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  1. Care during the third stage of labour: obstetricians views and practice in an Albanian maternity hospital

    PubMed Central

    2010-01-01

    Background Relatively little is known about current practice during the third stage of labour in low and middle income countries. We conducted a survey of attitudes and an audit of practice in a large maternity hospital in Albania. Methods Survey of 35 obstetricians and audit of practice during the third stage was conducted in July 2008 at a tertiary referral hospital in Tirana. The survey questionnaire was self completed. Responses were anonymous. For the audit, information collected included time of administration of the uterotonic drug, gestation at birth, position of the baby before cord clamping, cord traction, and need for resuscitation. Results 77% (27/35) of obstetricians completed the questionnaire, of whom 78% (21/27) reported always or usually using active management, and 22% (6/27) always or usually using physiological care. When using active management: 56% (15/27) gave the uterotonic after cord clamping; intravenous oxytocin was almost always the drug used; and 71% (19/27) clamped the cord within one minute. For physiological care: 42% (8/19) clamped the cord within 20 seconds, and 96% (18/19) within one minute. 93% would randomise women to a trial of early versus late cord clamping. Practice was observed for 156 consecutive births, of which 26% (42/156) were by caesarean section. A prophylactic uterotonic was used for 87% (137/156): this was given after cord clamping for 55% (75/137), although timing of administration was not recorded for 21% (29/137). For 85% of births (132/156) cord clamping was within 20 seconds, and for all babies it was within 50 seconds. Controlled cord traction was used for 49% (76/156) of births. Conclusions Most obstetricians reported always or usually using active management for the third stage of labour. For timing and choice of the uterotonic drug, reported practice was similar to actual practice. Although some obstetricians reported they waited longer than one minute before clamping the cord, this was not observed in

  2. Reported maternal styles and substance use: a cross-sectional study among educated Albanian young adults.

    PubMed

    Kalyva, Efrosini; Melonashi, Erika

    2014-05-01

    The study explored a predictive model of substance use including perceived maternal parenting style, age and gender. Participants were 347 Albanian young adults (144 males and 203 females) aged 18 to 28 years. They completed the Parental Authority Questionnaire and the Adolescent Alcohol and Drug Involvement Scale. Gender, perceived authoritative maternal style, and age predicted a proportion of substance use involvement. Gender and perceived authoritative maternal style also predicted the proportion of young people at risk for substance use or abuse. Implications of the findings and limitations of the study are discussed.

  3. Application of the Safety Attitudes Questionnaire (SAQ) in Albanian hospitals: a cross-sectional study

    PubMed Central

    Gabrani, Adriatik; Hoxha, Adrian; Simaku, Artan; Gabrani, Jonila (Cyco)

    2015-01-01

    Objective To establish the reliability and validity of the translated version of the Safety Attitudes Questionnaire (SAQ) by evaluating its psychometric properties and to determine possible differences among nurses and physicians regarding safety attitudes. Design A cross-sectional study utilising the Albanian version of the SAQ and a demographic questionnaire. Setting Four regional hospitals in Albania. Participants 341 healthcare providers, including 132 nurses and 209 doctors. Main outcome measure(s) The translation, construct validity and internal validity of the SAQ. The SAQ includes six scales and 30 items. Results A total of 341 valid questionnaires were returned, for a response rate of 70%. The confirmatory factor analysis and its goodness-of-fit indices (standardised root mean square residual 0.075, root mean square error of approximation 0.044 and comparative fit index 0.97) showed good model fit. The Cronbach's α values for each of the scales of the SAQ ranged from 0.64 to 0.82. The percentage of hospital healthcare workers who had a positive attitude was 60.3% for the teamwork climate, 57.2% for the safety climate, 58.4% for job satisfaction, 37.4% for stress recognition, 59.3% for the perception of management and 49.5% for working conditions. Intercorrelations showed that the subscales had moderate-to-high correlations with one another. Nurses were more hesitant to admit and report errors; only 55% of physicians and 44% of nurses endorsed this statement (χ2=4.9, p=0.02). Moreover, nurses received lower scores on team work compared with doctors (N 45.7 vs D 52.3, p=0.01). Doctors denied the effects of stress and fatigue on their performance (N 46.7 vs D 39.5, p<0.01), neglecting the workload. Conclusions The SAQ is a useful tool for evaluating safety attitudes in Albanian hospitals. In light of the health workforce's poor recognition of stress, establishing patient safety programmes should be a priority among policymakers in Albania. PMID:25877270

  4. Albanians accuse Serbs of waging demographic war, flock to secret birth clinics.

    PubMed

    1992-06-21

    Even giving birth has become a political issue in the tense Yugoslav province of Kosovo. Although ethnic Albanians in the province outnumber Serbs by nearly 10-to-1, they live 2nd-class lives. One ethnic Albanian midwife who lives near the capital of Pristina says that 1500 babies have been born in her spare room during the past 20 months to women who preferred to take risks rather than go to Serb-run clinics. Women who come to the midwife--she did not want her name used or even the name of her town mentioned--give birth on a narrow cot covered with 2 soiled plastic sheets. They clench their teeth to stifle the pain--the midwife saves her meager supply of anesthetic for severe cases only. Next to the cot is a small cradle, but otherwise there is no sign that the room with its sofas and cabinets is a maternity clinic. Albanians have a birth rate of 34/1000 residents--Europe's highest. In Kosovo, about 200,000 Serbs are outnumbered by 1.8 million albanians, in the land Serbia cherishes as the cradle of it civilization. The Serbs say they are being swamped by Albanians, and in the past 10 years, waves of Serbs have left Kosovo, Yugoslavia's poorest province. At least 2000 have left in the past 12 months. But ethnic Albanians say it is the Serbs who practice demographic warfare. After a period of unrest in mid-1990. Serbian forces clamped down on an Albanian independence drive. Albanian doctors and nurses were fired. The gynecological clinic in Pristina lost some top specialists. "They did it to change the demographic map of Kosovo--to discourage Albanian births," said Dr. Flora Doko, president of the health committee of the Democratic League--the main Albanian opposition party, which has formed a government-in-exile and seeks independence for the province. Unconfirmed reports of Albanian babies being positioned in hospitals further inflamed the atmosphere in the suspicious society. There is no law discriminating against Albanians in medical care, but they claim

  5. Maternal mortality--Pumwani Maternity Hospital--1975-1984.

    PubMed

    Ngoka, W M; Bansal, Y P

    1987-04-01

    The study is purpose was to identify the avoidable factors responsible for the high maternal mortality in the Pumwani Maternity Hospital in Nairobi, Kenya and to determine how the available facilities could be used to reduce the mortality. A retrospective study of maternal deaths was carried out at the hospital for the period 1975-1984. During this period, there were 223,111 births and 150 maternal deaths, giving an incidence of maternal mortality of 67.2/100,000 births. Eclampsia and severe preeclampsia, puerperal sepsis, ruptured uterus, and postpartum hemorrhage were among the leading causes of maternal deaths. The authors also concluded that the following factors contributed to the increased maternal mortality: high maternal age; primigravidy; grandmultiparity; lack of good antenatal, intranatal, and postnatal care; lack of investigations; lack of good transfusion services; lack of better skilled anesthetic staff; and lack of discipline among the medical personnel.

  6. Maternal mortality at Goroka Base Hospital.

    PubMed

    Campbell, G R

    1974-12-01

    Over the ten year period 1964-73, the causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital are reviewed. The leading causes of maternal mortality are sepsis and obstructed labour followed by ruptured uterus and abortion. Although it will be difficult to reduce the maternal mortality, some relevant recommendations are made.

  7. [Proximity and breastfeeding at the maternity hospital].

    PubMed

    Fradin-Charrier, Anne-Claire

    2015-01-01

    The establishment of breastfeeding, as well as its duration, are facilitated through the proximity of the mother with her new baby. However, in maternity hospitals, breastfeeding mothers very often leave their baby in the nursery at night time. A study carried out in 2014 in several maternity hospitals put forward suggestions and highlighted areas to improve in everyday practice.

  8. Measures of performance in Scottish maternity hospitals.

    PubMed Central

    Leyland, A H; Pritchard, C W; McLoone, P; Boddy, F A

    1991-01-01

    OBJECTIVE--To develop measures of hospital performance over time with particular reference to maternal and neonatal care by controlling for case mix. DESIGN--Analysis of computerised records of births. SETTING--Scotland, 1980-7. SUBJECTS--Over half a million singleton live births and stillbirths. MAIN OUTCOME MEASURES--Numbers of perinatal deaths and caesarean sections. RESULTS--Scottish maternity hospitals perform more or less equally with regard to perinatal mortality. When caesarean sections are considered, there is evidence that hospitals differ in their treatment of different groups of women; in two examples one hospital had an increased rate among women of parity 2 or more and another had a reduced rate of repeat caesarean section. CONCLUSIONS--Developing measures of performance over time by controlling for case mix is a valid system for monitoring hospital outcomes and activity, and allows comparison either between hospitals or with data for all Scottish maternity hospitals. Hospital profiles permit identification of differences for particular patient groups after allowance is made for other case mix variables. PMID:1912806

  9. Reading Difficulties in Albanian

    ERIC Educational Resources Information Center

    Avdyli, Rrezarta; Cuetos, Fernando

    2012-01-01

    Albanian is an Indo-European language with a shallow orthography, in which there is an absolute correspondence between graphemes and phonemes. We aimed to know reading strategies used by Albanian disabled children during word and pseudoword reading. A pool of 114 Kosovar reading disabled children matched with 150 normal readers aged 6 to 11 years…

  10. [Maternal mortality at the Hospital Central Militar].

    PubMed

    Ruiz Moreno, J A; Rodríguez Enríquez, C; Márquez Tavares, J F; Rosales Pérez, P; Coronado Ugalde, C A

    1982-02-01

    71 maternal deaths at the Hospital Central Militar (Central Military Hospital) over the 12-year period 1968-1979 were reviewed. Maternal mortality rate was 23.07% which is higher than for the rest of the population. The most frequent type of mortality was due to obstetrical causes (69.01%) and here it was infection, pre-eclampsia, eclampsia, and hemorrhage which were most frequent. Among nonobstetrical causes, viral hepatitis was the most frequent. Death occurred more often among young women ages 21-25 with 2-4 previous deliveries. Death was considered evitable and probably evitable in 50 cases (70.42%). Of these, 62% were the responsibility of physicians and hospitals, while the rest were attributable to the patient and the community. (author's modified)

  11. Reading difficulties in Albanian.

    PubMed

    Avdyli, Rrezarta; Cuetos, Fernando

    2012-10-01

    Albanian is an Indo-European language with a shallow orthography, in which there is an absolute correspondence between graphemes and phonemes. We aimed to know reading strategies used by Albanian disabled children during word and pseudoword reading. A pool of 114 Kosovar reading disabled children matched with 150 normal readers aged 6 to 11 years old were tested. They had to read 120 stimuli varied in lexicality, frequency, and length. The results in terms of reading accuracy as well as in reading times show that both groups were affected by lexicality and length effects. In both groups, length and lexicality effects were significantly modulated by school year being greater in early grades and later diminish in length and just the opposite in lexicality. However, the reading difficulties group was less accurate and slower than the control group across all school grades. Analyses of the error patterns showed that phonological errors, when the letter replacement leading to new nonwords, are the most common error type in both groups, although as grade rises, visual errors and lexicalizations increased more in the control group than the reading difficulties group. These findings suggest that Albanian normal children use both routes (lexical and sublexical) from the beginning of reading despite of the complete regularity of Albanian, while children with reading difficulties start using sublexical reading and the lexical reading takes more time to acquire, but finally both routes are functional.

  12. Albanian: Basic Radio Communications.

    ERIC Educational Resources Information Center

    Defense Language Inst., Washington, DC.

    This volume has been designed as a supplement to a course in Albanian developed by the Defense Language Institute. The emphasis in this text is placed on radio communications instruction. The volume is divided into five exercises, each of which contains a vocabulary, dictation, and an air-to-ground communications procedure conducted in Albanian…

  13. Albanian Geography and History.

    ERIC Educational Resources Information Center

    Defense Language Inst., Washington, DC.

    This volume supplements lessons 1-120 in the "Albanian Basic Course" developed by the Defense Language Institute. New words and idioms are introduced, and historical, political, cultural, and geographic information about Albania focuses on contemporary life. It is suggested that the work in this text be initiated during the final phase of the…

  14. Albanian: Basic Radio Communications.

    ERIC Educational Resources Information Center

    Defense Language Inst., Washington, DC.

    This volume has been designed as a supplement to a course in Albanian developed by the Defense Language Institute. The emphasis in this text is placed on radio communications instruction. The volume is divided into five exercises, each of which contains a vocabulary, dictation, and an air-to-ground communications procedure conducted in Albanian…

  15. Maternal 'near miss' at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit.

    PubMed

    Jayaratnam, Skandarupan; Burton, Alice; Connan, Kirsten Fiona; de Costa, Caroline

    2016-08-01

    Assessment of severe maternal morbidity using World Health Organization (WHO) 'near-miss' criteria is gaining in importance as a valuable tool in the assessment of maternity care of women. Identification of cases allows an understanding of aetiology of severe morbidity and factors contributing to poor maternal outcomes. The aim of this study is to determine the rate of maternal 'near miss' at Royal Darwin Hospital (RDH) and the utility of the WHO near-miss criteria as a tool for data collection in a regional Australian context. Cases of maternal 'near miss' and deaths were prospectively identified over a period of 12 months using the WHO criteria. During the audit period, there were 2080 live births at Royal Darwin Hospital (RDH): 10 women presented with a 'near miss' and there was one maternal death. The maternal mortality ratio for the hospital was 48/100 000 live births, the maternal 'near-miss' index ratio was 4.8/1000 live births, and the combination of maternal deaths and near misses gave a severe maternal outcome (SMO) ratio of 5.3/1000 live births. The main cause of obstetric 'near miss' was obstetric haemorrhage. Indigenous women and women from remote areas comprised a significant portion of 'near-miss' cases. The rates of maternal 'near miss' at RDH are consistent with other studies in the developed world. The WHO maternal 'near-miss' audit tool helps health professionals understand and anticipate severe maternal morbidities, with the aim of improving maternal and perinatal outcomes. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. The relationship between maternal self-esteem and maternal attachment in mothers of hospitalized premature infants.

    PubMed

    Chen, C W; Conrad, B

    2001-09-01

    The purpose of this study was to examine the relationship between maternal self-esteem and maternal attachment in mothers of hospitalized premature infants. The research instruments administered included: a demographic sheet, the Maternal Self-Report Inventory (MSRI), Rosenberg Self-Esteem Scale, and Leifer's How I Feel About My Baby Now Scale. Thirty-two mothers whose premature infants were medically stable and hospitalized in the NICU were studied. Two hypotheses on the positive relationships between maternal self-esteem and maternal attachment, and global self-esteem and maternal attachment could not be tested by correlational analyses due to the inadequate internal consistency of the How I Feel About My Baby Now Scale. A significant correlation was found between maternal self-esteem and global self-esteem. Thus, maternal role influenced general self-concept in mothers. In addition, it was found that there were no significant correlations between the MSRI and demographic variables, such as: maternal age, marital status, income, and educational level. Another result indicated that increased global self-esteem was correlated (p < .05) with maternal age, income, and educational level. The results of this study provide clinical nurses to pay attention not only to caregiving skills but also to the mother's appraisal of herself as a mother and attachment behaviors.

  17. Influence of the support offered to breastfeeding by maternity hospitals

    PubMed Central

    Passanha, Adriana; Benício, Maria Helena D’Aquino; Venâncio, Sônia Isoyama; dos Reis, Márcia Cristina Guerreiro

    2015-01-01

    ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals. PMID:26759966

  18. Informal patient payments in maternity hospitals in Kiev, Ukraine.

    PubMed

    Stepurko, Tetiana; Pavlova, Milena; Levenets, Olena; Gryga, Irena; Groot, Wim

    2013-01-01

    Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities. Copyright © 2012 John Wiley & Sons, Ltd.

  19. Preventable maternal mortality in Morocco: the role of hospitals.

    PubMed

    Abouchadi, Saloua; Alaoui, Abdelali Belghiti; Meski, Fatima Zahra; Bezad, Rachid; De Brouwere, Vincent

    2013-04-01

    In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths. The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved. Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities. The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals. © 2013 Blackwell Publishing Ltd.

  20. Albanian: A Survey of Albanian Language and Literature. Area Background Studies.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This survey of Albanian language and literature is a synopsis of linguistic studies and literary achievements in Albania. The first chapter discusses the origin of the Albanian language. The next chapters deal with the Greek, Latin, Slavic, and Turkish influences on the Albanian language. The influence of Albanian on other Balkan languages and the…

  1. Birthing Centers and Hospital Maternity Services

    MedlinePlus

    ... who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists. If ... certain medical conditions (such as gestational diabetes or high blood pressure), or ... early in pregnancy and given prenatal care at the birth center ...

  2. Maternal mortality in Ramathibodi Hospital: a 14-year review.

    PubMed

    Phuapradit, W; Sirivongs, B; Chaturachinda, K

    1985-12-01

    A retrospective review of maternal mortality in the obstetric unit of Bangkok's Ramathibodi Hospital in 1969-82 was conducted. In this 14-year period, there were 72,872 live births and 26 maternal deaths, yielding a maternal mortality rate of 0.4/1000. Direct obstetric causes accounted for 77% of these deaths. The distribution of the 20 direct obstetric deaths was as follws: septic abortion (10 cases), puerperal infection (3 cases), pre-eclampsia (1 case), eclampsia (2 cases), amniotic fluid embolism (3 cases), and placenta percreta with uterine rupture (1 case). Among the 6 deaths attributable to indirect causes, viral hepatitis was responsible for 3, systemic lupus erythematosus was the cause in 2 cases, and cardiac failure occurred in the final case. The maternal mortality rate was 0.8/1000 amond women 19 years of age and below and 0.6/1000 among women 35 years of age and above compared with 0.2/1000 among those 20-34 years of age. Maternal mortality was 0.6/1000 for cesarean section delivery compared with 0.1 for normal delivery. Ongoing statistical analyses of maternal mortality are urged to serve as the basis for preventive measures.

  3. Early hospital discharge in maternal and newborn care.

    PubMed

    Fink, Anne M

    2011-01-01

    This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow-up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow-up care to optimize maternal and newborn outcomes. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  4. Maternal satisfaction with organized perinatal care in Serbian public hospitals.

    PubMed

    Matejić, Bojana; Milićević, Milena Šantrić; Vasić, Vladimir; Djikanović, Bosiljka

    2014-01-13

    Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients' rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson's coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and

  5. Maternal satisfaction with organized perinatal care in Serbian public hospitals

    PubMed Central

    2014-01-01

    Background Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Methods Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. Results We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Conclusions Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would

  6. Maternal stressors during prolonged antepartum hospitalization following transfer for maternal-fetal indications.

    PubMed

    Doyle, Nora M; Monga, Manju; Kerr, Marcia; Hollier, Lisa M

    2004-01-01

    Our objective was to identify stressors in women requiring prolonged hospitalization following maternal-fetal transfer to a tertiary care center. Using a modified version of the previously validated Antepartum Hospital Stressors Inventory (AHSI), all women transferred to our university-based maternal-fetal service between May 2000 and June 2002 and hospitalized for greater than 1 month completed a semi-structured interview. The AHSI uses Likert scales to evaluate environment, health factors, communication with health care providers, family separation, self-image, and emotional and family status issues as stressors. Nine consecutive women met inclusion criteria and all agreed to participate. Median maternal age was 27 years (range 19 to 33), and gestational age at transfer was 25 weeks (range 20 to 31). Parity ranged from 0 to 3 and educational level ranged from grade 2 to graduate degrees. The women were from Caucasian, Hispanic, and Asian racial-ethnic backgrounds; all were married. Median distance from transferring hospital was 20 miles (range 10 to 275 miles). All patients reported separation from family, sleeping alone, anxiety about the pregnancy and the baby's health, boredom, and eating hospital meals as the greatest stressors. Stress was relieved in all women by ultrasounds, family members staying in the room, cable television, and internet access. Routine beauty maintenance, massage, physical therapy, and continued contact with referring physician were also cited as stress alleviators. Following maternal-fetal transfer, prolonged antepartum hospitalization is associated with stress that may be alleviated by access to the outside world via television and the internet, liberal visitation, access to health and beauty maintenance, and ongoing contact with the referring physician.

  7. Facility-based maternal death reviews: effects on maternal mortality in a district hospital in Senegal.

    PubMed Central

    Dumont, Alexandre; Gaye, Alioune; de Bernis, Luc; Chaillet, Nils; Landry, Anne; Delage, Joanne; Bouvier-Colle, Marie-Hélène

    2006-01-01

    OBJECTIVE: The improvement of obstetric services is one of the key components of the Safe Motherhood Programme. Reviewing maternal deaths and complications is one method that may make pregnancy safer, but there is no evidence about the effectiveness of this strategy. The objective of our before and after study is to assess the effect of facility-based maternal deaths reviews (MDR) on maternal mortality rates in a district hospital in Senegal that provides primary and referral maternity services. METHODS: We included all women who were admitted to the maternity unit for childbirth, or within 24 hours of delivery. We recorded maternal mortality during a 1-year baseline period from January to December 1997, and during a 3-year period from January 1998 to December 2000 after MDR had been implemented. Effects of MDR on organization of care were qualitatively evaluated. FINDINGS: The MDR strategy led to changes in organizational structure that improved life-saving interventions with a relatively large financial contribution from the community. Overall mortality significantly decreased from 0.83 (95% CI (confidence interval) = 0.60 -1.06) in baseline period to 0.41 (95% CI = 0.25 -0.56) per 100 women 3 years later. CONCLUSION: MDR had a marked effect on resources, management and maternal outcomes in this facility. However, given the design of our study and the local specific context, further research is needed to confirm the feasibility of MDR in other settings and to confirm the benefits of this approach for maternal health in developing countries. PMID:16583081

  8. CE: Beyond Maternity Nursing: The Baby-Friendly Hospital Initiative.

    PubMed

    Cardaci, Regina

    2017-08-01

    : The Baby-Friendly Hospital Initiative (BFHI) is a program developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to promote breastfeeding in hospitals and birthing facilities worldwide. Since the program was launched in 1991, breastfeeding initiation, duration, and exclusivity have increased globally, a trend largely attributed to changes in hospital policies and practices brought about by the BFHI. This article provides an overview of these practices and policies, the institutional benefits of achieving BFHI certification, and the process through which health care facilities can do so. All nurses-whether they work in maternity care or another nursing specialty in a hospital, ambulatory, or community setting-can play a role in promoting societal health through their support of long-term breastfeeding as recommended by the WHO and UNICEF.

  9. [Expectations of pregnant women on an ideal maternity hospital].

    PubMed

    Tuschy, B; Berlit, S; Hägele, F; Job, H; Sütterlin, M; Kehl, S; Siemer, J

    2012-12-01

    The aim of this study was to evaluate expectations of pregnant women on an ideal maternity hospital. We prospectively performed a survey among 566 pregnant women with regard to their expectations on a perfect hospital for obstetrics. Data collection was accomplished in 3 obstetrical departments in Mannheim, Germany. The questionnaire contained 23 general questions about sociodemographic characteristics and 34 specific questions about the anticipated childbirth. Women who were less than 20 weeks pregnant and women who did not speak German fluently were excluded from this study. In our survey the possibility to get to know midwifes and doctors at information evenings and a guided delivery room tour were defined as very important factors by the interviewed women. Of particular importance was a continuous care by a single midwife and the physical attendance of a family member during childbirth. Furthermore, friendliness of the staff and medical care by paediatricians after childbirth were identified to be important. To some extent, a modern appearance of the ward was also a matter of importance. The medical treatment of mother and the newborn child and the friendliness of the staff have been identified as the most important factors with regard to the expectations of women on an ideal maternity hospital. In addition, a pleasant ambiance of the ward and regular visits by a lactation specialist were named as important. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Maternal mortality at the Women's and Children's Hospital, South Okkalapa (1978-1982).

    PubMed

    Khin Kyi, M

    1988-02-01

    The maternal deaths between the years 1978 and 1982 were studied. There were 22,468 maternities and 10,623 abortion patients treated at the hospital. There were 44 maternal deaths; 22 due to abortion and 22 due to other causes. The maternal mortality rate including abortions was 1.33 per 1,000 maternities and that excluding abortions 0.98 per 1,000. The abortion was 2.0 per 1,000 abortions treated at the hospital. To reduce maternal mortality, ways and means should be found to reduce the abortion deaths, most of which were avoidable.

  11. Albanian: Basic Course. Military Interpreting Practice, Vol. 1.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This first of two volumes presents materials designed to supplement "Albanian: Basic Course" in the area of military science. The first section consists of parallel lists of questions on military subjects in English and Albanian. The second section is a list of 200 military questions in Albanian only. The third section is an English-Albanian words…

  12. Language Shift in Second Generation Albanian Immigrants in Greece

    ERIC Educational Resources Information Center

    Gogonas, Nikos

    2009-01-01

    Albanian immigration to Greece started in the beginning of the 1990s and the second generation of Albanian immigrants is a recent phenomenon. This paper presents the findings of research investigating language maintenance/shift among second generation Albanian immigrants in Athens using as main informants adolescents of Albanian origin.…

  13. Language Shift in Second Generation Albanian Immigrants in Greece

    ERIC Educational Resources Information Center

    Gogonas, Nikos

    2009-01-01

    Albanian immigration to Greece started in the beginning of the 1990s and the second generation of Albanian immigrants is a recent phenomenon. This paper presents the findings of research investigating language maintenance/shift among second generation Albanian immigrants in Athens using as main informants adolescents of Albanian origin.…

  14. Albanian Area Studies: Bibliography Arranged by Topics.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This bibliography on Albanian area studies is a guide of reference material for the student of Albanian language and culture. The first section on area background includes topics on history, physical and economic geography, natural resources, communication, transportation, demography, public utilities, industry, and agriculture. The next sections…

  15. Albanian Area Studies: Bibliography Arranged by Topics.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This bibliography on Albanian area studies is a guide of reference material for the student of Albanian language and culture. The first section on area background includes topics on history, physical and economic geography, natural resources, communication, transportation, demography, public utilities, industry, and agriculture. The next sections…

  16. Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet

    PubMed Central

    Miller, S; Tudor, C; Nyima; Thorsten, VR; Sonam; Droyoung; Craig, S; Le, P; Wright, LL; Varner, MW

    2007-01-01

    Introduction To determine the outcomes of vaginal deliveries in three study hospitals in Lhasa, Tibet Autonomous Region (TAR), People's Republic of China (PRC), at high altitude (3,650 m). Methods Prospective observational study of 1,121 vaginal deliveries. Results Pre-eclampsia/gestational hypertension (PE/GH) was the most common maternal complication 18.9% (n=212), followed by postpartum hemorrhage (blood loss ≥ 500 ml) 13.4%. There were no maternal deaths. Neonatal complications included: low birth weight (10.2%), small for gestational age (13.7%), preterm delivery (4.1%) and low Apgar (3.7%). There were 11 stillbirths (9.8/1,000 live births) and 19 early neonatal deaths (17/1,000 live births). Conclusion This is the largest study of maternal and newborn outcomes in Tibet. It provides information on the outcomes of institutional vaginal births among women delivering infants at high altitude. There was a higher incidence of PE/GH and low birth weight; rates of PPH were not increased compared to those at lower altitudes. PMID:17481630

  17. Obstetric performance of ethnic Kosovo Albanian asylum seekers in London: a case-control study.

    PubMed

    Yoong, W; Wagley, A; Fong, C; Chukwuma, C; Nauta, M

    2004-08-01

    The most recent Confidential Enquiry into Maternal Deaths expressed concern that mortality in women from non-English-speaking ethnic groups was twice that of native-born women. There are very few published data on the obstetric performance of Kosovo Albanian refugees who have relocated to the United Kingdom and the aim of this study was to compare the obstetric performances of Kosovo Albanian women currently residing in the United Kingdom with their British-born Caucasian counterparts. Sixty-one index and 61 control cases were analysed; 63% of the Kosovo Albanian women spoke little or no English and 50% were on income support. Of the study group, 9.8% had caesarean sections, 8.2% had instrumental vaginal deliveries and 82% achieved normal deliveries. The Kosovo Albanian women were statistically younger and had shorter duration of labour compared to controls (P < 0.05, unpaired t-test). Epidural use was significantly lower in Kosovan women (P < 0.05, chi2 test). The rates of induction of labour (IOL), caesarean section, instrumental deliveries, premature delivery and low birth weight < 2.5 kg were not statistically different (P > 0.05 in all cases, chi2 test) between the two groups. This is the first study to examine the obstetric outcomes of Kosovo Albanian women who have resettled in a western European country. Most Kosovo Albanian refugees living in the United Kingdom are not socio-economic migrants but displaced due to civil unrest and many had reasonable socio-economic status prior to resettlement. The similarity in obstetric and fetal outcomes between the study and control groups could be attributed to the 'healthy immigrant effect', where immigrant groups appear to have better outcomes due to family support and relatively lower intake of alcohol and nicotine. It also suggests that obstetricians may be heeding the recommendations from recent Confidential Enquiry into Maternal Deaths, which highlight the need for increased vigilance in women from ethnic

  18. Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study.

    PubMed

    Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Sulaiman, Zaharah; Azman, Mohd Yacob

    2016-03-05

    Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. A cross-sectional study with record review was conducted in 2014. Severe maternal morbidity and maternal near miss were classified using the new World Health Organization criteria. Health indicators for obstetric care were calculated and descriptive analyses were performed using SPSS version 22.0. In total, 21,579 live births, 395 women with severe maternal morbidity, 47 women with maternal near miss and two maternal deaths were analysed. The severe maternal morbidity incidence ratio was 18.3 per 1000 live births and the maternal near miss incidence ratio was 2.2 per 1000 live births. The maternal near miss mortality ratio was 23.5 and the mortality index was 4.1 %. The process indicators for essential interventions were almost 100.0 %. Haemorrhagic disorders were the most common event for severe maternal morbidity (68.6 %) and maternal near miss (80.9 %) and management-based criteria accounted for 85.1 %. Comprehensive emergency care and intensive care as well as overall improvements in the quality of maternal health care need to be achieved to substantial reduce maternal death.

  19. Maternal mortality in the government hospitals, West Malaysia 1967-1969.

    PubMed

    Ariffin Bin Marzuki; Thambu, J A

    1973-03-01

    The attempt was made to determine the factors responsible for the maternal deaths in the government hospitals of West Malaysia over the 1967-1969 period. The study covered all maternal deaths in the government hospitals during this 2-year period. Despite an increase in the number of deliveries in government hospitals from 83,654 in 1964 to 92,583 in 1969, the maternal mortality had declined from 27/10,000 to 22/10,000. The maternal mortality rate in government hospitals was higher than the national maternal mortality rate because of the practice of referring all abnormal obstetric cases to hospitals for management. Hemorrhage continued as the primary cause of maternal deaths with toxemia as the 2nd important cause and infection as the 3rd. In the rural areas midwives found postpartum hemorrhage a major problem because of the coexistence of anemia in pregnancy. Other complications of pregnancy, childbirth and puerperium included obstructed and neglected labors due to cephalo-pelvic disproportion, abnormal lie, and presentation and ruptured uterus referred from the rural areas to the hospitals. Hypertension was the most important cause in the associated maternal diseases. The following are included among the steps taken by the government to reduce maternal mortality: 1) development of an excellent infrastructure of health units; 2) a training program for midwives; and 3) a plan to integrate the family planning services with the health services.

  20. The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies

    PubMed Central

    Snowden, Jonathan M.; Cheng, Yvonne W.; Emeis, Cathy L.; Caughey, Aaron B.

    2014-01-01

    Objective The impact of hospital obstetric volume specifically on maternal outcomes remains under-studied. We examined the impact of hospital obstetric volume on maternal outcomes in low-risk women delivering non-low-birthweight infants at term. Study Design We conducted a retrospective cohort study of term, singleton, non-low-birthweight live births between 2007 – 2008 in California. Deliveries were categorized by hospital obstetric volume categories, separately for non-rural hospitals (Category 1: 50 – 1,199 deliveries per year; Category 2: 1,200 – 2,399; Category 3: 2,400 – 3,599, and Category 4: ≥3,600) and rural hospitals (Category R1: 50 – 599 births per year; Category R2: 600 – 1,699; Category R3: ≥1,700). Maternal outcomes were compared using the chi-square test and multivariable logistic regression. Results There were 736,643 births in 267 hospitals that met study criteria. After adjusting for confounders, there were higher rates of postpartum hemorrhage in the lowest-volume rural hospitals (Category R1 aOR 3.06; 95% CI 1.51 – 6.23). Rates of chorioamnionitis, endometritis, severe perineal lacerations, and wound infection did not differ between volume categories. Longer lengths of stay were observed after maternal complications (e.g., chorioamnionitis) in the lowest-volume hospitals (16.9% prolonged length of stay in Category 1 hospitals versus 10.5% in Category 4 hospitals; aOR, 1.91; 95% CI, 1.01 – 3.61 ). Conclusion After confounder adjustment, few maternal outcomes differed by hospital obstetric volume. However, elevated odds of postpartum hemorrhage in low-volume rural hospitals raises the possibility that maternal outcomes may differ by hospital volume and geography. Further research is needed on maternal outcomes in hospitals of different obstetric volumes. PMID:25263732

  1. The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies.

    PubMed

    Snowden, Jonathan M; Cheng, Yvonne W; Emeis, Cathy L; Caughey, Aaron B

    2015-03-01

    The impact of hospital obstetric volume specifically on maternal outcomes remains under studied. We examined the impact of hospital obstetric volume on maternal outcomes in low-risk women who delivered non-low-birthweight infants at term. We conducted a retrospective cohort study of term singleton, non-low-birthweight live births from 2007-2008 in California. Deliveries were categorized by hospital obstetric volume categories and separately for nonrural hospitals (category 1: 50-1199 deliveries per year; category 2: 1200-2399; category 3: 2400-3599, and category 4: ≥3600) and rural hospitals (category R1: 50-599 births per year; category R2: 600-1699; category R3: ≥1700). Maternal outcomes were compared with the use of the chi-square test and multivariable logistic regression. There were 736,643 births in 267 hospitals that met study criteria. After adjustment for confounders, there were higher rates of postpartum hemorrhage in the lowest-volume rural hospitals (category R1 adjusted odds ratio, 3.06; 95% confidence interval, 1.51-6.23). Rates of chorioamnionitis, endometritis, severe perineal lacerations, and wound infection did not differ between volume categories. Longer lengths of stay were observed after maternal complications (eg, chorioamnionitis) in the lowest-volume hospitals (16.9% prolonged length of stay in category 1 hospitals vs 10.5% in category 4 hospitals; adjusted odds ratio, 1.91; 95% confidence interval, 1.01-3.61). After confounder adjustment, few maternal outcomes differed by hospital obstetric volume. However, elevated odds of postpartum hemorrhage in low-volume rural hospitals raises the possibility that maternal outcomes may differ by hospital volume and geography. Further research is needed on maternal outcomes in hospitals of different obstetric volumes. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Quality of Care: A Review of Maternal Deaths in a Regional Hospital in Ghana.

    PubMed

    Adusi-Poku, Yaw; Antwil, Edward; Osei-Kwakye, Kingsley; Tetteh, Chris; Detoh, Eric Kwame; Antwi, Phyllis

    2015-09-01

    The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths.

  3. Out-of-hospital births and the supply of maternity units in France.

    PubMed

    Blondel, Béatrice; Drewniak, Nicolas; Pilkington, Hugo; Zeitlin, Jennifer

    2011-09-01

    Maternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005-6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Slavic-Albanian Language Contact, Convergence, and Coexistence

    ERIC Educational Resources Information Center

    Curtis, Matthew Cowan

    2012-01-01

    As historical relationships of Slavs and Albanians in the western Balkans have been subject to a wide range of scholarly interpretations, this dissertation seeks to present the facts of linguistic evidence of Slavic-Albanian contact, and apply them to an informed understanding of Slavs' and Albanians' interactions historically. Although individual…

  5. Slavic-Albanian Language Contact, Convergence, and Coexistence

    ERIC Educational Resources Information Center

    Curtis, Matthew Cowan

    2012-01-01

    As historical relationships of Slavs and Albanians in the western Balkans have been subject to a wide range of scholarly interpretations, this dissertation seeks to present the facts of linguistic evidence of Slavic-Albanian contact, and apply them to an informed understanding of Slavs' and Albanians' interactions historically. Although individual…

  6. Severe maternal morbidity and comorbid risk in hospitals performing <1000 deliveries per year.

    PubMed

    Hehir, Mark P; Ananth, Cande V; Wright, Jason D; Siddiq, Zainab; D'Alton, Mary E; Friedman, Alexander M

    2017-02-01

    While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical to reducing risk nationwide. We sought to characterize maternal risk profiles and severe maternal morbidity at low-volume hospitals in the United States. We used data from the Nationwide Inpatient Sample to evaluate trends in severe maternal morbidity and comorbid risk during delivery hospitalizations in the United States from 1998 through 2011. Comorbid maternal risk was estimated using a comorbidity index validated for obstetric patients. Severe maternal morbidity was defined as the presence of any 1 of 15 diagnoses representative of acute organ injury and critical illness. A total of 2,300,279 deliveries occurred at hospitals with annual delivery volume <1000, representing 20% of delivery hospitalizations overall. There were 7849 cases (0.34%) of severe morbidity in low-volume hospitals and this risk increased over the course of the study from 0.25% in 1998 through 1999 to 0.49% in 2010 through 2011 (P < .01). The risk in hospitals with ≥1000 deliveries increased from 0.35-0.62% during the same time periods. The proportion of patients with the lowest comorbidity decreased, while the proportion of patients with highest comorbidity increased the most. The risk of severe morbidity increased across all women including those with low comorbidity scores. Risk for severe morbidity associated with obstetric hemorrhage, infection, hypertensive diseases of pregnancy, and medical conditions all increased during the study period. Our findings demonstrate increasing maternal risk at hospitals performing <1000 deliveries per year broadly distributed over the patient population. Rates of morbidity in centers with ≥1000 deliveries have also increased. These findings

  7. [Readmission in a Maternity Hospital for early mother-child relationship disorders].

    PubMed

    Poizat, A

    1998-10-01

    We report the original experience of admission in a post-delivery care unit, of a mother and her one-month-old child, for the treatment of post-delivery depression, in association with mother-child relational disorders. In this emergency situation, a maternity hospital team was involved in a maternity care.

  8. Maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    Tebeu, Pierre-Marie; Pierre-Marie, Tebeu; Halle-Ekane, Gregory; Gregory, Halle-Ekane; Da Itambi, Maxwell; Maxwell, Da Itambi; Enow Mbu, Robinson; Robinson, Enow Mbu; Mawamba, Yvette; Yvette, Mawamba; Fomulu, Joseph Nelson; Nelson, Fomulu Joseph

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.

  9. Maternal mortality in Cameroon: a university teaching hospital report

    PubMed Central

    Tebeu, Pierre-Marie; Halle-Ekane, Gregory; Da Itambi, Maxwell; Mbu, Robinson Enow; Mawamba, Yvette; Fomulu, Joseph Nelson

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210

  10. Maternal Mortality in a Tertiary Care Hospital: A 10-year Review

    PubMed Central

    Murthy, Bhaskar K; Murthy, Mangala B; Prabhu, Priya M

    2013-01-01

    Background: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. Methods: This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed. Results: A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years, multiparous women (56.66%), women from rural areas (69.16%), illiterate women (65%), unbooked patients (83.33%), and patients of low socioeconomic status (83.33%). Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes. Conclusion: There is a wide scope for improvement as a large proportion of the observed deaths are preventable. PMID:23411635

  11. Evaluation of maternal and neonatal hospital care: quality index of completeness

    PubMed Central

    da Silva, Ana Lúcia Andrade; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; de Sá, Domicio Aurélio; de Souza, Wayner Vieira; Lyra, Tereza Maciel

    2014-01-01

    OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the

  12. Maternal Infection Requiring Hospitalization during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Atladottir, Hjordis O.; Thorsen, Poul; Ostergaard, Lars; Schendel, Diana E.; Lemcke, Sanne; Abdallah, Morsi; Parner, Erik T.

    2010-01-01

    Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards…

  13. Maternal Infection Requiring Hospitalization during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Atladottir, Hjordis O.; Thorsen, Poul; Ostergaard, Lars; Schendel, Diana E.; Lemcke, Sanne; Abdallah, Morsi; Parner, Erik T.

    2010-01-01

    Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards…

  14. [Obstetric care in Mali: effect of organization on in-hospital maternal mortality].

    PubMed

    Zongo, A; Traoré, M; Faye, A; Gueye, M; Fournier, P; Dumont, A

    2012-08-01

    Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali. This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models. The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa=0.59; 95% CI=0.34-0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome. Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  15. Maternal mortality ratio in Lebanon in 2008: a hospital-based reproductive age mortality study (RAMOS).

    PubMed

    Hobeika, Elie; Abi Chaker, Samer; Harb, Hilda; Rahbany Saad, Rita; Ammar, Walid; Adib, Salim

    2014-01-01

    International agencies have recently assigned Lebanon to the group H of countries with "no national data on maternal mortality," and estimated a corresponding maternal mortality ratio (MMR) of 150 per 100,000 live births. The Ministry of Public Health addressed the discrepancy perceived between the reality of the maternal mortality ratio experience in Lebanon and the international report by facilitating a hospital-based reproductive age mortality study, sponsored by the World Health Organization Representative Office in Lebanon, aiming at providing an accurate estimate of a maternal mortality ratio for 2008. The survey allowed a detailed analysis of maternal causes of deaths. Reproductive age deaths (15-49 years) were initially identified through hospital records. A trained MD traveled to each hospital to ascertain whether recorded deaths were in fact maternal deaths or not. ICD10 codes were provided by the medical controller for each confirmed maternal deaths. There were 384 RA death cases, of which 13 were confirmed maternal deaths (339%) (numerator). In 2008, there were 84823 live births in Lebanon (denominator). The MMR in Lebanon in 2008 was thus officially estimated at 23/100,000 live births, with an "uncertainty range" from 153 to 30.6. Hemorrhage was the leading cause of death, with double the frequency of all other causes (pregnancy-induced hypertension, eclampsia, infection, and embolism). This specific enquiry responded to a punctual need to correct a clearly inadequate report, and it should be relayed by an on-going valid surveillance system. Results indicate that special attention has to be devoted to the management of peri-partum hemorrhage cases. Arab, postpartum hemorrhage, development, pregnancy management, verbal autopsy

  16. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth.

    PubMed

    Xu, Xiao; Gariepy, Aileen; Lundsberg, Lisbet S; Sheth, Sangini S; Pettker, Christian M; Krumholz, Harlan M; Illuzzi, Jessica L

    2015-07-01

    Childbirth is the leading cause of hospital admission in the United States, yet there has been little research on variation in hospital costs associated with childbirth. Using data from the 2011 Nationwide Inpatient Sample, we characterized the variation in estimated facility costs of hospitalizations for low-risk childbirth across US hospitals. We found that the average estimated facility cost per maternity stay ranged from $1,189 to $11,986 (median: $4,215), with a 2.2-fold difference between the 10th and 90th percentiles. Estimated facility costs were higher at hospitals with higher rates of cesarean delivery or serious maternal morbidity. Hospitals having government or nonprofit ownership; being a rural hospital; and having relatively low volumes of childbirths, low proportions of childbirths covered by Medicaid, and long stays also had significantly higher costs. The large variation in estimated facility cost for low-risk childbirths among hospitals suggests that hospital practices might be an important contributor to variation in cost and that there may be opportunities for cost reduction. The safe reduction of cesarean deliveries, increasing the coordination of care, and emphasizing value of care through new payment and delivery systems reforms may help reduce hospital costs and cost variation associated with childbirth in the United States. Project HOPE—The People-to-People Health Foundation, Inc.

  17. Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study

    PubMed Central

    Ahmed, Salah Roshdy; Aitallah, Abdusaeed; Abdelghafar, Hazem M.

    2015-01-01

    Introduction Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. Aim To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). Materials and Methods A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. Results The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. Conclusion The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services. PMID:26674539

  18. Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach.

    PubMed

    Leung, K M; Elashoff, R M; Rees, K S; Hasan, M M; Legorreta, A P

    1998-03-01

    The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay. California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals. Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix. Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach.

  19. [Importance of sanitary-antiepidemic measures in preventing staphylococcal infections in maternity hospitals].

    PubMed

    Kitel', V S; Chumalo, P G; Gorbatiuk, K P

    1980-01-01

    The results of the realization of antistaphylococcal measures in maternity hospitals, carried out under the guidance and control of the sanitary and epidemiological service, are presented. The sanitary and epidemiological station registered each case of staphylococcal infection in nursing mothers and infants and investigated its epidemiological aspects. The exposure of the causes responsible for the disease allowed to take up the necessary antiepidemic measures in due direction, thus preventing the spread of hospital infections.

  20. Understanding Consumer Perceptions and Awareness of Hospital-Based Maternity Care Quality Measures.

    PubMed

    Maurer, Maureen; Firminger, Kirsten; Dardess, Pam; Ikeler, Kourtney; Sofaer, Shoshanna; Carman, Kristin L

    2016-06-01

    To explore factors that may influence use of comparative public reports for hospital maternity care. Four focus groups conducted in 2013 with 41 women and preintervention survey data collected in 2014 to 2015 from 245 pregnant women in North Carolina. As part of a larger randomized controlled trial, we conducted qualitative formative research to develop an intervention that will be evaluated through pre- and postintervention surveys. Analysis of focus group transcripts examined participants' perceptions of high-quality maternity care and the importance of different quality measures. Quantitative analysis included descriptive results of the preintervention survey and subgroup analyses to examine the impact of race, education, and being a first-time mom on outcomes. When describing high-quality maternity care, participants focused on interactions with providers, including respect for preferences and communication. The importance of quality measures was influenced by the extent to which they focused on babies' health, were perceived as the hospital's responsibility, and were perceived as representing "standard care." At baseline, 28 percent of survey respondents had used quality information to choose a hospital. Survey respondents were more aware of some quality measures (e.g., breastfeeding support) than others (e.g., episiotomy rates). Public reporting efforts could help increase relevance of maternity care quality measures by creating measures that reflect women's concerns, clearly explaining the hospital's role in supporting quality care, and showing how available quality measures can inform decisions about childbirth. © Health Research and Educational Trust.

  1. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania.

    PubMed

    Nyamtema, Angelo S; Urassa, David P; Pembe, Andrea B; Kisanga, Felix; van Roosmalen, Jos

    2010-06-03

    Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.

  2. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

    PubMed Central

    2010-01-01

    Background Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. Methods A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Results Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Conclusions Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions. PMID

  3. Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.

    PubMed

    Korst, Lisa M; Feldman, Daniele S; Bollman, D Lisa; Fridman, Moshe; El Haj Ibrahim, Samia; Fink, Arlene; Gregory, Kimberly D

    2015-10-01

    Measures of maternal mortality and severe maternal morbidity have risen in the United States, sparking national interest regarding hospitals' ability to provide maternal risk-appropriate care. We examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. We performed a cross-sectional survey to identify hospital-specific resources and classify hospitals by criteria for basic, intermediate, and regional maternal levels of care in all nonmilitary childbirth hospitals in California. We measured hospital compliance with maternal level of care criteria that were produced via consensus based on professional standards at 2 regional summits funded by the March of Dimes through a cooperative agreement with the Community Perinatal Network in 2007 (California Perinatal Summit on Risk-Appropriate Care). The response rate was 96% (239 of 248 hospitals). Only 82 hospitals (34%) were classifiable under these criteria (35 basic, 42 intermediate, and 5 regional) because most (157 [66%]) did not meet the required set of basic criteria. The unmet criteria preventing assignment into the basic category included the ability to perform a cesarean delivery within 30 minutes 100% of the time (only 64% met), pediatrician availability day and night (only 56% met), and radiology department ultrasound capability within 12 hours (only 83% met). Only 29 of classified hospitals (35%) had a nursery or neonatal intensive care unit level that matched the maternal level of care, and for most remaining hospitals (52 of 53), the neonatal intensive care unit level was higher than the maternal care level. Childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Maternal Mortality in the Main Referral Hospital in Angola, 2010-2014: Understanding the Context for Maternal Deaths Amidst Poor Documentation

    PubMed Central

    Umar, Abubakar Sadiq; Kabamba, Lusamba

    2016-01-01

    Background: Increasing global health efforts have focused on preventing pregnancy-related maternal deaths, but the factors that contribute to maternal deaths in specific high-burden nations are poorly understood. The aim of this study was to identify factors that influence the occurrence of maternal deaths in a regional maternity hospital in Kuando Kubango province of Angola. Methods: The study was a retrospective cross-sectional analysis of case notes of all maternal deaths and deliveries that were recorded from 2010 to 2014. The information collected included data on pregnancy, labor and post-natal period retrieved from case notes and the delivery register. Results: During the period under study, a total of 7,158 live births were conducted out of which 131 resulted in maternal death with an overall maternal mortality ratio of 1,830 per 100,000 live births. The causes of death and their importance was relatively similar over the period reviewed. The direct obstetric causes accounted for 51% of all deaths. The major causes were hemorrhage (15%), puerperal sepsis (13%), eclampsia (11%) and ruptured uterus (10%). In addition, indirect non-obstetric medical causes such as Malaria, Anemia, hepatitis, AIDs and cardiovascular diseases accounted for 49% of all maternal deaths. There is poor documentation of personal data and clinical case management of cases. The factors of mutual instability of statistical significance associated with maternal death are: place of domicile (P=0.0001) and distance to the hospital (P=0.0001). Conclusion and Global Health Implication: The study demonstrated that the MMR in maternity hospital is very high and is higher than the WHO 2014 estimates and the province is yet to achieve the desired MDG 5 target by the end of 2015. A reversal of the present state requires data driven planning in order to improve access and use of Maternal Health Services (MHS) and ultimately lower the number of pregnancy-related maternal deaths. PMID:28058194

  5. Preventing tuberculosis transmission at a maternity hospital by targeted screening radiography of migrants.

    PubMed

    Schechner, V; Lessing, J B; Grisaru-Soen, G; Braun, T; Abu-Hanna, J; Carmeli, Y; Aviram, G

    2015-07-01

    Israel has been the destination of large numbers of illegal migrants from East African countries in recent years. Despite efforts to detect and treat active tuberculosis (TB) at the border, 75% of all active TB cases diagnosed in our hospital were illegal migrants. In 2012, there was a large-scale TB exposure in our maternity ward, neonatal, and paediatric intensive care units following the admission of an infectious but apparently asymptomatic migrant who was in labour. A hospital-wide screening programme was subsequently implemented to prevent exposure of patients and staff to TB. To report the results of the first year of this intervention in the maternity hospital. All illegal migrants from countries where TB is highly prevalent were screened by chest radiography (CR) upon admission to the maternity hospital. The results were immediately categorized by a radiologist as either 'suggestive of active pulmonary TB' or 'non-suggestive'. Patients with CR suggestive of TB were placed in airborne isolation and underwent further evaluation. Four hundred and thirty-one apparently asymptomatic migrant women underwent CR screening. Most (363, 84%) presented in labour. Eleven women (2.6%) had a CR suggestive of active pulmonary TB which was confirmed in three (0.7% of screened women). No TB cases were missed by the CRs. Neither patients nor hospital staff were exposed to TB. Targeted CR screening for TB among high-risk women upon their admission to a maternity hospital had a high yield and was an effective strategy to prevent in-hospital transmission of TB. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  6. Albanian Basic Course: Workbook for Exercises in Grammar.

    ERIC Educational Resources Information Center

    Defense Language Inst., Washington, DC.

    This workbook in Albanian grammar requires students to fill in missing words following a particular grammatical pattern, selected from Exercises in Grammar used in the "Albanian Basic Course," prepared by the Defense Language Institute. Drills include: (1) interrogative pronouns, (2) demonstrative adjectives; (3) declension of nouns, possessive…

  7. Albanian Language Competencies for Peace Corps Volunteers in Albania.

    ERIC Educational Resources Information Center

    Haznedari, Ismail; Repishti, Sami

    This guide is designed for Albanian language training of Peace Corps workers in Albania, is intended to be used in a competency-based language training program, and reflects daily communication needs in that context. It consists of an introductory section on the history, alphabet, and phonology of the Albanian language and a series of 14 topical…

  8. Qualitative assessment of women's satisfaction with maternal health care in referral hospitals in Nigeria.

    PubMed

    Okonofua, Friday; Ogu, Rosemary; Agholor, Kingsley; Okike, Ola; Abdus-Salam, Rukiyat; Gana, Mohammed; Randawa, Abdullahi; Abe, Eghe; Durodola, Adetoye; Galadanci, Hadiza

    2017-03-16

    Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women's level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients' satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. A women-friendly approach to delivery of maternal health care based on adequate response to women's concerns and experiences of health care will be critical to curbing women

  9. [Epidemiological profile of maternal complications related to cesarean section at the Al Farabi Hospital in Oujda].

    PubMed

    Benkirane, Saad; Saadi, Hanane; Mimouni, Ahmed

    2017-01-01

    In Morocco cesarean section rate has increased from 2% in 1992 to 16% in 2011. This was associated with increased per- and postoperative mortality and morbidity, which was 19% in our case series. This study is the first of its kind to be conducted in the eastern region of Morocco and aims to analyze the comprehensive epidemiologic profile of maternal complications related to cesarean section on the basis of 2417 cases observed in the Maternity Department at the El Farabi Hospital, Oujda. We conducted an observational, descriptive, retrospective study of a series of 2416 patients undergoing cesarean section in the Maternity Department at the El Farabi Hospital, Oujda, over the period 1 January 2011-31 December 2013. Out of 24464 deliveries, 2416 were cesarean sections, reflecting a rate of 9.87%. The frequency of complications related to cesarean section was 19.45%. Postoperative complications accounted for 63.6% of the complications dominated by infection. Haemorrhagic complications accounted for 25.53% of all complications. 4 cases of maternal deaths were recorded. If the increased rate of cesarean sections has contributed to improve maternal-fetal prognosis, the surgical act itself is not complication-free, which leads us to review its indications for improved patient management.

