Neonatal outcomes of obstetric complications

Background/Aims Neonatal mortality remains a global challenge. In Ghana, neonatal mortality accounts for up to 50% of child mortality. A better understanding of the neonatal outcomes of obstetrics complications could contribute to context-specific evidence-based care to prevent neonatal deaths. This study aimed to describe the relationship between poor neonatal outcomes and obstetric complications in a tertiary health facility in the north of Ghana. Methods This was a cross-sectional quantitative study conducted at a tertiary health facility in northern Ghana. Purposive convenience sampling was used to select 384 mothers who experienced obstetric complications. A structured questionnaire was used to collect data on the participants' neonatal health outcomes. The chi-square test was performed to determine the relationship between neonatal health outcomes and obstetric complications, with significance set at P<0.05. Results A total of 20 obstetric complications were recorded. Overall, 327 participants had a single complication. The three most common obstetric complications resulting in adverse neonatal outcomes were obstructed labour (56.0%), pregnancy-induced hypertension (14.6%) and postpartum haemorrhage (11.6%). The majority (66.7%) of the neonates were healthy at birth, with 21.9% and 11.5% being sick or stillborn respectively. Obstetric complications were significantly associated with both neonatal morbidities and mortalities at P<0.000. Conclusions Preventable maternal obstetric complications continue to cause adverse neonatal outcomes in health facilities in Ghana. Appraisal of maternal and newborn care practices may be necessary to understand context-specific factors.

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Integrated Review of Cytokines in Maternal, Cord, and Newborn Blood: Part II— Associations With Early Infection and Increased Risk of Neurologic Damage in Preterm Infants

Biological Research For Nursing ◽

10.1177/1099800409344619 ◽

2009 ◽

Vol 11 (4) ◽

pp. 377-386 ◽

Cited By ~ 19

Author(s):

Rita Pickler ◽

Lisa Brown ◽

Jacqueline McGrath ◽

Debra Lyon ◽

Debra Rattican ◽

...

Keyword(s):

Preterm Infants ◽

Proinflammatory Cytokines ◽

Early Infection ◽

Neonatal Outcomes ◽

Mediators Of Inflammation ◽

Increased Risk ◽

Adverse Neonatal Outcomes ◽

Factor Α ◽

Relationship Of ◽

The Relationship

A growing body of literature supports the relationship of maternal inflammation with preterm birth and adverse neonatal outcomes, including infection and central nervous system (CNS) dysfunction. Mediators of inflammation, most notably proinflammatory cytokines, have been implicated as having an association with and perhaps playing a causal role in the pathogenesis, leading to adverse neonatal outcomes. Even though the association of cytokines with early adverse neonatal outcomes has been actively pursued as a line of research, there has been little integration of diverse findings across studies. Therefore, the purpose of this systematic review was to appraise and classify empirical evidence from human studies for the association of cytokine levels in blood (serum, plasma, or cells; maternal, cord, or neonatal) with two adverse early outcomes in preterm infants: early infection and increased risk of neurologic damage. The review revealed that the proinflammatory cytokines most frequently linked with sepsis are in the interleukin (IL) 1 family as well as tumor necrosis factor α (TNF-α) and IL-6. The proinflammatory cytokines most frequently linked to neurologic insult in the reviewed studies were IL-1β, IL-6, and IL-8. In all cases where IL-1β was studied, the levels were increased when there was neurologic insult. A better understanding of the relationship of these inflammatory substances with these adverse conditions is needed for the future development of maternal and neonatal biobehavioral nursing research.

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Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i3.93 ◽

2021 ◽

Vol 3 (3) ◽

pp. 59-63

Author(s):

Bekir Kahveci ◽

Mehmet Sukru Budak ◽

Ihsan Baglı ◽

Sedat Akgol

Keyword(s):

Neonatal Mortality ◽

Vaginal Birth ◽

Neonatal Outcomes ◽

Cesarean Birth ◽

Early Neonatal Mortality ◽

Mode Of Birth ◽

Adverse Neonatal Outcomes ◽

Early Neonatal Mortality Rate ◽

Vertex Presentation ◽

Twin Pregnancies

Objective: To evaluate vaginal birth safety by comparing the results of cesarean birth in twin pregnancies with the first twin in vertex presentation. Material and methods: A retrospective cohort study of vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks 6 days of gestation was conducted at our hospital from January 2013 to December 2014. The study population was divided according to the mode of birth. The primary outcome was early neonatal mortality, and secondary outcomes related to maternal and perinatal clinical characteristics were analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869) were twin pregnancies. Of the 295 pregnancies meeting the study criteria, 30.16% (n = 89) were in the vaginal birth group, while the remaining 69.84% (n = 206) were in the cesarean birth group. In the vaginal birth group, all the first twins were delivered via vaginal birth, while among the second twins, 82.03% (n = 73) were delivered via vaginal birth, and the remaining 17.97% (n = 16) were delivered via cesarean birth. In the vaginal birth group, the early neonatal mortality rate was 22.4‰ (n = 2), and it was 9.7‰ (n = 2) in the cesarean birth group. All of the deaths occurred in pregnancies under 37 weeks of gestation. Conclusion: The neonatal outcomes between the vaginal birth and cesarean birth groups were similar in term pregnancies with the first in twin vertex presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin pregnancies.

