatifs ont été ajustés, le cas échéant, par la méthode de Mantel-Haenszel. Les deux groupes étaient similaires pour la parité, l'âge maternel, l'âge gestationnel, et le poids de naissance. Par comparaison aux accouchements par forceps, les accouchements par ventouse étaient plus souvent effectués par des obstétriciens-gynécologues et plus souvent déclenchés médicalement. Dans le groupe des ventouses, l'anesthésie péridural e était moins fréquemment pratiquée et l'existence d'une détresse foetale était deux fois moins souvent mentionnée. Les déchirures périnéales du troisième ou du quatrième degré, les lacérations vaginales et cervicales, et la pose d'une sonde urinaire en post- partum ont été moins souvent observées dans le groupe des ventouses. Les risques relatifs correspondants étaient respectivement de 0,78 , 0,71 et 0,86. La fréquence de l'anémie post-partum, définie par une chute d'hémoglobine de 2 g/dl ou plus, était similaire dans les deux groupes. La morbidité maternelle était plus faible chez les multipares que chez les nullipares, dans les deux groupes. Mais quel que soit le niveau de parité, la morbidité chez les mères accouchées par ventouse était inférieure à celle chez les mères accouchées par forceps, en ce qui concerne les déchirures périnéales, les lacérations vaginales et la pose d'une sonde urinaire. Les nouveau-nés accouchés par ventouse ou par forceps avaient un Apgar comparable. La fréquence des abrasions cutanées était la même dans les deux groupes. Leur localisation, sur le scalp ou sur la face, était fonction de l'instrument utilisé. Les bosses séro-sanguines et les céphalhématomes étaient plus souvent notés dans le groupe des ventouses ( risques relatifs respectifs de 3,32 et de 1,30). La survenue d'un ictère néonatal était également plus fréquente: les risques relatifs d'une hyperbilirubinémie de 12mg/100ml ou plus et d'une photothérapie étaient respectivement de 1,38 et de 1,56. Dans les deux groupes, les complications néonatales graves étaient rares et aucune différence n'a été mise en évidence. Les 29 échecs de ventouse sont tous survenus chez des nullipares. Le poids moyen des nouveau-nés dans ce sous-groupe était supérieur de 135 g à celui des 264 enfants accouchés avec succès par ventouse. Dans ces 29 accouchements, la morbidité maternelle était p]us importante que dans les accouchements où un seul instrument avait été utilisé, même après ajustement pour la parité. La ventouse en Silastic de Kobayashi apparaît comme une alternative aux forceps dans les instrumentations du vertex en station basse. Son utilité dans d'autres indications telles que les instrumentations moyennes reste à évaluer.335942 Risks to the mother and newborn associated with the use of the Kobayashi Silastic vacuum extractor (VE) were compared to those associated with the use of low forceps (LF). Two hundred and ninety-three deliveries with the VE were compared to 468 with LF. Third or fourth degree perinea) tears, vaginal and cervical lacerations were all less frequently observed among women delivered with the VE. The need for post-partum bladder catheterization was also reduced for these women. Newborns delivered with the VE were at increased risk of cephalhematoma and neonatal jaundice. No difference in major neonatal morbidity was observed between the two groups. The Kobayashi cup appears to be a useful alternative to forceps in low vagina) instrumental deliveries.
Montréal Trigonix inc. 2018
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Athuman, S. K., i J. S. Ahmed. "Efficiency of maternal milk on morbidity at newborns with very low body weight at birth". Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27540.
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Laryea, Joycelyn, i Nipunika Jayasundara. "Automatic Speech Recognition System for Somali in the interest of reducing Maternal Morbidity and Mortality". Thesis, Högskolan Dalarna, Mikrodataanalys, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:du-34436.
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Developing an Automatic Speech Recognition (ASR) system for the Somali language, though not novel, is not actively explored; hence there has been no success in a model for conversational speech. Neither are related works accessible as open-source. The unavailability of digital data is what labels Somali as a low resource language and poses the greatest impediment to the development of an ASR for Somali. The incentive to develop an ASR system for the Somali language is to contribute to reducing the Maternal Mortality Rate (MMR) in Somalia. Researchers acquire interview audio data regarding maternal health and behaviour in the Somali language; to be able to engage the relevant stakeholders to bring about the needed change, these audios must be transcribed into text, which is an important step towards translation into any language. This work investigates available ASR for Somali and attempts to develop a prototype ASR system to convert Somali audios into Somali text. To achieve this target, we first identified the available open-source systems for speech recognition and selected the DeepSpeech engine for the implementation of the prototype. With three hours of audio data, the accuracy of transcription is not as required and cannot be deployed for use. This we attribute to insufficient training data and estimate that the effort towards an ASR for Somali will be more significant by acquiring about 1200 hours of audio to train the DeepSpeech engine
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Silva, Daniela Vitti Ribeiro da. "Morbidade materna grave: estudo qualitativo sobre a experiência de um grupo de mulheres". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-08012015-103617/.
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As taxas de morte materna vêm diminuindo em diversos países como resultado de esforços para atingir o Quinto Objetivo de Desenvolvimento do Milênio, o qual estipulou redução da morte materna no Brasil de 56/100.000 nascidos vivos para 16/100.000 nascidos vivos. Os estudos sobre a Morbidade Materna Grave vêm contribuir para compreensão das causas da morte materna, uma vez que se referem às mulheres que sobreviveram a graves complicações na gestação, parto ou puerpério. Neste contexto, o presente trabalho buscou conhecer e analisar as vivências, por parte de mulheres, em relação a um episódio de Morbidade Materna Grave. Utilizando o método qualitativo, foi possível compreender a vivência subjetiva das mulheres sobre a Morbidade Materna Grave. As mulheres que participaram do estudo foram identificadas durante internação decorrente do estado mórbido, sendo contatadas no hospital. Um segundo encontro foi agendado para realização de entrevista semiestruturada. Foram entrevistadas 16 mulheres que passaram por um episódio de Morbidade Materna Grave. As entrevistas foram transcritas e analisadas, segundo a análise de conteúdo. A análise das entrevistas permitiu identificar quatro temáticas: \"gravidez não é doença... mas eu adoeci\"; \"não estou doente, isso deve ser da gravidez\"; tratamento: um mal necessário; superação x alerta constante. As participantes apresentaram uma representação de saúde como ausência de doença e de saúde como algo incapacitante. Essa representação vai ao encontro da dificuldade em identificar os sintomas da morbidade em estágios iniciais, buscando auxílio apenas quando os sintomas estavam em estado avançado e interferindo na rotina das mulheres. A gestação foi representada como uma doença, uma vez que a experiência da Morbidade Materna Grave se sobressaiu à experiência da gestação. A Morbidade Materna Grave foi entendida como uma experiência negativa relacionada às dificuldades do tratamento e hospitalização. Também foi possível identificar nas falas das mulheres a presença de medo, preocupação com o feto, frustração da gravidez idealizada, trauma, mas também aprendizado e um propósito de Deus como aspectos positivos da experiência. Como consequência do evento mórbido, as mulheres relataram maior preocupação com a saúde e mudança em alguns comportamentos que possam evitar uma recaída. Diante esses achados, percebemos a importância de um acompanhamento efetivo no pré-natal e puerpério que possibilite uma maior reflexão sobre saúde e autocuidado, além de oferecer um suporte mais efetivo para as dificuldades e sequelas da Morbidade Materna GraveMaternal death rates are decreasing in many countries as a result of efforts to achieve the fifth Millennium Development Goal, which stipulates reduction of maternal death in Brazil from 56/100.000 live births to 16/100.000 live births. Studies on the Severe Maternal Morbidity helps to understand the causes of maternal death because it refers to women who have survived serious complications during pregnancy, childbirth or puerperium. In this context, the present study searched to understand and analyze the experiences of women about an episode of Severe Maternal Morbidity. By using the qualitative method, it was possible to understand the subjective experience of women about Severe Maternal Morbidity. Participants were identified and contacted during hospitalization due to a morbid state. A second meeting was scheduled to undergo semistructured interview. We interviewed 16 women who had an episode of Severe Maternal Morbidity. The interviews were transcribed and analyzed according to content analysis. The data analysis allowed us to identify four themes: \"pregnancy is not a disease... but I got sick\"; \"I\'m not sick, it must be part of the pregnancy\"; treatment: a necessary evil; overcoming x constant alert. Participants represent health as absence of disease and health as something disabling. This representation meets the difficulty in identifying the symptoms of morbidity in early stages, seeking help only when symptoms were at an advanced stage and interfering in women\'s routine. Pregnancy was represented as a disease once the experience of Severe Maternal Morbidity overcame the experience of pregnancy. The Severe Maternal Morbidity was perceived as a negative experience related to the difficulties of treatment and hospitalization. It was also possible to identify in the women\'s speech the presence of fear, concern for the fetus, and frustration of idealized pregnancy, trauma, but also learning and a purpose of God as positive aspects of the experience. Because of the morbid event, women reported greater concern about health and change in some behaviors that may prevent relapse. Given these findings, we realize the importance of an effective monitoring prenatal and postpartum that provides a larger reflection on health and self-care besides offering more effective support for the difficulties and consequences of Severe Maternal Morbidity
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Osano, Bonface Ombaba. "Morbidity and mortality among 5-17 year old children admitted in five hospitals in Kenya in the year 2013". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16723.
