scholarly journals Cesarean Section and Maternal-fetal Mortality Rates in Nigeria: An Ecological Lens into the Last Decade

2020 ◽  
Vol 9 (1) ◽  
pp. 128-135
Author(s):  
Hadiza Galadanci ◽  
Deepa Dongarwar ◽  
Wolfgang K ◽  
Oladapo Shittu ◽  
Murtala Yusuf ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Mortality Rates ◽  
Significant Rise ◽  
Fetal Mortality ◽  
Maternal Deaths ◽  
Spontaneous Vaginal Delivery ◽  
The Sustainable Development ◽  
Global Average

Background or Objectives: Despite the global decline in maternal mortality within the last decade, women continue to die excessively from pregnancy-related complicationsin developing countries. We assessed the trends in maternal mortality, fetal mortality and cesarean section (C-Section) rates within 25 selected Nigerian hospitals over the last decade. Methods: Basic obstetric data on all deliveries were routinely collected by midwives using the maternity record book developed for the project in all the participating hospitals. Trends of C-Section Rates (CSR), Maternal Mortality Rates (MMR), Fetal Mortality Rates (FMR) and Spontaneous Vaginal Delivery rates (SVD) were calculated using joinpoint regression models. Results: The annual average percent change in CSR was 12.2%, which was statistically significant, indicating a rise in CSR over the decade of the study. There was a noticeable fall in MMR from a zenith of about 1,868 per 100,000 at baseline down to 1,315/100,000 by the end of the study period, representing a relative drop in MMR of about 30%. An average annual drop of 3.8% in FMR and 1.5% drop in SVD over time were noted over the course of the study period. Conclusion and Global Health Implications: We observed an overall CSR of 10.4% and a significant rise in CSR over the 9-year period (2008-2016) of about 108% across hospital facilities in Nigeria. Despite the decrease in MMR, it was still high compared to the global average of 546 maternal deaths per 100 000 livebirths. The FMR was also high compared with the global average. The MMR found in this study clearly indicates that Nigeria is far behind in making progress toward achieving the Sustainable Development Goal 3 (SGD 3) which aims to reduce the global MMR to less than 70 per 100 000 live births by 2030. Key words: • Cesarean section • Maternal mortality • Fetal mortality • Spontaneous vaginal delivery • Trends in MMR • Nigeria   Copyright © 2020 Galadanci et al. This is an open-access article distributed under the terms of the Creative Com - mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

Introduction to newborn health

2018 ◽  
pp. 135-139
Author(s):  
Samantha Sadoo ◽  
Hannah Blencowe ◽  
Shefali Oza ◽  
Joy Lawn
Keyword(s):  
Sustainable Development ◽  
Maternal Mortality ◽  
Newborn Health ◽  
Mortality Rates ◽  
Maternal Deaths ◽  
Development Goal ◽  
The Sustainable Development ◽  
Neonatal Deaths ◽  
Under Five ◽  
Child Deaths

Since 1990, child and maternal mortality rates have halved worldwide; however, progress for neonatal mortality has been slower and it now accounts for 46% of all child deaths under five. The Sustainable Development Goal (SDG) targets have been set to end preventable neonatal deaths (≤12 neonatal deaths per 1000 livebirths in every country by 2030). Over 80% of all neonatal deaths are caused by direct complications of prematurity, intrapartum-related events, and infection. Over a third of deaths occurring on the day of birth, and targeting care around the time of birth can reduce maternal deaths, stillbirths, and newborn deaths and disability. There is an urgent need to improve data in order to track progress and prioritise programmatic action; currently half of all newborns are not registered at birth, and less than 5% of all neonatal deaths have a death certificate.

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

2020 ◽  
pp. 000486742095428
Author(s):  
Lei Sun ◽  
Su Wang ◽  
Xi-Qian Li
Keyword(s):  
Postpartum Depression ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Spontaneous Vaginal Delivery ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

scholarly journals The Efficacy of Intravenous Tranexamic Acid in Reduction of Blood Loss in Women at High Risk of Postpartum Hemorrhage

