The misleading choice for safer births in Brazilian’s most developed region: a cross-sectional study

Purpose: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery.

Materials and methods: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery.

Results: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0?±?6.0 years versus 25.9?±?6.5 years, p?2 versus 23.8?±?4.5?kg/m², p?Conclusions: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.     

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Background

Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.

Methods

We used cross-sectional data from a representative sample of 4684 women with children aged 0–11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.

Results

About 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05).

Conclusion

We found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.

     

Efficacy of natural family planning methods

Abstract

Objective To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception.

Method A total of 216 eligible pregnant women were randomised into antenatal and postnatal counselling groups. The ‘Antenatal group’ received one-to-one antenatal contraceptive counselling on several occasions while the ‘Postnatal group’ received a single one-to-one contraceptive counselling session at the sixth week postnatal check, as is routinely practised. All participants were contacted six months postpartum by telephone or personal visit, and questioned about their contraceptive use, if any.

Results More women who had multiple antenatal contraceptive counselling sessions used modern contraceptive methods than those who had a single postnatal counselling session (57% vs. 35%; p = 0.002). There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group (p = 0.014).

Conclusion Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception.     

Impact of a women's counselling programme on combined hormonal contraception in Portugal – The IMAGINE Study

ABSTRACT

Background The aim of this health education project was to measure the impact of counselling about combined hormonal contraceptive (CHC) methods on the subsequent choice of method by Portuguese women.

Method This was a multi-centre study with a representative population, at the national and regional levels, of 2951 Portuguese women ≥ 16 years of age visiting the gynaecologist. Counselling on available CHC methods was provided using a single leaflet, and their CHC choice was assessed before and after counselling.

Results A combined oral contraceptive (COC) was the method preferred by the majority of the women prior to counselling. After counselling, 35% of women who initially had chosen the pill, switched to either the vaginal ring or the transdermal patch, and the difference was statistically significant. Ease of use was the major reason for choosing the COC, while a lower probability of omission was the reason for choosing the vaginal ring and the patch.

Conclusions The implementation of a counselling programme significantly affected contraceptive choices leading in a number of cases to the selection of alternatives better suited to women's lifestyle. Age and educational level are socio-demographic factors which play an important role.     

Neuroleptic malignant syndrome in pregnancy: case report and literature review

Background: Neuroleptic malignant syndrome (NMS) is a serious complication associated with the use of drugs that affect dopaminergic system neurotransmission. The occurrence of NMS during pregnancy or gestation is considered a life-threatening obstetric emergency.

Case: We are reporting the first case in Latin America of NMS in one pregnant women with acute psychotic episode. One day after starting with antipsychotic therapy, she developed a fever higher than 39.0?°C with tachycardia, tachypnea, generalized muscle rigidity and somnolence, with creatine kinase (CPK) levels evidencing a result of 2800?U/L. She was treated successfully with levetiracetam, biperiden and quetiapine.

Discussion: A search in PubMed, Embase and Ovid from 1988 to 2016 resulted in seven cases reported in either pregnant or puerperal women. In general, NMS resolves within 3–14 days; most NMS cases reported during pregnancy have involved the use of haloperidol (5 case reports) which is concordant with this report. The obstetric results were good in cases reported, only two women showed signs, among them: hyperemesis gravidarum and preterm delivery. Most of the pregnant women who had NMS presented other associated comorbidities, being mostly of infectious origin. In other investigations, it has been affirmed that NMS can become lethal in adults; however, in our search for pregnant women with this disease, no associated mortality was found.

Conclusions: NMS is seen infrequently during pregnancy. The clinical diagnosis requires high suspicion by the examiner. It is important that obstetricians timely recognize the condition.     

Smoking during pregnancy and postpartum among Tunisian women

Objective.?The validity of self-reported smoking in population surveys remains an important question yet to be answered. This has been of particular concern in a situation where there is a strong social pressure against pregnant and postpartum women. An associated question is what would be the value of measuring urinary cotinine concentrations in such surveys to obtain validated smoking data.