  10. Observations from a maternal and infant hospital in Kabul, Afghanistan--2003.

    PubMed

    Williams, Jennifer L; McCarthy, Brian

    2005-01-01

    Afghanistan is believed to have one of the highest infant and maternal mortality rates in the world. As a result of decades of war and civil unrest, Afghan women and children suffer from poor access to health services, harsh living conditions, and insufficient food and micronutrient security. To address the disproportionately high infant and maternal mortality rates in Afghanistan, the US Department of Health and Human Services pledged support to establish a maternal health facility and training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected because this hospital admits approximately 36,000 patients and delivers more than 14,000 babies annually. This article reports the initial observations at Rabia Balkhi Hospital and describes factors that influenced women's access, the quality of care, and the evaluation health care services. This observational investigation examined areas of obstetric, laboratory and pharmacy, and ancillary services. The investigators concluded that profound changes were needed in the hospital's health care delivery system to make the hospital a safe and effective health care facility for Afghan women and children and an appropriate facility in which to establish an Afghan provider training program for updating obstetric skills and knowledge.

  11. Determinants of neonatal outcome in a Malaysian maternity hospital, 1980-1981.

    PubMed

    Abdul Kader, H

    1983-01-01

    This article descripes the compilation and analysis of basic perinatal statistics in the Maternity Hospital, Kuala Lumpur (MHKL), the largest maternity hospital in the country. The study period covered is 1980-1. Because consented autopsies are difficult to obtain in the social and religious setting of Malaysia, the approach of clinical classification of causes of neonatal deaths was adopted. Determinants of neonatal mortality included very low birthweight (less than 1.5kg), gestational age of less than 32 weeks, and clinical conditions of asphyxia, meconium aspiration syndrome, bacterial sepsis, and respiratory distress syndrome. The resulting charts underscore how simple neonatal data can be compiled to assess perinatal performance in a way which requires little statistical sophistication. Accurate perinatal statistics will enable better comprehension of preventable causes of perinatal deaths, and enhanced outcomes. Wider application of this approach is recommended in hospitals throughout Malaysia.

  12. [The role of the psychologist in hospitals and maternity wards in the state of Sergipe].

    PubMed

    Santos, Lyvia de Jesus; Vieira, Maria Jésia

    2012-05-01

    This article seeks to reflect on the professional activity of the psychologist in the hospital context by examining the role of psychologists working in hospitals and maternity wards in the State of Sergipe. It seeks to identify the specific role of these professionals in hospitals and maternity wards, as well as their motivating forces and the difficulties encountered. This work is part of a broader project that sought to study not only the activity per se, but also training aspects of these professionals. The sample was analyzed using a qualitative and quantitative approach for thematic analysis. Results revealed that the characterization of the role of psychologists has a focus on psychotherapeutic work with patients before and after surgery, as well as the caregivers and family members of critically ill patients in the following units: ICU, ICC, oncology, dialysis and surgical wards, offering support, especially at the pre- and post-surgery phase.

  13. Erbil Maternity and Pediatric Hospital. Erbil, Iraq. Sustainment Assessment.

    DTIC Science & Technology

    2007-04-19

    had not initiated any efforts to secure repair or replacement via the manufacturer. 30 Site Photo 37. Broken circuit breaker that...items, such as the switch gear circuit breaker , the heating and cooling systems’ water treatment system, and the RO system were non-operational most...coverage. Broken circuit breaker 31 Conclusions SIGIR inspectors did not find evidence that the original rehabilitation work on the hospital

  14. Maternal mortality in obstetrics and gynaecology in a tertiary care hospital.

    PubMed

    Khatun, K; Ara, R; Aleem, N T; Khan, S; Husein, S; Alam, S; Roy, A S

    2015-01-01

    Maternal mortality is the leading causes of death and disability of reproductive age in the developing countries. Bangladesh is one of the developing countries where maternal mortality is very high. The purpose of the present study was to see the causes of maternal deaths at Obstetrics and Gynaecology ward. This retrospective study was carried out in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital (DMCH). All maternal deaths were included in this study from July 2003 to June 2004 for a period of one year. The incidence of maternal death was 18.5/1000 live birth. Hypertensive disorder of pregnancy (41.84%) was the most common cause of maternal death followed by unsafe abortions (21.4%), PPH (10.2%), obstructed labour (8.2%). Among 98 patients 36(36.7%) cases are died due to eclampsia. Death due to pre-eclampsia (5.1%), unsafe Abortion (21.4%), Obstetric haemorrhage (18.4%) and obstructed labour (8.3%) were commonly found in this study. The study permits to conclude that Hypertensive disorder of pregnancy is the leading cause of pregnancy related deaths followed by unsafe abortions and obstetric haemorrhage. Other causes include obstructed labour, anaesthetic complications and others.

  15. Revisiting head circumference of Brazilian newborns in public and private maternity hospitals.

    PubMed

    Amorim, Maria do Socorro Teixeira; Melo, Aurea Nogueira de

    2017-06-01

    To revisit the head circumference (HC) of newborns in public and private maternity hospitals; to correlate our findings with the gestational age, gender, and type of delivery; and build and validate graphs and curves. This was a prospective study performed on healthy newborns. Differences in HC were analyzed as a function of gestational age, gender, the healthcare system and the type of delivery. Smoothed percentile curves were created using the least mean squares method. Of the included newborns, 697 were born in private maternity hospitals and 2,150 were born in public maternity hospitals. In all, 839 were born by vaginal delivery, and 1,311 were born by cesarean delivery. At 37 to 42 weeks of gestation, male newborns had a larger HC than females. Infants born in private maternity and those born by cesarean delivery had a larger HC. An important result of the present study is that our analyses allowed us to generate curves and statistically-validated graphs that can be used in clinical neonatal practice.

  16. A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

    PubMed

    Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada

    2015-11-13

    The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals

  17. Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

    PubMed Central

    Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.

    2014-01-01

    Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight

  18. The Association between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

    PubMed Central

    Howell, Elizabeth A.; Zeitlin, Jennifer; Hebert, Paul L.; Balbierz, Amy; Egorova, Natalia

    2015-01-01

    Importance In an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publically reported. The extent to which these measures are associated with maternal and neonatal morbidity is not known. Objective To examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity. Design, Setting, and Participants Population-based observational study using linked 2010 New York City discharge and birth certificate datasets. All delivery hospitalizations were identified and two perinatal quality measures were calculated. Published algorithms were used to identify severe maternal morbidity (delivery associated with a life threatening complication or performance of a life-saving procedure) and morbidity in non-anomalous term newborns (births associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient sociodemographic and clinical characteristics. Exposure Two Joint Commission perinatal quality measures: 1) elective (non-medically indicated) deliveries at >= 37 and < 39 weeks of gestation and 2) cesarean delivery performed in low-risk mothers. Main Outcomes and Measures Individual and hospital level maternal and neonatal morbidity. Results Severe maternal morbidity occurred among 2.4% of 115,742 deliveries and neonatal morbidity occurred among 7.8% of 103,416 non-anomalous term newborns. Rates for elective deliveries performed before 39 weeks of gestation ranged from: 15.5 to 41.9 per 100 deliveries among 41 hospitals. There were 11.7 to 39.3 cesareans per 100 deliveries performed in low-risk mothers. Overall maternal morbidity ranged from 0.9 to 5.7 mothers with complications per 100 deliveries and 3.1 to 21.3 neonates with complications per 100 deliveries

  19. Maternal request CS--role of hospital teaching status and for-profit ownership.

    PubMed

    Xirasagar, Sudha; Lin, Herng-Ching

    2007-05-01

    To examine whether hospitals' for-profit (FP) ownership and non-teaching status are associated with greater likelihood of maternal request cesarean (CS) relative to public and not-for-profit (NFP) and teaching status, respectively. Retrospective, cross-sectional, population-based study of Taiwan's National Health Insurance claims data, covering all 739,531 vaginal delivery-eligible singleton deliveries during 1997-2000, using multiple logistic regression analyses. Adjusted for maternal age and geographic location, FP district hospitals (almost all non-teaching), followed by ob/gyn clinics were significantly more likely to perform request CS (OR=3.5-2.3) than public and NFP teaching hospitals. Among non-teaching and teaching hospitals, FPs were more likely to perform request CS than public and NFP hospitals (OR=2.3 and 2.5, respectively). Our findings are consistent with greater propensity of physicians in FP institutions to accommodate patient requests involving revenue-maximizing procedures such as request CS. This effect is moderated by teaching hospitals' preference for complicated cases, consistent with their teaching mission and hi-tech infrastructure.

  20. Acute hemorrhagic pellagra in an Albanian refugee.

    PubMed

    Chaidemenos, George C; Mourellou, Olga; Karakatsanis, George; Koussidou, Thallia; Xenidis, Efthimios; Charalampidou, Haroula; Avgoloupis, Dimitris

    2002-02-01

    We report a peculiar case of hemorrhagic pellagra in an exhausted Albanian refugee who had walked for 3 days under sunny skies on his way from his country to Greece. The peculiarities of the case are the fulminant course of the disorder; the "terrifying" appearance of the patient (initially he was admitted to an emergency unit); the gangrenous appearance of the hemorrhagic lesions of the palms and fingernails; the disturbed hepatic function that gradually returned to normal; and the absence of a history of alcohol consumption, alcohol malabsorption, or drug intake.

  1. Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan.

    PubMed

    Graham, H; Tokhi, M; Edward, A; Salehi, A S; Turkmani, S; Duke, T; Bartlett, L

    2015-04-02

    This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

  2. Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986.

    PubMed

    Kampikaho, A; Irwig, L M

    1991-08-01

    This report presents results of a descriptive study to estimate the mortality rate, identify the type and the causes of maternal deaths. The study was conducted in 1987 in Kampala hospitals for a period covering seven years from 1st January 1980 to 31st December, 1986. The non abortion maternal mortality rate (NAMMR) was 2.65 per 1000 deliveries while the abortion related maternal mortality rate (ARMMR) was 3.58 per 1000 abortions. There was a statistically significant increase in NAMMR while the increase in ARMMR was almost significant over the seven year period. Of all maternal deaths, 80 per cent were non abortion while 20 per cent were abortion related. The commonest immediate causes of death, in order of importance, were sepsis, haemorrhage, ruptured uterus, anaesthesia and anaemia. The commonest patient management factors which contributed to death, in order of importance, were lack of blood for transfusion, lack of drugs and intravenous fluids, theatre problems and doctor related factors. We feel that a lot happens to the pregnant mother before she finally reaches a health unit for delivery and that there is a great need to improve on the community's gynaecological and obstetrical services as well as ambulance and emergency services. We also feel that maternal mortality in developing countries could be reduced if the health workers were imaginative in respect to each patient, tried not to operate as though they were working in a developed country, and created relevant solutions for the local problems.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Greek economic crisis and impaired perinatal parameters: experience from a public maternity hospital.

    PubMed

    Sdona, E; Papamichail, D; Ragkou, E; Briana, D D; Malamitsi-Puchner, A; Panagiotopoulos, T

    2017-07-04

    Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (<2500 g), prematurity (<37 weeks) and caesarean section (CS). During 2012-2014, compared to 2005-2007, LBW rate increased from 8.4 to 10.5% (RR 1.16; 95%CI 1.01-1.33); prematurity from 9.7 to 11.2% (RR 1.09; 95%CI 0.96-1.24), comprising mainly late-preterm neonates; CS from 43.2 to 54.8% (RR 1.21; 95%CI 1.16-1.26). Maternal age ≥30 years was risk factor for LBW, prematurity and CS; LBW was additional risk factor for CS. However, LBW and CSs increased during the study period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.

  4. Increased frequency of neonatal jaundice in a maternity hospital.

    PubMed

    Campbell, N; Harvey, D; Norman, A P

    1975-06-07

    The frequency of "significant" jaundice of the newborn at this hospital increased from 8-1% of all live births in 1971 to 12-1% in 1972 and 15-4% in 1973. This coincided with an increased use of oxytocic agents and epidural anaesthetics in labour, and a change in the artificial feed given to normal infants. A retrospective study of jaundiced infants born in 1972 failed to explain the increase in jaundice. Though the use of oxytocic agents was not the direct cause, since their use results in the delivery of more infants before 40 weeks of gestation it may be a contributory factor. The use of epidural anaesthetics was sastically related to the development of jaundice but the nature of the association was not clear. Mothers of infants who became jaundiced has a significantly higher frequency of poor past obstetric histories, but once again the association was not clear. The change in artificial feeds was excluded as a possible cause.

  5. Infant hospitalization and maternal depression, poverty and single parenthood - a population-based study.

    PubMed

    Guttmann, A; Dick, P; To, T

    2004-01-01

    There is variation in rates of hospitalization for young children which is unexplained by differences in health. We used population-based survey data to examine the contribution of family sociodemographic and psychodynamic factors to the risk of hospitalization in children under the age of 2 years in Canada. Baseline data from the National Longitudinal Survey of Children and Youth (a population-based study of child health and well-being) were used. A weighted sample of 332 697 (unweighted n = 2184) children between the age of 12 and 24 months, whose biological mother reported data on hospitalization over the past year, were included. Logistic regression analyses were conducted to estimate the risk of hospitalization by sociodemographic and psychodynamic factors controlling for important biological covariates. The overall proportion of children who were hospitalized was 11.2%. After adjusting for prematurity, the only statistically significant biological factor associated with the risk of hospitalization was reported present health [odds ratio (OR) 4.04, 95% confidence intervals (CI): 2.93, 5.58]. However, three family variables were significantly associated with hospitalization: low income adequacy (OR 1.66, 95% CI: 1.15, 2.40), single parenthood (OR 1.55, 95% CI: 1.03, 2.34) and maternal depression (OR 1.81, 95% CI: 1.22, 2.69). Having a parent who is a recent immigrant to Canada is associated with a reduced risk of hospitalization (OR 0.53, 95% CI: 0.35, 0.78). Most of the significant associations with hospitalization in the first 2 years of life in the Canadian population relate to the overall family's social and mental health. Maternal depression is a treatable disorder which if recognized might prevent some infant morbidity.

  6. [Analysis of abortions at a community maternity hospital in Bangui].

    PubMed

    Sepou, A; Ngbale, R; Yanza, M C; Domande-Modanga, Z; Nguembi, E

    2004-01-01

    Abortion, i.e., early termination of pregnancy, has few complications when it occurs spontaneously. However self-inflicted abortion (SIA) often leads to more or less serious complications. In view of the increasing number of abortion cases in our department, we undertook this yearlong transversal study to evaluate the incidence of SIA in the department, determine the demographic characteristics of the women that practiced SIA, and identify the complications of SIA. Only ongoing or incomplete abortions were studied. Amenorrhea not related to pregnancy or associated with ectopic pregnancy was excluded from study. Clinical and demographic data were noted on forms specially designed by the research team. Data analysis yielded the following findings. Abortion accounted for 719 of the 5292 hospitalizations (13.6%) in gynecology unit, including 43.4% of SIA. Mean patient age was 24.7 years (range, 13 to 39). Spontaneous abortion was more likely to be observed in married women than in students who usually presented SIA. Wanted pregnancy was more likely to be reported by married women than by single woman who posed the problem of unwanted pregnancy. Students had more SIA. The main reasons for practicing SIA were financial (61.5%). The most common methods used for SIA were drug combinations (39.1%) and mechanical tools (26.0%). All severe complications such as infection and death were observed in women who practiced SIA. The high incidence of SIA in the department was especially disturbing due to the young age of the women involved and the severity of the complications. More action is needed to spread information on contraceptive methods in schools and universities to avoid unintended pregnancies that drive young people to practice SIA.

  7. Care in movement: Health psychology in the Sofia Feldman Maternity Hospital in Belo Horizonte, Brazil.

    PubMed

    Spink, Peter Kevin; Horta, Julia C A; Brigagão, Jacqueline M; Menegon, Vera M; Spink, Mary-Jane P

    2016-03-01

    Psychologists in hospital settings are part of a complex network of professional relationships in constant negotiation. In addition, psychologists have skills that enable them to work with social phenomena and to act strategically within them. This is especially important in inter-disciplinary team work where professional boundaries can generate barriers to change. This article shows how psychologists of a maternity hospital in a working-class district of a large Brazilian city adapted to an integral approach to health care in a way that helped other professionals to rethink practices.

  8. Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

    PubMed Central

    Vallely, Lisa; Ahmed, Yusuf; Murray, Susan F

    2005-01-01

    Background Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. Methods Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. Results Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. Conclusions In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity. PMID:15686592

  9. Structure in Brazilian maternity hospitals: key characteristics for quality of obstetric and neonatal care.

    PubMed

    Azevedo Bittencourt, Sonia Duarte de; Costa Reis, Lenice Gnocchi da; Ramos, Márcia Melo; Rattner, Daphne; Rodrigues, Patrícia Lima; Neves, Dilma Costa Oliveira; Arantes, Sandra Lúcia; Carmo Leal, Maria do

    2014-08-01

    This study aimed to evaluate key characteristics of structure in a sample of maternity hospitals in Brazil. Structure was evaluated according to Ministry of Health criteria and included: geographic location, obstetric volume, presence of ICU, teaching activities, staff qualifications, and availability of equipment and medicines. The results showed differences in staff qualifications and availability of equipment in obstetric and neonatal care according to type of financing, region of the country, and degree of complexity. The North/Northeast and Central-West regions presented the most serious problems with structure. The public and mixed hospitals were better structured in the South/Southeast, reaching satisfactory levels on various items, similar or superior to the private hospitals. The current study contributes to the debate on quality of structure in Brazil's hospital services and emphasizes the need to develop analytical studies considering process and results of obstetric and neonatal care.

  10. Reliability of Reported Maternal Smoking: Comparing the Birth Certificate to Maternal Worksheets and Prenatal and Hospital Medical Records, New York City and Vermont, 2009.

    PubMed

    Howland, Renata E; Mulready-Ward, Candace; Madsen, Ann M; Sackoff, Judith; Nyland-Funke, Michael; Bombard, Jennifer M; Tong, Van T

    2015-09-01

    Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4% using birth certificates, 15.2 and 10.7% using maternal worksheets, 18.1 and 14.1% using medical records, and 20.5 and 15.0% using either maternal worksheets or medical records. Birth certificates had "almost perfect" agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and "substantial" agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information.

  11. Reliability of Reported Maternal Smoking: Comparing the Birth Certificate to Maternal Worksheets and Prenatal and Hospital Medical Records, New York City and Vermont, 2009

    PubMed Central

    Mulready-Ward, Candace; Madsen, Ann M.; Sackoff, Judith; Nyland-Funke, Michael; Bombard, Jennifer M.; Tong, Van T.

    2015-01-01

    Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4 % using birth certificates, 15.2 and 10.7 % using maternal worksheets, 18.1 and 14.1 % using medical records, and 20.5 and 15.0 % using either maternal worksheets or medical records. Birth certificates had “almost perfect” agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and “substantial” agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information. PMID:25676044

  12. [Hospital readmission after postpartum discharge of term newborns in two maternity wards in Stockholm and Marseille].

    PubMed

    Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G

    2016-03-01

    The consequences of early postpartum discharge (EPPD, within 2 days after birth) on newborn health remain debated. Early discharge has been associated with increased neonatal morbidity. However, neonatal re-hospitalization can be prevented by careful follow-up during the 1st week after birth. We compared the early neonatal hospitalization of term newborns over 2 years in two hospitals: Karolinska University Hospital in Stockholm (n=7300 births), which allowed early discharge from 6h after birth with specific neonatal follow-up, and Marseille University Hospital (AP-HM) (n=4385) where postpartum discharge was more conventional after 72 h. During the study period, the EPPD rate was 41% vs. 2% in Stockholm and Marseille, respectively (P<0.001). Hospital readmission was comparable (5.6‰ vs. 7‰, P=0.2). The leading cause associated with hospitalization was icterus in Stockholm (76% vs. 26%, P<0.001) and feeding difficulties in Marseille (17% vs. 48%, P<0.001). In conclusion, close neonatal follow-up during the 1st week of life associated with restricted maternal and neonatal eligibility criteria for EPPD are required to prevent early neonatal re-hospitalization. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. The prevalence of maternal medical conditions during pregnancy and a validation of their reporting in hospital discharge data.

    PubMed

    Hadfield, Ruth M; Lain, Samantha J; Cameron, Carolyn A; Bell, Jane C; Morris, Jonathan M; Roberts, Christine L

    2008-02-01

    Population health datasets are a valuable resource for studying maternal and obstetric health outcomes. However, their validity has not been thoroughly examined. We compared medical records from a random selection of New South Wales (NSW) women who gave birth in a NSW hospital in 2002 with coded hospital discharge records. We estimated the population prevalence of maternal medical conditions during pregnancy and found a tendency towards underreporting although specificities were high, indicating that false positives were uncommon.

  14. Hospital- and patient-related characteristics determining maternity length of stay: a hierarchical linear model approach.

    PubMed Central

    Leung, K M; Elashoff, R M; Rees, K S; Hasan, M M; Legorreta, A P

    1998-01-01

    OBJECTIVES: The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay. METHODS: California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals. RESULTS: Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix. CONCLUSIONS: Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach. PMID:9518967

  15. [Practices of maternal and perinatal care performed in public hospitals of Uruguay].

    PubMed

    Colomar, Mercedes; Belizán, María; Cafferata, María Luisa; Labandera, Ana; Tomasso, Giselle; Althabe, Fernando; Belizán, José M

    2004-09-01

    Quality of care can be measured by the rate of use of beneficial and ineffective or deleterious practices. To perform a survey of the use of maternal and perinatal care practices in public maternities of Uruguay, and to know the opinions and perspectives of the users concerning some of these practices. Cross-sectional hospital based descriptive study. For the prevalence study, a questionnaire filled with data taken from hospital records and a women survey were used. For the opinion study, a women questionnaire during early postpartum period was done. 773 women from 12 hospitals were enrolled in the study. The rate of administration of corticosteroids in women with risk of preterm delivery was < or = 40%. Periconceptional folic acid administration, psychosocial support during labour, active management during the third stage of labour, and supine position of the newborn, showed rates of utilization lower than 35%. Episiotomy and perineal shaving showed rates of use higher than 50%. Some evidence-based beneficial health care practices are still not routinely implemented in public hospitals. Ineffective and even harmful practices are still used.

  16. Relationship between maternal hypoglycaemia and small-for-gestational-age infants according to maternal weight status: a retrospective cohort study in two hospitals

    PubMed Central

    Shinohara, Satoshi; Uchida, Yuzo; Hirai, Mitsuo; Hirata, Shuji; Suzuki, Kohta

    2016-01-01

    Objective The relationship between pre-pregnancy body mass index (BMI) and low glucose challenge test (GCT) results by maternal weight status has not been examined. This study aimed to clarify the relationship between a low GCT result and small for gestational age (SGA) by maternal weight status. Design A retrospective cohort study in 2 hospitals. Setting This study evaluated the obstetric records of women who delivered in a general community hospital and a tertiary perinatal care centre. Participants The number of women who delivered in both hospitals between January 2012 and December 2013 and underwent GCT between 24 and 28 weeks of gestation was 2140. Participants with gestational diabetes mellitus or diabetes during pregnancy, and GCT results of ≥140 mg/dL were excluded. Finally, 1860 women were included in the study. Primary and secondary outcome measures The participants were divided into low-GCT (≤90 mg/dL) and non-low-GCT groups (91–139 mg/dL). The χ2 tests and multivariate logistic regression analyses were conducted to investigate the association between low GCT results and SGA by maternal weight status. Results The incidence of SGA was 11.4% (212/1860), and 17.7% (330/1860) of the women showed low GCT results. The patients were divided into 3 groups according to their BMI (underweight, normal weight and obese). When the patients were analysed separately by their weight status after controlling for maternal age, pre-pregnancy maternal weight, maternal weight gain during pregnancy, pregnancy-induced hypertension, thyroid disease and difference in hospital, low GCT results were significantly associated with SGA (OR 2.10; 95% CI 1.14 to 3.89; p=0.02) in the underweight group. Conclusions Low GCT result was associated with SGA at birth among underweight women. Examination of maternal glucose tolerance and fetal growth is necessary in future investigations. PMID:27913562

  17. Scheduled Cesarean Delivery: Maternal and Neonatal Risks in Primiparous Women in a Community Hospital Setting

    PubMed Central

    Quiroz, Lieschen H.; Chang, Howard; Blomquist, Joan L.; Okoh, Yvonne K.; Handa, Victoria L.

    2011-01-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications. PMID:19021093

  18. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    PubMed

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  19. A six-year review of maternal mortality in a teaching hospital in Addis Ababa.

    PubMed

    Yoseph, S; Kifle, G

    1988-07-01

    The case notes of all patients who died over the January 1980 to December 1985 period in Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, as a result of conditions associated with pregnancy, labor, and puerperium were reviewed in an effort to identify the most common causes of maternal death. Postpartum autopsy seldom was possible; consequently, the cause of death was based on clinical findings only. 216 deaths occurred over the 6-year period; there were 22,404 live births in the same period, giving a maternal mortality rate (MMR) of 9.6/1000. This rate included deaths from complications following abortions. 197 of the deaths occurred in women who were not booked into Tikur Anbessa Hospital. In terms of direct causes of death, abortion, puerperal sepsis, and ruptured uterus together accounted for 75.9% of deaths. Of indirect causes, infectious hepatitis, relapsing fever, and malaria accounted for 56.8% of deaths. Of deaths due to abortion, 21/48 occurred in nulliparas, and 25 were below age 19. Of the deaths caused by ruptured uterus, 20/29 occurred in multipara, and all of those women were from rural areas. The majority of deaths from hepatitis occurred in the 30-34 years age group. In Ethiopia, the maternal mortality rate is high because of both poor or inadequate antenatal and postnatal care as well as because of poor transportation and communication systems.

  20. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  1. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India.

    PubMed

    Dasari, Papa

    2015-06-01

    To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.

  2. Infant holding preferences in maternity hospitals: testing the hypothesis of the lateralized perception of emotions.

    PubMed

    Donnot, Julien; Vauclair, Jacques

    2007-01-01

    Infant holding biases of 202 mothers were studied in four French maternity hospitals. The study collected laterality for holding in mother/child dyads as a means of testing the emotional hypothesis (Manning & Chamberlain, 1991). Maternal holding side preferences and handedness were collected through questionnaires. In addition, hemispheric specialization for perceiving visual and auditory emotional cues was examined using a chimeric figure and dichotic listening task. The mothers displayed a significant left holding bias as well as a general perceptual bias in favor of the left side/right hemisphere. However, no significant associations were found between holding biases and emotional perceptual asymmetry. The absence of significant relationships between hemispheric specialization and holding biases does not support directly the emotional hypothesis for infant holding but can be interpreted according to the nature of the holding relationship.

  3. Dominance of community-associated methicillin-resistant Staphylococcus aureus clones in a maternity hospital.

    PubMed

    Udo, Edet E; Al-Sweih, Noura

    2017-01-01

    Methicillin- resistant Staphylococcus aureus (MRSA) is a major pathogen causing healthcare- and community- acquired infections. The purpose of this study was to characterize MRSA isolated at the Maternity Hospital between 2006 and 2011 for their genetic relatedness. The MRSA isolates were investigated using a combination of antibiogram, Staphylococcal chromosome cassette mec (SCCmec) and spa typing to determine their relatedness to MRSA isolated in other Kuwait hospitals. The isolates were also investigated for the carriage of genes for Pantone valentine Leukocidin (PVL). A total of 103 MRSA obtained from 64 neonates, 17 adult patients and 12 healthcare workers. The isolates were resistant to Kanamycin (46.6%), gentamicin (40.8%), trimethoprim (32%), ciprofloxacin (22.3%), fusidic acid (16.5%), tetracycline (19.4%), erythromycin (15.5%), clindamycin (15.5%), streptomycin (11.6%) high-level mupirocin (2.9%) and chloramphenicol (0.9%). Twenty (19.4%) of the isolates were multiresistant. Thirty-one (30.0%) isolates were positive for PVL. Molecular typing revealed the presence of 11 clonal complexes and 23 clones with ST5-V-t002, (N = 22), ST22-IV-t223 (N = 18), ST22-IV-t852 (N = 10), ST80-IV-t044 (N = 7), ST5-V-t688 (N = 5), ST772-V-t657 (N = 5) and ST239-III-t860 (N = 4) constituting 66.9% of the isolates. Other clones were isolated sporadically. The number of MRSA isolates increased from two in 2006 to 22 in 2011 with a peak of 43 in 2008. The study revealed a high prevalence of community-associated MRSA Maternity hospital. The MRSA population consisted of known strains, such as ST239-III-t680, ST22-IV-t223/t852 and ST80-IV-t044, that were reported previously in Kuwait and novel strains such as ST5-V-t002, and several sporadic strains obtained for the first time in the Maternity hospital. This study has provided an initial data which will serve as a platform for future comparative studies on the distribution of MRSA clones in the Maternity hospital in Kuwait.

  4. Dominance of community-associated methicillin-resistant Staphylococcus aureus clones in a maternity hospital

    PubMed Central

    Al-Sweih, Noura

    2017-01-01

    Background Methicillin- resistant Staphylococcus aureus (MRSA) is a major pathogen causing healthcare- and community- acquired infections. The purpose of this study was to characterize MRSA isolated at the Maternity Hospital between 2006 and 2011 for their genetic relatedness. Materials and methods The MRSA isolates were investigated using a combination of antibiogram, Staphylococcal chromosome cassette mec (SCCmec) and spa typing to determine their relatedness to MRSA isolated in other Kuwait hospitals. The isolates were also investigated for the carriage of genes for Pantone valentine Leukocidin (PVL). Results A total of 103 MRSA obtained from 64 neonates, 17 adult patients and 12 healthcare workers. The isolates were resistant to Kanamycin (46.6%), gentamicin (40.8%), trimethoprim (32%), ciprofloxacin (22.3%), fusidic acid (16.5%), tetracycline (19.4%), erythromycin (15.5%), clindamycin (15.5%), streptomycin (11.6%) high-level mupirocin (2.9%) and chloramphenicol (0.9%). Twenty (19.4%) of the isolates were multiresistant. Thirty-one (30.0%) isolates were positive for PVL. Molecular typing revealed the presence of 11 clonal complexes and 23 clones with ST5-V-t002, (N = 22), ST22-IV-t223 (N = 18), ST22-IV-t852 (N = 10), ST80-IV-t044 (N = 7), ST5-V-t688 (N = 5), ST772-V-t657 (N = 5) and ST239-III-t860 (N = 4) constituting 66.9% of the isolates. Other clones were isolated sporadically. The number of MRSA isolates increased from two in 2006 to 22 in 2011 with a peak of 43 in 2008. Conclusion The study revealed a high prevalence of community-associated MRSA Maternity hospital. The MRSA population consisted of known strains, such as ST239-III-t680, ST22-IV-t223/t852 and ST80-IV-t044, that were reported previously in Kuwait and novel strains such as ST5-V-t002, and several sporadic strains obtained for the first time in the Maternity hospital. This study has provided an initial data which will serve as a platform for future comparative studies on the distribution of

  5. Prevalence of cervical intraepithelial neoplasia (CIN) in patients attending Minia Maternity University Hospital.

    PubMed

    Sanad, Ahmad Sameer; Kamel, Hani Hassan; Hasan, Momen Mohammed

    2014-06-01

    Cervical cancer is the second most common cancer of the genital tract. Wide use of screening programs can help in prevention of cervical cancer. To screen and evaluate the prevalence of cervical intraepithelial neoplasia (CIN) by visualization of the cervix after application of 5 % acetic acid (VIA) in Minia Maternity University Hospital. The study included 3,600 women from outpatient clinics of Minia Maternity University Hospital. They were screened for cervical cancer with the use of visual inspection of the cervix after application of 5 % acetic acid (VIA). Positive cases were subjected to colposcopy after referral to the colposcopy unit in the same hospital. Colposcopy-guided biopsies were done for colposcopic positive patients. One hundred and twenty women with negative VIA as control were randomly examined with colposcopy to evaluate the effectiveness of the test used, and no cases experienced cervical lesion. The prevalence was 5.8 % for cervical lesions, 1.4 % for HPV infection alone, 3.3, 0.84 and 0.27 % for CIN I, CIN II and CIN III, respectively. The prevalence of CIN II or higher was 1.11 % (40/3,600). Prevalence of CIN in the study population was 138 out of 1,800 cases (7.7 %). Pre-invasive high-grade lesions represent 1.3 % in participant women. VIA can be used in national programs for cervical cancer screening.

  6. Major clonal lineages in impetigo Staphylococcus aureus strains isolated in Czech and Slovak maternity hospitals.

    PubMed

    Růžičková, Vladislava; Pantůček, Roman; Petráš, Petr; Machová, Ivana; Kostýlková, Karla; Doškař, Jiří

    2012-11-01

    One hundred and twenty-seven exfoliative toxin-producing (ET-positive) strains of Staphylococcus aureus collected in 23 Czech and one Slovak maternity hospitals from 1998 to 2011 were genotypically characterized by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) profiling, spa gene polymorphism analysis, and ETA-converting prophage carriage, which resulted in the identification of 21 genotypes grouped into 4 clonal complexes (CC). Ninety-one isolates carried the eta gene alone whilst 12 isolates harboured only the etb gene. Two new, to date not defined, spa types (t6644 and t6645) and 2 novel sequence types (ST2194 and ST2195) were identified in the set of strains under study. The predominant CC121 occurred in 13 Czech hospitals. CC15, CC9, and ST88 (CC88) exclusively included eta gene-positive strains while the strains belonging to ST121 harboured the eta and/or etb genes. This study highlights not only significant genomic diversity among impetigo strains and the distribution of major genotypes disseminated in the Czech and Slovak maternity hospitals, but also reveals their impact in epidermolytic infections. Copyright © 2012 Elsevier GmbH. All rights reserved.

  7. Poor standards of care in small, private hospitals in Maharashtra, India: implications for public-private partnerships for maternity care.

    PubMed

    Bhate-Deosthali, Padma; Khatri, Ritu; Wagle, Suchitra

    2011-05-01

    The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public-private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for.

  8. Determinants of postconflict symptoms in Albanian Kosovars.

    PubMed

    Eytan, Ariel; Gex-Fabry, Marianne; Toscani, Letizia; Deroo, Lisa; Loutan, Louis; Bovier, Patrick A

    2004-10-01

    During the period from 1998 to 1999, more than 1 million civilians from the province of Kosovo in the Balkans were displaced as a consequence of organized violence and war. The aim of the present study was to determine the prevalence of posttraumatic stress disorder (PTSD) in a sample of the Albanian Kosovar population more than 2 years after the end of the conflict and to assess the effect of exposure to war-related events. A total of 340 households were randomly selected among 12,900 families returned from a country of asylum (Switzerland). All adults in each household were invited to participate (N = 996). The following instruments were used: the Albanian translations of the PTSD section of the Mini International Neuropsychiatric Interview and of the Medical Outcomes Study 36-Item Short Form, and a list of traumatic events adapted from the Harvard Trauma Questionnaire. The overall prevalence of PTSD was 23.5%. A strong cumulative effect of trauma was observed, with odds ratios for PTSD rising steeply with the number of events to which people were exposed. After taking into account traumatic events, multivariable analysis indicated that female gender, older age, and having left Kosovo during the conflict were significantly associated with higher frequency of PTSD, whereas significant heterogeneity among municipalities was observed. Stratified analysis for people who stayed and left the province during the war suggested that different patterns of trauma may be relevant in the two subsamples, with forced separation and isolation strongly associated with PTSD in people who stayed in Kosovo. PTSD diagnosis was also significantly associated with lower scores on all dimensions of the Medical Outcomes Study 36-Item Short Form and lower economic status. The results suggest that responding to medium-term and long-term mental health consequences of conflict is a necessary task for the global rehabilitation of health care systems in a war devastated country.

  9. Effect of time of birth on maternal morbidity during childbirth hospitalization in California

    PubMed Central

    Lyndon, Audrey; Lee, Henry C.; Gay, Caryl; Gilbert, William M.; Gould, Jeffrey B.; Lee, Kathryn A.

    2015-01-01

    Objectives This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization. Study Design Composite maternal morbidities were determined using ICD9-CM and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005-2007. Time of birth, day of week, sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models. Results The odds for pelvic morbidity were lowest between 11PM and 7AM compared to other time periods and the reference value of 7AM-11 AM. The odds for pelvic morbidity peaked between 11AM and 7PM [Adjusted Odds Ratio (AOR) 1101-1500=1.07 (1.06, 1.09); 1501-1900=1.08 (1.06, 1.10)]. Odds for severe morbidity were higher between 11PM and 7AM [AOR 2301-0300=1.31 (1.21, 1.41); 0300-0700=1.30 (1.20-1.41)] compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity [AOR Saturday=1.00 (0.98, 1.02); Sunday=1.01 (0.99, 1.03)] or severe morbidity [AOR Saturday=1.09 (1.00, 1.18); Sunday=1.03 (0.94, 1.13)]. Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status, were also significantly associated with severe morbidity. Conclusions Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications like hypertensive disorders, birth between 11PM and 7AM is a significant independent risk factor for severe maternal morbidity. PMID:26196454

  10. Maternal stress after preterm birth: Impact of length of antepartum hospital stay.

    PubMed

    Pichler-Stachl, Elisabeth; Pichler, Gerhard; Baik, Nariae; Urlesberger, Berndt; Alexander, Avian; Urlesberger, Pia; Cheung, Po-Yin; Schmölzer, Georg Marcus

    2016-12-01

    Preterm birth is associated with increased parental stress, worry, and anxiety, and affects parental-child interactional behaviour. To evaluate the influence of length of antepartum hospital stay on maternal stress after the birth of a preterm infant. A prospective two-centre pilot case-control study was performed at two tertiary level Neonatal-Intensive-Care-Units (NICU). Mothers of preterm infants <36(+0) weeks of gestation admitted to the NICUs were included. The stress of mothers with length of antepartum hospital stay <12h (n=20) were case-matched and compared to that of mothers with length of antepartum hospital stay ≥12h (n=20). Maternal stress was assessed within three days after birth with the Parental-Stress-Scale:NICU (PSS:NICU) questionnaire measuring three scales: "relationship and parental role", "sights and sounds", and "baby looks and behaves". Maternal socio-demographic data were collected by questionnaire administered at the same time. Both groups of mothers had similar socio-demographic data. Stress scale of "sights and sounds" was significantly increased in mothers with antepartum stay ≥12h (2.48±0.69) compared to mothers with antepartum stay <12h (1.95±0.73) (p=0.024). There was no significant difference between the two groups regarding the "looks and behaves" (2.73±0.80 vs. 2.72±0.91; p=0.962) and "relationship and parental role" scales (3.31±1.08 vs. 3.58±1.18; p=0.484). Our study demonstrated higher levels of maternal stress after preterm birth in mothers, who had been admitted to hospital for longer periods of time before delivery. Interventional programmes starting in the antepartum period should be established in order to reduce the burden of stress and to improve parental-child interaction. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Comparative costs of family planning services and hospital-based maternity care in Turkey.

    PubMed

    Cakir, H V; Fabricant, S J; Kircalioğlu, F N

    1996-01-01

    The costs of running a recently established family planning program in the Turkish social security system were measured and compared with the costs of providing the medical services and nonmedical benefits for pregnant women. The undiscounted cost savings from averting pregnancy were estimated to exceed the program's recurrent costs by 17.6 to 1. Cost savings represent only 1 percent of all of the system's medical expenditures, but the family planning program is in an early stage, and potential savings could influence management decisionmaking regarding investments in specialized maternity hospitals.

  12. [Maternal mortality in the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie for a period of 10 years].

    PubMed

    González-Rosales, Ricardo; Ayala-Leal, Isabel; Cerda-López, Jorge Alejandro; Cerón-Saldaña, Miguel Angel

    2010-04-01

    In Mexico, maternal mortality has fallen substantially in recent decades. Although according to the Secretaria de Salud, in Tamaulipas the maternal mortality rate has increased in recent years. Despite these facts, Tamaulipas ranks among the ten institutions with the lowest level of maternal mortality. To describe the basic elements of epidemiologic behavior of maternal mortality during a period of ten years at the Gynecology and Obstetrics department of the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie in Tamaulipas, Mexico. A descriptive, transverse, retrospective and a cases series research was carried out at the Gynecology and Obstetrics department of the Hospital General de Matamoros Dr. Alfredo Pumarejo Lafaurie in Tamaulipas, Mexico. There was a revision of the expedients of direct and indirect obstetric maternal deaths occurred from January 1, 1998 to December 31, 2007. We used descriptive statistics with central trend measurements and standard deviation. 30 obstetric maternal deaths were registered. Maternal death ratio was 87.2 x 100,000 live births during the 10 years. The average age of patients was 25.1 +/- 7.8 years old. 54% were in their first pregnancy. Only 20% had adequate prenatal control. Direct obstetric causes were 60% and indirect obstetric causes 40%. The main causes of maternal deaths were preeclampsia/eclampsia (27%), obstetric hemorrhage (20%) and gravid-puerperal sepsis (13%). 83% was foreseeable. It was noted a clear trend towards the reduction in the maternal mortality ratio in the decade from 1998 to 2007. Preeclampsia-eclampsia and obstetric hemorrhage remain the main causes of maternal death. The maternal mortality ratio tended to invest when comparing the first five years with the last five years of the study, which talks about improvements in management and direct obstetric causes prevention.

  13. [Premature rupture of membranes seen at the Befelatanana maternity, Antananarivo University Hospital Center].

    PubMed

    Andriamady, R C; Rasamoelisoa, J M; Ravaonarivo, H; Ranjalahy, R J

    1999-01-01

    Generally preterm ruptures of membranes (PRM) are harmless, but they become serious if the labor doesn't occur in the following 24 hours. Then, they might generate neonatal infections which provoke heavy fetal and maternal mortality. A retrospective study was carried out in 1998 at the Maternity Hospital of Befelatanana, Antananarivo in order to sum up knowledges on epidemiology and fetal prognosis of this disease, and to draw up measures to aim to reduce causes of PRM. 4232 cases of PRM were registered for the study period. The average age of parturient women was of 27 years old. PRM occur frequently among primiparas and high level multiparas. Risk factors and determinative causes are gyneco-obstetrical history as abortion, preterm delivery, cicatricial uterus, urogenital infections; uterine malformation; placenta praevia; hydramnios; dystocic labor presentation; uterine distension due to either multiple pregnancy or disproportion of fetus and birth canal; irregular and poor prenatal visits quality; low standard of living. Numerous premature infants of PRM outcomes had infections: 1,619 out of 4315 new-borns. Infant perinatal mortality rate was of 11.7 per cent. Maternal complications were infections, uterine rupture, hemorrhages. 5 deaths were noted. The reduction of PRM rate might be obtained by improvement of standard of living and hygiene, correct cares during pregnancy and intergenesic periods.

  14. Anaesthesia for caesarean deliveries and maternal complications in a Nigerian teaching hospital.

    PubMed

    Rukewe, A; Fatiregun, A; Adebayo, K

    2014-03-01

    The aim of this audit was to evaluate the frequency of caesarean delivery, anaesthetic techniques employed, investigate potential trends and the rate of maternal complications associated with general or regional anaesthesia in our institution. We reviewed data collected on all deliveries from patients' medical records, anaesthetic charts and relevant surgical notes from 1 January 2008 to 31 December 2010. A total of 10,911 deliveries were conducted during the study period and there were 3389 caesarean sections, giving a rate of 31.1%; which showed an upward trend from 27.8% in the first year to 34% in the third year. Our data showed a predominant use of regional anaesthesia for caesarean section generally (86.2%) and 83.8% for emergency caesarean deliveries in line with global trends. The overall complication rate was 10.5%. However, 34.5% of parturients who had general anaesthesia in contrast with 6.7% who had regional techniques had anaesthesia-related complications, postoperative intensive care unit admission rather than recovery room care, intra-operative cardiac arrest and haemorrhage exceeding 1200 ml (p = 0.001). Haemodynamic fluctuations were the most common anaesthesia-related complication. Our data revealed that general anaesthesia was a significant risk factor for maternal complications. Obstetric general anaesthesia is low in our hospital. Our result showed that general anaesthesia was a significant risk factor for maternal complications during caesarean section.

  15. Cytogenetic Study in Children with Down Syndrome Among Kosova Albanian Population Between 2000 and 2010

    PubMed Central

    Kolgeci, Selim; Kolgeci, Jehona; Azemi, Mehmedali; Shala-Beqiraj, Ruke; Gashi, Zafer; Sopjani, Mentor

    2013-01-01

    Conflict of interest: none declared. Aim The aim of this research was to ascertain the frequency of three basic cytogenetical types of Down syndrome among Kosova Albanian population and to evaluate the maternal age effect on the frequency of births of children with Down syndrome. Methods Cytogenetics diagnosis has been made according to the standard method of Moorhead and Seabright. Results In the time period 2000-2010 cytogenetics diagnosis of overall 305 children with Down syndrome has been realized. Of which in 285 children (93.4%) were found free trisomy 21 (regular type), and in three other children (~1.0%) were detected mosaic trisomy 21. Translocation trisomy 21 was detected in 17 children (5.6%), of which in 14 children it occurred de novo translocation, whereas in 3 other children translocation has been inherited by a parent translocation carrier. The highest number of children with Trisomy 21 due to translocation was caused by Robertsonian translocation created by a fusion of two homologous chromosomes 21 (3.3%). Analysis showed that the number of children born with Down’s syndrome, from 2000 to 2010, was not decreasing among the Kosova Albanian population. Conclusion Down syndrome resulted by an extra free chromosome 21 is the most common genetic cause for that condition. Robertsonian translocations present in Down syndrome children often are de novo or inherited from a carrier parent with translocation. PMID:24082839

  16. A safety culture assessment by mixed methods at a public maternity and infant hospital in China

    PubMed Central

    Listyowardojo, Tita Alissa; Yan, Xiaoling; Leyshon, Stephen; Ray-Sannerud, Bobbie; Yu, Xin Yan; Zheng, Kai; Duan, Tao

    2017-01-01

    Objective To assess safety culture at a public maternity hospital in Shanghai, China, using a sequential mixed methods approach. The study was part of a bigger study looking at the application of the mixed methods approach to assess safety culture in health care in different organizations and countries. Methodology A mixed methods approach was utilized by first distributing the Safety Attitudes Questionnaire measuring six safety culture dimensions and five independent items to all hospital staff (n=1482) working in 18 departments at a single hospital. Afterward, semistructured interviews were conducted using convenience sampling, where 48 hospital staff from nine departments at the same hospital were individually interviewed. Results The survey received a response rate of 96%. The survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items. Similarly, the interview findings revealed that there were different, competing priorities between departments perceived to result in a reduced quality of collaboration and bottlenecks in care delivery. Another major finding was that staff who worked more hours per week would perceive working conditions significantly more negatively. Issues related to working conditions were also the most common concerns discussed in the interviews, especially the issue on high workload. High workload was also reflected in the fact that 91.45% of survey respondents reported that they worked 40 hours or longer per week. Finally, interview findings complemented survey findings, thus providing a more complete and accurate picture of safety culture. Conclusion Hospital leaders need to prioritize interventions focused on improving the quality of cross-department collaboration and reducing workload. A mixed methods assessment of safety culture provides more meaningful, targeted results, enabling leaders to prioritize and tailor improvement efforts to increase the impact of

  17. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals.

    PubMed

    Filippi, Veronique; Ronsmans, Carine; Gohou, Valerie; Goufodji, Sourou; Lardi, Mohamed; Sahel, Amina; Saizonou, Jacques; De Brouwere, Vincent

    2005-01-01

    This study examines near-miss obstetric events in African hospitals as to the frequency, nature, and ratio of near miss to death and considers whether these could become useful indicators for monitoring the performance of obstetric services in Africa. Prospective or retrospective reviews of medical records were conducted in nine referral hospitals in three countries (Benin, Côte d'Ivoire, and Morocco). We calculated the incidence of near-miss obstetric events, near-miss cases, and maternal deaths related to hemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia and analyzed these according to hospital and timing relative to admission. The incidence of near-miss cases was varied, and in some hospitals extremely large: from 1% to almost a quarter of all deliveries were near misses. Near-miss cases were 15 times more common than deaths (ranging from a ratio of 9:1-108:1). Most of the women with near-miss events (NMEs) (83%) were already in a critical condition on arrival at the hospital (range 54-90%), and two in three were referred from another facility. The most frequent types of NMEs were hemorrhage and hypertensive diseases of pregnancy, but anemia was the leading cause in three first referral level hospitals in Benin and Côte d'Ivoire. Near-miss events due to infections were rare. Near-miss events are extremely common in some African hospitals, with a high proportion arriving in critical conditions. Near-miss events must be estimated separately for those already in a critical condition on arrival and those developing after admission; the first as a good indicator of the effectiveness of emergency referrals and the second as a potential tool for monitoring the performance of obstetric services.

  18. Maternal and newborn outcomes at a tertiary care hospital in Lusaka, Zambia, 2008-2012.

    PubMed

    Vwalika, Bellington; Stoner, Marie C D; Mwanahamuntu, Mulindi; Liu, K Cherry; Kaunda, Eugene; Tshuma, Getrude G; Somwe, Somwe W; Ahmed, Yusuf; Stringer, Elizabeth M; Stringer, Jeffrey S A; Chi, Benjamin H

    2017-02-01

    To measure key obstetric and neonatal outcomes recorded at a tertiary hospital in Zambia over a 5-year period. A retrospective analysis was conducted among women who had delivered at the University Teaching Hospital in Lusaka, between January 1, 2008, and December 31, 2012. Data were extracted from electronic medical records. The main outcomes were maternal mortality, cesarean delivery, prenatal or intrapartum hemorrhage, stillbirth, a 5-minute Apgar score of less than 7, and admission to the neonatal intensive care unit. A total of 62 470 deliveries were recorded. Rates of maternal mortality, cesarean delivery, and hemorrhage during pregnancy all declined over time. Decreased admissions to the neonatal intensive care unit were observed; however, the rate spiked temporarily in late 2011 and early 2012 before returning to previous levels. The proportion of stillbirths remained stable over time but reports of a 5-minute Apgar score of less than 7 rose. Routinely collected obstetric and neonatal data could aid ongoing program monitoring and should be used to guide quality improvement activities. © 2016 International Federation of Gynecology and Obstetrics.

  19. Maternal Factors for Low Birth Weight and Preterm Birth At Tertiary Care Hospital.

    PubMed

    Ojha, N

    2015-01-01

    Low birth weight and preterm birth are the major community health problems in developing countries. They are the major determinants of perinatal survival and infant morbidity and mortality. The aim of this study was to determine the proportion and the maternal risk factors for low birth weight and preterm birth among hospital deliveries in Tribhuvan University Teaching Hospital. A cross sectional retrospective study was carried out in the Department of Obstetrics and Gynecology of TUTH. Maternal risk factors like age, parity, ethnicity, history of previous abortion, history of previous cesarean section, antepartum hemorrhage and medical disorders were studied. Information on all births that occurred was extracted from maternity case notes and delivery registers. During the study period, there were 685 singleton live births. Among these 78(11.4%) were low birth weight and 47(6.9%) were preterm birth. The mean birth weight was 2950±488 gm. The mean weight of female was statistically less compared to male babies (p=0.032). The significant risk factors for LBW were primiparity (OR 2.12; 95%CI 1.25-3.58), Indo-Aryan ethnicity (OR 1.97; 95%CI 1.12-3.45) and history of medical disorder (OR 3.08; 95%CI 1.17-8.12). As for PTB antepartum hemorrhage (OR 8.63; 95%CI 1.99-37.30) and history of medical disorder (OR 3.20; 95%CI 1.04-9.89) were significant risk factors. Parity, ethnicity, and medical disorders were the main risk factors for low birth weight. Antepartum hemorrhage and medical disorders were significant risk factors for preterm birth.

  20. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    PubMed Central

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are

  1. [Women hospitalized due to abortion in a maternity teaching hospital in Recife, Brazil].

    PubMed

    da Ramos, Karla Silva; Ferreira, Ana Laura Carneiro Gomes; de Souza, Ariani Impieri

    2010-09-01

    This cross-sectional study was performed with 160 women between 2005-2006. The objective was to describe the social-demographic and reproductive characteristics of women hospitalized due to abortions, and their knowledge about contraceptive methods and abortion induction. In order to determine the association between the abortion classification and social-demographic variables, Pearson's chi-square test was used, with a significance level of 5%. A frequency of 56.3% was found for probably induced abortions. Most cases of abortion occurred before 12 weeks (55.7%). As for the women's profiles: 48.9% were between 20-29 years old, 72.0% had eight years or more of schooling, 90.1% had a partner, 52.0% had 1-3 children, 100% knew about oral contraceptives and condoms and 80.0% had heard about misoprostol. The social-demographic and reproductive profile of women hospitalized at the referred service due to abortion did not change over the last years. Misoprostol remains the most known method for abortion induction.

  2. Severe maternal morbidity in the intensive care unit of a havana teaching hospital,1998 to 2004.

    PubMed

    Pérez, Albadio; Bacallao, Jorge; Alcina, Serafín; Gómez, Yamilka

    2008-07-01

    Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum. Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004. Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient's ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses. Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with

  3. [Assessment of undiagnosed critical congenital heart disease before discharge from the maternity hospital].

