scholarly journals Outcomes of Pregnancy-Related Referrals From Rural Health Facilities to Two Central Hospitals in Harare, Zimbabwe: A Prospective Descriptive Study

2020 ◽  
Author(s):  
William Busumani ◽  
Paddington Mundagowa
Keyword(s):  
Mortality Rate ◽  
Blood Transfusion ◽  
Rural Health ◽  
Perinatal Mortality ◽  
Rural Women ◽  
Perinatal Outcomes ◽  
Descriptive Study ◽  
Health Facilities ◽  
Maternal Deaths ◽  
Healthcare Facilities

Abstract BackgroundBetween the years 2000 and 2017, the global maternal mortality rate dropped by 38% however, 94% of all maternal deaths still emanated from low and lower-middle-income countries. Rural women at a significantly higher risk of dying from pregnancy when compared to women living in urban settings and early detection of complications as well as prompt referral to higher levels of care can reduce the associated maternal and perinatal mortality. This study aimed to determine the maternal and perinatal outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe.MethodsA prospective descriptive study was conducted using a sample of 206 patients. All mothers who were referred from rural healthcare facilities were recruited for participation. Data were extracted from patient notes using a structured questionnaire and missing information was obtained from the mother after she had recovered. Bivariate analysis was done using IBM SPSS.ResultsThe average age of study participants was 27.4±7.7 years. 87.4% were booked and 81.6% presented to the tertiary facility with their referral notes. The major reasons for referral were previous cesarean section (20.4%) and hypertensive disorders in pregnancy (18.4%). There were nine maternal deaths thus a case fatality rate of 4.4% while the perinatal mortality rate was 151/1000 live births. Young mothers were more likely to have adverse perinatal outcomes and primiparous mothers were more likely to have a blood transfusion. Mothers who traveled for >100km to the tertiary facility and mothers who did not attend any antenatal visit were more likely to be transfused. Delivering at the rural health facility was significantly associated with receiving a blood transfusion at the tertiary facility. Mothers who did not attend antenatal clinic visits were more likely to have negative perinatal outcomes.ConclusionThe proportion of obstetric patients being referred from rural facilities to tertiary institutions for complications in Zimbabwe reveals how primary and secondary healthcare facilities are falling short of offering the services they should be offering. Equipping these facilities with skilled human resources as well as contemporary equipment could help decongest the central hospitals, reduce the adverse maternal and perinatal outcomes.

scholarly journals Outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe: a prospective descriptive study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
William Busumani ◽  
Paddington T. Mundagowa
Keyword(s):  
Mortality Rate ◽  
Blood Transfusion ◽  
Rural Health ◽  
Perinatal Mortality ◽  
Rural Women ◽  
Perinatal Outcomes ◽  
Descriptive Study ◽  
Health Facilities ◽  
Maternal Deaths ◽  
Healthcare Facilities

Abstract Background Between the years 2000 and 2017, the global maternal mortality rate dropped by 38% however, 94% of maternal deaths still emanated from low-to middle-income countries. Rural women are at a significantly higher risk of dying from pregnancy when compared to their urban counterparts. Early detection of complications and prompt referral to higher levels of care can reduce the associated maternal and perinatal mortality. This study aimed to determine the maternal and perinatal outcomes of pregnancy-related referrals from rural health facilities to central hospitals in Harare, Zimbabwe. Methods A prospective descriptive study was conducted using a sample of 206 patients. All mothers who were referred from rural healthcare facilities were recruited for participation. Data were extracted from patient notes using a structured questionnaire and missing information was obtained from the mother after she had recovered. Bivariate analysis was done using IBM SPSS. Results The average age of study participants was 27.4 ± 7.7 years. 87.4% had booked for antenatal care and 81.6% presented to the tertiary facility with their referral notes. The major reasons for referring patients were previous cesarean section (20.4%) and hypertensive disorders in pregnancy (18.4%). There were nine maternal deaths thus a case fatality rate of 4.4% while the perinatal mortality rate was 151/1000 live births. Young mothers were at a higher risk of having adverse perinatal outcomes while primiparous mothers were more likely to have a blood transfusion. Mothers who traveled for > 100 km to the tertiary facility and those who did not attend any antenatal visit were more likely to need blood transfusion. Delivering at the rural health facility was significantly associated with receiving a blood transfusion at the tertiary facility. Mothers who did not attend antenatal visits were more likely to have negative perinatal outcomes. Conclusion The proportion of obstetric patients being referred from rural facilities to tertiary institutions for complications reveals how primary and secondary healthcare facilities in Zimbabwe are falling short of offering the services they should be offering. Equipping these facilities with skilled human resources as well as contemporary equipment could help decongest the central hospitals consequently reducing the adverse maternal and perinatal outcomes.