Methods.?Cross-sectional analysis of data on self-reported smoking and urinary cotinine among a sample of 398 pregnant women and recently pregnant, mothers of infants under the age of 2 months, who came to the Family Planning Clinic in Tunis urban area for either prenatal or newborn care. We used quantitative colorimetric urine test based on the könig reaction, in which pink-red chromophores formed from nicotine and its metabolites condensation with barbituric acid were extracted into acetate buffer.

Results.?The smoking prevalence among Tunisian pregnant women or mothers of newborn infants was 4%. The validity of self-reported daily smoking was relatively low. Among women reporting no smoking at the interview 16% misreported active smoking. According to urinary cotinine values, the smoking prevalence was 18.8%.

Conclusions.?These results substantiate the unreliability of self-report on smoking status among women in prenatal and postnatal period and have implications in clinical and education practice.     

Pregnant Women’s Perception of Risk With Use of the H1N1 Vaccine

ObjectiveDuring the H1N1 influenza pandemic in 2009, The Motherisk Program, a counselling service providing teratology information, received many calls from pregnant women inquiring about the safety of the H1N1 vaccine. We wished to explore pregnant women’s perception of risk and the factors associated with deciding whether or not to receive the vaccine.MethodsPregnant women who called Motherisk between October 1 and November 30, 2009, requesting counselling regarding the safety of the H1N1 vaccine, and who had not yet received the vaccine, were contacted for follow-up using a structured questionnaire.ResultsOne hundred thirty women completed the questionnaire; 104 (80%) had received the H1N1 vaccination following their call to Motherisk, and 26 (20%) had not. More than 70% of the women cited confusing and frightening information in the media as a trigger for their concern, prompting them to call Motherisk. Sixty percent stated that information from their primary health care providers or Motherisk contributed to their decision making.ConclusionsThe H1N1 vaccination rate in pregnant women who contacted Motherisk was higher than the rate in the general population, as many followed Motherisk’s recommendation to receive the vaccine. During this period, the media appeared to provide pregnant women with confusing information. In any future pandemic scare, accessibility to primary health care providers or specialized information services such as Motherisk will be key to providing guidance for pregnant women.     

Maternal second trimester blood levels of selected heavy metals in pregnancies complicated with neural tube defects

Purpose: Neural tube defects (NTDs) are the most common malformations of the central nervous system (CNS). There is continuing research for the identification of risk factors and interventions for prevention of NTDs. The aim of this study was to investigate the maternal second trimester blood levels of selected heavy metals namely, arsenic (As), cadmium (Cd), mercury (Hg), manganese (Mn), nickel (Ni), and lead (Pb) and their possible relation with the occurrence of NTDs.

Methods: Twenty-one healthy second trimester pregnant women with fetuses affected with NTD (cases) were matched with 21 healthy pregnant women with unaffected fetuses (controls) with respect to age, body mass index (BMI), and gestational age. Maternal blood levels of heavy metals were measured after an overnight fasting period.

Results: No significant differences were observed in terms of maternal blood levels of As, Cd, Hg, and Ni between NTD-affected and unaffected pregnancies. The blood Pb and Mn levels were found to be higher in pregnant women with a fetus affected with NTD when compared with pregnant women with unaffected fetuses (for Pb, in cases 12.3?±?5.5?µg/L, in controls 7.8?±?2.4?µg/L; for Mn in cases 3.6?±?1.4?µg/L, in controls 2.4?±?1.0?µg/L, p?Conclusions: High maternal second trimester blood levels of Pb and Mn during pregnancy are associated with NTDs in the newborn.     

Delivery-associated presence of supramolecular fibronectin-fibrin complexes in puerperal and cord plasma

Objective: The variable fibronectin (FN) molecular forms are known to be engaged in coagulation and fibrinolysis pathways as well as tissue remodeling and repair processes. Some of them seem to be indispensable molecules within intensive biological processes associated with delivery. The aim of the study was to evaluate the FN molecular status in maternal and cord plasma after vaginal birth and cesarean section (C-section).

Materials and methods: The study included nonpregnant women’s plasma samples (n?=?31) and puerperal and cord plasma samples collected from 49 mothers who delivered healthy newborns at term by vaginal birth (n?=?25) and C-section (n?=?24). The maternal and cord plasma FN concentrations and presence and relative ratios of different FN-fibrin complexes were determined by ELISA and sodium dodecyl sulfate (SDS) -agarose immunoblotting, respectively.