    PubMed

    Zhao, Q M; Liu, F; Wu, L; Ye, M; Jia, B; Ma, X J; Huang, G Y

    2017-04-02

    Objective: Undiagnosed critical congenital heart disease (CCHD) was assessed before discharge from maternity hospital.Basic information was provided for screening CCHD in the early neonatal stage.Chi-squared test was used for comparison of categorical variables(detection rate of different types of CCHD). Method: A retrospective cohort study was conducted in neonates with CCHD who were admitted to Children's Hospital of Fudan University between 1 January 2012 and 31 December 2015. For comparing with the previously reported undiagnosed rate of CCHD at discharge, CCHD was defined as all duct dependent congenital heart disease (DDCHD) and any cyanotic CHD that required early surgery. Result: A total of 1 036 infants with CCHD were included. The prenatal detection rate of CCHD was 14.04%(122/869). As a whole, 52.51% (544/1 036) of CCHD cases were undiagnosed at discharge, and 14.09%(146/1 036)were still missed after 6-week examination. The diagnoses most likely to be unrecognized at discharge included critical coarctation of the aorta (COA) (75.00%), total anomalous pulmonary venous connection (61.54%), pulmonary atresia (PA) with ventricle septal defect (VSD) (61.45%), single ventricle (SV) (60.10%) and critical aortic stenosis (52.94%). Among newborns diagnosed prior to discharge, 54.88% (270/492) due to symptom or prenatal ultrasonographic diagnosis, 45.12% (222/492) due to abnormal findings in routine examination. Among asymptomatic CCHD cases without prenatal diagnosis, 71.02% (544/766) were undiagnosed and the most common delayed diagnosis was SV (82.78%), interrupted aortic arch (81.82%), transposition of the great arteries with intact ventricular septum (79.63%), PA/VSD (79.07%), and critical COA (78.57%). Newborns with DDC were more likely to develop symptoms within the first few days after birth, in comparison with non-DDC cases. However, their detection rates were close to each other. Conclusion: The rate of misdiagnosis of CCHD before discharge from

  4. Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban, and Teaching Hospitals in the United States.

    PubMed

    Kozhimannil, Katy B; Thao, Viengneesee; Hung, Peiyin; Tilden, Ellen; Caughey, Aaron B; Snowden, Jonathan M

    2016-05-01

    Objectives This study aims to examine the relationship between hospital birth volume and multiple maternal morbidities among low-risk pregnancies in rural hospitals, urban non-teaching hospitals, and urban teaching hospitals, using a representative sample of U.S. hospitals. Study Design Using the 2011 Nationwide Inpatient Sample from 607 hospitals, we identified 508,146 obstetric deliveries meeting low-risk criteria and compared outcomes across hospital volume categories. Outcomes include postpartum hemorrhage (PPH), chorioamnionitis, endometritis, blood transfusion, severe perineal laceration, and wound infection. Results Hospital birth volume was more consistently related to PPH than to other maternal outcomes. Lowest-volume rural (< 200 births) and non-teaching (< 650 births) hospitals had 80% higher odds (adjusted odds ratio [AOR] = 1.80; 95% CI = 1.56-2.08) and 39% higher odds (AOR = 1.39; 95% CI = 1.26-1.53) of PPH respectively, than those in corresponding high-volume hospitals. However, in urban teaching hospitals, delivering in a lower-volume hospital was associated with 14% lower odds of PPH (AOR = 0.86; 95% CI = 0.80-0.93). Deliveries in rural hospitals had 31% higher odds of PPH than urban teaching hospitals (AOR = 1.31; 95% CI = 1.13-1.53). Conclusions Low birth volume was a risk factor for PPH in both rural and urban non-teaching hospitals, but not in urban teaching hospitals, where higher volume was associated with greater odds of PPH. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania.

    PubMed

    Litorp, Helena; Kidanto, Hussein L; Rööst, Mattias; Abeid, Muzdalifat; Nyström, Lennarth; Essén, Birgitta

    2014-07-23

    The maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications. We performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated. We identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33-39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460-730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6-11) of the MNM events and 13% (95% CI 6.4-23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12-37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8-12) (risk ratio 3.2, 95% CI 1.5-6.6). The occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be

  6. Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

    PubMed Central

    2011-01-01

    Background Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications. Method Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis. Results Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it. Conclusion Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff PMID

  7. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals

    PubMed Central

    2014-01-01

    Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of

  8. ‘Because of Poverty brought into Hospital: . . .’A Casenote-Based Analysis of the Changing Role of the Edinburgh Royal Maternity Hospital, 1850-1912

    PubMed Central

    Nuttall, Alison

    2008-01-01

    Summary Although the shift from a social to a medical function which occurred in nineteenth-century general hospitals has been explored, the occurrence of such a change in maternity hospitals has not been considered. Recent analyses of such institutions have examined particular aspects only, and thus give a somewhat static picture. This paper uses analysis of patient records (themselves an under-exploited resource) to explore the changing function of the Edinburgh Royal Maternity Hospital from a provider of shelter during childbirth to the destitute to a source of skilled medical care. It concludes that, although the Hospital had adopted the outward features of a medical institution by 1890, its casebooks suggest that its purpose only truly changed in the early twentieth century, and thus can perhaps be more appropriately linked with national anxiety regarding the health of babies and their mothers. PMID:18605328

  9. HIV self-care practices during pregnancy and maternal health outcomes among HIV-positive postnatal mothers aged 18-35 years at Mbuya Nehanda maternity hospital.

    PubMed

    Dodzo, Lilian Gertrude; Mahaka, Hilda Tandazani; Mukona, Doreen; Zvinavashe, Mathilda; Haruzivishe, Clara

    2017-06-01

    HIV-related conditions are one of the indirect causes of maternal deaths in Zimbabwe and the prevalence rate was estimated to be 13.63% in 2009. The study utilised a descriptive correlational design on 80 pregnant women who were HIV positive at Mbuya Nehanda maternity hospital in Harare, Zimbabwe. Participants comprised a random sample of 80 postnatal mothers. Permission to carry out the study was obtained from the respective review boards. Participants signed an informed consent. Data were collected using a structured questionnaire and record review from 1 to 20 March 2012. Interviews were done in a private room and code numbers were used to identify the participants. Completed questionnaires were kept in a lockable cupboard and the researcher had sole access to them. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 12. Descriptive statistics were used to analyse data on demographics, maternal health outcomes and self-care practices. Inferential statistics (Pearson's correlation and regression analysis) were used to analyse the relationship between self-care practices and maternal health outcomes. Self-care practices were good with a mean score of 8 out of 16. Majority (71.3%) fell within the good category. Maternal outcomes were poor with a mean score of 28 out of 62 and 67.5% falling in the poor category. Pearson's correlation indicated a weak significant positive relationship (r = .317, p = <.01). Regression analysis (R(2)) was .10 implying that self-care practices explained 10% of the variance observed in maternal health outcomes. More research needs to be carried out to identify other variables affecting maternal outcomes in HIV-positive pregnant women.

  10. Parental Perceptions of Health-Related Quality of Life of Albanian Children with Epilepsy.

    PubMed

    Kalyva, Efrosini; Melonashi, Erika

    2015-09-30

    Epilepsy adversely affects the health-related quality of life (HRQoL) of children living with it. Even though almost 80% of children with epilepsy live in developing countries very little research has been conducted with the specific population. The present study took place in Albania and aimed to investigate parental perceptions of the HRQoL of their children with epilepsy. Considering the well-defined gender roles in the Albanian traditional family it was expected that mothers and fathers reports of their children's HRQoL would differ. Results showed no differences in maternal and paternal reports; instead there was a moderate correspondence between the reports across all dimensions. Parents also reported the highest scores of HRQoL in the interpersonal dimension and the lowest scores in the intrapersonal dimension. The findings have implications in the context of future research and also medical care for children with epilepsy in Albania.

  11. A 10-year review of maternal mortality in Chon Buri Hospital, Thailand.

    PubMed

    Pinchun, P; Chullapram, T

    1993-06-01

    1. The overall maternal mortality rate (MMR) in Chon Buri Hospital in the 10-yr period from 1982-1991 was 51.1/100,000 livebirths. 2. The top causes of death were abortion related complications, pregnancy induced hypertension, puerperal infection and postpartum hemorrhage. 3. What we have done is to improve the quantity and quality of obstetric and medical care, solve the problem of vital statistics reports in our hospital, contact doctor in nearby hospitals in referral and interhospital OB-GYN conferences to meet and discuss both knowledge and management problems. 4. What we still faced in the last 4-yr were deaths from abortion related complications, puerperal sepsis and postpartum hemorrhage. Most of the deaths were preventable. 5. So what we have to target to lessen the MMR is to improve the obstetric and medical care, improve the quality of medical personnel in our area in KAP aspect (knowledge, attitude, practice) especially in the field of family planning to prevent unwanted pregnancies, proper prevention and management of postpartum hemorrhage, and prevention and treatment of puerperal and postabortal infection.

  12. Maternal assessment of recommendations on the newborn infant care upon hospital discharge.

    PubMed

    Herrero-Morín, José David; Huidobro Fernández, Belén; Amigo Bello, María Cristina; Quiroga González, Rocío; Fernández González, Nuria

    2015-01-01

    It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.

  13. Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity.

    PubMed

    Hedriana, Herman L; Wiesner, Suzanne; Downs, Brenda G; Pelletreau, Barbara; Shields, Laurence E

    2016-03-01

    To determine whether predefined maternal early warning triggers (MEWTs) can predict pregnancy morbidity. In a retrospective case-control study, obstetric patients admitted to the intensive care unit (ICU) between 2012 and 2013 at seven pilot US hospitals were compared with control patients who had a normal delivery outcome. Six MEWTs were assessed. The case and control groups each contained 50 patients. Hemorrhage (15/50, 30%), sepsis (12/50, 24%), cardiac dysfunction (8/50, 16%), and pre-eclampsia (6/50, 12%) were the most common reasons for ICU admission. Significant associations were recorded between ICU admission and tachycardia (OR 5.0, 95% CI 2.1-11.7), mean arterial pressure less than 65 mm Hg (OR 4.5, 95% CI 1.9-10.8), temperature of at least 38°C (OR 44.1, 95% CI 13.0-839.1), and altered mental state (OR 44.1, 95% CI 13.1-839.0). Two or more triggers were persistent for 30 minutes or more in 36 (72%) ICU patients versus 2 (4%) controls (OR 61.7, 95% CI 13.2-288.0). Earlier medical intervention might have led to a lesser degree of maternal morbidity for 31 (62%) ICU patients with at least one MEWT. Persistent MEWTs were present in most obstetric ICU cases. Retrospectively, MEWTs in this cohort seemed to separate normal obstetric patients from those for whom ICU admission was indicated; their use might reduce maternal morbidity. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. [Normative prenatal evaluation at a philanthropic maternity hospital in São Paulo].

    PubMed

    Corrêa, Claudia Regina Hostim; Bonadio, Isabel Cristina; Tsunechiro, Maria Alice

    2011-12-01

    This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of São Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.

  15. Assessment of client satisfaction in labor and delivery services at a maternity referral hospital in Ethiopia.

    PubMed

    Melese, Tadele; Gebrehiwot, Yirgu; Bisetegne, Daniel; Habte, Dereje

    2014-01-01

    Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study is aimed to assess the client`s satisfaction in a maternal health care setting. This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client's address away from Addis Ababa were found to be the predictors of client satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems.

  16. Assessment of client satisfaction in labor and delivery services at a maternity referral hospital in Ethiopia

    PubMed Central

    Melese, Tadele; Gebrehiwot, Yirgu; Bisetegne, Daniel; Habte, Dereje

    2014-01-01

    Introduction Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study is aimed to assess the client`s satisfaction in a maternal health care setting. Methods This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. Results The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client's address away from Addis Ababa were found to be the predictors of client satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. Conclusion Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems. PMID:25018826

  17. Postnatal depression among women availing maternal health services in a rural hospital in South India

    PubMed Central

    Johnson, Avita Rose; Edwin, Serin; Joachim, Nayanthara; Mathew, Geethu; Ajay, Shwetha; Joseph, Bobby

    2015-01-01

    Background and Objective: Postnatal depression, with an estimated prevalence of 13-19%, causes significant impairment of mental health among women worldwide and has long term consequences. However, more than half of all cases are not detected by healthcare providers. Screening for postnatal depression has not been given importance in maternal health programs in India. Our objective was to screen for postnatal depression among women attending a rural hospital in India, immediately postpartum and at 6-8 weeks post-delivery, and to study associated factors. Methods: A cross sectional study was done on 123 postnatal women attending a rural maternity hospital in Karnataka, South India, of whom 74 women were interviewed within one week of childbirth, and 49 women at 6-8 weeks post-delivery. The Edinburgh Postnatal Depression Scale was used to screen for postnatal depression. Results: About 45.5% of the women screened positive for postnatal depression (44.6% of all subjects within one week of delivery and 46.9% at 6-8 weeks after delivery). Postnatal depression was significantly associated with mood swings during antenatal period, staying with the family of birth during pregnancy and away from their husbands, and was significantly higher among women who perceived their life as stressful and having a low self-esteem (P<0.05) Conclusions: This study found a high prevalence of postnatal depression in women in rural Karnataka. This underlines the need for incorporating screening for postnatal depression in the routine care of women during pregnancy and delivery. PMID:26101501

  18. Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records.

    PubMed

    Lydon-Rochelle, Mona T; Holt, Victoria L; Nelson, Jennifer C; Cárdenas, Vicky; Gardella, Carolyn; Easterling, Thomas R; Callaghan, William M

    2005-11-01

    While the impact of maternal morbidities and intrapartum procedures is a common topic in perinatal outcomes research, the accuracy of the reporting of these variables in the large administrative databases (birth certificates, hospital discharges) often utilised for such research is largely unknown. We conducted this study to compare maternal diagnoses and procedures listed on birth certificates, hospital discharge data, and birth certificate and hospital discharge data combined, with those documented in a stratified random sample of hospital medical records of 4541 women delivering liveborn infants in Washington State in 2000. We found that birth certificate and hospital discharge data combined had substantially higher true positive fractions (TPF, proportion of women with a positive medical record assessment who were positive using the administrative databases) than did birth certificate data alone for labour induction (86% vs. 52%), cephalopelvic disproportion (83% vs. 35%), abruptio placentae (85% vs. 68%), and forceps-assisted delivery (89% vs. 55%). For procedures available only in hospital discharge data, TPFs were generally high: episiotomy (85%) and third and fourth degree vaginal lacerations (91%). Except for repeat caesarean section without labour (TPF, 81%), delivery procedures available only in birth certificate data had low TPFs, including augmentation (34%), repeat caesarean section with labour (61%), and vaginal birth after caesarean section (62%). Our data suggest that researchers conducting perinatal epidemiological studies should not rely solely on birth certificate data to detect maternal diagnoses and intrapartum procedures accurately.

  19. Infant and maternal characteristics in neonatal abstinence syndrome--selected hospitals in Florida, 2010-2011.

    PubMed

    Lind, Jennifer N; Petersen, Emily E; Lederer, Philip A; Phillips-Bell, Ghasi S; Perrine, Cria G; Li, Ruowei; Hudak, Mark; Correia, Jane A; Creanga, Andreea A; Sappenfield, William M; Curran, John; Blackmore, Carina; Watkins, Sharon M; Anjohrin, Suzanne

    2015-03-06

    Neonatal abstinence syndrome (NAS) is a constellation of physiologic and neurobehavioral signs exhibited by newborns exposed to addictive prescription or illicit drugs taken by a mother during pregnancy. The number of hospital discharges of newborns diagnosed with NAS has increased more than 10-fold (from 0.4 to 4.4 discharges per 1,000 live births) in Florida since 1995, far exceeding the three-fold increase observed nationally. In February 2014, the Florida Department of Health requested the assistance of CDC to 1) assess the accuracy and validity of using Florida's hospital inpatient discharge data, linked to birth and infant death certificates, as a means of NAS surveillance and 2) describe the characteristics of infants with NAS and their mothers. This report focuses only on objective two, describing maternal and infant characteristics in the 242 confirmed NAS cases identified in three Florida hospitals during a 2-year period (2010-2011). Infants with NAS experienced serious medical complications, with 97.1% being admitted to an intensive care unit, and had prolonged hospital stays, with a mean duration of 26.1 days. The findings of this investigation underscore the important public health problem of NAS and add to current knowledge on the characteristics of these mothers and infants. Effective June 2014, NAS is now a mandatory reportable condition in Florida. Interventions are also needed to 1) increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age, 2) improve drug addiction counseling and rehabilitation referral and documentation policies, and 3) link women to these resources before or earlier in pregnancy.

  20. Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality.

    PubMed

    Grytten, Jostein; Monkerud, Lars; Skau, Irene; Sørensen, Rune

    2014-08-01

    To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries. © Health Research and Educational Trust.

  1. Regionalization and Local Hospital Closure in Norwegian Maternity Care—The Effect on Neonatal and Infant Mortality

    PubMed Central

    Grytten, Jostein; Monkerud, Lars; Skau, Irene; Sørensen, Rune

    2014-01-01

    Objective To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. Data The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. Study Design Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. Principal Finding Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. Conclusion A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries. PMID:24476021

  2. Association Between Hospital Trauma Designation and Maternal and Neonatal Outcomes after Injury among Pregnant Women in Washington State.

    PubMed

    Distelhorst, John T; Krishnamoorthy, Vijay; Schiff, Melissa A

    2016-03-01

    Approximately 8% of all pregnant women experience a traumatic injury during pregnancy. There has been no evaluation of a state trauma system's effect on birth outcomes. This study examined the association of treatment in a designated trauma hospital vs a nontrauma hospital on maternal and neonatal outcomes among injured pregnant patients in Washington State. We conducted a population-based retrospective cohort study (1995 to 2012). The Washington State Birth Events Records Database and the Comprehensive Hospital Abstract Recording System were linked to ascertain all hospitalized injured pregnant patients. The cohort was dichotomized by exposure to trauma vs nontrauma hospitals. We analyzed the association between trauma hospital designation and risk of adverse birth outcomes using logistic regression to estimate odds ratios and 95% CI, adjusting for Injury Severity Score and other confounders. We ascertained 3,429 injured pregnant women. Patients treated in trauma hospitals had an adjusted odds ratio (aOR) of 0.60 (95% CI, 0.50-0.73) for preterm labor, aOR = 0.74 (95% CI, 0.57-0.96) for gestational age <37 weeks, aOR = 0.72 (95% CI, 0.54-0.97) for birth weight <2,500 g, and aOR = 0.54 (95% CI, 0.39-0.76) for meconium at delivery. No statistically significant associations were found for maternal death (aOR = 2.57; 95% CI, 0.32-20.38), fetal death (aOR = 1.60; 95% CI, 0.35-7.35), or neonatal death (aOR = 1.50; 95% CI, 0.50-4.49). Treatment of injured pregnant women at designated trauma hospitals was associated with several improved birth outcomes. Trauma hospital treatment, with a greater focus on maternal resuscitation and monitoring, might explain these findings. Published by Elsevier Inc.

  3. Albanian: Basic Course. Volume IX, Lessons 91-110.

    ERIC Educational Resources Information Center

    Defense Language Inst., Monterey, CA.

    This ninth of ten volumes of audiolingual classroom instruction in Albanian for adult students contains 20 lessons designed to apply the student's knowledge of the Gege dialect to the Toske dialect, and to introduce military terminology. Each lesson consists of a dialogue and a prose narrative that are the center of classroom work, and sentences…

  4. Family Language Policies among Albanian Immigrants in Greece

    ERIC Educational Resources Information Center

    Chatzidaki, Aspassia; Maligkoudi, Christina

    2013-01-01

    This article reports on an investigation of family language policies among 37 Albanian immigrant families in Northern Greece within the framework of Spolsky's language policy model. Data collection was based on semi-directed interviews with parents which were analysed using both content and discourse analysis. According to our findings, three…

  5. Family Language Policies among Albanian Immigrants in Greece

    ERIC Educational Resources Information Center

    Chatzidaki, Aspassia; Maligkoudi, Christina

    2013-01-01

    This article reports on an investigation of family language policies among 37 Albanian immigrant families in Northern Greece within the framework of Spolsky's language policy model. Data collection was based on semi-directed interviews with parents which were analysed using both content and discourse analysis. According to our findings, three…

  6. High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

    PubMed Central

    2011-01-01

    Background Burnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience. Methods In the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout. Results In terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment. Conclusions Based on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting. PMID:21605379

  7. Placenta Previa and Pre-Eclampsia: Analyses of 1645 Cases at Medani Maternity Hospital, Sudan

    PubMed Central

    Adam, Ishag; Haggaz, AbdElrahium D.; Mirghani, Omer A.; Elhassan, Elhassan M.

    2013-01-01

    A retrospective case-control study was conducted to investigate the risk factors for pre-eclampsia – including the protective effect of placenta previa – at Medani Maternity Hospital, Sudan. Medical files of the patients during the period 2003–2010 were reviewed for age, parity, education level, prenatal care, placenta previa, and hemoglobin level. Women with pre-eclampsia were the cases, and women with normal pregnancy were the controls. There were 54,339 singleton deliveries and 1765 women with pre-eclampsia in the hospital, giving the incidence of pre-eclampsia of 3.2%. The risk factors for pre-eclampsia were; women with age >35 years (OR = 1.4, 95% CI: 1.1–1.8), primiparity (OR = 3.3, 95% CI: 2.7–4.0), para >5 (OR = 3.1, 95% CI: 2.4–4.0), and anemia (OR = 3.3, 95% CI: 2.8–3.9). The risk of pre-eclampsia was inversely increased with education level and prenatal care attendance. The prevalence of placenta previa was 0 (0%) and 55 (3.3%), P < 0.001 in pre-eclamptic and control women, respectively. Placenta previa was a significant protective factor of pre-eclampsia (OR = 0.3, 95% CI: 0.1–0.7). Although, the socio-demographic risk factors for pre-eclampsia observed among women at Medani hospital were similar to those found in other settings; placenta previa was associated with decreased incidence of pre-eclampsia. PMID:23450096

  8. Placenta previa and pre-eclampsia: analyses of 1645 cases at medani maternity hospital, Sudan.

    PubMed

    Adam, Ishag; Haggaz, Abdelrahium D; Mirghani, Omer A; Elhassan, Elhassan M

    2013-01-01

    A retrospective case-control study was conducted to investigate the risk factors for pre-eclampsia - including the protective effect of placenta previa - at Medani Maternity Hospital, Sudan. Medical files of the patients during the period 2003-2010 were reviewed for age, parity, education level, prenatal care, placenta previa, and hemoglobin level. Women with pre-eclampsia were the cases, and women with normal pregnancy were the controls. There were 54,339 singleton deliveries and 1765 women with pre-eclampsia in the hospital, giving the incidence of pre-eclampsia of 3.2%. The risk factors for pre-eclampsia were; women with age >35 years (OR = 1.4, 95% CI: 1.1-1.8), primiparity (OR = 3.3, 95% CI: 2.7-4.0), para >5 (OR = 3.1, 95% CI: 2.4-4.0), and anemia (OR = 3.3, 95% CI: 2.8-3.9). The risk of pre-eclampsia was inversely increased with education level and prenatal care attendance. The prevalence of placenta previa was 0 (0%) and 55 (3.3%), P < 0.001 in pre-eclamptic and control women, respectively. Placenta previa was a significant protective factor of pre-eclampsia (OR = 0.3, 95% CI: 0.1-0.7). Although, the socio-demographic risk factors for pre-eclampsia observed among women at Medani hospital were similar to those found in other settings; placenta previa was associated with decreased incidence of pre-eclampsia.

  9. Incidence and determinants of severe maternal morbidity: a transversal study in a referral hospital in Teresina, Piaui, Brazil.

    PubMed

    Madeiro, Alberto Pereira; Rufino, Andréa Cronemberger; Lacerda, Érica Zânia Gonçalves; Brasil, Laís Gonçalves

    2015-09-07

    Maternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil. A transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined. Five thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1%) and hemorrhagic complications (10.0%) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR < 7 in the 1(st) minute (p = 0.015). SMM and MNM were quite prevalent in the population studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.

  10. Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey.

    PubMed

    Tort, Julie; Rozenberg, Patrick; Traoré, Mamadou; Fournier, Pierre; Dumont, Alexandre

    2015-09-30

    Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Sub-Saharan-Africa (SSA). Although clinical guidelines treating PPH are available, their implementation remains a great challenge in resource poor settings. A better understanding of the factors associated with PPH maternal mortality is critical for preventing risk of hospital-based maternal death. The purpose of this study was thus to assess which factors contribute to maternal death occurring during PPH. The factors were as follows: women's characteristics, aspects of pregnancy and delivery; components of PPH management; and organizational characteristics of the referral hospitals in Senegal and Mali. A cross-sectional survey nested in a cluster randomized trial (QUARITE trial) was carried out in 46 referral hospitals during the pre-intervention period from October 2007 to September 2008 in Senegal and Mali. Individual and hospital characteristics data were collected through standardized questionnaires. A multivariable logistic mixed model was used to identify the factors that were significantly associated with PPH maternal death. Among the 3,278 women who experienced PPH, 178 (5.4%) of them died before hospital discharge. The factors that were significantly associated with PPH maternal mortality were: age over 35 years (adjusted OR = 2.16 [1.26-3.72]), living in Mali (adjusted OR = 1.84 [1.13-3.00]), residing outside the region location of the hospital (adjusted OR = 2.43 [1.29-4.56]), pre-existing chronic disease before pregnancy (adjusted OR = 7.54 [2.54-22.44]), prepartum severe anemia (adjusted OR = 6.65 [3.77-11.74]), forceps or vacuum delivery (adjusted OR = 2.63 [1.19-5.81]), birth weight greater than 4000 grs (adjusted OR = 2.54 [1.26-5.10]), transfusion (adjusted OR = 2.17 [1.53-3.09]), transfer to another hospital (adjusted OR = 13.35 [6.20-28.76]). There was a smaller risk of PPH maternal death in hospitals with gynecologist

  11. Maternity hospital practices and breast feeding self-efficacy in Finnish primiparous and multiparous women during the immediate postpartum period.

    PubMed

    Koskinen, Katja S; Aho, Anna L; Hannula, Leena; Kaunonen, Marja

    2014-04-01

    to explore the relationship between maternity hospital practices and breast feeding self-efficacy. the data were collected using a cross-sectional survey. The study is a part of a larger longitudinal research and development project called 'Urban parenthood'. three urban maternity hospitals in Southern Finland. altogether 1400 questionnaires were given out and 573 primiparous and multiparous women completed the questionnaire within a week after childbirth. The response rate was 41%. early and successful initiation of breast feeding, rooming-in and exclusive breast feeding during the hospital stay were associated with higher maternal breast feeding self-efficacy in both primiparous and multiparous women. The reason (medical or non-medical), frequency or method (bottle or cup) for supplementation was not associated with breast feeding self-efficacy. breast feeding experiences during the immediate postpartum period have an association with breast feeding self-efficacy. Mothers who are not able to initiate breast feeding within an hour after birth or whose infants are supplemented during the hospital stay may benefit from additional support and breast feeding counselling. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Maternal characteristics and hospital policies as risk factors for nonreceipt of hepatitis B vaccine in the newborn nursery.

    PubMed

    O'Leary, Sean T; Nelson, Christina; Duran, Julie

    2012-01-01

    A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV. A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV. A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49-1.85; >$75,000 vs. <$15,000: adjusted OR = 1.21, 95% CI = 1.13-1.30). Lack of a hospital policy stipulating a universal birth dose strongly predicted nonreceipt of a birth dose of HBV (policy with no birth dose vs. policy with a birth dose: adjusted OR = 2.21, 95% CI = 2.13-2.30). Maternal characteristics such as higher education and income are associated with nonreceipt of the HBV during the perinatal period. To effectively reduce risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.

  13. A retrospective review of maternal and child health services at the Albert Schweitzer Hospital in rural Haiti.

    PubMed

    Wallace, C E; Marshall, F N; Robinson, C

    1982-01-01

    For the past 25 years the Albert Schweitzer Hospital in Deschapelles, Haiti has been providing a wide range of maternal and child health services to the people of its rural district. Numerous special services for mothers and children have been added over the years, but these began to realize considerably greater potential with the creation of the hospital's Community Health Department in 1967. This department has carried out numerous preventive health programs and services designed to accommodate these groups' special health needs. Attention is directed to neonatal tetanus control; surveillance, treatment, and prevention of malnutrition; and other maternal and child health services (school programs, immunization activities, prenatal and postnatal care, family planning, the midwives' program, the "cord-cut" unit, the low birth weight project, and dispensaries and health agents). In 1967 the hospital began to develop programs especially designed to control neonatal tetanus. Communities were immunized systematically. By establishing outdoor immunization clinics at the hospital and at major marketplaces in the district and by working with traditional midwives, these programs were responsible for a sharp decline in the incidence of neonatal tetanus. Malnutrition has remained the most frequently occurring health problem among children in the hospital district. Several services and programs have been established throughout the years to meet the identified needs. These include the following which are described: the nutrition clinic; courtyard education; "weigh-ins;" nutrition recovery centers; the 3-day center at Deschapelles; nutrition intervention and case follow-up program; and malnutrition treatment. The hospital's family planning program has gradually increased its use of community education to reach the population and to try to gain acceptance of the need to space and limit births. This community education has been disseminated by dispensaries, mobile health team

  14. Prevalence of vaginitis among pregnant women attending Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal.

    PubMed

    Shrestha, S; Tuladhar, N R; Basnyat, S; Acharya, G P; Shrestha, P; Kumar, P

    2011-12-01

    Vaginitis is the most prevalent disorder among the pregnant women. The objective of this study was to find out the prevalence of common types of vaginitis among the pregnant women visiting Paropakar Maternity and Women's Hospital in Kathmandu. Among 200 pregnant women included in the study, 78 (39.0%) had vaginitis. Of total 78 positive cases of vaginitis, 29.5% had candidiasis, 52.6% bacterial vaginosis and 1.3% trichomoniasis. Approximately 83% had monomicrobial infection and 16.7% had polymicrobial infection. Vaginitis was common in the age group of 20 to 29 years (41.8%) and 30-39 years (40.0%). Ethnically, Indo-Aryans (40.2%) were mostly infected. The infection rate was the highest among illiterate women (47.6%) and least among the women having education above secondary (23.0%). The positive infection rate was higher in women from rural area (45.2%) than those from urban area (37.3%). Nearly half of the women with agriculture occupation (48.4%) had vaginitis. Vaginitis was common in women with third pregnancy (52.6%). Among 78 vaginitis cases, 53 (67.9%) were asymptomatic cases.

  15. Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.

    PubMed

    Allam, Ihab Serag; Gomaa, Ihab Adel; Fathi, Hisham Mohamed; Sukkar, Ghada Fathi Mahmoud

    2014-11-01

    To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital. Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity. The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.

  16. Cytomegalovirus and herpes simplex infections in mothers and newborns in a Havana maternity hospital.

    PubMed

    Festary, Aimée; Kourí, Vivian; Correa, Consuelo B; Verdasquera, Denis; Roig, Tania; Couret, Martha P

    2015-01-01

    Cytomegalovirus and herpes simplex virus are associated with congenital or perinatal infection, causing potential damage to the newborn. Determine the prevalence of active or latent infection by cytomegalovirus and herpes simplex virus in a population of mothers, congenital infection by these agents in their infants, and association between prevalence of virus infection in mothers and in their newborns. A cross-sectional study was conducted from June to September 2012 in a population of 95 pregnant women admitted to the Dr Ramón González Coro University Maternity Hospital during the third trimester of pregnancy, and their infants (98). Patients were tested for antibodies specific to these viruses; vaginal swabs and urine from the women and serum and urine from the newborns were tested for viral genome. The Fisher exact test with 95% confidence interval was used for comparisons. Of the women studied, 89.5% tested positive for cytomegalovirus and 83.2% for herpes simplex. Active infection from cytomegalovirus was detected in 16.7%, and from herpes simplex in 3.2%. Congenital cytomegalovirus infection was detected in 4.1% of newborns; no herpes simplex virus infection was found in this group. Two newborns of women with active cytomegalovirus infection were congenitally infected. Serology demonstrated that most of the women were immune to both viruses. Active cytomegalovirus infections are common in this population, and newborns of women with active cytomegalovirus infection during pregnancy are at increased risk of congenital infection.

  17. In a tertiary maternity hospital, when should a paediatrician be present in the delivery room?

    PubMed

    Tourneux, Pierre; Pascard, Loriane; Daune, Pascale; Gondry, Jean; Fontaine, Cécile

    2017-07-01

    10% of newborns require positive pressure ventilation (PPV) at birth. There are few data on prenatal or early postnatal factors that are predictive of the need for a paediatrician in the delivery room. The study analysed prenatal obstetric and early postnatal factors associated with the requirement for paediatrician assistance in this setting. Over a three-month period, all consecutive births in a tertiary hospital's maternity unit were prospectively evaluated with regard to the need for paediatrician assistance (requested either before or after the delivery), the requirement for resuscitation, and transfer to a neonatal intensive care unit (NICU). For a total of 584 consecutive births, paediatrician assistance was requested before delivery in 170 cases (30.5%) and after in 78 cases (13.3%). 78% of the newborns requiring PPV, 95.8% of those requiring endotracheal intubation and 86.3% of those requiring transfer to the NICU matched recently published prenatal criteria for paediatrician assistance. Along with a low Apgar score and a cord blood pH <7.20, these criteria covered 95% of the prenatal and early postnatal requests for paediatrician assistance. These criteria for neonatal resuscitation in the delivery room would enable medical staff to anticipate the need for paediatrician assistance.

  18. Assessment of maternal risk factors associated with low birth weight neonates at a tertiary hospital, Nanded, Maharashtra.

    PubMed

    Domple, Vijay Kishanrao; Doibale, Mohan K; Nair, Abhilasha; Rajput, Pinkesh S

    2016-01-01

    To assess the maternal risk factors associated with low birth weight (LBW) neonates at a tertiary hospital, Nanded, Maharashtra. This study was carried out in a tertiary care hospital in Nanded city of Maharashtra between January 2014 and July 2014 among 160 cases (LBW-birth weight ≤2499 g) and 160 controls (normal birth weight-birth weight >2499. Data collection was done by using predesigned questionnaire and also related health documents were checked and collected the expected information during the interview after obtaining informed consent from mothers. The data were analyzed by Epi Info 7 Version. The present study found the significant association among gestational age, sex of baby, type of delivery, maternal age, religion, education of mother and husband, occupation of mother and husband, type of family, maternal height, weight gain, hemoglobin level, planned/unplanned delivery, bad obstetric history, interval between pregnancies, previous history of LBW, underlying disease, tobacco chewing, timing of first antenatal care (ANC) visit, total number of ANC visit, and iron and folic acid (IFA) tablets consumption with LBW. No significant association was found among maternal age, residence, caste, consanguinity of marriage, socioeconomic status, gravida, birth order, multiple pregnancy, and smoking with LBW in our study. It was concluded that hemoglobin level, weight gain during pregnancy, gestational age, planned/unplanned delivery, bad obstetric history, and IFA tablets consumption during pregnancy were independent risk factors for LBW.

  19. The Kangaroo Program at a Brazilian maternity hospital: the preterm/low-weight babies' health-care under examination.

    PubMed

    Véras, Renata Meira; Traverso-Yépez, Martha

    2011-03-01

    The Kangaroo Program, originally developed in Colombia, was adopted as a public policy by the Brazilian Unified Health System (SUS) in 2000, in an effort to improve maternal and infant health in the country. This article aims to examine the Kangaroo Program as it is practiced and carried out at a maternity hospital in the northeastern Brazilian region. Through an institutional ethnographic approach, research demonstrates that the Kangaroo Program has been effective in saving lives and improving some of the infants' health outcomes. However, research also demonstrates that: (i) the socioeconomic profile of mothers in the Kangaroo Program, (ii) conflicting relationships between healthcare workers and users, and (iii) lack of socioeconomic and emotional support are impairing the adequate implementation of the program. Due to the low literacy level of most of these mothers, institutional power is used as a form of social control to keep mothers uninformed about the possibility of leaving the maternity wards. In a two-tier health system, this controlling behavior is part of existing social inequities, as the Kangaroo Program is a choice in the private health system but tends to be mandatory at SUS maternity hospitals across Brazil.

  20. [French hospital discharge database: data production, validity, and origins of errors in the field of severe maternal morbidity].

    PubMed

    Chantry, A A; Deneux-Tharaux, C; Bal, G; Zeitlin, J; Quantin, C; Bouvier-Colle, M-H

    2012-06-01

    The organization of obstetric care in France brings all women in contact with the hospital system. Thus, hospital discharge data from the Program of Medicalization of the Information System (PMSI) constitute a potentially valuable source of information, particularly regarding rare events such as severe maternal morbidity. These data cover a large population but their quality has not been assessed in that field. Our objectives were to study the processes of production and the validity of PMSI data related to severe maternal morbidity. The study was conducted in four French tertiary teaching hospitals (Caen, Cochin [AP-HP, Paris], Grenoble and Lille). First, the organization of each step of the medical information process -production, formatting, verification and processing- was detailed in each center with a standardized form. Second, the validation study was based on the comparison of data related to severe maternal morbid events in the PMSI from these centers for 2006 and 2007, with the content of medical records which constituted the gold standard. Indicators of sensitivities and positive predictive values of PMSI were calculated. The processes of PMSI data production showed major differences between the four centers. In hospital discharge data, diagnoses (eclampsia and pulmonary embolism) had a high proportion of false-positives (68%). Inversely, procedures (four procedures for management of severe haemorrhage) had less than 1% of false-positives, but a low sensitivity with 37% false-negatives which could be corrected in 95%. Regarding intensive care provision, all indicators of hospital data quality were very high. In addition, the validity of hospital data in centers 1 and 2 was higher for all events. The heterogeneity of the process of PMSI data production is associated with a variable quality of these data. Intensive care provision can be used in the PMSI, as well as procedures after correction. For diagnoses, the quality of the PMSI data is better in

  1. Profile of maternal and foetal complications during labour and delivery among women giving birth in hospitals in Matlab and Chandpur, Bangladesh.

    PubMed

    Huda, Fauzia Akhter; Ahmed, Anisuddin; Dasgupta, Sushil Kanta; Jahan, Musharrat; Ferdous, Jannatul; Koblinsky, Marge; Ronsmans, Carine; Chowdhury, Mahbub Elahi

    2012-06-01

    Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases--either spontaneous or induced--were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh.

  2. Profile of Maternal and Foetal Complications during Labour and Delivery among Women Giving Birth in Hospitals in Matlab and Chandpur, Bangladesh

    PubMed Central

    Ahmed, Anisuddin; Dasgupta, Sushil Kanta; Jahan, Musharrat; Ferdous, Jannatul; Koblinsky, Marge; Ronsmans, Carine; Chowdhury, Mahbub Elahi

    2012-01-01

    Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases—either spontaneous or induced—were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh. PMID:22838156

  3. Association of Maternal Factors with Low Birth Weight in Selected Hospitals of Nepal.

    PubMed

    Shakya, K L; Shrestha, N; Kisiju, P; Onta, S R

    2015-01-01

    The high prevalence of low birth weight remains a major public health problem around the world. Nepal has prevalence of it as high as 21%. Because of poor dietary intake, majorities of Nepalese women have low body mass index and are anaemic that results in poor pregnancy outcome. This hospital based case-control study was carried out in four hospitals of Nepal from August 2012 to September 2013. It sought the association of factors to low birth weight like maternal height, weight, and body mass index, food intake, past history of low birth weight, and preterm delivery. Total sample of 1533 were taken, among them 511 were cases and 1022 were controls. Total of 1533 mothers were interviewed across four hospitals. The study revealed mean height, weight and body mass index of mothers were 150cm (SD:6.6), 49kg (SD:6.8), and 21.5kg/m (SD:3) respectively. On crude odds analysis, mothers with height <145cm had 1.5 times (CI:1.1-2.1), weight <45kg had 2.4 times (CI:1.9-3.1), body mass index <18.5kg/m 2 2 had 2.2 times (CI:1.6-2.9), food taken <2 times had 2 times (CI:1.4-2.9) higher chance of delivering low birth weight babies respectively. On adjusted OR analysis, height <145cm (AOR=0.5, CI:0.3-0.9); weight <45kg (AOR=0.5, CI:0.3-1.0) history of low birth weight (AOR=5.1, CI:2.1-12.8) were associated to current low birth weight. The study concluded that the chances of delivering low birth weight were higher among mothers who are thin, short, low body mass index, less food intake, had history on low birth weight and preterm birth. Among them, a past history on low birth weight was the strongest predictor in this study.

  4. Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon.

    PubMed

    Djomhou, Manuella; Sobngwi, Eugene; Noubiap, Jean Jacques N; Essouma, Mickael; Nana, Philip; Fomulu, Nelson J

    2016-08-22

    Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. A prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers' clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70-29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series.

  5. Maternal and foetal outcome of 206 high risk pregnancy cases in border guard hospital, dhaka.

    PubMed

    Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S

    2015-04-01

    This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post

  6. Prenatal lead exposure and relationship with maternal exposure determinants in a public maternity hospital of La Plata, Argentina.

    PubMed

    Martins, Enrique; Varea, Ana; Apezteguía, María; González, Horacio F; Girardelli, Ana; Caro, Laura Sanchez; Lobisuto, Mario; Delgado, Griselda; Disalvo, Liliana

    2014-03-01

    Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning.

  7. Transfer from primary maternity unit to tertiary hospital in New Zealand - timing, frequency, reasons, urgency and outcomes: Part of the Evaluating Maternity Units study.

    PubMed

    Grigg, Celia P; Tracy, Sally K; Tracy, Mark; Schmied, Virginia; Monk, Amy

    2015-09-01

    to examine the transfers from primary maternity units to a tertiary hospital in New Zealand by describing the frequency, timing, reasons and outcomes of those who had antenatal or pre-admission birthplace plan changes, and transfers in labour or postnatally. mixed methods prospective (concurrent) cohort study, which analysed transfer and clinical outcome data (407 primary unit cohort, 285 tertiary hospital cohort), and data from the six week postpartum survey (571 respondents). well, pregnant women booked to give birth in a tertiary maternity hospital or primary maternity unit in one region in New Zealand (2010-2012). All women received midwifery continuity of care, regardless of their intended or actual birthplace. fewer than half of the women who planned a primary unit birth gave birth there (191 or 46.9%). A change of plan may have been made either antenatally or before admission in labour; and transfers were made after admission to the primary unit in labour or during the postnatal stay (about 48 hours). Of the 117 (28.5%) planning a primary unit birth who changed their planned birthplace type antenatally 73 (62.4%) were due to a clinical indication. Earthquakes accounted for 28.1% of birthplace change (during the research period major earthquakes occurred in the study region). Most (73.8%) labour changes occurred before admission in labour to the primary unit. For the 76 women who changed plan at this stage the most common reasons to do so were a rapid labour (25.0%) or prolonged rupture of membranes (23.7%). Transfers in labour from primary unit to tertiary hospital occurred for 27 women (12.6%) of whom 26 (96.3%) were having their first baby. "Slow progress" of labour accounted for 21 (77.8%) of these and 17 (62.9%) were classified as 'non-emergency'. The average transfer time for 'emergency' transfers was 58 minutes. The average time for all labour transfers from specialist consultation to birth was 4.5 hours. Nine postnatal transfers (maternal or neonatal

  8. Lichenized and lichenicolous fungi from the Albanian Alps (Kosovo, Montenegro)

    PubMed Central

    Strasser, Eva A.; Hafellner, Josef; Stešević, Danijela; Geci, Fehmi; Mayrhofer, Helmut

    2016-01-01

    396 taxa (381 species) of lichenized and 45 species of lichenicolous fungi from the upper montane, subalpine and alpine belts of the Albanian Alps (= Prokletije Mountain Range, Bjeshkët e Nemuna) are presented. 92 lichenized and 26 lichenicolous fungi are new to Montenegro, 165 lichenized and 24 lichenicolous fungi are new to Kosovo, and 25 lichenized fungi (23 species) are new for the Balkan Peninsula. PMID:26869727

  9. The Albanian National Question and the Myth of Greater Albania

    DTIC Science & Technology

    2013-03-01

    Greater Serbia and Greater Greece.72 Moreover, Albanians have never lived in one state except for a short period during the Fifteenth Century ...no reason to disregard it unnecessarily. — Robert Vansittart, British Foreign Office1 In the late 19th Century Western geographers “condemned...particularly punished, especially during the late 19th century and 20th century . Their history is 2 characterized by the Great Powers unjust

  10. The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence syndrome.

    PubMed

    Wachman, Elisha M; Newby, P K; Vreeland, Joy; Byun, John; Bonzagni, Anthony; Bauchner, Howard; Philipp, Barbara L

    2011-12-01

    To examine the relationship between maternal opioid agonists, methadone, or buprenorphine (BPH), and concurrent psychiatric medication use on length of hospitalization (LOS) among infants with neonatal abstinence syndrome (NAS). We reviewed the charts of infants born at Boston Medical Center between 2003 and 2009 with a diagnosis of NAS whose mothers were prescribed methadone or BPH for opiate addiction. Univariate and multivariate linear regression analyses were used to examine associations between maternal opioid substitution concurrent with psychiatric medication use and infant LOS. We also tested whether exposure to BPH was associated with a shorter hospitalization. A total of 273 mother-infant pairs were identified. The average LOS for all infants was 22.9 days (SD: 10.9). In bivariate analyses, maternal use of any psychiatric medication was associated with a longer infant LOS (P < 0.005). Compared with those prescribed methadone alone (n = 158), those also taking benzodiazepines (n = 56) had a 5.88-day longer LOS (95% confidence interval [CI]: 2.15-9.60, P = 0.002). Infants of mothers taking methadone plus an selective serotonin re-uptake inhibitor (n = 51) had a longer LOS (β = 4.47, 95% CI: 1.15-7.79) compared to methadone alone; results remained significant in an initial multivariate model, however the effect was attenuated when additional psychiatric medication use was added to the model. Compared with those exposed to methadone, those exposed to BPH (n = 22) had a significantly shorter LOS (ß = -7.35, CI: -0.18 to -14.52, P = 0.04). Maternal use of prescribed methadone and benzodiazepines, compared to methadone alone, increased LOS for infants with NAS by 6 days. Maternal use of BPH was associated with a shorter LOS.

  11. Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan.

    PubMed

    Abdelaziz, Zeinab A; Ibrahim, Mutasim E; Bilal, Naser E; Hamid, Mohamed E

    2014-04-15

    Microbial infections of the vagina in pregnant women are health problems that lead to serious medical complications and consequences. This study aimed to investigate and determine antimicrobial susceptibilities of the causative agents of vaginal infections in pregnant women. A cross-sectional study of pregnant women (n = 200) was conducted between August and December 2008 at Omdurman Maternity Hospital, Khartoum, Sudan. Vaginal and cervical swabs were obtained from each subject and processed for isolation and identification of pathogenic microorganisms using standard methods of wet mount preparation, direct Gram smear, Nugent scoring system, direct immunofluorescence, and cultural techniques. Antimicrobial susceptibility testing of bacterial isolates was performed using standard procedures. Statistical analysis was done using SPSS program version 12.0.1. A p value < 0.05 was considered statistically significant. Of the 200 pregnant women enrolled, BV was detected in 49.8%, followed by Chlamydia trachomatis (31.3%) and Candida albicans (16.6%), with low frequencies of Neisseria gonorrhoeae (1.8%) and Trichomonas vaginalis (0.5%). Higher infection rates were recorded among subjects in the third trimester (71.6%) than in the second trimester of gestation (28.4%). No significant association (p = 0.7) between history of abortions and C. trachomatis infections was found. Gentamicin was the most active agent against Gram-positive and Gram-negative bacteria. Clarythromycin was the most active against Mycoplasma species. Pregnant women with vaginal complaints revealed various positive microbiology results. Such cases may require specific medication. Routine culture of vaginal and cervical samples should be performed on all pregnant women during prenatal visits.

  12. Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur.

    PubMed

    Tee E Siong; Kandiah, M; Ali, J; Kandiah, V; Zahari, M R; Kuladevan, R; Hamzah, Z

    1984-06-01

    The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their 3rd trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40% of the women could be considered anemic; approximately 50% of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9% had low serum folate levels; and about 30% may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD). The mean gestational age was 38.6 weeks. One of the infants had a birth weight of 2.0 kg; incidence of low birth weight, 2.5 kg, was 8.3%. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1-3 and 4 parity groups, these differences were not statistically significant.

  13. Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal.

    PubMed

    Wrammert, Johan; Sapkota, Sabitri; Baral, Kedar; Kc, Ashish; Målqvist, Mats; Larsson, Margareta

    2017-06-01

    The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation. Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  14. [Reminiscence on the municipal out-of-hospital maternity unit and the motherhood home in Novi Sad].

    PubMed

    Dobanovacki, Dusanka; Breberina, Milan; Vujosević, Bozica; Pećanac, Marija; Zakula, Nenad; Trajković, Velicko

    2013-01-01

    In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

  15. Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer

    PubMed Central

    Slusher, Tina M.; Imosemi, Donald O.; Emokpae, Abieyuwa A.

    2017-01-01

    Background Mothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life. Methods Prior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby’s nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression. Results Some 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™. Conclusions Bilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice

  16. Public and private maternal health service capacity and patient flows in Southern Tanzania: using a geographic information system to link hospital and national census data.

    PubMed

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-01-01

    Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase

  17. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data.

    PubMed

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-12-01

    Background Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. Objective To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. Design A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. Results The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. Conclusions We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health

  18. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study

    PubMed Central

    Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo

    2015-01-01

    Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018

  19. Pregnancy outcome at advanced maternal age in a group of African women in two teaching Hospitals in Yaounde, Cameroon.

    PubMed

    Ngowa, Jean Dupont Kemfang; Ngassam, Anny-Nadege; Dohbit, Julius Sama; Nzedjom, Celestine; Kasia, Jean Marie

    2013-01-01

    Women older than 40 years have been termed "advanced maternal age" and considered to be at risk of adverse pregnancy outcome. This study aimed to examine the obstetrical outcomes among primiparous and multiparous African advanced maternal age women. We conducted a retrospective cohort study study at two teaching hospitals at Yaounde, Cameroon. From the hospital records, obstetrical characteristics of 585 consecutive women aged 40 or above who delivered from January 2007 to December 2011 were compared with those of 1816 younger mothers aged 20 to 29 years as control cases. Associations between maternal age and selected obstetrical variables were assessed with the contigency X (2) test or two-tailed Fisher exact test. Primiparous and multiparous advanced maternal age were more likely to undergo cesarean delivery than were their younger counterparts (38.5% vs 13.5%, RR=2.85, p<0.05 and 16.1% vs 9.1%, RR=1.76, p<0.05). Older primiparous women had similar perinatal outcomes than their younger counterparts. Older multiparous women had increased incidence of preeclampsia/eclampsia (2.4% vs 0.6%, RR=4, p<0.01); antepartum hemorrhage (1.8% vs 0.8%, RR=2.25, p<0.01); fetal distress (3.5% vs 1.3%, RR=2.69, p<0.01); fetal death (3.5% vs 1.6%, RR= 2.18, p<0.05); postpartum hemorrhage (2.4% vs 1.2%; RR=2, p<0.05); preterm delivery (12% vs 9.2%, RR=1.30, p<0.05); low birth weight (11% vs 7.7%, RR=1.42, p<0.05); admission to special care neonatalogy unit(14.1% vs 10.2%, RR=1.38, p<0.05); low Apgar scores at 1min and 5min; and perinatal mortality (3.5% vs 1.6, RR=2.18, p<0.05). Advanced maternal age women are at higher risk to cesarean delivery. Increased risk of antepartum and intra partum complications among multiparous advanced maternal age women were associated to adverse perinatal outcome. Our results are in concordance with the view that increased risk of adverse perinatal outcome with advanced maternal age is indirectly related to age through the increased risk of

  20. [Analysis of maternal mortality during three periods at Hospital de Ginecología y Obstetricia del Centro Médico Nacional de Occidente].

    PubMed

    Angulo Vázquez, José; Cortés Sanabria, Laura; Torres Gómez, Luís Guillermo; Aguayo Alcaraz, Guadalupe; Hernández Higareda, Salvador; Avalos Nuño, Joel

    2007-07-01

    Most of deceases due to pregnancy, delivery, puerperium and them attention are avoidable with current medicine resources. To analyze some basic elements of epidemiologic behavior of a hospital environment maternal mortality in a third level hospital during a period of 21 years. Analytical cross-sectional study, 222 maternal deaths registered at Hospital de Ginecologia y Obstetricia, Centro Medico Nacional de Occidente del Instituto Mexicano del Seguro Social, were included, during the period 1985-2005. Deaths were analyzed in three periods of 7 years each one. The analysis of results was made based on descriptive statistic. chi2 was used for comparison between periods. Maternal death ratio was 73 per 100,000 live births during the 21 years. Maternal mortality was lower in the group of women under 20 years and increase agreed maternal age. Frequency of direct obstetric deaths decreased when comparing the 3 periods. The main causes of maternal death were preeclampsia/eclampsia and obstetric hemorrhage, which were responsible for almost 50% of maternal deaths. There was no significant difference to anticipation by comparing periods, between 28 and 37% of deaths were foreseen. 98% of deaths occurred at Intensive Care Units. Direct and indirect maternal deaths show very similar values in the third period, which translates in an improvement in anticipation. It must be reinforce the simple and opportune information to the patient with regard to warning signs and the permanent medical training must be a priority at the 3 medical levels.

  1. [Hospital maternal mortality: causes and consistency between clinical and autopsy diagnosis at the Northeastern Medical Center of the IMSS, Mexico].

    PubMed

    Calderón-Garcidueñas, Ana Laura; Martínez-Salazar, Griselda; Fernández-Díaz, Héctor; Cerda-Flores, Ricardo M

    2002-02-01

    The aim was to study the causes of maternal mortality (MM) and the percent of concordance between the clinical diagnosis and the autopsy findings. The autopsies of maternal death (1980-1999) from the Hospital de Especialidades, Centro Médico del Noreste, IMSS in Monterrey, México, were analyzed. The cases were classified in directly obstetric maternal mortality (DOM) and indirectly obstetric maternal mortality (IOM), the causes were studied and the percent of concordance between pre- and post-mortem diagnosis was determined. There were 124 deaths. Autopsy was performed in 61 (49.1%) women. In 55 cases the clinical file and the autopsy protocol were available. This was our sample for study. Sixty percent of the cases were DO. Causes of DOM were: specific hypertensive pregnancy disease (SHPD) (51.6%), sepsis (35.5%), hypovolemic shock (9.7%), anesthetic accidents (3%); causes of IOM were: sepsis (41.7%), malignancies (16.7%), hematological diseases (12.5%), cardiopathy and systemic arterial hypertension (12.5%), hepatic disorders (12.5%), and Superior Longitudinal Sinus thrombosis (4%). A 100% clinical-pathological concordance was observed in DOM cases, while only a 41.6% was found in IOM cases. In those cases of sepsis (IOM), the etiologic agents were identified only in 20% before death. The early detection and treatment of SHPD and the prevention of sepsis should decrease the MM. This study showed some weakness in the Health Services that should be improved.

