scholarly journals Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034942
Author(s):  
Anne C C Lee ◽  
Rachel Whelan ◽  
Nazmun Nahar Bably ◽  
Lauren E Schaeffer ◽  
Sayedur Rahman ◽  
...  
Keyword(s):  
Rural Communities ◽  
Gestational Age ◽  
Health Workers ◽  
Late Pregnancy ◽  
Statistical Modelling ◽  
Abdominal Girth ◽  
Anthropometric Measures ◽  
Maternal Characteristics ◽  
Pregnancy Cohort ◽  
Uterine Volume

ObjectiveTo improve the accuracy of the prediction of gestational age (GA) before birth with the standardised measurement of symphysis-fundal height (SFH), estimation of uterine volume, and statistical modelling including maternal anthropometrics and other factors.DesignProspective pregnancy cohort study.SettingRural communities in Sylhet, Bangladesh.Participants1516 women with singleton pregnancies with early pregnancy ultrasound dating (<20 weeks); 1486 completed follow-up.MethodsSFH and abdominal girth were measured at subsequent antenatal care (ANC) visits by community health workers at 24 to 28, 32 to 36, and/or >37 weeks gestation. An estimated uterine volume (EUV) was calculated from these measures. Data on pregnancy characteristics and other maternal anthropometrics were also collected.Primary outcome measureGA at subsequent ANC visits, as defined by early ultrasound dating.Results1486 (98%) women had at least one subsequent ANC visit, 1102 (74%) women had two subsequent ANC visits, and 748 (50%) had three visits. Using the common clinical practice of approximating the GA (in weeks) with the SFH measurement (cm), SFH systematically underestimated GA in late pregnancy (mean difference −4.4 weeks, 95% limits of agreement −12.5 to 3.7). For the classification of GA <28 weeks, SFH <26 cm had 85% sensitivity and 81% specificity; and for GA <34 weeks, SFH <29 cm had 83% sensitivity and 71% specificity. EUV had similar diagnostic accuracy. Despite rigorous statistical modelling of SFH, accounting for repeated longitudinal measurements and additional predictors, the best model without including a known last menstrual period predicted 95% of pregnancy dates within ±7.4 weeks of early ultrasound dating.ConclusionsWe were unable to predict GA with a high degree of accuracy before birth using maternal anthropometric measures and other available maternal characteristics. Efforts to improve GA dating in low- and middle-income countries before birth should focus on increasing coverage and training of ultrasonography.Trial registration numberNCT01572532

scholarly journals Incidence of congenital toxoplasmosis in southern Brazil: a prospective study

2003 ◽  
Vol 45 (3) ◽  
pp. 147-151 ◽  
Author(s):  
Liége Mozzatto ◽  
Renato Soibelmann Procianoy
Keyword(s):  
Toxoplasma Gondii ◽  
Gestational Age ◽  
Newborn Infants ◽  
Congenital Toxoplasmosis ◽  
Congenital Infection ◽  
First Trimester ◽  
Laboratory Diagnosis ◽  
Anthropometric Measures ◽  
Maternal Characteristics ◽  
The Town

The study aimed to determine the incidence of congenital infection by Toxoplasma gondii and to describe neonatal and maternal characteristics regarding newborn infants treated at a teaching hospital in the town of Passo Fundo, State of Rio Grande do Sul, Brazil. Cord blood samples collected from 1,250 live newborns were analyzed. The laboratory diagnosis was established by the detection of Toxoplasma gondii IgM using an enzyme linked fluorescent assay. Gestational age, intrauterine growth, anthropometric measures, and prenatal characteristics were assessed. The incidence of congenital toxoplasmosis at birth was 8/10,000 (95%CI 0.2-44.5). Mean birthweight was 3,080 ± 215.56 grams and mean gestational age was 38.43 ± 1.88 weeks. With regard to prenatal care, 58% of the pregnant patients visited their doctors five times or more and 38.9% were serologically tested for toxoplasmosis in the first trimester of pregnancy. The incidence of congenital toxoplasmosis was similar to that found in most studies conducted in our country and abroad. Our study sample is representative of the town of Passo Fundo and therefore it is possible to consider the frequency observed as the prevalence of the disease in this town during the study period.

scholarly journals Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort

2021 ◽  
Author(s):  
Ila R Falcão ◽  
Rita de Cássia Ribeiro-Silva ◽  
Marcia Furquim de Almeida ◽  
Rosemeire L Fiaccone ◽  
Natanael J Silva ◽  
...  
Keyword(s):  
Gestational Age ◽  
Multinomial Logistic Regression ◽  
Mixed Race ◽  
Sociodemographic Factors ◽  
Reproductive Age ◽  
Large For Gestational Age ◽  
Maternal Characteristics ◽  
Factors Associated ◽  
Study Population ◽  
Brazilian Populations

ABSTRACT Background Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations. Objectives To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil. Methods The study population consisted of women of reproductive age (14–49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest. Results Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14–20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35–49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1–3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1–3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27). Conclusions In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.