Results: FN concentration in puerperal plasma after vaginal birth (232.08?±?71.8?mg/L) and C-section (228.17?±?71.2?mg/L) was significantly higher than in the plasma of nonpregnant women (190.00?±?48.75?mg/L). In contrast, FN concentration in cord plasma of the C-section group (101.95?±?30.3?mg/L) was significantly lower than that of the vaginal birth group (121.80?±?22.2?mg/L). Immunoblotting of puerperal and cord plasma distinguished the most abundant dimeric plasma FN form, the 220–280-kDa FN degradation products and 750–1900-kDa FN-fibrin complexes, which occurred more frequently and in higher amounts in puerperal and cord plasma groups than the nonpregnant women group, although independently of the mode of delivery.

Conclusions: Occurrence and relative amount of delivery-associated FN–fibrin complexes in both puerperal and cord plasmas might be bound with the physiological adaptive mechanisms reducing the risk of hemorrhage and intensive remodeling and repair processes after delivery.     

The effect of counselling on preconception lifestyle and awareness in Iranian women contemplating pregnancy: a randomized control trial

Purpose: This study was conducted to determine the effect of counselling on preconception lifestyle and awareness about it in healthy women planning to get pregnant.

Methods: This study was conducted on 152 women aged 18–35 who planned to get pregnant within the next year. Using block randomization, the participants were assigned into a counselling and a control group (n?=?76 per group). The intervention group attended six group counselling sessions, twice per week, over 3 weeks. The preconception lifestyle questionnaire and preconception lifestyle awareness questionnaire were completed by the participants before the intervention and 4 and 8 weeks after the intervention. The repeated measure ANOVA was used to analyse the data.

Results: The two groups were matching in terms of their sociodemographic characteristics and the baseline scores of preconception lifestyle and awareness about preconception lifestyle. The mean score of preconception lifestyle (adjusted mean difference?=?0.17; 95% confidence interval?=?0.13–0.21) and awareness about preconception lifestyle (7.8; 8.7–6.9) showed statistically significant improvements in the intervention group compared to the control group.

Conclusions: Preconception lifestyle group counselling is associated with increased awareness and improved lifestyle in women planning to get pregnant.     

Effect of counseling on maternal-fetal attachment in women with unplanned pregnancy: a randomized controlled trial

ABSTRACT

Introduction: Since the maternal-fetal attachment level in unplanned pregnancies is weaker than their planned counterparts, this study aimed to determine the effect of counselling on maternal-fetal attachment in women with unplanned pregnancy.

Methods: This was a randomised controlled clinical trial on pregnant women with unplanned pregnancy and weak-average maternal-fetal attachment scores. Participants were assigned to a control (n = 40) and an intervention (n = 40) group through randomised blocking. The intervention group attended 1–3 individual and 6 group counselling sessions and the control group received routine care. The participants completed the Maternal-Fetal Attachment Scale before and four weeks after the intervention.

Results: The mean (standard deviation) maternal-fetal attachment score of the intervention group was increased from 73.6 (8.9) before the intervention to 96.6 (9.3) after the intervention. However, the mean (standard deviation) maternal-fetal attachment scores of the control group were 76.0 (9.4) and 76.5 (6.4) before and after the intervention, respectively. The mean maternal-fetal attachment score of the counselling group was significantly higher than that of the control group (adjusted mean difference: 21.7; 95% confidence interval: 18.6 to 24.9; P < 0.001).

Conclusion: Counseling has a positive contribution to improving maternal-fetal attachment in women with unplanned pregnancies.     

Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study

Objective: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors.

Methods: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling.

Results: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20–72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10?min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with ‘east region’, OR_adj?=_?3.33, 95% CI: 2.12–5.21) conducted more PAFP counseling; providers with more knowledge (OR_adj?=_?2.08, 95% CI: 1.38–3.15) provided more counseling; and compared with ‘middle school and below’, providers with higher education gave more counseling [OR_adj(95% CI)] for ‘college’, ‘university’ and ‘master/doctor’ [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively].

Conclusions: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.     

