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1.
Cyril Engmann Richard Matendo John Ditekemena Robert L. Goldenberg Waldemar A. Carlo Carl Bose 《International journal of gynaecology and obstetrics》2009,105(2):112-117
Objective
To develop a prospective perinatal registry that characterizes all deliveries, differentiates between stillbirths and early neonatal deaths (ENDs), and determines the ratio of fresh to macerated stillbirths in the northwest Democratic Republic of Congo.Method
Birth outcomes were obtained from 4 rural health districts.Results
A total of 8230 women consented, END rate was 32 deaths per 1000 live births, and stillbirth rate was 33 deaths per 1000 deliveries. The majority (75%) of ENDs and stillbirths occurred in neonates weighing 1500 g or more. Odds of stillbirth and END increased in mothers who were single or who did not receive prenatal care, and among premature, low birth weight, or male infants. The ratio of fresh to macerated stillbirths was 4:1.Conclusion
Neonates weighing 1500 g or more at birth represent a group with a high likelihood of survival in remote areas, making them potentially amenable to targeted intervention packages. The ratio of fresh to macerated stillbirths was approximately 10-fold higher than expected, suggesting a more prominent role for improved intrapartum obstetric interventions. 相似文献2.
Archana Shah Bukola Fawole Faouzi Amokrane Jean-José Wolomby Isilda Neves Marius Kublickas 《International journal of gynaecology and obstetrics》2009,107(3):191-197
Objective
To assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities.Methods
Data were obtained from all births over 2-3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity.Results
Median cesarean delivery rate was 8.8% among 83 439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity—probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths.Conclusion
Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths. 相似文献3.
Anne C. Lee Luke C. Mullany Joanne Katz Steven C. LeClerq Ramesh K. Adhikari 《International journal of gynaecology and obstetrics》2011,113(3):199-204
Objective
To assess stillbirth rates and antepartum risk factors in rural Nepal.Methods
Data were collected prospectively during a cluster-randomized, community-based trial in Sarlahi, Nepal, from 2002 to 2006. Multivariate regression modeling was performed to calculate adjusted relative risk estimates.Results
Among 24 531 births, the stillbirth rate was 35.4 per 1000 births (term stillbirth rate 21.2 per 1000 births). Most births occurred at home without a skilled birth attendant. The majority (69%) of intrapartum maternal deaths resulted in stillbirth. The adjusted RR (aRR) of stillbirth was 2.74 among nulliparas and 1.47 among mothers with history of a child death. Mothers above the age of 30 years carried a 1.59-fold higher risk for stillbirth than mothers who were 20-24 years old. The stillbirth risk was lower among households where the father had any formal education (aRR 0.70). Land ownership (aRR 0.85) and Pahadi ethnicity (aRR 0.67; reference: Madhesi ethnicity) were associated with significantly lower risks of stillbirth.Conclusion
Stillbirth rates were high in rural Nepal, with the majority of stillbirths occurring at full-term gestation. Nulliparity, history of prior child loss, maternal age above 30 years, Madhesi ethnicity, and socioeconomic disadvantage were significant risk factors for stillbirth.Clinicaltrials.govNCT00 109616 相似文献4.
Elshiekh Bader 《International journal of gynaecology and obstetrics》2010,109(2):144-146
Objective
The study was conducted in the labor ward of Omdurman Maternity Hospital, Sudan, from November 2007 to February 2008 to investigate the prevalence and risks factors for stillbirth.Methods
A case-control study. Cases were women who delivered stillbirths; 2 consecutive women who delivered a live-born singleton neonate at term (37-42 weeks) per case were used as controls. Sociodemographic, clinical (including malaria infections), and obstetric histories were gathered using standard questionnaires. Maternal body mass index and hemoglobin levels were measured. Maternal, placental, and cord blood smears were investigated for malaria parasites.Results
Among 4760 singleton deliveries, there were 103 stillbirths, yielding a stillbirth rate of 22 per 1000 deliveries. Over half (52.4%) of these stillbirths were macerated stillbirths. Maternal sociodemographic characteristics were not associated with stillbirth, while a history of maternal malaria in the index pregnancy was the main risk factor for stillbirth (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P = 0.04).Conclusion
Measures to prevent malaria infection should help to prevent stillbirth in this part of Sudan. 相似文献5.
