Obstetrics and Gynecology Commons^™

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

Infant Growth And Body Composition From Birth To 24 Months: Are Infants Developing The Same?, Shane A. Norris, Lukhanyo H. Nyati, Alexia Murphy Alford, Nishani Lucas, Ina S. Santos, Caroline S. Costa, Rebecca Kuriyan, V Pujitha Wickranasinghe, Shabina Ariff, Andrew P. Hills

Department of Paediatrics and Child Health

Background: Given the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries.
Methods: We recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3-24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length …

A Mini-Review Of What Matters In The Management Of Nas, Is Esc The Best Care?, Enrique Gomez Pomar

Pediatrics Faculty Publications

As the use of opioids and polysubstance by pregnant women has increased over the years, there has also been a sharp increase in cases of neonatal abstinence syndrome (NAS). Classically, infants affected by NAS have been cared for in neonatal intensive care units resulting in an increase of healthcare expenditure and resource utilization as well as separation from the families. Consequently, the Eat, Sleep, and Console (ESC) tool was developed and promoted as a novel method that focuses on maternal/infant dyad during hospital stay while decreasing the use of pharmacological interventions and therefore decreasing the length of stay and healthcare …

Implementing Team Birth To Improve Patient Satisfaction On An Ldrp (Team Birthsingleroom ) Unit, Deanna Higgins, Alyson Willard, Teresa Rangel

Articles, Abstracts, and Reports

No abstract provided.

Identifying And Improving System Barriers To Promote Successful Breastfeeding In Resident Physicians, Brigette Schuman, Michelle Drobny, Elizabeth Savage, Colleen Zimmermann

Articles, Abstracts, and Reports

No abstract provided.

The Presence Of A Single Nuchal Cord In The Third Trimester May Not Affect Tei Index In Lga Fetuses, Julia Murlewska, Przemysław Poszwa, Oskar Sylwestrzak, Maria Respondek-Liberska, Dennis Wood

Department of Obstetrics and Gynecology Faculty Papers

(1) Background: The aim of this study was to assess the RV (right ventricle) and LV (left ventricle) Tei index in large for gestational age (LGA) fetuses with a single 360-degree umbilical coil of the umbilical cord around the fetal neck identified by ultrasound in the third trimester of gestation. (2) Methods: The RV and LV Tei index for the cardiac function were measured in 297 singleton pregnancies, and we identified 25 LGA fetuses. There were 48% of LGA fetuses with a nuchal umbilical cord—LGA/NC—larger for gestational age fetuses with a nuchal cord. NC was detected with a color Doppler …

Metabolomics Of A Neonatal Cohort From The Alliance For Maternal And Newborn Health Improvement Biorepository: Effect Of Preanalytical Variables On Reference Intervals, Lena Jafri, Aysha Habib Khan, Muhammad Ilyas, Muhammad Imran Nisar, Javairia Khalid, Hafsa Majid, Aneeta Hotwani, Fyezah Jehan

Department of Pathology and Laboratory Medicine

Background: The study was conducted to determine reference interval (RI) and evaluate the effect of preanalytical variables on Dried blood spot (DBS)-amino acids, acylcarnitines and succinylacetone of neonates.
Methodology: DBS samples were collected within 48-72 hours of life. Samples were analyzed for biochemical markers on tandem mass spectrometer at the University of Iowa. Comparison of RI across various categorical variables were performed.
Results: A total of 610 reference samples were selected based on exclusion criteria; 53.2% being females. Mean gestational age (GA) of mothers at the time of delivery was 38.7±1.6 weeks; 24.5% neonates were of low birth weight and …

Knowledge, Attitudes, And Practices (Kap) Towards Covid-19 Pandemic Among Pregnant Women In A Tertiary Hospital In Karachi, Pakistan, Sumaira Naz, Syeda Dur E Shawar, Shamila Saleem, Ayesha Malik, Amir Raza

Department of Obstetrics & Gynaecology

Background: The aim of this study was to evaluate the knowledge, attitude, and practices (KAP) of the pregnant population during the COVID-19 pandemic in a tertiary care hospital.
Methods: This cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. KAP towards COVID-19 was assessed using 21-item questionnaires. A score for each category was calculated and points were summed. The outcome variables of KAP were compared with demographic characteristics. Data were analyzed by using SPSS 19.
Results: A total of 377 patients participated in the study. The majority of the patients were multiparous (36.8%) in the age group of …

