Obstetrics and Gynecology Commons^™

Association Between Pregnancy Intention And Maternal Characteristics, Outcomes, And Cost Of Care: A Pilot Study, Kristy M. Kelel, Kiley B. Vander Wyst, Danielle M. Greer, Danish Siddiqui

Journal of Patient-Centered Research and Reviews

Background: An estimated 51% of pregnancies in the United States are unintended. In Wisconsin, unplanned pregnancies account for 40% of all pregnancies and cost $148 million in public funds. Unintended pregnancy, which creates increased hardship for mothers and threatened well-being of infants, has been recognized as an important health, social and economic problem.

Purpose: To determine the pregnancy intentions of postpartum women and the maternal characteristics, outcomes and costs of care associated with unintended pregnancies at a large urban hospital in Milwaukee, Wisconsin.

Methods: Postpartum women were surveyed prior to discharge. The 20-item survey included whether or not the woman …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein L. Kidanto, Lennarth Nyström, Birgitta Essén

Obstetrics and Gynaecology, East Africa

Background, In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods, During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Maternal Arsenic Exposure And Gestational Diabetes And Glucose Intolerance In The New Hampshire Birth Cohort Study, Shohreh F. Farzan, Anala Gossai, Yu Chen, Lisa Chasan-Taber, Emily Baker, Margaret Karagas

Dartmouth Scholarship

Background: Gestational diabetes mellitus (GDM) is a major pregnancy complication with detrimental effects for both mothers and their children. Accumulating evidence has suggested a potential role for arsenic (As) exposure in the development of GDM, but current studies have not assessed As exposure from water, urine or toenail samples.

Methods: We investigated the association between As exposure and risk of glucose intolerance and GDM among 1151 women enrolled in the New Hampshire Birth Cohort Study. Arsenic was measured in home well water and via biomarkers (i.e., maternal urine collected ~24–28 weeks gestation and toenail clippings collected 2 weeks postpartum).

Results: …

Losing Ground: Awareness Of Congenital Cytomegalovirus In The United States, Sara M. Doutre, Tyson S. Barrett, Janelle Greenlee, Karl R. White

Journal of Early Hearing Detection and Intervention

One in 150 infants is born with cytomegalovirus (CMV) and one in 750 will have lifelong disabilities due to CMV. Even though congenital CMV is the leading viral cause of congenital disabilities and the leading non-genetic cause of childhood hearing loss, most adults have never heard of it. Data from the 2015 and 2016 HealthStyles^TM surveys were analyzed and compared to data from similar studies and show an awareness rate of 7% for US adults (5% for men and 9% for women), a statistically significant decrease from 2005 and 2010 studies. Predictors of awareness include gender and education level. …

Improving Standards Of Care In Obstructed Labour: A Criteria-Based Audit At A Referral Hospital In A Low-Resource Setting In Tanzania, Andrew H. Mgaya, Hussein Kidanto, Lennarth Nystrom, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting.

Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases …

Breech Delivery At A University Hospital In Tanzania, Ulf Högberg, Catrin Claeson, Lone Krebs, Agneta Skoog Svanberg, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.

Methods The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999–2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein Kidanto, Lennarth Nyström, Birgitta Essén

Faculty of Health Sciences, East Africa

Background In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Obstetric Patients In Intensive Care Unit: Perspective From A Teaching Hospital In Pakistan, Rahat Qureshi, Sheikh Irfan Ahmed, Amir Raza, Ayesha Khurshid, Uzma Chishti

Department of Obstetrics & Gynaecology

Objective: Review of obstetric cases admitted to the intensive care unit.
Design: Ten year retrospective review of individual patients' medical records.
Participants: Records of obstetric patients admitted from 2005-2014.
Setting: Aga Khan University Hospital Karachi.
Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay …

Addressing The Intersection Between Alcohol Consumption And Antiretroviral Treatment: Needs Assessment And Design Of Interventions For Primary Healthcare Workers, The Western Cape, South Africa, M. Schneider, M. Chersich, Marleen Temmerman, C. D. Parry

Obstetrics and Gynaecology, East Africa

Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Journal of Health Disparities Research and Practice

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Syrian Refugee Women In Jordan: Family Planning Preferences And Barriers In A Host Community, Hilary Smith

Independent Study Project (ISP) Collection

The aims of this pilot study were to research and analyze the availability of birth control and family planning resources among Syrian refugee women at a reproductive age. This study took place in the host community of Karak, Jordan. Syrian women are a vulnerable population based solely on their gender. But being refugee women makes them more vulnerable and sometimes, their needs do not get met. This study is important because it will look into reproductive health aspects for this vulnerable population to ensure that there is satisfaction among women about their own health. This cross-sectional study sought to answer …

Secondary Postpartum Hemorrhage Due To Spontaneous Uterine Artery Rupture After Normal Vaginal Delivery Managed By Selective Arterial Embolization, Mili Thakur, Henry O. Adekola, Radwan Asaad, Bernard Gonik

Department of Obstetrics and Gynecology Research Publications

Secondary postpartum hemorrhage due to an intraperitoneal bleed following a vaginal delivery is extremely rare. We present a case of spontaneous rupture of the uterine artery following a normal vaginal delivery with a delayed presentation, which resulted in significant morbidity. This case discusses the presentation and management of this rare obstetrical emergency. The report also discusses the role of selective arterial embolization in management of secondary postpartum hemorrhage.