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Includes bibliographical referencesBackground: Global morbidity and mortality trends have changed over time and are expected to continue changing. Preventable diseases, such as those caused by infectious agents, still account for a large proportion of morbidity cases in Africa. With increased survival of children under five years old, there is likely to be a change in morbidity and mortality pattern s for children aged 6 - 18 years. However, there are few studies in Africa that explore the burden of disease (morbidity and mortality) and injuries in children above the age of five. This study aims to determine the morbidity and mortality patterns among children aged 5 - 17 years in six Kenyan hospitals in 2013. Methods: This study is designed as a retrospective review of patients' medical records. Data was collected from all patient records at Kisii Level 5 Hospital (KL5H), Naivasha County Referral Hospital, Karatina Hospital, Garissa Provincial General Hospital, Mbagathi District Hospital , and Gertrude ' s Children ' s Hospital in Kenya , of patients who presented from the 1st day of January to 31st December 2013. Data was analysed to provide descriptive statistics and Pearson's chi - square test and odds ratios were calculated to explore differences in morbidity and mortality rates between age categories, gender and hospitals. Results: 4 520 patient records were retrieved for patients who met the inclusion criteria. Among these admissions, 70% suffered from communicable diseases, maternal causes or nutritional diseases (32.3% were common infectious diseases , such as malaria and diarrhoea ; 14.9% were respiratory infections ; 24% were pregnancy related ), 33.1% suffered from non - communicable diseases , while 13% of the admissions had injuries (mainly from falls/trips and road traffic accidents), with motorcycles causing the majority (58%) of road traffic accidents . Injuries increased with age for males. The in-hospital mortality rate was 3.5%. Among deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non - communicable diseases and 11.9% had injuries. There were variations in admissions and deaths between the ages, gender s and hospitals. There were more female (57%) patients admitted but more male (57%) deaths. Conclusion: Infectious and maternal cause s are the biggest contributor to morbidity while infectious causes have the highest proportion of causes of death. There is a need to understand why the high proportion of females under 18 years of age is admitted for maternal al causes and to develop reproductive health services to better address the health care needs of adolescents on Kenya.
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Ruiz, Santacruz Javier Sebastian. "Maternal Mortality and Morbidity Related to Hypertensive Disorders During Pregnancy : A Socio-Demographic view in Colombia". Thesis, Stockholms universitet, Sociologiska institutionen, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-78664.
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Reducing maternal mortality is number five in the United Nations Millennium Development Goals. Preeclampsia is a particular form of hypertension during the pregnancy period that can cause maternal deaths. In Colombia, is the first cause of morbidity and maternal mortality (Serrano-Díaz & Díaz-Martinez 2005). This study attempts to determine how the socio-demographic causes that are involved in the development in order to contribute to the description of the environmental causes, more specifically to determine if socio-demographic factors influence the development of the disease. This study is based on data from two sources especially, one from the National Department of Statistics (DANE) or Statistics Colombia to give a better contextualization about the rates and tendencies of the Maternal Mortality Ratio (MMR) on ICD-10 codes related with obstetric risks. The other called GenPE project (Genetics and Preeclampsia), which has been developed in Colombia and it has had a great impact on the genetic factors but contains socio-demographic information. For this purpose some statistical robustness checks as chi-square tests, logistic regression and multilevel models to determine which is the way to conceptualize the problem. The findings stress on more prenatal care early in the pregnancy (p<0.01) as well as the intensity or number of controls (p<0.01) to decrease the risk of preeclampsia. Besides, familiar background regarding hypertensive disorders is still important in the development of the disease (p<0.01), which gives information as an environmental and genetic contribution.GenPE proyect in genetics and preeclampsia
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Randall, Njoki M. "The impact of structural adjustment policies on maternal mortality and morbidity: a case study of Kenya". DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/2549.
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This study examines the conflicting and differing political-economic crisis facing Kenya over time in an effort to explain people’s health and, especially women’s health in the areas of maternal mortality and morbidity. In that respect, this study has particularly assessed structural adjustment policies instituted by the World Bank and the International Monetary Fund (IMF), in order to determine how they might have exacerbated the health conditions of women in Kenya.
Since maternal mortality and morbidity in Kenya have escalated under structural adjustment policies, this study used two methodological approaches to assess the health situation: (1) the historical-comparative approach and (2) interviews with appropriate medical personnel. Basically, the historical approach allowed for a historical investigation of the imposition of colonial rule and the state policies on the general welfare of the Kenyan people, including the health care system. Interviews were used to assess specific behavioral patterns, conditions and circumstances related to the provision of health care services.
Numerous factors such as the discrepancy between the growth in population and medical care, unsafe and clandestine abortions due to laws that prohibit abortion in Kenya, the problems of unmet need and poverty influence maternal mortality and morbidity. While the above explanations are relevant, it is important to note that the following factors are also relevant:
1. The colonial legacy is a factor.
2. The level of postcolonial appropriations to the health system which has declined over time; and
3. Post-1986 pressures placed on the government by the International Financial Institutions through structural adjustment policies.
Conclusions drawn from the findings establish that, while other underlying endogenous causes have played an adverse role in the maternal health of Kenyans in particular, the problem has been exacerbated by the exogenous factors of structural adjustment policies.
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Magalhães, Daniela Mendes dos Santos [UNESP]. "Morbidade materna near miss na Secretaria de Estado de Saúde do Distrito Federal, Brasil". Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/151208.
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Análise da incidência, identificação dos casos e distribuição dos critérios para a morbidade materna grave, no Distrito Federal. Utilizou-se para a identificação dos casos os critérios da OMS (2010). Inicialmente, delineou-se um estudo transversal, desenvolvido em nove hospitais públicos do Distrito Federal que são referência para a assistência a gestação e ao parto de risco habitual e alto risco, no período entre 01 de julho de 2013 e 29 de dezembro de 2015, a fim de verificar a incidência e identificar os casos de condições potencialmente ameaçadoras da vida (CPAV) e near miss (NM) por meio de busca ativa dos casos e entrevista direta com a paciente. Identificou-se 174 casos de morbidade materna grave em 62.706 nascidos-vivos, gerando uma incidência de 2,77 casos por mil nascidos-vivos. Dos 174 casos entrevistados, 26 foram classificados como CPAV e 148 como NM correspondendo a incidências de 0,4/1.000 e 2,36/1.000, respectivamente. As condições hemorrágicas foram as condicionantes primárias mais significantes (p<0,001) nos casos de maior gravidade (NM). Concomitantemente, desenvolveu-se um estudo caso-controle para estimar a associação entre os fatores de risco para a ocorrência de morbidade materna grave (MMG) utilizando-se o modelo de regressão logística múltipla hierarquizada. Verificou-se a associação entre cada variável preditora e a variável desfecho por meio do teste do Quiquadrado, em sequência, a análise multivariada foi realizada seguindo a entrada hierarquizada das variáveis definidas à priori e que produziram estimativas de odds ratio (OR) com valores de p≤0,25 no modelo univariado. O nível mais distal foi constituído de fatores sociodemográficos, o nível mais proximal por cuidados obstétricos e o intermediário os antecedentes clínicos. Neste estudo foram considerados fatores de risco para morbidade materna grave a cor da pele declarada não branca, renda familiar de até dois salários mínimos, não tem companheiro, realizar menos que seis consultas de pré-natal, não estar vinculada a maternidade de referência e a ausência de trabalho de parto na admissão. Neste estudo, a presença de indicadores socioeconômicos precários e o cuidado obstétrico desqualificado apresentaram relação significativa com o risco para morbidade materna grave.