scholarly journals Frequency of Overweight Women and Ovarian Enlargement among Females Presented with Pelvic Pain Complains

2021 ◽  
pp. 1-4
Author(s):  
Rukhsana Soomro ◽  
Zahida Parveen Brohi ◽  
Asma Jabeen ◽  
Afra Rehman ◽  
Mehreen Yousaf Rana
Keyword(s):  
Body Mass Index ◽  
Data Collection ◽  
Rural Health ◽  
Body Mass ◽  
Pelvic Pain ◽  
Ultrasound Examination ◽  
Descriptive Study ◽  
Health Facilities ◽  
Ovarian Mass ◽  
Overweight Women

Objective: To determine the frequency of overweight females and ovarian enlargement among women presenting with pelvic pain complaints at rural Health facilities of district Tando Muhammad Khan. Methodology: This descriptive study was conducted at physiology department of Sindh University with the collaboration of different rural health facilities of Tando Muhammad Khan, Sindh. All the females presented with pelvic pain and age more than 18 and up to 45 years were included. Body mass index (BMI) was assessed by the ratio of the individual's weight in kilograms divided by the height in meters squared (BMI = kg/m2). All the patients underwent ultrasound examination. Data collection was done by structured study proforma. Analysis of the data was done by the SPSS version 20. Results: A total of 239 women with pelvic pain complaints were studied, their mean age was 32.79+4.31 years. Neoplastic ovarian lesions were seen amogn12.54% of the cases. Cystic ovarian lesions were among 30.54% of the females, 5.01% had ovarian mass and 21.33% females had mixed pathologies. BMI was normal among 62.76% cases, while 20.08% women were overweight, 03.34% were obese and 13.8%females were underweight. Conclusion: Overweight females and ovarian enlargement were observed to be highly frequent among females presented with pelvic pain complaints. Cystic enlargement was observed to be the commonest cause of ovarian enlargement.

scholarly journals Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in Central Punjab.

2019 ◽  
Vol 26 (10) ◽  
pp. 1645-1650
Author(s):  
Rabia Mushtaq ◽  
Afroza Abbas ◽  
Waqas Ahmed
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Low Birthweight ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Perinatal Mortality Rate

Objectives: Antepartum Hemorrhage is bleeding from or into the genital tract from the period of viability of fetus (28 weeks) till the end of second stage of labor. Antepartum hemorrhage is associated with a very high perinatal mortality rate. We present our experience of perinatal outcomes in cases of antepartum hemorrhage with the aim of highlighting the cause of antepartum hemorrhage and the adverse outcomes. Study Design: Descriptive Cross sectional study. Setting: Department of Gynecology & Obstetrics, Sargodha Medical College, Sargodha. Period: Jan 2018 to Jun 2018. Material and Methods: Ninety six pregnant patients between ages of 15-45 years diagnosed as cases of antepartum hemorrhage were enrolled. Patients with coagulation disorders, twin pregnancies, abnormal lie or presentation, previous scar and any known congenital anomaly. Cause of antepartum hemorrhage and mode of delivery was recorded. Perinatal outcomes were determined in terms of frequencies of perinatal mortality, stillbirth and low birthweight babies. Results: The etiology of antepartum hemorrhage in our setup was placenta previa (43.75%); placental abruption (37.5%); Toxemia (10.41%) and unclassified causes in 8.33% patients. The perinatal mortality rate was 43.75% in our study. The overall frequency of low birthweight babies and stillbirth was 62.5% and 27.08% respectively. Conclusion: Antepartum hemorrhage is a major cause of perinatal mortality in our country. A prompt diagnosis of the cause followed by early cesarean section can help reduce the overall mortality.

Perinatal Mortality in Retrospect and Prospect

1969 ◽  
Vol 14 (3) ◽  
pp. 89-94
Author(s):  
J. Thomson
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
No Reduction ◽  
Maternity Hospital ◽  
Early Years ◽  
National Data ◽  
Maternal Deaths ◽  
Neonatal Deaths ◽  
Marked Decline ◽  
The Subject

Little interest was displayed in perinatal mortality until the work of Ballantyne in the early years of this century. Scotland has had national figures available for causes of stillbirths since 1939 and also for neonatal deaths since 1958. The National Perinatal Mortality rate has dropped by 50 per cent since 1939 but the mortality rate for the first 24 hours of life has shown no improvement. Comparison of national data with figures from a maternity hospital shows a greatly increased number of deaths from unknown causes in the national data: it is suggested that the national data do not present a true picture due to inadequate certification. Study of the hospital figures over a period of 15 years shows little change in the total deaths, the marked decline in the number of stillbirths being balanced by a marked increase in first-day deaths. Difficult labour and birth injury are decreasing as causes of perinatal mortality. Deaths from malformations, toxaemia, placental haemorrhage and unknown causes show little or no reduction. It is suggested that perinatal deaths should be the subject of an inquiry such as that for maternal deaths. The changing pattern of perinatal mortality calls for constant reassessment.