Thiol/disulfide homeostasis in pregnant women with obstructive sleep apnea syndrome

Background: Repetitive episodes of hypoxia and reoxygenation during sleep in patients with obstructive sleep apnea syndrome (OSAS) resemble an ischemia-reperfusion injury. We aimed to test the hypothesis that oxidative stress occurs in pregnant women with OSAS. We also aimed to compare thiol/disulfide homeostasis with ischemia-modified albumin (IMA) and total antioxidant capacity (TAC) as markers of ischemia-reperfusion injury in pregnant women with and without OSAS and healthy control.

Methods: This study included 29 pregnant women with OSAS, 30 women without OSAS in the third trimester applying for periodic examinations, and 30 healthy women. Serum IMA and TAC (using the ferric reducing power of plasma method) were measured. Serum thiol/disulfide homeostasis was determined by a novel automated method.

Results: The mean age of the pregnant women with OSAS was 31.0?±?4.7 years with a mean gestational age of 36.5?±?3.0 weeks. The mean age of pregnant women without OSAS was 29.8?±?4.9 years with a mean gestational age of 36.9?±?2.7 weeks. The mean age of the nonpregnant control group was 29.7?±?6.4 years. Both native thiol (291?±?29?μmol/L versus 314?±?30?μmol/L; p?=?.018) and total thiol (325?±?32 versus 350?±?32, p?=?.025) levels were lower in pregnant women with OSAS compared to pregnant women without OSAS, respectively (p?Conclusions: This is the first study demonstrating the thiol/disulfide homeostasis in pregnant women with OSAS. Native thiol and total thiol levels were lower in pregnant women with OSAS compared to those without OSAS. However, dynamic thiol/disulfide homeostasis parameters cannot provide valuable information to discriminate OSAS in pregnant women.     

The influence of gender roles on health seeking behaviour during pregnancy in Turkey

Objectives To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth.

Methods The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants.

Results Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only ‘serious’ conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use.

Conclusions Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.     

Women's awareness of long-acting,reversible contraceptive methods (LARCs) in community family planning clinics and general practice

Objectives To investigate whether awareness and choice of long-acting reversible contraceptives (LARCs) of women attending a community family planning clinic differ from those of women seeing general practitioners (GPs).

Methods Information was collected from women in their reproductive years about their current contraceptive method, their awareness of LARCs and whether they felt well informed about their options. After additional information was provided the respondents were asked whether they would consider changing their method and if their GP offered this option.

Results Questionnaires were completed by 177 women attending a city-centre contraception and sexual health (CASH) clinic (n = 96) and a GP's surgery in a neighbouring city (n = 81). Forty percent of women in the CASH cohort and 6% in the primary care group were using LARCs. Women attending the CASH service were more aware of their contraceptive options and felt better informed but less than 50% in either group had heard of the levonorgestrel-releasing intrauterine system. At least 50% of women would consider using a LARC yet few knew if their GP fitted/provided these methods.

Conclusion LARC usage was considerably higher in CASH services compared to primary care. Those providing contraceptive care should give up-to-date information covering all methods and referral to local specialist services, as appropriate.     

Community midwives' acceptability in their communities: A qualitative study from two provinces of Pakistan

Objectivesthis study was aimed to understand in depth how the community midwives (CMWs) in Pakistan perceive are the important factors for their acceptability and community related barriers to their practice of maternal and child health care services.Designqualitative study design using in-depth interviews (IDIs) and focus group discussions (FGDs).Settingtwo districts in Khyber Pakhtunkhwa and Punjab provinces in Pakistan.Participantswe used qualitative study design and conducted 34 in depth interviews (IDIs) and 9 focus group discussions (FGDs) with 100 participants which included CMWs, lady health supervisors (LHSs) and managers in maternal neonatal and child health (MNCH) program of two provinces of Pakistan.Measurementscontent analysis of the findings was performed manually and findings were arranged in relevant themes originating from the study.FindingsCMWs in our study experienced restrictions from their families, especially husbands and in-laws, to be independently available to attend to women during pregnancy and delivery. Communication between the communities and MNCH program was found to be weak therefore CMWs had to struggle to win the trust of and persuade pregnant women to use their services. Most CMWs attributed low utilization of their services to inherent taboos prevalent in the communities under which they relied more on unskilled traditional birth attendants (TBAs). Gender sensitivity and fears of insecurity in many conflict hit areas affected CMWs' mobility within their own communities which affected the access of rural women to skilled maternal and child care.     

