Factors associated with delivery complications in rural Bangladesh

Objectives There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. Methods A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. Results and conclusions It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.     

Factors associated with contraceptive practices of married women in Bangladesh with respect to their employment status.

OBJECTIVE: There might be a difference between non-working and working women in their perception of rights and privileges which may influence their contraceptive behavior. The purpose of this study was to examine contraceptive behavior among non-working and working women in Bangladesh determining associated factors. METHOD: Analysis was based on data from the 1999-2000 Bangladesh Demographic and Health Survey which employs nationally representative sample. RESULTS: The prevalence of current contraceptive use (any method) was 58.2% among non-working women and 65.5% among working women. Both rates are still low for the country. Some factors, such as discussed family planning with husband, husband approves family planning, desire for more children, and husband lives together, were influential determinants of lower contraceptive prevalence among the non-working women. CONCLUSION: The results indicate a necessity for social activities promoting husband-wife communication and women's participation in employment to enhance the use of contraceptives among Bangladeshi women, especially non-working women.     

Factors associated with acute postpartum hemorrhage in low-risk women delivering in rural India.

OBJECTIVE: Postpartum hemorrhage (PPH), a major cause of maternal mortality and morbidity in low-income countries, can occur unpredictably. This study examined the sociodemographic, clinical, and perinatal characteristics of low-risk women who experienced PPH. METHODS: This analysis was conducted using data on 1620 women from a randomized trial testing oral misoprostol for prevention of PPH in rural India. RESULTS: Of the women, 9.2% experienced PPH. No maternal or sociodemographic factors and few perinatal factors differed between women with PPH and those without, other than treatment with misoprostol. Having fewer than 4 prenatal visits and lack of iron supplementation increased the risk for PPH (P<0.001 and P=0.037, respectively). Several factors unknown until the second stage of labor (perineal tear and birth weight) were also associated (P=0.003). CONCLUSIONS: Among women at low risk for PPH, there were few factors associated with further risk. Given that PPH can occur without warning, rural communities should consider ways to increase both primary prevention (iron supplementation, AMTSL) and secondary prevention of PPH (availability of obstetric first aid, availability of transport, and availability of emergency obstetric care).     

Factors associated with successful vaginal delivery after cesarean section

To assess obstetric parameters that would predict successful vaginal delivery in patients with prior cesarean sections, the perinatal records of 579 such patients were reviewed. Sixty-six percent of the patients (385) had elective repeat cesarean sections. Of the 194 patients who attempted vaginal delivery, three-fourths (148) had success. Perinatal parameters that were statistically significant indicators of success included: nonrecurrent indication for cesarean section, vaginal delivery either prior or subsequent to cesarean section, duration of labor less than 24 hours prior to cesarean section, infant's birth weight less than 4,000 gm and cervical dilatation greater than 4 cm on admission for attempted vaginal delivery.     

A simple checklist for preventing major complications associated with cesarean delivery

I propose a simple, evidence-based, eight-item checklist that, if followed, should reduce the frequency of many of the most serious complications associated with cesarean delivery: endometritis, wound infection, wound disruption, thrombophlebitis, and uterine scar dehiscence in a subsequent pregnancy. The frequency of abdominal wound infections can be reduced significantly by using electric clippers, rather than a razor, to remove the hair at the site of the surgical incision, washing the skin with a chlorhexidine solution, and administering broad-spectrum antibiotic prophylaxis before the start of surgery rather than after the neonate's umbilical cord has been clamped. Administration of broad-spectrum antibiotic prophylaxis and removal of the placenta by traction on the umbilical cord, rather than by manual extraction, will reduce the frequency of postcesarean endometritis. Closure of the uterine incision in two layers rather than one will significantly reduce the frequency of scar dehiscence in a subsequent pregnancy. Closure of the deep subcutaneous layer in patients whose subcutaneous tissue is greater than 2 cm in thickness will significantly reduce the risk of seroma, hematoma, and subsequent wound disruption. Institution of appropriate prophylaxis for deep vein thrombosis in intermediate and high-risk patients will reduce the risk of subsequent thromboembolic events.     

Factors associated with contraceptive practices of married women in Bangladesh with respect to their employment status

Objective?There might be a difference between non-working and working women in their perception of rights and privileges which may influence their contraceptive behavior. The purpose of this study was to examine contraceptive behavior among non-working and working women in Bangladesh determining associated factors.

Method?Analysis was based on data from the 1999–2000 Bangladesh Demographic and Health Survey which employs nationally representative sample.

Results?The prevalence of current contraceptive use (any method) was 58.2% among non-working women and 65.5% among working women. Both rates are still low for the country. Some factors, such as discussed family planning with husband, husband approves family planning, desire for more children, and husband lives together, were influential determinants of lower contraceptive prevalence among the non-working women.

Conclusion?The results indicate a necessity for social activities promoting husband–wife communication and women's participation in employment to enhance the use of contraceptives among Bangladeshi women, especially non-working women.     

