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This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.
Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy and entails high costs for health systems. Currently, no reliable labor proximity prediction techniques are available for clinical use. Regular checks by uterine electrohysterogram (EHG) for predicting preterm labor have been widely studied. The aim of the present study was to assess the feasibility of predicting labor with a 7- and 14-day time horizon in TPL women, who may be under tocolytic treatment, using EHG and/or obstetric data. Based on 140 EHG recordings, artificial neural networks were used to develop prediction models. Non-linear EHG parameters were found to be more reliable than linear for differentiating labor in under and over 7/14 days. Using EHG and obstetric data, the <7- and <14-day labor prediction models achieved an AUC in the test group of 87.1 ± 4.3% and 76.2 ± 5.8%, respectively. These results suggest that EHG can be reliable for predicting imminent labor in TPL women, regardless of the tocolytic therapy stage. This paves the way for the development of diagnostic tools to help obstetricians make better decisions on treatments, hospital stays and admitting TPL women, and can therefore reduce costs and improve maternal and fetal wellbeing.
Schistosoma haematobium infection has been documented as an uncommon cause of vesicovaginal fistula (VVF) and can result in impaired wound healing of urogenital tissues. For these reasons, it could potentially be linked to an increased rate of obstetric fistula among women who experience obstructed labor and/or in a higher failure rate of fistula repair. Therefore, the primary objective of our study was to determine the prevalence of S. haematobium infection among women undergoing obstetric VVF repair in Lilongwe, Malawi. Our secondary objectives were to assess if S. haematobium infection could be a risk factor for obstetric fistula development or unsuccessful VVF repair in our patient population.
Use of pharmacotherapy during pregnancy is common and increasing. Physiologic changes during pregnancy may significantly alter the overall systemic drug exposure, necessitating dose changes. A search of PubMed for pharmacokinetic clinical trials showed 494 publications during pregnancy out of 35,921 total pharmacokinetic published studies (1.29%), from the late 1960s through August 31, 2013. Closer examination of pharmacokinetic studies in pregnant women published since 2008 (81 studies) revealed that about a third of the trials were for treatment of acute labor and delivery issues, a third included studies of infectious disease treatment during pregnancy, and the remaining third were for varied ante-partum indications. Approximately, two-thirds of these recent studies were primarily funded by government agencies worldwide, one-quarter were supported by private non-profit foundations or combinations of government and private funding, and slightly <10% were supported by pharmaceutical industry. As highlighted in this review, vast gaps exist in pharmacology information and evidence for appropriate dosing of medications in pregnant women. This lack of knowledge and understanding of drug disposition throughout pregnancy place both the mother and the fetus at risk for avoidable therapeutic misadventures - suboptimal efficacy or excess toxicity - with medication use in pregnancy. Increased efforts to perform and support obstetric dosing and pharmacokinetic studies are greatly needed.
Obstetric fistula is the presence of a hole between a woman's genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987-2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40-79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level.
Introduction. Asymptomatic bacteriuria (ASB), occurring in 2-11% of pregnancies, is a major predisposition to the development of pyelonephritis, which is associated with obstetrical complications, such as preterm labor and low birth weight infants. The aim of this study was to determine the prevalence of ASB, the antibacterial susceptibilities of the isolated microorganisms and the associated risk factors in an outpatient clinical setting in Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey. Material and Methods. Between December 2009 and May 2010, pregnant women admitted to the antenatal outpatient clinic were included in this study. The results of a complete urine analysis, midstream urine culture and antibacterial susceptibility were evaluated. Results. Of the 2011 pregnant women included, 171 had ASB (8.5%). E. coli was the most frequently isolated microorganism (76.6%), followed by Klebsiella pneumonia (14.6%). Both microorganisms were highly sensitive to fosfomycin, sensivity being 99.2% for E. coli and 88% for Klebsiella pneumonia. Conclusions. In this certain geographical region, we found E. coli as the most common causative agent of ASB in the obstetric population and it is very sensitive to fosfomycin. We recommend fosfomycin for ASB in pregnant women due to its high sensitivity, ease of administration and safety for use in pregnancy.
Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools.
Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06-3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01-15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16-2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68-5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13-6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17-11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.
Rates of cesarean section (CS) are increasing and abnormal fetal heart rate tracing and concern about consequent acidosis remain one of the most common indications for primary CS. Umbilical artery (UA) lactate sampling provides clinicians with point of care feedback on CTG interpretation and intrapartum care and may result in altered future practice.
