Anaemia during pregnancy: impact on birth outcome and infant haemoglobin level during the first 18 months of life

To determine the effect of maternal anaemia on pregnancy outcome and describe its impact on infant haemoglobin level in the first 18 months of life, we conducted a prospective study of 617 pregnant women and their children in Benin. Prevalence of maternal anaemia at delivery was 39.5%, and 61.1% of newborns were anaemic at birth. Maternal anaemia was not associated with low birth weight [OR = 1.2 (0.6-2.2)] or preterm birth [OR = 1.3 (0.7-2.4)], whereas the newborn's anaemia was related to maternal anaemia [OR = 1.8 (1.2-2.5)]. There was no association between an infant's haemoglobin level until 18 months and maternal anaemia. However, malaria attacks during follow-up, male gender and sickle cell trait were all associated with a lower infant haemoglobin level until 18 months, whereas good infant feeding practices and a polygamous family were positively associated with a higher haemoglobin level during the first 18 months of life.     

Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn

The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short‐term impacts, when they address only part of the health system. Third, the long‐term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings.     

Effet du mouvement de balancement sur la douleur du travail avant la mise en place du cathéter péridural en position assise

Objectives

To assess the effects of rocking motion on labour pain and before epidural catheter insertion.

Study design

Clinical prospective observational study.

Patients and methods

Pain scores (numerical scale: 0–10) were recorded in 50 laboring women in three consecutive positions: lying down, sitting and then rocking back and forth while seated. The overall satisfaction (0–10) and any comment related to the rocking procedure were also recorded.

Results

One woman refused to rock during the procedure and five alternated moving and still periods. Pain scores were similar in the lying (8.1 ± 1.8) and sitting position (8.0 ± 1.8), whereas they significantly decreased while rocking (6.6 ± 1.7; p < 0.001 versus both lying and sitting still positions). Satisfaction associated with rocking chair motion was high (8.9 ± 1.4).

Discussion

Within the limits of an observational and preliminary study, we observed that rocking motion during the procedure was associated with a significant decrease in labour pain and that patient satisfaction was high. Several hypotheses are proposed to explain these effects, i.e. patient's involvement in an action that focuses attention, loss of parturient's landmarks and stimulation of the vestibular system which might lead to a change in the cognitive perception of the body.