scholarly journals Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Shah ◽  
Q Jamali ◽  
F Aisha
Keyword(s):  
Rural Communities ◽  
Data Collection ◽  
Umbilical Cord ◽  
Rural Areas ◽  
Health Workers ◽  
High Rate ◽  
Cord Care ◽  
Community Based ◽  
Sindh Province ◽  
At Home

Abstract Background Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality. Methods We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan. Results Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day. Conclusions Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan. Key messages Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.

scholarly journals Blood Biomarkers of Late Pregnancy Exposure to Trihalomethanes in Drinking Water and Fetal Growth Measures and Gestational Age in a Chinese Cohort

2016 ◽  
Vol 124 (4) ◽  
pp. 536-541 ◽  
Author(s):  
Wen-Cheng Cao ◽  
Qiang Zeng ◽  
Yan Luo ◽  
Hai-Xia Chen ◽  
Dong-Yue Miao ◽  
...  
Keyword(s):  
Drinking Water ◽  
Fetal Growth ◽  
Gestational Age ◽  
Late Pregnancy ◽  
Blood Biomarkers ◽  
Chinese Cohort

scholarly journals Fetal foot length for assessment of gestational age: a cross sectional study

2021 ◽  
Vol 10 (8) ◽  
pp. 3153
Author(s):  
Vaibhav Sharma ◽  
Ruchi Saxena ◽  
Priyanka Gaur
Keyword(s):  
Gestational Age ◽  
Abdominal Ultrasound ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Maternal Characteristics ◽  
Foot Length ◽  
Adverse Pregnancy ◽  
The Relationship ◽  
Singleton Pregnancies

Background: Fetal age actually begins at conception and an equivalent term is conceptional age. Uncertain gestational age (GA) has been associated with adverse pregnancy outcomes independent of maternal characteristics. The objective was to evaluate the accuracy of fetal foot length (FFL) in estimation of gestational age.Methods: It was a cross sectional study. Trans abdominal ultrasound on 150 pregnant women with normal singleton pregnancies between 16 to 40 weeks was done to measure FFL. The relationship between GA and FFL was analysed by simple linear regression.Results: A linear relationship was demonstrated between FFL and GA. (GA (in weeks)=7.490+0.393×FFL (in mm)) with significant correlation (r=0.985, p<0.001).Conclusions: Ultrasonographic measurement of FFL is a reliable indicator of gestational age and can be a useful alternative to estimate GA when other routine biometric parameters are not conclusive.

scholarly journals Effectiveness of a Human Capacity-building Initiative on Improving the Health of Rural Communities

2021 ◽  
Author(s):  
Hamed Rezakhani Moghaddam ◽  
Vahideh Aghamohammadi ◽  
Aghil Habibi ◽  
Yousef Hamidzadeh
Keyword(s):  
Rural Communities ◽  
Capacity Building ◽  
Communication Skills ◽  
Health Workers ◽  
Healthy Lifestyle ◽  
Intervention Group ◽  
Control Group ◽  
Control Group Design ◽  
Job Motivation ◽  
Knowledge And Practice

Abstract Background: Given the major role of capacity building in improving the health of rural communities and due to the lack of studies performed on this issue, we aimed to investigate the effectiveness of educational and capacity building intervention on staff communication, job motivation skills, educational performance, and knowledge and behavior of health house clients in Ardabil city’s rural communities.Methods: The pretest-posttest nonequivalent control group design was conducted. In this study, convenience sampling was performed and a total of 220 health care recipients and 108 staff were surveyed in both interventional and control groups. The intervention was designed based on four approaches for capacity building introduced by Crisp et al. Data were collected using three questionnaires including knowledge and practice about healthy lifestyle, communication skills self-assessment, and Wright's job motivation. All statistical analyses were fulfilled using IBM SPSS Statistics software.Results: At the end of the study; the mean scores of knowledge and practice of referrals to health centers about a healthy lifestyle and communication skills and job motivation of healthcare worker increased statistically in the intervention group compared to the baseline (p< 0.05), but changes in these variables were not significant in the control group (p>0.05). Following 3 months of intervention, there were significant differences among the study groups (p< 0.05).Conclusion: Capacity building comprehensive interventions can help in identifying rural community health needs, increasing knowledge and practice of rural communities' residents about health issues, promoting health workers empowerment, and improving health workers' motivation.

The Description of Knowledge about Antenatal Care in Village X Bandung Regency in 2019

2021 ◽  
Vol 8 (1) ◽  
pp. 033-037
Author(s):  
Antri Ariani ◽  
Andria Pragholapati
Keyword(s):  
Antenatal Care ◽  
Gestational Age ◽  
Health Workers ◽  
Mortality Rates ◽  
Knowledge Questionnaire ◽  
Care Visit ◽  
High Knowledge ◽  
Quantitative Descriptive ◽  
Postpartum Mothers ◽  
Improve Health

The lack of maternal Antenatal care visit is one of the determinants that cause maternal mortality rates in Indonesia. Antenatal care is care for pregnant women during pregnancy, starting from conception to the birth of the fetus. The purpose of this study was to study the Antenatal Care Knowledge Overview in Village X Bandung Regency in 2019. The design of this study was quantitative descriptive with 74 postpartum mothers respondents. Data were collected using a knowledge questionnaire. The results obtained from the knowledge of Antenatal Care in Village X Bandung Regency in 2019 were high knowledge of Antenatal Care (73%) and low knowledge of 27%. The conclusion of the study showed respondents who had high knowledge of ANC was more than 73% compared to those who had low knowledge of 27%. Health workers need to improve health education for mothers with high gestational age and home visits.