Incidence analysis, case identification and distribution of criteria for severe maternal morbidity in the Federal District. The WHO criteria (2010) were used to identify the cases. Initially, a cross-sectional study was developed in 09 public hospitals of the Federal District there are a reference for the assistance of gestation and delivery at usual risk and high risk, between July 1, 2013 and December 29, 2015, In order to verify the incidence and identify the cases of potentially life threatening conditions (PLTC) and near miss (NM) by means of active case search and direct interview with the patient. We identified 174 cases of severe maternal morbidity in 62,706 live births, generating an incidence of 2.77 cases per thousand live births. Of the 174 interviewed cases, 26 were classified as PLTC and 148 as NM corresponding to incidence of 0.4 / 1,000 and 2.36 / 1,000, respectively. Hemorrhagic conditions were the most significant primary conditioners (p <0.001) in cases of greater severity (NM). Concurrently, a case-control study was developed to estimate the association between risk factors for the occurrence of severe maternal morbidity (SMM) using the hierarchical multiple logistic regression model. The association between each predictor variable and the outcome variable was verified by means of the Qui-square test, in sequence, the multivariate analysis was performed following the hierarchical input of the variables defined a priori and that produced estimates of odds ratio (OR) with values of P≤0,25 in the univariate model. The most distal level was composed of sociodemographic factors, the most proximal level for obstetric care and the intermediate clinical history. In this study, the risk factors for severe maternal morbidity were declared non-white skin, family income of up to two minimum wages, no partner, less than six prenatal consultations, no reference maternity, and Absence of labor on admission. In this study, the presence of precarious socioeconomic indicators and disqualified obstetric care had a significant relation with the risk for severe maternal morbidity.
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Masters, Heather R. "Maternal Obesity is an Independent Risk Factor for ICU Admission during Hospitalization for Delivery". University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491559250082122.
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van, Zyl Tharine. "An exploration of the reasons for late presentation of pregnant women for antenatal care in Worcester, Cape Winelands District". University of the Western Cape, 2018. http://hdl.handle.net/11394/6858.
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Magister Public Health - MPHBackground: Antenatal Care (ANC) is a key strategy in achieving positive maternal health outcomes. ANC is an important entry point into formal health care services. ANC is very low in cost and among the most effective packages to promote and establish good health before childbirth and the early postnatal period; therefore, it is very feasible for the good results it is proven to have on maternal and child health. South Africa has had free ANC services since 1994. Despite these free services a lot of women still attend the ANC clinics late or do not attend follow-up visits, hindering the quality of care during pregnancy. The first ANC visit should be in the first trimester of pregnancy or as early as possible, because with the first visit underlying conditions must be identified and managed to promote maternal and foetal health. ANC initiation after 20 weeks may increase maternal, foetal and perinatal morbidity and mortality. In the Cape Winelands there are still 27.3% of women that attend ANC after 20 weeks gestation. This may hinder the quality of care during pregnancy and may lead to negative health outcomes for mother and or baby. The purpose of the study is to understand why some women still do not attend ANC before 20 weeks gestation even when it is available.
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Männistö, T. (Tuija). "Maternal thyroid function during pregnancy:effects on pregnancy, peri- and neonatal outcome and on later maternal health". Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514294037.
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Abstract Maternal thyroid dysfunction and/or antibodies are present in 5–10% of pregnancies and may be associated with increased risks of adverse pregnancy and perinatal outcomes. In the present study maternal thyroid function and antibody status in the Northern Finland Birth Cohort 1986 was analyzed using early pregnancy serum samples. The impact of long-term storage on the stability of thyroid hormones and antibodies was studied and while TSH and thyroid hormone levels were not affected by storage time the concentrations of thyroid antibodies appeared to be significantly increased after 10 years of storage. Normal maternal thyroid function was evaluated by calculating thyroid hormone reference intervals in the thyroid antibody-negative population using a biobank of stored serum samples. Thyrotropin, free thyroxine and triiodothyronine reference intervals in the first and second trimester were 0.07–3.1 mU/L and 0.10–3.5 mU/L, 11.4–22.4 pmol/L and 11–18.9 pmol/L; and 3.4–7.0 pmol/L and 3.5–7.3 pmol/L, respectively, in this population (Abbott Architect method). Compared with thyroid antibody-negative mothers, antibody-positive mothers had significantly higher TSH and lower fT4 concentrations and an increased risk of experiencing death of an infant in the perinatal period with odds ratios (ORs) of 3.1 (95% confidence interval 1.4–7.1) for thyroid-peroxidase and OR 2.6 (1.1–6.2) for thyroglobulin antibody positivity. These infants were more often born very preterm, which could possibly explain these increased risks. Positive thyroid antibody status was not associated with preterm birth in this study. No other major pregnancy or perinatal complications were observed among mothers or newborns of mothers with thyroid dysfunction/antibodies. Mothers, who had hypothyroidism or thyroid antibodies during pregnancy, had a very high risk of subsequent thyroid disease: hazard ratio (HR) 17.7 (7.8–40.6) for overt hypothyroidism, 4.2 (2.3–7.4) for thyroid-peroxidase and 3.3 (1.9–6.0) for thyroglobulin antibody positivity. Mothers with hypothyroidism during pregnancy had increased risk of subsequent diabetes, (HR 6.0 [2.2–16.4]). Women at risk of thyroid dysfunction should be recognized and their prepregnancy counseling, blood sampling and treatment is probably beneficial. Whether universal screening of all pregnant women is justified is still under debateTiivistelmä Kilpirauhasen toimintahäiriö tai ainoastaan kilpirauhasvasta-aineita (tyreoideaperoksidaasi- tai tyreoglobuliinivasta-aineita) esiintyy 5–10 % raskaana olevista naisista ja ne mahdollisesti lisäävät riskiä raskausajan ja vastasyntyneisyyskauden ongelmiin. Tässä väitöskirjatyössä tutkittiin Pohjois-Suomen syntymäkohorttia vuodelta 1985–1986. Äitien kilpirauhasen toimintaa tutkittiin alkuraskauden verinäytteiden avulla. Selvitimme pitkäaikaisen (20 vuotta) pakkassäilytyksen vaikutusta kilpirauhaslaboratoriokokeisiin. Tutkimuksessamme pakkassäilytyksellä ei ollut vaikutusta kilpirauhashormonien pitoisuuksiin, mutta kilpirauhasvasta-aineiden pitoisuudet olivat merkittävästi lähtötasoa korkeampia 10 säilytysvuoden jälkeen. Äitien normaali kilpirauhasen toiminta arvioitiin laskemalla aineistosta kilpirauhashormonien viitevälit kilpirauhasvasta-ainenegatiivisille naisille raskauden ensimmäiselle ja toiselle kolmannekselle käyttäen Abbott Architect metodia. Viitearvot olivat: tyreotropiinille 0.07–3.1 mU/l ja 0.10–3.5 mU/l, vapaalle tyroksiinille 11.4–22.4 ja 11–18.9 pmol/l sekä vapaalle trijodotyroniinille 3.4–7.0 ja 3.5–7.3 pmol/l. Äidin kilpirauhasen toimintahäiriöt eivät liittyneet vaikeisiin raskausajan tai vastasyntyneisyyskauden ongelmien, kuten ennenaikaisuuden ja kohtukuolemien esiintymiseen. Äidin kilpirauhasvasta-aineiden esiintyminen, mikä osoittaa kroonista autoimmuunityreoidiittia, lisäsi riskiä lapsen kohtukuolemaan ja ensimmäisen elinviikon kuolemaan; riski oli jopa kolminkertainen tyreoideaperoksidaasivasta-ainepositiivisten äitien vastasyntyneillä. Nämä vastasyntyneet olivat usein syntyneet hyvin ennenaikaisina (ennen 28. raskausviikkoa), mikä voi selittää tätä riskiä. Äidin kilpirauhasvasta-aineet eivät kuitenkaan lisänneet ennenaikaisten synnytysten riskiä tässä tutkimuksessa. Äideillä, joilla oli todettu kilpirauhasen vajaatoiminta tai kilpirauhasvasta-aineita, itsellään oli korkea, jopa 17-kertainen, riski sairastua myöhempiin kilpirauhasen sairauksiin, ja kilpirauhasen vajaatoiminta kuusinkertaisti sokeritautiin sairastumisriskin. Olisi tärkeää tunnistaa jo ennen raskautta ne naiset, joilla on riski sairastua kilpirauhasen vajaatoimintaan. Raskauden aikaisesta yleisestä seulonnasta ei vielä ole yksimielisyyttä
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Ferreira, Elton Carlos 1982. "Utilização do Sistema de Classificação de Dez Grupos de Robson para partos na investigação da morbidade materna grave = Applying the Robson Ten Group Classification System for deliveries to the investigation of severe maternal morbidity". [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312757.