  2. Language Policy, Ethnic Conflict, and Conflict Resolution: Albanian in the Former Yugoslavia

    ERIC Educational Resources Information Center

    Duncan, Daniel

    2016-01-01

    The 1990s disintegration of Yugoslavia was marked by vicious ethnic conflict in several parts of the region. In this paper, I consider the role of policy towards the Albanian language in promoting and perpetuating conflict. I take three case studies from the former Yugoslavia in which conflict between ethnic Albanians and the dominant group…

  3. A Cross-Cultural Study of Differences in Romantic Attitudes between American and Albanian College Students

    ERIC Educational Resources Information Center

    Hoxha, Eneda; Hatala, Mark N.

    2012-01-01

    Cross-cultural differences in romantic attitudes are often taken for granted and accepted. However, very little research has been conducted to clearly state how much and how different Albanian and American college students are in the way they love. Results indicate that Americans are more romantic than Albanians. In addition, Americans are more…

  4. A Cross-Cultural Study of Differences in Romantic Attitudes between American and Albanian College Students

    ERIC Educational Resources Information Center

    Hoxha, Eneda; Hatala, Mark N.

    2012-01-01

    Cross-cultural differences in romantic attitudes are often taken for granted and accepted. However, very little research has been conducted to clearly state how much and how different Albanian and American college students are in the way they love. Results indicate that Americans are more romantic than Albanians. In addition, Americans are more…

  5. Language Policy, Ethnic Conflict, and Conflict Resolution: Albanian in the Former Yugoslavia

    ERIC Educational Resources Information Center

    Duncan, Daniel

    2016-01-01

    The 1990s disintegration of Yugoslavia was marked by vicious ethnic conflict in several parts of the region. In this paper, I consider the role of policy towards the Albanian language in promoting and perpetuating conflict. I take three case studies from the former Yugoslavia in which conflict between ethnic Albanians and the dominant group…

  6. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    PubMed

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

  7. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

    PubMed Central

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

  8. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

    PubMed Central

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. Main outcome measures The culture of care in an Afghan maternity hospital. Results A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment. Conclusions Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. PMID:25394518

  9. The dilemma of a practice: experiences of abortion in a public maternity hospital in the city of Salvador, Bahia.

    PubMed

    McCallum, Cecilia; Menezes, Greice; Reis, Ana Paula Dos

    2016-01-01

    The article discusses abortion and miscarriage from the perspective of women admitted to a public maternity hospital in Salvador (BA), Brazil. Based on qualitative and quantitative research, it draws on participant observation of everyday hospital life. Taking an ethnographic approach, it addresses the hospital experiences of women who had miscarriages or induced abortions, also presenting the views of health professionals. It argues that the way the institution structures care for abortion and miscarriage involves symbolic processes that profoundly affect women's experiences. The discrimination against women who have had abortions/miscarriages is an integral part of the structure, organization and culture of these institutions, and does not derive solely from the individual actions of healthcare personnel.

  10. Serotypes and antibiotic resistance in Group B streptococcus isolated from patients at the Maternity Hospital, Kuwait.

    PubMed

    Boswihi, Samar S; Udo, Edet E; Al-Sweih, Noura

    2012-01-01

    A total of 143 group B streptococcus (GBS) isolates collected from mothers at the Maternity Hospital in Kuwait were investigated for their serotypes and antibiotic resistance, and screened by PCR for the carriage of genes for resistance to tetracycline (tetk, tetM, tetL, tetO), erythromycin (ermA, ermB, ermC, ermTR, ermM, mefA, mefE, msrA) and aminoglycosides (aph3, ant4, ant6). All isolates were serotyped using a latex agglutination test. Most of the isolates belonged to serotypes V (38.5 %), III (20.9 %), Ia (7.7 %) and II (11.2 %). Sixteen isolates (11.2 %) were nontypable. All isolates were susceptible to penicillin, ampicillin and cefotaxime (MICs 0.016-0.094 µg ml(-1)) but were resistant to trimethoprim (92.3 %), tetracycline (89.5 %), minocycline (89.5 %), high-level kanamycin (76.9 %), chloramphenicol (30.0 %), erythromycin (12.6 %), clindamycin (7.0 %), high-level streptomycin (3.5 %) and ciprofloxacin (0.7 %). The tetracycline-resistant isolates contained tetM (94.5 %), tetO (3.9 %), tetL (1.6 %) and tetK (0.8 %). The erythromycin-resistant isolates contained ermB (61.1 %), ermTR (38.9 %), ermA (5.5 %), mefA (5.5 %) and mefE (11 %). All high-level kanamycin-resistant isolates contained aph3. One of the high-level streptomycin-resistant isolates contained ant6. Partial DNA sequencing of aph3 revealed sequences with 99 % similarity to aph3 found in Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis, suggesting that the GBS isolates could have acquired aph3 from other Gram-positive cocci. The high proportion of isolates with resistance to tetracycline, high-level kanamycin and trimethoprim, and the increase in the prevalence of erythromycin resistance, represents an emerging public health concern that needs further surveillance.

  11. Maternal Chlamydia trachomatis Infections and Preterm Births in a University Hospital in Vitoria, Brazil

    PubMed Central

    Schmidt, Renylena; Muniz, Renan Rosetti; Cola, Elizandra; Stauffert, Dulce; Silveira, Mariangela Freitas; Miranda, Angelica E.

    2015-01-01

    Background Preterm birth (PTB) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTB and premature rupture of membranes. Objetives To evaluate the prevalence of and associated factors for CT among cases of PTB attended at a University Hospital in Vitoria, Brazil. Methods A cross-sectional study performed among parturient who had preterm birth from June 2012 to August 2013 in Vitoria, Brazil. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Chi-square tests were used for proportion differences and Student’s-t tests and variance analysis were used for testing differences between mean values. Odds ratio was used as a measure of association with a 95% confidence interval. Results The prevalence of PTB during the period of the study was 26% and the prevalence of CT among them was 13.9%. A total of 31.6% pregnant women were younger than 25 years old and women infected by CT were even younger than women not infected by CT (p = 0.022). Most of them (76.2%) were married or had a living partner, and CT infection was more frequent among the single ones (p = 0.018); 16.7% of women reported their first sexual intercourse under 14 years old. The causes of prematurity were maternal-fetal in 40.9%; rupture of the membranes in 29.7% and premature labor in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 0.48 (95%CI:0.24–0.97)]. None of the other characteristics were associated with CT infection. Conclusions This study shows a high prevalence of CT infection among parturient who have preterm birth. This high prevalence highlight the need for defining screening strategies focused on young

  12. [The Hospital Information System of the Brazilian Unified National Health System: a performance evaluation for auditing maternal near miss].

    PubMed

    Nakamura-Pereira, Marcos; Mendes-Silva, Wallace; Dias, Marcos Augusto Bastos; Reichenheim, Michael E; Lobato, Gustavo

    2013-07-01

    This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss.

  13. Home or hospital? Midwife or physician? Preferences for maternity care provider and place of birth among Western Australian students.

    PubMed

    Stoll, Kathrin H; Hauck, Yvonne L; Hall, Wendy A

    2016-02-01

    Australian caesarean birth rates have exceeded 30% in most states and are approaching 45%, on average, in private hospitals. Australian midwifery practice occurs almost exclusively in hospitals; less than 3% of women deliver at home or in birthing centres. It is unclear whether the trend towards hospital-based, high interventionist birth reflects preferences of the next generation of maternity care consumers. We conducted a descriptive cross-sectional online survey of 760 Western Australian (WA) university students in 2014, to examine their preferences for place of birth, type of maternity care, mode of birth and attitudes towards birth. More students who preferred midwives (35.8%) had vaginal birth intentions, contested statements that birth is unpredictable and risky, and valued patient-provider relationships. More students who preferred obstetricians (21.8%) expressed concerns about childbirth safety, feared birth, held favourable views towards obstetric technology, and expressed concerns about the impact of pregnancy and birth on the female body. One in 8 students preferred out-of-hospital birth settings, supporting consumer demand for midwife-attended births at home and in birthing centres. Stories and experiences of friends and family shaped students' care provider preferences, rather than the media or information learned at school. Students who express preferences for midwives have significantly different views about birth compared to students who prefer obstetricians. Increasing access to midwifery care in all settings (hospital, birthing centre and home) is a cost effective strategy to decrease obstetric interventions for low risk women and a desirable option for the next generation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  14. Live maternal speech and singing have beneficial effects on hospitalized preterm infants.

    PubMed

    Filippa, Manuela; Devouche, Emmanuel; Arioni, Cesare; Imberty, Michel; Gratier, Maya

    2013-10-01

    To study the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level. Eighteen mothers spoke and sang to their medically stable preterm infants in their incubators over 6 days, between 1 and 2 pm. Heart rate (HR), oxygen saturation (OxSat), number of critical events (hypoxemia, bradycardia and apnoea) and change in behavioural state were measured. Comparisons of periods with and without maternal vocal stimulation revealed significantly greater oxygen saturation level and heart rate and significantly fewer negative critical events (p < 0.0001) when the mother was speaking and singing. Unexpected findings were the comparable effects of maternal talk and singing on infant physiological parameters and the differential ones on infant behavioural state. A renewed connection to the mother's voice can be an important and significant experience for preterm infants. Exposure to maternal speech and singing shows significant early beneficial effects on physiological state, such as oxygen saturation levels, number of critical events and prevalence of calm alert state. These findings have implications for NICU interventions, encouraging maternal interaction with their medically stable preterm infants. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  15. Medical ethnobotany of the Albanian Alps in Kosovo.

    PubMed

    Mustafa, Behxhet; Hajdari, Avni; Krasniqi, Feriz; Hoxha, Esat; Ademi, Hatixhe; Quave, Cassandra L; Pieroni, Andrea

    2012-01-28

    Ethnobotanical studies are crucial in South-Eastern Europe for fostering local development and also for investigating the dynamics of Traditional Environmental Knowledge (TEK) related to plants in one of the most crucial European hotspots for biocultural diversity. The current medico-ethnobotanical survey was conducted in rural alpine communities in Kosovo. The aims of the study were twofold: 1) to document the state of TEK of medicinal plants in these communities; 2) to compare these findings with that of similar field studies previously conducted among local populations inhabiting the Montenegrin and Albanian side of the same Alpine range. Field research was conducted in 36 villages on the Kosovar side of the Albanian Alps. Snowball sampling techniques were used to recruit 91 elderly informants (≥ 50 years-old) for participation in semi-structured interviews and structured surveys regarding the use of the local flora for medicinal and food purposes. Standard ethnobotanical methods were employed and prior informed consent was obtained for all study participants. The uses of 98 plants species belonging to 39 families were recorded; the most quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Mainly decoctions and infusions were quoted as folk medicinal preparations and the most common uses referred to gastrointestinal and respiratory disorders, as well as illnesses of the uro-genital system. Among the most uncommon medicinal taxa quoted by the informants, Carduus nutans L., Echinops bannaticus Rochel ex Schrad., and Orlaya grandiflora Hoffm. may merit phytochemical and phytopharmacological investigations.Comparison of the data with other ethnobotanical field studies recently conducted on the Albanian and Montenegrin sides of the same Alps has shown a remarkable link between the medical ethnobotany of Montenegrin and Kosovar side of the Albanian Alps. Moreover, folk uses of the most quoted wild medicinal taxa recorded in Kosovo often include those

  16. Medical ethnobotany of the Albanian Alps in Kosovo

    PubMed Central

    2012-01-01

    Background Ethnobotanical studies are crucial in South-Eastern Europe for fostering local development and also for investigating the dynamics of Traditional Environmental Knowledge (TEK) related to plants in one of the most crucial European hotspots for biocultural diversity. The current medico-ethnobotanical survey was conducted in rural alpine communities in Kosovo. The aims of the study were twofold: 1) to document the state of TEK of medicinal plants in these communities; 2) to compare these findings with that of similar field studies previously conducted among local populations inhabiting the Montenegrin and Albanian side of the same Alpine range. Methods Field research was conducted in 36 villages on the Kosovar side of the Albanian Alps. Snowball sampling techniques were used to recruit 91 elderly informants (≥ 50 years-old) for participation in semi-structured interviews and structured surveys regarding the use of the local flora for medicinal and food purposes. Standard ethnobotanical methods were employed and prior informed consent was obtained for all study participants. Results and Conclusion The uses of 98 plants species belonging to 39 families were recorded; the most quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Mainly decoctions and infusions were quoted as folk medicinal preparations and the most common uses referred to gastrointestinal and respiratory disorders, as well as illnesses of the uro-genital system. Among the most uncommon medicinal taxa quoted by the informants, Carduus nutans L., Echinops bannaticus Rochel ex Schrad., and Orlaya grandiflora Hoffm. may merit phytochemical and phytopharmacological investigations. Comparison of the data with other ethnobotanical field studies recently conducted on the Albanian and Montenegrin sides of the same Alps has shown a remarkable link between the medical ethnobotany of Montenegrin and Kosovar side of the Albanian Alps. Moreover, folk uses of the most quoted wild medicinal

  17. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital

    PubMed Central

    Teixeira, Marina Parca Cavelagna; Queiroga, Tatiana Peloso Reis; Mesquita, Maria dos Anjos

    2016-01-01

    ABSTRACT Objective: To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. Methods: This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. Results: There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). Conclusion: In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. PMID:27759818

  18. Can managers empower nurse-midwives to improve maternal health care? A comparison of two resource-poor hospitals in Tanzania.

    PubMed

    Tibandebage, Paula; Kida, Tausi; Mackintosh, Maureen; Ikingura, Joyce

    2016-10-01

    Maternal mortality is very high in Tanzania. Competent hospital care is key to improving maternal outcomes, but there is a crisis of availability and performance of health workers in maternal care. This article uses interviews with managers, nurse-midwives, and women who had given birth in two hospitals providing virtually all the emergency maternal care in one Tanzania city. It contrasts women's experience in the two hospitals, and analyses interconnections with nurse-midwives' and managers' experiences of working conditions. The conceptual literature on nurse empowerment identifies some key explanatory variables for these contrasts. Staff experienced less frustration and constraint in one of the hospitals; had more access to structurally empowering resources; and experienced greater congruence between job commitment and working culture, resulting in better work engagement. Conversely, nurse-midwives in the other hospital were constrained by supply shortages and recurrent lack of support. Contrasting management styles and their impacts demonstrate that even in severely resource-constrained environments, there is room for management to empower staff to improve maternal care. Empowering management practices include participatory management, supportive supervision, better incentives, and clear leadership concerning ward culture. Structural constraints beyond the capacity of health facility managers must however also be addressed. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

  19. [Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA].

    PubMed

    Diniz, Normélia Maria Freire; Gesteira, Solange Maria Dos Anjos; Lopes, Regina Lúcia Mendonça; Santos Mota, Rosana; Pérez, Bárbara Angélica Gómez; Gomes, Nadirlene Pereira

    2011-01-01

    Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.

  20. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing

    PubMed Central

    Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

    2017-01-01

    Abstract In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications. From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons. The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011. After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia

  1. Maternal and foetal risk factor and complication with immediate outcome during hospital stay of very low birth weight babies.

    PubMed

    Mannan, M A; Jahan, N; Dey, S K; Uddin, M F; Ahmed, S

    2012-10-01

    This prospective study was done to find out the maternal and foetal risk factors and complications during hospital stay. It was conducted in Special Care Neonatal Unit (SCANU), Department of Child Health, Bangabandhu Memorial Hospital (BBMH), University of Science and Technology Chittagong (USTC) from1st October 2001 to 30th March 2002 and cases were 35 very low birth weight (VLBW) newborns. Common complications of VLBW babies of this series were frequent apnea (40%), Septicemia (25.71%), Hypothermia (17.14%), NEC (14.28%), Convulsion (11.43%), Hyper-bilirubinaemia (8.57%), Anemia (5.71%), IVH (5.71%), RDS (2.86%), HDN (2.86%), CCF (2.86%), ARF (2.86%), either alone or in combination with other clinical conditions. Newborns 62.86% male, 37.14% female & their mortality rate were 40.91% & 38.46% respectively; Preterm 88.57% & their mortality (41.93%) were higher than term babies (25.00%); AGA 62.86%, SGA 37.14% & mortality rate of AGA babies (45.46%) were higher than of SGA (30.77%) babies. The mortality rate of VLBW infants of teen age (≤ 18 years) mothers (57.14%) & high (≥ 30 years) aged mothers (50.00%) were higher than average (19-26 yrs) maternal age mothers (33.33%). Mortality rate was higher among the babies of primi (41.67%) than multiparous (36.36%), poor socioeconomic group (53.33%) than middle class (30.00%) & mothers on irregular ANC (47.83%) than regular ANC (25.00%). It has been also noted the mortality rate of home delivered babies (50.00%) higher than institutional delivered (34.78%) babies; higher in LUCS babies (46.15%) than normal vaginal delivered babies (31.58%); higher in the babies who had antenatal maternal problem (48.15%) than no maternal problems babies (12.50%); higher in the babies who had fetal distress (50.00%) and twin (46.67%) than no foetal risk factors (28.57%) during intrauterine life; higher in the babies who had problems at admission (46.67%) than no problems (35.00%); and mortality higher in twin (46.67%) than singleton

  2. Breastfeeding Resources in Maternity Hospitals and Birth Centers in the Commonwealth of Massachusetts (USA): A Content Analysis of Discharge Packets.

    PubMed

    Eshelman, Jill; Edwards, Roger A; Ghiringhelli, Kara; Mainello, Kristen; Colchamiro, Rachel; Forgit, Julie; Tolan, Ellen; Nordstrom, Christina

    2015-11-01

    Few studies have analyzed patient education materials provided at discharge. To the best of our knowledge, there are no comprehensive studies analyzing and reporting the content of breastfeeding discharge packets within the United States. This study analyzed the extent to which patient education materials provided at discharge from maternity facilities in Massachusetts cover topics that support successful breastfeeding. We collected discharge packets from all 48 maternity hospitals/birth centers. Topics for analysis were based on recommendations associated with the Baby-Friendly Hospital Initiative and content identified for discharge packets generally. Materials were reviewed independently and scored according to 39 criteria that we assembled from various sources for optimal breastfeeding information at discharge. Bivariate and multivariate analyses were used to explore if any hospital characteristics predicted presence of breastfeeding education topics in written information provided at discharge. An average of 25.4 of 39 criteria (65.2%, ranging from 30.7%-97.4%) were included in packets submitted by all 48 facilities. Exploratory multivariate analyses did not show relationships of hospital characteristics to contents of packets. Each facility received a 2-page report noting strengths, suggestions for improvement, and individual scores on all 39 criteria. Discharge packet contents varied widely; whereas some institutions' information met and/or exceeded recommended content, others were limited and/or missing information. These analyses provide a thorough review of discharge packet content for all facilities in Massachusetts; however, further study is needed to identify the implications of such variation for breastfeeding outcomes. © The Author(s) 2015.

  3. Maternal/child seroprevalence of antibodies against Treponema pallidum at four general hospitals in the state of Morelos, Mexico.

    PubMed

    Yáñez-Alvarez, Irais; Conde-González, Carlos J; Uribe-Salas, Felipe J; Olamendi-Portugal, Ma L; García-Cisneros, Santa; Sánchez-Alemán, Miguel A

    2012-10-01

    Treponema pallidum can cause syphilis in pregnant women and congenital syphilis in the newborn. In Latin America, 330,000 pregnant women are diagnosed with syphilis every year. Adequate prenatal care to detect syphilis reduces maternal morbidity and fetal and neonatal mortality and morbidity. We undertook this study to determine T. pallidum seroprevalence among pregnant and puerperal women from Morelos, Mexico, as well as to evaluate the sexual behavior, demographic and clinical variables associated with the infection. A cross-sectional study was carried out among pregnant and puerperal women from four general hospitals from Morelos, Mexico during 2005-2009. Women answered a questionnaire and provided a blood sample to detect antibodies against T. pallidum. A total of 2331 women were analyzed with 0.26% of T. pallidum seroprevalence. There were four cases with active syphilis and two cases with latent syphilis, as well as two cases of congenital syphilis. Illiterate women had 6.7 times higher risk of being infected. Women who did not undergo a urine test had a 5.3 times higher risk for infection and women who do not have piped water inside their household had a 5.0-fold higher risk of having anti-T. pallidum antibodies. All seropositive cases were from the same hospital (Cuautla General Hospital) with demographic, sexual behavior and medical care characteristics different from the other three hospitals. Syphilis during pregnancy and congenital syphilis are still present in Mexico. It may be that the more urban a population the higher the chance of the prevalence of maternal syphilis. It would be beneficial to reinforce the observance of the Official Mexican Norm and to implement rapid diagnostics tests to contend with this public health problem. Copyright © 2012 IMSS. Published by Elsevier Inc. All rights reserved.

  4. Early pushing urge in labour and midwifery practice: a prospective observational study at an Italian maternity hospital.

    PubMed

    Borrelli, Sara E; Locatelli, Anna; Nespoli, Antonella

    2013-08-01

    to investigate the early pushing urge (EPU) incidence in one maternity unit and explore how it is managed by midwives. The relation to some obstetric outcomes was also observed but not analysed in depth. prospective observational study. Italian maternity hospital. 60 women (44 nullips and 16 multips) experiencing EPU during labour. the total EPU incidence percentage was 7.6%. The single midwives' incidences range had a very wide margin, noting an inverse proportion between the number of diagnoses of EPU and midwife's waiting time between urge to push and vaginal examination. Two care policies were adopted in relation to the phenomenon: the stop pushing technique (n=52/60) and the 'let the woman do what she feels' technique (n=8/60). In case of stop pushing techniques, midwives proposed several combined techniques (change of maternal position, blowing breath, vocalisation, use of the bath). The EPU diagnosis at less than 8cm of cervical dilatation was associated with more medical interventions. Maternal and neonatal outcomes were within the range of normal physiology. An association between the dilatation at EPU diagnosis and obstetric outcomes was observed, in particular the modality of childbirth and perineal outcomes. this paper contributes new knowledge to the body of literature around the EPU phenomenon during labour and midwifery practices adopted in response to it. Overall, it could be argued that EPU is a physiologic variation in labour if maternal and fetal conditions are good. Midwives might suggest techniques to woman to help her to stay with the pain, such as change of position, blowing breath, vocalisation and use of the bath. However, the impact of policies, guidelines and culture on midwifery practices of the specific setting are a limitation of the study because it is not representative of other similar maternity units. Thus, a larger scale work should be considered, including different units and settings. The optimal response to the phenomenon

  5. Characteristics of RSV-Specific Maternal Antibodies in Plasma of Hospitalized, Acute RSV Patients under Three Months of Age

    PubMed Central

    Widjaja, Ivy; Ahout, Inge M. L.; de Groot, Ronald; Guichelaar, Teun; Luytjes, Willem; de Jonge, Marien I.; de Haan, Cornelis A. M.; Ferwerda, Gerben

    2017-01-01

    Respiratory syncytial virus (RSV) is the leading cause for respiratory illness that requires hospitalization in infancy. High levels of maternal antibodies can protect against RSV infection. However, RSV-infected infants can suffer from severe disease symptoms even in the presence of high levels of RSV-specific antibodies. This study analyzes several serological characteristics to explore potential deficiencies or surpluses of antibodies that could relate to severe disease symptoms. We compare serum antibodies from hospitalized patients who suffered severe symptoms as well as uninfected infants. Disease severity markers were oxygen therapy, tachypnea, oxygen saturation, admission to the intensive care unit and duration of hospitalization. Antibodies against RSV G protein and a prefusion F epitope correlated with in vitro neutralization. Avidity of RSV-specific IgG antibodies was lower in RSV-infected infants compared to uninfected controls. Severe disease symptoms were unrelated to RSV-specific IgG antibody titers, avidity of RSV-IgG, virus neutralization capacity or titers against pre- and postfusion F or G protein ectodomains and the prefusion F antigenic site Ø. In conclusion, the detailed serological characterization did not indicate dysfunctional or epitope-skewed composition of serum antibodies in hospitalized RSV-infected infants suffering from severe disease symptoms. It remains unclear, whether specific antibody fractions could diminish disease symptoms. PMID:28135305

  6. Spatial Changes and Population Movements on the Albanian Coastline

    NASA Astrophysics Data System (ADS)

    Kanjir, U.; Gregorič Bon, N.

    2016-06-01

    The last decade has seen a large increase in construction along the southern Albanian coastline, mainly in the rise of large tourist complexes comprising hotels, apartment houses, touristic villages, and so on. These constructions rarely follow urban planning and not only change its landscape but also often threaten the ecological value of the coastal zone. The uncontrolled and devastating construction along the coast has been accompanied by coastal erosion caused by the sea with the intensity up to 50 cm/year. This paper investigates the environmental change monitoring on the Albanian Riviera by analysing optical remote sensing data (Landsat 5 and 8) in the period between 1984 and 2015. The image analysis results grounded on the change vector analysis indicate coastal morphology changes and land cover changes in the coastal environment, which appear mostly due to erosion in river delta and urban growth. Apart from identifying both phenomena through time, the objective of this study is to show that these landscape changes in fact correlate with the population migration as well as to explain why and the extent to which Albania is one of the most migratory countries in Europe. Based on the multidisciplinary research, which combines anthropological method with spatial analysis, this presentation anticipates future changes in this area. It argues that movements of both people and in landscape formations strongly influence each other, constituting a closely corresponding relationship.

  7. Patient assessments of hospital maternity care: a useful tool for consumers?

    PubMed Central

    Finkelstein, B S; Harper, D L; Rosenthal, G E

    1999-01-01

    OBJECTIVE: To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences. DATA SOURCES/STUDY SETTING: Surveys that were mailed to 27,674 randomly selected patients admitted to 18 hospitals in a large metropolitan region (Northeast Ohio) for labor and delivery in 1992-1994. We received completed surveys from 16,051 patients (58 percent response rate). STUDY DESIGN: Design was a repeated cross-sectional study. DATA COLLECTION: Surveys were mailed approximately 8 to 12 weeks after discharge. We used three previously validated scales evaluating patients' global assessments of care (three items)as well as assessments of physician (six items) and nursing (five items) care. Each scale had a possible range of 0 (poor care) to 100 (excellent care). PRINCIPAL FINDINGS: Patient assessments varied (p<.001) across hospitals for each scale. Mean hospital scores were higher or lower (p<.01) than the sample mean for seven or more hospitals during each year of data collection. However, within individual hospitals, mean scores were reproducible over the three years. In addition, relative hospital rankings were stable; Spearman correlation coefficients ranged from 0.85 to 0.96 when rankings during individual years were compared. Patient characteristics (age, race, education, insurance status, health status, type of delivery) explained only 2-3 percent of the variance in patient assessments, and adjusting scores for these factors had little effect on hospitals' scores. CONCLUSIONS: The findings indicate that patient assessments of care may be a sensitive measure for discriminating among hospitals. In addition, hospital scores are reproducible and not substantially affected by case-mix differences. If our findings regarding patient assessments are generalizable to other patient

  8. Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

    PubMed

    Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

    2015-11-01

    Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

  9. Evaluation of Maternal Complications in Severe Preeclampsia in a University Hospital in Tirana

    PubMed Central

    Ndoni, Eriseida; Hoxhallari, Redi; Bimbashi, Astrit

    2016-01-01

    BACKGROUND: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality. AIM: To evaluate maternal complications associated with severe preeclampsia. METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001), HELLP syndrome (2.4% vs. 11.0%; P < 0.001), stroke (0.5% vs 1.9%, P = 0.105) pulmonary edema (0.25% vs. 1.3%, P = 0.0035), renal failure (0.9% vs. 2.6%, P = 0.107), admission in ICU (19.5% vs. 71.4%, P = 0.007), caesarean section rates (55.5% vs. 77%, P = 0.508), placental abruption (4.3% vs. 7.8%, P = 0.103) and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628). CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications. PMID:27275340

  10. [Presence of the rotavirus antigen in newborn infants at maternity hospitals in Moldavia].

    PubMed

    Avram, G; Constantiniu, S; Combiescu, A A; Perşu, A; Mihai, A; Alexandru, D; Macovei, V; Zavate, O

    1988-01-01

    Studies conducted on 417 feces samples collected from newborn infants from seven maternity homes revealed the presence of rotavirus in 1.2 to 9.5% of the subjects. The infants get infection during the first 24 to 48 hours of life (1.8%) and the positivity rate reaches a peak the 7th day (9.7%). Enteroviruses were found in 3.4% and enterobacteria in 11.8% of the samples.

  11. Determinants of maternal near miss among women in public hospital maternity wards in Northern Ethiopia: A facility based case-control study.

    PubMed

    Mekango, Dejene Ermias; Alemayehu, Mussie; Gebregergs, Gebremedhin Berhe; Medhanyie, Araya Abrha; Goba, Gelila

    2017-01-01

    In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. "Maternal near miss" (MNM), defined by the World Health Organization (WHO) as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia. Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6) public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage) were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression ("odds ratio") analyses were calculated at 95% CI. Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37-41 weeks. Among cases, severe obstetric hemorrhage (44.7%), hypertensive disorders (38.8%), dystocia (17.5%), sepsis (9.7%) and severe anemia (2.9%) were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2.5;95%CI:1

  12. An Analysis of United States-Albanian Security Relations in Light of the War on Terrorism

    DTIC Science & Technology

    2004-12-01

    between Albania and Allied governments.80 77 The Albanian representative in Caserta, Mr. Kadri Hoxha...Nationalist Leader (Gani Kryeziu ) opposed to Hoxha; a Greek minister of press had claimed Northern Epirus (Southern Albania) and forces of a rightist

  13. Social psychological predictors of satisfaction with intrapartum and postpartum care – what matters to women in Czech maternity hospitals?

    PubMed Central

    Seidlerová, Jitka Mlíková; Šulová, Lenka; Hoskovcová, Simona Horáková

    2015-01-01

    Objective To identify the social psychological factors affecting women’s evaluation of care provided in Czech maternity hospitals using following criteria: satisfaction with intrapartum and postpartum care, willingness to return to a given hospital and to recommend the hospital to others. Methods 762 women completed a 71-item original Czech questionnaire KLI-P designed to measure the psychosocial climate in both delivery and after-birth unit on six scales. The sample was representative of the Czech parturients population. Multivariate logistic regression was used to investigate the predictive value of the questionnaire scales for maternal satisfaction, willingness to return to and to recommend a given hospital. Results For delivery unit, the satisfaction predictors were: helpfulness and empathy of midwives (Χ2=48.9), communication of information and availability of caregivers (Χ2=16.6), helpfulness and empathy of physicians (Χ2=10.9), symmetrical and respectful attitude of staff members (Χ2=9.7) and physical comfort and services (Χ2=7.6). The predictors of satisfaction with after-birth unit included helpfulness and empathy of the staff (Χ2≥42.1), communication of information and availability of caregivers (Χ2=52.5), physical comfort and services (Χ2=30.6), control and involvement in decision-making (Χ2=6.6) and parity (Χ2=8.6). The factors influencing women’s willingness to return to and to recommend a hospital differed from the predictors of general satisfaction. Conclusions The satisfaction factors revealed in this research correspond predominantly to the results of studies conducted in other countries (warm, non-formal and supportive approach, sufficient and well-timed provision of information and explanation, availability of caregivers, physical environment). However, participation in decision making, which has been repeatedly shown to be among the strongest predictors of childbirth satisfaction, was not important for the Czech parturients

  14. Social psychological predictors of satisfaction with intrapartum and postpartum care - what matters to women in Czech maternity hospitals?

    PubMed

    Takács, Lea; Seidlerová, Jitka Mlíková; Šulová, Lenka; Hoskovcová, Simona Horáková

    2015-01-01

    To identify the social psychological factors affecting women's evaluation of care provided in Czech maternity hospitals using following criteria: satisfaction with intrapartum and postpartum care, willingness to return to a given hospital and to recommend the hospital to others. 762 women completed a 71-item original Czech questionnaire KLI-P designed to measure the psychosocial climate in both delivery and after-birth unit on six scales. The sample was representative of the Czech parturients population. Multivariate logistic regression was used to investigate the predictive value of the questionnaire scales for maternal satisfaction, willingness to return to and to recommend a given hospital. For delivery unit, the satisfaction predictors were: helpfulness and empathy of midwives (Χ(2)=48.9), communication of information and availability of caregivers (Χ(2)=16.6), helpfulness and empathy of physicians (Χ(2)=10.9), symmetrical and respectful attitude of staff members (Χ(2)=9.7) and physical comfort and services (Χ(2)=7.6). The predictors of satisfaction with after-birth unit included helpfulness and empathy of the staff (Χ(2)≥42.1), communication of information and availability of caregivers (Χ(2)=52.5), physical comfort and services (Χ(2)=30.6), control and involvement in decision-making (Χ(2)=6.6) and parity (Χ(2)=8.6). The factors influencing women's willingness to return to and to recommend a hospital differed from the predictors of general satisfaction. The satisfaction factors revealed in this research correspond predominantly to the results of studies conducted in other countries (warm, non-formal and supportive approach, sufficient and well-timed provision of information and explanation, availability of caregivers, physical environment). However, participation in decision making, which has been repeatedly shown to be among the strongest predictors of childbirth satisfaction, was not important for the Czech parturients' satisfaction with

  15. Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals.

    PubMed

    Escuriet-Peiró, Ramón; Goberna-Tricas, Josefina; Pueyo-Sanchez, Maria J; Garriga-Comas, Neus; Úbeda-Bonet, Immaculada; Caja-López, Carmen; Espiga-López, Isabel; Ortún-Rubio, Vicente

    2015-02-13

    As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37-42 weeks) singleton births. Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a

  16. Maternal and Perinatal Outcomes Among Adolescents and Mature Women: A Hospital-Based Study in the North of Mexico.

    PubMed

    Minjares-Granillo, Ramón O; Reza-López, Sandra A; Caballero-Valdez, Selene; Levario-Carrillo, Margarita; Chávez-Corral, Dora Virginia

    2016-06-01

    To compare maternal and newborn pregnancy outcomes from adolescents and mature women. A cross-sectional study was carried out in a public hospital, including women with singleton pregnancies, who were classified according to their age, as follows: group 1: younger than 16 years old (n = 37), group 2: 16-19 years old (n = 288), and group 3: 20-34 years old (n = 632). Information on clinical characteristics, gynecological and obstetric history, pregnancy complications, and perinatal outcomes was obtained through interviews and from clinical records. Thirty-four percent of deliveries were from adolescents. Mature women were more likely to have prepregnancy overweight or obesity than adolescents (odds ratio [OR] = 2.4, 95% confidence interval [CI], 1.7-3.4). The frequency of maternal complications during pregnancy or delivery was not different between groups. Birth asphyxia was more frequent in group 2 (P = .02). Women with inadequate prenatal care had an increased risk of preterm deliveries (OR = 1.64; 95% CI, 1.06-2.54) and of having newborns with low birth weight (OR = 2.02; 95% CI, 1.22-3.35). Weight of newborns from noncomplicated pregnancies was lower in group 1 (P = .02), after adjustment for prepregnancy body mass index, gestational weight gain, preterm delivery, and newborn sex. The frequency of maternal and perinatal complications was similar in adolescents and mature women. Birth weight was decreased in noncomplicated pregnancies of adolescents younger than 16 years of age. Adequate prenatal care might be helpful in prevention of some adverse perinatal outcomes. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

    PubMed

    Parveen, T; Begum, F; Akhter, N

    2015-07-01

    Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

  18. [Maternal risk factors associated to stillbirth in a public hospital at West of Mexico].

    PubMed

    Pérez-Molina, Jesús; Quezada-López, Claudia; Panduro-Barón, Guadalupe; Castro-Hernández, Juan Francisco

    2012-01-01

    Mortality rates in preterm births and stillbirth are high. To identify maternal risk factors relating to stillbirth in preterm infants. We conducted a cross-sectional, analytic study of 1,022 newborns between 20 and 36 weeks of gestation, from September 2004 to August 2005. Stillbirth was defined as fetal death prior to expulsion or extraction from the mother. Data was collected prospectively by directly interviewing the pregnant women and from the medical chart. The dependent variable was stillbirth and the independent ones were the maternal risk factors. Associations were evaluated by logistic regression. RESULTS. One thousand and twenty-four (1,024) preterm births were detected in a total of 14,882 births (6.9%/year). One hundred and fifty-two (152) were stillborn and 870 were live births. The fetal mortality rate was 10.3 per 1,000 live births. The least common maternal factors associated to stillbirth included: urinary tract infection (22/152, 14% vs. 224/869, 26%, p = 0.020), PMR > 24 h (18/152, 12% vs. 172/869, 20%, p = 0.020) and cesarean delivery (24/138, 17% vs. 344/719, 48%, p < 0.001). The crude odd risk ratios for stillbirth included spontaneous preterm delivery (OR 4.38, CI95% 2.70-7.17) and deficient prenatal care (OR 2.64, CI95% 1.83-3.82). By multivariate analysis, stillbirth predictors included: spontaneous preterm delivery (OR 4.00, CI 95% 2.61-6.61) and deficient prenatal care (OR 2.54, CI 95% 1.78-3.62). Deficient prenatal care was the only statistically significant and clinically coherent variable predicting stillbirth.

  19. Serum Retinol Concentrations in Mothers and Newborns at Delivery in a Public Maternity Hospital in Recife, Northeast Brazil

    PubMed Central

    Andreto, Luciana Marques; Vieira, Carmina Silva dos Santos; de Arruda, Ilma Kruze Grande; Diniz, Alcides da Silva

    2014-01-01

    Serum retinol concentrations were compared in a consecutive series of 65 mother-newborn pairs at delivery in a public maternity hospital in Recife, Brazil, from January to August 2008 and examined their association with biological, socioeconomic, environmental and obstetrical characteristics. Serum retinol concentrations of the newborns (umbilical cord) and mothers (brachial venipuncture) were analyzed by high-performance liquid chromatography. Prevalence of low (<0.70 µmol/L) and inadequate (<1.05 µmol/L) serum retinol concentrations were observed in 23.1% (95% CI 13.9-35.5) and 23.0% (95% CI 13.5-35.8) among newborns and mothers respectively. The serum retinol distribution was lower in male than female infants (-0.4 µmol/L, p=0.01) and, across both sexes, concentrations in paired newborn and mother were correlated (r=0.27, p=0.04). Further, maternal status explains only 7% of the variance in retinol concentrations in newborn's cord plasma. Among mothers delivering in public facilities in Recife, hypovitaminosis may exist. PMID:24847590

  20. Bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's Hospital Thapathali, Kathmandu.

    PubMed

    Adhikari, N; Shah, P K; Acharya, G; Vaidya, K M

    2014-12-01

    Neonatal Sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. Identification of the common bacteria and risk factors causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was carried out to determine the bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's hospital. A cross-sectional prospective study was conducted among neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified and antibiotic susceptibility was carried out with standard microbiological methods. Data were analysed by using SPSS. Ver. 16 software. The positive yield of blood culture was 21%. The most common isolates were Staphylococcus epidermidis, E. coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas spp. In Antibiotic susceptibility pattern Gentamycin showed the highest sensitivity to all types of isolated organisms. Vancomycin sensitivity was highest for Gram positive organism and Ciprofloxacin was most effective for Gram negative organisms isolated. Ampicillin and Amoxycillin were the least effective drug. Multiple drug resistance was observed in 77.15% of isolates. Prematurity, low birth weight and maternal pyrexia before delivery were found to be strongly associated with neonatal sepsis. Gram positive organisms were more prevalent than gram negative organisms.

  1. [Perinatal deaths and childbirth healthcare evaluation in maternity hospitals of the Brazilian Unified Health System in Belo Horizonte, Minas Gerais, Brazil, 1999].

    PubMed

    Lansky, Sônia; França, Elisabeth; César, Cibele Comini; Monteiro Neto, Luiz Costa; Leal, Maria do Carmo

    2006-01-01

    This paper analyzes the association between perinatal mortality and factors related to hospital care during labor, considering that healthcare assessment is needed in order to reduce perinatal mortality. A population-based case-control study was conducted with 118 perinatal deaths (cases) and 492 births (controls) that took place in maternity hospitals of the Brazilian Unified Health System (SUS) in Belo Horizonte, Minas Gerais, Brazil. Male sex, prematurity, diseases during pregnancy, low birth weight, newborn diseases, lack of prenatal care, lack of partograph use during labor, and less than one fetus assessment per hour during labor were significantly associated with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes.

  2. Maternal mortality--a twelve-year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria.

    PubMed

    Adetoro, O O

    1987-04-01

    This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin over a 12-year period (1972-1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50 per 1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the third stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity services in our hospital, health education programs for the public and particularly the expectant women and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.

  3. The psychometric and psychosocial dimension of Albanian immigration: data from a preliminary study.

    PubMed

    Naimo, M; Massagli, A; Degortes, D; Favaro, A; Campagnola, N; Vidotto, G

    2006-01-01

    The present study is part of a wider ministerial project aimed at analysing--both the healthcare and psychological aspects--the phenomenon of illegal immigration, in particular Albanian immigration in Apulia. The CBA 2.0 Primary Scale was duly translated, in accordance with the guidelines set out in literature, to allow for identification and future use of psychological tools in Albanian and therefore assess the psychological dimension of a sample group of adult Albanians. Moreover, the eventual presence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in subjects who arrived in Italy after a traumatic journey was studied. 82 Albanians were chosen (47 male and 35 female) having lived in Italy for over a year. All subjects were given the Albanian version of CBA 2.0 Primary Scale; subjects who had entered Italy illegally were asked to answer the DSM-IV questionnaire to assess PTSD and MDD and a semi-structured questionnaire made up to evaluate their experiences, before, during and after the trauma of their journey. CBA 2.0 translated into Albanian does not reveal psychological disturbances of clinical significance but did reveal values of hardship significantly lower than the normal Italian standards. Only 3 cases of PTSD and 6 of MDD arose from the questionnaire regarding the assessment of PTSD and MMD.

  4. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.

    PubMed

    Bauer, Melissa E; Bateman, Brian T; Bauer, Samuel T; Shanks, Amy M; Mhyre, Jill M

    2013-10-01

    Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the United States. Data were obtained from the Nationwide Inpatient Sample for the years 1998 through 2008. The presence of severe sepsis was identified by the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression analysis was used to assess temporal trends for sepsis, severe sepsis, and sepsis-related death and also to identify independent associations of severe sepsis. Of an estimated 44,999,260 hospitalizations for delivery, sepsis complicated 1:3333 (95% confidence interval [CI], 1:3151-1:3540) deliveries, severe sepsis complicated 1:10,823 (95% CI, 1:10,000-1:11,792) deliveries, and sepsis-related death complicated 1:105,263 (95% CI, 1:83,333-1:131,579) deliveries. While the overall frequency of sepsis was stable(P = 0.95), the risk of severe sepsis and sepsis-related death increased during the study period, (P < 0.001) and (P = 0.02), respectively. Independent associations for severe sepsis, with an adjusted odds ratio and lower bound 95% CI higher than 3, include congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement. Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.

  5. [Maternal risk factors and low birth weight in Senegalese teenagers: the example of a hospital centre in Dakar].

    PubMed

    Ndiaye, O; Diallo, D; Ba, M G; Diagne, I; Moreau, J C; Diadhiou, F; Kuakuvi, N

    2001-01-01

    a) to identify the risk factors associated with newborn babies' low birth weight in teenage mothers; b) to propose prevention strategies for lower-ing neonatal morbidity and mortality. SPHERE OF THE STUDY: the study was carried out at the maternity and neonatology service of the Abass Ndao hospital centre, a urban community hospital located in the Southern part of Dakar. MATIERIAL AND METHODS: this retrospective study was carried out between July 1, 1998 and June 31, 1999. All new mothers under 20 who had given birth to living newborn babies have been included in the study and categorised into two groups, according to their babies' birth weight: 1) a first group of teenagers whose newborn babies' birth weight was lower than 2,500 g (low birth weight); 2) a second group constituted of women whose newborn babies' birth weight was higher than 2,500 g, and which was used as a control. The socio-demographic, biometrics, maternal and obstetric factors have been analysed and compared. out of the 4,586 women in childbirth during the study period, 456 were under 20 years of age, which corresponds to a prevalence rate of 10%. One hundred and five women had newborns weighing less than 2,500 g, which corresponds to a prevalence rate of 23%. Certain factors were found to be significantly associated with low birth weight: low weight gain during pregnancy (p = 0.04), fewer antenatal consultations (0.006), and kidney-related syndromes during pregnancy (0.0005). The results of that study allow us to recommend the following strategies: - control and improvement of nutritional behaviour during pregnancy; campaigning for a better attendance at antenatal consultation services for the early detection of pathologies during pregnancy and for preventing kidney-related syndromes.

  6. A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting

    PubMed Central

    Murphy, Deirdre J; Fahey, Tom

    2013-01-01

    Objective To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting. Design Retrospective cohort study. Setting Urban maternity hospital in Ireland. Population A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011. Methods The study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors. Main outcome measures Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator. Results Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000). Conclusions Privately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences. PMID:24277646

  7. [Extreme maternal morbidity in the Hospital General Dr. Aurelio Valdivieso, Oaxaca Health Services].

    PubMed

    Calvo-Aguilar, Omar; Morales-García, Victor Edilberto; Fabián-Fabián, Jaime

    2010-12-01

    Obstetric Morbidity Extreme (OME) is a promising addition to the investigation of maternal deaths and is used for the evaluation and improvement of maternal health services is defined as a severe obstetric complication that threatens the life of the pregnant woman and requires urgent medical intervention to prevent death of the mother. To identify association between diseases and obstetric morbidity Extreme. Transversal review analytical records. We searched for codes related to conditions that could cause extreme obstetric morbidity and the indirect causes that might cause it. The prevalence of OME 21 per 1000 newborns, diseases with greater association were eclampsia, liver failure and preeclampsia yielded the highest OR and statistical significance, the association of OME derived from surgery despite having a high prevalence in the analysis showed no association, in the same way if other variables showed association but had no significance and confidence intervals are below the unit that is the case of renal failure, metabolic failure and blood transfusion. The OME is caused by group entities specific disease (FLASOG) in most cases such as preeclampsia, eclampsia and obstetric hemorrhage.

  8. HIV infection in pregnancy: maternal and perinatal outcomes in a tertiary care hospital in Calabar, Nigeria.

    PubMed

    Ikpim, Ekott Mabel; Edet, Udo Atim; Bassey, Akpan Ubong; Asuquo, Otu Akaninyene; Inyang, Ekanem Etim

    2016-04-01

    Human immunodeficiency virus (HIV) infection is likely to have untoward effects on pregnancy and its outcome. This study assessed the impact of maternal HIV infection on pregnancy outcomes in a tertiary centre in Calabar, Nigeria. This retrospective study analysed delivery records of 258 HIV-positive and 257 HIV-negative women for pregnancy and delivery complications. Maternal and fetal outcomes of HIV-positive pregnancies were compared with those of HIV-negative controls. Adverse pregnancy outcomes significantly associated with HIV status were: anaemia: 33 (8.1%) vs. 8 (3.1%) in controls; puerperal sepsis: 18 (7%) vs. 2 (0.8%); and low birth weight: 56 (21.7%) vs. 37 (14.4%). Caesarean delivery was higher among HIV-positive women than controls: 96 (37.2%) vs. 58 (22.6%). Preterm births were higher in those HIV cohorts who did not receive antiretroviral therapy (ART): 13 (16.9%) vs. 7 (3.9%). HIV-positive status increased adverse birth outcome of pregnancy. ART appeared to reduce the risk of preterm births in HIV-positive cohorts. © The Author(s) 2015.

  9. Loneliness and pregnancy in an urban Latino community: associations with maternal age and unscheduled hospital utilization.

    PubMed

    Geller, Jeffrey S

    2004-01-01

    The objective is to compare loneliness in a pregnant population to a non-pregnant control group, and to evaluate loneliness and unscheduled hospital visits during pregnancy. A prospective cohort study in a Latino urban community including 53 consecutive pregnant women in their first trimester, and 61 non-pregnant women as a control. The UCLA Loneliness Scale version 3, and demographic information was collected. A chart review after delivery determined total number of unscheduled pregnancy related hospital visits. Appropriate data analysis using t-test and regression analysis was used. Forty-eight women continued to delivery. There was no difference in mean loneliness scores between pregnant (41) and non-pregnant groups (43), or that of normal populations (41). There was a significant association between UCLA loneliness scores and total pregnancy related unscheduled hospital visits p = 0.042, beta = 0.06, r= 0.29. There was a significant association between increasing age and increasing loneliness during pregnancy p = 0.007, beta = 0.21, r= 0.36, not seen in the non-pregnant group p = 0.98. Loneliness, when controlling for age, yielded a stronger association with unscheduled hospital visits p = 0.018, beta = 0.076, and r = 0.40. The findings were that increased loneliness is associated with increased unscheduled pregnancy related hospital utilization during pregnancy. Older pregnant women had higher loneliness scores. Loneliness was more significant than age in predicting higher unscheduled hospital visits. The combination of increased loneliness and younger age predicted the highest number of unscheduled hospital visits.

  10. Working conditions, work style, and job satisfaction among Albanian teachers

    NASA Astrophysics Data System (ADS)

    Kloep, Marion; Tarifa, Fatos

    1994-03-01

    For the first time in Albania, a large-scale study investigating teachers' working conditions was conducted. 349 teachers from many parts of the country and from all school levels answered an extensive questionnaire, providing a comprehensive description of their working situation. As data for parts of the study exist from the USA, Germany, Singapore, England, and Poland, results could be discussed in comparison to the conditions in these countries, showing that self-reported job satisfaction and engagement in effective classroom practices is relatively high among Albanian teachers, while the economic and physical conditions are bad. Stepwise regression analyses reveal that the items measuring professional autonomy account for a considerable part of the variance of the job satisfaction measure; while work efficiency is mainly predicted by items measuring social support and, again, professional autonomy.

  11. Maternal asthma, diabetes, and high blood pressure are associated with low birth weight and increased hospital birth and delivery charges; Hawai'i hospital discharge data 2003-2008.

    PubMed

    Hayes, Donald K; Feigal, David W; Smith, Ruben A; Fuddy, Loretta J

    2014-02-01

    Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (<2500 grams), high birth weight (>4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.

  12. Maternal and Umbilical Cord Blood Levels of Zinc and Copper in Active Labor Versus Elective Caesarean Delivery at Khartoum Hospital, Sudan.

    PubMed

    Elhadi, Alaeldin; Rayis, Duria A; Abdullahi, Hala; Elbashir, Leana M; Ali, Naji I; Adam, Ishag

    2016-01-01

    A case-control study was conducted in Khartoum Hospital Sudan to determine maternal and umbilical cord blood levels of zinc and copper in active labor versus elective cesarean delivery. Cases were women delivered vaginally and controls were women delivered by elective cesarean (before initiation of labor). Paired maternal and cord zinc and copper were measured using atomic absorption spectrophotometry. The two groups (52 paired maternal and cord in each arm) were well matched in their basic characteristics. In comparison with cesarean delivery, the median (interquartile range) of both maternal [87.0 (76.1-111.4) vs. 76.1 (65.2-88.3) μg/dL, P = 0.004] and cord zinc [97.8 (87.0-114.1) vs. 81.5(65.2-110.2) μg/dL P = 0.034] levels were significantly higher in the vaginal delivery. While there was no significant difference in the maternal copper [78.8 (48.1-106.1) vs. 92.4 (51.9-114.9) μg/dL, P = 0.759], the cord copper [43.5(29.9-76.1) vs. 32.2(21.7-49.6) μg/dL, P = 0.019] level was significantly higher in vaginal delivery. There was no significant correlation between zinc (both maternal and cord) and copper. While the cord zinc was significantly correlated with maternal zinc, there was no significant correlation between maternal and cord copper. The current study showed significantly higher levels of maternal and cord zinc and cord copper in women who delivered vaginally compared with caesarean delivery.

  13. Maternal and paternal lineages in Albania and the genetic structure of Indo-European populations.

    PubMed

    Belledi, M; Poloni, E S; Casalotti, R; Conterio, F; Mikerezi, I; Tagliavini, J; Excoffier, L

    2000-07-01

    Mitochondrial DNA HV1 sequences and Y chromosome haplotypes (DYS19 STR and YAP) were characterised in an Albanian sample and compared with those of several other Indo-European populations from the European continent. No significant difference was observed between Albanians and most other Europeans, despite the fact that Albanians are clearly different from all other Indo-Europeans linguistically. We observe a general lack of genetic structure among Indo-European populations for both maternal and paternal polymorphisms, as well as low levels of correlation between linguistics and genetics, even though slightly more significant for the Y chromosome than for mtDNA. Altogether, our results show that the linguistic structure of continental Indo-European populations is not reflected in the variability of the mitochondrial and Y chromosome markers. This discrepancy could be due to very recent differentiation of Indo-European populations in Europe and/or substantial amounts of gene flow among these populations.

  14. Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China.

    PubMed

    Hu, Ling-Qun; Zhang, Jin; Wong, Cynthia A; Cao, Qinying; Zhang, Guohua; Rong, Huijuan; Li, Xia; McCarthy, Robert J

    2015-04-01

    To evaluate the association between the introduction of neuraxial (epidural) labor analgesia and mode of delivery in a large urban maternity hospital in China. A single-intervention impact study was conducted at Shijiazhuang Obstetrics and Gynecology Hospital in Shijiazhuang. Baseline data collection occurred between August 1 and December 31, 2009, when no analgesic method was routinely employed during labor. An intervention was then implemented, consisting of a neuraxial labor analgesia service. The service was fully operational from September 1, 2010, and data were collected to August 31, 2011. The mode of delivery was compared between the different periods. Neuraxial analgesia rate was used in none of the 3787 deliveries during the baseline period and 3429 (33.5%) of 10 230 in the implementation period. Cesareans were performed in 1533 (40.5%) deliveries in the baseline period and 3441 (33.6%) in the implementation period (difference -6.8%, 99.8% confidence interval [CI] -9.7% to -3.9%; P<0.0017). The proportion of vaginal deliveries in which forceps were used was unchanged (difference -0.8%, 99.8% CI -0.7% to 2.2%; P=0.92). The introduction of epidural analgesia reduced the frequency of cesarean delivery, which improved obstetric and neonatal outcomes. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  15. Maternal healthcare needs assessment survey at Rabia Balkhi Hospital in Kabul, Afghanistan.