A clinical carepath for obese pregnant women: a pragmatic pilot cluster randomized controlled trial

Abstract

Objectives: Obese women are at increased risks for complications during pregnancy, birth, and in their infants. Although guidelines have been established for the clinical care of obese pregnant women, management is sometimes suboptimal. Our goal was to determine the feasibility of implementing and testing a clinical carepath for obese pregnant women compared to standard care, in a pilot cluster randomized controlled trial (RCT).

Methods: A pragmatic pilot cluster RCT was conducted, randomly allocating eight clinics to the carepath or standard care for obese pregnant women. Women were eligible if they had a pre-pregnancy body mass index (BMI) of ≥30?kg/m² and a viable singleton <21?weeks. The primary outcomes were the feasibility of conducting a full-scale cluster RCT (defined as >80%: randomization of clinics, use in eligible women, and completeness of follow-up) and of the intervention (defined as >80%: compliance with each step in the carepath and recommendation of the carepath by clinicians to a colleague).

Results: All eight approached clinics agreed to participate and were randomized. Half of the intervention clinics used the carepath, resulting in <80% uptake of eligible women. High follow-up (99.5%) was achieved, in 188 of 189 women. The carepath was feasible for numerous guideline-directed recommendations for screening, but less so for counseling topics. When the carepath was used in the majority of women, all clinicians, most of whom were midwives, reported they would recommend it to a colleague. The intervention group had significantly higher overall adherence to the guideline recommendations compared to control (relative risk: 1.71, 95% confidence interval: 1.57–1.87).

Conclusions: In this pragmatic pilot cluster RCT, a guideline-directed clinical carepath improved some aspects of care of obese pregnant women and was recommended by clinicians, particularly midwives. A cluster RCT may not be feasible in a mix of obstetric and midwifery clinics, but may be feasible in midwifery clinics.     

Severe vitamin D deficiency among pregnant women and their newborns in Turkey

Objectives: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey.

Methods: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers’ age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels.

Results: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97?±?3.27?ng/ml and 4.29?±?2.44?ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p?<?0.05). Ninety-five mothers had serum 25(OH)D3 below 20?ng/ml and all cord blood serum 25(OH)D3 levels were below 20?ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71?±?1.88 and 5.2?±?3.4?ng/ml, respectively, with a significant difference between them (p?<?0.05).

Conclusion: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.     

A clinical and microbiological study of puerperal sepsis in a tertiary care hospital in India

Objective: This prospective study was carried out to evaluate the clinical profile and bacterial isolates among women with puerperal sepsis in a tertiary hospital in North India.

Materials and methods: Women with puerperal sepsis (n?=?45) admitted from January 2015 to April 2016 were followed prospectively. Cultures were obtained from cervix, blood, urine, and pyoperitoneum. Initial antibiotics were cefotaxime or piperacillin with tazobactam plus amikacin plus clindamycin or metronidazole and were changed according to sensitivity.

Results: Out of 7887 deliveries during this period, 45 (0.2%) women had puerperal sepsis. 16 (35.5%) delivered in the present hospital, 25 (55.5%) at another health care facility, and 4 (8.9%) at home. Delivery was by cesarean section (CS) in 24/45 (53.3%) and vaginal in 21/45 (46.6%). Grade 1 sepsis occurred in 21, grade 2 in two, and grade 3 in 22 women. Majority (29/45 or 64.5%) had no risk factor for puerperal sepsis. There were two (4.4%) deaths and 13/45 (28.8%) had near-miss morbidity. Pathogenic bacteria were isolated in 33/45 (73.3%) in cervical swab (69%), blood, urine, or pus culture with no significant difference in the bacterial yield or species isolated between cotton or polyester swabs (p?>?.05). Escherichia coli were the commonest isolate and was sensitive to amikacin in all. Five had stillbirths and 4/40 neonates developed sepsis but recovered.

Conclusions: Escherichia coli was the commonest pathogen and was uniformly sensitive to amikacin, which may be included among the initial antibiotics to treat puerperal sepsis in India.