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Orientadores: Jose Guilherme Cecatti, Maria Laura Costa do NascimentoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: avaliar a distribuição dos partos segundo o Sistema de Classificação em Dez Grupos de Robson (RTGCS) explorando os dados da Rede Brasileira de Vigilância da Morbidade Materna Grave (RBVMMG) e do Hospital da Mulher (CAISM) da Universidade Estadual de Campinas (UNICAMP), Brasil; e comparação de ambos com os dados do estudo Global Survey da Organização Mundial de Saúde (WHO). Método: Foram realizadas duas abordagens. A primeira foi uma análise secundária de um estudo de corte transversal multicêntrico que ocorreu em 27 maternidades brasileiras de referência, localizadas nas cinco regiões do país e participantes da RBVMMG. Foi realizada a codificação dos dados para alocação de todas as mulheres segundo o RTGCS e as mulheres foram classificadas de acordo com o espectro clínico de gravidade e a condição subjacente de morbidade materna grave. Para a segunda abordagem, foi realizado um estudo de corte transversal, com avaliação das mulheres admitidas para parto no CAISM no período de janeiro 2009 a julho de 2013. As mulheres foram agrupadas segundo a RTGCS e, adicionalmente, a distribuição das mulheres entre os diferentes grupos foi comparada entre os casos que tiveram morbidade materna grave, operacionalmente definida pela necessidade de internação em unidade de terapia intensiva (UTI), com os demais casos sem complicações graves. Para as duas abordagens (RBVMMG e CAISM), realizou-se também uma comparação com resultados publicados de outro grande estudo, realizado em diferentes contextos e países, fundamentalmente com os dados para o Brasil, disponíveis no estudo Global Survey da WHO. Resultados: Para a RBVMMG, das 7247 mulheres que compuseram o estudo, 73.2% foram submetidas à cesariana (CS). O grupo 10, grupo com provável indicação de cesárea por complicação materna e/ou fetal, foi o mais prevalente com 33.9% e também aquele com maior contribuição para a taxa geral de cesárea, 28%. Os grupos que tiveram maior gravidade (¨near miss¨ e óbito materno) foram, em ordem decrescente, os grupos 7 e 9, o grupo 8 e o grupo 10. O grupo 3 teve um caso de resultado materno grave (¨near miss¨ + óbito materno) para cada 29 casos de condição potencialmente ameaçadora da vida. Nas mulheres desse grupo submetidas a CS, essa relação atingiu valores de 1:10. Em todos os grupos avaliados, a hipertensão foi o fator de gravidade mais frequente. Na segunda abordagem, foram admitidas 12.771 parturientes durante o período do estudo. A taxa de cesariana encontrada foi de 46.6%. O grupo 1 foi o mais prevalente com 28.1%, sendo o grupo 5 aquele que mais contribui para a taxa geral de cesárea (12.7%). Apresentaram, proporcionalmente, mais internação em UTI os grupos 10 (46.8%), 5 (13.3%) e 2 com 9.8%. Conclusões: O estudo evidenciou uma alta taxa de cesárea nas duas populações avaliadas e o uso do RTGCS mostrou-se útil, evidenciando grupos clinicamente relevantes com alta taxa de parto por cesárea. Estudos futuros serão necessários para melhor avaliar a associação entre cesárea e morbidade materna grave, assim como definir possíveis intervenções e a taxa de cesárea esperada para esse grupo específico de mulheres
Abstract: Objective: To evaluate the distribution of delivering women according to the Robson¿s Ten Group Classification System (RTGCS) exploring the data from the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG) and from a tertiary hospital (CAISM), University of Campinas, Brazil; comparing both data with that from the WHO Global survey. Method: Two approaches were proposed. The first, a secondary analysis of a database obtained from a multicenter cross-sectional study taking place in 27 referral obstetric units located in the five geographical regions of Brazil, members of the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG), was carried out. For this analysis, data was organized following information necessary to classify all women into one of the RTGCS and cases from each of the 10 groups were classified according to case severity and underlying cause of severe morbidity. Subsequently, certain Robson groups were subdivided for further analysis. For the second approach, a cross-sectional study of data from women delivering at CAISM from January 2009 to July 2013 was carried out. Women were grouped according to RTGCS and, additionally, the distribution of women among the different groups was compared between cases who had severe maternal morbidity (SMM), operationally defined by intensive care unit (ICU) admission, with the other cases without severe complications. For both approaches (RBVMMG and CAISM), patients distributed among groups were compared to another Brazilian study population, available on the WHO Global Survey study. Results: For RBVMMG, among the 7247 women considered, 73.2% underwent cesarean section (CS). Group 10 had the highest prevalence rate (33.9%), also contributing most significantly (28%) to the overall CS rate. Groups associated with a severe maternal outcome (maternal ¨near miss¨ or maternal death), in decreasing order were: groups 7 and 9, 8 and 10. Group 3 had one case of severe maternal outcome (maternal ¨near miss¨ + maternal death) for every 29 cases of potentially life-threatening conditions. When evaluating only women undergoing CS in this group, ratios of 1:10 were achieved, indicating a worse outcome. Among all groups evaluated, hypertension was the most common condition of severity. For CAISM, of the 12771 women, 46.6% underwent CS. Group 1 had the highest prevalence rate (28%) and Group 5 contributed most significantly to overall CS rates. ICU admission was proportionally higher in groups 10 (46.8%), 5 (13.3%) and 2 with 9.8%.Conclusions: The study demonstrated a high cesarean section rate in the two populations studied and the use of RTGCS proved to be extremely useful, showing clinically relevant groups with high rates of cesarean section. Future studies are needed to better evaluate the association between cesarean section and severe maternal morbidity, as well as to define possible interventions and the expected cesarean section rate for this particular group of women
Mestrado
Saúde Materna e Perinatal
Mestre em Ciências da Saúde
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Rocha, Filho Edilberto Alves Pereira da 1976. "Hemorragia como causa de complicação obstétrica na Rede Brasileira de Vigilância de Morbidade Materna Grave". [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312758.