    PubMed

    Khorrami, Homa; Karzai, Fatima; Macri, Charles J; Amir, Azizullah; Laube, Douglas

    2008-06-01

    Since the Department of Health and Human Services chose Rabia Balkhi Hospital (RBH) in Kabul, Afghanistan, as a site for intervention in 2002, the status of women's health there has been of interest. This study created a tool to assess accessibility and quality of care of women admitted from May to July, 2005. A 39-item questionnaire was created in English and translated into Dari. Hospital staff administered the survey to 292 women admitted to RBH for obstetric and gynecological complaints. Approximately 40% of the women traveled between 1 and 5 hours to reach RBH. Only 54% (158/292) of women reported having their blood pressure monitored during their pregnancy. About one-third of women reported that they had never received an immunization. This survey tool ascertained that women who received care at RBH traveled great lengths to reach the facility. Preventative measures such as blood pressure checks and immunizations are areas that need improvement.

  16. Maternity staff perspectives regarding resource demands of breastfeeding supportive practices in accordance with the Baby-Friendly Hospital Initiative accreditation: a Q methodology approach.

    PubMed

    Huang, Chiu-Mieh; Hung, Wei-Shu; Lai, Jung-Nien; Kao, Yu-Hsiu; Wang, Ching-Ling; Guo, Jong-Long

    2016-06-01

    To explore the resource demands of implementing the Baby-Friendly Hospital Initiative among maternity staff. Implementing the Baby-Friendly Hospital Initiative is the most recognized global strategy for ensuring that hospital routines support breastfeeding. The maternity services of Baby-Friendly Hospital Initiative accredited hospitals are evaluated according to the Ten Steps to Successful Breastfeeding. Q methodology was applied to investigate the perspectives of 60 maternity staff in Northern Taiwan. Data were collected from May - December 2014. An online Q-sort platform was designed for the participants to perform sorting. The Q-sorts were subjected to factor analysis by using PQ Method software. Factors were extracted using principal component analysis with a varimax rotation. A combination of eigenvalues and a scree plot were employed to determine the number of retained factors. Four factors retained in the final model accounted for 56% of the total variance: (1) emphasis on implementing an institutional policy; (2) emphasis on providing supportive practices for breastfeeding mothers; (3) emphasis on establishing continual breastfeeding support; and (4) emphasis on managing breastfeeding supportive practices concerning a designated time period. The participants that were associated with Factors 1 and 3 emphasized the necessity of allocating resources to Steps 1, 2 and 10 of the Ten Steps. The participants associated with Factors 2 and 4 emphasized allocating resources to Steps 2-5 and 7. This study revealed the various perspectives of maternity staff regarding the resource demands of implementing the Baby-Friendly Hospital Initiative. These perspectives may serve as a reference for decision-makers in prioritizing resource allocation. © 2016 John Wiley & Sons Ltd.

  17. [Characteristics of hospital care and its relationship to severe maternal morbidity in Medellín, Colombia].

    PubMed

    González Ortiz, Luz Denise González; Gómez Arias, Rubén Darío; Vélez Álvarez, Gladis Adriana; Agudelo Londoño, Sandra Milena; Gómez Dávila, Joaquín; Wylie, John

    2014-01-01

    The objective of this study was to determine whether there is an association between severe maternal mortality (SMM) and the characteristics of access to and use of obstetric services by the participating women. A study of cases and controls was conducted in a group of 600 women who were attended during pregnancy or the puerperium between 2011 and 2012 by obstetric services located in Medellín, Colombia. The study considered cases (n = 150) in obstetric patients who met the criteria for SMM established by the surveillance system being used in Medellín at the time of their admission. The controls (n = 450) were randomly selected in the same institutions where the patients were being treated. The information was obtained through an in-person interview, review of the patient's clinical history, and rating of the medical care provided by surveillance program personnel. The analysis was based on the model Road Map for Preventing Maternal Death developed jointly by Pan American Health Organization/World Health Organization, Centers for Disease Control, United Nations Population Fund for Latin America and the Caribbean, and Mothercare UK. The proportion of unplanned pregnancies in the women studied was 57.6%, while the proportion of delay in the decision to seek care was 32.0%. Two variables were found to be associated with SMM: ethnicity (OR = 1.79) and delays due to deficiencies in the quality of care provided (OR = 8.54). The findings suggest that improving the effectiveness and quality of family planning, prenatal check-up, and hospital obstetric care programs could help to reduce avoidable cases of SMM.

  18. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial.

    PubMed

    Dumont, Alexandre; Fournier, Pierre; Abrahamowicz, Michal; Traoré, Mamadou; Haddad, Slim; Fraser, William D

    2013-07-13

    Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second

  19. Pattern of abortion care in a tertiary level maternity hospital in Nepal.

    PubMed

    Paudel, Punya; Paudel, Luna; Bhochhibhoya, Manisha; Vaidhya, Sapana Amatya; Shah, Nabina; Khatiwada, Dipendra

    2013-01-01

    Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly. A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed. Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste. The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future.

  20. Adverse Maternal and Birth Outcomes in Women Admitted to Hospital for Hyperemesis Gravidarum: a Population-Based Cohort Study.

    PubMed

    Fiaschi, Linda; Nelson-Piercy, Catherine; Gibson, Jack; Szatkowski, Lisa; Tata, Laila J

    2017-10-06

    Evidence for risks of adverse maternal and birth outcomes in women with hyperemesis gravidarum (HG) is predominantly from small studies, unknown, or conflicting. A population-based cohort study using secondary health care records (Hospital Episode Statistics covering all of England from 1997 to 2012) was used to calculate odds ratios (OR) with 99% confidence intervals (CI) for the association between HG hospital admission and adverse outcomes, adjusting for maternal and pregnancy confounders. Within 8 211 850 pregnancies ending in live births or stillbirths, women with HG had increased odds of anaemia (OR 1.28, 99% CI 1.23, 1.33), preeclampsia (OR 1.16, 99% CI 1.09, 1.22), eclampsia (OR 1.84, 99% CI 1.07, 3.18), venous thromboembolism antenatally (OR 1.94, 99% CI 1.57, 2.39 for deep vein thrombosis, and OR 2.54, 99% CI 1.89, 3.40 for pulmonary embolism) and post-partum. Odds of stillbirth (OR 0.77, 99% CI 0.66, 0.89) and post-term (OR 0.86, 99% CI 0.81, 0.92) delivery were decreased. Women were more likely to be induced (OR 1.20, 99% CI 1.16, 1.23), to deliver preterm (OR 1.11, 99% CI 1.05, 1.17), very preterm (OR 1.18, 99% CI 1.05, 1.32), or by caesarean section (OR 1.12, 99% CI 1.08, 1.16), to have low birthweight (OR 1.12, 99% CI 1.08, 1.17) or small for gestational age (OR 1.06, 99% CI 1.01, 1.11) babies and although absolute risks were small, their offspring were more likely to undergo resuscitation or neonatal intensive care. HG may have important antenatal and postnatal consequences that should be considered in communications between health care professionals and women to best manage HG and prevent progression during pregnancy. © 2017 John Wiley & Sons Ltd.

  1. Individual maternal and child exposure to antibiotics in hospital - a national population-based validation study.

    PubMed

    Almqvist, C; Örtqvist, A K; Gong, T; Wallas, A; Ahlén, K M; Ye, W; Lundholm, C

    2015-04-01

    Exposure to antibiotics in early life may affect future health. Most antibiotics are prescribed in outpatient care, but inpatient exposure is also important. We estimated how specific diagnoses in hospitals corresponded to individual antibiotic exposure. All pregnant women and children from birth to 5 years of age with infectious diseases and common inpatient diagnoses between July 2005 and November 2011 were identified from the Swedish National Patient Register. Random samples of individuals from predefined groups were drawn, and medical records received from the clinics were manually reviewed for antibiotics. Medical records for 4319 hospital visits were requested and 3797 (88%) were received. A quarter (25%) of children diagnosed as premature had received antibiotics, and in children from one to 5 years of age, diagnoses associated with bacterial infections were more commonly treated with antibiotics (62.4-90.6%) than those associated with viruses (6.3-22.2%). Pregnant women who had undergone a Caesarean section were more likely to be treated with antibiotics than those who had had a vaginal delivery (40.1% versus 11.1%). This study defines the proportion of new mothers and young children who received individual antibiotic treatment for specific inpatient diagnoses in Sweden and provides a useful basis for future studies focusing on antibiotic use. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  2. [Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

    PubMed

    Fujihara, Satoko; Tsukisawa, Miyoko

    2014-03-01

    The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

  3. CYP2D6 allele distribution in Macedonians, Albanians and Romanies in the Republic of Macedonia

    PubMed Central

    Kuzmanovska, M; Dimishkovska, M; Maleva Kostovska, I; Noveski, P; Sukarova Stefanovska, E

    2015-01-01

    Abstract Cytochrome P450 2D6 (CYP2D6) is an enzyme of great importance for the metabolism of clinically used drugs. More than 100 variants of the CYP2D6 gene have been identified so far. The aim of this study was to investigate the allele distribution of CYP2D6 gene variants in 100 individuals of each of the Macedonian, Albanian and Romany population, by genotyping using long range polymerase chain reaction (PCR) and a multiplex single base extension method. The most frequent variants and almost equally distributed in the three groups were the fully functional alleles *1 and *2. The most common non functional allele in all groups was *4 that was found in 22.5% of the Albanians. The most common allele with decreased activity was *41 which was found in 23.0% of the Romany ethnic group, in 11.0% of the Macedonians and in 10.5% of the Albanians. Seven percent of the Albanians, 6.0% of the Romani and 4.0% of the Macedonians were poor metabolizers, while 5.0% of the Macedonians, 1.0% of Albanians and 1.0% of the Romanies were ultrarapid metabolizers. We concluded that the CYP2D6 gene locus is highly heterogeneous in these groups and that the prevalence of the CYP2D6 allele variants and genotypes in the Republic of Macedonia is in accordance with that of other European populations. PMID:27785397

  4. CYP2D6 allele distribution in Macedonians, Albanians and Romanies in the Republic of Macedonia.

    PubMed

    Kuzmanovska, M; Dimishkovska, M; Maleva Kostovska, I; Noveski, P; Sukarova Stefanovska, E; Plaseska-Karanfilska, D

    2015-12-01

    Cytochrome P450 2D6 (CYP2D6) is an enzyme of great importance for the metabolism of clinically used drugs. More than 100 variants of the CYP2D6 gene have been identified so far. The aim of this study was to investigate the allele distribution of CYP2D6 gene variants in 100 individuals of each of the Macedonian, Albanian and Romany population, by genotyping using long range polymerase chain reaction (PCR) and a multiplex single base extension method. The most frequent variants and almost equally distributed in the three groups were the fully functional alleles *1 and *2. The most common non functional allele in all groups was *4 that was found in 22.5% of the Albanians. The most common allele with decreased activity was *41 which was found in 23.0% of the Romany ethnic group, in 11.0% of the Macedonians and in 10.5% of the Albanians. Seven percent of the Albanians, 6.0% of the Romani and 4.0% of the Macedonians were poor metabolizers, while 5.0% of the Macedonians, 1.0% of Albanians and 1.0% of the Romanies were ultrarapid metabolizers. We concluded that the CYP2D6 gene locus is highly heterogeneous in these groups and that the prevalence of the CYP2D6 allele variants and genotypes in the Republic of Macedonia is in accordance with that of other European populations.

  5. [Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011].

    PubMed

    Yepes, Francisco J; Gómez, Joaquin G; Zuleta, John Jairo; Londoño, Juan Luis; Acosta-Reyes, Jorge Luis; Sánchez-Gómez, Luz Helena; Ramírez, Marta L

    2016-11-01

    The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

  6. [Maternal mortality rate in the Aurelio Valdivieso General Hospital: a ten years follow up].

    PubMed

    Noguera-Sánchez, Marcelo Fidias; Arenas-Gómez, Susana; Rabadán-Martínez, Cesar Esli; Antonio-Sánchez, Pedro

    2013-01-01

    Antecedentes: en México, la mortalidad materna ha disminuido en las últimas décadas. En Oaxaca esto no se ha manifestado porque se incrementó la tasa de mortalidad materna. Este estado se ubica entre las entidades con más muertes maternas. Objetivo: analizar 10 años de mortalidad materna en el Hospital General Dr. Aurelio Valdivieso de los Servicios de Salud de Oaxaca, para conocer el comportamiento epidemiológico y caracterización de los decesos. Material y métodos: estudio retrospectivo, transversal y descriptivo efectuado mediante la revisión de expedientes clínicos de mortalidad materna en la División de Gineco-Obstetricia. Se consideraron variables sociales, obstétricas y circunstanciales y las comprobaciones se efectuaron con estadística general y descriptiva. Resultados: entre el 1 de enero de 2000 y el 31 de diciembre de 2009 se registraron 109 muertes maternas, excluidas dos que no fueron obstétricas; es decir, que hubo 107 muertes maternas: 75 directas y 32 indirectas. La tasa de mortalidad materna fue de 172.14 × 100,000 nacidos vivos. De las muertes maternas revisadas 89 pudieron evitarse (83%) y 18 no (17%), esto con base en el dictamen del Comité ad hoc del Hospital General Dr. Aurelio Valdivieso. La enfermedad hipertensiva aguda del embarazo fue la de mayor mortalidad; la escolaridad y el puerperio ueron el mayor riesgo. Conclusiones: las variables atribuibles a bajo índice de desarrollo humano, como: baja escolaridad y paridad elevada incrementaron el riesgo de mortalidad materna, que fue intrahospitalaria y durante el puerperio. La tasa de mortalidad materna fue la mayor encontrada en publicaciones nacionales con respecto a este referente.

  7. [Neoliberalism in health: the torture of the health care workers of the Bogota's Instituto Materno Infantil (child and maternity hospital)].

    PubMed

    Abadía, César B; Pinilla, María Y A; Ariza, Katerine R; Ruíz, Héctor C S

    2012-06-01

    To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years. A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital

  8. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin.

    PubMed

    Cabacungan, Erwin T; Ngui, Emmanuel M; McGinley, Emily L

    2012-10-01

    We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.

  9. The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.

    PubMed

    Goodman, David M; Ramaswamy, Rohit; Jeuland, Marc; Srofenyoh, Emmanuel K; Engmann, Cyril M; Olufolabi, Adeyemi J; Owen, Medge D

    2017-01-01

    To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual. From 2007-2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of $158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from $97-$218. QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to

  10. Does lack of routine postnatal examination on maternity unit increase the risk of hospital admission in the first week of life?

    PubMed

    Abelian, Arthur; Turner, Jim; Cusack, Jonathan

    2010-02-01

    The purpose of this study is to establish whether omitting routine postnatal examination on maternity units increases the risk of hospitalisation in the first week of life of the newborn. Retrospective analysis of maternal and baby details and paediatric admission data spanning 12 months in the setting of two maternity units and children's admission unit (CAU) at the University Hospitals of Leicester NHS Trust, Leicester, UK looking at all live-born babies not admitted to neonatal units (n = 7,058). For babies within first week of life, main outcome measures are: (1) risk of the need to be assessed on CAU and (2) risk of hospitalisation for 48 h. Babies who had routine postnatal examination on maternity unit (n = 3,631) and babies who had no such examination (n = 3,427) had similar risks of the need to be seen on CAU (3% and 2.4%, respectively; p = 0.057) and of hospitalisation for 48 h (0.82% and 0.67%, respectively; p = 0.22). Babies born to first-time mothers and/or premature were more likely to have postnatal examination on the maternity unit and were at a higher risk of hospitalisation in the first week of life. With prudent selection and extended surveillance of at-risk babies, lack of routine postnatal examination on maternity unit did not increase the risks of hospital review or admission in the first week of life. Worryingly, however, as many as 27% of all babies might not have had routine postnatal examination at all.

  11. Birthing support and breastfeeding initiation in Somaliland: experiences at the Edna Adan Maternity Hospital in Hargeisa, Somaliland.

    PubMed

    Holder, Kelly

    2011-03-01

    Research has identified a relationship between birthing practices and breastfeeding initiation Continuous support during labor and delivery is a key component to increasing breastfeeding initiation. The purpose of this project was to assess the impact of labor support on breastfeeding initiation in a setting in which women receive traditional birthing support from female family members. Research was conducted at the Edna Adan Maternity Hospital in Hargeisa, Somaliland using the grounded theory method of qualitative research. Semi-structured interviews, direct observations and participant observations were conducted. A purposeful, non-statistical sample was chosen: ten women, five family members, six health care providers and five birth observations were included. The CDC EZ-Text, a software program developed by the Center for Disease Control and Prevention for use in qualitative research, was used in managing and analyzing the data. Data analysis and interpretation was conducted using micro-analysis, open, axial and selective coding procedures. The results indicated that due to cultural influences, contradictory beliefs and practices, lack of critical thinking and lack of long term planning, traditional birthing support was not always indicative of immediate breastfeeding initiation. The presence of a labor companion is a low-cost, preventative intervention that is consistent with the cultural practices of Somaliland. Breastfeeding education and support should, therefore, include a tertiary approach which includes pregnant and birthing women, labor support persons or family members and health care providers.

  12. Sociodemographic predictors of acceptance of voluntary HIV testing among pregnant women in a large maternity hospital, Omdurman, Sudan.

    PubMed

    Idris, A K M; Elsamani, E Z; Elnasri, A E A

    2015-06-09

    This study aimed to determine the sociodemographic predictors of willingness of pregnant women in Sudan to accept HIV testing. A random sample of 500 pregnant women attending antenatal care clinics in Omdurman maternity hospital in 2010 were interviewed. Significant predictors of women's tendency to accept HIV testing were: age < 30 years (OR 3.5, 95% CI: 2.2-5.8), primigravida (OR 1.5, 95% CI: 1.0-2.3), better education level (OR 3.4, 95% CI: 1.7-6.7), owning a radio (OR 2.1, 95% CI: 1.3-3.4), in employment (OR 2.5, 95% CI: 1.2-5.0) and ≥ 2 antenatal care visits (OR 1.9, 95% CI: 1.2-2.9). Husband's age ≥ 35 years (OR 3.2, 95% CI: 2.0-5.2) and Christian faith (OR 3.8, 95% CI: 1.4-10.7) were significant variables, although with a wide margin of confidence. These predictors should be considered in strategies to increase the acceptance and use of HIV testing and counselling services.

  13. [Epidemiological aspects of acute pelvic pain of gynecologic origin at the maternity of the Befelatanana Hospital Center, Antananarivo].

    PubMed

    Randriamiarisoa, N A; Andriamady, R C; Ranjalahy, R J; Rakotomanga, S

    2000-01-01

    Acute pelvic pains of pregnancy (APPP) generate a lot of social and professional problems to pregnancy. A retrospective study was carried out in 1996 at the Maternity Hospital of Befelatanana, Antananarivo in order to specify epidemiological feature of APPP suffering pregnancy and to search favourising factors and determinative causes of this disease so that a strategy will be drawn up to reduce its frequency and to organize correct cares. 1,612 APPP were registered for the study period, i.e. an annual incidence of 15.5 per cent. Non periodic APPP were the most frequent clinical forms (99.6 per cent). The average age of pregnancy was 26 years old. Risk factors and determinative causes are infections, hormonal diseases, nulliparity and primiparity, low standard of living. APPP had been associated to hemorrhages (37.4 per cent), circulatory shock (14.5 per cent), and hyperthermia (63.5 per cent). 83 deaths were noted. Deaths are provoked by abortion infectious complications, hemorrhages, hepato-nephric lesions due to abortifacient plants. The authors conclude that prevent measures remain as the best therapy. They are based on Information-Education-Communication program drawn towards sexual education, Reproduction Health and improvement of genital infections cares.

  14. Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia.

    PubMed

    Schantz, Clémence; Sim, Kruy Leang; Ly, Ek Meng; Barennes, Hubert; Sudaroth, So; Goyet, Sophie

    2015-05-01

    First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013-14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7-96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0-24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.

  15. Traditional pharmacopoeias and medicines among Albanians and Italians in southern Italy: a comparison.

    PubMed

    Pieroni, Andrea; Quave, Cassandra L

    2005-10-03

    A cross-cultural comparison of traditional household remedies in primary health care and ritual healing practices in two economically and socio-demographically similar communities in Lucania (inland southern Italy) was considered: Ginestra/Zhurë, inhabited by ethnic Albanians, who migrated to the area during the 15th century, and Castelmezzano, inhabited by autochthonous South-Italians. In Ginestra/Zhurë, the number of traditional natural remedies (mainly derived from local medicinal plants) was only half of that in the local folk pharmacopoeia quoted in Castelmezzano. However, ritual magic-healing practices still play a central role among the Albanians in Ginestra/Zhurë, while they do not in Castelmezzano. Reasons for this shift, as well as components that have affected cultural adaptation phenomena and transitions among the Albanians are discussed.

  16. Alveolar and Velarized Laterals in Albanian and in the Viennese Dialect.

    PubMed

    Moosmüller, Sylvia; Schmid, Carolin; Kasess, Christian H

    2016-12-01

    A comparison of alveolar and velarized lateral realizations in two language varieties, Albanian and the Viennese dialect, has been performed. Albanian distinguishes the two laterals phonemically, whereas in the Viennese dialect, the velarized lateral was introduced by language contact with Czech immigrants. A categorical distinction between the two lateral phonemes is fully maintained in Albanian. Results are not as straightforward in the Viennese dialect. Most prominently, female speakers, if at all, realize the velarized lateral in word-final position, thus indicating the application of a phonetically motivated process. The realization of the velarized lateral by male speakers, on the other hand, indicates that the velarized lateral replaced the former alveolar lateral phoneme. Alveolar laterals are either realized in perceptually salient positions, thus governed by an input-switch rule, or in front vowel contexts, thus subject to coarticulatory influences. Our results illustrate the subtle interplay of phonology, phonetics and sociolinguistics.

  17. Wine Traceability: A Data Model and Prototype in Albanian Context.

    PubMed

    Vukatana, Kreshnik; Sevrani, Kozeta; Hoxha, Elira

    2016-02-17

    Vine traceability is a critical issue that has gained interest internationally. Quality control programs and schemes are mandatory in many countries including EU members and the USA. Albania has transformed most of the EU regulations on food into laws. Regarding the vine sector, the obligation of wine producers to keep traceability data is part of the legislation. The analysis on the interviews conducted with Albanian winemakers show that these data are actually recorded only in hard copy. Another fact that emerges from the interviews is that only two producers have implemented the ISO (International Organization for Standardization) standards on food. The purpose of this paper is to develop an agile and automated traceability system based on these standards. We propose a data model and system prototype that are described in the second and third section of this work. The data model is an adaption along the lines of the GS1 (Global Standards One) specifications for a wine supply chain. The proposed prototype has a key component that is mobile access to the information about wine through barcode technology. By using this mechanism the consumer obtains transparency on his expectations concerning the quality criteria. Another important component of the proposed system in this paper is a real-time notification module that works as an alert system when a risk is identified. This can help producers and authorities to have a rapid identification of a contaminated product. It is important in cases when recalling the product from the market or preventing it from reaching the consumer.

  18. Fertility trends, marriage patterns, and savant typologies in Albanian context.

    PubMed

    Doja, Albert

    2010-01-01

    In this article, the author focuses on the speculative literalism and typologism in current scholarship to construct a taken-for-granted view, taking issue especially with many points raised in the literature on the subject that have associated fertility rates in Albania more closely with the existence of patriarchal cultural traits. This leads the author to argue that the specific rationale for the myth of many children, high fertility rates, and complex family structures in Albanian context, as elsewhere in patrilineal societies, is an ideological elaboration of patriarchy. Methodologically, the analysis of the standard view of childbearing, based on standard ethnographic methods, traditional historical sources and aggregate demographic data, is aimed to illustrate the inadequacy of the historical-ethnographic paradigm against the available empirical evidence. In turn, understanding how ideological elements are emphasized in cultural activism should lead, against current scholarship claims, to an understanding of the way in which the urgent need for male children must have been to hide away other more troubling reasons.

  19. The Permian and Triassic in the Albanian Alps

    NASA Astrophysics Data System (ADS)

    Gaetani, Maurizio; Meço, Selam; Rettori, Roberto; Henderson, Charles M.; Tulone, Accursio

    2015-09-01

    The sedimentary succession of the Permian to Middle Triassic of the Albanian Alps is described, as part of the eastern Adria passive margin towards the Tethys. A carbonate ramp deepening towards NE in present day coordinates developed during the Middle Permian and was affected by block faulting with the deposition of carbonate breccia. The Early Triassic was characterized by intense terrigenous deposition with several cobble conglomerate units up to 80 m-thick, and by oolitic carbonate shoals. The fine clastic deposition ended gradually during the earliest Anisian and a wide calcarenitic ramp occupied the area, with small local carbonate mounds. Basinward, the red nodular limestone of the Han Bulog Formation was interbedded with calcarenitic material exported from the ramp. Drowning to more open conditions occurred towards the end of the Pelsonian. Subsequently, cherty limestone and tuffitic layers spread over the entire area. Towards the end of the Ladinian, with the end of the volcanic activity, red pelagic limestone was deposited locally for a short period. By the latest Ladinian most of the area returned to shallow-water conditions, with a peritidal carbonate platform. In the Theth area, in contrast, a basin with black organic-rich dolostone and limestone developed which seems to be unique in that part of the Adria passive margin. The occurrence of cobble conglomerate units in the Lower Triassic testifies to very active block faulting and high accommodation, not yet described for the area.

  20. [Career perspectives of hospital health workers after maternity and paternity leave: survey and observational study in Germany].

    PubMed

    Engelmann, C; Grote, G; Miemietz, B; Vaske, B; Geyer, S

    2015-02-01

    A term of maternity and paternity (parental) leave becomes frequent on the career paths of medical personnel. Hospitals are highly competitive environments. The question employees universally face is how such a leave will alter their personal work situation and prospects upon return. We questioned 709 leave-takers and 88 department heads of a German university hospital (2009-12; full data sets: n = 406 and n = 63) about their experiences. This data was validated by epidemiology data extraction and expert interviews, also in a Swiss and in a Norwegian institution. Parental leave elicited high emotionality (score: 4.0 +/- 2 out of 5). Superiors' appraisal of employees' parental leave was more positive than negative (p < 0.001, mean + 0.8 +/- 0.9 on a bipolar Likert scale (BLS) from - 2 to + 2). However, the annual labor turnover in leave takers doubled to 39 %; 51 % of leave-takers experienced significant task profile changes. 58 % of doctors thought about changing their employer and 17 % of leave-taking executives lost status after return. Employees' "power" and "influence" dropped significantly (p < 0.05; determined on BLS) whereas the "professional workload" increased (p < 0.001). Consequently, after return career perspectives (measured on a bipolar visual analogue scale from - 5 to + 5) were perceived significantly more negative than positive (p < 0.0001, mean: - 1.3 +/-  2), especially by high-commitment staff (i. e. female executives, mean: - 2.1 +/- 2, pΔ < 0.05 vs. others). These perceptions significantly influenced future choices concerning further terms of leave. The Swiss and Norwegian comparators appeared to have more liberal substitution and part-time schemes than the German institution. A competitive hospital environment can effectively demote leave-taking medical employees in their jobs. Despite sufficient financial arrangements high-commitment staff will only take parental

  1. IGHG1 phenotypes in three population samples from Italy (Albanians, Calabrians, northern Italians): a critical revision.

    PubMed

    De Benedictis, G; Rose, G; De Lange, G G; Brancati, C

    1988-01-01

    This paper presents data on the distribution of IGHG1 phenotypes in three populations living in Italy (Albanians, Calabrians and Northern Italians). IGHG1 typing for the allotypes z, x, a, f has been performed by using standard antisera provided by the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service (Amsterdam). The results are compared with those obtained for the same populations using alloantisera from polytransfused subjects and Behringwerke antisera. It is shown that the results obtained by using the different antisera are not in agreement. Moreover, standard antisera reveal that the IGHG1 za haplotype is more frequent in Albanians than in Northern Italians.

  2. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital.

    PubMed

    Teixeira, Marina Parca Cavelagna; Queiroga, Tatiana Peloso Reis; Mesquita, Maria Dos Anjos

    2016-01-01

    To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. Determinar a frequência e os fatores de risco de recém-nascidos pequenos para idade gestacional em uma maternidade de alto risco. Trata-se de um estudo observacional, transversal e caso-controle, realizado em maternidade pública de nível terciário. Foram levantados dados de 998 recém-nascidos e de suas respectivas mães por meio de entrevista e análise de prontuários e de cartões do pré-natal. Algumas placentas foram submetidas à análise anatomopatológica. As variáveis dos recém-nascidos pequenos e não pequenos para idade gestacional e de suas respectivas mães foram comparadas estatisticamente pelo teste paramétrico t de Student, pelo teste exato de Fisher e por odds ratio. O nível de signific

  3. Association between maternal exposure to housing renovation and offspring with congenital heart disease: a multi-hospital case-control study.

    PubMed

    Liu, Zhen; Li, Xiaohong; Li, Nana; Li, Shengli; Deng, Kui; Lin, Yuan; Chen, Xinlin; You, Fengzhi; Li, Jun; Mu, Dezhi; Wang, Yanping; Zhu, Jun

    2013-03-25

    Congenital heart disease (CHD) is one of the most prevalent birth defects. Housing renovations are a newly recognized source of indoor environmental pollution that is detrimental to health. A growing body of research suggests that maternal occupational exposure to renovation materials may be associated with an increased risk of giving birth to fetuses with CHD. However, the effect of indoor housing renovation exposure on CHD occurrence has not been reported. A multi-hospital case-control study was designed to investigate the association between maternal periconceptional housing renovation exposure and the risk of CHD for offspring. In total, 346 cases and 408 controls were enrolled in this study from four hospitals in China. Exposure information was based on a questionnaire given to women during pregnancy. The association between housing renovation exposure and CHD occurrence was assessed by estimating odds ratios (OR) with logistic regression models adjusted for potential confounders. The risk for CHD in offspring was significantly associated with maternal exposure to housing renovations (AOR: 1.89, 95% CI: 1.29-2.77). There were similar risks for cardiac defects with or without extra-cardiac malformation (AOR of 2.65 and 1.76, respectively). Maternal housing renovation exposure may increase the fetus' risk of suffering from conotruncal defect or anomalous venous return. There were significant risks for cardiac defects if the pregnant woman moved into a new house within one month after decoration at either 3 months before pregnancy (AOR: 2.38, 95% CI: 1.03 to 5.48) or during first trimester (AOR: 4.00, 95% CI: 1.62 to 9.86). Maternal exposure to housing renovations may have an increased risk of giving birth to fetuses with some selected types of CHD. This relationship was stronger for women who moved into a newly decorated house. However, considering the limited number of subjects and the problem of multiple exposures, more research is needed to clarify the

  4. Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

    PubMed Central

    Dumont, Alexandre; Tourigny, Caroline; Fournier, Pierre

    2009-01-01

    Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1) bad quality of information in medical files; (2) non-participation of the head of department in the audit meetings; (3) lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1) high level of professional qualifications or experience of the data collector; (2) involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3) participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We recommend for future

  5. Subethnic variation in the diets of Moslem, Sikh and Hindu pregnant women at Sorrento Maternity Hospital, Birmingham.

    PubMed

    Wharton, P A; Eaton, P M; Wharton, B A

    1984-11-01

    The previous paper (Eaton et al. 1984) described the nutrient intake of pregnant Asian women attending Sorrento Maternity Hospital, Birmingham using the weighed and recall methods. The present paper describes the subethnic variation in nutrient intake by comparing the results from Pakistanis, Sikhs, Hindus and Bangladeshis and also describes food eaten by the pregnant women. Generally, Sikhs had the highest intake of most nutrients (mean energy 7.5 MJ (1800 kcal)/d) and the greatest variety of foods; they ate chapatti and paratha but few ate meat. Hindus had a very similar diet but more ate meat, chicken and rice. Pakistanis had an energy intake about 10% below that of the Sikhs and Hindus; meat was eaten, and intake of fruit, and therefore vitamin C, was quite large. Bangladeshis were the smallest women; they had the lowest intake of energy (mean energy 6.5 MJ (1555 kcal)/d) and most nutrients, except for protein, so that 15% of energy was provided by protein. Fish, rice and a low-fat intake were other features of their diet. From a nutritional standpoint, peoples coming from the Asian subcontinent should be divided into subethnic groups; the collective term 'Asian' is insufficient. It is not clear whether these differences have any effect on the life and health of the individuals. Comparison of groups does not suggest an obvious relationship between dietary intake and fetal growth; however, there is other evidence to implicate the possible role of deficiencies of protein, energy, zinc and pyridoxine. The results provide some support for the community nutritional policies of (a) offering vitamin D supplements to all pregnant Asian women and (b) fortifying bread with calcium, thiamin and nicotinic acid. There is probably no need to offer vitamin A and C supplements but they are harmless. Indications for iron supplementation are no different from those for white English women.

  6. Microbial flora of the lower genital tract of women in labour at Harare Maternity Hospital. The Puerperal Sepsis Study Group.

    PubMed

    Mason, P R; Katzenstein, D A; Chimbira, T H; Mtimavalye, L

    1989-03-01

    The vaginal flora of 214 women who had been referred, in labour, to Harare Maternity Hospital was investigated by examination of vaginal washings and of cervical and urethral swabs taken before and/or after delivery. Four groups of patients were studied: women who had a normal vaginal delivery (NVD), women who were referred because of meconium stained liquor (MSL), women with a history of prolonged rupture of membranes (PROM), and women who were delivered by cesarean section (CS). The first three groups had received no antibiotics during the 7 days preceding specimen collection, while specimens were collected from CS patients only after at least 48 hr of i.v. penicillin and chloramphenicol. T. vaginalis was identified in 19 percent of women, but was not associated with any specific patient group. Chlamydial antigen was detected in 13 percent of patients, but in only one patient (2 percent) in the MSL group. N. gonorrhoeae were isolated from 7 percent of women overall and 25 percent of the strains were penicillinase-producing. Gonococci were recovered significantly more frequently from the PROM patients than from NVD patients as were Group B streptococci and pigment-producing Bacteroides species. Lactobacilli were isolated from only 20 percent of women, despite the use of specific transport and isolation media for these organisms. Specimens from CS patients were taken after these had received parenteral penicillin and chloramphenicol and it was therefore not surprising to find major differences in their vaginal flora with a virtual absence of Gram-positive bacteria, and a high-rate of carriage of multi-resistant coliforms.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. [Mid trimester pregnancy termination--review of the caseload for 2012 of Maternity University Hospital 'Maichin Dom', Sofia, Bulgaria].

    PubMed

    Andreeva, A; Marinov, B

    2013-01-01

    Midtrimester pregnancy termination is yet an ongoing clinical issue in spite of the hard work on the matter in the recent years. There is a significant withdrawal from the surgical methods, absence of adequate drug preparations for medical termination and absence of guidelines for such form the Bulgarian Society of Obstetricians and Gynaecologists. In order to obtain a clear view on the current situation, we made a review on all the cases of midtrimester induced abortion in Maternity University Hospital 'Maichin dom' for the year of 2012. We found that the mid trimester abortions represent 11.7% of all abortions performed in the hospital in 2012. Most widely used are the following methods: vaginal application of prostaglandin E2 vag. tabl. 3 mg--33.5%, intrauterine balloon-catheter application after priming of the cervix with prostaglandin E2 3 mg--18%, prostaglandin F 2alpha as intrauterine extraamniotic continuous infusion through a balloon catheter, noweighton--9%, vaginal application of Prostaglandin E1--5.4%. Surgical termination was used in as little as 6% of the cases. The shortest interval for expulsion had been registered with the application of PG E1--19'55", compared with the most widely spread method of application of PG E2, which was more than twice longer--42'12". Application of balloon catheter, after priming of the cervix with 3 mg PG E2 vag. tabl. proved to be inefficient with mean interval for expulsion of 88'42". Surgical termination for midtrimester pregnancy is seen as the last alternative, it is rarely applied and mostly as anurgent procedure. In conclusion, the existing regimes for medical termination of midtrimester pregnancy are inefficient; application of 3 mg PG E2 is ineffective during the second trimester, insertion of balloon catheter attached to a weight is unacceptable. It is highly recommended that more attention is paid to the surgical termination with regards to residence training programmes and maintaining of qualification. This

  8. Wine Traceability: A Data Model and Prototype in Albanian Context

    PubMed Central

    Vukatana, Kreshnik; Sevrani, Kozeta; Hoxha, Elira

    2016-01-01

    Vine traceability is a critical issue that has gained interest internationally. Quality control programs and schemes are mandatory in many countries including EU members and the USA. Albania has transformed most of the EU regulations on food into laws. Regarding the vine sector, the obligation of wine producers to keep traceability data is part of the legislation. The analysis on the interviews conducted with Albanian winemakers show that these data are actually recorded only in hard copy. Another fact that emerges from the interviews is that only two producers have implemented the ISO (International Organization for Standardization) standards on food. The purpose of this paper is to develop an agile and automated traceability system based on these standards. We propose a data model and system prototype that are described in the second and third section of this work. The data model is an adaption along the lines of the GS1 (Global Standards One) specifications for a wine supply chain. The proposed prototype has a key component that is mobile access to the information about wine through barcode technology. By using this mechanism the consumer obtains transparency on his expectations concerning the quality criteria. Another important component of the proposed system in this paper is a real-time notification module that works as an alert system when a risk is identified. This can help producers and authorities to have a rapid identification of a contaminated product. It is important in cases when recalling the product from the market or preventing it from reaching the consumer. PMID:28231105

  9. The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative.

    PubMed

    Wieczorek, Christina C; Marent, Benjamin; Dorner, Thomas E; Dür, Wolfgang

    2016-03-14

    The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice. In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis. Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice. Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter

  10. Medication use and drug-related problems among women at maternity wards-a cross-sectional study from two Norwegian hospitals.

    PubMed

    Smedberg, J; Bråthen, M; Waka, M S; Jacobsen, A F; Gjerdalen, G; Nordeng, H

    2016-07-01

    There is a lack of knowledge about drug-related problems (DRPs) among pregnant and lactating women. The aim of this study was to determine the extent and type of DRPs among pregnant and lactating women in the maternity ward at two Norwegian hospitals. We also aimed to investigate which drugs were involved in the identified DRPs, and the outcome of solving the DRPs. Patient-reported treatment reviews were performed to assess the prevalence and type of DRPs among women at the two maternity wards. In all, 212 women were included in the study, of which 89 (42 %) had experienced at least one DRP (105 DRPs in total). "Need for additional drug" (49 cases, 46.7 %) was the most frequent. The most frequent drug group involved in DRPs was drugs acting on the respiratory system, and the most common intervention was raising awareness/providing confidence/giving information during the patient-reported treatment review. Over four out of ten women in the maternity wards have DRPs, and many have questions about drug use during pregnancy and lactation. Many of the DRPs could probably be avoided by providing patient-reported treatment reviews to pregnant women as a part of antenatal care. Multidisciplinary collaboration including physicians, midwifes, and pharmacists in antenatal care and in maternity ward could possibly prevent DRPs and thereby promote patient safety for pregnant and lactating women.

  11. The "7 Keys of the Dragon": An E-Learning Gamelike Environment for Albanian and Russian

    ERIC Educational Resources Information Center

    Revithiadou, Anthi; Kourtis-Kazoullis, Vasilia; Soukalopoulou, Maria; Konstantoudakis, Konstantinos; Zarras, Christos; Pelesoglou, Nestoras

    2014-01-01

    In this article we report on the development of an interactive open source extensible software, dubbed "The 7 Keys of the Dragon," for the teaching/learning of Albanian and Russian to students (9-12 years old) with the respective languages as their heritage languages. Based on the assumption that games in language learning are associated…

  12. Applicability of an Albanian version of the OIDP in an adolescent population.

    PubMed

    Thelen, Dorina S; Bårdsen, Asgeir; Astrøm, Anne N

    2011-07-01

    The impact of oral conditions on quality of life of adolescents has not been thoroughly investigated. The purpose of this study was to assess the reliability and validity of an Albanian version of the oral impact of daily performance (OIDP) questionnaire. A total of 493 adolescents attending secondary public schools in Albania attended clinical examination and completed a questionnaire that included an Albanian version of the OIDP inventory. The psychometric properties of the OIDP were evaluated in terms of reliability and validity. The validity and reliability of the Albanian version of OIDP were good. Cohen's Kappa ranged from 0.72 to 0.79. In terms of internal consistency, Cronbach's alpha was 0.77. Construct and criterion validity were demonstrated in that the OIDP frequency scores were statistically significant with global measures of self-rated and self-perceived oral health status variables and some of the clinical variables used in this study. A total 60.9% of participants reported having at least one oral impact. The most prevalent impact was difficulty in smiling, whereas difficulty in speaking was less prevalent impact. The Albanian version of OIDP seems to be a reliable and valid scale for use in an urban adolescent population. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  13. The Relationship between Emotional Competence and Hostile/Prosocial Behavior in Albanian Preschoolers: An Exploratory Study

    ERIC Educational Resources Information Center

    Farina, Eleonora; Belacchi, Carmen

    2014-01-01

    We explored the relationship between the ascribed tendency of Albanian preschoolers' to take on prosocial and/or hostile roles and their empathy and emotion comprehension. Participants were 63 preschoolers (3- to 6-years-old) and six teachers. Pupils' empathy and hostile/prosocial roles were assessed via teacher reports and their emotional…

  14. The Relationship between Emotional Competence and Hostile/Prosocial Behavior in Albanian Preschoolers: An Exploratory Study

    ERIC Educational Resources Information Center

    Farina, Eleonora; Belacchi, Carmen

    2014-01-01

    We explored the relationship between the ascribed tendency of Albanian preschoolers' to take on prosocial and/or hostile roles and their empathy and emotion comprehension. Participants were 63 preschoolers (3- to 6-years-old) and six teachers. Pupils' empathy and hostile/prosocial roles were assessed via teacher reports and their emotional…

  15. Identity Projects in Complementary and Mainstream Schools: The Views of Albanian and Bulgarian Students in England

    ERIC Educational Resources Information Center

    Tereshchenko, Antonina; Archer, Louise

    2015-01-01

    This paper contributes to the literature on complementary schools as sites of learning and social and cultural identification. We draw on a small-scale multi-method qualitative study conducted in Albanian and Bulgarian community schools in London to explore the agendas of "new" Eastern European complementary schools with respect to…

  16. Outbreak of Late-onset Group B Streptococcal Infections in Healthy Newborn Infants after Discharge from a Maternity Hospital: A Case Report

    PubMed Central

    Kim, Hyung Jin; Kim, Soo Young; Seo, Won Hee; Yoo, Young; Lee, Kee Hyoung; Eun, Baik Lin; Kim, Hai Joong

    2006-01-01

    During a four-week period, four healthy term newborn infants born at a regional maternity hospital in Korea developed late-onset neonatal group B Streptococcus (GBS) infections, after being discharged from the same nursery. More than 10 days after their discharge, all of the infants developed fever, lethargy, and poor feeding behavior, and were subsequently admitted to the Korea University Medical Center, Ansan Hospital. GBS was isolated from the blood cultures of three babies; furthermore, GBS was isolated from 2 cerebral spinal fluid cultures. Three babies had meningitis, and GBS was isolated from their cerebral spinal fluid cultures. This outbreak was believed to reflect delayed infection after early colonization, originating from nosocomial sources within the hospital environment. This report underlines the necessity for Korean obstetricians and pediatricians to be aware of the risk of nosocomial transmissions of GBS infection in the delivery room and/or the nursery. PMID:16614527

  17. The effects of severe iron-deficiency anaemia on maternal and neonatal outcomes: A case-control study in an inner-city London hospital.

    PubMed

    Luis, J; Fadel, M G; Lau, G Y; Houssein, S; Ravikumar, N; Yoong, W

    2016-05-01

    This case-control study investigates the effects of severe iron-deficiency anaemia in pregnancy on maternal and neonatal outcomes in a relatively deprived inner-city population in a North London hospital. The study group comprised of 106 women with haemoglobin (Hb) < 8 g/dl at any point during pregnancy, while controls were 106 women with Hb > 11 g/dl throughout pregnancy. The study group lost an average of 80 ml more blood at delivery (p = 0.032) and had higher rates of postpartum haemorrhage than the control group (27 vs 12 patients, p = 0.012). However, anaemia did not appear to influence other maternal or neonatal outcomes; these may have been confounded by antenatal intervention with oral haematinics or blood transfusion.

  18. Obstetric outcome following free maternal care at Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, South-eastern Nigeria.

    PubMed

    Ezugwu, E C; Onah, H; Iyoke, C A; Ezugwu, F O

    2011-07-01

    This study aims to determine the impact of free maternal care on the utilisation of the available delivery services and to evaluate the obstetric outcome. All deliveries at ESUTH, Parklane within the 4 months of free maternal care from 1 September to 31( )December 2008 were studied and compared with deliveries that took place 4 months before and after the free services. The results were analysed using Epi-info statistical software version 3:2:2. There was an 88% rise in the number of deliveries with the introduction of free maternal services and a 30% drop within 4 months of its termination. The maternal mortality ratio (MMR) dropped slightly, but morbidity increased significantly, as well as stillbirth rate (77/1,000 births), especially intrapartum stillbirth. Cost barrier limits women's access to healthcare in developing countries and must be addressed if we aim to achieve Millennium Development Goals (MDGs) 4 and 5.

  19. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery.

    PubMed

    Kottwitz, Anita

    2014-05-01

    Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.

  20. Quality of labour neuraxial analgesia and maternal satisfaction at a tertiary care teaching hospital: a prospective observational study.

    PubMed

    Clivatti, Jefferson; Siddiqui, Naveed; Goel, Akash; Shaw, Melissa; Crisan, Ioana; Carvalho, Jose C A

    2013-08-01

    Current labour analgesia practices are evidence-based; however, such evidence often originates in controlled trials, the results of which may not be readily applicable in the context of day-to-day clinical practice. The objective of this study was to evaluate the effectiveness of and maternal satisfaction with the neuraxial labour analgesia regimen provided at a tertiary care teaching hospital. All women with a viable pregnancy who requested neuraxial analgesia for labour during November 2011 at our institution were approached to participate in this prospective study. Patients were managed as per departmental routine based on a patient-controlled epidural analgesia regimen with a maintenance solution of 0.0625% bupivacaine and fentanyl 2 μg·mL(-1). Demographic and obstetric data, characteristics of the neuraxial analgesia, pain scores, side effects, and complications were recorded. After delivery, patients completed a satisfaction questionnaire. All 332 eligible women were approached, and 294 completed the study. Most women received epidural analgesia and considered its placement comfortable. A large number of women reported having experienced pain during the first or second stages of labour (38% and 26%, respectively). Although 24.4% of women required top-ups both by nurses and physicians, adjustment in the local anesthetic maintenance concentration was made in only 7.8% of the cases. Most women (92%) were satisfied with the quality of analgesia. Unintentional dural puncture occurred in three (1%) cases, and there were no cases of intravascular catheter insertion or systemic local anesthetic toxicity. Overweight women (body mass index 25-30 kg·m(-2)) (adjusted odds ratio [AOR] = 2.56; 95% confidence interval [CI]: 1.1 to 5.97), those undergoing induced labour (AOR = 2.4; 95% CI: 1.2 to 5.2), and those requiring top-ups by the anesthesiologist (AOR = 5.08; 95% CI: 2.31 to 11.11) were associated with more dissatisfaction with pain control during the first stage

  1. Are Women of East Kazakhstan Satisfied with the Quality of Maternity Care? Implementing the WHO Tool to Assess the Quality of Hospital Services

    PubMed Central

    DAULETYAROVA, Marzhan; SEMENOVA, Yuliya; KAYLUBAEVA, Galiya; MANABAEVA, Gulshat; KHISMETOVA, Zayituna; AKILZHANOVA, Zhansulu; TUSSUPKALIEV, Akylbek; ORAZGALIYEVA, Zhazira

    2016-01-01

    Background: To evaluate the satisfaction of mothers with the quality of care provided by maternity institutions in East Kazakhstan on the basis of the “Quality of hospital Care for mothers and newborn babies, assessment tool” (WHO, 2009). Methods: This cross-sectional study took place in 2013 and covered five maternity hospitals in East Kazakhstan (one referral, two urban and two rural). To obtain information, interviews with 872 patients were conducted. The standard tool covered 12 areas ranging from pregnancy to childcare. A score was assigned to each area of care (from 0 to 3). The assessment provided the semi-quantitative data on the quality of hospital care for women and newborns from the perception of mothers. Results: The average satisfaction score was 2.48 with a range from 2.2 to 2.7. The mean age of women was 27.4 yr. Forty-two percent were primiparas. Mean birth weight was 3455.4 g. All infants had ‘skin to skin’ contact with their mothers immediately after birth. Mean number of antenatal visits to family clinics was 8.6. Only 42.1% of the respondents used contraceptives while the rest were not aware of contraception, never applied it and could not distinguish between different methods and devices. Conclusion: The quality of care was substandard in all institutions. To improve the quality of care, WHO technologies in perinatal care could be applied. PMID:27648415

  2. A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital.

    PubMed

    Toohill, Jocelyn; Turkstra, Erika; Gamble, Jenny; Scuffham, Paul A

    2012-12-01

    to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). a prospective non-randomised trial. an Australian metropolitan hospital. women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system. health-care costs to the hospital and government. generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology.

  4. Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon.

    PubMed

    Mayi-Tsonga, Sosthene; Oksana, Litochenko; Ndombi, Isabelle; Diallo, Thierno; de Sousa, Maria Helena; Faúndes, Aníbal

    2009-11-01

    Deaths resulting from unsafe induced abortions represent a major component of maternal mortality in countries with restrictive abortion laws. Delays in obtaining care for maternal complications constitute a known determinant of a woman's risk of death. However, data on the role of delays in providing care at health care facilities are sparse. The association between the cause of maternal death (abortion versus post-partum haemorrhage or eclampsia) and the time interval between admission to hospital and the initiation of treatment were evaluated among women who died at the Maternité du Centre Hospitalier de Libreville, Gabon, between 1 January 2005 and 31 December 2007. The women's characteristics and the time between diagnosis of the condition that led to death and the initiation of treatment were compared for each cause of death. After controlling for selected variables, the mean time between admission and treatment was 1.2 hours (95% CI: 0.0-5.6) in the case of women who died from post-partum haemorrhage or eclampsia and 23.7 hours (95% CI: 21.1-26.3) in the case of women who died of abortion-related complications. In conclusion, delay in initiating care was far greater in cases of women with complications of unsafe abortion compared to other pregnancy-related complications. Such delays may constitute an important determinant of the risk of death in women with abortion-related complications.

  5. Trends of preeclampsia/eclampsia and maternal and neonatal outcomes among women delivering in addis ababa selected government hospitals, Ethiopia: a retrospective cross-sectional study

    PubMed Central

    Wagnew, Maereg; Dessalegn, Muluken; Worku, Alemayehu; Nyagero, Josephat

    2016-01-01

    Introduction The burden of preeclampsia has been a major concern worldwide, particularly in developing countries such as Ethiopia. Preeclampsia is associated with substantial maternal complications, both acute and long-term. The aim of this research was to determine the magnitude and trends of preeclampsia/ eclampsia, maternal complications, and neonatal complications among women delivering babies at selected government hospitals in Ethiopia. Methods Data were collected retrospectively by reviewing the five-year medical records for 2009 to 2013, using data abstraction tools, to identify mothers with preeclampsia/eclampsia. A total of 1,809 cases were reviewed for general characteristics of the mother, delivery details, and any complications. Descriptive analyses were employed. In addition, extended Mantel Haenszel chi square for linear trend was used to check for significance of the trends. Results The five year average proportion of preeclampsia/eclampsia was 4.2% (95%CI 4.02%, 4.4%). The proportion of women with preeclampsia was 2.2% in 2009 and increased to 5.58% in 2013 (p<0.001), which was a 154% increase. Of the 1,809 mothers with preeclampsia/eclampsia, 36% (95%CI 33.85%, 38.28%) experienced at least one maternal complication; there was an increase of 26.5% (p<0.01) over the five year period. The main complications were HELLP (variant of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count) syndrome, 257 (39.5%); aspiration pneumonia, 114 (17.5%); pulmonary edema, 114 (17.5%); and abruption placentae, 100 (15.3%). At least one neonatal complication occurred in 66.4% (95%CI 64.24%, 68.59%) of deliveries during the five-year study. A decreasing trend in neonatal complications was observed from 2009 (76%) to 2013 (66%), which showed a percentage change over time of negative 13.2%. The most common neonatal complications were stillbirths, which accounted for 363 (30.2%); prematurity, with 395 (32.8%); respiratory distress syndrome, with 456

  6. Trends of preeclampsia/eclampsia and maternal and neonatal outcomes among women delivering in addis ababa selected government hospitals, Ethiopia: a retrospective cross-sectional study.

    PubMed

    Wagnew, Maereg; Dessalegn, Muluken; Worku, Alemayehu; Nyagero, Josephat

    2016-01-01

    The burden of preeclampsia has been a major concern worldwide, particularly in developing countries such as Ethiopia. Preeclampsia is associated with substantial maternal complications, both acute and long-term. The aim of this research was to determine the magnitude and trends of preeclampsia/ eclampsia, maternal complications, and neonatal complications among women delivering babies at selected government hospitals in Ethiopia. Data were collected retrospectively by reviewing the five-year medical records for 2009 to 2013, using data abstraction tools, to identify mothers with preeclampsia/eclampsia. A total of 1,809 cases were reviewed for general characteristics of the mother, delivery details, and any complications. Descriptive analyses were employed. In addition, extended Mantel Haenszel chi square for linear trend was used to check for significance of the trends. The five year average proportion of preeclampsia/eclampsia was 4.2% (95%CI 4.02%, 4.4%). The proportion of women with preeclampsia was 2.2% in 2009 and increased to 5.58% in 2013 (p<0.001), which was a 154% increase. Of the 1,809 mothers with preeclampsia/eclampsia, 36% (95%CI 33.85%, 38.28%) experienced at least one maternal complication; there was an increase of 26.5% (p<0.01) over the five year period. The main complications were HELLP (variant of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count) syndrome, 257 (39.5%); aspiration pneumonia, 114 (17.5%); pulmonary edema, 114 (17.5%); and abruption placentae, 100 (15.3%). At least one neonatal complication occurred in 66.4% (95%CI 64.24%, 68.59%) of deliveries during the five-year study. A decreasing trend in neonatal complications was observed from 2009 (76%) to 2013 (66%), which showed a percentage change over time of negative 13.2%. The most common neonatal complications were stillbirths, which accounted for 363 (30.2%); prematurity, with 395 (32.8%); respiratory distress syndrome, with 456 (37.9%); and low birth

  7. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study.