Jane E. Hirst Susan M. Arbuckle Lieu T.T. Ha 《International journal of gynaecology and obstetrics》2010,110(2):109-113
Objective
To describe major epidemiologic and placental findings regarding stillbirth in Vietnam.Methods
A cross-sectional study of all stillbirths in a tertiary referral facility in Ho Chi Minh City, Vietnam, was performed. Detailed examination of each infant, placental pathology, and semi-structured maternal interviews were conducted according to the Perinatal Society of Australia and New Zealand Perinatal Death Classification guidelines. Maternal, fetal, and placental characteristics were examined.Results
Between December 8, 2008, and January 9, 2009, there were 4694 live births and 122 stillbirths at the facility. In total, 107 (87.7%) cases were included in the study. Low education level was associated with a lack of prenatal care; induced abortion accounted for 34.6% of fetal deaths (gender selection was not the reason); 35.5% of infants were born at 22-28 weeks of gestation; 31.8% of stillbirths were small for gestational age; histologic evidence of chorioamnionitis was present in 40.2% of cases. Calcium supplements were less likely to have been taken in cases in which death from hypertension occurred. α-Thalassemia was the main cause of fetal hydrops (6.2%).Conclusion
Improving access to prenatal care and prenatal calcium and iron supplementation, and screening for congenital abnormalities and α-thalassemia may help to reduce rates of perinatal death in Vietnam. 相似文献6.
Hadiza Galadanci Oladapo Shittu Manfred Gruhl 《International journal of gynaecology and obstetrics》2011,114(1):23-28
Objective
To achieve Millennium Development Goals 4 and 5 in Nigeria, a quality assurance project in obstetrics in 10 hospitals in northern Nigeria was established to improve maternal and fetal outcome.Methods
The project commenced in January 2008 with assessment and improvement of the structure of the 10 hospitals. Continuous maternal and fetal data collection and analysis were conducted from 2008 to 2009 by means of a maternity record book and structured monthly summary form. The quality of hospital infrastructure and equipment was also assessed.Results
The mean maternal mortality ratio (MMR) was reduced from 1790 per 100 000 births in the first half of 2008 to 940 per 100 000 births in the second half of 2009. The average fetal mortality ratio (FMR) decreased slightly from 84.9 to 83.5 per 1000 births. There was an inversely proportional relationship between the total number of deliveries in a hospital and MMR and FMR. There was a close correlation between the MMR and the equipment status and hygiene conditions of the hospitals.Conclusion
Continuous monitoring of quality assurance in maternity units raised the awareness of the quality of obstetric performance and improved the quality of care provided, thereby improving MMR. 相似文献7.
8.
Thomas van den Akker Beatrice Mwagomba Jos van Roosmalen 《International journal of gynaecology and obstetrics》2009,107(3):289-294
Objectives
To improve obstetric care and reduce the incidence of uterine rupture through the use of audits.Methods
Data were collected from medical records and from questioning women who sustained uterine rupture over a 12-month period in Thyolo District Hospital, Malawi. Audit sessions were performed every 2-3 weeks for the first 3 months with relevant members of the hospital staff, after which an extended audit was held with input from two external expert obstetricians. Cases were also audited by the principal investigator for delays in referral, diagnosis, and treatment.Results
Thirty-five cases of uterine rupture were diagnosed at the facility during the study period. Sixteen ruptures were diagnosed during the first 3 months, an incidence of 19.2 per 1000 deliveries. Following audit and implementation of recommendations, the incidence of uterine rupture decreased by 68% (OR 0.32; 95% CI, 0.16-0.63) to 6.1 per 1000 deliveries over the next 9 months. The overall case fatality rate was 11.4%, and the perinatal mortality rate was 829 per 1000 live births.Conclusions
Audit is an inexpensive, appropriate, and effective intervention to improve the quality of facility-based maternal care and decrease the incidence of uterine rupture in low-resource settings. Ensuring constructive self-criticism, continuous professional learning, and good participation by district health managers in audit sessions may be important requirements for their success. 相似文献9.
Folashade O. Omokhodion Modupe O. Onadeko Jeremy R. Beach Nicola M. Cherry 《International journal of gynaecology and obstetrics》2010,111(2):165-170
Objective
To identify the determinants of low birth weight (LBW), preterm birth, and stillbirth, and the factors associated with paid or domestic work that affected pregnancy outcome in Ibadan, Nigeria.Methods
A cross-sectional study of women who delivered live or stillborn singleton neonates at 4 hospitals between February and June 2008. Participants were interviewed to obtain information on paid and domestic work activities during pregnancy, as well as obstetric history. Pregnancy outcomes and other clinical data were extracted from case notes.Results
A total of 1504 mothers aged 20-45 years recorded 137 (9.1%) LBW neonates (< 2.5 kg), 154 (10.2%) preterm deliveries (< 37 weeks), and 56 (3.7%) stillbirths. There was no overall increased risk of these outcomes among working mothers. Multivariate logistic regression analysis of working mothers who had booked their deliveries revealed that lifting heavy objects at home, a clinical record of proteinuria, and hospital admission during pregnancy were associated with LBW. Predictors for preterm birth were self-reported exposure to vibration at work, nulliparity, history of preterm birth, 4 or fewer compared with more than 8 antenatal visits, and prolonged rupture of membranes. Predictors for stillbirth were low education and prolonged rupture of membranes.Conclusion
The results further support recommendations that physical exertion in paid and domestic work should be reduced during pregnancy. 相似文献10.