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Orientadores: José Guilherme Cecatti, Maria Laura Costa do NascimentoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivo: Avaliar a ocorrência de complicações graves e óbitos associadas a gravidez ectópica (GE) e a hemorragias ante e intraparto (HAI) e pós-parto (HPP) entre mulheres da Rede Brasileira de Vigilância de Morbidade Materna Grave. Métodos: Estudo de corte transversal multicêntrico realizado em 27 unidades de referência obstétrica no Brasil entre julho de 2009 e junho de 2010. Foi avaliada a ocorrência de condições potencialmente ameaçadoras da vida (CPAV), near miss materno (NMM) e mortes maternas (MM) associadas com GE, HAI e HPP em 9.555 mulheres identificadas como tendo alguma complicação obstétrica. Características sóciodemográficas e obstétricas e o uso de critérios de manejo nestas hemorragias graves também foram avaliados. Foram calculadas as razões de prevalência (RP) com seus respectivos intervalos de confiança de 95% ajustados para o efeito de cluster e análise de regressão logística múltipla para identificar os fatores associados de forma independente com a ocorrência de resultado materno grave (Severe Maternal Outcome - SMO=NMM+MM). Resultados: Das 9.555 mulheres com complicações obstétricas, 312 (3,3%) tiveram complicações por GE, sendo 286 (91,7%) CPAV, 25 (8,0%) NMM e 1 (0,3%) MM. HPP foi a causa principal entre 1192 mulheres (12,5%), sendo 981 CPAV, 181 NMM e 30 MM. HAI ocorreu em 8% (767) das mulheres que experimentam algum tipo de complicação obstétrica e foi responsável por 7,1% (613) dos casos de CPAV, 18,2 % (140) de NMM e 10% (14) das MM. Mulheres com GE complicada tiveram maior risco de transfusão sanguínea, laparotomia e menor risco de admissão em UTI e tempo prolongado de internação do que mulheres com outras complicações. Houve cuidado deficiente ou demoras no atendimento associado a casos de GE complicados. Os fatores associados ao melhor resultado foram uma cicatriz uterina prévia e ser não branca. Entre as mulheres que apresentaram HPP, a idade materna, idade gestacional precoce, cicatriz uterina anterior e cesariana prévia foram os principais fatores associados com maior risco de ocorrência de SMO. Essas mulheres também tiveram uma maior proporção de transfusão sanguínea e retorno para a sala operatória. Já para as que apresentaram HAI, a idade materna e cesariana anterior foram independentemente associadas a este maior risco. Conclusão: O aumento da morbidade materna devido a GE aumentou a conscientização sobre a doença e seu impacto sobre a vida reprodutiva feminina. A hemorragia pós-parto persiste como uma das principais complicações obstétricas e importante causa de morbidade e morte materna no Brasil. O conhecimento dos fatores associados a um maior risco de ocorrência de SMO pode ser útil para melhorar a qualidade da atenção obstétrica e dos resultados maternos. SMO devido a hemorragia ante e intraparto foi altamente prevalente entre as mulheres brasileiras. Alguns fatores de risco, em particular a idade materna e cesareana prévia, foram associados com a ocorrência desta complicação hemorrágica. Os serviços obstétricos devem desenvolver diretrizes e intervenções específicas para prevenir a morbidade materna grave para cada condição hemorrágica obstétrica específica identificada
Abstract: Objective: To evaluate the occurrence of severe obstetric complications associated with ectopic pregnancy (EP) and antepartum or intrapartum (AIH) and postpartum hemorrhage (PPH) among women in the Brazilian Network for the Surveillance of Severe Maternal Morbidity. Methods: A multicenter cross-sectional study conducted in 27 referral obstetric units in Brazil between July 2009 and June 2010. The occurrence of potentially life-threatening conditions (PLTC), maternal near miss (MNM) and maternal death (MD) associated with EP, AIH and HPP were evaluated among 9,555 women identified as having some obstetric complication. Socio demographic and obstetric characteristics and use of management criteria in these severe hemorrhages were also assessed. Prevalence ratios (PR) were calculated with their respective 95% confidence intervals adjusted for the cluster effect and multiple logistic regression analysis to identify factors independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD) . Results: Among the 9,555 women with obstetric complications, 312 (3.3%) had complications due to EP, with 286 (91.7 %) PTLC, 25 (8.0%) MNM and 1 (0.3 %) MD. HPP was the leading cause in 1192 women (12.5 %), with 981 PTLC, 181 MNM and 30 MD. AIH occurred in 8% (767) of women experiencing any type of obstetric complication and accounted for 613 (7.1%) of the PTLC cases, 140 (18.2%) of MNM and 10% (14) of MD. Women with complicated PE had a higher risk of blood transfusion, laparotomy and lower risk of ICU admission and prolonged hospitalization than women with other complications. There was a substandard care or delays associated with cases of complicated EP. The factors associated with a better outcome were a previous uterine scar and to be non-white. Among women who had PPH, maternal age, early gestational age, previous uterine scar and previous cesarean delivery were the main factors associated with a risk of SMO. These women also had a higher proportion of blood transfusion and return to operating room. For those who had AIH, maternal age and previous cesarean section were independently associated with this increased risk. Conclusion: Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. Postpartum hemorrhage persists as one of the main obstetric complication and important cause of maternal morbidity and mortality in Brazil. The knowledge of factors associated with a severe maternal outcome (SMO=MNM+MD) could be useful for improving the quality of obstetric care and maternal outcomes. SMO due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Some risk factors, maternal age and prior cesarean delivery in particular, were associated with the occurrence of this hemorrhagic complication. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity for each specific obstetric hemorrhagic condition identified
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
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Magalhães, Daniela Mendes dos Santos. "Morbidade materna near miss na Secretaria de Estado de Saúde do Distrito Federal, Brasil". Botucatu, 2017. http://hdl.handle.net/11449/151208.
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Orientador: Adriano DiasResumo: Análise da incidência, identificação dos casos e distribuição dos critérios para a morbidade materna grave, no Distrito Federal. Utilizou-se para a identificação dos casos os critérios da OMS (2010). Inicialmente, delineou-se um estudo transversal, desenvolvido em nove hospitais públicos do Distrito Federal que são referência para a assistência a gestação e ao parto de risco habitual e alto risco, no período entre 01 de julho de 2013 e 29 de dezembro de 2015, a fim de verificar a incidência e identificar os casos de condições potencialmente ameaçadoras da vida (CPAV) e near miss (NM) por meio de busca ativa dos casos e entrevista direta com a paciente. Identificou-se 174 casos de morbidade materna grave em 62.706 nascidos-vivos, gerando uma incidência de 2,77 casos por mil nascidos-vivos. Dos 174 casos entrevistados, 26 foram classificados como CPAV e 148 como NM correspondendo a incidências de 0,4/1.000 e 2,36/1.000, respectivamente. As condições hemorrágicas foram as condicionantes primárias mais significantes (p<0,001) nos casos de maior gravidade (NM). Concomitantemente, desenvolveu-se um estudo caso-controle para estimar a associação entre os fatores de risco para a ocorrência de morbidade materna grave (MMG) utilizando-se o modelo de regressão logística múltipla hierarquizada. Verificou-se a associação entre cada variável preditora e a variável desfecho por meio do teste do Quiquadrado, em sequência, a análise multivariada foi realizada seguindo a entrada hierarquizada ... (Resumo completo, clicar acesso eletrônico abaixo)
Doutor
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Nehemia, Elsa Jacinto José Maria. "Fatores associados a morbidade materna grave: a relação com o HIV e AIDS, Maputo, Moçambique". Instituto de Saúde Coletiva, 2014. http://repositorio.ufba.br/ri/handle/ri/16333.
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Introdução: Morbidade Materna Grave (MMG) é um quadro clínico observado em mulheres no ciclo gravídico-puerperal, composto por condições graves a extremamente graves, que ao sobreviverem são conhecidos por near miss materno; estes últimos são identificados por sinais de disfunção orgânica subsequentes a condições ameaçadoras da vida. As evidências vêm mostrando a carga da pandemia do HIV/AIDS sobre as condições clínicas de pacientes portadoras de outras doenças. Objetivos: estimar a incidência da razão de resultado materno grave e investigar os fatores associados à MMG em Maputo. Métodos: estudo caso-controle realizado na Cidade de Maputo, Moçambique, no período de Março a Novembro de 2012. As participantes elegíveis para o grupo de casos foram mulheres residentes em Maputo com MMG, segundo a definição da OMS. Os controles foram pacientes admitidas nos mesmos hospitais e no mesmo período, seguindo os mesmos critérios para a seleção dos casos, à excepção da condição clínica exigida para estes. Para o cálculo do tamanho da amostra utilizou-se o programa Epi Info, considerando-se um poder do estudo de 80%, um alfa=0,05, nível de confiança=0,95, relação caso/controle 1:2 e Odds Ratio (OR) esperada de 1,5, obtendo-se uma amostra com 485 casos e 970 controles. A exposição foi a infeção pelo HIV/AIDS, sendo utilizadas variáveis sócio-demográficas, clínico-assistenciais e comportamentais, como o uso de álcool e fumo. Os dados coletados de morbidade materna grave e near miss materno foram extrapolados para o período de doze meses por Regressão Linear Simples, utilizando-se termos quadrático e cúbico e calculados os indicadores. Para a diferença entre proporções utilizou-se o teste 2 de Pearson. A medida de associação entre HIV/AIDS e MMG (desfecho) foi a OR e seus intervalos de confiança a 95% por Regressão Logistica não condicional. Nas análises foi utilizado o pacote estatístico STATA versão 10.0. Resultados: A Razão de Resultado Materno Grave foi de 1,7/1.000 NV, Razão de NMM 0,4/1.000 NV, Razão near miss/morte materna de 28:100, Indice de Mortalidade de 78,3% e Razão de mortalidade materna de 133/100.000 NV. As principais causas de MMG foram as doenças hipertensivas (69,7%) seguidas das hemorrágicas (19,0%); entre as near miss materno foram as hemorrágicas (64,3%) e entre as mortes maternas foi a AIDS (50,0%). Foram fatores associados a um maior risco da gravidade o antecedente de aborto (OR=2,2; IC=1,4 -3,7); HIV positivo (OR=2,5; IC=1,9 – 3,3), puérpera (OR=2,7; IC=2,1 – 3,6), parto cesáreo (OR=14,9; IC=7,3 – 30,4) e tempo de trajeto entre casa e hospital superior a 30 minutos (OR=2,1; IC=1,4 – 3,2). A procura direta do hospital de referência atuou como fator protetor OR=0,6; IC=0,5 – 0,8. A associação entre a infeção por HIV e morbidade materna grave foi de OR=2,7 (IC=2,1 – 3,5). A Fração Atribuível Populacional ao HIV foi de 21,3% Conclusões: A morbidade materna grave é cerca de três vezes maior nas grávidas ou puérperas infectadas pelo vírus do HIV/AIDS do que nas não infectadas. A Razão de Resultado Materno Grave em Maputo é relativamente elevada, sendo as principais causas as doenças hemorrágicas e a infeção pelo HIV/AIDS. Os fatores associados estão relacionados sobretudo aos antecedentes reprodutivos das mulheres, orientando para uma maior atenção ao grupo de maior risco, pelo uso de normas e procedimentos padronizados.
