Overview of obstetric patients and their outcome in a tertiary hospital of Bangladesh

Background: In developing countries like Bangladesh major population lives in rural areas, lacking access to essential obstetric facilities. Timely referral can reduce maternal morbidity and avoid maternal death in many instances. However lack of structured referral system is a major hurdle that delays proper management of such cases. The objective of the study was to review the pattern of obstetric cases admitted in our hospital, to study the clinical course and management of women during the hospital stay and to study the maternal and perinatal outcomes in terms of live birth or still birth, intra uterine fetal death and neonatal admission. Methods: It is a retrospective observational study conducted in the department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, from July 2018 to June 2019, including2880 obstetric cases admitted in the hospital. Detailed history of the patients were taken, frequency of each disease was calculated separately. Management of the patient and mode of delivery were noted. Fetal outcome parameters like live or still birth and intra uterine fetal death were noted. Results: Among 3953 admitted patients, obstetric cases were 2880 (73%).Maximum number of patients were booked cases(84.09%) and 75% were from urban area. The patients were in the age group from 18 to 40 years,32% were primigravida and 68% were multi gravida. Majority of our admitted patients had either diabetes mellitus or gestational diabetes mellitus, 58.19% and 23.95% respectively. Common co morbidities and obstetric complications were hypertensive disorder of pregnancy, anaemia, premature rupture of membrane, oligohydramnios and fetal growth restriction. Among the 2084 delivered cases were delivered by ceasarean section (86.42%) 13.53% were delivered vaginally. Commonest indication for cesarean delivery was history of previous cesarean section. Conclusion: Wide spectrum of complicated obstetric cases were admitted to our tertiary care hospital. Many complicated patients were referred from different centers for special management. But delayed referral sometimes could not help properly and also resulted in a high number of cesarean section. BIRDEM Med J 2022; 12(1): 41-44

Frequency of Maternal Factors in Patients of Stillbirth in Pakhtoon Families Visiting Public Hospitals of Peshawar

Aim: To determine the frequency of maternal factors in patients of still birth in Pakhtoon families visiting hospitals of Peshawar. Study design: Cross-sectional study Place and duration of study: Department of Community & Preventive Medicine, Kabir Medical College Gandhara University Peshawar from 1stJanuary 2020 to 31stDecember 2020 Methodology: Five hundred pregnant women were enrolled. All multiparous pregnant women of Pakhtoon families with still birth admitted in Gynaecology wards in public hospitals of Peshawar were included. All multiparous pregnant women of Pakhtoon families with still births with renal diseases, accidental trauma, respiratory diseases and history of physical violence visiting public hospitals of Peshawar were excluded. Results: 65% of respondents were from 31-45 years. Maternal risk factors were education below matric 64.4%, 7% respondents were working, 78% respondents with total income less than 30 thousand. 59.8% with last birth interval less than 2 years. 44% respondents had haemoglobin less than 7g/dl. 40.2% respondents had comorbidity with stillbirth i.e. hypertension. Conclusion: Maternal risk factors were low socioeconomic status, birth interval less than 2 years, severe anemia and hypertension in current study. Keywords: Still birth, Socioeconomic, Ante-partum hemorrhage

Still Birth classification: Application of Relevant Condition at Death (ReCoDe) classification system in a tertiary care hospital of Pakistan

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system. Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe). Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In this study, 80% of women were in the age group of 20-35 years, 16% had advanced maternal age while 3.8% of women accounted for less than 20 years. Among the maternal factors; 54.5% cases were booked and the remaining were were un-booked cases. Pre-eclampsia was the most common associated maternal condition (14.9%). Fetal cause accounted for 34.7% of stillbirths and the fetal growth restriction (FGR) was the most common; 23.6%. After application of ReCoDe classification, in 81% of stillbirth cases associated condition were found and only 18.8% of cases were categorized unexplained. Conclusion: Application of ReCoDe classification is easy to understand and applicable, especially in low resource settings with associated causes identified in vast majority of cases. doi: https://doi.org/10.12669/pjms.38.1.4470 How to cite this:Kashif U, Bhamani S, Patel A, Shamsul Islam Z. Still Birth classification: Application of Relevant Condition at Death (ReCoDe) classification system in a tertiary care hospital of Pakistan. Pak J Med Sci. 2022;38(1):133-137. doi: https://doi.org/10.12669/pjms.38.1.4470 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Still birth in a tertiary health facility in Enugu state South-East Nigeria: a hidden tragedy

Background: Stillbirth is one of the common adverse outcomes of pregnancy that occur worldwide. The prevalence differs in different continents of the world and even within different localities in the same country. The objective of this study was to determine the prevalence and social determinants of health that affect still birth in Enugu state, Nigeria.Methods: The study was a prospective hospital-based study conducted at the obstetrics and gynecology department of a tertiary health facility in Nigeria. All the data were retrieved from the ante natal and delivery card of all the women that delivered at the unit within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test. The level of significance was set at p value≤0.05.Results: The mean age of the mothers was 29.76±4.69 while most of them were aged 21-30 years 431(56.0%). Majority of them were employed 529 (68.7%) and had tertiary education 484 (62.9%). The prevalence of still birth was 40.3 per 1000 births. Maternal age, marital status, educational levels and booking status affected the prevalence of still birth.On logistic regression, un-booked mothers had 25 times odds of having still birth when compared to those that booked after 28 weeks gestationConclusions: The prevalence of still birth is high in Enugu state with un-booked mothers contributing about 88.6%. Early booking helps to detect possible complications early with timely interventions.

