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Midwife-led obstetric units working 'CLEVER': Improving perinatal outcome indicators in a South African health district.

BACKGROUND: South Africa did not meet its Millennium Development Goals with regard to the reduction in maternal and under-5 mortality. Furthermore, many birthing women do not receive intrapartum care with empathy and endure disrespect-ful and abusive care. OBJECTIVES: To implement a multicomponent, context-specific intervention package to change the complex interplay between preventable maternal and perinatal mortality and morbidity and poor clinical governance and supervision in midwife-led labour units. METHODS: A mixed-methods intervention study was conducted in Tshwane District, South Af

Obstetrical outcomes after first-trimester chorionic villus sampling in twin pregnancies: A retrospective case-control study.

AIM: Prenatal diagnostic testing by chorionic villus sampling (CVS) is sometimes recommended for women with twin pregnancies. However, few studies have compared the outcomes between twins with CVS and control twins without intervention. This study aimed to compare the obstetrical outcomes of CVS in twin pregnancies and those in non-intervention twin pregnancies. METHODS: First-trimester transabdominal CVS was performed on dichorionic-diamniotic twins (n = 54; Group 1) between December 2006 and January 2017 at the Department of Obstetrics and Gynecology at our hospital, and the data were retro…

Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria.

BACKGROUND: Inappropriate and excessive use of surgical antibiotic prophylaxis are associated with the emergence of antibiotic resistance. Antibiotic prophylaxis malpractices are common in obstetrics and gynecology settings and antibiotic stewardship is used to correct such malpractice. OBJECTIVE: To evaluate the impact of antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis practice in obstetrics and gynecology surgeries. METHOD: A prospective pre- and post-intervention study was conducted in two tertiary hospitals between May and December 2016. The durati…

Obstetric anal sphincter injuries before and after the introduction of the Episcissors-60: A multi-centre time series analysis.

OBJECTIVE: To investigate the impact of the Episcissors-60 on obstetric anal sphincter injury (OASI) rates. STUDY DESIGN: Observational multi-centre time series analysis at four maternity units in the North-East of England. The main outcome measures were obstetric anal sphincter injury rates and delivery blood loss. RESULTS: Data were analysed for women who had a vaginal birth of a singleton pregnancy before (11,192) and after (8064) the introduction of the Episcissors-60. There were 2115 episiotomies before and 1498 after the introduction of the Episcissors-60, of which 1311 (87.5%) were un

Post - effects of obstetric fistula in Uganda; a case study of fistula survivors in KITOVU mission hospital (MASAKA), Uganda.

BACKGROUND: Obstetrical fistula (OF) is a public health challenge that is among the previously neglected components of maternal health in the developing world. The condition, which in the recent past has increasingly drawn more attention from the public, has a devastating impact on the health and wellbeing of both women and girls worldwide. The most common cause of obstetric fistula in developing countries is prolonged obstructed labor affecting approximately 2 million women and girls across Africa and Asia. The objective of this study was to examine the post-effects of fistula and reintegrati

Obstetric and neonatal outcome of ART in patients with polycystic ovary syndrome: IVM of oocytes versus controlled ovarian stimulation.

STUDY QUESTION: Does IVM of immature oocytes retrieved from small antral follicles in women with polycystic ovary syndrome (PCOS) have an impact on obstetric and neonatal outcomes compared to controlled ovarian stimulation (COS)? SUMMARY ANSWER: Obstetric and neonatal outcomes after IVM appear to be similar to those after COS. WHAT IS KNOW ALREADY: Women with PCOS have an increased risk of adverse pregnancy outcomes and congenital malformations in their offspring. For patients with PCOS who require IVF, IVM of germinal vesicle (GV)-stage oocytes retrieved from antral follicles has been adopt

Obstetrical and neonatal factors associated with optimal public banking of umbilical cord blood in the context of delayed cord clamping.

PURPOSE: To assess the association of specific newborn and maternal factors with indicators of increased blood-forming capacity in umbilical cord blood to inform strategic collection strategies that could augment the quality of units in public cord blood banks. METHODS: Data regarding 268 consecutive cord blood units (CBUs) banked by Canadian Blood Services were analyzed. Multivariate analysis was performed to identify factors associated with markers of hematopoietic potency and likelihood of utilization. RESULTS: Delayed clamping of the cord beyond 60 s was associated with reduced volume co

"The sun keeps rising but darkness surrounds us": a qualitative exploration of the lived experiences of women with obstetric fistula in Ethiopia.

BACKGROUND: Obstetric fistula is a hole between the vagina and bladder, and/or between the vagina and rectum, triggered by prolonged obstructed labor. The World Health Organization has estimated that at least 50,000 to 100,000 cases of obstetric fistula occur every year, and that over two million women with obstetric fistula in developing countries remain untreated. Research on women's lived experiences of obstetric fistula is limited. This study aimed to explore the lived experience of women with obstetric fistula at Bahir Dar Hamlin Fistula Center, Amhara Regional State, Ethiopia. METHODS:

Development of an Anatomical Silicone Model for Simulation-based Medical Training of Obstetric Anal Sphincter Injury Repair in Bangladesh.

Advancing global healthcare in developing countries has traditionally been an area of interest for many North American medical organizations, as they strive to improve patient outcomes by helping to control disease and death-related illnesses. Women's healthcare in developing countries, in particular, presents a unique set of complexities, revealing high maternal mortality statistics surrounding pregnancy, labor, and childbirth, which is often tied to home births without medically trained attendants. In September 2018, Team Broken Earth, a Canadian-based outreach initiative, hosted a three-day

Obstetric neonatal brachial plexus and facial nerve injuries: A 17 years single tertiary maternity hospital experience.