scholarly journals The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Tesfalidet Beyene ◽  
Catherine Chojenta ◽  
Roger Smith ◽  
Deborah Loxton
Keyword(s):  
Birth Weight ◽  
Mortality Rate ◽  
Perinatal Mortality ◽  
Maternal Deaths ◽  
Apgar Scores ◽  
Neonatal Deaths ◽  
Factors Associated ◽  
South Ethiopia ◽  
Early Neonatal Mortality ◽  
Early Neonatal Deaths

Abstract Background Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia. Methods Three years (2014–2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association. Result The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths. Conclusion Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths.

scholarly journals Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e027504
Author(s):  
Victoria Nakibuuka Kirabira ◽  
Mamuda Aminu ◽  
Juan Emmanuel Dewez ◽  
Romano Byaruhanga ◽  
Pius Okong ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Perinatal Mortality ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Stillbirth Rate ◽  
Neonatal Mortality Rate ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
Early Neonatal Mortality Rate

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary outcome measuresPrimary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis.Results526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention.ConclusionThe introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.

The Effect of “Off Hours” on Maternal and Perinatal Outcomes in a Diverse U.S. Cohort

2021 ◽  
Author(s):  
Erol Arslan ◽  
Brett D. Einerson ◽  
Jingwen Zhang ◽  
Jun Zhang ◽  
D. Ware Branch
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Perinatal Mortality ◽  
Maternal Death ◽  
Secondary Analysis ◽  
Perinatal Outcomes ◽  
Neonatal Morbidity ◽  
The United States ◽  
Neonatal Outcomes ◽  
Perinatal Mortality Rate

Objective This study aimed to evaluate the “off-hour effect” on maternal and neonatal adverse events in a large cohort representing U.S. population. Study Design A secondary analysis of the Consortium on Safe Labor (CSL) dataset with 208,695 women and 229,385 deliveries was performed. The study included the deliveries of ≥23 gestational weeks from 19 hospitals in the United States from 2002 to 2008. Babies with congenital anomalies were excluded from neonatal outcomes. We compared maternal and neonatal outcomes of patients delivered during weekdays versus off hours (nights and weekends). The primary outcomes of the study were composite maternal and composite neonatal adverse events. The secondary outcomes were delivery type and individual maternal and neonatal adverse events including maternal death and perinatal mortality rate. Associations between off hours and all the outcomes were analyzed in bivariable and multivariable analyses. The same analyses were performed in strata by indication for admission (spontaneous labor or induction of labor). Results Composite maternal adverse events (6.19 vs. 6.06%, p = 0.41) and maternal death (0.01 vs. 0.01%, p = 0.19) were not significantly different between off hours and weekday groups. In contrast, composite neonatal adverse events (6.91 vs. 5.84%, p < 0.001) and perinatal mortality rate (1.03 vs. 0.77%, p < 0.001) were higher in the off-hour group. After adjusting for confounding variables, only the composite neonatal outcome continued to be associated with off hours (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI]: 1.04–1.16). Stratified analyses showed that the off-hour effect for the neonatal composite outcome was not present in those presenting in spontaneous labor (6.1 vs. 5.9%, p = 0.40). Conclusion Off-hour delivery was not associated with severe maternal morbidity and was only modestly associated with severe neonatal morbidity. This association was observed in women undergoing induction, not in those presenting in spontaneous labor. These data draw into question the existence of a clinically meaningful and correctable “off-hour effect” in obstetrics. Key Points

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.

Predictors of intimate partner violence in patients attending general health services at rural health facilities in Makueni county, Kenya

2020 ◽  
Vol 20 ◽  
pp. 200191
Author(s):  
Victoria Mutiso ◽  
Christine Musyimi ◽  
Tahilia Rebello ◽  
Isaiah Gitonga ◽  
Albert Tele ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Health Services ◽  
Rural Health ◽  
Partner Violence ◽  
General Health ◽  
Intimate Partner ◽  
Health Facilities

scholarly journals Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Koech Irene ◽  
Poli Philippe Amubuomombe ◽  
Richard Mogeni ◽  
Cheruiyot Andrew ◽  
Ann Mwangi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Mortality ◽  
Mode Of Delivery ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Induction Of Labour ◽  
Chi Square ◽  
Case Series Study ◽  
Chi Square Test ◽  
Series Study

Abstract Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.

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