Introduction: Severe Maternal Morbidity (SMM) is a clinical condition of women in their pregnancy and childbirth, composed of conditions ranging from severe to extreme severity, which are known when survive by maternal near miss (MNM); these cases are identified by signs of organ dysfunction subsequent to life-threatening conditions. Furthermore, surveys have shown evidence of the burden of the HIV / AIDS pandemic on the clinical condition of patients with other diseases. Objectives: To estimate the incidence of Severe Maternal Outcome Ratio (SMOR) and investigate factors associated with SMM in Maputo. Methods: case-control study conducted in Maputo, Mozambique, from March to November 2012. Eligible participants for the group of cases were resident women living with SMM, according to the WHO definition. Controls were patients admitted to the same hospitals during the same period, using the same criteria for selection of cases, with the exception of the clinical condition for these. To calculate the sample size we used the Epi Info program, considering a study power of 80%, an alpha = 0.05, confidence level = 0.95, compared case / control 1:2 and an expected odds ratio (OR) of 1.5. 485 cases and 970 controls were obtained. The exposure was the infection with HIV / AIDS; socio-demographic, clinical, healthcare and behaviour variables such as smoking e alcool utilization being used. The data for SMM and MNM were extrapolated to the period of twelve months by Simple Linear Regression with quadratic and cubic terms and calculated indicators. For the difference between proportions used the 2 test of Pearson. The measure of association between HIV / AIDS and SMM (outcome) was the OR and confidence intervals at 95% by unconditional Logistic Regression. For the analysis STATA version 10.0 was used. Results: SMOR was 1,7/1.000 LB, MNM Ratio 0,4/1.000 LB, maternal near miss/maternal death ratio of 28:100, mortality index of 78.3% and maternal mortality ratio of 133/100.000 LB. The main causes of SMM were hypertensive disorders (69,7%) followed by bleeding disorders (19.0%); among maternal near miss were bleeding (64.3%) and among maternal deaths were AIDS (50,0%). Factors associated with an increased risk of severity were history of abortion (OR = 2.2, CI = 1.4 - 3.7), HIV positive (OR = 2,5, CI = 1.9 to 3.3), pospartum period (OR = 2.7, CI = 2.1 to 3.6), caesarean delivery (OR = 14.9, CI = 7.3 to 30.4) and time between home and hospital exceeding 30 minutes (OR = 2.1, CI = 1.4 to 3.2) .The association between HIV infection and severe maternal morbidity was OR = 2.7 CI =( 2.1 to 3.5). The direct search of the reference hospital acted as a protective factor OR = 0.6; CI = 0.5 to 0.8. The Population Attributable Fraction of HIV was 21.3%. Conclusions: Severe maternal morbidity is about three times higher in pregnant or postpartum HIV / AIDS infected women than in uninfected. SMOR is high in Maputo and the main causes are bleeding disorders and infection by HIV / AIDS. Associated factors are mainly related to reproductive history of women, requiring greater attention to the high risk group, by the use of standards and standardized procedures.
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Lindquist, Anthea Clare. "The impact of socioeconomic position on outcomes of severe maternal morbidity amongst women in the UK and Australia". Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:3ec55671-e8b8-42c6-a777-fb7667b33e6e.
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Aims: The aims of this thesis were to investigate the risk of severe maternal morbidity amongst women from different socioeconomic groups in the UK, explore why these differences exist and compare these findings to the setting in Australia. Methods: Three separate analyses were conducted. The first used UK Obstetric Surveillance System (UKOSS) data to assess the incidence and independent odds of severe maternal morbidity by socioeconomic group in the UK. The second analysis used quantitative and qualitative data from the 2010 UK National Maternity Survey (NMS) to explore the possible reasons for the difference in odds of morbidity between socioeconomic groups in the UK. The third analysis used data from the Victorian Perinatal Data Collection (VPDC) unit in Austra lia to assess the incidence and odds of severe maternal morbidity by socioeconomic group in Victoria. Results: The UKOSS analysis showed that compared with women from the highest socioeconomic group, women in the lowest 'unemployed' group had 1.22 (95%CI: 0.92 - 1.61) times greater odds associated with severe maternal morbidity. The NMS analysis demonstrated that independent of ethnicity, age and parity, women from the lowest socioeconomic quintiJe were 60% less likely to have had any antenatal care (aOR 0.40; 95%CI 0.18 - 0.87), 40% less likely to have been seen by a health professional prior to 12 weeks gestation (aOR 0.62; 95%CI 0.45 - 0.85) and 45% less likely to have had a postnatal check with their doctor (aOR 0.55; 95%CI 0.42 - 0.70) compared to women from the highest quintile. The Victorian analysis showed that women from the lowest socioeconomic group were 21% (aOR 1.21 ; 95% CI 1.00 - 1.47) more likely and that Aboriginal and Torres Strait Islander women were twice (aOR 2.02; 95%CI 1.32 - 3.09) as likely to experience severe morbidity. Discussion: The resu lts suggest that women from the lowest socioeconomic group in the UK and in Victoria have increased odds of severe maternal morbidity. Further research is needed into why these differences exist and efforts must be made to ensure that these women are appropriately prioritised in the future planning of maternity services provisio n in the UK and Australia.
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Keurentjes, Amy Elizabeth. "Relationship of Osteopathic Manipulative Treatment During Labor and Delivery on Selected Maternal Morbidity Outcomes: A Randomized Controlled Trial". Diss., Virginia Tech, 2009. http://hdl.handle.net/10919/26177.
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Osteopathic Manipulative Treatment (OMT) has been used for more than 100 years to enhance the physiologic process of labor and delivery by normalizing pelvic structures and providing adequate blood supply to the uterus. Since maternal morbidity and mortality is a major health concern for developing countries, it was desirable to explore the benefits of OMT.
After IRB approval by the Virginia College of Osteopathic Medicine and Virginia Tech, the research was conducted in Santo Domingo, Dominican Republic at Hospital Maternidad Nuestra Señora de la Altagracia to determine the relationship of OMT during labor and delivery on rates of cesarean section and perineal lacerations/ episiotomies. Qualifying candidates received the next sequentially numbered envelope with a randomized number assigning her to either the treatment or control group. Staff physicians at the hospital provided care to women in the control group according to their standard protocol. Four Osteopathic Physicians and one pre-doctoral OMM fellow performed OMT on women during the first and second stages of labor and performed their deliveries.
There were 33 parturients in the OMT Treatment group and 32 in the control, for a total of 65 in the trial. The results of a logistic regression analysis using Wald criterion, with a statistical significance of alpha = 0.05, indicated treatment group reduction of rates of episiotomies in the primiparous (P = .04) and marginal significance in the combined primiparous and multiparous population (P = .05). The percentage of episiotomies in the primiparous treatment group was 35.29% and 75% in the control group. The percentage of episiotomies in the combined primiparous and multiparous groups were 15.15% in the treatment group and 37.5% in the control group. The cesarean rate for the treatment group was 9.09% and 18.75% for the control group (P = 0.098). The percentages of grade I & II perineal lacerations were 15.15% for the treatment group and 12.5% for the control group (P = 0.55) due to the extensive use of episiotomies in the control group. There were composite calculations made of the total number of parturients who had either a cesarean section, an episiotomy, or a perineal laceration so that overall maternal morbidity in each group could be compared. In the combined groups, there were fourteen total parturients (42.42%) who had undergone one of the three outcomes measures in the treatment group and twenty-one (65.63%) in the control group. This brings an odds ratio of 0.200 and a significant P value of 0.0235.