Pregnancy Outcomes Of Patients With Ultrasound-Indicated And History-Indicated Mcdonald Cervical Cerclage, Zaibunnisa Memon, Naureen Anjum, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Objective: To assess pregnancy outcomes of patients with ultrasound-indicated and history-indicated McDonald cervical cerclage.
Materials and methods: This was a cross-sectional study of pregnant women who had cervical cerclage performed at Aga Khan University Hospital, Karimabad campus. We obtained Institutional Review Board approval and reviewed the medical records of patients. A purposive continuous sampling technique was used. A total of 88 patients were included. There were no exclusion criteria. Outcome data were collected from the medical record of patients from January 2010 to December 2016.
Results: Analysis reported a statistically significant lower gravidity and parity in the scan-indicated group as …

Antenatal Dexamethasone For Improving Preterm Newborn Outcomes In Low-Resource Countries: A Cost-Effectiveness Analysis Of The Who Action-I Trial, Who Action Trial Collaborators, Katherine E. Eddy, Joshua P. Vogel, Nick Scott, Dagnachew Fetene, Shabina Ariff, Sajid Bashir Soofi, Lumaan Sheikh, Farrukh Raza, Almas Aamir

Department of Paediatrics and Child Health

Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries.
Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk …

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Shama Munim

Department of Obstetrics & Gynaecology

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.
Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, …

Are Women With Disabilities Less Likely To Utilize Essential Maternal And Reproductive Health Services?-A Secondary Analysis Of Pakistan Demographic Health Survey, Shafaq Mahmood, Waqas Hameed, Sameen Siddiqi

Community Health Sciences

Background: People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan.
Methods: This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 …

Barriers And Facilitators To Exclusive Breastfeeding In Rural Pakistan: A Qualitative Exploratory Study, Atif Riaz, Shelina Bhamani, Sheraz Ahmed, Fayyaz Umrani, Sadaf Jakhro, Abdul Khaliq Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Exclusive breastfeeding (EBF) of children until six months of age is considered one of the most critical interventions in tackling childhood undernutrition. EBF rates are suboptimal in Pakistan, particularly in rural areas where child undernutrition is most prevalent. This study aimed to explore barriers to EBF in a rural context of Pakistan.
Methods: The study was conducted in the rural district Matiari of Sindh, Pakistan, during Jan-March 2020. We used a qualitative exploratory study design and conducted 36 focus group discussions (FGDs). Participants were purposively selected mothers who had not practiced EBF during their previous childbirth, their spouses and …

The Global Network Socioeconomic Status Index As A Predictor Of Stillbirths, Perinatal Mortality, And Neonatal Mortality In Rural Communities In Low And Lower Middle Income Country Sites Of The Global Network For Women's And Children's Health Research, Archana B. Patel, Carla M. Bann, Cherryl S. Kolhe, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Lester Figueroa, Nancy F. Krebs, Fabian Esamai, Sarah Saleem

Community Health Sciences

Background: Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations.
Objective: The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia.
Methods: The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded …

Early Neonatal Mortality Is Modulated By Gestational Age, Birthweight And Fetal Heart Rate Abnormalities In The Low Resource Setting In Tanzania – A Five Year Review 2015–2019, Aisa Shayo, Pendo Mlay, Emily Ahn, Hussein Kidanto, Michael Espiritu, Jeffrey Perlman

Obstetrics and Gynaecology, East Africa

Background: Early Neonatal mortality (ENM) (<7days) remains a signifcant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute signifcantly to ENM. The study objectives were to determine: frst, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the infuence of decreasing GA (<37weeks) and BW (<2500g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period.

Methods: Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM<7days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis.