    PubMed

    Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

    2017-02-01

    In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in

  8. Association between maternal exposure to housing renovation and offspring with congenital heart disease: a multi-hospital case–control study

    PubMed Central

    2013-01-01

    Background Congenital heart disease (CHD) is one of the most prevalent birth defects. Housing renovations are a newly recognized source of indoor environmental pollution that is detrimental to health. A growing body of research suggests that maternal occupational exposure to renovation materials may be associated with an increased risk of giving birth to fetuses with CHD. However, the effect of indoor housing renovation exposure on CHD occurrence has not been reported. Methods A multi-hospital case–control study was designed to investigate the association between maternal periconceptional housing renovation exposure and the risk of CHD for offspring. In total, 346 cases and 408 controls were enrolled in this study from four hospitals in China. Exposure information was based on a questionnaire given to women during pregnancy. The association between housing renovation exposure and CHD occurrence was assessed by estimating odds ratios (OR) with logistic regression models adjusted for potential confounders. Results The risk for CHD in offspring was significantly associated with maternal exposure to housing renovations (AOR: 1.89, 95% CI: 1.29-2.77). There were similar risks for cardiac defects with or without extra-cardiac malformation (AOR of 2.65 and 1.76, respectively). Maternal housing renovation exposure may increase the fetus’ risk of suffering from conotruncal defect or anomalous venous return. There were significant risks for cardiac defects if the pregnant woman moved into a new house within one month after decoration at either 3 months before pregnancy (AOR: 2.38, 95% CI: 1.03 to 5.48) or during first trimester (AOR: 4.00, 95% CI: 1.62 to 9.86). Conclusions Maternal exposure to housing renovations may have an increased risk of giving birth to fetuses with some selected types of CHD. This relationship was stronger for women who moved into a newly decorated house. However, considering the limited number of subjects and the problem of multiple exposures

  9. A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria

    PubMed Central

    Onoh, Robinson Chukwudi; Eze, Justus Ndulue; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe

    2015-01-01

    Background The global rise in cesarean delivery rate has been a major source of public health concern. Aim To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction. PMID:25999769

  10. Higher risk for adverse obstetric outcomes among immigrants of African and Asian descent: a comparison study at a low-risk maternity hospital in Norway.

    PubMed

    Bakken, Kjersti S; Skjeldal, Ola H; Stray-Pedersen, Babill

    2015-06-01

    Immigrants have higher risks for some adverse obstetric outcomes, and 40 percent of women giving birth at the low-risk maternity ward in Baerum Hospital, Norway, are immigrants. This study compared obstetric outcomes between immigrants and ethnic Norwegians giving birth in a low-risk setting. This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period to immigrant and ethnic Norwegian women at Baerum Hospital from 2006 to 2010. The main outcome measures were onset of labor, operative vaginal delivery, cesarean delivery, episiotomy, postpartum bleeding > 500 mL, epidural analgesia, labor dystocia, gestational age, meconium-stained liquor, 5-minute Apgar score, birthweight, and transfer to a neonatal intensive care unit. A total of 11,540 women originating from 141 countries were divided into seven groups. Compared with Norwegians, women from East, Southeast, and Central Asia had increased risk for operative vaginal delivery, postpartum bleeding, and low Apgar score. The African women had increased risk for postterm birth, meconium-stained liquor, episiotomy, operative vaginal delivery, emergency cesarean delivery, postpartum bleeding, low Apgar score, and low birthweight. Women from South and Western Asia had increased risk for low birthweight. Obstetric outcomes of immigrants differ significantly from those of Norwegians, even in a low-risk maternity unit. Thus, immigrant women would benefit from more targeted care during pregnancy and childbirth, even in low-risk settings. © 2015 Wiley Periodicals, Inc.

  11. Maternal Perceptions of the Preterm Infant.

    ERIC Educational Resources Information Center

    Chatwin, Sara L.; MacArthur, Barton A.

    1993-01-01

    Examined mothers' perceptions of low birthweight infants, neonatal hospital environment, and general parenting attitudes during the perinatal period. Maternal age and socioeconomic status were associated with maternal perceptions of hospital environment. Variables including maternal health, smoking, and length of infant hospitalization contributed…

  12. Mission impossible: upholding successfully a charge of infanticide in the Albanian legal practice

    PubMed Central

    Myftari, Kreshnik; Vyshka, Gentian

    2014-01-01

    Infanticide is a horrendous crime universally condemned from all ethical, juridical and moral standpoints. However, legislation on infanticide foresees mitigating circumstances for infanticidal mothers, with sentences by far disproportionate to the severity of the crime. The main justification for this abstaining from severe punishments has been the so-called post puerperal psychosis, whose diagnostic criteria and existence are still very confusing. Psychiatric experts and even jurors show excessive feelings of empathy toward defendant mothers, and fair verdicts under this setting and with this judicial tradition are questionable. Albanian courts have in some cases even denied defendant mothers the unwilling albeit necessary psychiatric treatment, thus exposing them to recidivism and to other social difficulties. Upholding the charge of infanticide in an Albanian court is hereby an impossible enterprise, with high chances for defendants to achieve acquittal on mental insanity grounds. Through describing three cases of infanticide and filicide in recent years of Albanian judicial proceedings, authors raise the concern formulated from other sources regarding the excessive empathy surrounding infanticidal mothers, a deleterious obstacle toward achieving justice. PMID:25512825

  13. A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo.

    PubMed

    Iacopino, V; Frank, M W; Bauer, H M; Keller, A S; Fink, S L; Ford, D; Pallin, D J; Waldman, R

    2001-12-01

    This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.

  14. A Population-Based Assessment of Human Rights Abuses Committed Against Ethnic Albanian Refugees From Kosovo

    PubMed Central

    Iacopino, Vincent; Frank, Martina W.; Bauer, Heidi M.; Keller, Allen S.; Fink, Sheri L.; Ford, Doug; Pallin, Daniel J.; Waldman, Ronald

    2001-01-01

    Objectives. This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. Methods. Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. Results. The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. Conclusions. The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians. PMID:11726386

  15. [Women's complaint leadership in the Causa Kleinwächter. A contribution to patient history of the Innsbruck maternity hospital].

    PubMed

    Hilber, Marina

    On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.

  16. [Maternal complications related to the mode of delivery in pregnant women with heart disease in a specialist high risk delivery hospital in Fortaleza, CE].

    PubMed

    Cavalcante, Maria do Socorro; Guanabara, Everardo de Macêdo; Nadai, Camila Pinto de

    2012-03-01

    To determine the association between maternal complications and type of delivery in women with heart disease and to identify the possible clinical and obstetrical factors implicated in the determination of the route of delivery. This was a retrospective and descriptive study of the medical records of pregnant women with heart disease admitted to a tertiary reference hospital in the municipality of Fortaleza, Ceará, from 2006 to 2007. The study population included all pregnant women with an antepartum diagnosis of heart disease admitted for delivery, while women who received a diagnosis of heart disease after delivery were excluded, regardless of age and gestational week. A semi-structured questionnaire regarding sociodemographic, clinical and obstetrical variables was used. A descriptive analysis was first performed based on simple frequencies and proportions of the sociodemographic variables. Next, possible associations between clinical and obstetrical aspects and type of delivery were analyzed, with the verification of association between maternal complications and type of delivery. The Fisher exact test was applied for this analysis, with the level of significance set at p<0.05. The collected data were processed and analyzed using the Epi-InfoTM software version 6.04 (Atlanta, USA). Seventy-three pregnant women with heart disease were included in the study. Interatrial communication was the condition most frequently observed among congenital diseases (11.0%) and mitral calcification among the acquired ones (24.6%). The proportion of cesarean deliveries was higher than the proportion of vaginal deliveries, except for women with acquired heart disease. An association was detected between type of heart disease and type of delivery (p=0.01). There were 13 cases of maternal complications (17.8%). Among them, ten (76.9%) occurred during cesarean section and three during vaginal delivery. No association mas detected between maternal complications and type of delivery

  17. Spatial data integration for analyzing the dynamics of Albanian Adriatic shoreline

    NASA Astrophysics Data System (ADS)

    Arapi, Luan; Nikolli, Pal; Kovaçi, Sander

    2016-04-01

    Shoreline mapping and shoreline change detection are critical subjects for coastal resource management, coastal environmental protection and sustainable coastal development and planning. Coastal changes are attracting more focus since they are important environmental indicators that directly impact coastal economic development and land management. Changes in the shape of shoreline may essentially affect the environment of the coastal zone. These may be caused by natural processes and human activities. The undertaken work focuses on analyzing the Adriatic shoreline dynamics, using spatial temporal data, by taking advantage of Geographic Informatin System (GIS) and Remote Sensing (RS). Shoreline mapping focuses on some specific issues such as mapping methods used to acquire shoreline data, models and database design used to represent shoreline in the spatial database and shoreline -change analysis methods. The study area extends from the mouth of Buna River in the north to Vlora Bay in the south covering a total length of about 220 km. Detection and future assessment of Albanian Adriatic shoreline spatial position is carried out through integration of multi scale resolution of spatial temporal data and different processing methods. We have combined topographic maps at different scales (1:75 000, 1918; 1:50 000, 1937; 1:25 000, 1960, 1986 and 1:10 000, 1995), digital aerial photographs of 2007 year, satellite images of Landsat TM, Landsat ETM+ and field observed GIS data. Generation of spatial data is carried out through vectorization process and image processing. Monitoring the dynamics of shoreline position change requires understanding the coastal processes as well as coastal mapping methods. The net rates of variations in the position of the shoreline are calculated according to transects disposed perpendicularly to the baseline and spaced equally along the coast. Analysis of the relative impact of the natural factors and human activities, it is fundamental

  18. Mental health status among ethnic Albanians seeking medical care in an emergency department two years after the war in Kosovo: a pilot project.

    PubMed

    Fernandez, William G; Galea, Sandro; Ahern, Jennifer; Sisco, Sarah; Waldman, Ronald J; Koci, Bajram; Vlahov, David

    2004-02-01

    The long-term psychological effects of war are under appreciated in clinical settings. Describing the postwar psychosocial burden on medical care can help direct public health interventions. We performed an emergency department (ED)-based assessment of the mental health status of ethnic Albanian patients 2 years after the North Atlantic Treaty Organization-led bombing of Serbia and Kosovo in 1999. This study was conducted July 30, 2001, to August 30, 2001, in the ED of a hospital in Pristina, Kosovo. Investigators collected data through systematic sampling of every sixth nonacute ED patient presenting for care; 87.7% of patients agreed to participate. Respondents completed a structured questionnaire, including demographic characteristics, the Short Form-36, and the Harvard Trauma Questionnaire. All 306 respondents were ethnic Albanians; mean age was 39 years (SD 17.9 years). Of respondents, 58% had become refugees during the war. Two hundred ninety-six (97%) reported experiencing at least one traumatic event during the war; the average number of traumatic events encountered by participants was 6.6. Forty-three (14%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for posttraumatic stress disorder; mean Short Form-36 Mental Component Summary score was 42.1 (SD 12.5). Separate multivariable linear regression models confirmed our belief that older age, female sex, less than a high school education, and having experienced a greater number of traumatic events would be associated with more posttraumatic stress disorder symptoms and lower Mental Component Summary scores. Mental health problems among ED patients in Kosovo, particularly among specific vulnerable populations, are a significant public health concern 2 years after the conflict.

  19. [Maternal mortality in the Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto (USP) from 1957 to 1977. Pt. 1: Incidence (Author's transl)].

    PubMed

    Parente, J V; Martinez, A R; Franco Jg; De Carvalho, R L; Carravazzo, N C; Meirelles, R S

    1979-08-01

    A study was carried out from 1957-1977 which investigated the incidence of maternal mortality in the Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto. The yearly distribution of these deaths related to the resolution of pregnancy always showed predominance of the abortion group over the others (pregnant patients, normal delivery, and surgical delivery), with increased evidence starting at the beginning of the 1970's. When the deaths were distributed by relating pregnancy resolution to marital status, absolute predominance of married over single patients was observed, including the abortion group. When the site of the 21st obstetrical aid was considered, it was observed that in 17 of 68 cases studied, the patients were directed to another hospital or delivered at home assisted by a midwife. The mortality rate for the entire period studied was 22.04%. When the cases receiving 1st obstetrical aid outside the Hospital das Clinicas are subtracted, the rate drops to 16.53% and to 8.1% when the abortion group is also excluded. On the basis of these data, it was concluded that abortion is the greatest medical-social problem detected in this study.

  20. Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993-1997 and 2001-2005.

    PubMed

    Berg, Cynthia J; Mackay, Andrea P; Qin, Cheng; Callaghan, William M

    2009-05-01

    To assess progress toward meeting the U.S. Healthy People 2010 objective of reducing the rate of maternal morbidity at delivery hospitalization by comparing National Hospital Discharge Survey data from two time periods. Using data from the National Hospital Discharge Survey, we estimated rates of intrapartum morbidity defined by obstetric complications, preexisting medical conditions, and cesarean delivery during 2001-2005 and compared them with rates published for 1993-1997. We calculated and compared the rates for categories of morbidity as well as rates for the summary groups of morbidity. Between the two time periods, the rate of obstetric complications remained unchanged at 28.6%; the prevalence of preexisting medical conditions at delivery increased from 4.1% to 4.9%. Rates of chronic hypertension and preeclampsia, gestational and preexisting diabetes, asthma, and postpartum hemorrhage increased, whereas rates of third- and fourth-degree lacerations and various types of infection decreased. The cesarean delivery rate increased from 21.8% to 28.3%. Between 1993-1997 and 2001-2005, the rate of intrapartum morbidity associated with obstetric complications was unchanged and the rate of pregnancies complicated by preexisting medical conditions increased.

  1. A longitudinal study to determine association of various maternal factors with neonatal birth weight at a tertiary care hospital

    PubMed Central

    Misra, Akshay; Ray, Sougat; Patrikar, Seema

    2015-01-01

    Background Neonatal birth weight is a powerful predictor of infant growth and survival and maternal factors like poor knowledge and insufficient dietary intake are significant risk factors. Other preventable determinants like pre pregnant BMI <18.5, low gestational weight gain (GWG) and anemia are also associated with low birth weight. This study was carried out to identify the impact of these maternal factors with risk of low birth weight (LBW). Methods A longitudinal study was carried out on 124 booked antenatal cases at a tertiary care center. A validated protocol containing socio demography, food frequency and anthropometry was administered at the 3rd trimester. Birth weight of the newborn was noted after delivery. Results 26.28% children had low birth weight (<2500 g), 14.6% mothers were thin (BMI < 18.5), 55.3% mothers had a weight gain of less than 9 kgs and 45.5% were anemic. 81.81% mothers with BMI >18.5 and 28.92% women who were educated till high school had a baby with LBW. Most mothers consumed milk and vegetables daily and a few consumed non vegetarian foods but quality and quantity of food were grossly inadequate. GWG levels and Hb levels were significantly different in different birth weight groups and also were significantly associated with low birth weight. Conclusion Quality and quantity of maternal dietary intake during pregnancy, even in normal weight mothers (BMI > 18.5), are important determinants of birth weight. Nutritional counseling for mothers during the antenatal period is the cornerstone for healthy mother and healthy child. PMID:26288495

  2. Community-Academic Partnership to Investigate Low Birth Weight Deliveries and Improve Maternal and Infant Outcomes at a Baltimore City Hospital.

    PubMed

    Harvey, Elizabeth M; Strobino, Donna; Sherrod, Leslie; Webb, Mary Catherine; Anderson, Caroline; White, Jennifer Arice; Atlas, Robert

    2017-02-01

    Purpose Mercy Medical Center (MMC), a community hospital in Baltimore Maryland, has undertaken a community initiative to reduce low birth weight (LBW) deliveries by 10 % in 3 years. MMC partnered with a School of Public Health to evaluate characteristics associated with LBW deliveries and formulate collaborations with obstetricians and community services to improve birth outcomes. Description As part of the initiative, a case control study of LBW was undertaken of all newborns weighing <2500 grams during June 2010-June 2011 matched 2:1 with newborns ≥2500 grams (n = 862). Assessment Logistic regression models including maternal characteristics prior to and during pregnancy showed an increased odds of LBW among women with a previous preterm birth (aOR 2.48; 95 % CI: 1.49-4.13), chronic hypertension (aOR: 2.53; 95 % CI: 1.25-5.10), hospitalization during pregnancy (aOR: 2.27; 95 % CI:1.52-3.40), multiple gestation (aOR:12.33; 95 % CI:5.49-27.73) and gestational hypertension (aOR: 2.81; 95 % CI: 1.79-4.41). Given that both maternal pre-existing conditions and those occurring during pregnancy were found to be associated with LBW, one strategy to address pregnant women at risk of LBW infants is to improve the intake and referral system to better triage women to appropriate services in the community. Meetings were held with community organizations and feedback was operationalized into collaboration strategies which can be jointly implemented. Conclusion Education sessions with providers about the referral system are one ongoing strategy to improve birth outcomes in Baltimore City, as well as provision of timely home visits by nurses to high-risk women.

  3. Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey.

    PubMed

    Asıcıoglu, O; Güngördük, K; Yildirim, G; Aslan, H; Günay, T

    2014-05-01

    In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

  4. Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals.

    PubMed

    Guise, Jeanne-Marie; Lowe, Nancy K; Deering, Shad; Lewis, Patricia O; O'Haire, Christen; Irwin, Lori K; Blaser, Molly; Wood, Laurie S; Kanki, Barbara G

    2010-10-01

    Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.

  5. [Use of rehabilitation services by technology-dependent children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil].

    PubMed

    Gavazza, Cláudia Zornoff; Fonseca, Vânia Matos; da Silva, Kátia Silveira; Cunha, Sueli Rezende

    2008-05-01

    The objective of this study was to describe the dependence on technology and use of rehabilitation services by children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil. Using a cross-sectional design, the following variables were analyzed: gender and age of the children and adolescents, socioeconomic characteristics of the family, technology dependence, and use of rehabilitation services. The majority of the study population consisted of preschoolers (56.3%), boys (58.3%), residing in Greater Metropolitan Rio de Janeiro (89.3%), from low-income families (70.9%), and cared for mainly by their mothers (93.8%), who in turn have low schooling (54.2%) and are unemployed (89.6%). Of the entire study population, 22.9% were dependent on more than three different technologies, with medication as the most prevalent. Government and nonprofit institutions fund the rehabilitation, and physical therapists are the most widely used health professionals during treatment (60.4%). The target hospital provides all of the specialized medical treatment and most of the rehabilitation.

  6. Maternal mortality in Sirur.

    PubMed

    Shrotri, A; Pratinidhi, A; Shah, U

    1990-01-01

    The research aim was 1) to determine the incidence of maternal mortality in a rural health center area in Sirur, Maharashtra state, India; 2) to determine the relative risk; and 3) to make suggestions about reducing maternal mortality. The data on deliveries was obtained between 1981 and 1984. Medical care at the Rural Training Center was supervised by the Department of Preventive and Social Medicine, the B.J. Medical College in Pune. Deliveries numbered 5994 singleton births over the four years; 5919 births were live births. 15 mothers died: 14 after delivery and 1 predelivery. The maternal mortality rate was 2.5/1000 live births. The maternal causes of death included 9 direct obstetric causes, 3 from postpartum hemorrhage of anemic women, and 3 from puerperal sepsis of anemic women with prolonged labor. 2 deaths were due to eclampsia, and 1 death was unexplained. There were 5 (33.3%) maternal deaths due to indirect causes (3 from hepatitis and 2 from thrombosis). One woman died of undetermined causes. Maternal jaundice during pregnancy was associated with the highest relative risk of maternal death: 106.4. Other relative risk factors were edema, anemia, and prolonged labor. Attributable risk was highest for anemia, followed by jaundice, edema, and maternal age of over 30 years. Maternal mortality at 30 years and older was 3.9/1000 live births. Teenage maternal mortality was 3.3/1000. Maternal mortality among women 20-29 years old was lowest at 2.1/1000. Maternal mortality for women with a parity of 5 or higher was 3.6/1000. Prima gravida women had a maternal mortality rate of 2.9/1000. Parities between 1 and 4 had a maternal mortality rate of 2.3/1000. The lowest maternal mortality was at parity of 3. Only 1 woman who died had received more than 3 prenatal visits. 11 out of 13 women medically examined prenatally were identified with the following risk factors: jaundice, edema, anemia, young or old maternal age, parity, or poor obstetric history. The local

  7. The phenomenon of intrapartum transfer from a western Australian birth centre to a tertiary maternity hospital: The overall experiences of partners.

    PubMed

    Kuliukas, Lesley; Hauck, Yvonne; Duggan, Ravani; Lewis, Lucy

    2015-05-01

    the aim of this Western Australian study was to describe the overall labour and birth experience of partners within the context of an intrapartum transfer occurring from a low risk midwifery-led, woman-centred unit to an obstetric unit. a descriptive phenomenological design was used. 15 male partners were interviewed in the first 8 weeks post partum between July and October, 2013 to explore their experience of the intrapartum transfer. a midwifery-led birth centre set on the grounds of a tertiary maternity referral hospital. partners of women who were transferred from the birth centre to the onsite tertiary hospital due to complications during the first and second stages of labour. five main themes emerged: (1) 'emotional roller coaster'; (2) 'partner׳s role in changing circumstances' with subthemes: 'acknowledgement for his inside knowledge of her' and 'challenges of being a witness'; (3) 'adapting to a changing model of care' with subthemes: 'moving from an inclusive nurturing and continuity model' and 'transferring to a medicalised model'; (4) 'adapting to environmental changes' with subthemes: 'feeling comfortable in the familiar birth centre', 'going to the place where things go wrong' and 'Back to comfortable familiarity afterwards' and (5) 'coming to terms with altered expectations around the labour and birth experience'. partners acknowledged the benefits of midwifery continuity of care, however, noted that as partners they also provided essential continuity as they felt they knew their woman better than any care provider. Partners found it difficult to witness their woman׳s difficult labour journey. They found the change of environment from birth centre to labour ward challenging but appreciated that experienced medical assistance was at hand when necessary. Being able to return to the birth centre environment was acknowledged as beneficial for the couple. Following the transfer experience partners asked for the opportunity to debrief to clarify and

  8. National and Post-National Discourses and the Construction of Linguistic Identities by Students of Albanian Origin in Greece

    ERIC Educational Resources Information Center

    Archakis, Argiris

    2016-01-01

    Drawing on Critical Discourse Analysis and, more specifically, on the relationship between the macro-level of dominant discourses and the micro-level of individual positionings, we examine the way linguistic identities are constructed by immigrant students of Albanian origin in Greece. We elaborate on two "competitive" discourses: the…

  9. National and Post-National Discourses and the Construction of Linguistic Identities by Students of Albanian Origin in Greece

    ERIC Educational Resources Information Center

    Archakis, Argiris

    2016-01-01

    Drawing on Critical Discourse Analysis and, more specifically, on the relationship between the macro-level of dominant discourses and the micro-level of individual positionings, we examine the way linguistic identities are constructed by immigrant students of Albanian origin in Greece. We elaborate on two "competitive" discourses: the…

  10. Albanian violets of the section Melanium, their morphological variability, genetic similarity and their adaptations to serpentine or chalk soils.

    PubMed

    Słomka, Aneta; Godzik, Barbara; Szarek-Łukaszewska, Grażyna; Shuka, Lulëzim; Hoef-Emden, Kerstin; Bothe, Hermann

    2015-02-01

    Violets of the section Melanium from Albanian serpentine and chalk soils were examined for their taxonomic affiliations, their ability to accumulate heavy metals and their colonization by arbuscular mycorrhizal fungi (AMF). The sequence analysis of the ITS1-5.8S rDNA-ITS2 region showed that all the sampled six Albanian violets grouped between Viola lutea and Viola arvensis, but not with Viola tricolor. The fine resolution of the ITS sequences was not sufficient for a further delimitation of the Albanian violets within the V. lutea-V. arvensis clade. Therefore, the Albanian violets were classified by a set of morphological characters. Viola albanica, Viola dukadjinica and Viola raunsiensis from serpentine soils as well as Viola aetolica from a chalk meadow were unambiguously identified, whereas the samples of Viola macedonica showed high morphological variability. All the violets, in both roots and shoots contained less than or similar levels of heavy metals as their harboring soils, indicating that they were heavy metal excluders. All the violets were strongly colonized by AMF with the remarkable exception of V. albanica. This violet lived as a scree creeper in shallow serpentine soil where the concentration of heavy metals was high but those of P, K and N were scarce.

  11. Perinatal and maternal outcomes in a midwife-led centre in Italy: a comparison with standard hospital assistance.

    PubMed

    Dante, Giulia; Neri, Isabella; Bruno, Raffaele; Salvioli, Chiara; Facchinetti, Fabio

    2016-06-01

    In many countries midwives are the primary providers of care for childbearing women. The aim of the present study was to compare the outcomes of childbirth occurring in the birth benter (midwifery-lead) vs. the traditional delivery room organization (doctor-lead) of the Policlinico of Modena Hospital. A prospective observational study was conducted over four years. At 35-36th week, women with a single, uneventful pregnancy, being classified at low-risk according to The National Institute for Health and Care Excellence (NICE) guidelines on intrapartum care, were offered to deliver with standard care assistance (SC) in a doctors-led unit or in the Birth Centre (BC). The number of women included was 3156. Overall emergency cesarean sections were lower in BC vs. SC group, and a significant decrease in the rate of augmentation of labor with intravenous oxytocin, in the use of episiotomy and operative deliveries in women of BC were recorded more than in the SC group. More women with intact perineum were present in BC group, while no significant differences in perineal tears was described between groups. Our results suggest that midwifery care can result in a decrease of medical interventions during labor, namely a reduction of cesarean section and episiotomy rate. Also, the BC remains a valid option for women who satisfy low-risk criteria and wish to give birth in a hospital setting. In Italy the concern to education of all midwives, obstetricians and women at a global level is urgently required, with specific focus on ethics, communication and philosophy of care to enable normalization and humanization of birth.

  12. Maternal mortality in rural Zambia.

    PubMed

    Vork, F C; Kyanamina, S; van Roosmalen, J

    1997-08-01

    To assess maternal mortality. Sisterhood method survey and hospital data. Communities in Kalabo District, a very remote rural area in western Zambia; Kalabo District Hospital. The number of respondents in the sisterhood method survey was 1,978. The estimated maternal mortality ratio derived from this survey was 1,238 per 100,000 live births. The hospital study involved 2,474 deliveries of 2,374 live babies. The official number of maternal deaths was 13. Further investigation of files revealed an additional 15 maternal deaths, bringing the institutional maternal mortality rate from 548 to 1,179 per 100,000 live births. The major causes of direct maternal deaths were obstructed labor and sepsis. In 71% of all cases substandard care factors contributed. Maternal mortality in rural Zambia is among the highest as reported in the world. Official hospital data tend to underestimate maternal mortality in the community due to underreporting. The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural areas of developing countries.

  13. Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: a population-based matched birth cohort study.

    PubMed

    Canova, Cristina; Pitter, Gisella; Ludvigsson, Jonas F; Romor, Pierantonio; Zanier, Loris; Zanotti, Renzo; Simonato, Lorenzo

    2016-01-05

    Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education.

  14. Maternal risk factors and perinatal outcomes among pacific islander groups in Hawaii: a retrospective cohort study using statewide hospital data.

    PubMed

    Chang, Ann Lee; Hurwitz, Eric; Miyamura, Jill; Kaneshiro, Bliss; Sentell, Tetine

    2015-10-05

    Studies suggest Pacific Islander women have disparate rates of preterm birth, primary cesarean delivery, preeclampsia, gestational diabetes, and low birthweight infants. However, data is limited. In order to improve the health of Pacific Islanders, it is essential to better understand differences in obstetric outcomes in this diverse population This study compared perinatal outcomes between Pacific Islander (9,646) and White (n = 5,510) women who delivered a singleton liveborn in any Hawaii hospital from January 2010 to December 2011 using the Hawaii Health Information Corporation (HHIC) database. Pacific Islanders were disaggregated into the following groups: Native Hawaiian, Samoan, Micronesian, and Other Pacific Islanders. Perinatal outcomes (e.g. hypertensive diseases, birthweight, mode of delivery) were compared using multivariable logistic models controlling for relevant sociodemographic and health risk factors (e.g. age and payer type). Significant differences in perinatal outcomes between Pacific Islander and White women and newborns were noted. All Pacific Islander groups had an increased risk of hypertension. Outcome differences were also seen between Pacific Islanders groups. Native Hawaiians had the highest risk of low birthweight infants, Samoans had the highest risk of macrosomic infants and Micronesians had the highest risk of cesarean delivery. Important differences in perinatal outcomes among Pacific Islanders exist. It is important to examine Pacific Islander populations separately in future research, public health interventions, and policy.

  15. The Google news effect: did the tainted milk scandal in China temporarily impact newborn feeding patterns in a maternity hospital?

    PubMed

    Seror, Jeremy; Amar, Audrey; Braz, Leslie; Rouzier, Roman

    2010-06-01

    Many factors influence a mother's decision to breastfeed. We investigated whether the melamine scandal involving infant formula influenced the decision to breastfeed. News of the melamine scandal was revealed in September 2008 and rapidly spread via the Internet. We illustrate that this scandal significantly and rapidly impacted the pattern of newborn feeding among Chinese women who delivered at a hospital in the eastern district of Paris. This area is home to one of the largest groups of Chinese people in France. The breastfeeding rate increased sharply in September 2008 from 14% to a peak of 31% (p = 0.014) before decreasing over a 6-month period at a rate slower than the diminishing media frenzy. The effect of the melamine news coverage on the Internet was temporary and strongly associated to ethnicity and language (p = 0.015, p = 0.004, respectively). Numerous patients utilize the Internet to access medical information, and these findings highlight the Internet's role in the healthcare equation.

  16. Measuring maternal mortality.

    PubMed

    Royston, E; AbouZahr, C

    1992-07-01

    There are various methods of measuring maternal mortality each with its own advantages and disadvantages. Most official maternal mortality statistics underestimate true maternal mortality levels. Major reasons for underestimates depend on death certification practices and the advancement of the vital registration system. Only 35% of the world's population routinely record cause of death. Misclassification of the cause of death accounts for much of the bias in areas with good vital registration. In France, clerks miscode maternal-related causes of death as something else, e.g., they misclassified cerebral hemorrhages as diseases of the circulatory system and not complications of pregnancy, childbirth, and the puerperium. In countries with few maternal deaths, pregnant or puerperium women in life-threatening conditions are transferred from obstetric departments so cause of death on the certificate may not be the obstetric condition which precipitated the fatal series of events. Governments must determine the type of measurement method for maternal mortality by balancing precision against human and financial costs. Statisticians can measure the maternal mortality rate using several methods. They can include questions about maternal mortality such as maternal deaths of sisters of the adult women or of any women they know who had died from maternal causes in the last year in ongoing household surveys. These surveys tend to be expensive, however . A more cost-effective and successful method is reproductive age mortality surveys which consist of investigating the causes of all deaths of women of reproductive age. If civil registration or other population-based data do not exist, researchers can use hospital data despite their limitations. They can also use records at the primary care level. They can use incomplete data to estimate maternal mortality and to evaluate rates obtained from civil registers, studies, or other sources.

  17. Resilience at the border: traditional botanical knowledge among Macedonians and Albanians living in Gollobordo, Eastern Albania

    PubMed Central

    2014-01-01

    Background Ethnobotany in South-Eastern Europe is gaining the interest of several scholars and stakeholders, since it is increasingly considered a key point for the re-evaluation of local bio-cultural heritage. The region of Gollobordo, located in Eastern Albania and bordering the Republic of Macedonia, is of particular interest for conducting ethnobiological studies, since it remained relatively isolated for the larger part of the 20th Century and is traditionally inhabited by a majority of ethnic Macedonians and a minority of Albanians (nowadays both sharing the Muslim faith). Methods An ethnobotanical survey focused on local food, medicinal, and veterinary plant uses was conducted with 58 participants using open and semi-structured interviews and via participant observation. Results We recorded and identified 115 taxa of vascular plants, which are locally used for food, medicinal, and veterinary purposes (representing 268 total plant reports). The Macedonian Traditional Ecological Knowledge (TEK) was greater than the Albanian TEK, especially in the herbal and ritual domains. This phenomenon may be linked to the long socio-cultural and linguistic isolation of this group during the time when the borders between Albania and the former Yugoslavia were completely closed. Moreover, the unusual current food utilisation of cooked potatoes leaves, still in use nowadays among Macedonians, could represent the side effect of an extreme adaptation that locals underwent over the past century when the introduction of the potato crop made new strategies available for establishing stable settlements around the highest pastures. Additionally, the difference in use of Helichrysum plicatum, which is popular in the local Macedonian folk medicine but absent among Albanians, confirms the particular significance of this taxon as it relates to the yellow colour of its flowers in South Slavic folklore. Conclusion Botanical studies with an ethnographic approach are crucial for

  18. Vascular Genetic Variants and Ischemic Stroke Susceptibility in Albanians from the Republic of Macedonia

    PubMed Central

    Kamberi, Bajram; Kamberi, Farije; Spiroski, Mirko

    2016-01-01

    BACKGROUND: Acute first-ever ischemic stroke (FIS) is a heterogeneous, polygenic disorder. The contribution of vascular genetic variants as inherited causes of ischemic stroke has remained controversial. AIM: To examine the association of genetic variants in vascular factors with the occurrence of FIS. MATERIAL AND METHODS: The current research was performed in a group of 39 patients with FIS (study group) and 102 healthy volunteers (control group). We analyzed the prevalence of vascular genetic variants in following genes: factor V, prothrombin, methylenetetrahydrofolate reductase (MTHFR), factor XIII, plasminogen activator 1, endothelial protein C receptor (EPCR), apolipoprotein B, apolipoprotein E, β-fibrinogen, human platelet antigen 1, angiotensin-converting enzyme (ACE), endothelial nitric oxide synthase (eNOS) and lymphotoxin alpha. RESULTS: It was found that heterozygous LTA 804C>A and FXIII V34L Leu/Leu were significantly more frequent in patients with FIS than in control group (p = 0.036 and p = 0.017, respectively). The frequency of FXIII V34L Val/Val was significantly lower in patients with FIS than in control group (p = 0.020). Other frequencies of vascular gene variants in patients with FIS and in control group were not significantly different. CONCLUSIONS: This is the first comprehensive study to present data indicating that polymorphism of vascular genes in the prevalence of acute FIS exists in the Albanian population from the Republic of Macedonia. Variations in these genes have been detected in patients with acute FIS, suggesting that their combination might act in a susceptible or protective manner in this Albanian population. PMID:28028391

  19. An overview of the first 'no exit' midwifery group practice in a tertiary maternity hospital in Western Australia: Outcomes, satisfaction and perceptions of care.

    PubMed

    Lewis, Lucy; Hauck, Yvonne L; Crichton, Caroline; Pemberton, Alissa; Spence, Megan; Kelly, Georgina

    2016-12-01

    Midwifery group practice (MGP) is a care model offered by a primary midwife in a small team. Evidence confirms MGP is acceptable to women, safe and cost effective. We aimed to provide a systematic overview of the first 'no exit' MGP in a Western Australian (WA) tertiary maternity hospital, using a mixed methods approach, involving four phases. Between July 2013 and June 2014: phase one assessed MGP characteristics, obstetric and neonatal outcomes by parity; phase two examined women's satisfaction by mode of delivery; and phase three qualitatively explored perceptions of care. Phase four compared the proportion of MGP women and the 2012 WA birthing population. Phase one included 232 MGP women; 87% achieved a vaginal birth. Phase two included 97% (226 of 232) women, finding 98% would recommend the service. Phase three analysis of 62 interviews revealed an overarching theme 'Continuity with Midwives' encompassing six sub-themes: only a phone call away; home away from home; knowing me; a shared view; there for me; and letting it happen. Phase four compared the MGP cohort to 33,393 WA women. Intrapartum MGP women were more likely than the WA population to have a vaginal birth (87% vs 65%, P≤0.001) and intact perineum (49% vs 36%, P≤0.001) and less likely to use epidural/spinal analgesia (34% vs 59%, P≤0.001), or have a caesarean (13% vs 35%, P≤0.001). Mixed methods enabled systematic examination of this new 'no exit' MGP confirming safety and acceptability. Findings contribute to our knowledge of MGP models. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Xpert HIV-1 point-of-care test for neonatal diagnosis of HIV in the birth testing programme of a maternity hospital: a field evaluation study.

    PubMed

    Technau, Karl-Günter; Kuhn, Louise; Coovadia, Ashraf; Murnane, Pamela M; Sherman, Gayle

    2017-10-01

    Point-of-care testing (POCT) among HIV-exposed infants might improve linkage to care relative to laboratory-based testing (LABT). We evaluated HIV-1 POCT at birth in the context of universal LABT in a maternity hospital and describe our implementation experience. We did a field evaluation study between Oct 1, 2014, and April 30, 2016, at the urban Rahima Moosa Mother and Child Hospital (RMMCH), Johannesburg, South Africa. We aimed to sample consecutive neonates at birth with POCT (Cepheid Xpert HIV-1 Qualitative test) and compared results with those of LABT (Roche COBAS TaqMan HIV-1 Qualitative test) with respect to performance in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's κ coefficient, result return, antiretroviral treatment (ART) initiation, and coverage. 18 268 women delivered livebirths at RMMCH and 4267 (23%) were HIV-positive with 4336 HIV-exposed neonates delivered. Mothers of 4141 (96%) HIV-exposed neonates were offered infant birth testing. Mothers of 4112 (99%) neonates consented. In 78 neonates with consent (2%), a test was not done due to early neonatal death (n=13), mother departing before venesection, or staff unavailability. Among 3970 infants who had LABT, 57 (1%) tested positive, 3906 (99%) tested negative, two (<1%) were indeterminate, and five (<1%) had an error result. 2238 (56%) of these infants had concurrent POCT. POCT detected all 30 HIV-infected neonates (sensitivity 100%; 95% CI 88·4-100) with two additional false-positive results (specificity 99·9%; 99·7-100). All positive and 96·2% of negative POCT results were returned compared with 88·9% of positive and 52·8% of negative LABT results. Although every POCT required 90 min of instrument time, 2·6 h (IQR 2·3-3·1) elapsed between phlebotomy and result return. In days, median time of result return for POCT was 1 day, significantly earlier than 10 days for LABT (p<0·0001). ART was initiated in 30 neonates (100

  1. [Psychosocial climate in maternity hospitals from the perspective of parturients I. Results from a national survey on perinatal care satisfactionusing a representative sample of 1195 Czech parturients].

    PubMed

    Takács, L; Seidlerová, J

    2013-04-01

    To assess women's satisfaction with psychosocial aspects of perinatal care provided in Czech maternity hospitals, to identify areas that need improvement and to compare satisfaction with maternity care between selected subgroups of parturients. Original study. Department of Psychology, Faculty of Philosophy, Charles University, Prague. A survey on satisfaction with perinatal care was conducted with a sample of 1195 Czech parturients. The sample was representative of the Czech parturients population in terms of educational level, age, parity, and rate of vaginal and caesarean section delivery. The sample was proportionated as regards the number of births at small and large hospitals and at hospitals in different regions as well. All currently existing Czech maternity hospitals were included. For the data collection, the original Czech questionnaire KLI-P was used. The KLI-P measures psychosocial climate of maternity hospitals on following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. In addition, differences in satisfaction rates between different subgroups of respondents were investigated: primiparas/multiparas, women with lower/higher educational status, women who gave birth at smaller/lager hospitals (< 800 / > 800 births per year), women who gave birth at university/other hospitals, women after vaginal delivery/caesarean section, women accommodated in high-standard rooms at after-birth unit, and women who filled the questionnaire within one year after/later than one year after delivery. The overall satisfaction with care provided at delivery unit (DU) and after-birth unit (ABU) was 70% and 61%, respectively. The best rated scale at DU was physical comfort and services (69%), the worst evaluation score received the scale control and involvement in decision-making (34%). At ABU, the

  2. Mental health, social functioning, and feelings of hatred and revenge of Kosovar Albanians one year after the war in Kosovo.

    PubMed

    Lopes Cardozo, Barbara; Kaiser, Reinhard; Gotway, Carol A; Agani, Ferid

    2003-08-01

    A cross-sectional cluster sample survey was conducted in June 2000 in Kosovo to assess the prevalence of mental health problems associated with traumatic experiences, feelings of hatred and revenge, and the level of social functioning among Kosovar Albanians approximately 1 year after the end of the war. Findings of the second cross-sectional survey were compared with those from our 1999 mental health survey in Kosovo. Included in the survey were 1399 Kosovar Albanians aged 15 years or older living in 593 randomly selected households across Kosovo. Twenty-five percent of respondents reported PTSD symptoms, compared with 17.1% in 1999. The MOS-20 social functioning score improved to 69.8 from 29.5 in 1999. In the 2000 survey 54% of men felt hatred toward the Serbs, compared with 88.7% in 1999.

  3. [Maternity blues].

    PubMed

    Gonidakis, F

    2007-04-01

    Maternity blues is a transient change of mood that occurs mainly between the 1st and 10th day of puerpartum and is characterized by bursts of tears, mild depressive mood, anxiety and liability of mood. The frequency of maternity blues varies in different studies form 4% to 80%. A number of biological and psychosocial parameters have been studied in order to determine their correlation with maternity blues. The most well studied biological parameters are progesterone and cortizol although their relation with maternity blues has not yet been clearly defined. Stress and the emotional state of the woman during pregnancy as well as history of mood disorders or maternity blues in a previous birth are the psychosocial parameters that are more likely to correlate with the occurrence of maternity blues. Most of the authors suggest that information on maternity blues and reassurance of the woman are the best way to deal with maternity blues both on preventive and therapeutical basis.

  4. Use of the Modified Checklist for Autism, Revised with Follow Up-Albanian to Screen for ASD in Albania

    ERIC Educational Resources Information Center

    Brennan, Laura; Fein, Deborah; Como, Ariel; Rathwell, Iris Carcani; Chen, Chi-Ming

    2016-01-01

    The Modified Checklist for Autism in Toddlers Revised-Albanian screener (M-CHAT-R-A) was used to screen 2,594 toddlers, aged 16-30 months, at well-child visits. Two hundred fifty-three (9.75%) screened positive; follow up on failed items were conducted by phone with 127 (50%); the remainder were lost to follow-up. Twenty-six toddlers (21%)…

  5. A detection of microevolutionary changes by the analysis of qualitative dermatoglyphic traits: an example of Albanians from Kosovo.

    PubMed

    Temaj, Gazmend; Petranović, Matea Zajc; Skarić-Jurić, Tatjana; Behluli, Ibrahim; Narancić, Nina Smolej; Xharra, Shefki; Sopi, Ramadan; Milicić, Jasna

    2012-01-01

    In this study we analyzed the qualitative dermatoglyphic traits in the Albanians from three Kosovo distinct regions. We aimed to detect possible microevolutionary changes, which could have happened as a consequence of geographical and cultural isolation. The dermatoglyphic traits were analyzed for total 641 Albanians of both sexes. The analysis included 4 variables on fingers, 8 on palms and terminations of A, B, C, D and T main-lines. The differences in patterns incidence were tested using the chi-square test. The frequencies of several pattern types varied to a great extent between distinct groups with statistically significant difference in most of the cases. Our results indicated that the Albanians from South Morava valley and from Kosovo plain were genetically close, and the population from Dukagjini valley is less close to any of them. The analysis of qualitative dermatoglyphic patterns may be utilized effectively to track the microevolutionary changes. This is especially useful in a developing country like Kosovo, since it is an inexpensive and effective tool for screening and studying the patterns influenced by the divergence of population.

  6. Glucose-6-phosphate dehydrogenase (G6PD) deficiency in the Albanian ethnic minority of Cosenza province, Italy.

    PubMed

    Tagarelli, A; Cittadella, R; Bria, M; Brancati, C

    1992-01-01

    The Albanian ethnic minority of the Cosenza province (Calabria, Southern Italy) is constituted by a population of 42,305 inhabitants living in 19 communes. The first presence of this population, in Southern Italy, dates back to the fifteenth century as a result of different immigrations. We have studied the G6PD in the population of this province by determining both the frequency of the G6PD-deficiency and the type of Gd(-) alleles in samples from 19 communes. The overall frequency estimate turned out to be 0.0294 and those of the 8 highland communes and of the 11 communes located in the valleys were 0.0242 and 0.033 respectively. Both the frequencies and the ratio between the frequencies of the different Gd(-) alleles are significantly different with respect to a previous study carried out on the non-Albanian population of the same areas. The high endogamy rate found among the grandparents' and among the parents of the probands living in the Albanian community, shows that this community is to a large extent reproductively isolated from the neighbouring populations, thus accounting for these differences.

  7. Developing a successful alternative maternity unit.

    PubMed

    Jones, C

    1987-07-01

    The users of maternity services are becoming increasingly interested in alternative delivery options, as a result hospitals are developing customer oriented, competitive maternity services. In this article, the author describes one hospital's efforts at developing a customer oriented family birthing center: the rationale, the benefits, the marketing and the satisfying results.

  8. [Malaria morbidity at the Center for Maternal and Child Prevention of the Central Hospital, Yaounde, Cameroon. Observations of a sample of 903 infants].

    PubMed

    Loué, P; Andela, A; Carnevale, P

    1989-09-01

    From April 1988 to March 1989, 903 randomly chosen children were examined in the Maternal and Child Health Department of the Central Hospital of Yaounde (Cameroon) to determine the importance of malaria in general morbidity, the relation between clinical symptoms and parasite densities and to have some idea of the population's self-medication behaviour. We adopted the criteria formerly worked out in West Africa, i.e. a fever (t degree higher than 37.9 degrees C) without any obvious febrile disease and a parasitaemia higher than 10,000 red blood cells parasitized by Plasmodium falciparum/mm3. In the sample under investigation, the average plasmodic index was 32.5%, mainly P. falciparum (98% of all infections), while 120 children had a parasitaemia higher than the critical level of 10,000 par./mm3 (i.e. 13.3% of the whole sample and 40.1% of Plasmodium carriers. 559 of the 903 children were actually febrile and among them 94 had a so-called malaria crisis (i.e. 16.8% of fevers and 10.4% of all consultations). It was confirmed that not one single clinical symptom is pathognomic for malaria crisis but fever, splenomegaly and anaemia seemed to occur more frequently among sick children. It also appeared that the proportion of children with fever increased as their parasitaemia exceeded the critical threshold of 10,000 par./mm3, while splenomegaly tends to drop with very high parasitaemia. Faced with fever as a clinical symptom, self-medication is a common behaviour (65% of people interviewed admitted such practice); it is mainly based upon chloroquine tablet ingestion but at a subcurative dosage. Such self-medication could induce an underestimation of malaria morbidity from clinical statistics and, on the other hand, a growing drug pressure, which could play a role in the current spread of P. falciparum chloroquine resistant strains in Central Africa and elsewhere in sub-saharan regions.

  9. [Birth in Out-of-Hospital Settings--Differences in Maternal and Neonatal Outcome of Women with their Second Child and a Prior Caesarean Section Compared to First Paras].

    PubMed

    Beckmann, L; Dorin, L; Metzing, S; Hellmers, C

    2015-12-01

    Vaginal birth after Caesarean (VBAC) in out-of-hospital settings is controversial. With increasing Caesarean rates, more women with a prior Caesarean will decide to give birth in midwife-led birth-centres or at home. Therefore the study explores the question about maternal and neonatal outcomes in German out-of-hospital settings. A retrospective study of German out-of-hospital data from 2005 to 2011 was undertaken. Included were 66,437 singleton pregnancies in cephalic presentation at term. This study describes the outcome parameters of first paras compared to mothers with their second child who had a prior Caesarean. The VBAC rate was 77.8%, and the first para vaginal birth rate was 89.8% (p<0.001). The intrapartum transfer rate of women with a prior Caesarean section was significantly more than for the first paras (38.2 vs. 27.2%; p<0.001). A prolonged first stage was the most frequently documented indication for intrapartal transfer in both groups. There were no significant differences in rates of maternal postpartum complications, or in postpartum hospital transfer rates. Also, neither neonatal transfer rates nor Apgar scores were statistically different between the groups. These results are consistent with other studies which reported that an out-of-hospital setting is an alternative to the clinical setting for women with a prior Caesarean. However, the fact that the intrapartum transfer rate of women with a prior Caesarean was almost 40% should be included in antenatal counselling about the place of labour and birth. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo.

    PubMed

    Lopes Cardozo, B; Vergara, A; Agani, F; Gotway, C A

    2000-08-02

    The 1998-1999 war in Kosovo had a direct impact on large numbers of civilians. The mental health consequences of the conflict are not known. To establish the prevalence of psychiatric morbidity associated with the war in Kosovo, to assess social functioning, and to identify vulnerable populations among ethnic Albanians in Kosovo. Cross-sectional cluster sample survey conducted from August to October 1999 among 1358 Kosovar Albanians aged 15 years or older in 558 randomly selected households across Kosovo. Nonspecific psychiatric morbidity, posttraumatic stress disorder (PTSD) symptoms, and social functioning using the General Health Questionnaire 28 (GHQ-28), Harvard Trauma Questionnaire, and the Medical Outcomes Study Short-Form 20 (MOS-20), respectively; feelings of hatred and a desire for revenge among persons surveyed as addressed by additional questions. Of the respondents, 17.1% (95% confidence interval [CI], 13.2%-21.0%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PTSD; total mean score on the GHQ-28 was 11.1 (95% CI, 9.9-12.4). Respondents reported a high prevalence of traumatic events. There was a significant linear decrease in mental health status and social functioning with increasing amount of traumatic events (P

  11. [Maternal phenylketonuria].

    PubMed

    Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László

    2013-05-05

    Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.

  12. Maternal understanding of infective endocarditis after hospitalization: assessing the knowledge of mothers of children with congenital heart disease and the practical implications.

    PubMed

    Knöchelmann, Anja; Geyer, Siegfried; Grosser, Urte

    2014-02-01

    This study aimed to examine the knowledge of mothers of children with congenital heart disease as well as the association of cardiological factors and maternal characteristics with maternal understanding. Mothers of 135 children (≤2 years old) were interviewed to assess maternal knowledge of infective endocarditis (IE) using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease. Two subscales, endocarditis and risk factors, were used. Cardiological data as well as maternal characteristics were collected. Two-thirds of the mothers achieved only low scores, answering 0-20 % of the questions correctly (endocarditis = 64.4 %; risk factors = 71.1 %). Mothers with higher education recalled the correct definition of IE (P = 0.001) and the importance of dental hygiene (P = 0.004) more often. Mothers with only one child were more likely to know the most typical symptom (P = 0.007). The severity of the heart disease and the requirement of endocarditis prophylaxis did not influence maternal understanding. Yet, mothers assessing the heart disease as severe showed better knowledge (typical symptom P = 0.021; importance of dental hygiene P = 0.007). If mothers learned the diagnosis before their child's birth, they remembered relevant information more often. Mothers receiving information by the medical staff and from the Internet showed better knowledge (definition P = 0.014; importance of dental hygiene P = 0.001). Due to low levels of knowledge, more efforts must be put into the education of mothers. Educational programs should take maternal characteristics into account, providing written material and thereby keeping the instruction of lower-educated persons in mind. Furthermore, education should be focused on mothers of children requiring IE prophylaxis.

  13. [Population study of knowledge and practice in the Albanian population regarding water usage and diarrhea prevention].

    PubMed

    Schinaia, N; Faria, S; Sallabanda, A; Kakarriqi, E; Di Renzi, M; Rossi, F

    2003-01-01

    The worsening of the social-environmental conditions during the period of transition of Albania and an epidemic of cholera (1994) were the cue for the execution of the study. The main objective is the description of knowledge and attitudes of the Albanian mothers about the risk factors for the gastroenteritis. This is a descriptive study of a representative sample (2100 families) of the population who reside in the central area of Albania, in 1996. The sample has been selected by cluster-sampling method. Interviewers trained previously, collected the data with a questionnaire ad hoc. Data elaboration has been carried out with the software Epilnfo 5. 99.7% (2094) of the enlisted mothers, mean age 28.7 years, were interviewed. 2/3 of them reside in rural areas. We considered social-demographic variables and their relation with the generic hygienic norms and those relative to water, foods, animals. The basic knowledge was very insufficient, particularly in rural areas, and in relation with lower social-economic index and instruction. The study reflects the state of transition train of the political and social-sanitary situation of Albania in the last decade. Still the knowledge and the attitudes about the alimentary hygiene are inadequate. It seems opportune to face this emergency with campaigns aimed at health education and public health interventions.

  14. Factors Associated with Physical Activity among Macedonian Adolescents in Albanian Ethnic Community

    PubMed Central

    GONTAREV, Seryozha; KALAC, Ruzdija; AMETI, Vullnet; REDJEPI, Agim

    2016-01-01

    Background: The purpose of this study was to determine the relationship of demographic, psychological, social and environmental factors with physical activity and to determine whether indicators of physical activity differ by gender among Macedonian adolescents from Albanian ethnic community from 11 to 14 yr (N = 886). Methods: Research were conducted in 2014 in several primary schools randomly selected from Tetovo and Gostivar region of the R. Macedonia. Students completed a questionnaire which examined their level of participation in physical activity and sedentary behavior along with a number of potential correlates. Hierarchical regression was used to explore the relationship between hypothesised factors and physical activity. Results: The boys unlike the girls showed significantly higher levels of physical activity (P=0.001). Respondents of both genders who perceive greater benefits from the physical activity (P=0.010). They have more confidence in their abilities (P=0.001), enjoy more in the physical activities (P=0.016), perceive greater social support from friends (P=0.008) and parents (P=0.001) and have higher levels of physical activity. Conclusions: The results indicate the importance of developing a national plan and program to promote physical activity in order to help young people to change unhealthy lifestyle habits and increase the physical activity, thus improving their health. PMID:27252917

  15. Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis.