Though cross-cultural issues made it difficult to perform the research as originally intended, there is evidence that Osteopathic Obstetrics provides benefit to parturients. A multi-institutional randomized controlled trial is proposed as the next step for the evaluation of OMT during labor and delivery.Ph. D.
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Haddad, Samira El Maerrawi Tebecherane 1981. "Rede nacional de vigilância de morbidade materna grave : explorando aspectos metodológicos da abordagem do near miss materno = Brazilian network for surveillance of severe maternal morbidity: exploring methodological aspects of maternal near miss approach". [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310050.
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Orientador: José Guilherme CecattiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A saúde materna é um dos focos das Metas de Desenvolvimento do Milênio das Nações Unidas para 2015. As mais recentes estimativas sugerem que o número de mulheres que morrem de complicações durante a gestação e parto caiu 47% de 1990 a 2010. Para alcançar a redução planejada de 75% até 2015, a taxa anual deveria cair em 5,5%. Porém, um pouco além da metade do que seria necessário foi conseguido. Para que as metas sejam atingidas, intervenções efetivas são identificadas como necessárias. Além de melhorias com investimentos estruturais locais, uma das bases para a organização de ações efetivas é a obtenção de dados fidedignos e o desenvolvimento de sistemas de informação em saúde. Até um passado recente, não havia padronização de conceitos para morbidade materna grave. Em 2009, condições ameaçadoras da vida foram definidas pela Organização Mundial da Saúde (OMS). Como resultado, critérios clínicos, laboratoriais e de manejo específicos orientam a identificação de casos de near miss. A criação de uma rede de vigilância no Brasil utilizando os novos critérios de near miss poderia trazer um panorama desta condição em um país de média renda e população heterogênea. Com tais informações, novas estratégias para melhoria da assistência à saúde materna e perinatal poderiam ser desenvolvidas, com potencial redução real de mortes. Objetivos: Avaliar a homogeneidade amostral dos casos incluídos na Rede, validar os critérios de near miss da OMS, desenvolver um modelo de predição de mortalidade baseado na gravidade dos casos e, a partir deste modelo, avaliar o desempenho dos centros da Rede na prestação de cuidados obstétricos. Métodos: A Rede Nacional de Vigilância de Morbidade Materna Grave foi um estudo de corte transversal multicêntrico implantado em 27 hospitais entre todas as regiões do país, com coleta prospectiva de dados pelo período de um ano, utilizando os novos critérios de near miss da OMS. A partir de 9555 casos incluídos no período, foram calculados os coeficientes de correlação intraclasse (ICC) e efeitos do desenho por cluster das variáveis do estudo. Também, testes de acurácia diagnóstica foram utilizados para validar dos critérios da OMS. Um modelo de regressão logística bivariada foi utilizado para avaliar a correlação entre os critérios de near miss e variáveis distais na ocorrência de morte e desenvolver uma ferramenta para predição de mortalidade, o Maternal Severity Index (MSI). A partir deste modelo, foi analisada a razão entre as mortes observadas e aquelas esperadas de acordo com a gravidade dos casos e avaliados os níveis de desempenhos dos centros na prestação de cuidado obstétrico. Conclusão: Os ICC para as variáveis de desfecho da Rede são considerados pequenos, o que indica adequada heterogeneidade amostral. Seus valores podem ser utilizados para o cálculo do tamanho amostral de estudos futuros na área. O uso dos critérios de near miss da OMS para identificação de casos de morbidade materna grave foi validado. O índice de gravidade materna (MSI) pode ser utilizado como ferramenta para predição de mortalidade e avaliação de desempenho e adequação de cuidado em instituições que prestem atendimento a mulheres com condições ameaçadoras a vida
Abstract: Introduction: Maternal health is one of the focuses of the United Nations' Millennium Development Goals for 2015. The most recent estimates suggest that the number of women who died from complications during pregnancy and childbirth fell 47% from 1990 to 2010. To achieve the planned reduction of 75% by 2015, the annual rate should fall by 5.5%. However, a little more than half of what is required has been obtained. To achieve the goals, effective interventions are identified as necessary. In addition to improvements in local structural investments, one of the bases for the organization of effective actions is obtaning reliable data and the development of health information systems. Until recently, there was no standardazed concept for severe maternal morbidity. In 2009, the World Health Organization (WHO) defined life-threatening conditions. As a result, specific clinical, laboratory and management criteria guide the identification of near miss cases. The development of a surveillance network in Brazil using the new criteria for maternal near miss could bring an overview of this condition in a middle-income country with heterogeneous population. With such information, new strategies to improve maternal and perinatal care could be developed, with potential real reduction of deaths. Objectives: To evaluate the homogeneity of the sample included in the network, to validate the WHO near miss criteria, to develop a predictive model of mortality based on severity of cases and, from this model, to evaluate the performance of the Network facilities in providing obstetric care. Methods: The Brazilian Network for Surveillance of Severe Maternal Morbidity was a multicenter cross-sectional study implemented in 27 hospitals from all regions of the country, with prospective data collection for a one year period, using the new WHO maternal near miss criteria. From 9555 cases included in the period, the intraclass correlation coefficients (ICC) and cluster design effects for the variables of the study were calculated. Also, diagnostic accuracy tests were used to validate the WHO criteria. A bivariate logistic regression model was used to evaluate the correlation between the near miss criteria and distal variables in the occurrence of death and to develop a tool for prediction of mortality, the Maternal Severity Index (MSI). From this model, the ratio between the number of observed and expected deaths was analyzed according to the severity of cases and the performance levels of the centers in providing obstetric care was assessed. Conclusion: The ICC for the outcome variables of the network are considered small, what indicates adequate sample heterogeneity. Their values can be used to calculate the sample size of further studies in the area. The use WHO maternal near miss criteria to identify cases of severe maternal morbidity has been validated. The maternal severity index (MSI) can be used as a tool for assessing the performance and appropriateness of care in facilities providing care for women with life threatening conditions
Doutorado
Saúde Materna e Perinatal
Doutora em Ciências da Saúde
45
Saaka, Mahama. "Effect of prenatal zinc supplementation on malarial morbidity, pregnancy anaemia and birth weight". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/281.
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Anaemia and malaria are two related problems of public health significance in malaria endemic countries including Ghana that continue to impact negatively on pregnancy outcomes, despite interventions being put in place to address them. The reasons for the apparent lack of efficacy of routine iron supplementation in reducing the risks of preterm and other adverse pregnancy outcomes are not clearly established in Ghana. It is not also known whether all pregnant women benefit from iron supplementation and whether there are some other factors that limit the effectiveness of prenatal iron supplementation. This study tested the primary hypothesis that prenatal zinc supplementation in combination with malaria prophylaxis and an iron and folic acid intervention package in a zinc-deficient and malaria-edemic population will increase mean birth weight.
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Hatamleh, Reem Abdallah. "Birth technology : induction of birth and its impact on maternal, fetal and neonatal mortality and morbidity in Northern Ireland". Thesis, University of Ulster, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.425233.
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Greenwell, Audry, Judy G. McCook, Stacey Williams, Sheeba Anand i Beth Bailey. "Polycystic Ovary Syndrome: Morbidity Issues and the Psychosocial Impact on Infertile Women". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/7186.
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Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women's psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life.
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Påfs, Jessica. "The Quest for Maternal Survival in Rwanda : Paradoxes in Policy and Practice from the Perspective of Near-Miss Women, Recent Fathers and Healthcare Providers". Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-306604.
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Rwanda has made significant progress in decreasing the number of maternal deaths and increasing the number of antenatal care visits and childbirths at health facilities. This thesis seeks to illuminate potential barriers for Rwanda’s goal for maternal survival. The studies explore the bottom-up perspective of policies and practices in regards to maternal care in Kigali. Semi-structured interviews were conducted between 2013 and 2016 with women who nearly died (‘near-miss’) during pregnancy, their partners, and with other recent fathers and community members, as well as healthcare providers who work within abortion care. The framework of naturalistic inquiry guided the study design and data collection. Analysis was conducted using framework analysis, thematic analysis and naturalistic inquiry. The findings identify paradoxical outcomes in the implementation of maternal care policies. Despite recent amendments of the abortion law, safe abortion was identified as being non-accessible. Abortion-related symptoms continue to carry a criminalized and stigmatized label, which encourages risk-taking and clandestine solutions to unwanted pregnancies, and causes care-seeking delays for women with obstetric complications in early pregnancy. Healthcare providers had limited awareness of the current abortion law, and described tensions in exercising their profession due to fear of litigation. The first antenatal care visit appeared to require the accompaniment of a male partner, which underpinned women’s reliance on men in their care-seeking. Men expressed interest in taking part in maternal care, but faced resistance for further engagement from healthcare providers. Giving birth at a health facility was identified as mandatory, yet care was experienced as suboptimal. Disrespect during counseling and care was identified, leading to repeated care-seeking and may underpin the uptake of traditional medicine. An enhanced implementation of the current abortion law is recommended. Reconsideration of policy is recommended to ensure equitable and complete access to antenatal care: women should be able to seek care accompanied by their person of choice. These findings further recommend action for improved policy to better address men’s preferred inclusion in maternal health matters. The findings of this thesis promote continued attention to implementing changes to strengthen quality, and trust, in public maternal care.
