Frequency and Fetomaternal Outcome in COVID 19 Positive Pregnant Women

Objective: To determine the frequency and outcome in pregnant women with COVID-19 infection. Study Design: This is a observational cohort study. Setting: Study carried out at Department of Obstetrics & Gynecology, Civil Hospital, Dow University of health sciences Karachi, from July 2020 to November 2021. Materials & Methods: The study was conducted in a tertiary care hospital in Karachi. Women having COVID-19 positive status during any stage of their pregnancy having antenatal visits in our hospital were included in our study. Maternal demographics, race, maternal outcome, and neonatal complications were noted on a self-made Performa. Statistical analysis was done by SPSS version 21 and descriptive statistics with frequencies were mainly calculated. Results: During the defined time of 14 months, we had 143 women visiting antenatal outpatient department and were tested positive for COVID-19. Majority of the women were tested for COVID-19 due to symptoms like fever, flu, cough and diarrhea. The mean age of women in our study was found to be 30 ± 6.7 years. The most frequent maternal outcome with SARSCOV-2 was preterm delivery. Out of 143, 27 cases had emergency lower segment C-section.PCR testing of neonates was carried out and 8.39% (n=12) neonates tested positive for SARSCOV-2. Conclusion: Infection with Covid-19 during pregnancy is associated with adverse pregnancy outcomes. Covid-19 infection can be transmitted to the fetus during pregnancy or childbirth. Neonatal has a high chance of being admitted to the ICU, and women also faces other complications of Covid 19, such as the risk of miscarriage and premature delivery.

Gestational Anaemia and its Associated Factors in Normal Pregnant Women

Objectives: To determine the hemoglobin levels in normal pregnant women and investigate the association of anemia with gestational age, number of antenatal visits, obstetrical complications and mode of delivery. Methodology: This is a cross-sectional study conducted at the Lady Willingdon Hospital, Khairpur Mirs, Pakistan from May 2021 to August 2021. A total of 139 normal pregnant women were recruited during antenatal visits. Patients were grouped into normal and anemic groups based on serum hemoglobin levels. Gestational age, obstetrical complications, mode of delivery and fetal outcome were recorded to find its association with anemia. Data was analyzed on SPSS 20.0 and p-value < 0.05 was considered as statistically significant. Results: Out of n=139 normal pregnant women, n=26 women had normal hemoglobin levels, n=49 were mild anemic, n=46 had moderate anemia whereas n=18 had severe anemia. Overall, the prevalence of gestational anemia was 81%. There was significant association between hemoglobin status and number of antenatal visits and complications in previous pregnancies. Hemoglobin status was not significantly associated with gestational age and mode of delivery. Conclusion: In conclusion, we found that gestational anemia is highly prevalent in Pakistan. Early detection of anemia and its correction via supplementations are recommended.

Hubungan Pengetahuan Mengenai Tanda Perdarahan dengan Kunjungan Antenatal pada Ibu Hamil Trimester III

Knowledge is an important factor for pregnant women to be able to adapt to physiological and psychological changes during pregnancy. Failure to adapt causes several health problems for pregnant women, one of which is bleeding. Bleeding events can be prevented by obediently carrying out antenatal visits. To determine the relationship between respondent’s characteristics and knowledge of signs of bleeding during pregnancy with antenatal visit compliance in third trimester pregnant women. Quantitative research with a cross sectional approach and purposive sampling technique on 30 third trimester pregnant women, in October-November 2020. Using a questionnaire and data analysis using Chi-Square. Characteristics of respondents aged 20-35 years (93.3%), primigravida (56.7%), secondary education (60%), less knowledgeable (60%), obedient to antenatal visits (76.7%). The p-value=1,000. There is no significant relationship between the knowledge of third trimester pregnant women about signs of bleeding during pregnancy and compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. Nurses have a duty to provide counseling regarding the compliance of third trimester pregnant women in antenatal visits to prevent the risk of bleeding.

Determinants of Place Birth: A Multinomial Logistic Regression and Spatial Analysis of the 2019 Ethiopian Mini Demographic and Health Survey Data

Background: The presence of skilled attendants at birth and institutional delivery with quality serves significantly improves maternal and neonatal health. However, in countries where a practice of home birth is common, maternal and neonatal mortality remained high. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia. Methods: Ethiopian mini-DHS-2019 data was used in this analysis. A survey multinomial logistic regression model was used to analyze determinants of place of birth. An adjusted relative risk ratio and its 95% confidence interval with a p-value of < 0.05 and marginal effect and its 95% confidence interval with a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The magnitude of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth. Result: Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low cluster level coverage of 4+ antenatal visits were predictors of home birth. Homebirth was clustered across enumeration areas and it was over 40% in most parts of the country with >75% in the Somali region. SaTScan analysis detected most likely clusters in the Somali region, eastern and southern zones of Oromia region, central zones of Amhara region, and eastern zones of the South Nations Nationalities and People’s region. Conclusion: Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities through qualified providers with midwifery skills and systems of back-up in place could be supportive.

