Predictors for timely initiation of breastfeeding after birth in the hospitals of Nepal- a prospective observational study

Background Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal. Method A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression. Results Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55). Conclusions The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.

STUDY OF DIC AS AN OBSTETRIC COMPLICATION AND FETO-MATERNAL OUTCOME

Disseminated intravascular coagulation (DIC) occurs when the nely controlled process of haemostasis becomes disrupted. As a result, coagulant responses can change from being naturally protective to the host into a maladaptive response with pathological consequences. Clinically, this is reected in the increased morbidity and mortality that is associated with DIC. The recognition that DIC arises as a complication of different disease states reects the variety of ways in which clinical events can uncouple normal haemostasis.

Hamman's Syndrome: A Rare cause of Peri partum chest pain

Hamman’s syndrome is a potentially life-threatening clinical condition characterized by peripartum subcutaneous emphysema and pneumo mediastinum. This obstetric complication typically occurs in late pregnancy and labor and is frequently observed in young healthy primi parous women.1. Excessive Valsalva maneuver during vaginal delivery and excessive retching, coughing, and straining are frequently reported causes2. Subcutaneous emphysema and pneumomediastinum in labour and delivery is a rare but potentially serious occurrence that must be identified and managed appropriately to avoid unnecessary investigations and interventions. Published reports indicate that subsequent pregnancies pose no additional risk for recurrence3.

Awareness of Obstetric Fistula and Associated Factors Among Women in Reproductive Age Group Attending Public Hospitals, Ilubabor Zone, Oromia Regional State, South West Ethiopia, 2021

Background: Obstetric fistula occurs in all developing countries but it is confined to the “fistula belt” across the northern half of Sub-Saharan Africa from Mauritania to Eritrea and in the developing countries of the Middle East and Asia. Ending obstetric fistula is critical to achieving the Sustainable Development by 2030. So creating awareness on obstetrics fistula among women in reproductive age group have crucial role in reducing morbidity, mortality and social stigma.Objective: To assess awareness on obstetric fistula and its associated factors among reproductive age women attending governmental hospitals in Ilubabor zone, Oromia region, Ethiopia, 2021.Methods: Institutional based cross-sectional study design was conducted. The sample size was estimated by using a single population proportion formula. The collected data was coded and entered to Epi data version 3.1 then exported to SPSS version 24 for descriptive and inferential analysis. Adjusted odds ratio (AOR) along with 95% confidence level was estimated to assess the strength of the association and a p value <0.05 was considered to declare the statistical significance in the multivariable analysis in this study.Result: In this study a total of 400 clients were participated in the study. The mean ages of participants were 30.26 (SD±8.525) years old. Education of women’s who cannot read and write are 85% less likely to have good awareness than women who are above secondary level of education (AOR=0.162:95% CI (0.081-0.364)). While Women’s who have primary education level are 83% less likely to have good awareness than women who are above secondary level of education (AOR=0.170:95% CI (0.085-0.446)).In addition, my study shows women’s who haven’t heard about obstetric complication are 54% less likely to have awareness on obstetric fistula than those who heard about obstetric complication (AOR=0.458:95% CI (0.368-0.643). Conclusion: This study identifies that, educational level of women, history of pregnancy, distance to the nearby health institution and awareness on obstetrics complications were the factors associated with awareness of reproductive age women on obstetrics fistula. Hence, increasing awareness on obstetric fistula plays a key role to avert this problem.

Recurrent Puerperal Uterine Inversion

Uterine inversion is rare and life threatening obstetric complication. This is a case of recurrent uterine inversion managed successfully with Johnson’s Maneuver followed by condom tamponade placement.