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Clayton, Heather Breeze. "Low Documented Risk Cesarean Sections and Late-Preterm Births: The Florida Experience". Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/3476.
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There are increasing concerns about the excessive use of cesarean delivery in the United States, as cesarean deliveries have been associated with adverse maternal and infant health outcomes. Currently, the cesarean section (C/S) rate for Florida is the second highest in the nation. Furthermore, preliminary reports from the Florida Department of Health (FDOH) have implicated the increasing rate of cesarean delivery to an increase in the rate of late preterm births (PTB) in Florida (births at 34 to 36 weeks gestational age). Information on the impact of late PTB associated with cesarean delivery on the rate of maternal and infant morbidity in Florida as well as corresponding utilization of health care services is scarce. Information on the validity of data sources used to investigate infant and maternal health outcomes in Florida is also scarce. Therefore, the objectives of this research project were: (1) to determine the validity of data sources used to investigate low documented risk C/S and late PTB, and (2) to assess the impact of low documented risk C/S on maternal and infant morbidity and subsequent healthcare utilization. To determine the accuracy of data elements reported on the Florida birth certificate and hospital discharge data, sensitivity, specificity, positive predictive value, negative predictive value, kappa statistics and likelihood ratios were calculated. To assess differences in morbidity by route of delivery, generalized estimating equations and survival analyses were employed. Markov Chain Monte Carlo methods were used to determine appropriate morbidities for inclusion in all analyses. Differences in accuracy of data by data source was observed, with linked birth certificate and hospital discharge data demonstrating improved accuracy compared to birth certificate and discharge data alone. Further, significant differences in the rate of maternal and infant morbidity by route of delivery were observed, with cesarean delivery increasing the risk of adverse health outcomes, and intensive use of healthcare services.
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Souza, Renato Teixeira 1985. "Uma análise do parto prematuro terapêutico no contexto da prematuridade no Brasil : An analysis of provider-initiated preterm birth in the context of Brazilian prematurity". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312755.
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Orientador: José Guilherme CecattiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Mais de 15 milhões de bebês nascem prematuros anualmente no mundo, sendo a prematuridade a maior causa de óbitos no período neonatal. A prematuridade terapêutica tem papel importante nesse contexto, pois se estima que 20 a 40% dos partos prematuros ocorrem por indicação dos provedores de assistência obstétrica. Dessa forma, a redução dos partos prematuros terapêuticos adquire cada vez mais importância para o controle da taxa de prematuridade e da morbimortalidade neonatais. O conhecimento dos fatores relacionados ao parto prematuro terapêutico é ponto fundamental para atingir essa redução. Objetivos: Avaliar a ocorrência do parto prematuro terapêutico e seus fatores associados na população do Estudo Multicêntrico de Investigação em Prematuridade (EMIP). Métodos: Análise secundária do EMIP, um estudo brasileiro de caso-controle aninhado a um corte transversal multicêntrico. O estudo ocorreu em 20 hospitais de referência em 3 regiões do Brasil de abril de 2011 a julho de 2012 e realizou a vigilância de 33.740 partos nesse período. O principal desfecho a ser avaliado é a ocorrência de parto prematuro terapêutico, definido como o parto que ocorreu antes de 37 semanas e que foi indicado pela equipe de assistência devido uma condição materna ou fetal. O grupo controle foi composto pelas mulheres com parto a termo. Os partos prematuros foram categorizados, conforme recomendações da Organização Mundial da Saúde, em prematuro extremo, muito prematuros e pretermo moderado Uma quarta categoria de idade gestacional, contemplando apenas os prematuros tardios, também foi analisada. Variáveis relacionadas a características sociodemográficas, pôndero-estaturais e de estilo de vida maternos, características da assistência ao pré-natal e ao parto e sobre a presença de morbidade ou complicação durante a gravidez, parto ou puerpério foram avaliadas na análise de risco para parto prematuro terapêutico. Foi realizada uma análise bivariada para estimar o risco de parto prematuro terapêutico para cada e uma análise multivariada com regressão logística não condicional para obter os fatores independentemente associados ao desfecho. Resultados: O parto prematuro terapêutico foi responsável por 35,4% dos partos prematuros na amostra estudada. As síndromes hipertensivas, o descolamento prematuro de placenta e a diabetes foram as condições que mais frequentemente motivaram a resolução prematura da gravidez. A idade materna avançada, a hipertensão crônica, a obesidade e a gravidez múltipla foram as principais condições maternas relacionadas à ocorrência de parto prematuro terapêutico. Houve uma tentativa de tratamento da condição materna que motivou a resolução em mais de 50% dos casos e 74,5% das mulheres com parto entre 28 e 31 semanas receberam corticoterapia. A cesariana foi a via de parto mais frequente. A proporção de mortalidade neonatal, do Apgar do quinto minuto menor que sete e da admissão em unidade intensiva neonatal foi muito maior nos prematuros terapêuticos do que no termo, mesmo considerando os prematuros tardios. Conclusões: Os resultados do estudo corroboram com a crescente importância do parto prematuro terapêutico, devido sua prevalência e impacto nos resultados perinatais. A gravidez múltipla, idade materna avançada, a obesidade e a presença de morbidades pré-gestacionais são os fatores que requerem especial atenção nas estratégias de prevenção da prematuridade terapêutica
Abstract: Background: More than 15 million babies are born prematurely each year worldwide and its the leading cause of deaths in the neonatal period. Provider-initiated preterm birth (piPTB) plays an important role in this context because it is estimated that 20-40% of preterm births occur by indication of obstetric care providers. Thus, the reduction in piPTB rate acquires more importance to decrease the rate of prematurity and neonatal morbidity and mortality. Knowledge of the factors related to piPTB is a key factor to achieve this reduction. Objectives: To evaluate the occurrence of provider-initiated preterm birth and the associated factors in the Multicenter Study on Preterm Birth in Brazil (EMIP) population. Methods: Secondary analysis of EMIP, a Brazilian multicenter cross-sectional study plus a nested case-control. The study took place in 20 referral hospitals in 3 regions of Brazil from April 2011 to March 2012 and conducted surveillance of 33,740 deliveries in this period. The primary outcome to be evaluated is the occurrence of provider-initiated preterm birth, defined as birth that occurred before 37 weeks and was medically indicated due to maternal or foetal condition. The control group was composed of women with term delivery. Preterm birth was categorized into extremely premature, very premature and moderate preterm, according to the World Health Organization. Another category that includes only the late preterm was also evaluated. Maternal, socio-demographic, obstetrical, prenatal care, delivery and postnatal characteristics were assessed as factors associated with piPTB. A bivariate analysis to estimate the risk for piPTB and a multivariate analysis using unconditional logistic regression for the factors independently associated with piPTB was performed. Results: The therapeutic preterm labor accounted for 35.4% of premature births in the sample. Hypertensive disorders, placental abruption and diabetes were the main conditions related to pi-PTB indications. Advanced maternal age, chronic hypertension, obesity and multiple pregnancy were the main maternal conditions related to pi-PTB. There was an attempt to treat maternal condition that led to the resolution in over 50% of cases and 74.5% of women with birth between 28 and 31 weeks received corticosteroid therapy. Cesarean section was the most frequent mode of delivery. The proportion of neonatal mortality, Apgar score<7 at 5 minutes and NICU admission were much higher in provider-initiated preterm newborns than in term newborns, even considering the late preterms. Conclusions: The results of our study corroborate the increasing notability of provider-initiated preterm birth, due to its prevalence and impact on perinatal outcomes. Multiple pregnancies, advanced maternal age, obesity and the presence of pre-gestational morbidities are the main factors that require special attention in prematurity prevention strategies
Mestrado
Saúde Materna e Perinatal
Mestre em Ciências da Saúde