Results: The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change signifcantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased signifcantly (OR 0.62; 95% confdence interval (CI) …

The Efficacy Of Low-Dose Aspirin In Pregnancy Among Women In Malaria-Endemic Countries, Melissa Bauserman, Sequoia I. Leuba, Jennifer Hemingway-Foday, Tracy L. Nolen, Janet Moore, Elizabeth M. Mcclure, Adrien Lokangaka, Antoinette Tsehfu, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Low dose aspirin (LDA) is an effective strategy to reduce preterm birth. However, LDA might have differential effects globally, based on the etiology of preterm birth. In some regions, malaria in pregnancy could be an important modifier of LDA on birth outcomes and anemia.
Methods: This is a sub-study of the ASPIRIN trial, a multi-national, randomized, placebo controlled trial evaluating LDA effect on preterm birth. We enrolled a convenience sample of women in the ASPIRIN trial from the Democratic Republic of Congo (DRC), Kenya and Zambia. We used quantitative polymerase chain reaction to detect malaria. We calculated crude prevalence …

Prenatal Drug Exposure And Its Effects On Fetal Development: Clinical And Health Education Implications, Johanna Marie Olo Tapangan

Senior Honors Theses

Prenatal drug exposure is a common clinical phenomenon in pregnancy cases. Pregnancy is a fragile period of time for both the mother and the fetus. Therefore, strict drug regulation is important to ensure the safety and wellbeing of the developing fetus. Certain drugs, once thought to be safe, have been found to have detrimental effects on the normal development of functioning organ systems in the fetus. Current research has identified drugs that when taken during pregnancy can result in the onset of fetal physical abnormalities, impaired brain development, and disrupted organogenesis and organ function. Thalidomide, losartan, opioids, alcohol, and caffeine …

Factors Associated With Home Delivery In Rural Sindh, Pakistan: Results From The Global Network Birth Registry, Afreen Sadia, Shafaq Mahmood, Farnaz Naqvi, Seemab Naqvi, Zahid Soomro, Sarah Saleem

Community Health Sciences

Background: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan.
Methods: Data for this study were taken from The Global Network's Maternal Newborn Health Registry (MNHR), which is a prospective, population-based …

Characteristics And Birth Outcomes Of Pregnant Adolescents Compared To Older Women: An Analysis Of Individual Level Data From 140,000 Mothers From 20 Rcts, Nadia Akseer, Emily Catherine Keats, Pravheen Thurairajah, Simon Cousens, Ana Pilar Bétran, Brietta M. Oaks, David Osrin, Ellen Piwoz, Exnevia Gomo, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.
Methods: This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, …

Understanding The Needs Of A Mobile Phone-Based Telemonitoring Program For Pregnant Women At High Risk For Pre-Eclampsia: Interpretive Qualitative Description Study, Anam Shahil Feroz, Kristina De Vera, Nadia D. Bragagnolo, Sarah Saleem, Zulfiqar Ahmed Bhutta, Emily Seto

Community Health Sciences

Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan.
Objective: This study aims to explore the needs of …

Knowledge, Attitude And Practices Of Pregnant Women Related To Covid-19 Infection: A Cross-Sectional Survey In Seven Countries From The Global Network For Women's And Children's Health, Farnaz Naqvi, Seemab Naqvi, Sk Masum Billah, Sarah Saleem, Elizabeth Fogleman, Nalini Peres Da-Silva, Lester Figueroa, Manolo Mazariegos, Ana L. Garces, Sana Yousaf

Community Health Sciences

Objective: We sought to understand knowledge, attitudes and practices (KAP) regarding COVID-19 in pregnant women in seven low and middle-income countries (LMIC).
Design: Population-based prospective, observational study.
Settings: Study sites in DRC, Kenya, Zambia, Bangladesh, India (two sites), Pakistan and Guatemala.
Population and sample: Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR).
Methods: A KAP questionnaire was administered in face-to-face interviews with pregnant women from September 2020 through October 2021 in the MNHR.
Main outcome measures: KAP regarding COVID-19 during pregnancy.
Results: In all, 25 260 women completed the survey. Overall, 56.8% of women named ≥3 …

Nutritional Support And Prophylaxis Of Azithromycin For Pregnant Women To Improve Birth Outcomes In Peri-Urban Slums Of Karachi, Pakistan-A Protocol Of Multi-Arm Assessor-Blinded Randomized Controlled Trial (Mumta Pw Trial), Ameer Muhammad, Zoha Zahid Fazal, Benazir Baloch, Muhammad Imran Nisar, Fyezah Jehan, Yasir Shafiq

Medical College Documents

Background: Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan.
Methods: The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. …

Still Birth Classification: Application Of Relevant Condition At Death (Recode) Classification System In A Tertiary Care Hospital Of Pakistan, Urooj Kashif, Shelina Bhamani, Asma Patel, Zaheena Shamsul Islam