伴有母胎合并症及并发症妊娠的分娩时机

当继续妊娠伴随的母胎风险高于终止妊娠所带来的母婴风险时,就具有终止妊娠的指征,即分娩时机正合适。当母胎出现合并症和并发症时,大多数未能自然临产,临床中需要引产,因此,在决定引产前,确定最佳的分娩时机不仅是关乎围产结局的关键因素,也是产科精准医疗的临床再现。分娩时机不是一成不变的,也不是机械刻板的,遵循母婴安全为第一要务的宗旨,采取个体化医疗的原则,最适宜的才是最好的。文章从胎儿因素（胎儿生长受限、双胎妊娠）、母体及产科因素（妊娠期高血压疾病、妊娠合并糖尿病、胎膜早破、曾有不明原因的死胎或死产）、胎盘及子宫因素（前置胎盘、胎盘植入、瘢痕子宫、子宫破裂）三方面总结伴有母胎合并症及并发症妊娠的分娩时机。     

Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer

Purpose

To identify clinical and non-clinical factors associated with utilization of primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT) in women with advanced stage epithelial ovarian cancer (EOC).

Respiratory complications associated with cryotherapy in premature infants.

We reviewed the frequency of respiratory complications associated with cryotherapy in 14 premature infants who underwent 17 cryotherapy procedures. Five of the procedures were performed on infants already being mechanically ventilated. Two of these infants required increased ventilatory support during and following the procedure for decreased spontaneous respirations. For the 12 procedures performed on 11 infants who were not being mechanically ventilated at the time of cryotherapy, four infants had no complications, three infants had minor respiratory deteriorations, and five infants required positive pressure ventilation for severe apnea and bradycardia episodes (one just after narcotic administration, four during the procedure). Excluding the three infants (five procedures) who were already receiving mechanical ventilation at the time of cryotherapy, the infants who had severe apnea requiring the initiation of positive pressure ventilation weighed less and were younger than those infants not having a serious respiratory complication (p less than 0.05).     

Delivery-related complications and early postpartum morbidity in Dhaka, Bangladesh.

OBJECTIVE: To describe delivery-related complications and postpartum morbidity of women living in slum areas of Dhaka, Bangladesh. METHOD: From November 1993 to May 1995, 1506 women were interviewed regarding delivery-related complications and postpartum morbidities. Operational definitions were applied to maternal reports to categorize serious delivery-related complications and postpartum morbidity. Corroborating information was identified from medical records for facility-based deliveries and physical examinations by female physicians 14 to 22 days postpartum. RESULT: Thirty-six percent of women described serious delivery-related complications and 75% of women reported postpartum morbidity. There were two maternal deaths among 1471 live births. When maternal reports were related to corroborating information, the proportion of women's reports of serious complications and morbidity appears reasonably accurate for some conditions. CONCLUSION: A large proportion of urban slum women in Dhaka experience serious delivery-related complications and/or postpartum morbidity. Information on delivery practices that contribute to morbidity and factors that influence appropriate care seeking is needed.     

The differentials and determinants of perinatal mortality in rural Bangladesh.

OBJECTIVE: In Bangladesh, the perinatal mortality is very high. This study examined the differentials and determinants of perinatal mortality in rural Bangladesh. METHODS: The study was based on the prospective data on maternal morbidity collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). This prospective study was conducted during the period November 1992 to December 1993. In this study, the factors associated with perinatal deaths were examined, employing differential and multivariate analyses. RESULTS: It was found that assisted delivery caused higher risks of stillbirth and death among live births during the first week of life. It was also observed that five or more pregnancies, prior to the index pregnancy, were positively associated with perinatal death. CONCLUSION: If the delivery is assisted or there are complications in delivery, then it is likely that the incidence of perinatal mortality will increase sharply. If the newborn baby was given colostrum, then perinatal mortality decreased to a great extent.     

Experience with Lippes loop and copper-T intrauterine devices in rural Bangladesh

Experience with IUD use among rural Bangladeshi women within two programmatic efforts demonstrates that the Copper-T IUD suited the needs of younger, lower-parity women better than Lippes Loop. The differential performance by the device was especially marked within the program that offered a broad selection of contraceptive methods and occurred mainly because of lower rates of expulsion and lower rates of discontinuation for bleeding and pain among the Copper-T users. Nevertheless, the easy availability of a wide choice of methods during the second program successfully encouraged dissatisfied IUD discontinuers to try other methods of contraception.     

Cesarean delivery complications in women with morbid obesity

Objective: To compare cesarean complication rates between women with body mass index (BMI) 40–49.9?kg/m² and BMI?≥?50?kg/m² and associations with surgical techniques.

Methods: This retrospective cohort study from 2009 to 2014 included women who underwent cesarean with delivery BMI?≥?50 and an equal number with BMI 40–49.9. Wound infections and/or separations were compared. We also examined wound complication rates between skin closure techniques and self-retaining retractor use.

Results: Among 498 patients (249 with BMI?≥?50 and 249 with BMI 40–49.9) there were no differences in estimated blood loss >1000?mL, blood transfusion, deep vein thrombosis or endometritis. Among those with outpatient follow-up (144 with BMI?≥?50 and 162 with BMI 40–49.9), those with BMI?≥?50 had a significantly higher rate of wound separations (p?=?0.01) but not infections. There were no differences in wound complication rates between skin closure techniques or self-retaining retractor use, though the study was not powered for these comparisons.

Conclusion: Wound complications, particularly separations, increase with BMI?≥?50 compared to a lesser degree of morbid obesity. Skin closure techniques and self-retaining retractor use were not associated with cesarean wound complications in patients with morbid obesity.