Influence of maternal occupation on adverse pregnancy outcomes in a Nigerian tertiary health facility

Background: There is accumulating evidence that the type of work and environmental exposures in the work environment during pregnancy may have adverse effects on fetal development and pregnancy outcome. The objective was to determine the influence of maternal occupation on adverse pregnancy outcomes.Methods: The study was a prospective hospital based study conducted at the obstetrics and gynecology department of a tertiary health facility in Nigeria. All the data were retrieved from the ante natal and delivery card of all the women that delivered at the unit within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test. The level of significance was set at p value ≤ 0.05.Results: Maternal occupation did not significantly affect the gestational age at delivery (X2=10.143, p=0.428) and birth weight (X2=16.807, p=0.079) however, it significantly affected the still birth (X2=28.134, p=0.002). Agricultural, forestry and fishery workers and plant and machine operators were about 8 times and 17 times more likely to have still birth than the unemployed respectively.Conclusions: There were substantial differences in the risk of adverse pregnancy outcomes between the different occupational groups.

Still birth : soundwalking Garrison Creek.

"My project is about nature in the body and in the individuated imaginary, nature in the soundscape, sound in nature and the nature of sound. When contrasted to culture, I use Astuti's definition of nature as that aspect over which humans have no control (1998, 2001). My audio-piece is about how we locate ourselves through activation -- an activation very literal in soundwalking, which is mobile and receptive, and the creation of an accompanying soundscape which is a statement of personal engagement and, I hope, a communication event."--Page 2.

Still birth : soundwalking Garrison Creek.

"My project is about nature in the body and in the individuated imaginary, nature in the soundscape, sound in nature and the nature of sound. When contrasted to culture, I use Astuti's definition of nature as that aspect over which humans have no control (1998, 2001). My audio-piece is about how we locate ourselves through activation -- an activation very literal in soundwalking, which is mobile and receptive, and the creation of an accompanying soundscape which is a statement of personal engagement and, I hope, a communication event."--Page 2.

Impact of Pandemic on Women Health Indicators in a Tertiary Health Centre of Bihar

BACKGROUND This study was conducted to analyse the impact of pandemic on healthcare, evaluate the negative psychological behaviour towards health professionals and study the effect of Covid-19 infection on hospital avoiding attitude of female patients. METHODS This was a case-control study conducted in Department of Obstetrics and Gynaecology at Patna Medical College and Hospital, Patna, Bihar. Study period was from 01st April 2020 to 30th September 2020. All the patients except Covid-19 positive cases, coming to Gynaecology Outpatient Department (GOPD), antenatal care (ANC) and labour room emergency (LRE) were included in the study. Patients who were seen from April 2019 to September 2019, total of 20,961 were in ‟pre Covid-19ˮ control group, while patients seen from April 2020 to September 2020, a total of 8,859 were in ‟during Covid-19” case group. Records of all health parameters for patients were reviewed, and then divided into two groups as patient input indicators and healthcare efficiency indicators. Number of patients visiting GOPD, ANC and admitted in LRE comprised patient input indicators (implying hospital avoiding attitude) while delivery rate, dilation and evacuation (D & E) rate, stillbirth rate and mortality rate comprised healthcare efficiency indicators. RESULTS Overall patients visiting the hospital dropped down from 21,361 to 8859 (by 58.5 %); GOPD patients reduced by 74 % while total ANC patients reduced by 44 %; and total LRE admissions reduced by 35.3 %. CONCLUSIONS Despite increased health professionals (workdays) per patient in LRE, mortality rate and still birth rate increased by 60.2 % and 23 % respectively indicating worsening of efficiency which is direct hidden negative psychological impact of pandemic immediately calling for the need of positive counselling and proper psychiatric care of both the health professionals and patients. KEY WORDS Covid-19, Pandemic, Still Birth Rate

Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study

Background Although the rate of stillbirth has decreased globally, it remains unacceptably high in low- and middle-income countries. Only ten countries including Ethiopia attribute more than 65% of global burden of still birth. Ethiopia has the 7th highest still birth rate in the world. Identifying the predictors of stillbirth is critical for developing successful interventions and monitoring public health programs. Although certain studies have assessed the predictors of stillbirth, they failed in identify the proximate predictors of stillbirth. In addition, the inconsistent findings in identify the predictors of stillbirth, and the methodological limitations in previously published works are some of the gaps. Therefore, this study aimed to identify the predictors of stillbirth among mothers who gave birth in six referral hospitals in Southern, Ethiopia. Methods A hospital-based unmatched case-control study was conducted in six referral hospitals in Southern, Ethiopia from October 2019 to June 2020. Consecutive sampling techniques and simple random techniques were used to recruit cases and controls respectively. A structured standard tool was used to identify the predictors of stillbirth. Data were entered into Epi Info 7 and exported to SPSS 23 for analysis. A multivariable logistic regression model was used to identify the independent predictors of stillbirth. The goodness of fit was tested using the Hosmer and Lemeshow goodness-of-fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 138 stillbirth cases and 269 controls were included. Women with multiple pregnancy [AOR = 2.98, 95%CI: 1.39–6.36], having preterm birth [AOR = 2.83, 95%CI: 1.58–508], having cesarean mode of delivery [AOR = 3.19, 95%CI: 1.87–5.44], having no ANC visit [AOR = 4.17, 95%CI: 2.38–7.33], and being hypertensive during pregnancy [AOR = 3.43, 95%CI: 1.93–6.06] were significantly associated with stillbirth. Conclusions The predictors of stillbirth identified are manageable and can be amenable to interventions. Therefore, strengthening maternal antenatal care utilization should be encouraged by providing appropriate information to the mothers. There is a need to identify, screen, and critically follow high-risk mothers: those who have different complications during pregnancy, and those undergoing cesarean section due to different indications.