Department of Obstetrics & Gynaecology

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.
Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).
Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In …

Clavicular Fractures In Newborns: What Happens To One Of The Commonly Injured Bones At Birth?, Hina Mumtaz Hashmi, Nazia Shamim, Vinod Kumar, Naureen Anjum, Khalil Ahmad

Department of Paediatrics and Child Health

Introduction: The clavicle is one of the most commonly injured bones during the birth process. The objective of this study was to determine the frequency and outcome of fractured clavicle amongst neonates born in a five-year period at a Secondary Hospital setting and to determine the Maternal and Neonatal Characteristics involved in such cases and compare them with a control group and determine the significance of any factors.
Methods: All cases of fractured clavicle were retrospectively reviewed in a Secondary care hospital setting during a five-year period from July 2015 to June 2020. Maternal and neonatal factors were determined and …

Impact Evaluation Of The Efficacy Of Different Doses Of Vitamin D Supplementation During Pregnancy On Pregnancy And Birth Outcomes: A Randomised, Controlled, Dose Comparison Trial In Pakistan, Sidrah Nausheen, Atif Habib, Maria Asif Bhura, Arjumand Rizvi, Fariha Shaheen, Kehkashan Begum, Junaid Iqbal, Shabina Ariff, Lumaan Sheikh, Syed Shamim Raza, Sajid Bashir Soofi

Department of Obstetrics & Gynaecology

Background: Vitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.
Methods: We conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births …

How Children Perceive Covid-19? Kids Drawings And Perceptions Of Parents, Shelina Bhamani, Vardah Bharuchi, Nasreen Ali, Areeba Makhdoom, Ramla Hashmi, Sanober Nadeem, Hijaan Mitha, Alyza Muhammad, Mohsina Hussain, Fatima Shafiq, Ali Faisal Saleem, Lumaan Sheikh

Department of Obstetrics & Gynaecology

COVID-19 affected many lives, number of children become stressful and socially isolated. School closure also has great impact on children’s social-emotional development and overall wellbeing. The aim of current study was to identify children’s reactions to COVID-19 and its impact on academic and social life. Qualitative participatory research design was used to assess children perception about COVID-19. Data were collected from parent’s interview and Children drawing. Three major themes include: Fear of the drastic changes, increased sense of responsibility, and gratitude for being at home with family was reported by the parents however children drawings revealed that most of the …

Machine Learning Guided Postnatal Gestational Age Assessment Using New-Born Screening Metabolomic Data In South Asia And Sub-Saharan Africa, Sunil Sazawal, Kelli K. Ryckman, Sayan Das, Muhammad Imran Nisar, Usma Mehmood, Amina Barkat, Farah Khalid, Muhammad Ilyas Muhammad Ilyas, Ambreen Nizar, Fyezah Jehan

Department of Paediatrics and Child Health

Background: Babies born early and/or small for gestational age in Low and Middle-income countries (LMICs) contribute substantially to global neonatal and infant mortality. Tracking this metric is critical at a population level for informed policy, advocacy, resources allocation and program evaluation and at an individual level for targeted care. Early prenatal ultrasound examination is not available in these settings, gestational age (GA) is estimated using new-born assessment, last menstrual period (LMP) recalls and birth weight, which are unreliable. Algorithms in developed settings, using metabolic screen data, provided GA estimates within 1-2 weeks of ultrasonography-based GA. We sought to leverage machine …

Causes And Circumstances Of Maternal Death: A Secondary Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials Cohort, Annet M. Aukes, Kristina Arion, Jeffrey N. Bone, Jing Li, Marianne Vidler, Mrutyunjaya B. Bellad, Zahra Hoodbhoy, Rahat Qureshi, Sana Sheikh, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.
Methods: The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were …

Relationship Between Sexual Activity, Contraceptive Utilization And Biopsychosocial Characteristics Among Homeless Shelter Adolescents., Brittney A Gaudet, Nina Liu, Allison N Kayne, Taylor L Jarvill, Cecilia Zemanek, Jeffrey M Downen, Hoonani M Cuadrado, Amy B Smith, Marna R Greenberg, Jessica L Jacoby, Joanne N Quinones

Department of Emergency Medicine

Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.