Risk Factors for Early Neonatal Death despite Cesarean Section

Objective: To identify the risk factors for early neonatal death (NND) despite cesarean section (CS). Methods: This case-control study was carried out between 1st February and 31st May, 2019. Files of women whose newborns died within seven days following CS and those of women whose newborns were alive seven days after CS were examined. The main variables recorded included maternal age, educational level, gestational age at delivery, number of antenatal visits done, whether the woman was referred or not, intrapartum fever or hemorrhage, indication of CS, decision delivery interval, birthweight and sex of newborn. Data were analyzed using SPSS 21.0. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of NND after CS was 4.8% (51/1053). Significant risk factors for NND after CS were birth weight <2000g (aOR 48.18, 95%CI 12.97-152.21), intra-partum hemorrhage (aOR 12.15, 95%CI 5.77-25.97), intra-partum fever (aOR 5.64, 95%CI 1.81-17.66), ˂4 antenatal visits (aOR 4.13, 95%CI 2.71-6.74), arrival ˃1h after referral (aOR 3.09, 95%CI 1.67-5.71) and primary school education level (aOR 2.39, 95%CI 1.16-4.92). Conclusion: From the risk factors identified above, we can recommend that women, especially those with primary school education level, should be counselled to attend at least four antenatal visits to allow the diagnosis and treatment of some diseases. Moreover, CS should be carried out as fast as possible in the cases of intrapartum hemorrhage. Women with intrapartum fever needs particular attention. Lastly, referral should be organized so that the woman arrives earlier.

Sleep Quality and BMI in Pregnancy– A Prospective Cohort Study

Background: Pregnancy associated sleep disturbance is a common pregnancy-related complication which can lead to significant maternal distress and adverse pregnancy outcomes. Sleep quality can be affected by multiple factors and high BMI or obesity has been recognized as one of them. Various previous studies have demonstrated poorer sleep quality during pregnancy. However, most studies included assessment at only one point of pregnancy. This prospective cohort study aimed to better evaluate the effect of pregnancy on the quality of sleep throughout the antenatal period and how BMI affects antenatal sleep.Methods: A total of 926 women were recruited before 14 weeks of gestation and followed throughout pregnancy. The Pittsburgh Sleep Quality Index questionnaire was employed to assess sleep quality in 4 antenatal visits throughout pregnancy. Their weight was also recorded at each visit.Results: The PSQI global score was higher towards the later part of pregnancy (6.4 to 8.0, p<0.001) and highest at the 4th visit. Sleep latency was longer as pregnancy progressed (18.5 mins to 23.2 mins, p=0.001). Sleep duration became shorter over time and was the shortest at the 4th visit (7.1 hours to 6.5 hours, p<0.001). Sleep efficiency was the lowest at the 4th visit (85.2% to 81.6%, p<0.001). The same trend was observed for subjects in different BMI groups throughput pregnancy. PSQI score increased and sleep duration decreased as BMI increased. The effect of increasing BMI on PSQI and sleep duration was only observed in the higher BMI groups (>25kg/m2).Conclusions: Our study showed that sleep quality gradually declined throughout pregnancy for all BMI groups. Higher BMI was associated with poorer sleep as represented by PSQI score and sleep duration, particularly in the high BMI subgroups.

Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers

IntroductionPregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition.MethodsWe included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic).ResultsBetween 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents.ConclusionPregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions.

Incidence and risk factors for maternal surgical site infection after cesarean section.

Objective: To ascertain the frequency and risk factors for post-operative surgical site infection (SSI) in cesarean section. Study Design: Cross-sectional study. Setting: Departments of Gynecology & Obstetrics and Anesthesiology, Secondary Care Hospital. Period: January to December 2017. Material & Methods: After the approval of hospital ethical committee, 337 parturient who underwent cesarean section were included in our study. Outcomes were: frequency and risk factors for post-cesarean wound infection. Data was analyzed by SPSS version 20. Qualitative data presented as frequency and percentage. Chi-square (Fishers test) used to analyze significance. P-value ≤ 0.05 taken as significant. Results: A total of 337 patients were included in our final analysis. The frequency of wound infection was 15 (4.4%). The mean age was 27.5 years ± 5.8 in our study population. There was no difference in age (p=0.781), parity (p=0.898), antenatal visits (p=0.319), referral from doctor (p=0.205), anemia (p=0.731), nature of surgery (elective or emergency LSCS) p=0.548, severity of anemia (p=0.962), blood grouping Rh-factor (p=0.531), chorioamnionitis (p=0.707), labor (p=0.955), premature rupture of membrane (p=0.427) and antepartum hemorrhage (p=0.769). 11 (3.3%) of the patients with SSI were treated conservatively while 4 (1.2%) required debridement and secondary suturing. None of our patients required referral to tertiary care hospital for treatment of SSI. Conclusion: The incidence of SSI after cesarean section was less in our study and we didn’t find maternal age, gestational age, previous cesareans delivery, antenatal visits, PROM, labor before LSCS, anemia to be associated with risk of SSI.

Placental mesenchymal dysplasia- A case report

Placental mesenchymal dysplasia is a rare disorder mainly characterized by enlarged placenta. Patients on antenatal visits present with normal or slightly raised Beta-HCG, raised Alfa-fetoprotein and cystic structures on USG resembling a molar pregnancy. It has to be differentiated from molar pregnancies to avoid unnecessary termination of pregnancy. This condition is associated with IUGR or IUFD. Mostly the fetus are females. Due to lack of awareness of this condition it remains underreported. Here we present a case report of 20 years old female 37 week pregnant with IUGR with clinical suspicion of molar pregnancy gave birth to alive female fetus and on histopathological examination of placenta was diagnosed with PMD.