WIDOWER’S AGE AND NUMBER OF CHILDREN AFFECT PARENTING STYLE AND REMARRIAGE DECISION

Highlight:1. The widow will outsource childcare to other people, such as the widow's mother, stepmother, aunt, or other relatives who believe they know more about childcare after the wife's death.3. There was a significant relationship between widower’s age and the number of children affecting parenting style and remarriage decision.Abstract:Background: The high maternal mortality ratio automatically represents the highest number of widowers in Indonesia. The change of status from a husband to a widower does not rule out the possibility of being able to change his role and function in the family. Objective: To describe that the widower’s age and the number of children have an impact on the parenting style and the desire to remarry. Materials and Methods: This study was an observational study with a cross-sectional design. Husbands who had been left by their wives for two years or more owing to maternal death and had one or more children before the wife's maternal death were the subjects of this study. Widower’s age, as well as kid’s parenting patterns before the death of the mother were recorded. This study was likewise subjected to an ethics review and relied on informed consent. Results: Widowers who had one child before their wife's death and decided to remarry accounted for 7 subjects (87.5%), while those who did not remarry accounted for 5 (31.3%). On the association between a widower’s age and child-rearing practices, there were two respondents (40%) who chose to entrust their children’s care to someone else or not to be cared by themselves. Conclusion: There was a significant relationship between widower’s age and the number of children and the parenting style and remarriage decision. Single parents who decided to remarry were single parents at a relatively younger age.

Analysis of Maternal Death in a Tertiary Care Hospital

Objectives: Maternal death was analyzed in Shaheed Suhrawardy Medical College hospital to improve the quality of maternal health care. Methods: In this cross -sectional study, each case was reviewed individually and factors responsible for maternal death were identified and noted. Results: During the study period January 2019 to December 2019 total 16 maternal death recorded among 3410 deliveries. 68% deceased mother were less than 30 years of age. Parity shows 37.50% multipara. 75% deceased mother was delivered by caesarean section, 6% was vaginal delivery and 12.5% mother died undelivered. Regarding time interval 25% of death occurred within 24 hours of admission to hospital. The main causes of death were severe preeclampsia- eclampsia (31.25%), PPH (12.5%), septicemia (12.5%), DIC (12.5%). Some factors were identified and among them lack of proper ANC, delayed admission to hospital, delayed blood transfusion were related. Conclusion: Substantial number of maternal death occurred at or <30 years of age. Preeclampsia-eclampsia, hemorrhage, septicemia were identified as the major cause of maternal death. J Shaheed Suhrawardy Med Coll 2020; 12(2): 63-66

Case series of maternal mortality and maternal near miss due to severe acute respiratory syndrome coronavirus 2

The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes the COVID-19 pandemic has affected every household of the remotest part of North East India, Mizoram. The pregnant women do not have a higher chance of getting infected, yet the infection seems to be more severe. We are reporting five cases of maternal death and two cases of maternal near miss in ZMC of Mizoram. Case 1 to 5 were maternal death due to COVID-19. All of them were multigravida within the age group of 27–41 years with a period of gestation 24–37 weeks. The presenting complaints were fever and cough more than 3 days with an investigation report revealing raised C-reactive protein (CRP) and severe pneumonia. Case 6 (Near miss) was 20 years, primigravida at term pregnancy in labor with a history of fever for 2 days with an investigation report revealing raised CRP and severe pneumonia, the baby was delivered asphyxiated and died. Case 7 (Near miss) was 17 years old primigravida at term pregnancy admitted as asymptomatic COVID-19 positive, elective caesarean section was done for Obstetrics indication, the patient later developed fever and moderate pneumonia on 5 days of hospitalization, she also developed eclampsia on 7th hospital day, she survived after intensive care in the intensive care unit.

Clinical Analysis of Four Maternity Deaths in Iraq by COVID-19

This study aims to identify maternal death cases caused by Coronavirus infection 2019 pneumonia, including disease progression, fetal consequences, and the fatality cause. Patients and methodology: A retrospective case collection of Iraqi pregnant women in their second and third trimesters diagnosed with COVID-19 pneumonia and died due to it. The four cases were all of a young age, had a brief complaint period, and had no comorbidities. Fever, dyspnea, and fatigue were the most common symptoms. Hypoxia was present in all cases and was the cause of mortality in three cases, with thromboembolism being a potential cause in the fourth. Prelabour membrane breakup, fetal growth restriction, and fetal death are all examples of adverse fetal effects. Conclusion: COVID-19 pneumonia induces substantial fetal and maternal mortality rates through pregnancy, which should be considered when treating these cases.

Tendencia actual de la mortalidad materna. Maternidad “Concepción Palacios” 2014-2020

Objective: To analyze maternal mortality in the Maternidad “Concepción Palacios” Hospital between January 2014 and December 2020. Methods: A descriptive, analytical, and retrospective study of maternal deaths occurred in the 2013-2018 period was carried out. Results: There were 73 maternal deaths, and a ratio of 135.96 per 100,000 live births. Direct maternal deaths were 60, 82.19% of the population and 13 indirect maternal deaths, 17.80%. The causes of direct maternal death were hypertensive disorders of pregnancy 48.33%, sepsis 26.66%, and obstetric hemorrhage 23.33%, with a 1: 3 ratios of maternal deaths at extreme ages of reproductive life. Conclusions: The maternal death ratio in the Maternidad “Concepción Palacios” Hospital duplicates the goals of the sustainable development goals of the 2016-2030 agenda; there is an increase in hypertensive disorders of pregnancy as a direct cause of maternal mortality. Primiparity, the absence or lack of data from prenatal control, cesarean sections, and admission-death time of less than 24 hours prevailed. Recommendations: Advances are needed in sexual and reproductive health education, education and training of health personnel in extreme maternal morbidity, analysis by theoretical premises identifying the social determinants of maternal mortality and the health reality related to its management, implementing preventive public policies with specific care guidelines. Keywords: Maternal mortality, Hypertensive disorders of pregnancy, Maternal sepsis, Obstetric hemorrhage.

Case Study in the COVID-19 Pandemic: Stunting, Low Birth Weight, Maternal Mortality and Infant Mortality in Semarang, Central Java-Indonesia

Background and Objective: Stunting, low birth weight, maternal death, and child mortality have all become public health issues in recent years, particularly in Semarang, Indonesia. Simultaneously, the COVID-19 pandemic is spreading. Between the years 2019 and 2021. Methods: The Semarang City Health Service's secondary data analysis strategy was combined with a quantitative descriptive research methodology in this study. To evaluate numerical patterns in stunting, low birth weight, maternal death, and infant mortality in the data, simple regression were utilized. Results: According to the findings, the trend of stunting (modeling results y = 35,236 x + 361.77) and maternal mortality (modeling results 0.0218x+1.2921) increased between 2019 and 2021, whereas the trend of low birth weight (modeling results y = - 0.5425x+60.008) and child mortality (modeling results y = -0.0028x+ 2.202) decreased. The number of low birth weight has the lowest trend value, while the stunting rate has the greatest. Conclusion: Stunting rates increased, the low birth weight dropped, maternal mortality increased, and child mortality decreased in Semarang. The conditions of the Covid-19 epidemic have at least influenced this condition.

Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls

Objectives To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). Results One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14–2.28). Conclusions SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.

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

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