The effect of inter-pregnancy interval on stillbirth in urban South Ethiopia: a community-based prospective cohort study

Background Stillbirth is an invisible and poorly understood adverse pregnancy outcome that remains a challenge in clinical practice in low-resource settings. It is also a key concern in Ethiopia where more than half of pregnancies occur shortly after preceding childbirth. Whether the interval between pregnancies has an effect on stillbirth or not is unclear. Therefore, we aimed to assess the effect of inter-pregnancy interval on stillbirth in urban South Ethiopia. Methods A community-based prospective cohort study was conducted among 2578 pregnant women and followed until delivery. Baseline data were collected at the household level during registration and enrolment. End-line data were collected from hospitals during delivery. Exposed groups were pregnant women with inter-pregnancy intervals < 18 months and 18–23 months. Unexposed group contains women with inter-pregnancy intervals 24–60 months. A generalized linear model for binary outcome was applied, using R version 4.0.5 software. Relative risk (RR) was used to estimate the effect size with a 95% confidence level. Attributable fraction (AF) and population attributable fraction (PAF) were used to report the public health impact of exposure. Results The overall incidence of stillbirth was 15 per 1000 total births, (95% CI: 11, 20%). However, the incidence was varied across months of inter-pregnancy intervals; 30 (< 18 months), 8 (18–23 months) and 10 (24–60 months) per 1000 total births. The risk of stillbirth was nearly four times (ARR = 3.55, 95%CI: 1.64, 7.68) higher for women with inter-pregnancy interval < 18 months as compared to 24–60 months. This means, about 72% (AF = 72, 95%CI: 39, 87%) of stillbirth among the exposed group (inter-pregnancy interval < 18 months category) and 42% (PAF = 42, 95%CI: 23, 50%) of stillbirth in the study population were attributed to inter-pregnancy interval < 18 months. These could be prevented with an inter-pregnancy interval that is at least 18 months or longer. Conclusions Inter-pregnancy interval under 18 months increases the risk of stillbirth in this population in urban South Ethiopia. Interventions targeting factors contributing to short inter-pregnancy intervals could help in reducing the risk of stillbirth. Improving contraceptive utilization in the community could be one of these interventions.

Comparison of Perinatal Outcome (Low Birth Weight, Preterm Delivery) in Women with <6 Month Versus 12-17 Months of IBI

Objectives: To compare the perinatal outcome (low birth weight, preterm delivery) in women with <6 month versus 12-17 months of interpregnancy birth interval. Material and methods: This Cohort study was conducted at Department of Obstetrics and Gynecology, Lahore General Hospital Lahore from March 2020 to September 2020. Total 420 patients with age range 18-40 years, singleton pregnancy, women with previous live birth, parity 1-4 and Gestational age > 28 weeks assessed on LMP were selected for this study. Patients were divided into two groups (A & B) according to their inter-pregnancy interval i.e. <6 months group labelled as A group and 12-17 months group labelled as B group. All patients in both groups will be followed till delivery and the perinatal outcome i.e. preterm delivery (birth occurred before completion of 37 weeks of gestation) and low birth weight (those babies whose weight less than 2.5 Kg at the time of birth) were noted. Results: The mean age of women in group A was 26.73 ± 6.56 years and in group B was 26.73 ± 6.56 years. The perinatal outcome was preterm delivery in 189 (90.0%) and low birth weight babies in 143 (68.10%) women of <6 months while in 12-17 months interpregnancy interval, it was noted in 111 (52.86%) and 102 (48.57%) women respectively Conclusion: Our study concluded that appropriate inter pregnancy interval could reduce the rate of preterm delivery and low birth weight babies and optimal interval associated with the lowest risk of adverse perinatal outcome was 12-17 months. Keywords: Birth spacing, short interval, preterm delivery, low birth weight.

Determinants of low birth weight deliveries at five referral hospitals in Western Area Urban district, Sierra Leone

Background Low birth weight (LBW) contributes significantly to infant and child mortality. Each year, about 20 1million deliveries are LBW with 96.5% occurring in developing countries. Whiles the incidence of LBW is reducing in other districts of Sierra Leone, it has been reported to be increasing in the Western Area Urban district. Determining the risk factors in a specific geographic area is important for identifying mothers at risk and thereby for planning and taking appropriate action. The current study sought to identify factors associated with LBW deliveries in the Western Area Urban district of Sierra Leone. Methods A hospital-based unmatched 1:2 case-control study was conducted among mothers who delivered live singleton babies from November, 2019 to February, 2020 in five referral health facilities. Mothers were conveniently sampled and sequentially enrolled into the study after delivery. Their antenatal care cards were reviewed and a pre-tested questionnaire administered to the mothers. Data analysis was done using Stata 15.0 and association between maternal socio-demographic, socio-economic, obstetric and lifestyle factors and LBW assessed using bivariable and multivariable logistic regression analyses. Results A total of 438 mothers (146 cases and 292 controls), mean age: 24.2 (±5.8) and 26.1 (±5.5) years for cases and controls respectively participated in the study. Multivariable analysis revealed that being unemployed (AoR = 2.52, 95% CI 1.16–5.49, p = 0.020), having anaemia during pregnancy (AoR = 3.88, 95% CI 1.90–7.90, p < 0.001), having less than 2 years inter-pregnancy interval (AoR = 2.53, 95% CI 1.11–5.73, p = 0.026), and smoking cigarettes during pregnancy (AoR = 4.36, 95% CI 1.94–9.80, p < 0.001) were significantly associated with having LBW babies. Conclusion Factors associated with LBW identified were unemployment, anaemia during pregnancy, < 2 years inter-pregnancy interval and cigarette smoking during pregnancy. Health care providers should screen and sensitize mothers on the risk factors of LBW during antenatal sessions.

Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia

Background Short inter-pregnancy interval is an interval of <24 months between the dates of birth of the preceding child and the conception date of the current pregnancy. Despite its direct effects on the perinatal and maternal outcomes, there is a paucity of evidence on its prevalence and determinant factors, particularly in Ethiopia. Therefore, this study assessed the prevalence and associated factors of short inter-pregnancy interval among pregnant women in Debre Berhan town, Northern Ethiopia. Methods A community based cross-sectional study was conducted among a randomly selected 496 pregnant women in Debre Berhan town from February 9 to March 9, 2020. The data were collected by using an interviewer-administered questionnaire and analyzed using STATA (14.2) statistical software. To identify the predictors of short inter-pregnancy interval, multivariable binary logistic regression was fitted and findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). Result The overall prevalence of short inter-pregnancy interval (<24 months) among pregnant women was 205 (40.9%). Being over 30 years of age at first birth (AOR = 3.50; 95% CI: 2.12–6.01), non-use of modern contraceptive (AOR = 2.51; 95% CI: 1.23–3.71), duration of breastfeeding for less than 12 months (AOR = 2.62; 95% CI: 1.32–5.23), parity above four (AOR = 0.31; 95% CI: 0.05–0.81), and unintended pregnancy (AOR = 5.42; 95% CI: 3.34–9.22) were independently associated factors with short inter-pregnancy interval. Conclusion Despite the public health interventions being tried in the country, the prevalence of short inter-pregnancy interval in this study is high. Therefore, it implies that increasing contraceptive use and encouraging optimal breastfeeding might help in the efforts made to avert the problem.

Reproductive Pattern of Parous Women and The Risk of Cancer in Later Life

We assessed the risk of any and site-specific cancers in a case-control study of parous women living in northeast Scotland in relation to: total number of pregnancies, cumulative time pregnant, age at first delivery and interpregnancy interval. We analysed 6430 women with cancer and 6430 age-matched controls. After adjustment for confounders, women with increasing number of pregnancies had similar odds of cancer diagnosis as women with only one pregnancy. The adjusted odds of cancer diagnosis were no higher in women with cumulative pregnancy time 50–150 weeks compared to those pregnant ≤ 50 weeks. Compared with women who had their first delivery at or before 20 years of age, the adjusted odds ratio (AOR) among those aged 21–25 years was 0.81, 95% CI 0.74, 0.88; 26–30 years AOR 0.77, 95% CI 0.69, 0.86; >30 years AOR 0.63, 95% CI 0.55, 0.73. After adjustment, the odds of having any cancer were higher in women who had an inter-pregnancy interval >3 years compared to those with no subsequent pregnancy (AOR 1.17, 95% CI 1.05, 1.30). Older age at first pregnancy was associated with increased risk of breast and gastrointestinal cancer, and reduced risk of invasive cervical, carcinoma in situ of the cervix and respiratory cancer.

Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

Frequency of short interpregnancy interval in preterm birth.

Objective: The objective of this study is to determine frequency of short interpregnancy interval in female with preterm labour. Study Design: Descriptive Cross Sectional study. Setting: Department of Obstetrics and Gynecology Bacha Khan Medical Complex Swabi. Period: 01July 2018 to 31-December 2018. Material & Methods: After meeting inclusion criteria a total of 212 females with preterm birth as per operational definition were taken. Birth interval ≤ 6 months was labeled as short interpregnancy interval. Results: The mean age of patients in this study was 29.00±6.37 years with mean parity in this study was observed to be 3.23±2.31 with minimum and maximum parity of 1 and 9 respectively. The mean gravida in this study was 2.17±2.25 with minimum and maximum of 0 and 8. The mean gestational age among patients was 29.83±3.29 weeks with minimum and maximum gestational ages of 24.00 weeks and 36.00 weeks respectively. The mean inter-pregnancy interval observed in this study was 7.39±6.14 months with minimum and maximum intervals of 2.00 months and 14.00 months respectively. According to definition, 155 (73.1%) patients had short inter-pregnancy interval. Conclusion: Through this study we found high frequency of short inter pregnancy interval. We must have to establish more and effective family planning awareness to increase birth gap to avoid poor fetomaternal outcome as it is clear that short IPI may directly or indirectly influence the maternal and perinatal health and can potentially increase risk of preterm birth.