scholarly journals Obstetric outcomes of women referred for delivery to a tertiary hospital in northern Tanzania– a descriptive retrospective study based on a hospital birth registry

2020 ◽  
Author(s):  
Carolyn Lissu ◽  
Helena Volgsten ◽  
Festu Mazuguni ◽  
Eusebious Maro
Keyword(s):  
Retrospective Study ◽  
Pregnant Women ◽  
Tertiary Hospital ◽  
Health Facilities ◽  
Obstetric Outcomes ◽  
Birth Registry ◽  
Maternal Deaths ◽  
Hospital Birth ◽  
Northern Tanzania ◽  
Lower Health

Abstract Background: Maternal mortality remains a great challenge in a low-income country like Tanzania, despite global and national efforts to improve women’s reproductive health. Timeliness and appropriateness of referral from a lower- to higher-level health facility comprise an important factor for the obstetrics outcome for pregnant women. This study aimed to determine the obstetric outcomes, such as maternal deaths, of women referred to KCMC, a tertiary hospital in northern Tanzania. Methods: A descriptive retrospective study based on a hospital birth registry was conducted, using consecutive stored data on pregnant women referred while in labor and managed at the KCMC tertiary hospital in northern Tanzania between the years 2000 and 2015. All referred pregnant women whose labor status information was missing during admission were excluded from the study. Results: During the study period, a total of 53662 deliveries were managed at KCMC. Among these, 6066 women were referred from lower health facilities, with 4193 (69.2%) of them being referred while in labor. The main reason for referral was poor progress of labor (31.0%), followed by prolonged labor (27.1%) and obstructed labor (19.5%). For 1859 (44.6%) women, delivery was by caesarean section. A total of 292 maternal deaths occurred between 2000 and 2015. Of these, almost a quarter (22.6%) occurred in women referred from other health facilities while in labor. Conclusions: Most of the maternal complications during labor and delivery were prevalent among women referred from lower health facilities. This underscores the need to strengthen lower health facilities’ ability to detect complications in timely manner and provide effective emergency obstetric care, as well as to refer women to higher-level facility.

scholarly journals A ten year analysis of maternal deaths in a tertiary hospital using the three delays model

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mo’men M. Mohammed ◽  
Saad El Gelany ◽  
Ahmed Rida Eladwy ◽  
Essam Ibrahium Ali ◽  
Mohamed T. Gadelrab ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Paradigm Shift ◽  
Tertiary Hospital ◽  
Health Facilities ◽  
Phase Delay ◽  
Second Phase ◽  
Maternal Deaths ◽  
Third Phase ◽  
Three Delays ◽  
Three Phases

Abstract Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. Conclusions There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers’ training. Trial registration This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

scholarly journals Epidemiology of maternal mortality in Befelatanana maternity during 2016-2017

2019 ◽  
Vol 8 (8) ◽  
pp. 3234
Author(s):  
Tanjona A. Ratsiatosika ◽  
Romuald Randriamahavonjy ◽  
Tahiana Rakotonirainy ◽  
Marie Valérie Rajaonarivony ◽  
A. Lantonirina Rainibarijaona ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pregnant Woman ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Urban Area ◽  
Developing Country ◽  
Maternal Deaths ◽  
Common Causes ◽  
Adequate Management ◽  
Regular Training

Background: Maternal mortality remains a permanent obsession for the pregnant woman and her entourage, and is still one of the topical issues faced by a developing country, such as Madagascar. Our study aims to determine the epidemiological and etiological profile.Methods: We conducted a descriptive retrospective study over a 2-year period from January 1st, 2016 to December 31st, 2017 at the Befelatanana Gynecology-Obstetrics Hospital on maternal deaths.Results: We had 76 maternal deaths out of 5430 births, or 1.39%. The average age was 31.18±8.38 years with extremes of 14 and 49 years. The average parity was 2.67±1.85. The majority of pregnancies were poorly followed with a mean ANC of 2.18±1.85. The referred patients predominated at 68.42%. Women living in the urban area had a 57.89% majority. Among the etiology, hypertensive complications predominated at 42.11% followed by hemorrhagic (38.16%) and infectious (19.14%) complications. The patients who underwent surgery predominated at 78.94% and 59.21% were transfused.Conclusions: Maternal mortality remains a major concern at the Befelatanana Obstetrics Gynecology Hospital. During our study, hypertensive complications were found to be the most common causes requiring adequate management. For this, an awareness of pregnant women for the standardization of ANC, as well as regular training of health actor are necessary.