OBJECTIVES: To establish the incidence of obstetric neonatal brachial plexus and facial nerve injuries in a tertiary maternity hospital in the United Kingdom and to identify associated risk factors with an emphasis on the time of delivery. STUDY DESIGN: From our hospital electronic data bases we identified all live births born between 2000 and 2016 and those neonates who sustained a nerve injury during delivery. We performed a logistic regression analysis linking "facial nerve injury" and "brachial plexus injury" with variables for which we had complete cohort data including "breech", "gestat

A clinicopathologic review and obstetric outcome of uterine smooth muscle tumor of uncertain malignant potential (STUMP) in a single institution.

OBJECTIVES: The present study aimed to analyze the clinicopathologic features and treatment of uSTUMP in a single institution. In addition, we described the obstetric outcomes after uterine-preserving surgery for uSTUMP. METHODS AND MATERIALS: A retrospective chart review was performed of patients diagnosed with uSTUMP between January 2000 and February 2018 at the Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center. We obtained data on the patients' demographics, treatment, therapeutic results, time to recurrence, disease-free and overall survival, and subsequent obstetric out

Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi.

BACKGROUND: Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied. METHODS: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities.

Beyond the verbal: Pregnant women's preferences for receiving influenza and Tdap vaccine information from their obstetric care providers.

OBJECTIVE: Prenatal providers are pregnant women's most trusted sources of health information, and a provider's recommendation is a strong predictor of maternal vaccine receipt. However, other ways women prefer receiving vaccine-related information from prenatal providers, aside from face-to-face conversations, is unclear. This study explores what secondary communication methods are preferred for receiving maternal vaccine-related information. STUDY DESIGN: Obstetric patients at four prenatal clinics around Atlanta, Georgia received a 27-item survey between May 5th, 2016 and June 15th, 2016.

First Trimester Screening for Fetal Aneuploidies Using Placental Growth Factor: The Great Obstetrical Syndrome (GOS) Study.

OBJECTIVE: This study sought to estimate the ability of first trimester maternal serum placental growth factor (PlGF) to identify fetal aneuploidies. METHODS: A prospective cohort study of singleton pregnancy at 11 to 13 weeks was conducted. Maternal serum PlGF concentration was measured using BRAHMS PlGF plus KRYPTOR automated assays (Thermo Scientific BRAHMS, Hennigsdorf, Germany). PlGF and nuchal translucency were log-transformed and reported as multiples of the median (MoM) adjusted for crown-rump length. Detection rates were calculated using receiver-operator characteristic curves. RESU

Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study.

To assess associations between discrepancy of pregnancy dating methods and adverse pregnancy, delivery, and neonatal outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for discrepancy categories among all singleton births from the Medical Birth Register (1995-2010) with estimated date of delivery (EDD) by last menstrual period (LMP) minus EDD by ultrasound (US) -20 to +20 days. Negative/positive discrepancy was a fetus smaller/larger than expected when dated by US (EDD postponed/changed to an earlier date). Large discrepancy was <10th or >90th percentile. Reference

Акушерская анестезия/анагезия не влияет на курс болезни при множественном склерозе: 10- Ретроспективное когортное исследование.

ЦЕЛИ: Множественный склероз (МС) часто встречается у молодых женщин, а воздействие акушерской анестезии/анагезии на болезнь плохо изучено. Ни одно из предыдущих исследований не было посвящено изучению состояния заболевания женщин, работающих в Чешской Республике. Цель этого исследования заключалась в оценке случаев или отсутствия рецидивов 6-month Послеродовый период в MS parturients с акушерской анестезией и без нее. МАТЕРИАЛЫ И МЕТОДЫ: Мы ретроспективно изучили все поставки (n = 58,455) в университетской больнице Брно 2004 в адрес 2013 и выявила женщин, имеющих ICD-10 код G35 (MS), зарегистр

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… Indications for Cesarean section (C‐section) is strictly obstetric, vaginal delivery is recommended. Methods of obstetric analgesia should be available to the patient, including epidural obstetric analgesia (EOA) (Houtchens, 2013 ). … Anaesthesia for the obstetric patient with (non‐obstetric) systemic disease . Best Practice and Research Clinical Obstetrics and Gynaecology , 24 ( 3 ), 313 – 326 . 10.1016/j.bpobgyn.2009.11.012 20335074 Runmarker , B. , & Andersen , O. ( 1995 ). …

Prenatal detection of critical cardiac outflow tract anomalies remains suboptimal despite revised obstetrical imaging guidelines.

BACKGROUND: Fetal echocardiography can accurately diagnose critical congenital heart disease prenatally, but relies on referrals from abnormalities identified on routine obstetrical ultrasounds. Critical congenital heart disease that is frequently missed due to inadequate outflow tract imaging includes anomalies such as truncus arteriosus, double outlet right ventricle, transposition of the great arteries, tetralogy of Fallot, pulmonary stenosis, and aortic stenosis. OBJECTIVE: This study evaluated the prenatal detection rate of critical outflow tract anomalies in a single urban pediatric hos

[Obstetric fistulas among people living in northern Katanga province, Democratic Republic of the Congo: about 242 cases].

Obstetric fistulas are a major public health problem in poor countries. This study aimed to describe the epidemiological, clinical and therapeutic features of obstetric fistulas in northern Katanga province, Democratic Republic of the Congo. We conducted a descriptive cross-sectional study of 242 patients with obstetric fistula living in northern Katanga province from September 2009 to December 2013. The parameters studied included maternal sociodemographic data, obstetric and neonatal parameters, specific features of the fistula as well as management approach and outcome. Variables were analy

Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center.

OBJECTIVE: Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women. METHODS: Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994-2004; period 2: 2005-2015) and place of delivery (our institution and lo