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The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03361-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tannia Tembo ◽

Aybüke Koyuncu ◽

Haoran Zhuo ◽

Martha Mwendafilumba ◽

Albert Manasyan

Keyword(s):

Clinical Trial ◽

Cohort Study ◽

Health Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Maternal Age ◽

Health Facilities ◽

Neonatal Outcomes ◽

Trial Registration ◽

Adverse Neonatal Outcomes

Abstract Background Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia. Methods This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05. Results The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21). Conclusions Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes. Trial registration Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

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Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04021-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hua Li ◽

Angela Bowen ◽

Rudy Bowen ◽

Nazeem Muhajarine ◽

Lloyd Balbuena

Keyword(s):

Depression Scale ◽

Late Pregnancy ◽

Neonatal Outcomes ◽

Depression And Anxiety ◽

Logistic Regression Models ◽

Mood Instability ◽

Antenatal Depressive Symptoms ◽

Adverse Neonatal Outcomes ◽

The Relationship ◽

In Pregnancy

Abstract Background Antenatal women experience an increased level of mood and anxiety symptoms, which have negative effects on mothers’ mental and physical health as well as the health of their newborns. The relation of maternal depression and anxiety in pregnancy with neonate outcomes is well-studied with inconsistent findings. However, the association between antenatal mood instability (MI) and neonatal outcomes has not been investigated even though antenatal women experience an elevated level of MI. We sought to address this gap and to contribute to the literature about pregnancy neonate outcomes by examining the relationship among antenatal MI, depression, and anxiety and neonatal outcomes. Methods A prospective cohort of women (n = 555) participated in this study at early pregnancy (T1, 17.4 ± 4.9 weeks) and late pregnancy (T2, 30.6 ± 2.7 weeks). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal depressive symptoms, anxiety was measured by the EPDS anxiety subscale, and mood instability was measured by a visual analogue scale with five questions. These mood states together with stress, social support, as well as lifestyle were also examined in relation to neonatal outcomes using chi-square tests and logistic regression models. Results Mood instability, depression, and anxiety were unrelated to adverse neonatal outcomes. Only primiparous status was associated with small for gestational age after Bonferroni correction. Conclusions We report no associations between antenatal mood symptoms including MI, depression, and anxiety and neonatal outcomes. More studies are required to further explore the relationship between antenatal mood instability, depression, and anxiety and neonatal outcomes.

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Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs (Preprint)

10.2196/preprints.12879 ◽

2018 ◽

Author(s):

Hannah Brown Amoakoh ◽

Kerstin Klipstein-Grobusch ◽

Diederick E Grobbee ◽

Mary Amoakoh-Coleman ◽

Ebenezer Oduro-Mensah ◽

...

Keyword(s):

Decision Making ◽

Health Outcomes ◽

Information Needs ◽

Clinical Decision Making ◽

Clinical Decision ◽

Time Of Day ◽

Neonatal Health ◽

Facility Type ◽

Maternal And Neonatal Health ◽

The Relationship

BACKGROUND Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.

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Comparison of Common Adverse Neonatal Outcomes Among Preterm and Term Infants at the National Referral Hospital in Tanzania: A Case-Control Study

10.21203/rs.3.rs-613224/v1 ◽

2021 ◽

Author(s):

Bernadether Terentius Rugumisa ◽

Raphael Zozimus Sangeda ◽

Erik Bongcam-Rudloff ◽

Sylvester Leonard Lyantagaye ◽

Siriel Nanzia Massawe

Keyword(s):

Health Outcomes ◽

Preterm Infants ◽

Case Control Study ◽

Health Sector ◽

Neonatal Outcomes ◽

Term Infants ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Adverse Neonatal Outcomes ◽

Control Study

Abstract BackgroundThe first month of life is the most critical in a child’s heath because it is associated with the highest risk of adverse health outcomes. In Tanzania the risk of adverse health outcomes in preterm infants is five times higher compared to term infants.The objective of this study was to assess common adverse health outcomes and compare the risk of such outcomes between preterm and term infants, in Tanzania, within the first 28 days of life.MethodsThis was a case-control study involving preterm (cases) and term (controls) infants delivered at the Muhimbili National Hospital between August and October 2019 . About 222 pairs of cases and controls were reviewed for their medical records. Logistic regression was used to compare the risk of neonatal outcomes between the study groups. Statistical significance was achieved at P-value < 0.05 and 95% confidence interval.ResultsPreterm infants have an increased risk of mortality (OR = 7.2, 95% CI: 3.4-15.1), apnea (OR = 4.7, 95% CI: 3.4-15.1), respiratory distress syndrome (OR = 4.8, 95% CI: 3.2-7.3), necrotizing enterocolitis (OR = 5.5, 95% CI: 1.2-25.3), anemia (OR = 4.3 , 95% CI: 2.8-6.6), pneumonia (OR = 2.7, 95% CI: 1.6-4.6) and sepsis (OR = 2.6, 95% CI: 1.7-3.9) in the first month of life compared to term infants. No differences in the risk of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus and jaundice were observed between preterm and term infants. ConclusionThe findings of this study informs the Tanzanian health sector about the most common and high risk neonatal outcomes in preterm infants. Additionaly, for promoting neonates' health, the health sector needs to consider preventing and treating the most common and high risk adverse neonatal outcomes in preterm infants.

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