Hamisu M. Salihu Jingyi DuanSarah K. Nabukera Alfred K. Mbah Amina P. Alio 《European journal of obstetrics, gynecology, and reproductive biology》2011,154(1):31-36
Objective
To assess whether young maternal age at initiation of childbearing is associated with recurrence of perinatal mortality (PM), as well as its components: stillbirth and neonatal death.Study design
We conducted a population-based, retrospective cohort study on the Missouri maternally linked longitudinal data files comprising adolescent (10-19 years; n = 73,533) or mature (20-24 years; n = 78,618) mothers in their first pregnancy with follow-up in their second pregnancy to document the occurrence of PM or its components. The study covered the period 1989-2005. We used unconditional logistic regression modeling to generate odds ratios and to control for confounding.Results
A history of perinatal mortality, stillbirth, or neonatal mortality increased the risk of a recurrence by 4-5 times. Among women with a history of PM or stillbirth in the first pregnancy, maternal age at initiation of pregnancy was not a risk factor for subsequent PM or its components. However, adolescent mothers with a history of neonatal mortality in the first pregnancy were about 5 times as likely to experience stillbirth in the second pregnancy, as compared to their mature counterparts.Conclusions
Young maternal age at the initiation of childbearing is not associated with an overall increased risk of recurrent perinatal loss. However, prior history of neonatal mortality among teen mothers is strongly predictive of subsequent stillbirth. 相似文献11.
Godfrey Mbaruku Jos van Roosmalen Iluminata Kimondo Staffan Bergström 《International journal of gynaecology and obstetrics》2009,106(1):85-88
Objective
To audit intrapartum fetal and early neonatal deaths of infants weighing ≥ 2000 g in a regional hospital in western Tanzania.Methods
The 3-delays methodology was applied to a cohort of perinatal deaths from July 2002 to July 2004.Results
The overall perinatal mortality rate in the hospital was 38 per 1000 live births, and in just over half of these cases the birth weight was ≥ 2000 g. The leading clinicopathologic causes of death were birth asphyxia (19.0%), prolonged or obstructed labor (18.5%), antepartum hemorrhage (11.5%), and uterine rupture (9.0%). First delays occurred in 19.0% of the cases, second delays occurred in 21.5%, and third delays occurred in 72.5%.Conclusion
For women who delivered in this hospital, most of the substandard care occurred after admission to the health facility. The improvement of institutional health care may have a significant impact on the decision to attend health institutions and, thereby, reduce first delays. 相似文献12.
Caroline S.E. Homer RM Msc. Med. PhD Professor of Midwifery Rebecca Johnston BSc Research Assistant Maralyn J. Foureur RM BA Grad Dip PhD Professor of Midwifery 《Midwifery》2011,27(2):165-169
Objectives
to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality.Design and setting
cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006.Participants
women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria.Measurements
data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state.Findings
over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who ‘attempted a vaginal birth’ also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers ‘attempted’ a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers ‘attempted’ a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small.Key conclusions
rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings.Implications for practice
decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours. 相似文献13.
Objective
the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking.Design
secondary analyses using published data from the Euro-PERISTAT study.Setting and participants
women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term).Methods
odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data.Main outcome measures
combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births.Findings
compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3).Key conclusions
the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. 相似文献14.
Objective
Increased availability of oxytocin and misoprostol is needed to reduce the risk of postpartum hemorrhage. This review compiles rates and risks of adverse maternal and perinatal outcomes associated with use of these medications for labor induction and augmentation in low-income countries. Recommendations are proposed based on the findings.Methods
We did a structured literature review using 5 databases followed by analysis of induction and augmentation rates from existing data.Results
Combined induction and augmentation rates were documented in up to 50% of hospital-based deliveries identified in the databases. Data are sparse but suggest associations between induction/augmentation and stillbirth, neonatal resuscitation, and uterine rupture, and inappropriate administration of oxytocin and misoprostol both outside and inside healthcare systems in low-income countries.Conclusions
Guidelines for labor induction/augmentation are needed specifically for low resourced settings. Rigorous studies should be pursued to quantify the magnitude and effect of inappropriate induction and augmentation on maternal and perinatal morbidity and mortality. Programs are needed to ensure community-wide awareness of the adverse effects of the improper use of these drugs on mothers and babies, especially in out-of-hospital settings. 相似文献15.