Uterocervical angle has been suggested as a marker to predict preterm birth. However, the literature has limited data about its predictive role in preterm delivery. Moreover, no evidence is present to clarify the role of second-trimester uterocervical angle in induction success and postpartum hemorrhage. Here, it was aimed to compare the role of uterocervical angle with cervical length in predicting preterm labor and assess the utility of the second-trimester uterocervical angle in induction success and postpartum hemorrhage.
Background. Accurate timing of antenatal corticosteroids (ACS) has resulted in improved neonatal outcomes. Objectives. Our primary objective was to determine predictors for optimal timing of ACS in women presenting with spontaneous preterm labor. Study Design. A retrospective cohort study of women receiving ACS for spontaneous preterm birth was conducted. Women were included if they presented with preterm labor or preterm premature rupture of membranes. Accurate timing of ACS was defined as administration within 7 days of delivery. Maternal demographic and obstetrics characteristics were compared between the groups receiving ACS ≤7 days and >7 days from delivery. Statistical analyses were performed using parametric and nonparametric tests. P < 0.05 was considered significant. Results. The study included 215 subjects. Median latency from ACS administration to delivery was 6 days (IQR 32). Accurate timing of ACS occurred in 113 (53%) women and was associated with rupture of membranes (OR 13.8, 95% CI 5.9-32.6), cervical change (OR 7.1, 95% CI 3.0-17.1), and cervical dilation ≥ 2 cm (OR 3.9, 95% CI 1.5-10.3). Conclusions. Rupture of membranes, cervical change, and cervical dilation ≥ 2 cm were strong predictors of optimal timing. 53% of women with preterm labor received ACS optimally.
Anesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain.
Objective: To assess perceptions about vaginal examinations (VEs) during labor among women referred to the Akbarabadi Hospital in Tehran, Iran. Methods: This was a cross-sectional study conducted from December 2015 to May 2016. It included 200 primiparous women. Convenience sampling was used to select participants. The data collection tool was a questionnaire that collected both demographic and obstetric data from participants, as well as data in relation to women's experiences according to a designated and validated scale, 24 hours after childbirth. Higher scores were indicative of a more positive perception in relation to a participant's experience of VE. Results: The mean ± SD score for the perception of the VE and number of examinations in the active phase of labor was 62.9 ± 26.2 and 7.4 ± 2.44, respectively. Multiple linear regression analysis showed a significant relationship between perceived duration of examination (short, average [B = -1.03], long [B = 3.84]), feeling of comfort with the examiner (B = 2.73), and number of examiners (B = -0.81) with the mean scores of their perceptions (P < .05). These 3 variables accounted for 8% of the changes in the women's perceptions score of VE. Conclusion: The majority of participants in this study underwent excessive VEs during labor. If obstetrically safe, a reduction in the number of examinations during labor along with decreased duration based on women's perceptions could improve women's perceptions of VE overall. Additionally, should each VE be performed by the same clinician, women's perceptions in relation to VEs may also improve.
Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia.
Maternal health still remains a major challenge in almost all developing countries. In Myanmar, the country met only 62% of its target for the maternal mortality rate (130 per 100,000 live birth) even though proportion of skilled birth attendant (SBA) and antenatal care (ANC) coverage was 80% in 2015. Despite the estimated large maternal complications, most maternal healthcare program ignored the burden of those morbidity because of limited understanding of the incidence and prevalence of morbidity conditions and cost of those morbidity burdens on society. The present study provides a general idea of the scope of obstetric complication, incidence of obstetric complication, and cost of those morbidity burdens on society. We conducted a retrospective incidence-based cost of illness study related to obstetric complication from the healthcare system perspective at 25 bedded township hospital in Yedashae during the fiscal year of 2015-2016. For the cost of obstetric complication, average treatment cost was 26.83 USD (±8.59). When looking by disease category, average treatment cost for incomplete abortion was 35.45 USD (±1.75); pelvic inflammatory disease (PID) was 16.01 USD; pregnancy-induced hypertension (PIH) was 21.02 USD (±4.68); ante-partum hemorrhage (APH) was 14.24(± 0.25); post-partum hemorrhage (PPH) was 27.04 USD (±1.56); prolonged labor was 37.55 USD (±0.42); and septicemia was 16.51 USD (±2.15). Significant predicting variables in obstetric complication cost model were incomplete abortion, prolonged labor, post-partum hemorrhage (PPH), pregnancy induced hypertension (PIH), patient age and septicemia. From this study, we can summarize the most frequently occurred obstetric complication in that township area, actual cost burden of those complications and obstetric complication cost model which can be useful for hospital financial management. This study can be considered as a starting point for cost of illness analysis in Myanmar to prioritize and target specific health problem at a country level for policy maker to set priorities for health care intervention.
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