Comparison Of The Prevalence And Characteristics Of Inpatient Adverse Events Using Medical Records Review And Incident Reporting, William Macharia, Charles Muteshi, Sikolia Wanyonyi, Abraham Mukaindo, Ahmed Ismail, Herman Ekea, Abdallah Abdulkarim, John Tole, Anthony Ngugi

Paediatrics and Child Health, East Africa

No abstract provided.

Lessons Learnt From The Cerca Project, A Multicomponent Intervention To Promote Adolescent Sexual And Reproductive Health In Three Latin America Countries: A Qualitative Post-Hoc Evaluation., Olena Ivanova, Kathya Cordova Pozo, Zoyla Esmeralda Segura, Bernardo Vega, Venkatraman Chandra-Mouli, Michelle J. Hindin, Marleen Temmerman, Peter Decat, Sara De Meyer, Kristien Michielsen

Obstetrics and Gynaecology, East Africa

The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011–2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA’s design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis.

Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong …

The Road Into The Future Of Health Care: The Importance Of Addressing Access To Health Facilities In Transportation Infrastructure Investment Decisions, Nicola (Nikki) Van Den Heever

Independent Study Project (ISP) Collection

Background: One school of thought argues that transportation infrastructure is not an ultimate end goal of development and therefore shouldn’t be addressed within development funding decisions while the other argues that transportation infrastructure is the crucial foundation from which all development efforts are based and therefore needs to be addressed within development funding decisions. Within this framework, there is a lack of academic and other research addressing how physical access to health care for pregnant women can better be addressed when making decisions regarding funding of transportation infrastructure projects.

Purpose: To demonstrate the importance of considering access to health care …

A Preliminary Study Of Intergenerational Differences In Masxha Regarding Practice And Attitudes Towards Zulu Traditions During Pregnancy And Birth, Momoko Oyama

Independent Study Project (ISP) Collection

In the Zulu culture, several traditions and rituals are practiced during a woman’s pregnancy and perinatal period. However, as urbanization spreads and western influences strengthen, these rituals risk being lost. This project aims to capture existing knowledge of these traditions and to assess the intergenerational changes in practice and attitudes towards practicing the rituals.

Information on Zulu traditions practiced during a woman’s pregnancy and perinatal period was collected through two interviews and a focus group consisting of three elderly women in Masxha, a Black township in KwaZulu-Natal. Following the interviews and focus group, 32 Masxha residents were recruited to complete …

Access Is Not Enough: Family Planning In Dar Es Salaam, Claire Burrus

Independent Study Project (ISP) Collection

Population growth is a large problem, both globally and at local levels. The global population is growing at an unsustainable rate, particularly in developing nations. Tanzania, as a developing nation, is one of the fastest growing countries in the world, and as a result, faces many hardships related to high population. The Tanzanian government, non-governmental organizations, and private institutions have made attempts to address these concerns by encouraging family planning. Even so, the national population continues to rise. Many social and cultural factors have contributed to this phenomenon. This study was performed in the Women’s Clinic at Sanitas Hospital in …

Comparative Effects Of Ballooning Intracervical Catheter And Prostaglandin Pessary On Cervical Ripening, Raheela Baloch, Qamarunissa Muhabat, Fakhrunissa Waheed, Waqarunissa Ahmed

Department of Obstetrics & Gynaecology

Labor is induced to stimulate the uterine contraction in effort to have vaginal birth. Induction may be advocated to reduce fetal or neonatal morbidity and mortality. Indication of labor needs to be considered when risk and benefits analysis indicates that delivering the baby is safe option for mother or both rather than continuing the pregnancy and when there are no clear indications for caesarean section and no contraindication for vaginal delivery.

Comparing Effectiveness Of Active And Passive Client Follow-Up Approaches In Sustaining The Continued Use Of Long Acting Reversible Contraceptives (Larc) In Rural Punjab: A Multicentre, Non-Inferiority Trial, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghazunfer Abbas, Erik Munroe, Rebecca Harrison, Wajahat Hussain Shamsi, Ghulam Mustafa, Omar Farooq Khan

Community Health Sciences

Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November …

Community Health Worker Knowledge And Management Of Pre-Eclampsia In Rural Karnataka State, India., Umesh Ramadurg, Marianne Vidler, Umesh Charanthimath, Geetanjali Katageri, Mrutyunjaya Bellad, Ashalata Mallapur, Shivaprasad Goudar, Shashidhar Bannale, Chandrashekhar Karadiguddi, Diane Sawchuck, Rahat Qureshi, Peter Von Dadelszen, Richard Derman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: In India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess. However, there is limited research regarding their ability to manage pregnancy complications. This study aims to describe the current state of …