Zouhair Amarin Yousef Khader Hashim Jaddou 《International journal of gynaecology and obstetrics》2010,111(2):152-156
Objective
To estimate the number of maternal deaths per 100 000 live births during 2007-2008 among Jordanian women; to identify the causes of maternal mortality; and to compare the results with those of the last report for 1995-1996.Methods
Reproductive-age mortality study of maternal deaths among women aged 15-49 years in Jordan in 2007-2008.Results
Among 1406 identified deaths of reproductive-aged women, 76 maternal deaths were identified out of 397 588 live births, for a maternal mortality ratio of 19.1 deaths per 100 000 live births. Forty-three (56.6%) deaths were attributable to hemorrhage, thrombosis and thromboembolism, and sepsis. Avoidable factors were present in 53.9% of women, 52.6% had substandard care, and 31.5% had 3 or fewer antenatal visits. Of those with available information on family planning, only 29.4% had ever used any form of contraception.Conclusions
Maternal deaths in Jordan are declining. The maternal mortality ratio of 19.1 deaths per 100 000 live births reported for 2007-2008 showed a remarkable reduction of 53.9% achieved in the 12 years since the 1995-1996 report (a 4.5% annual reduction), which is approaching the 75% reduction recommended by Millennium Development Goal 5. 相似文献16.
17.
Antonio F. Oliveira Neto José G. Cecatti João P. Souza 《International journal of gynaecology and obstetrics》2009,105(3):252-256
Objective
To identify factors associated with maternal death among women with severe maternal morbidity.Methods
A retrospective study of 673 women admitted to an obstetric intensive care unit was undertaken. The odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for selected characteristics. The maternal mortality and severe maternal morbidity ratios were determined for groups of complications according to outcome (death or survival).Results
The risk of maternal death was higher among adolescents (OR 3.3; 95% CI, 1-9.7) and patients referred from other hospitals (OR 9.8; 95% CI, 2.7-53.3). The severe maternal morbidity ratio was 46.6 per 1000 deliveries and the mortality:morbidity ratio 1:37.4. Obstetric complications led to 65.8% of admissions and 50% of maternal deaths. The number of interventions/procedures and total maximum sequential organ failure assessment score were higher in cases of death.Conclusion
The strong association between interhospital transfer and maternal death suggests delays in diagnosis, management, and referral. Adopting organ dysfunction-based criteria may contribute toward identifying the most severe cases. 相似文献18.
Dekker RR Schutte JM Stekelenburg J Zwart JJ van Roosmalen J 《European journal of obstetrics, gynecology, and reproductive biology》2011,157(1):27-31
Objective
To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands.Study design
A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the Netherlands between 2004 and 2006, in which all 98 maternity units in the Netherlands participated. Maternal mortality ratio (MMR) and incidence of severe maternal morbidity were the main outcome measures.Results
The MMR from direct maternal mortality from AFLP was 0.13 per 100,000 live births (95% CI 0.05-0.29). The incidence of severe maternal morbidity from AFLP was 3.2 per 100,000 deliveries (95% CI 1.8-5.7).Conclusions
AFLP is a rare condition which still causes severe maternal morbidity and in some cases mortality. Referral to a tertiary care hospital for treatment of this uncommon disease should be considered. 相似文献19.
Liying Zou Xin WangYan Ruan Guanghui LiYi Chen Weiyuan Zhang 《International journal of gynaecology and obstetrics》2014
Objective
To determine the incidence of preterm birth, its regional distribution, and associated neonatal mortality in mainland China.Methods
In a multicenter, hospital-based investigation of preterm birth, 2011 data were obtained from the seven administrative regions of mainland China. Between one and three subcenters were randomly selected for each administrative region, followed by secondary and tertiary hospitals within the chosen subcenters. Data were obtained from women’s medical records, and obstetric and perinatal events were summarized.Results
Data for 107 905 deliveries were analyzed, which included 7769 (7.1%) preterm births (occurring between 28 and 37 weeks of pregnancy). The incidence varied among regions. Late preterm birth (between 34 and 37 weeks) accounted for 5495 (70.7%) of preterm births. The neonatal mortality rate was 33 deaths per 1000 live preterm births. Of the 254 neonatal deaths, 147 (57.9%) occurred after very preterm birth (between 28 and 32 weeks). Overall, 4519 (58.2%) preterm births occurred by cesarean.Conclusion
The distribution of preterm birth across China is unbalanced, and neonatal mortality associated with preterm birth is high. 相似文献20.
Gary L Darmstadt Mohammad Yawar Yakoob Rachel A Haws Esme V Menezes Tanya Soomro Zulfiqar A Bhutta 《BMC pregnancy and childbirth》2009,9(Z1):S6