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
K M Diab ◽  
R M Mohamed ◽  
A G Abdelhay
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Aim of the Work To assess the efficacy and safety intravenous tranexamic acid in reduction of amount of blood loss in high risk women who deliver by cesarean section or vaginal delivery in postpartum period. Patients and Methods This prospective double blind randomized controlled clinical trial study was conducted on 200 patients planned for LSCS or vaginal delivery at Gestational Age ≥ 34 Weeks at Ain Shams University Maternity Hospital. Recruitment of data begun once the protocol was approved by research and ethical committee of the department of obstetrics and gynecology. Results No significant difference between Study and Control groups as regards age (p = 0.508), no significant difference between Study and Control groups as regards Gestational age (p = 0.447),total blood loss (p < 0.001) was significantly lower in study group than control group, Vaginal pads in the 1st 24 hours post-partum was significantly less soaked in study group than control group (p < 0.001). no significant difference between Study and Control groups as regards Preoperative Hemoglobin, Postoperative Hemoglobin was significantly higher in study group than control group (p < 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p < 0.001), no significant difference between Study and Control groups as regards Preoperative Hematocrite, Postoperative Hematocrit was significantly higher in study group than control group (p < 0.001), Reduction in Hematocrite was significantly less in study group than control group (p < 0.001).Need to iron replacement or blood transfusion was significantly less frequent in study group than control group (p = 0.24). Conclusion The use of tranexamic acid prior to cesarean section or vaginal delivery is effective as a prophylaxis against post-partum hemorrhage as shown by the results of this study. It can significantly reduce blood loss during and after cesarean section or vaginal delivery.

scholarly journals Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianghui Cai ◽  
Mi Tang ◽  
Yu Gao ◽  
Hongxi Zhang ◽  
Yanfeng Yang ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Vertical Transmission ◽  
Mode Of Delivery ◽  
Biomedical Literature ◽  
Sufficient Evidence ◽  
Cochrane Library ◽  
Pregnant Mother ◽  
Maternal Deaths ◽  
Neonatal Deaths

Background: The impact of delivery mode on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate.Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from 31 December 2019 to 18 June 2020. We applied no language restrictions. We screened abstracts for relevance, extracted data, and assessed the risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different delivery modes. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049.Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on the mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1,019 pregnant women and 1,035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1,035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) were tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths were reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths were reported compared with 11/603 (1.82%) delivered by cesarean. Two women died before delivery. Sensitivity analyses and subgroup analyses showed similar findings.Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths are no greater when the mother gave birth through vaginal delivery. Based on the evidence available, there is no sufficient evidence supporting that the cesarean section is better than vaginal delivery in preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. The mode of birth should be individualized and based on disease severity and obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens are urgently needed.Study registration: PROSPERO CRD42020194049.

scholarly journals Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

2013 ◽  
Vol 3 (2) ◽  
pp. 77-83
Author(s):  
Sheuly Begum ◽  
Ferdousi Islam ◽  
Arifa Akter Jahan
Keyword(s):  
Cesarean Section ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Birth Asphyxia ◽  
Maternal Outcome ◽  
Maternal Complications ◽  
Medical College ◽  
Group I ◽  
Significant Difference

Background: Over  half-a-million women die each year  from pregnancy-related  causes, and  99 percent of these occur in developing countries. In Bangladesh though maternal mortality  rate (MMR) declined  significantly  around 40% in  the  past  decade,  still  eclampsia  accounts  for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure  is  delivery  regardless  of  gestational  age.  A  rational  therapy  for  general  management  of  hypertension and convulsion has been established in Bangladesh by the Eclampsia Working  Group.  But  controversy  still  exists  regarding  obstetric  management. Objective: To  evaluate  the  feto-maternal  outcome  in  cesarean  section  compared  to  vaginal  delivery  in  eclamptic  patients. Materials  and  Methods: This  prospective  cohort  study  was  conducted  in  the  department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from  January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus  were purposively included in the study (Group I, 50 patients with vaginal delivery and Group  II, 50 with cesarean section). Results: Out  of these 100 patients 56% were aged <20 years,  71%  were  primigravida  and  77%  were  from  low  socioeconomic  status.  Sixteen  percent  patients from vaginal delivery group and 18% from cesarean section group had no antenatal  care. The mean gestational age was about 38 weeks in two groups. No significant difference  was found between the two groups regarding blood pressure, proteinuria, consciousness level  and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group  compared  to  6%  in  cesarean  section  group.  Maternal  complications  such  as  postpartum  hemorrhage,  cerebrovascular  accident,  renal  failure,  obstetric  shock  and  abruptio  placenta  were  higher  among  vaginal  delivery  group  patients  (46%)  than  cesarean  section  patients  (16%).  Maternal  mortality  was 6% in  the  vaginal  delivery  group  and  none  in  the  cesarean  section  group.  Regarding  fetal  outcome,  stillbirth  was  20%  after  vaginal  delivery  and  6%  after cesarean section,  the result was statistically  significant.  Birth asphyxia was less  in  the  cesarean  section  group  (23.4%)  than  in  vaginal  delivery  group  (60%)  and  this  was  statistically  significant. Conclusions:  The  result  of  the  present  study  shows  a  better  feto- maternal outcome in the cesarean section group than in the vaginal delivery group. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128