Abstract P176: Associations of Gestational Lipids and Apolipoproteins With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Amanda M Perak ◽  
Alan Kuang ◽  
Nicola Lancki ◽  
Darwin R Labarthe ◽  
Svati H Shah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnancy Outcome ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcome ◽  
Late Pregnancy ◽  
Large For Gestational Age ◽  
Obstetric Outcomes ◽  
Outcome Study ◽  
Adverse Pregnancy

Introduction: Gestational hyperlipidemia has traditionally been considered physiologic and benign, but the significance of inter-individual variation in lipid levels for maternal-fetal health are poorly understood. We examined associations of gestational lipids and apolipoproteins with adverse obstetric and neonatal outcomes. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,813 mother-child dyads from 9 field centers in 6 countries: US (25%), Barbados (24%), UK (20%), China (16%), Thailand (8%), and Canada (7%). Fasting lipids and apolipoproteins were directly measured at a mean of 28 (range 23-34) weeks’ gestation. Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of lipids and apolipoproteins (per +1 SD; log-transformed if skewed) with pregnancy outcomes, adjusted for center, demographics, and maternal covariates such as BMI, blood pressure, and glycemia. Results: See Table for lipid and apolipoprotein levels in pregnant mothers. In fully adjusted models ( Table ), 1 SD higher log-triglycerides (i.e., ~2.7-fold higher triglyceride level) in late pregnancy was significantly associated with higher odds for preeclampsia (OR 1.53 [95% CI, 1.15-2.05]), large for gestational age infant (1.42 [1.21-1.67]), and infant insulin sensitivity <10 th percentile (1.25 [1.03-1.50]), but not with unplanned primary cesarean section or infant sum of skinfolds >90 th percentile. There were no significant associations of maternal HDL-C, LDL-C, or log-ApoB/A1 ratio with any outcome. Conclusion: Triglyceride levels in the latter half of pregnancy were uniquely associated with both maternal risks (preeclampsia) and neonatal risks (large for gestational age and insulin resistance), even after adjustment for maternal BMI, blood pressure, and glycemia.

scholarly journals Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038187
Author(s):  
Yuelin Wu ◽  
Sheng Wan ◽  
Shengyi Gu ◽  
Zhengqian Mou ◽  
Lingling Dong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Caesarean Section ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Late Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.

scholarly journals “They have been neglected for a long time”: a qualitative study on the role and recognition of rural health motivators in the Shiselweni region, Eswatini

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Caroline Walker ◽  
Doris Burtscher ◽  
John Myeni ◽  
Bernhard Kerschberger ◽  
Bernadette Schausberger ◽  
...  
Keyword(s):  
Rural Communities ◽  
Qualitative Study ◽  
Rural Health ◽  
Health Workers ◽  
Influencing Factor ◽  
Limiting Factors ◽  
Positive Health ◽  
Community Stakeholders ◽  
Public Health Challenges

Abstract Background Community health workers (CHWs) are increasingly engaged to address human resource shortages and fill primary healthcare gaps. In Eswatini, a cadre of CHWs called Rural Health Motivators (RHM) was introduced in 1976 to respond to key public health challenges. However, the emergence of health needs, particularly HIV/TB, has been met with inadequate programme amendments, and the role of RHMs has become marginalised following the addition of other CHWs supported by non-governmental organisations. This study was implemented to understand the role of RHMs in decentralised HIV/TB activities. In this paper, we explore the findings in relation to the recognition of RHMs and the programme. Methods This exploratory qualitative study utilised individual in-depth interviews, group and focus group discussions, participatory methods (utilising a game format) and observations. Participants were purposively selected and comprised RHM programme implementers, community stakeholders and local and non-governmental personnel. Data collection took place between August and September 2019. Interviews were conducted in English or siSwati and transcribed. SiSwati interviews were translated directly into English. All interviews were audio-recorded, manually coded and thematically analysed. Data was validated through methodical triangulation. Results Suboptimal organisational structure and support, primarily insufficient training and supervision for activities were factors identified through interviews and observation activities. Significant confusion of the RHM role was observed, with community expectations beyond formally endorsed tasks. Community participants expressed dissatisfaction with receiving health information only, preferring physical assistance in the form of goods. Additionally, gender emerged as a significant influencing factor on the acceptability of health messages and the engagement of RHMs with community members. Expectations and structurally limiting factors shape the extent to which RHMs are recognised as integral to the health system, at all social and organisational levels. Conclusions Findings highlight the lack of recognition of RHMs and the programme at both community and national levels. This, along with historical neglect, has hindered the capacity of RHMs to successfully contribute to positive health outcomes for rural communities. Renewed attention and support mechanisms for this cadre are needed. Clarification of the RHM role in line with current health challenges and clearer role parameters is essential.

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