scholarly journals Co-infection and Risk Factors Associated with STIs among Pregnant Women in Rural Health Facilities in Nigeria: A Retrospective Study

2021 ◽  
Vol 58 ◽  
pp. 004695802199291
Author(s):  
MaryJoy Umoke ◽  
Peter Sage ◽  
Tor Bjoernsen ◽  
Prince Christian Ifeanachor Umoke ◽  
Christian Ezeugworie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Pregnant Women ◽  
Rural Health ◽  
Health Workers ◽  
Health Facilities ◽  
Healthcare Facilities ◽  
Sexually Transmitted ◽  
Factors Associated ◽  
High Prevalence

Globally, sexually transmitted infections are recognized as a public and reproductive health challenge. The study determined the prevalence, co-infection, and risk factors associated with HBV, HCV, HIV, and Syphilis infections among pregnant women receiving antenatal care in rural health facilities in Ebonyi State, Nigeria. A retrospective study was conducted from January to December 2018 in 8 primary healthcare facilities using antenatal records of all the 4657 pregnant women who attended ANC within the period. Data were analyzed using descriptive and inferential statistics with IBM SPSS statistics version 20 and hypotheses tested at P < .05. The findings indicated a medium prevalence of HBV (4.1%), a high prevalence of HCV (4.1%) and syphilis (1.8%), and a low prevalence of HIV (0.9%). An overall co-infection rate of 0.623% that was not significant ( P > .05) was observed. Also, prevalence was more among the younger mothers (<20 years), those with secondary education. And the history of blood transfusion was significantly associated with HBV and HCV prevalence (χ2 = 7.865; P = .05*), 11.8%. conclusively, due to medium HBV prevalence and a high prevalence of HCV and syphilis observed, attention should be paid to blood screening before transfusion by health workers. Relevant stakeholders should provide intensive health education and appropriate free treatment services particularly for younger mothers and the less educated.

A Psychosocial Assessment of Patients Receiving Orthopaedic Treatment in a Tertiary Hospital in Northern Tanzania

2018 ◽  
Author(s):  
Joy Obayemi ◽  
Elizabeth Card ◽  
Octavian Shirima ◽  
Honest Massawe ◽  
Faiton Mandari ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Psychosocial Assessment ◽  
Orthopaedic Treatment ◽  
Northern Tanzania

Challenges in Antenatal Corticosteroid Prescribing: A Retrospective Study

2020 ◽  
Vol 16 (4) ◽  
pp. 327-333
Author(s):  
Shannon Armstrong-Kempter ◽  
Lucinda Beech ◽  
Sarah J. Melov ◽  
Adrienne Kirby ◽  
Roshini Nayyar
Keyword(s):  
Retrospective Study ◽  
Obstetric Care ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Optimal Timing ◽  
Prescribing Practices ◽  
Antenatal Corticosteroids ◽  
Term Infants ◽  
Preterm Premature Rupture ◽  
To Receive

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging. Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period. Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed. Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]). Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

scholarly journals Pregnant Women Living with Obesity: A Cross-Sectional Observational Study of Dietary Quality and Pregnancy Outcomes

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1652
Author(s):  
Margaret Charnley ◽  
Lisa Newson ◽  
Andrew Weeks ◽  
Julie Abayomi
Keyword(s):  
Pregnant Women ◽  
Maternal Obesity ◽  
Maternal Nutrition ◽  
Saturated Fatty Acids ◽  
Poor Quality ◽  
Dietary Quality ◽  
Obstetric Outcomes ◽  
Dietary Intakes ◽  
Singleton Pregnancy ◽  
Cross Sectional

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m2, were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks’ gestation. Clinical data were recorded directly from the women’s medical records. Nutrient intake was determined using ‘MicrodietTM’, then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered ‘over nourished’, may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from ‘dieting’ onto positive messages, emphasising key nutrients required for good maternal and foetal health.

scholarly journals Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliette Servante ◽  
Gill Swallow ◽  
Jim G. Thornton ◽  
Bethan Myers ◽  
Sandhya Munireddy ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Pregnant Women ◽  
Clinical Evidence ◽  
Case Reports ◽  
Standard Form ◽  
Test Results ◽  
Maternal Deaths ◽  
High Clinical Suspicion ◽  
Increased Risk ◽  
Definition Of

Abstract Background As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Methods Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. Results One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. Conclusions Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.

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