    PubMed

    Hutcheon, J A; Strumpf, E C; Harper, S; Giesbrecht, E

    2015-08-01

    To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39 weeks of gestation improved neonatal health, maternal health, and healthcare costs. Retrospective cohort study. British Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012. Women with a low-risk planned repeat caesarean delivery. An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39 weeks of gestation, introduced on 1 April 2008. Composite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of <7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out-of-hour deliveries, length of stay, and healthcare costs. Between 2005 and 2008, 60% (1204/2021) of low-risk planned caesarean deliveries were performed before 39 weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95% CI -25.8, -14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95% CI -0.4, 4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95% CI 1.6, 10.9). We found little evidence that a hospital policy to limit planned caesareans before 39 weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing. © 2015 Royal College of Obstetricians and Gynaecologists.

  16. [Precautionary maternity leave in Tirol].

    PubMed

    Ludescher, K; Baumgartner, E; Roner, A; Brezinka, C

    1998-01-01

    Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in

  17. A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627

    PubMed Central

    Althabe, Fernando; Buekens, Pierre; Bergel, Eduardo; Belizán, José M; Kropp, Nora; Wright, Linda; Goco, Norman; Moss, Nancy

    2005-01-01

    Background A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. Methods/Design The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions. PMID:15823211

  18. 'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

    PubMed Central

    Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

    2015-01-01

    Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers

  19. A cross-cultural comparison of folk plant uses among Albanians, Bosniaks, Gorani and Turks living in south Kosovo.

    PubMed

    Mustafa, Behxhet; Hajdari, Avni; Pieroni, Andrea; Pulaj, Bledar; Koro, Xhemajli; Quave, Cassandra L

    2015-05-12

    Kosovo represents a unique hotspot of biological and cultural diversity in Europe, which allows for interesting cross-cultural ethnobotanical studies. The aims of this study were twofold: 1) to document the state of traditional knowledge related to local (esp. wild) plant uses for food, medicine, and handicrafts in south Kosovo; and 2) to examine how communities of different ethnic groups in the region (Albanians, Bosniaks/Gorani, and Turks) relate to and value wild botanical taxa in their ecosystem. Field research was conducted in 10 villages belonging to the Prizren municipality and 4 villages belonging to the Dragash municipality, located in the Sharr Mountains in the southern part of Kosovo. Snowball sampling techniques were used to recruit 139 elderly informants (61 Albanians, 32 Bosniaks/Gorani and 46 Turks), for participation in semi-structured interviews regarding the use of the local flora for medicinal, food, and handicraft purposes. Overall, we recorded the local uses of 114 species were used for medicinal purposes, 29 for food (wild food plants), and 20 in handicraft activities. The most important species used for medicinal purposes were Achillea millefolium L., Sambucus nigra L., Urtica dioica L., Tilia platyphyllos Scop. Hypericum perforatum L., Chamomilla recutita (L.) Rauschert, Thymus serpyllum L. and Vaccinium myrtillus L. Chamomilla recutita was the most highly valued of these species across the populations surveyed. Out of 114 taxa used for medicinal purposes, only 44 species are also included in the European Pharmacopoeia. The predominantly quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Comparison of the data recorded among the Albanian, Bosniak/Gorani, and Turkish communities indicated a less herbophilic attitude of the Albanian populations, while most quoted taxa were quoted by all three communities, thus suggesting a hybrid character of the Kosovar plant knowledge. Cross-cultural ethnobiological studies are crucial in

  20. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  1. Alternative Maternity Services in Washington State.

    ERIC Educational Resources Information Center

    Starzyk, Patricia M.

    The nature of maternity services has changed in the past 20 years, with a movement away from traditional (physician delivery in a hospital) towards other alternative services. This study examined alternative maternity services in Washington State, which ranks eighth in the country in the use of such services. Data were collected from birth and…

  2. Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005

    PubMed Central

    Muganyizi, Projestine S; Kidanto, Hussein L

    2009-01-01

    Background Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania. Methods We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant. Results The proportion of teenage mothers (12–19 years) progressively decreased over time while that of 30–34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6–1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71–0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30–34 years age group had no impact on this. Conclusion The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change. PMID:19622146

  3. Quality improvement competency gaps in primary care in Albanian, polish and slovenian contexts: a study protocol.

    PubMed

    Czabanowska, Katarzyna; Burazeri, Genc; Klemenc-Ketis, Zalika; Kijowska, Violetta; Tomasik, Tomasz; Brand, Helmut

    2012-12-01

    Nowadays, general practitioners (GPs) and family doctors (FDs) face increasing demands, as a consequence of complex patients' expectations, developments in science and technology, and limitations within healthcare systems which can result in competency gaps. Therefore, there is a need to identify which competencies in quality improvement (QI) are most important for GPs and FDs to possess in order to meet the demands of contemporary health care practice. To date, however, little information is available on the self-assessment of competencies related to QI among GPs and FDs. To deal with these issues, a project on QI in continuous medical education was launched in 2011. The project aims to broaden the GPs'/ FDs' continuous education offer, its quality and attractiveness, as well as provide them with opportunities for vocational advancement and enable the development of common, European frame of reference for GPs'/FDs' occupational competencies. The third work package of the project consists of the validation research of the questionnaire developed on the basis of the competency framework in QI for GPs/FDs in Europe. A cross-sectional study will be carried out using the self-assessment QI questionnaire which was originally developed in English and subsequently it was cross-culturally adapted in Slovenian, Albanian and Polish settings by use of a pilot study on a conveniently selected group of FDs/GPs (N=10) in each participating country. The final version of the questionnaire will be administered to large samples in each country involved in the survey. Two weeks after the first administration of the questionnaire, a second round, with the same procedure and including the same group of respondents, will follow. Psychometric tests will be conducted including internal consistency (after the initial and subsequent application of the instrument) and stability over time (two-week test-retest reliability). This self-assessment study will demonstrate the complex environment

  4. Phenylketonuria and maternal phenylketonuria.

    PubMed

    Purnell, H

    2001-07-01

    Phenylketonuria is a genetic disease affecting 1:10,000 to 14,000 live births. In NSW there is an average of nine cases diagnosed each year (Dietitians Working Party 1996). This paper discusses the management of phenylketonuria, and in particular the value of breastfeeding, complemented with a low phenylalanine infant formula, in facilitating easier maintenance of satisfactory phenylalanine blood levels. The 'diet for life' approach to managing phenylketonuria is to avoid long-term neurological deficits and, in particular, the risk that maternal PKU, which is not under strict dietary control, will have adverse effects on infants born of mothers with the disease. There have been 31 successful pregnancies to 1997 managed by the Nutrition and Dietetics Department of The Children's Hospital at Westmead, Sydney. The Maternal PKU diet is presented with the case of a client with phenylketonuria who has achieved two normal pregnancies and breastfed her second child for six months.

  5. [A case-control study of factors associated with repeat teen pregnancy based on a sample from a university maternity hospital].

    PubMed

    Silva, Andréa de Albuquerque Arruda; Coutinho, Isabela C; Katz, Leila; Souza, Alex Sandro Rolland

    2013-03-01

    Repeat teen pregnancy is a frequent issue and is considered an aggravating factor for increased maternal and fetal morbidity and social problems. The aim of the study was to identify factors associated with repeat teen pregnancy. A case-control study was conducted in 90 postpartum adolescents with more than one pregnancy (cases) and 90 adult women with a history of only one pregnancy during adolescence (controls). Statistical analysis used hierarchical logistic regression with 5% significance. Early sexual initiation (< 15 years), early age at first pregnancy (< 16 years), not raising the children themselves, and low family income (< one minimum wage) were associated with repeat teenage pregnancy, while partner change was inversely associated. Repeat teen pregnancy was mainly associated with reproductive and socioeconomic factors. Partner change appeared as a protective factor. Measures should be adopted during the postpartum period of teenage mothers in order to avoid repeat pregnancy.

  6. Use of Maternal Early Warning Trigger tool reduces maternal morbidity.

    PubMed

    Shields, Laurence E; Wiesner, Suzanne; Klein, Catherine; Pelletreau, Barbara; Hedriana, Herman L

    2016-04-01

    Maternal mortality in the United States has increased unabated for the past 20 years. Maternal morbidity is also affecting an increasingly large number of women in the United States. A number of national and state organizations have recommend the use of maternal early warning tools as a method to combat this problem. There are limited data suggesting that the use of these types of clinical assessment tools can reduce maternal morbidity. We sought to determine if maternal morbidity could be reduced with the implementation of a clinical pathway-specific Maternal Early Warning Trigger (MEWT) tool. The tool was developed internally and prospectively implemented as a pilot project in 6 of 29 hospitals within a large hospital system. The primary goal was early assessment and treatment of patients suspected of clinical deterioration. The tool addressed the 4 most common areas of maternal morbidity: sepsis, cardiopulmonary dysfunction, preeclampsia-hypertension, and hemorrhage. To be considered positive, triggers needed to be sustained for >20 minutes and were defined as severe (single abnormal value): maternal heart rate (HR) >130 beats/min (bpm), respiratory rate >30/min, mean arterial pressure <55 mm Hg, oxygen saturation <90%, or nurse concern; or nonsevere (required 2 abnormal values): temperature >38 or <36°C, blood pressure >160/110 or <85/45 mm Hg, HR >110 or <50 bpm, respiratory rate >24 or <10/min, oxygen saturation <93%, fetal HR >160 bpm, altered mental status, or disproportionate pain. Within each group, recommended management or assessment was also provided. Outcome measures were Centers for Disease Control and Prevention (CDC)-defined severe maternal morbidity, composite maternal morbidity, and intensive care unit (ICU) admissions. Two time intervals were used to analyze the effect of the MEWT tool: a 24-month baseline control period and a 13-month MEWT study period. To determine that the findings noted were not simply changes that would have occurred

  7. [Breastfeeding counseling and early mother-child contact are associated with exclusive maternal breastfeeding. A hospital-based-case-control study].

    PubMed

    González-Salazar, Francisco; Cerda-Flores, Ricardo M; Robledo-García, José A; Valdovinos-Chávez, Salvador; Vargas-Villarreal, Javier; Said-Fernández, Salvador

    2005-01-01

    The aim of this study was to assess the association between exclusive breastfeeding (EBF) and some factors that may influence breastfeeding in a closely related population attending a private hospital sponsored by a major Mexican brewing company. We carried out a retrospective hospital-based unmatched case-control study. A sample of 124 mother-newborn couples was interviewed in a private medical unit in Monterrey, Mexico, from January 2001 to January 2002. The association between EBF and 11 explanatory factors was analyzed by logistic regression analysis. Counseling and early contact between mother-newborn couples were positively associated with EBF. Counseling and early contact improve EBF practice. We believe these two practices would favor better adherence to EBF in other populations.

  8. Self-reported Prevalence and Risk Factors of Non-communicable Diseases in the Albanian Adult Population

    PubMed Central

    Kraja, Fatjona; Kraja, Bledar; Mone, Iris; Harizi, Ilda; Babameto, Adriana; Burazeri, Genc

    2016-01-01

    Aim: There is growing evidence that non-communicable diseases (NCDs) are a major health problem in developing and transitional countries. The prevalence of NCDs and associated factors are under-researched in Albania. We aimed to assess the prevalence and socio-demographic and lifestyle correlates of NCDs in the Albanian adult population. Methods: The study was carried out in the framework of Albania Living Standard Measurement Survey (LSMS), a national population-based cross-sectional study conducted in 2012 including 12,554 men and women aged ≥35 years. All participants reported on the presence of at least one chronic condition, which in the analysis was dichotomized into “yes” vs. “no”. Information on socio-demographic characteristics (age, gender, education, employment status, residence) and lifestyle factors (smoking and alcohol consumption) was also collected. Logistic regression was used to assess socio-demographic and behavioral correlates of NCDs. Results: Overall, the prevalence of chronic diseases in this population-based sample of Albanian adults was 2864/12554=22.8%. Upon multivariable adjustment for all covariates, positive correlates of chronic conditions were older age (OR=6.0, 95%CI=5.3-6.8), female gender (OR=1.2, 95%CI=1.1-1.4), residence in coastal areas of Albania (OR=2.0, 95%CI=1.7-2.5), unemployment (OR=1.8, 95%CI=1.6-2.0), low education (OR=1.6, OR=1.3-1.9) and current smoking (OR=1.2, 95%CI=1.1-1.5). Conversely, there was an inverse association with poverty (OR=0.8, 95%CI=0.7-1.0). Conclusions: This study provides evidence on self-reported NCDs and its determinants in transitional Albania. These baseline data may be useful for assessment of future NCD trends in Albania and cross-comparisons with the neighboring countries. PMID:27594748

  9. Carrier screening for alpha- and beta-thalassemia in pregnancy: the results of an 11-year prospective program in Guangzhou Maternal and Neonatal hospital.

    PubMed

    Liao, Can; Mo, Qiu-Hua; Li, Jian; Li, Li-Yan; Huang, Yi-Ning; Hua, Liang; Li, Qiu-Ming; Zhang, Ji-Zeng; Feng, Qiong; Zeng, Rong; Zhong, Hui-Zhu; Jia, Shi-Qi; Cui, Yong Yi; Xu, Xiang-Min

    2005-02-01

    To evaluate the first prospective screening program in China for control of alpha and beta-thalassemia in the population of pregnant couples. During the period between January 1993 and December 2003, a hospital-based preventive program was conducted at the biggest birth center in Guangzhou, with 1/17 of all deliveries in this city referred annually by use of conventional heterozygote screening strategy in combination with the system of regular healthcare examination in pregnancy. The screened records included 49 221 pregnant women, and 4503 husbands of the pregnant women showed positive on the screening test. Of the at-risk couples, there were 198 for alpha-thal (4.4%) and 83 for beta-thal (1.8%), respectively. Genetic counseling was offered to all at-risk couples and a successful prenatal diagnosis was performed for 269 out of 281 (95.7%) for alpha- or beta-thal major, with the remaining 12 couples refusing to accept prenatal diagnosis. Out of 187 pregnancies at risk for homozygous alpha0-thal and 82 at risk for beta-thal major, 51 hydrops fetalis with Hb Bart's and 18 beta-thal major were identified. All pregnancies with affected fetuses were voluntarily terminated, leading to a marked reduction of severe alpha- and beta-thal births at this hospital since the program has been launched. Our hospital-based program proved to be highly effective in reducing severe thals in pregnant populations. Copyright 2005 John Wiley & Sons, Ltd.

  10. Maternal adjustment and maternal attitudes in adolescent and adult pregnant women.

    PubMed

    Figueiredo, Bárbara; Tendais, Iva; Dias, Cláudia C

    2014-08-01

    This study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy. A sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24(th) and 36(th) weeks of gestation. Maternal Adjustment and Maternal Attitudes Questionnaire(1) RESULTS: Adolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education. Adolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  11. [Maternal and foetal prognostic during severe toxemia].

    PubMed

    Rachdi, Radhouane; Kaabi, Mehdi; Zayene, Houssine; Basly, Mohamed; Messaoudi, Fathi; Messaoudi, Lotfi; Chibani, Mounir

    2005-02-01

    Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

  12. Maternal Depression and Parent Management Training Outcomes.

    PubMed

    Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E

    2016-09-01

    This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.

  13. [The incidence of a neonatal bacterial infection syndrome with maternofetal transmission in the Neonatal Department of the Baia Mare District Maternity Hospital in 1983-1987].

    PubMed

    Pohl, A; Radu, I; Mesaroş, M; Surianu, E; Bancoş, T

    1991-01-01

    In a retrospective study extending on a 5-year period, authors have analysed the incidence of the bacterial infectious syndrome with maternofetal transmission in the newborns admitted to the above-mentioned department. Among 20,674 live-born infants, 241 cases (1.16%) with diseases of an infectious character with vertical transmission were recorded. The incidence of the neonatal infectious syndrome was marked by a yearly increase, from 0.86% in the first year of the study to 1.24% in the last year, with a peak of 1.43% in 1986. The infection risk by maternofetal transmission was more than 10 times higher in the group of premature children. During the study period, of the total of 128 deaths, 31 (24.22%) were due to the neonatal infectious syndrome; of these 31 deaths, 21 occurred in premature children, hence 2/3 of all the failures were recorded in premature infants. Authors conclude that the prevention of the neonatal bacterial infectious syndrome could surely exert a favorable influence on the course of perinatal mortality and on the incidence of premature births in maternities.

  14. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in Albanian overweight children.

    PubMed

    Kodhelaj, K; Resuli, B; Petrela, E; Malaj, V; Jaze, H

    2014-02-01

    Overweight and obesity has emerged as a significant global health problem in the pediatric population. Childhood non-alcoholic fatty liver disease (NAFLD) has become a common and important liver disease. Although mostly benign, some children with NAFLD develop fibrosis and in some case cirrhosis. The aims of this study were to determine the prevalence of NAFLD/non-alcoholic steatohepatitis (NASH) in overweight Albanian children, to evaluate the demographic and biochemical details and to assess the association between the severity of fatty liver changes and demographic and biochemical abnormalities. A total of 80 school aged children, 24 overweight (85th≤BMI≤94th percentile) and 55 obese (BMI≥94th percentile), aged 10.43±2.2 years (M±SD) were included in the current study, in January-December 2010. Their age was in the range of 7-15 years. Their sex distribution was 36 female and 44 male. The children were enrolled to the Tirana schools and none of them were part of any weight or diet programmer. Children who were found to have TBC, evidence of HBV or HCV, infections, drug toxicity, autoimmune hepatitis, inborn error of metabolism or concomitant cortisteroid therapy were excluded. Laboratory parameters were measured at the time of bioclinical examinations. Fatty liver was diagnosed by ultrasonography detection of the most characteristic features of fatty infiltration. The scoring system was used in order to graduate the severity of the disease. The child was considered to have mild, moderate and severe fatty liver changes if the overall score was 1-3, 4-6 and 7-9, respectively. Multivariate regression analysis was used to assess the association between the different variables and the severity of NAFLD. NAFLD was present in 55/80 (68.7%) of the overweight children, 34 (61.8%) boys and 21 (38.2%) girls. Mild, moderate and severe degree of fatty liver were found in 35 (43.7%), 19 (23.7%) and 1 (1.3%), respectively. Nash was seen in 13 (23.7%) of the children

  15. The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity

    PubMed Central

    Souza, Joao Paulo; Cecatti, Jose Guilherme; Haddad, Samira M.; Parpinelli, Mary Angela; Costa, Maria Laura; Katz, Leila; Say, Lale; Almeida, Elson J; Amaral, Eliana M; Amorim, Melania M; Andreucci, Carla B; Aquino, Márcia M; Bahamondes, Maria V; Lima, Antonio C Barbosa; Barroso, Frederico; Bione, Adriana; Brum, Ione R; Calderon, Iracema M; Camargo, Rodrigo S; Campanharo, Felipe F; Carvalho, Luiz E; Carvalho, Simone A; Cecatti, José G; Chaves, George N; Cordioli, Eduardo; Costa, Maria L; Costa, Roberto A; Costa, Sergio M; Feitosa, Francisco E; Freire, Djacyr M; Gonçalves, Simone P; Guanabara, Everardo M; Guimarães, Daniela; Gurgel, Lúcio T; Haddad, Samira M; Katz, Leila; Leite, Debora; Lima, Moises D; Lobato, Gustavo; Lotufo, Fátima A; Luz, Adriana G; Filho, Nelson L Maia; Martins, Marilia G; Matias, Jacinta P; Mattar, Rosiane; Menezes, Carlos A; Moises, Elaine C; Filho, Olímpio B Moraes; Moreira, Joaquim L; Nakamura-Pereira, Marcos; Nascimento, Denis J; Ohnuma, Maria H; Oliveira, Fernando C; Pacagnella, Rodolfo C; Paiva, Cláudio S; Parpinelli, Mary A; Pattinson, Robert C; Paula, Liv B; Peraçoli, Jose C; Peret, Frederico A; Perez, Cynthia D; Pessoni, Cleire; Peterossi, Alessandra; Pfitscher, Lucia C; Silva, João L Pinto e; Quintana, Silvana M; Radaci, Ivelyne; Filho, Edilberto A Rocha; Rodrigues, Simone M; Rohloff, Roger D; Rudge, Marilza V; Saint'ynes, Gloria C; Santana, Danielly S; Santos, Patricia N; Say, Lale; Schmaltz, Luiza E; Sousa, Maria H; Sousa, Maria R; Souza, Joäo P; Surita, Fernanda G; Zanette, Elvira A; Zotareli, Vilma

    2012-01-01

    Objectives To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. Methods In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. Results Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56–114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909–0.993)). Conclusion The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment. PMID:22952897

  16. [The relationship between early neo-maternal exposure, and maternal attachment, maternal self-esteem and postpartum depression in the mothers of NICU infants].

    PubMed

    Ahn, Young-Mee; Kim, Mi-Ran

    2005-08-01

    This study was performed to investigate the quantities of three neo-maternal exposures; visiting frequency, auditory contact and physical contact, and to examine the relationship between the quantities of each exposure and maternal attachment, maternal self-esteem and postpartum depression in 40 mothers of NICU babies during the first week in the NICU. Each neo-maternal exposure was counted at every mother's visit to the newborn and maternal attachment, maternal self-esteem and postpartum depression were measured using the maternal attachment inventory, the maternal self-report inventory and Edinburgh Postpartum Depression Scale (EPDS) on the first and seventh day in the NICU. The Mean of each neo-maternal exposure was 8.77(2.81) for the visiting frequency, 5.82(3.66) for the auditory contact and 5.60(2.89) for the physical contact during 7 days in the NICU. No significant changes were found in the scores of maternal attachment, maternal self-esteem and postpartum depression between the first and the seventh day in the NICU. The quantities of neo-maternal exposures were positively related to the scores of maternal attachment and maternal self-esteem but not related to postpartum depression. The results of the study suggest the lack of early neo-maternal exposure in cases of NICU hospitalization negate its beneficial effects on maternal psychological well-being in increasing maternal attachment and self-esteem. More efforts are needed for the neo-maternal interaction and the reevaluation of NICU visitation hours in order to promote maternal-infant interaction.

  17. Maternal mortality studies in Ethiopia--magnitude, causes and trends.

    PubMed

    Gaym, Asheber

    2009-01-01

    Reduction of maternal mortality is a global public health priority. Periodic maternal mortality studies are required to monitor changing trends. Both direct and indirect methods of maternal mortality measurement are used in different settings. To study the geographic coverage, study base, type, maternal mortality ratio level and proportion of different causes of maternal deaths identified by maternal mortality studies conducted in Ethiopia. Electronic databases search coupled with search in local journals of health as well as interview with relevant university departments for unpublished literatures on maternal mortality studies was conducted. Structured questionnaire was used to extract relevant data which was analyzed using SPSS 13 statistical package. Twelve maternal mortality studies were identified from 1980 to 2008. Eight were hospital based and four community based studies. Only two were based on a national sample. Maternal mortality ratios ranged from 567 to 2600 per hundred thousand live births. Hospital studies had nearly double ratios compared to community studies. Maternal mortality ratios from hospitals outside Addis were nearly double or more compared to Addis hospital ratios. Abortion complications, ruptured uterus, puerperal sepsis, postpartum hemorrhage and preeclampsia/ eclampsia were the five major causes of maternal mortality. The only study conducted since 2000 has shown a marked reduction in abortion related mortality; compared to findings of earlier studies. Only four of the country's nine regions were covered by the hospital studies. The large pastoralist community has not been adequately addressed by any of the studies. There is a need to conduct national health facility based studies to gather representative data on the proportion of different causes of maternal deaths and their predisposing factors. Inclusion of verbal autopsy techniques to demographic and health surveys and the decennial census can increase the power of these studies to

  18. Exploitation of Albanian wheat cultivars: characterization of the flours and lactic acid bacteria microbiota, and selection of starters for sourdough fermentation.

    PubMed

    Nionelli, Luana; Curri, Nertila; Curiel, José Antonio; Di Cagno, Raffaella; Pontonio, Erica; Cavoski, Ivana; Gobbetti, Marco; Rizzello, Carlo Giuseppe

    2014-12-01

    Six Albanian soft and durum wheat cultivars were characterized based on chemical and technological features, showing different attitudes for bread making. Gliadin and glutenin fractions were selectively extracted from flours, and subjected to two-dimensional electrophoresis. Linja 7 and LVS flours showed the best characteristics, and abundance of high molecular weight (HMW)-glutenins. Type I sourdoughs were prepared through back slopping procedure, and the lactic acid bacteria were typed and identified. Lactobacillus plantarum and Leuconostoc mesenteroides were the predominant species. Thirty-eight representative isolates were singly used for sourdough fermentation of soft and durum wheat Albanian flours and their selection was carried out based on growth and acidification, quotient of fermentation, and proteolytic activity. Two different pools of lactic acid bacteria were designed to ferment soft or durum wheat flours. Sourdough fermentation with mixed and selected starters positively affected the quotient of fermentation, concentration of free amino acids, profile of phenolic acids, and antioxidant and phytase activities. This study provided the basis to exploit the potential of wheat Albanian flours based on an integrated approach, which considered the characterization of the flours and the processing conditions.

  19. Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital

    PubMed Central

    El Sakka, Abeer; El Shimi, Mohamed Sami; Salama, Kareem; Fayez, Hend

    2016-01-01

    The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources. PMID:27777705

  20. Wāhine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand Māori and non-Māori women in relation to infant respiratory admissions and timely immunisations

    PubMed Central

    2013-01-01

    Background Significant health inequities exist around maternal and infant health for Māori, the indigenous people of New Zealand. The infants of Māori are more likely to die in their first year of life and also have higher rates of hospital admission for respiratory illnesses, with the greatest burden of morbidity being due to bronchiolitis in those under one year of age. Timely immunisations can prevent some respiratory related hospitalisations, although for Māori, the proportion of infants with age appropriate immunisations are lower than for non-Māori. This paper describes the protocol for a retrospective cohort study that linked local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes in relation to respiratory admissions and timely immunisations for infants of Māori and non-Māori women. Methods/Design The study population included pregnant women who gave birth in hospital in one region of New Zealand between 1995 and 2009. Routinely collected local hospital data were linked via a unique identifier (National Health Index number) to national health information databases to assess rates of post-natal admissions and access to health services for Māori and non-Māori mothers and infants. The two primary outcomes for the study are: 1. The rates of respiratory hospitalisations of infants (≤ 1 yr of age) calculated for infants of both Māori and non-Māori women (for mothers under 20 years of age, and overall) accounting for relationship to parity, maternal age, socioeconomic deprivation index, maternal smoking status. 2. The proportion of infants with age appropriate immunisations at six and 12 months, calculated for both infants born to Māori women and infants born to non-Māori women, accounting for relationship to parity, maternal age, socioeconomic deprivation index, smoking status, and other risk factors. Discussion Analysis of a wide range of routinely collected health information in which

  1. Changing trends of maternal mortality in developing countries.

    PubMed

    Pandit, R D

    1987-12-01

    An in-depth study of maternal mortality was carried out from 1929-83 at Nowrosjee Wadia Maternity Hospital, Bombay, India. Results have shown that maternal mortality dropped from 1920/100,000 livebirths during 1929-39 to 80/100,000 livebirths between 1980-83. The direct obstetric death rate for the period 1929-39 which was 670/100,000 livebirths declined to 40/100,000 for the period 1980-83, while the indirect obstetric death rate has declined from 690/100,000 livebirths during 1929-39 to 30/100,000 for the 1980-83 period. Multiple factors are responsible. It is emphasized that ideal antenatal, intranatal, and postnatal care is a contributing factor to the declining maternal mortality. Confidential maternal mortality committees in various hospitals and institutions, as well as periodic reviews of maternal mortality on a national and international level will help aid and further reductions in maternal mortality.

  2. [Maternal malnutrition. The nursing task].

    PubMed

    Grotestán Liverpool, G; Grant, W A; Ibáñez Peña, E

    1990-01-01

    A retrospective study of 577 patients from urban and periurban areas of Las Tunas municipality is made. These patients were delivered in "Dr. Ernesto Guevara de la Serna" Hospital between January and April 1986, both inclusive; their characteristics included being single pregnancies and not having suffered maternal diseases that influenced fetal growth. The following variables were studied: state of maternal nutrition at implantation, initial weight and weight gain, newborn weight, as well as maternal age and place of residence; these variables were interrelated with the view to know their influence or lack of influence on fetal weight. A survey of 89 of these women is made; they had been classified as malnourished and the purpose of the survey is to analyze their knowledge and views on malnutrition, as well as the instructions received during pregnancy and after delivery. Conclusions are derived and nursing recommendations are made.

  3. Midwives' knowledge and attitudes when encountering Gender-Based Violence in their practice at a maternity-hospital in Kingston, Jamaica.

    PubMed

    Pitter, Cynthia Pearl

    2016-01-01

    Gender-based violence (GBV) can have devastating consequences for pregnancy because both mother and child are at risk. Midwives are in a strategic position to identify and empower pregnant women experiencing GBV; however, currently midwives in Jamaica are not required to screen for GBV, neither are they prepared to do so. This study forms the baseline of a larger study designed to improve the capacity of midwives to identify and treat pregnant women experiencing GBV in Jamaica. This specific component assessed midwives' knowledge and attitudes when encountering GBV in their practice in Kingston, Jamaica. A qualitative study design was used. Six practicing midwives were purposely selected to participate in a focus group discussion at the antenatal clinic of a hospital in Kingston, Jamaica. All six respondents said it was very important to screen for GBV among pregnant women in their care. The findings from their report revolved around six themes, namely midwives have suboptimal knowledge, are exposed to women experiencing GBV in pregnancy, lack professional preparedness, report gaps in the institutional framework to guide their practice, are concerned for their safety and security, and are willing to intervene. This study confirmed that midwives are aware of the problem and are willing to intervene but are faced with lack of formal procedures to detect and treat pregnant women who are experiencing GBV. Findings could be used to inform a protocol which is being developed to guide midwives' practice. Findings could also be incorporated in the national strategy to eliminate GBV.

  4. State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality.

    PubMed

    Jarlenski, Marian; Hutcheon, Jennifer A; Bodnar, Lisa M; Simhan, Hyagriv N

    2017-05-01

    To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the United States. We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer. The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such coverage (62.4 compared with 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% confidence interval [CI] 4.0-16.5) of severe maternal morbidity in adjusted analyses relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5-17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively) nor for private insurance-paid hospitalizations (5.6 and 6.1 per 100,000, respectively). State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary

  5. Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland 1994-2003: retrospective population based study using hospital maternity records

    PubMed Central

    Bonellie, Sandra R; Chalmers, James; Greer, Ian; Jarvis, Stephen; Kurinczuk, Jennifer J; Williams, Claire

    2009-01-01

    Objective To quantify the contribution of smoking during pregnancy to social inequalities in stillbirth and infant death. Design Population based retrospective cohort study. Setting Scottish hospitals between 1994 and 2003. Participants Records of 529 317 singleton live births and 2699 stillbirths delivered at 24-44 weeks’ gestation in Scotland from 1994 to 2003. Main outcome measures Rates of stillbirth and infant, neonatal, and post-neonatal death for each deprivation category (fifths of postcode sector Carstairs-Morris scores); contribution of smoking during pregnancy (“no,” “yes,” or “not known”) in explaining social inequalities in these outcomes. Results The stillbirth rate increased from 3.8 per 1000 in the least deprived group to 5.9 per 1000 in the most deprived group. For infant deaths, the rate increased from 3.2 per 1000 in the least deprived group to 5.4 per 1000 in the most deprived group. Stillbirths were 56% more likely (odds ratio 1.56, 95% confidence interval 1.38 to 1.77) and infant deaths were 72% more likely (1.72, 1.50 to 1.97) in the most deprived compared with the least deprived category. Smoking during pregnancy accounted for 38% of the inequality in stillbirths and 31% of the inequality in infant deaths. Conclusions Both tackling smoking during pregnancy and reducing infants’ exposure to tobacco smoke in the postnatal environment may help to reduce stillbirths and infant deaths overall and to reduce the socioeconomic inequalities in stillbirths and infant deaths perhaps by as much as 30-40%. However, action on smoking on its own is unlikely to be sufficient and other measures to improve the social circumstances, social support, and health of mothers and infants are needed. PMID:19797343

  6. Midwives’ knowledge and attitudes when encountering Gender-Based Violence in their practice at a maternity-hospital in Kingston, Jamaica

    PubMed Central

    Pitter, Cynthia Pearl

    2016-01-01

    Introduction Gender-based violence (GBV) can have devastating consequences for pregnancy because both mother and child are at risk. Midwives are in a strategic position to identify and empower pregnant women experiencing GBV; however, currently midwives in Jamaica are not required to screen for GBV, neither are they prepared to do so. Aim This study forms the baseline of a larger study designed to improve the capacity of midwives to identify and treat pregnant women experiencing GBV in Jamaica. This specific component assessed midwives’ knowledge and attitudes when encountering GBV in their practice in Kingston, Jamaica. Methods A qualitative study design was used. Six practicing midwives were purposely selected to participate in a focus group discussion at the antenatal clinic of a hospital in Kingston, Jamaica. Results All six respondents said it was very important to screen for GBV among pregnant women in their care. The findings from their report revolved around six themes, namely midwives have suboptimal knowledge, are exposed to women experiencing GBV in pregnancy, lack professional preparedness, report gaps in the institutional framework to guide their practice, are concerned for their safety and security, and are willing to intervene. Conclusion This study confirmed that midwives are aware of the problem and are willing to intervene but are faced with lack of formal procedures to detect and treat pregnant women who are experiencing GBV. Findings could be used to inform a protocol which is being developed to guide midwives’ practice. Findings could also be incorporated in the national strategy to eliminate GBV. PMID:26894744

  7. [Beneficial effect of maternity leave on delivery].

    PubMed

    Xu, Qian; Séguin, Louise; Goulet, Lise

    2002-01-01

    To identify the contribution of the duration of the prenatal maternity leave on term delivery. Characteristics of the prenatal maternity leave and delivery among 363 working women who had delivered a full-term infant at 1 of 4 hospitals in Montreal during 1996 were studied. The presence of an intervention or complication during delivery was observed in 68.9% of the participants. The average duration of the prenatal maternity leave was about 8 weeks (SD = 7). The adjusted risk of a difficult delivery decreased significantly with the duration of the prenatal maternity leave (OR = 0.96; 95% CI: 0.93-0.99). The duration of the maternity leave before delivery is associated with an easier term delivery for working women.

  8. Light on maternal mortality in India.

    PubMed

    Bhatia, J C

    1990-01-01

    In order to investigate the degree and causes of maternal mortality in Anantapur District, Andhra Pradesh, India, detailed enquiries were made at the grass roots and the records of health facilities were examined. The number of maternal deaths proved to be much higher than would have been revealed by a perusal of official data alone. Many women in a serious condition died on the way to hospital or soon after arrival because the means of transport were too slow or otherwise unsuitable. Maternal mortality rates varied substantially from place to place, reflecting differing levels of economic development and the presence or absence of primary health centres and subcentres.

  9. Maternal creatine in pregnancy: a retrospective cohort study.

    PubMed

    Dickinson, H; Davies-Tuck, M; Ellery, S J; Grieger, J A; Wallace, E M; Snow, R J; Walker, D W; Clifton, V L

    2016-10-01

    To estimate creatine concentrations in maternal plasma and urine, and establish relationships with maternal characteristics, diet and fetal growth. Retrospective cohort study. Lyell McEwin Hospital, Adelaide, Australia. A biobank of plasma and urine samples collected at 13, 18, 30 and 36 weeks' gestation from 287 pregnant women from a prospective cohort of asthmatic and non-asthmatic women. Creatine was measured by enzymatic analysis. Change in creatine over pregnancy was assessed using the Friedman test. Linear mixed models regression was used to determine associations between maternal factors and diet with creatine across pregnancy and between creatine with indices of fetal growth at birth. Maternal creatine concentrations, associations between maternal factors and creatine and between creatine and fetal growth parameters. Maternal smoking, body mass index, asthma and socio-economic status were positively and parity negatively associated with maternal plasma and/or urine creatine. Maternal urine creatine concentration was positively associated with birthweight centile and birth length. After adjustment, each μmol/l increase in maternal urinary creatine was associated with a 1.23 (95% CI 0.44-2.02) unit increase in birthweight centile and a 0.11-cm (95% CI 0.03-0.2) increase in birth length. Maternal factors and fetal growth measures are associated with maternal plasma and urine creatine concentrations. Maternal creatine is altered by pregnancy; fetal growth measures are associated with maternal creatine concentrations. © 2016 Royal College of Obstetricians and Gynaecologists.

  10. Vaginal Infections of Albanian women Infected with HPV and their impact in intraepithelial cervical lesions evidenced by Pap test

    PubMed Central

    Kone, Elsa S; Balili, Avenir D; Paparisto, Piro D; Ceka, Xheladin R; Petrela, Elizana D

    2017-01-01

    Background: Cervical cytology is the best single method for large screening of the population in identifying precancerous lesions of the uterine cervix. Aim: To estimate the frequency of human papillomavirus (HPV) positivity in a group of Albanian women, the prevalence of vaginal coinfections, and the relationship of coinfections with HPV, as well as their role in metaplasia or cervical intraepithelial lesions (CIN). Materials and Methods: In this retrospective study, 2075 vaginal smears were examined. The Papanicolaou stain was used for all slides. The New Bethesda System 2001 was used for the interpretations of the smears. Data analysis was completed using the Statistical Package for the Social Sciences version 19.0. Results: Prevalence of HPV positivity was 43.9% with an average age of 35.48 ± 9.27 years. Candida coinfection resulted in 57.8% of HPV positive women with a significant relationship between them. Gardnerella coinfection resulted in 36 (23%), mixed flora in 34 (8%), and Trichomonas vaginalis in 50% of HPV positive woman. Among the women with positive HPV, 19% had CIN, 8% had metaplasia, and 1% had metaplasia and CIN; 9% of the women with HPV had CIN1 and one of the coinfections. Conclusions: There is a strong relationship between CIN1 and HPV positivity as well as between CIN1 and coinfections. HPV infection is a major factor contributing to metaplasia, and bacterial coinfections in HPV positive women have a statistically significant impact in the development of metaplasia. PMID:28182076

  11. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe

    PubMed Central

    2016-01-01

    Religion affects people’s daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  12. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    PubMed

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Maternal Care and Attachment Security in Ordinary and Emergency Contexts.

    ERIC Educational Resources Information Center

    Posada, German; Jacobs, Amanda; Carbonell, Olga A.; Alzate, Gloria; Bustamante, Maria R.; Arenas, Angela

    1999-01-01

    Two studies examined the relationship between maternal sensitivity and infant security of attachment in home and hospital contexts. Results are discussed in terms of links between methodology and effect sizes, the generality of links between maternal care and child security, need for research on caregiving in ordinary and emergency situations, and…

  14. Birthing Centers and Hospital Maternity Services

    MedlinePlus

    ... use a certified nurse-midwife (CNM) . CNMs are registered nurses who have a graduate degree in midwifery, meaning ... home births. In addition to obstetricians and CNMs, registered nurses (RNs) attend births to take care of the ...

  15. Nucleotide variation in Sabin type 3 poliovirus from an Albanian infant with agammaglobulinemia and vaccine associated poliomyelitis.

    PubMed

    Foiadelli, Thomas; Savasta, Salvatore; Battistone, Andrea; Kota, Majlinda; Passera, Carolina; Fiore, Stefano; Bino, Silvia; Amato, Concetta; Lozza, Alessandro; Marseglia, Gian Luigi; Fiore, Lucia

    2016-06-10

    Vaccine-associated paralytic poliomyelitis (VAPP) and immunodeficient long-term polio excretors constitute a significant public health burden and are a major concern for the WHO global polio eradication endgame. Poliovirus type 3 characterized as Sabin-like was isolated from a 5-month-old Albanian child with X-linked agammaglobulinemia and VAPP after oral polio vaccine administration. Diagnostic workup and treatment were performed in Italy. Poliovirus replicated in the gut for 7 months. The 5' non coding region (NCR), VP1, VP3 capsid proteins and the 3D polymerase genomic regions of sequential isolates were sequenced. Increasing accumulation of nucleotide mutations in the VP1 region was detected over time, reaching 1.0 % of genome variation with respect to the Sabin reference strain, which is the threshold that defines a vaccine-derived poliovirus (VDPV). We identified mutations in the 5'NCR and VP3 regions that are associated with reversion to neurovirulence. Despite this, all isolates were characterized as Sabin-like. Several amino acid mutations were identified in the VP1 region, probably involved in growth adaptation and viral persistence in the human gut. Intertypic recombination with Sabin type 2 polio in the 3D polymerase region, possibly associated with increased virus transmissibility, was found in all isolates. Gamma-globulin replacement therapy led to viral clearance and neurological improvement, preventing the occurrence of persistent immunodeficiency-related VDPV. This is the first case of VAPP in an immunodeficient child detected in Albania through the Acute Flaccid Paralysis surveillance system and the first investigated case of vaccine associated poliomyelitis in Italy since the introduction of an all-Salk schedule in 2002. We discuss over the biological and clinical implications in the context of the Global Polio Eradication Program and emphasize on the importance of the Acute Flaccid Paralysis surveillance.

  16. Maternal mortality following caesarean sections.

    PubMed

    Sikdar, K; Kundu, S; Mandal, G S

    1979-08-01

    A study of 26 maternal deaths following 3647 caesarean sections was conducted in Eden Hospital from 1974-1977. During the time period there were 35,544 births and 308 total maternal deaths (8.74/1000). Indications for Caesarean sections included: 1) abnormal presentation; 2) cephalopelvic disproportion; 3) toxemia; 4) prolonged labor; 5) fetal distress; and 6) post-caesarean pregnancies. Highest mortality rates were among cephalopelvic disproportion, toxemia, and prolonged labor patients. 38.4% of the patients died due to septicaemia and peritonitis, but other deaths were due to preclampsia, shock, and hemorrhage. Proper antenatal care may have prevented anemia and preclampsia and treated other pre-existing or superimposed diseases.

  17. Repetition of the same pair of surnames in marriages in Albanian Italians, Greek Italians, and the Italian population of Campobasso Province.

    PubMed

    Biondi, G; Raspe, P; Mascie-Taylor, C G; Lasker, G W

    1996-08-01

    The isolation of a population as a result of any boundary leads to a kinship mating pattern, the extent of which can be measured by the frequency of repeated pairs of surnames in actual marriages compared with that in random pairings. The repeated pairs within surname lineages (RPw) method can be used to assess random repetitions and the endogamous or exogamous behavior of a population. The RPw method was applied to data from grandparent surnames of children living in 45 Albanian Italian and 13 Greek Italian villages of southern Italy and Sicily and in 22 Italian villages of Campobasso Province (central Italy). The total mean RPw was 0.02782 in Albanian Italians, 0.01993 in Greek Italians, and 0.03427 in the Italian-speaking population. When RPw was subdivided into its components and compared with random and marital isonymy, the low level of inbreeding shown by the two southern Italian ethnic minorities and by the Italian population of Campobasso Province could be accounted for by the subdivision of the populations.

  18. Goodbye, Mandatory Maternity Leaves

    ERIC Educational Resources Information Center

    Nation's Schools, 1972

    1972-01-01

    In precedent-setting decrees, courts and federal and State authorities have branded compulsory maternity leaves either unconstitutional or illegal. School administrators are urged to prod boards of education to adopt more lenient maternity leave policies -- now. (Author)

  19. Maternal anxiety, maternal sensitivity, and attachment.

    PubMed

    Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A

    2013-01-01

    Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels (N = 98). Following Mary Ainsworth's lead, our maternal sensitivity measures were primarily based on ratings of direct observations. Six sets of measures were obtained: positive maternal style at home (a mean of four different ratings); providing a sensitive framework, limit setting, allowing autonomy, criticizing/cutting in (each a mean over two laboratory joint tasks); and tension-making (a mean of three different ratings in a fear-inducing task). Regression analyses showed firstly that maternal anxiety rather than behavioral inhibition or sex of child was the significant predictor of each maternal sensitivity measure; and secondly that these measures rather than maternal anxiety or sex were the significant predictors of security of attachment. Finally, ANOVA's indicated which sets of maternal ratings were associated with each pattern of attachment (Avoidant, Secure, Ambivalent, or Controlling).

  20. The importance of family planning in reducing maternal mortality.

    PubMed

    Fortney, J A

    1987-01-01

    Maternal mortality in many developing countries remains at distressingly high levels despite improvements in hospital obstetrics. WHO estimates that 1/2 million maternal deaths occur each year, 99% of which are in developing countries. While many people expect that widespread acceptance of family planning will bring down levels of maternal mortality, some analyses have claimed disappointing reductions, though others were more encouraging. The primary reason for this discrepancy lies in the choice of measure of maternal mortality, compounded somewhat by a confusion in terminology. Maternal mortality can be measured by: 1) the number of maternal deaths; 2) the maternal mortality ratio; 3) the maternal mortality rate; or 4) the lifetime risk of death in childbirth. Family planning use influences the maternal mortality ratio only to the extent that it reduces the proportion of pregnancies to high-risk women. The maternal mortality rate can be substantially influenced by the prevalence of contraception, but it is primarily the reduction in the number of births, per se, that exerts the influence. The choice of measure should be determined by the issue being addressed, and which of the 2 determinants of maternal mortality (obstetric risk or prevalence of pregnancy) is the focus. Current levels of maternal mortality in the developed countries have been achieved only with both good obstetric care and with low fertility. In developing countries today, modern obstetric care is often available only in a few teaching hospitals, but family planning programs are feasible even in remote areas. While implementing family planning programs is not easy, it is more feasible than the implementation of significant improvements in the quality and availability of obstetric care. The contribution of family planning to lower maternal mortality and morbidity should not be underestimated.

  1. Maternity Protection at Work.

    ERIC Educational Resources Information Center

    World of Work, 1998

    1998-01-01

    Discusses the need for maternity benefits for working women. Suggests that although most countries provide paid maternity leave by law, there is a gap between that law and practice. Includes a chart depicting maternity protection (length of leave, cash benefits, who pays) around the world. (JOW)

  2. HLA-DRB1 and HLA-DQB1 allele associations in an Albanian patient population with rheumatoid arthritis: correlations with the specific autoantibody markers and inter-population DRB1 allele frequency variability.

    PubMed

    Prifti-Kurti, Margarita; Nunes, José Manuel; Shyti, Erkena; Ylli, Zamira; Sanchez-Mazas, Alicia; Sulcebe, Genc

    2014-08-01

    The prevalence of rheumatoid arthritis and its specific autoantibodies varies in different populations. This variability depends on the genetic polymorphism of the immune response genes among which the HLA system plays a major role. In this context, we studied the HLA-DRB1 and HLA-DQB1 first-level allele frequencies in 100 Albanian patients with rheumatoid arthritis (RA), and taking into account their rheumatoid factor (RF) and anticitrullinated peptide antibodies (ACPA) serologic subgroups, we compared them with the respective frequencies in a population of 191 Albanian individuals without known pathology. No differences were found between the controls and the RA patient group as a whole, but three statistically significant differences were found: an increase in DRB1*04 among ACPA+, RF+ and ACPA+/RF+ patients, a significant decrease in DRB1*11 among ACPA+/RF+ and also a decrease in DRB1*13 among RF+ patient subgroups. Comparing allele frequencies of putatively associated RA alleles in different European populations revealed a significant negative correlation between the RA predisposing DRB1*04 and protective DRB1*11 allele frequencies. A statistically significant correlation was also found between RA prevalence rates and DRB1*04 as well as DRB1*11 frequencies. The relatively low frequencies of DRB1*04 and high DRB1*11 in the Albanian population might explain the rather low positivity rate of ACPA and RF antibodies among the Albanian RA patients. These specific association patterns suggest that this first study of RA in an Albanian population should be followed up to include second level or higher definition of HLA alleles and to compare RA patterns among European populations.

  3. Maternal mortality: a global overview.

    PubMed

    Choolani, M; Ratnam, S S

    1995-02-01

    Reduction of maternal mortality in developing countries is possible through elimination of unsafe abortion, active management of labor, appropriate management of pregnancy complications, and availability of adequate facilities. Prevention and early recognition are key factors in preventing maternal deaths due to ruptured uteri. A well equipped hospital is the appropriate place for delivery of mothers with a history of previous cesarean sections, a grossly contracted pelvis, previous myomectomies, previous multiple births, and previous abnormal births or complications during delivery. Complicated procedures, use of oxytocins, and administration of anesthesia should be performed with experienced, trained medical personnel. Surveillance of and correction for anemia should occur during the course of the pregnancy. Infections can be controlled with tetanus toxoid immunization and use of chest X-rays. The health care system should be tiered with primary health care services located in suburbs and rural districts. Services should be situated to account for population distribution, extent of maternal mortality in the region, transportation facilities, and the nearest secondary hospital. Birthing homes with sanitary facilities are an option for rural districts. A two-way referral system should be established between the primary, secondary, and tertiary level hospitals. Audits should be conducted as a means of checking for needed improvements in the system. Planning that includes proper roads, transportation, and communication facilities is important. Funding can come in the form of money, materials, and manpower. Safe motherhood requires the commitment of local people and local governments. The first step in a safe motherhood program is creating awareness among the political and economic elite. Governments are encouraged to shift resources from the military to housing, transportation, communications, education, and health during peace-times. Local professional associations

  4. [Towards a lower maternity risk].

    PubMed

    Ekra, C W

    1989-10-01

    Pregnant women delivering in Sub-Saharan Africa (SSA) are dying from causes that are related to poverty rather than to ignorance: 1) hemorrhages; 2) infections due to the lack of sanitary conditions; 3) toxemia; 4) anemia resulting from malnutrition, intestinal parasites and malaria; and 5) too many pregnancies that are too closely spaced. Additional institutional problems are the lack of adequate health facilities, especially for maternity; the lack of personnel and services in the rural areas, and when they do exist, underutilization because of the of lack equipment, supplies and drugs, burdening the patient with such purchases. Pregnant women do not get prenatal care because health personnel are badly trained, they do not speak local languages nor know the local customs and their training is inadequate to provide crisis- intervention. The situation in the urban areas is somewhat better, with more than 2/3 of pregnant women getting prenatal care and delivering in maternity hospitals. However, the logistical problems are growing with up to 50 patients delivering per day, coupled with an insufficient number of badly trained health personnel and the unacceptable sanitary conditions in the hospitals. This situation had let to the inability of staff to diagnose and survey patients with pregnancy complications, the lack of professional assistance during deliveries, the lack of adequate health facilities and equipment to treat emergencies and the lack of ambulances to transport critical patients. The solutions require building maternity centers that are decentralized (near to people's homes in the villages) and near to hospitals; training traditional birth attendants in public health practices that are also practical for their own environments; increasing prenatal care in health centers and through home visits and providing post-partum follow-up visits that include family planning.

  5. Community level risk factors for maternal mortality in Madagascar.

    PubMed

    Hernandez, Julio C; Moser, Christine M

    2013-12-01

    This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.

  6. Maternal mortality in caesarean section.

    PubMed

    Mehtaji, S P; Loynmoon, S

    1970-06-01

    The maternal mortality rate for 2 hospitals dropped from 15.8 per 1000 in 1930 to 4.2 per 1000 in 1968, accompanied by a reduction in mortality from caesarean section from 5% to 0.8%. However, caesarean section rates were twice those of vaginal delivery rates. 340 cases were reviewed; sepsis, postoperative shock, hemorrhage and anesthetic mishaps caused two-thirds of all caesarean section deaths. The authors recommend more effective ante-natal care, improved blood transfusion facilities, and better anesthetic management.

  7. Sicca symptoms, and lacrimal and salivary flow in Albanian patients with rheumatoid arthritis.

    PubMed

    Aliko, Ardita; Ciancaglini, Riccardo; Alushi, Adem; Tafaj, Argjend

    2010-09-01

    Rheumatoid arthritis affects primarily the synovial joints, but is often accompanied by extra-articular manifestations, including lacrimal and salivary gland involvement. The aim of the present study was to estimate the prevalence of ocular and oral sicca symptoms and reduced lacrimal and salivary flow in rheumatoid arthritis and the relation between sicca symptoms and objective measures of lacrimal and salivary flow. We examined 88 consecutive hospitalized patients with rheumatoid arthritis and 88 age- and gender-matched healthy controls. The examination included the standardized questionnaire for keratoconjunctivitis sicca and xerostomia which forms part of the European criteria for Sjögren's syndrome, the Schirmer's I test and measurement of unstimulated whole salivary flow rate. A significantly higher proportion of patients (40.9%) reported ocular sicca symptoms than healthy matched controls (8.0%). Further, a significantly higher proportion of patients (44.3%) reported oral sicca symptoms compared to controls (13.6%). 48.9% of the patients had low Schirmer I score, compared to 20.5% of controls. Reduced salivary flow was found in 27.3% of patients, compared to 9.1% of controls. The differences in lacrimal and salivary flow between patient and control group were statistically significant. The minimum prevalence of secondary Sjögren's syndrome was 14.8%. Weak association was observed between sicca symptoms and the objective measures of lacrimal and salivary flow in patients, and no association was detected in control subjects. Sicca symptoms and reduced lacrimal and salivary flow were common manifestations in rheumatoid arthritis and should be given adequate consideration during management of patients with rheumatoid arthritis. © 2010 The Authors. Journal of Oral Pathology & Medicine © 2010 John Wiley & Sons A/S.

  8. Reducing maternal mortality in Kigoma, Tanzania.

    PubMed

    Mbaruku, G; Bergström, S

    1995-03-01

    An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.

  9. Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children.