Locked twins—remote from term: a case report

Background Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:100 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days. Case summary A 27 years-old primigravida Oromo mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin. Conclusion Locked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

Predictors of Preterm Birth among Mothers Who Gave Birth in Silte Zone Public Hospitals, Southern Ethiopia

Background. A preterm birth is the leading cause of death in both neonatal and children under five years of age every year throughout the world, particularly in Sub-Saharan Africa. The causes of a preterm birth are complex and multifactorial; many risk factors that contribute it are not fully understood. The aim of this study was to identify predictors of a preterm birth among mothers who gave birth in Silte Zone Public Hospitals, Southern Ethiopia (2019/20). Methods and Materials. A hospital-based unmatched case-control study design was carried out from July 15th to October 30th, 2019, by assigning mothers who gave preterm births as cases and those with term births as controls. A total of 365 respondents (91 cases and 274 controls) were selected by a consecutive simple random sampling until the required sample size was achieved. For each case, three consecutive controls were included. Data were collected using a structured interview questionnaire complement with record reviewing. The data were entered into Epi Info 7 and exported into SPSS 25 for analysis. Descriptive analysis was computed to obtain summary values for cases and controls separately. All candidate variables in bivariate analysis were entered into the multivariable logistic regression model by using the backward likelihood ratio selection methods. Finally, variables with p value ≤ 0.05 were considered as potential determinants of a preterm birth and reported in the form of adjusted odds ratio with 95% confidence interval. Results. Among a total of 365 mothers who gave live birth, 91 (24.9%) were cases compared to 274 (75.1%) which were controls. The final multivariable logistic regression analysis results showed that having history of a previous preterm birth ( AOR = 3.51 ; 95 % CI = 1.40 − 8.81 ), having shorter interpregnancy interval ( AOR = 4.46 ; 95 % CI = 1.95 − 10.21 ), experiencing obstetric complication ( AOR = 3.82 ; 95 % CI = 1.62 − 9.00 ), and having infant born with low birth weight ( AOR = 5.58 ; 95 % CI = 2.39 − 13.03 ) were found to be independent predictors of a preterm birth. Conclusions. According to this finding, mothers having previous history of a preterm birth, experiencing obstetric complication, having shorter interpregnancy interval, and having infant born with low birth weight were reported as the independent predictors of a preterm birth. Improving the quality of antepartum and intrapartum, counseling on birth space, creating awareness on family planning, and early screening of preterm determinants are mandatory.

Adverse Pregnancy Outcomes by Degree of Maternal Serum Analyte Elevation: A Retrospective Cohort Study

Objective The aim of this study was to evaluate rates of preterm birth (PTB) and obstetric complication with maternal serum analytes > 2.5 multiples of the median (MoM) by degree of elevation. Study Design Retrospective cohort study of singleton live-births participating in the California Prenatal Screening Program (2005–2011) examining PTB and obstetric complication for α-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A (INH) by analyte subgroup (2.5 to < 6.0, 6.0 to < 10.0, and ≥ 10.0 MoM vs. < 2.5 MoM). Results The risk of obstetric complication increased with increasing hCG, AFP, and INH MoM, and were greatest for AFP and INH of 6.0 to <10.0 MoM. The greatest risk of any adverse outcome was seen for hCG MoM ≥ 10.0, with relative risk (RR) of PTB < 34 weeks of 40.8 (95% confidence interval [CI]: 21.7–77.0) and 13.8 (95% CI: 8.2–23.1) for obstetric complication. Conclusions In euploid, structurally normal fetuses, all analyte elevations > 2.5 MoM confer an increased risk of PTB and, except for uE3, obstetric complication, and risks for each are not uniformly linear. These data can help guide patient counseling and antenatal management.

Fetal head entrapment within the lower uterine segment

Fetal head entrapment by a uterine scar or adhesion is a rare obstetric complication. We present a case of a uterine constriction diagnosed in pregnancy that resulted in confinement of the fetal head to the lower uterine segment. The developing fetus ultimately suffered growth restriction of the head and was delivered after the mother experienced preterm premature rupture of membranes (PROM). Severe adhesions of the lower uterine segment were confirmed during the patient’s classical cesarean section.