scholarly journals Government Revenue and Child and Maternal Mortality

2020 ◽  
Author(s):  
Stephen Hall ◽  
Janine Illian ◽  
Innocent Makuta ◽  
Kyle McNabb ◽  
Stuart Murray ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Inverse Function ◽  
Mortality Rates ◽  
Government Revenue ◽  
The Sustainable Development ◽  
Poor Access ◽  
Non Linear ◽  
Mortality Ratio ◽  
Per Capita

Abstract Most maternal and child deaths result from inadequate access to the critical determinants of health: clean water, sanitation, education and healthcare, which are also among the Sustainable Development Goals. Reasons for poor access include insufficient government revenue for essential public services. In this paper, we predict the reductions in mortality rates — both child and maternal — that could result from increases in government revenue, using panel data from 191 countries and a two-way fixed-effect linear regression model. The relationship between government revenue per capita and mortality rates is highly non-linear, and the best form of non-linearity we have found is a version of an inverse function. This implies that countries with small per-capita government revenues have a better scope for reducing mortality rates. However, as per-capita revenue rises, the possible gains decline rapidly in a non-linear way. We present the results which show the potential decrease in mortality and lives saved for each of the 191 countries if government revenue increases. For example, a 10% increase in per-capita government revenue in Afghanistan in 2002 ($24.49 million) is associated with a reduction in the under-5 mortality rate by 12.35 deaths per 1000 births and 13,094 lives saved. This increase is associated with a decrease in the maternal mortality ratio of 9.3 deaths per 100,000 live births and 99 maternal deaths averted. Increasing government revenue can directly impact mortality, especially in countries with low per- capita government revenues. The results presented in this study could be used for economic, social and governance reporting by multinational companies and for evidence-based policymaking and advocacy.

Alterations in the Umbilical Cord Blood NK Cells Related to the Mode and the Time of Delivery.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3926-3926 ◽  
Author(s):  
Barbara Królak-Olejnik ◽  
Igor Olejnik
Keyword(s):  
Cesarean Section ◽  
Nk Cells ◽  
Natural Killer ◽  
Vaginal Delivery ◽  
Epidural Anesthesia ◽  
Umbilical Cord Blood ◽  
Full Term ◽  
Preterm Neonates ◽  
Term Neonates ◽  
Spontaneous Vaginal Delivery

Abstract Natural killer (NK) cells take part in the early immunological response to infection. Their lower cytotoxic activity in the neonates, especially premature ones, compared to children and adults, is assumed to be one of the factors responsible for high susceptibility to infections. Moreover, alterations in every components of immune response during anesthesia and surgery have been suggested. The numbers of natural killer cells are decreased postoperatively. The aim of the study was to estimate the influence of the mode and time of delivery on the number of leukocytes, number and percentage of lymphocytes and natural killer (NK) cells. The NK cells were examined by the three-color flow cytometry with the use of monoclonal antibodies of Becton Dickinson in the following study groups: (1) full-term neonates born by normal spontaneous vaginal delivery (n=19); (2) preterm neonates born by normal spontaneous vaginal delivery (n=15); (3) full-term neonates born by elective cesarean section under epidural anesthesia (n=23); (4) preterm neonates born by cesarean section under epidural anesthesia (n=22). The number of leukocytes was similar in all examined neonates. The numbers of leukocytes were lower albeit not significantly in preterm neonates born by cesarean section. The numbers of lymphocytes were also similar in all examined neonates but the percentage of lymphocytes was higher in the preterm neonates than in the full-term ones (p<0,05). The number and percentage of natural killer (NK) cells were higher in the neonates born by normal spontaneous vaginal delivery both full-term and preterm ones. The significant lowest value of NK cells was in the preterm neonates born by cesarean section under epidural anesthesia. These results suggest that either mode of delivery or time of delivery might influence the NK cell numbers in the umbilical cord blood of the neonates.

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