    PubMed

    Jarani, J; Grøntved, A; Muca, F; Spahi, A; Qefalia, D; Ushtelenca, K; Kasa, A; Caporossi, D; Gallotta, M C

    2016-01-01

    This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min(-1) · kg(-1) (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min(-1) · kg(-1) (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in

  10. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    PubMed Central

    Shpata, Vjollca; Ohri, Ilir; Nurka, Tatjana; Prendushi, Xhensila

    2015-01-01

    Purpose Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18–64 years), and to examine the negative consequences associated with risk of malnutrition in older adults. Materials and methods A prospective cohort study in the ICU of the University Hospital Center of Tirana, Albania, was conducted. Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay, the duration of being on the ventilator, the total complications, the infectious complications, and the mortality. Results In this study, 963 patients participated, of whom 459 patients (47.7%) were aged ≥65 years. The prevalence of malnutrition risk at the time of ICU admission of the patients aged ≥65 years old was 71.24%. Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients, for 1) infections (odds ratio [OR] =4.37; 95% confidence interval [CI]: 2.61–7.31); 2) complications (OR =6.73; 95% CI: 4.26–10.62); 3) mortality (OR =2.68; 95% CI: 1.72–4.18); and 4) ICU length of stay >14 days (OR =5.18, 95% CI: 2.43–11.06). Conclusion Malnutrition risk is highly prevalent among elderly ICU patients, especially among severely ill patients with malignancy admitted to the emergency ward. ICU elderly patients at malnutrition risk will have higher complication and infection rates, longer duration of ICU stay, and increased mortality. Efforts should be made to implement a variety of nutritional care strategies, to change the nutritional practices not only at ward level, but nationally, according to the best clinical practice and recent guidelines. PMID:25733824

  11. Levels of maternal mortality in developing countries.

    PubMed

    Boerma, J T

    1987-01-01

    This paper is aimed at improving our ability to assess the magnitude of maternal mortality in developing countries, where reliable data on maternal deaths are scarce. First, the upper and lower limits of maternal mortality in a population are determined based on the general levels of mortality and fertility in a population. The relative importance of maternal deaths as a proportion of death among women of reproductive ages may, therefore, vary from less than 1 percent in low-mortality countries to about 25-30 percent in high-mortality countries. Second, the analysis and interpretation of maternal mortality data from health facilities and vital registration systems can be improved if a variety of other data sources are used, such as coverage of deliveries in hospitals and at home, and all causes of death among women of reproductive age. It is estimated that approximately 515,000 women died annually due to pregnancy-related causes in developing countries between 1980 and 1985. Ninety percent of these deaths took place in Africa and South Asia, where births are frequent and maternal mortality levels are high.

  12. [Relationship between maternal and neonatal iron stores].

    PubMed

    Vásquez-Molina, M E; Corral-Terrazas, M; Apezteguia, M A; Carmona-Sawasky, J; Levario-Carrillo, M

    2001-01-01

    To establish the relationship of normal, low, and moderate blood iron values in mothers and their newborns. A cross-sectional study was conducted among 163 pregnant women and their newborns, users of Hospital de Ginecología y Obstetricia número 15, Instituto Mexicano del Seguro Social, from Chihuahua, Mexico. The mothers' clinical histories were collected and analyzed; hemoglobin, hematocrit, and ferritin serum levels were measured in maternal and umbilical cord samples. Iron maternal stores were determined by ferritin (microgram/l) values as follows: low: < or = 11; moderate: 12-20; and normal: > or = 20.1. The Kruskal-Wallis test was used to establish differences among group; the chi-squared test to determine differences of proportions; and Pearson's correlation coefficient for assessing the association between maternal and newborn iron stores. A weak correlation between maternal and neonatal ferritin was found (r = 0.14, p = 0.07). Geometric means of neonatal ferritin for low, moderate, and normal maternal iron stores were 4.77, 4.85, and 5.02 respectively (p = 0.12). The maternal iron stores changed after iron supplementation (p = 0.01). Iron stores in mothers and their newborns are closely related. Women who take iron supplements during pregnancy have significantly higher iron stores at the end of pregnancy.

  13. Postpartum maternal and newborn discharge.

    PubMed

    Cargill, Yvonne; Martel, Marie-Jocelyne

    2007-04-01

    To summarize the evidence available with regard to discharge planning for mothers and newborns. Assessment of maternal and neonatal morbidity and mortality as it relates to length of hospital stay. A Medline database search of articles from January 1995 to December 2004, using the key words early postpartum discharge. 1. Early discharge from hospital postnatally increases the risk of neonatal mortality and morbidity. Follow-up programs should take account of this. (II-2B) 2. The physical, psychological, and social wellbeing of the mother and newborn must be assessed when discharge planning takes place. Primiparous, young, single women are most likely to return to emergency departments with their neonates. (II-2A) 3. Programs in place for postpartum care in the community are well used and appreciated. Additional programs in the community may decrease neonatal mortality, morbidity, and readmissions. (II-2).

  14. Effects of twin gestation on maternal morbidity.

    PubMed

    Young, Brett C; Wylie, Blair J

    2012-06-01

    As the incidence of twin gestation increases, it is important to consider the maternal risks associated with carrying multiples. Compared with singleton gestation, there are increased risks to the mother during the antepartum, intrapartum, and postpartum periods. Certain pregnancy complications are more likely to occur during a twin gestation, including preeclampsia and other hypertensive disorders, antepartum hospitalization for preterm labor or abnormal bleeding, nutritional deficiencies, cesarean delivery, and postpartum hemorrhage. Women carrying twins may benefit from early education regarding these issues, close maternal monitoring as well as physical therapy sessions, and nutrition counseling during their pregnancies.

  15. Public Reporting of Hospital-Specific Breastfeeding Measures.

    PubMed

    Jurkowski, Janine M; Svistova, Juliana; Nguyen, Trang; Dennison, Barbara A

    2016-11-01

    Establishing breastfeeding in the first days of an infant's life is important for longer term success in breastfeeding. In 2009, New York State (NYS) was the second state to require maternity care facilities to collect infant feeding information and to publicly disseminate hospital-specific infant feeding statistics. Public reporting of these statistics as performance measures is a strategy to prompt hospitals to improve breastfeeding support. This qualitative study sought to explore how maternity care administrators and clinical staff responded to the mandate for publicly reported performance measures and whether they used this information to improve maternity care practices. This study used a stratified random sample of NYS hospitals with maternity care units. Participants were recruited by email and telephone calls. A total of 25 hospitals participated in the study, and 37 hospital administrators and staff completed in-depth interviews by telephone. The interviews were analyzed using an explanatory framework in NVivo 8. Publicly reported hospital-specific breastfeeding measures increased attention to breastfeeding performance. Hospital administrators and staff reported comparing their relative rankings to other hospitals in the state. Some hospitals used publicly reported breastfeeding measures to monitor performance, whereas others were prompted to generate additional measures for more frequent monitoring. Hospitals with relatively low breastfeeding statistics took certain actions to improve their maternity care practices to support breastfeeding. Limitations of the usefulness of publicly reported measures were reported by interview participants. Publicly reported, hospital-specific breastfeeding measures may prompt hospitals to monitor and improve maternity care practices related to supporting breastfeeding.

  16. Maternal deaths in the Nordic countries.

    PubMed

    Vangen, Siri; Bødker, Birgit; Ellingsen, Liv; Saltvedt, Sissel; Gissler, Mika; Geirsson, Reynir T; Nyfløt, Lill T

    2017-09-01

    Despite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths. We present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated. We registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from 6.8 to 8.1 between the countries. Cardiac disease (n = 29) was the most frequent cause of death, followed by preeclampsia (n = 24), thromboembolism (n = 20) and suicide (n = 20). Improvements to care which could potentially have made a difference to the outcome were identified in one-third of the deaths, i.e. in as many as 60% of preeclamptic, 45% of thromboembolic, and 32% of the deaths from cardiac disease. Direct deaths exceeded indirect maternal deaths in the Nordic countries. To reduce maternal deaths, increased efforts to better implement existing clinical guidelines seem warranted, particularly for preeclampsia, thromboembolism and cardiac disease. More knowledge is also needed about what contributes to suicidal maternal deaths. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Maternal mortality in Denmark, 1985-1994.

    PubMed

    Andersen, Betina Ristorp; Westergaard, Hanne Brix; Bødker, Birgit; Weber, Tom; Møller, Margrete; Sørensen, Jette Led

    2009-02-01

    In Denmark, maternal mortality has been reported over the last century, both locally through hospital reports and in national registries. The purpose of this study was to analyze data from national medical registries of pregnancy-related deaths in Denmark 1985-1994 and to classify them according to the UK Confidential Enquiry into Maternal Deaths (CEMD). All deaths of women with a registered pregnancy within 12 months prior to the death were identified by comparing the Danish medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-10). All cases were classified using the UK CEMD classification. Cases of maternal death were further evaluated by an audit group. 311 cases were classified. 92 deaths (29.6%) occurred 42 days), 1 woman died from a direct obstetric cause, 46 from indirect causes, and 172 from fortuitous causes. Hypertensive disorders of pregnancy were the major cause of direct maternal deaths. The rate of maternal deaths constituted 9.8/100,000 maternities (i.e. the number of women delivering registrable live births at any gestation or stillbirths at 24 weeks of gestation or later). This is the first systematic report on deaths in Denmark based on data from national registries. The maternal mortality rate in Denmark is comparable to the rates in other developed countries. Fortunately, statistics are low, but each case represents potential learning. Obstetric care has changed and classification methods differ between countries. Prospective registration and registry linkage seem to be a way to ensure completion. This retrospective study has provided the background for a prospective study on registration and evaluation of maternal mortality in Denmark.

  18. Barrier-free communication in maternity care of allophone migrants: BRIDGE study protocol.

    PubMed

    Origlia Ikhilor, Paola; Hasenberg, Gabriele; Kurth, Elisabeth; Stocker Kalberer, Barbara; Cignacco, Eva; Pehlke-Milde, Jessica

    2017-08-23

    To describe communication and access barriers encountered by allophone women of different migration backgrounds in the Swiss maternity care services, from the perspective of users, healthcare professionals and intercultural interpreters. In addition to the challenges of maternal adjustment, pregnant migrant women must also deal with an unfamiliar health service system. Some must overcome language barriers and the stress of uncertain residence status. Limited access to maternity care increases perinatal morbidity and mortality. Almost 10% of foreigners speak none of Switzerland's official languages. Factors that facilitate or hinder communication between migrant women and perinatal healthcare professionals are under-studied and must be understood if we are to overcome those barriers in clinical practice. Qualitative exploratory study with quantitative sub-study. Participants will be drawn from German to speaking regions of Switzerland. We will conduct focus group discussions and semi-structured interviews with users in their own language (Albanian and Tigrinya) and with healthcare professionals and intercultural interpreters (March-June 2016), then perform Thematic Analysis on the data. In the sub-study, midwives will report their experience of using a telephone interpreting service during postnatal home visits in a questionnaire (October 2013-March 2016). Data will be analysed with descriptive statistics. Our study will reveal patterns in communications between allophone migrant women and healthcare providers and communication barriers. By incorporating multiple perspectives, we will describe the challenges all parties face. Our results will inform those who draft recommendations to improve provision of maternity care to allophone women and their families. ClinicalTrials.gov ID: BernUAS NCT02695316. © 2017 John Wiley & Sons Ltd.

  19. Association between maternal nutritional status of pre pregnancy, gestational weight gain and preterm birth.

    PubMed

    Xinxo, Sonela; Bimbashi, Astrit; Z Kakarriqi, Eduard; Zaimi, Edmond

    2013-01-01

    Maternal nutritional status of pre pregnancy and gestational weight gain affects the preterm birth. The association between maternal nutritional status of pre pregnancy and preterm birth appears to be complex and varied by studies from different countries, thus this association between the gestational weight gain and preterm birth is more consolidated. The study aims to determine any association between the pre pregnancy maternal nutritional status, gestational weight gain and the preterm birth rate in the Albanian context. In case control study, we analyzed women who have delivered in obstetric institutions in Tirana during the year 2012. Body mass index and gestational weight gain of 150 women who had a preterm delivery were compared with those of 150 matched control women who had a normal delivery regarding the gestation age. The self-reported pre pregnancy weight, height, gestational weight gain, age, education and parity are collected through a structured questioner. The body mass index and gestational weight gain are categorized based on the Institute of Medicine recommendation. The multiple logistic regression is used to measure the association between the nutritional status of pre pregnancy and gestational weight gain and the preterm birth rate. The women which have a underweight status or obese of pre pregnancy are more likely to have a preterm birth compared to the women of a normal pre-pregnancy nutritional status (respectively OR =2.7 and 4.3 p<0.05). Women who do not reach the recommended gestational weight gain are more likely to have a preterm birth compared to the women which reach this weight (OR=1.8 p< 0.05). Maternal nutritional status and gestational weight gain affects the risk for preterm birth. Pre-pregnancy and gestation nutritional assessments should be part of routine prenatal visits.

  20. Maternal food restrictions during breastfeeding

    PubMed Central

    Jeong, Goun; Park, Sung Won; Lee, Yeon Kyung; Ko, Sun Young

    2017-01-01

    Purpose This study investigated self-food restriction during breastfeeding, reviewed the literature showing the effect of maternal diet on the health of breast-fed infants, and explored the validity of dietary restrictions. Methods Questionnaire data were collected from breastfeeding Korean mothers who visited the pediatric clinic of Cheil General Hospital & Women's Healthcare Center from July 2015 through August 2015. The survey included items assessing maternal age, number of children, maternal educational attainment, household income, degree of difficulty with self-food restriction, types of self-restricted foods, dietary customs during breastfeeding, and sources of information about breastfeeding. Results The questionnaire was completed by 145 mothers. More than a third (n=56, 39%) had discomfort from and usually avoided 4–5 types of food (mean, 4.92). Mothers younger than 40 years had more discomfort (odds ratio [OR], 12.762; P=0.017). Primiparas felt less discomfort than multiparas (OR, 0.436; P=0.036). Dietary practices were not influenced by maternal educational attainment or household income. The most common self-restricted foods were caffeine (n=131, 90.3%), spicy foods (n=124, 85.5%), raw foods (n=109, 75.2%), cold foods (n=100, 69%), and sikhye (traditional sweet Korean rice beverage) (n=100, 69%). Most mothers (n=122, 84.1%) avoided foods for vague reasons. Conclusion Most mothers restricted certain foods unnecessarily. Literature review identified no foods that mothers should absolutely avoid during breastfeeding unless the infant reacts negatively to the food. PMID:28392822

  1. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  2. Y-STR variation in Albanian populations: implications on the match probabilities and the genetic legacy of the minority claiming an Egyptian descent.

    PubMed

    Ferri, Gianmarco; Tofanelli, Sergio; Alù, Milena; Taglioli, Luca; Radheshi, Erjon; Corradini, Beatrice; Paoli, Giorgio; Capelli, Cristian; Beduschi, Giovanni

    2010-09-01

    Y chromosome variation at 12 STR (the Powerplex® Y system core set) and 18 binary markers was investigated in two major (the Ghegs and the Tosks) and two minor (the Gabels and the Jevgs) populations from Albania (Southern Balkans). The large proportion of haplotypes shared within and between groups makes the Powerplex 12-locus set inadequate to ensure a suitable power of discrimination for the forensic practice. At least 85% of Y lineages in the Jevgs, the cultural minority claiming an Egyptian descent, turned out to be of either Roma or Balkan ancestry. They also showed unequivocal signs of a common genetic history with the Gabels, the other Albanian minority practising social and cultural Roma traditions.

  3. One century later: the folk botanical knowledge of the last remaining Albanians of the upper Reka Valley, Mount Korab, Western Macedonia

    PubMed Central

    2013-01-01

    Background Ethnobotanical surveys of the Western Balkans are important for the cross-cultural study of local plant knowledge and also for obtaining baseline data, which is crucial for fostering future rural development and eco-tourism initiatives in the region. The current ethnobotanical field study was conducted among the last remaining Albanians inhabiting the upper Reka Valley at the base of Mount Korab in the Mavrovo National Park of the Republic of Macedonia. The aims of the study were threefold: 1) to document local knowledge pertaining to plants; 2) to compare these findings with those of an ethnographic account written one century ago and focused on the same territory; and 3) to compare these findings with those of similar field studies previously conducted in other areas of the Balkans. Methods Field research was conducted with all inhabitants of the last four inhabited villages of the upper Reka Valley (n=17). Semi-structured and open interviews were conducted regarding the perception and use of the local flora and cultivated plants. Results and conclusion The uses of ninety-two plant and fungal taxa were recorded; among the most uncommon uses, the contemporary use of young cooked potato (Solanum tuberosum) leaves and Rumex patientia as a filling for savory pies was documented. Comparison of the data with an ethnographic study conducted one century ago in the same area shows a remarkable resilience of original local plant knowledge, with the only exception of rye, which has today disappeared from the local foodscape. Medicinal plant use reports show important similarities with the ethnobotanical data collected in other Albanian areas, which are largely influenced by South-Slavic cultures. PMID:23578063

  4. One century later: the folk botanical knowledge of the last remaining Albanians of the upper Reka Valley, Mount Korab, Western Macedonia.

    PubMed

    Pieroni, Andrea; Rexhepi, Besnik; Nedelcheva, Anely; Hajdari, Avni; Mustafa, Behxhet; Kolosova, Valeria; Cianfaglione, Kevin; Quave, Cassandra L

    2013-04-11

    Ethnobotanical surveys of the Western Balkans are important for the cross-cultural study of local plant knowledge and also for obtaining baseline data, which is crucial for fostering future rural development and eco-tourism initiatives in the region. The current ethnobotanical field study was conducted among the last remaining Albanians inhabiting the upper Reka Valley at the base of Mount Korab in the Mavrovo National Park of the Republic of Macedonia.The aims of the study were threefold: 1) to document local knowledge pertaining to plants; 2) to compare these findings with those of an ethnographic account written one century ago and focused on the same territory; and 3) to compare these findings with those of similar field studies previously conducted in other areas of the Balkans. Field research was conducted with all inhabitants of the last four inhabited villages of the upper Reka Valley (n=17). Semi-structured and open interviews were conducted regarding the perception and use of the local flora and cultivated plants. The uses of ninety-two plant and fungal taxa were recorded; among the most uncommon uses, the contemporary use of young cooked potato (Solanum tuberosum) leaves and Rumex patientia as a filling for savory pies was documented. Comparison of the data with an ethnographic study conducted one century ago in the same area shows a remarkable resilience of original local plant knowledge, with the only exception of rye, which has today disappeared from the local foodscape. Medicinal plant use reports show important similarities with the ethnobotanical data collected in other Albanian areas, which are largely influenced by South-Slavic cultures.

  5. Maternal Infections During Pregnancy and Cerebral Palsy in the Child

    PubMed Central

    Bear, Joshua J.; Wu, Yvonne W.

    2016-01-01

    INTRODUCTION Chorioamnionitis is a risk factor for cerebral palsy. The relationship between extra-amniotic infections and cerebral palsy is less well studied. We examined maternal intra- and extra-amniotic infections and risk of cerebral palsy in the child. METHODS Among a retrospective cohort of six million Californian births, 1991–2001, we analyzed administrative maternal and newborn hospital discharge abstracts linked to records of all children receiving services for cerebral palsy at the California Department of Developmental Services. We identified maternal hospital diagnoses of intra-amniotic (chorioamnionitis) and extra-amniotic (other genitourinary and respiratory) infections occurring up to twelve months before delivery. Using multivariable logistic regression, we determined the independent association between maternal infections and cerebral palsy, adjusting for infant sex, maternal age, race, education, socioeconomic status, and obesity. RESULTS 5.5% of mothers had a hospital discharge diagnosis of at least one of the following: chorioamnionitis (2.0%), other genitourinary (3.1%), and respiratory infection (0.6%). An infection diagnosis was more common in mothers of the 8,473 infants with cerebral palsy than in mothers of unaffected children (13.7% vs. 5.5%, P<0.001). All three types of maternal infections (chorioamnionitis, OR 3.1, 95% CI 2.9–3.4; other genitourinary infection, OR 1.4, 95% CI 1.3–1.6; and respiratory infection, OR 1.9, 95% CI 1.5–2.2) were associated with cerebral palsy in multivariable analyses. Maternal extra-amniotic infections, whether diagnosed during prenatal or birth hospitalizations, conferred an increased risk of cerebral palsy. CONCLUSIONS Maternal extra-amniotic infections diagnosed in the hospital during pregnancy are associated with a modestly increased risk of cerebral palsy in the child. PMID:26857522

  6. Maternal intake of antioxidant vitamins in pregnancy in relation to maternal and fetal plasma levels at delivery.

    PubMed

    Scaife, Alison R; McNeill, Geraldine; Campbell, Doris M; Martindale, Sheelagh; Devereux, Graham; Seaton, Anthony

    2006-04-01

    The aim of the present study was to test the hypothesis that maternal intake of antioxidant vitamins is associated with maternal and cord plasma levels at delivery. Women were recruited in early pregnancy in Aberdeen Maternity Hospital and habitual diet during pregnancy was assessed by a food-frequency questionnaire mailed at 34 weeks gestation. Blood samples were taken at recruitment (n 1149) and maternal (n 1149) and cord blood samples (n 747) taken at delivery for analyses of vitamins A, C, E and beta-carotene. Maternal plasma levels of vitamin E and beta-carotene at delivery were significantly higher than levels in early pregnancy while levels of vitamins A and C were significantly lower. Positive correlations were observed for maternal levels of all the vitamins between early pregnancy and delivery. At delivery, maternal plasma concentrations of vitamins A, E and beta-carotene were significantly higher than cord levels, while maternal levels of vitamin C were significantly lower. There were significant correlations between maternal and cord plasma concentrations for beta-carotene and vitamin C but not for vitamins A or E. Maternal dietary intakes were positively correlated with maternal plasma levels of vitamins C, E and beta-carotene in early pregnancy, with maternal plasma levels of beta-carotene and vitamin C at delivery and with cord plasma levels of beta-carotene and vitamin C. The results from the present study show that, in this population, maternal diet influences cord plasma levels of beta-carotene and vitamin C, but not vitamins A and E.

  7. An oceanic core complex (OCC) in the Albanian Dinarides? Preliminary paleomagnetic and structural results from the Mirdita Ophiolite (northern Albania)

    NASA Astrophysics Data System (ADS)

    Maffione, M.; Morris, A.; Anderson, M.

    2010-12-01

    Oceanic core complexes (OCCs) are dome-shaped massifs commonly associated with the inside corners of the intersection of transform faults and slow (and ultra-slow) spreading centres. They represent the uplifted footwalls of large-slip oceanic detachment faults (e.g. Cann et al., 1997; Blackman et al., 1998) and are composed of mantle and lower crustal rocks exhumed during fault displacement (Smith et al., 2006, 2008). Recent paleomagnetic studies of core samples from OCCs in the Atlantic Ocean (Morris et al., 2009; MacLeod et al., in prep) have confirmed that footwall sections undergo substantial rotation around (sub-) horizontal axes. These studies, therefore, support “rolling hinge” models for the evolution of OCCs, whereby oceanic detachment faults initiate at a steep angle at depth and then “roll-over” to their present day low angle orientations during unroofing (Buck, 1988; Wernicke & Axen, 1988; Lavier et al., 1999). However, a fully integrated paleomagnetic and structural analysis of this process is hampered by the one-dimensional sampling provided by ocean drilling of OCC footwalls. Therefore, ancient analogues for OCCs in ophiolites are of great interest, as these potentially provide 3-D exposures of these important structures and hence a more complete understanding of footwall strain and kinematics (providing that emplacement-related phases of deformation can be accounted for). Recently, the relationship between outcropping crustal and upper mantle rocks led Tremblay et al. (2009) to propose that an OCC is preserved within the Mirdita ophiolite of the Albanian Dinarides (northern Albania). This is a slice of Jurassic oceanic lithosphere exposed along a N-S corridor which escaped the main late Cenozoic Alpine deformation (Robertson, 2002, 2004; Dilek et al., 2007). Though in the eastern portion of the Mirdita ophiolite a Penrose-type sequence is present, in the western portion mantle rocks are in tectonic contact with upper crustal lithologies

  8. Australian primary maternity units: past, present and future.

    PubMed

    Monk, Amy R; Tracy, Sally; Foureur, Maralyn; Barclay, Lesley

    2013-09-01

    Primary maternity units are commonly those run by midwives who provide care to women with low-risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pregnancies, particularly in rural and remote areas. However there are very few primary maternity units in Australia, largely due to the fact that over the past 200 years, the concept of safety has become inherently linked with the immediate on-site availability of specialist medical support. The purpose if this paper is to explore the various drivers and barriers to the sustainability of primary maternity units in Australia. It firstly looks at the historical antecedents that shaped primary level maternity services in Australia, from the time of colonisation to now. During this period the space and management of childbirth moved from home and midwifery-led settings to obstetric-led hospitals. Following on from this an analysis of recent political events shows how Australian government policy both supports and undermines the potential of primary maternity units. It is important that researchers, clinicians and policy makers understand the past in order to manage the challenges facing the development and maintenance of midwifery-led maternity services, in particular primary maternity units, in Australia today. Copyright © 2013 Australian College of Midwives. All rights reserved.

  9. Recommendations for saving mothers' lives in Japan: Report from the Maternal Death Exploratory Committee (2010-2014).

    PubMed

    Hasegawa, Junichi; Ikeda, Tomoaki; Sekizawa, Akihiko; Tanaka, Hiroaki; Nakamura, Masamitsu; Katsuragi, Shinji; Osato, Kazuhiro; Tanaka, Kayo; Murakoshi, Takeshi; Nakata, Masahiko; Ishiwata, Isamu

    2016-12-01

    To make recommendations for saving mothers' lives, issues related to maternal deaths including diseases, causes, treatments, and hospital and regional systems are analyzed by the Maternal Death Exploratory Committee in Japan. In this report, we present ten clinical important recommendations based on the analysis of maternal deaths between 2010 and 2014 in Japan. © 2016 Japan Society of Obstetrics and Gynecology.

  10. Albanian women in physics

    NASA Astrophysics Data System (ADS)

    Deda, Antoneta; Alushllari, Mirela; Mico, Silvana

    2015-12-01

    In this report, presented at the 5th IUPAP International Conference on Women in Physics, we describe the status of women physicists in Albania and offer some statistical data illustrating the present situation. Undergraduate physics enrollment by girls is high and stable, more women are receiving financial support for doctoral studies, women are well represented in recent academic promotions, and recently women scientists have been appointed to several leadership positions. However, both women and men are challenged by the overall low levels of funding for research and by issues of availability and affordability of child care.

  11. Albanian Refugee Children.

    ERIC Educational Resources Information Center

    Blake, Caroline; Ademi, Xhevat

    1998-01-01

    Uses the experience of a project working with unaccompanied refugee minors from Albania to England to describe the circumstances of these immigrants. Experience suggests that those in mainstream schools have the best chance of building a life in England. Support should be provided to ensure education and social services for these students. (SLD)

  12. Maternal representation of the self as parent: connections with maternal sensitivity and maternal structuring.

    PubMed

    Biringen, Z; Matheny, A; Bretherton, I; Renouf, A; Sherman, M

    2000-09-01

    Maternal representations of the self as parent were assessed via the Parent Attachment and Peer Relationship Interviews (Bretherton, Biringen, Ridgeway, Maslin-Cole, & Sherman, 1989; Biringen & Bretherton, 1988) when children were 39 months of age. Maternal sensitivity and maternal structuring during mother-child interactions were assessed at 18, 24 and 39 months. The central question of this study was whether maternal representations were related to aspects of observed maternal sensitivity and maternal structuring. We found that maternal sensitivity at 18 months predicted later maternal representations of the self as parent. But beginning at 24 months and continuing to 39 months maternal structuring proved to be a more important predictor of maternal representations of the self, in particular maternal self-esteem, even after controlling for maternal sensitivity.

  13. "I was on the way to the hospital but delivered in the bush": Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban.

    PubMed

    Rishworth, Andrea; Dixon, Jenna; Luginaah, Isaac; Mkandawire, Paul; Tampah Prince, Caesar

    2016-01-01

    This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. [A Maternal Health Care System Based on Mobile Health Care].

    PubMed

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  15. Caregivers' role in maternal-fetal conflict.

    PubMed

    Avci, Ercan

    2015-01-01

    The case, which occurred in a public hospital in Turkey in 2005, exhibits a striking dilemma between a mother's and her fetus' interests. For a number of reasons, the mother refused to cooperate with the midwives and obstetrician in the process of giving birth, and wanted to leave the hospital. The care providers evaluated the case as a matter of maternal autonomy and asked the mother to give her consent to be discharged from the hospital, which she did despite the fact that her cervix was fully open. She left the hospital and gave birth shortly thereafter. Subsequently, the baby died two days later. In light of the contemporary ethical principles, the mother's competency could be debatable due to the physical and psychological conditions the mother confronted. Furthermore, protection of the fetus' life should have been taken into account by the caregivers when making a decision concerning discharging of the mother.

  16. Sepsis and maternal mortality.

    PubMed

    Acosta, Colleen D; Knight, Marian

    2013-04-01

    Despite global progress towards reducing maternal mortality, sepsis remains a leading cause of preventable maternal death. This review focuses on current measurement challenges, trends, causes and efforts to curb maternal death from sepsis in high and low-income countries. Under-reporting using routine registration data, compounded by misclassification and unreported deaths, results in significant underestimation of the burden of maternal death from sepsis. In the UK and the Netherlands the recent increase in maternal death from sepsis is mainly attributed to an increase in invasive group A streptococcal infections. Susceptibility to infection may be complicated by modulation of maternal immune response and increasing rates of risk factors such as caesarean section and obesity. Failure to recognize severity of infection is a major universal risk factor. Standardized Surviving Sepsis Campaign (SSC) recommendations for management of severe maternal sepsis are continuing to be implemented worldwide; however, outcomes differ according to models of intensive care resourcing and use. The need for robust data with subsequent analyses is apparent. This will significantly increase our understanding of risk factors and their causal pathways, which are critical to informing effective treatment strategies in consideration of resource availability.

  17. Maternal knowledge of acute seizures.

    PubMed

    Asiri, Nawal A; Bin Joubah, Mohammed A; Khan, Samar M; Jan, Mohammed M

    2015-10-01

    To study maternal knowledge -of, and behavior during acute seizures. A cross sectional study conducted from September 2013 to January 2014 included consecutive mothers presenting at the Pediatric Neurology Clinics of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. A structured 30-item questionnaire was designed to examine their demographics, knowledge, and behavior on acute seizures. A total of 92 mothers were interviewed and 41% witnessed at least one acute seizure in their affected child (range 1-15 years, mean 4.5). Up to 26% felt not knowledgeable at all regarding the acute care and management of seizure. Mothers with higher education (college or university degree) were more likely to feel very knowledgeable (19% versus 11%, p=0.02). Only 10% were aware of an antiepileptic drug that could be used at home to stop prolonged seizures, and 35% mentioned that they would wait for 15 minutes before taking the child to the emergency department. Most mothers (93%) wanted more information. Those who felt strongly regarding that (66%), were more likely to be younger (<27 years) (p=0.01), and have at least 3 out of 7 mismanagement decisions (p=0.003). Maternal level of knowledge and behavior during acute seizures needs improvement. Many mothers have significant misinformation, negative behavior, and poor management practices. Increased awareness and educational programs are needed.

  18. Maternal mortality in Giza, Egypt: magnitude, causes, and prevention.

    PubMed

    Kane, T T; el-Kady, A A; Saleh, S; Hage, M; Stanback, J; Potter, L

    1992-01-01

    This article presents results from a population-based study of the magnitude and causes of maternal mortality in the Giza governorate of Egypt in 1985-86. Deaths to women in the reproductive ages were identified through the death registration system. Family members of the deceased were interviewed using the "verbal autopsy" approach. Immediate and underlying causes of death were then assessed by a medical panel. This methodology allows for the classification of multiple causes of death and is appropriate when registration of adult deaths is nearly complete, but reporting on cause of death on death certificates is poor. Of all reproductive-age deaths, 19 percent were maternal deaths. The maternal mortality ratio for Giza is estimated to be, at minimum, 126 maternal deaths per 100,000 live births. The maternal mortality rate is estimated to be, at minimum, 22 maternal deaths per 100,000 women aged 15-49, over 100 times the rate in Sweden. An average of 2.3 causes per maternal death were reported; the most common causes were postpartum hemorrhage (31 percent of cases) and hypertensive diseases of pregnancy, such as toxemia and eclampsia (28 percent of cases). Women experiencing hemorrhage, hypertensive diseases of pregnancy, or other serious complications must have easy access to hospital and maternity centers equipped for handling these conditions. Since most deliveries occur at home, many with the help of traditional birth attendants, TBAs will need training in early diagnosis, treatment, and/or effective referral of problem pregnancies.

  19. Severe maternal morbidity in Canada, 1991–2001

    PubMed Central

    Wen, Shi Wu; Huang, Ling; Liston, Robert; Heaman, Maureen; Baskett, Tom; Rusen, I.D.; Joseph, K.S.; for, Michael S. Kramer

    2005-01-01

    Background Although death rates are often used to monitor the quality of health care, in industrialized countries maternal deaths have become rare. Severe maternal morbidity has therefore been proposed as a supplementary indicator for surveillance of the quality of maternity care. Our purpose in this study was to describe severe maternal morbidity in Canada over a 10-year period, among women with or without major pre-existing conditions. Methods We carried out a retrospective cohort study of severe maternal morbidity involving 2 548 824 women who gave birth in Canadian hospitals between 1991 and 2000. Thirteen conditions that may threaten the life of the mother (e.g., eclampsia) and 11 major pre-existing chronic conditions (e.g., diabetes) that could be identified from diagnostic codes were noted. Results The overall rate of severe maternal morbidity was 4.38 per 1000 deliveries. The fatality rate among these women was 158 times that of the entire sample. Rates of venous thromboembolism, uterine rupture, adult respiratory distress syndrome, pulmonary edema, myocardial infarction, severe postpartum hemorrhage requiring hysterectomy, and assisted ventilation increased substantially from 1991 to 2000. The presence of major pre-existing conditions increased the risk of severe maternal morbidity to 6-fold. Interpretation Severe maternal morbidity occurs in about 1 of 250 deliveries in Canada, with marked recent increases in certain morbid conditions such as pulmonary edema, myocardial infarction, hemorrhage requiring hysterectomy, and the use of assisted ventilation. PMID:16186582

  20. Maternal smoking during pregnancy and adult male criminal outcomes.

    PubMed

    Brennan, P A; Grekin, E R; Mednick, S A

    1999-03-01

    Perinatal risk factors are related to persistent and violent criminal outcomes. Prenatal maternal smoking may represent an additional perinatal risk factor for adult criminal outcomes. Our study examines maternal smoking during pregnancy as a predictor of offspring crime in the context of a prospective, longitudinal design. Subjects were a birth cohort of 4169 males born between September 1959 and December 1961 in Copenhagen, Denmark. During the third trimester of pregnancy, mothers self-reported the number of cigarettes smoked daily. When the male offspring were 34 years of age, their arrest histories were checked in the Danish National Criminal Register. Additional data were collected concerning maternal rejection, socioeconomic status, maternal age, pregnancy and delivery complications, use of drugs during pregnancy, paternal criminal history, and parental psychiatric hospitalization. Results indicate a dose-response relationship between amount of maternal prenatal smoking and arrests for nonviolent and violent crimes. Maternal prenatal smoking was particularly related to persistent criminal behavior rather than to arrests confined to adolescence. These relationships remained significant after potential demographic, parental, and perinatal risk confounds were controlled for. Maternal prenatal smoking predicts persistent criminal outcome in male offspring. This relationship has not been accounted for by related parental characteristics or perinatal problems. Potential physiologic or central nervous system mediators between maternal smoking during pregnancy and offspring criminal outcomes need further study.

  1. Maternal and Child Health Care Services in Albania.

    PubMed

    Bali, Donjeta; Kuli-Lito, Georgina; Ceka, Nedime; Godo, Anila

    2016-10-01

    Albania has one of the youngest populations among the European countries. Albania continues to be involved in a progressive improvement of standards for the protection and respect of children's rights to health. We describe the Albanian pediatric health system, with a particular focus on pediatric primary health care and, first access care, and the structure and staffing of health centers and women and children's consulting centers. Secondary and tertiary pediatric care and neonatal care are also described. The Albanian national laws approved during recent years have had a positive impact on the status of women and children; however, the outcomes seem to be insufficient because of the persistence of several negative socioeconomic factors. The Albanian Pediatric Society believes that the important and beneficial changes observed during the last 20 years should be further supported and implemented. In this regard, Albanian Pediatric Society is fully committed to developing initiatives described in this report and to join the efforts of international collaborative programs and studies aimed at improving the social and health conditions of Albanian children. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [Maternal mortality and referral maternities in Morocco: how to (re)motivate professionals?].

    PubMed

    Péchevis, M; Fernandez, H; Cook, J; Bensalah, A; Aouraghe, M; Benbaha, A

    1999-06-01

    The very high rates of maternal mortality and perinatal mortality, as well as the deficiencies and dysfunctions observed in maternity hospitals, which play the role of referential maternity wards, led the Moroccan Minister of Public Health to implement a project in order to improve the quality of care of parturient women and new-borns. This project included 8 provinces in the country. The strategy chosen was "the team approach to resolving health problems", which is a learning process which leads local teams to implement and evaluate projects they have developed themselves. This pedagogical approach, which is carried out over a period of more than a year, proved itself to be very motivating and mobilising for the professionals included, despite the obstacles that were encountered. It also contributed to creating a true team spirit. Most activities planned within these projects were carried out and many indicators improved.

  3. Contemporary labor patterns and maternal age.

    PubMed

    Zaki, Mary N; Hibbard, Judith U; Kominiarek, Michelle A

    2013-11-01

    To evaluate labor progress and length according to maternal age. Data were abstracted from the Consortium on Safe Labor, a multicenter retrospective study from 19 hospitals in the U.S. We studied 120,442 laboring gravid women with singleton, term, cephalic fetuses with normal outcomes and without a prior cesarean delivery from 2002 to 2008. Maternal age categories were younger than 20 years of age, 20-29 years of age, 30-39 years of age, and 40 years of age or older with the reference being younger than 20 years of age. Interval-censored regression analysis was used to determine median traverse times (progression centimeter by centimeter) with 95th percentiles adjusting for covariates (race, admission body mass index, diabetes, gestational age, induction, augmentation, epidural use, and birth weight). A repeated-measures analysis with an eighth-degree polynomial model was used to construct mean labor curves for each maternal age category stratified by parity. Traverse times for nulliparous women demonstrated the time to progress from 4 to 10 cm decreased as age increased up to age 40 years (median 8.5 hours compared with 7.8 hours in those 20-29 years of age group and 7.4 hours in the 30-39 years of age group, P<.001); the length of the second stage with and without epidural increased with age (P<.001). For multiparous women, time to progress from 4 to 10 cm decreased as age increased (median 8.8 hours, 7.5, 6.7, and 6.5 from the youngest to oldest maternal age groups, P<.001). Labor progressed faster with increasing maternal age in both nulliparous and multiparous women in the labor curves analysis. The first stage of labor progressed more quickly with increasing age for nulliparous women up to age 40 years and all multiparous women. Contemporary labor management should account for maternal age. II.

  4. Effect of maternal anaemia on birth weight.

    PubMed

    Ahmad, Muhammad Owais; Kalsoom, Umay; Sughra, Ume; Hadi, Usman; Imran, Muhammad

    2011-01-01

    Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is commonly considered a risk factor for low birth weight (LBW) babies. Some studies have demonstrated a strong association between low haemoglobin before delivery and LBW babies. However, others have not found a significant association. Therefore, there is insufficient information to assess the overall adverse impact of anaemia during pregnancy. The aim of this study was to determine whether maternal anaemia would affect the birth weight of the baby and compare this with that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward of Fauji Foundation Hospital, Rawalpindi. One hundred subjects divided into two groups each containing 50 subjects on the basis of consecutive non probability sampling were included in the study. Group-A included 50 Anaemic pregnant women and Group-B 50 non-anaemic pregnant women. Information was collected by direct interviewing method through a precoded structured questionnaire. The Hb level and birth weights were taken from the labour room record. The mean age of the mothers in anaemic group was found to be older than the non anaemic group, i.e., (29.44 versus 27.98), though the difference was statistically non significant. The number of low birth weight infants (64%) was statistically very highly significantly more (p<0.001) in the anaemic group of mothers than the non anaemic group (10%). The results of this study show an association of maternal anaemia in pregnancy with increased risk of LBW babies.

  5. Maternal and neonatal outcomes of macrosomic pregnancies

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Weisz, Boaz; Achiron, Reuven; Dulitzky, Mordechai

    2012-01-01

    Summary Background To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. Material/Methods A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000–4250 g, 4250–4500 g and ≥4500 g). Results The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000–4250 g, 4250–4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000–4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. Conclusions Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500g group. PMID:22936200

  6. Cesarean delivery in Finland: maternal complications and obstetric risk factors.

    PubMed

    Pallasmaa, Nanneli; Ekblad, Ulla; Aitokallio-Tallberg, Ansa; Uotila, Jukka; Raudaskoski, Tytti; Ulander, Veli-Matti; Hurme, Saija

    2010-07-01

    To assess the rate of maternal complications related to cesarean section (CS) and to compare morbidity between elective, emergency and crash-emergency CS. To establish risk factors associated with maternal CS morbidity. A prospective multicenter cohort study. Twelve delivery units in Finland. Women delivering by CS (n = 2,496) during a 6 months period in the study hospitals. Data on pregnant women, CS, and maternal recovery during the hospital stay was collected prospectively on report forms. The complication rates by different CSs were calculated, and factors associated with morbidity were analyzed by odds ratios (OR). Maternal complication rates in different types of CS. The association of risk factors with morbidity. About 27% of women delivering by CS had complications; 10% had severe complications. The complication rate was higher in emergency CS than in elective CS, and highest in crash-emergency CS. Significant independent risk factors for maternal morbidity were emergency CS and crash-emergency CS compared to elective CS (OR 1.8; 95% confidence interval (CI) 1.5-2.2), pre-eclampsia (OR 1.5; CI 1.1-2.0), maternal obesity (OR 1.4; CI 1.1-1.8) and maternal increasing age (OR 1.1; CI 1.03-1.2 per each 5 years). Maternal complications are frequent in CS, and although performing CS electively reduces the occurrence of complications, the frequency is still high. The complication rate depends on the degree of emergency, and increases with maternal obesity, older age and pre-eclampsia.

  7. Maternal mortality in Indonesia and Egypt.

    PubMed

    Fortney, J A; Susanti, I; Gadalla, S; Saleh, S; Feldblum, P J; Potts, M

    1988-02-01

    Twenty-three percent of deaths to women of reproductive age (15-49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100,000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two-thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children--the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.

  8. Rural maternity care.

    PubMed

    Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

    2012-10-01

    To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

  9. Maternal obesity, caesarean delivery and caesarean delivery on maternal request: a cohort analysis from China.

    PubMed

    Zhou, Yubo; Blustein, Jan; Li, Hongtian; Ye, Rongwei; Zhu, Liping; Liu, Jianmeng

    2015-05-01

    To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. We followed 1,019,576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, kg/m(2) ), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. During the 18-year period, 404,971 (39.7%) caesareans and 93,927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice. © 2015 John Wiley & Sons Ltd.

  10. Maternal methadone dose during pregnancy and infant clinical outcome.

    PubMed

    Wouldes, Trecia A; Woodward, Lianne J

    2010-01-01

    In recent decades there has been an increase in the methadone dosages prescribed for opioid dependent women during pregnancy. Using prospective longitudinal data from a cohort of 32 methadone exposed and 42 non-methadone exposed infants, this study examined the relationship between maternal methadone dose during pregnancy and a range of infant clinical outcomes. Of particular interest was the extent to which any observed associations might reflect the direct causal effects of maternal methadone dose and/or the confounding effects of adverse maternal lifestyle factors correlated with methadone use during pregnancy. Findings revealed the presence of clear linear relationships between the mean methadone dose prescribed for mothers during pregnancy and a range of adverse infant clinical outcomes. With increasing maternal methadone dose there was a corresponding increase in infants' risk of being born preterm, being symmetrically smaller, spending longer periods in hospital and the need for treatment for Neonatal Abstinence Syndrome. After due allowance for potentially confounding maternal health and lifestyle factors, maternal methadone dose during pregnancy remained a significant predictor of preterm birth, growth, and the duration of infant hospitalization post delivery. These findings suggest a need to examine more closely the potential impacts of recent trends towards the use of higher methadone dose levels during pregnancy.

  11. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan.

    PubMed

    Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

    2016-03-21

    To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Descriptive study. Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). The preventability and problems in each maternal death. Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay

    PubMed Central

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-01-01

    Objective To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. Methods This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). Results A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%–67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. Conclusion This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. PMID:20605151

  13. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay.

    PubMed

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-08-01

    To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%-67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Why did maternal mortality decline in Matlab?

    PubMed

    Maine, D; Akalin, M Z; Chakraborty, J; de Francisco, A; Strong, M

    1996-01-01

    In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the physicians at the Matlab maternity clinic. Their ability to refer patients to higher levels of care was important. The data further indicate that the decline in deaths depended upon the functioning of the government hospital in Chandpur, where cesarean sections and blood transfusions were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangladesh.

  15. Maternal mortality in Benghazi: a clinicoepidemiological study.

    PubMed

    Legnain, M; Singh, R; Busarira, M O

    2000-01-01

    We conducted a clinicoepidemiological study of 14 maternal deaths out of 79,981 live births at Al-Jamahiriya Hospital, Benghazi between 1993 and 1997. The maternal mortality rate per 100,000 live births was 17.5. The reproductive profile of these women was: mean age 31.5 +/- 6.9 years, mean parity 4.5, mean birth interval 14.6 +/- 7.0 months, mean gestation 27.7 +/- 14.6 weeks and mean haemoglobin 9.3 +/- 2.1 g/dL. None of the women had prebooked their delivery, 50% had preconceptional medical or obstetric risk factors, around 70% were anaemic, almost all were admitted with serious medical conditions and > 50% required surgical intervention. The main underlying medical causes of death were: hypertensive disease of pregnancy (28.6%), haemorrhage (14.3%), pulmonary embolism (14.3%) and brain tumour (14.3%).

  16. Contemporary Trends of Reported Sepsis Among Maternal Decedents in Texas: A Population-Based Study.

    PubMed

    Oud, Lavi

    2015-09-01

    Recent studies indicate that death certificate-based single-cause-of-death diagnoses can substantially underestimate the contribution of sepsis to mortality in the general population and among maternal decedents. There are no population-based data in the United States on the patterns of the contribution of sepsis to pregnancy-associated deaths. We studied the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations with reported hospital death during 2001-2010. We then examined the annual reporting of sepsis, and that of other reported most common causes of maternal death, including hemorrhage, embolism, preeclampsia/eclampsia, cardiovascular conditions, cardiomyopathy, cerebrovascular accidents, and anesthesia complications. The annual rate of sepsis among decedents, its trend over time, and changes of its annual rank among other examined potential causes of maternal death were assessed. There were 557 pregnancy-associated hospital deaths during study period. Sepsis was reported in 131 (23.5%) decedents. Sepsis has been increasingly reported among decedents, rising by 9.1%/year (P = 0.0025). The rank of sepsis, as compared to the other examined potential causes of maternal death rose from the 5th in 2001 to 1st since 2008. At the end of the last decade, sepsis has been reported in 28.1% of pregnancy-associated deaths. More than one potential cause of maternal death was reported in 39% of decedents. Sepsis has become the most commonly reported potential cause of death among maternal decedents in the present cohort, noted in over 1 in 4 fatal hospitalizations by the end of the last decade. Although causality cannot be inferred from administrative data, given its known contribution to maternal death, it is likely that sepsis plays an increasing role in fatal maternal hospital outcomes. The prevalent co-reporting of multiple potential causes of maternal death in the present cohort underscores the complexity of determining the sources of

  17. Maternal and neonatal tetanus

    PubMed Central

    Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

    2017-01-01

    Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58 000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

  18. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  19. Maternal Competition in Women.

    PubMed

    Linney, Catherine; Korologou-Linden, Laurel; Campbell, Anne

    2017-03-01

    We examined maternal competition, an unexplored form of competition between women. Given women's high investment in offspring and mothers' key role in shaping their reproductive, social, and cultural success as adults, we might expect to see maternal competition between women as well as mate competition. Predictions about the effect of maternal characteristics (age, relationship status, educational background, number of children, investment in the mothering role) and child variables (age, sex) were drawn from evolutionary theory and sociological research. Mothers of primary school children (in two samples: N = 210 and 169) completed a series of questionnaires. A novel nine-item measure of maternal competitive behavior (MCQ) and two subscales assessing Covert (MCQ-C) and Face-to-Face (MCQ-FF) forms of competition were developed using confirmatory factor analysis. Competitiveness (MCQ score) was predicted by maternal investment, single motherhood, fewer children, and (marginally) child's older age. The effect of single motherhood (but not other predictors) was partially mediated by greater maternal investment. In response to a scenario of their child underperforming relative to their peers, a mother's competitive distress was a positive function of the importance she ascribed to their success and her estimation of her child's ability. Her competitive distress was highly correlated with the distress she attributed to a female friend, hinting at bidirectional dyadic effects. Qualitative responses indicated that nonspecific bragging and boasting about academic achievements were the most common irritants. Although 40% of women were angered or annoyed by such comments, less than 5% endorsed a direct hostile response. Instead, competitive mothers were conversationally shunned and rejected as friends. We suggest that the interdependence of mothers based on reciprocal childcare has supported a culture of egalitarianism that is violated by explicit competitiveness.

  20. Mother-baby friendly hospital.

    PubMed

    Aragon-choudhury, P

    1996-01-01

    In Manila, the Philippines, the Dr. Jose Fabella Memorial Hospital has been a maternity hospital for 75 years. It averages 90 deliveries a day. Its fees are P200-P500 for a normal delivery and P800-P2000 for a cesarean section. Patients pay what they can and pay the balance when they can. The hospital provides a safe motherhood package that encompasses teaching responsible parenthood, prenatal care, labor, delivery, postpartum care, breast feeding, family planning, and child survival. In 1986, the hospital introduced innovative policies and procedures that promote, protect, and support breast feeding. It has a rooming-in policy that has saved the hospital P6.5 million so far. In the prenatal stage, hospital staff inform pregnant women that colostrum protects the newborn against infections, that suckling stimulates milk production, and that there is no basis to the claim of having insufficient breast milk. Sales representatives of milk substitutes are banned from the hospital. Staff confiscate milk bottles or formula. A lactation management team demonstrates breast feeding procedures. Mothers also receive support on the correct way of breast feeding from hospital staff, volunteers from the Catholic Women's League, consumer groups, and women lawyers. The hospital's policy is no breast milk, no discharge. This encourages mothers to motivate each other to express milk immediately after birth. The hospital has received numerous awards for its breast feeding promotion efforts. UNICEF has designated Fabella Hospital as a model of the Baby-Friendly Hospital Initiative. The hospital serves as the National Lactation Management Education Training Center. People from other developing countries have received training in lactation management here. The First Lady of the Philippines, the First Lady of the US, and the Queen of Spain have all visited the hospital. The hospital has also integrated its existing services into a women's health care center.

  1. Maternal methadone dose and neonatal withdrawal.

    PubMed

    Berghella, Vincenzo; Lim, Pearl J; Hill, Mary K; Cherpes, Jennifer; Chennat, Jennifer; Kaltenbach, Karol

    2003-08-01

    The purpose of this study was to determine whether maternal methadone dosage correlates with neonatal withdrawal in a large heroin-addicted pregnant population. A retrospective review of all maternal/neonatal records of pregnancies that were maintained on methadone therapy in our institution was conducted. After in-hospital stabilization, women were given daily methadone therapy under direct surveillance, with liberal dosage increases according to maternal withdrawal symptoms. Neonatal withdrawal was assessed objectively by the neonatal abstinence score. The average methadone dose in the last 12 weeks of pregnancy and the last methadone dose before delivery (cutoffs of 40, 60, or 80 mg) were correlated to various objective measures of neonatal withdrawal. One hundred mother/neonate pairs on methadone therapy were identified. Women who received an average methadone dose of <80 mg (n=50 women) had a trend toward a higher incidence of illicit drug abuse before delivery than women who received doses of >/=80 mg (n=50 women; 48% vs 32%; P=.1). Women who received an average methadone dose of <80 mg had similar highest neonatal abstinence score, need for neonatal treatment for withdrawal, and duration of withdrawal compared with women whose condition was maintained with dosages of >/=80 mg (score, 11.1 vs 11.5; 68% vs 66%; and 13.3 vs 13.6 days, respectively; all P>.5). For all cutoffs that were used for high versus low dose and for both the average and last methadone dosage analyses, neonatal withdrawal was similar. The maternal methadone dosage does not correlate with neonatal withdrawal; therefore, maternal benefits of effective methadone dosing are not offset by neonatal harm.

  2. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

    PubMed Central

    2014-01-01

    Background Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. Methods This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Results Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusions In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe

  3. Maternal deaths in Tanzania -- a challenge.

    PubMed

    1994-08-01

    A reproductive health approach to health care has many consequences for women in Tanzania. Conditions are currently such that in one hospital in Amana there were 30 to 40 deliveries daily, but only 2 beds. The consequence was patients were treated while lying on the floor. The main city hospital did not have a vacuum aspirator, resuscitation equipment for newborns, or a sterilizer. A Dar es Salaam study shows a hospital maternal mortality rate of 754/100,000 live births, which is much higher than the 200-400/100,000 live births estimated by the WHO. The barriers to women's health are low socioeconomic status, poor nutrition, lack of income, lack of employment opportunities, and limited access to basic sanitation. There is discrimination against women in food, education, and economic independence, and social custom that denies decision making about marriage and reproduction. Access to information is limited to mother and child clinics. Men tend not to be involved in family planning or in treatment for sexually transmitted diseases. Strategies have been narrowly focused on maternal mortality, rather than on reproductive health and the right to live. Pregnancy threatens the right to life.

  4. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    PubMed

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands