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  • A comprehensive reproductive health program for vulnerable adolescent girls
    Reprod. Health (IF 2.295) Pub Date : 2020-01-23
    Razieh Pourkazemi; Mojgan Janighorban; Zahra Boroumandfar; Firoozeh Mostafavi

    Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls’ reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

    更新日期:2020-01-23
  • Supporting women of childbearing age in the prevention and treatment of overweight and obesity: a scoping review of randomized control trials of behavioral interventions
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-23
    Melinda J. Hutchesson; Mette de Jonge Mulock Houwer; Hannah M. Brown; Siew Lim; Lisa J. Moran; Lisa Vincze; Megan E. Rollo; Jenna L. Hollis

    Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to prevent and treat overweight and obesity. Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15–44 years), evaluated interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention, weight loss or maintenance and reported weight-related outcomes. Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n = 46 RCTs, n = 2 systematic reviews), preventing postpartum weight retention (n = 18 RCTs) or a combination of the two (n = 14 RCTs, n = 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet and physical activity behaviors (n = 84) and were delivered in-person (n = 85). This scoping review identified an increasing volume of research over time undertaken to support women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research is being undertaken to support the young adult female population unrelated to pregnancy or preconception.

    更新日期:2020-01-23
  • Breastfeeding practices 2008–2009 among Chinese mothers living in Ireland: a mixed methods study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-23
    Qianling Zhou; Katherine M. Younger; Tanya M. Cassidy; Wenyi Wang; John M. Kearney

    Migration to another country has a potential influence on breastfeeding practices. A significant difference in breastfeeding rates between Irish nationals and non-nationals has been reported. This study was conducted to explore breastfeeding practices of the Chinese in Ireland, one of the largest Irish ethnic groups, and to explore the influence of living in Ireland on breastfeeding practices. This is the first and the only migration study so far on breastfeeding practices among the Chinese in Ireland. A sequential explanatory mixed methods approach was adopted. The first phase was a cross-sectional self-administered retrospective mailed survey, to explore breastfeeding practices and determinants of breastfeeding among a convenience sample of Chinese mothers living in Ireland (n = 322). Recruitment was conducted in the Dublin metropolitan area, with the application of the snowball technique to increase sample size. The second phase consisted of seven semi-structured focus groups (n = 33) conducted in Dublin, to explore the influence of living in Ireland on breastfeeding among Chinese mothers who had given birth in Ireland. Quantitative data were analyzed by univariate and multivariate logistic regression analyses, and informed the qualitative data collection. Qualitative data were analyzed by thematic content analyses, to explain and enrich the qualitative results. The breastfeeding initiation rate among Chinese immigrants to Ireland who gave birth in Ireland (CMI) (75.6%) was high and close to that of Chinese immigrant mothers who gave birth in China (CMC) (87.2%). However, giving birth in Ireland was independently associated with a shorter duration of breastfeeding (< 4 months) among Chinese immigrants. Qualitative results explained that a shorter breastfeeding duration among CMI than that of CMC was mainly due to cultural conflicts, a lack of family support, language barriers, immigrants’ low socioeconomic status, and mothers’ preference for infant formula on the Irish market. Both quantitative and qualitative data revealed a strong cultural belief in the efficacy of the traditional Chinese postpartum diet for breast milk production for both CMC and CMI. Antenatal feeding intention was a strong determinant for breastfeeding initiation and duration among CMI. Migration to Ireland was found to be associated with a shorter duration of breastfeeding of the Chinese. Culturally sensitive and language-specific education and support of breastfeeding is needed for the Chinese mothers living in Ireland. The mixed methods design presented here might serve as a template for future migration research on breastfeeding.

    更新日期:2020-01-23
  • Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-23
    Sunday Azagba; Lauren Manzione; Lingpeng Shan; Jessica King

    Maternal smoking during pregnancy remains a public health concern in the United States (US). We examined whether the prevalence of smoking during pregnancy decreased between 2010 and 2017 and how trends differed by demographic subgroups. We used 2010–2017 data from the National Center for Health Statistics. Rao-Scott Chi-Square tests were performed to compare characteristics between smoking and nonsmoking groups. Cochran–Armitage tests and logistic regression were used to assess overall changes in the prevalence of smoking during pregnancy over time and changes for age, race, and educational attainment subgroups. The prevalence of smoking during pregnancy decreased from 9.2% in 2010 to 6.9% in 2017. In 2017, the prevalence was highest among women aged 20–24 (9.9%), American Indian/Alaskan Natives (15%), and those with a high school diploma or General Educational Development (GED) (12.2%). The prevalence was lowest among women younger than 15 (1.7%), Asian/Pacific Islanders (1%), and those who had a master’s degree and higher (0.3%). Prevalence did not decrease significantly over time in the 35–39 age group (4.5 to 4.4%; p = 0.08), and increased dramatically for women with less than a high school diploma from 10.2 to 11.8%; p < 0.0001. Smoking prevalence during pregnancy in the US is declining, but is highest among younger women (20–24), American Indian/Alaska Natives, and women with a high school diploma or GED. In addition, the prevalence has increased for women with the least education. Targeted research and tobacco control interventions could help address the specific needs of these high-risk subpopulations.

    更新日期:2020-01-23
  • A mental health program for infertile couples undergoing oocyte donation: protocol for a mixed methods study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-22
    Shohre Ghelich-Khani; Ashraf Kazemi; Malek Fereidooni-Moghadam; Mousa Alavi

    The psychological consequences of infertility in couples undergoing oocyte donation differ culturally, racially, religiously, and legally from other infertile couples undergoing assisted reproductive treatments. Therefore, the inclusion of a mental health program in assisted reproductive services is essential for these couples. As such, the aim of this study is to develop a program for improving the mental health of these couples. This study is designed using an exploratory mixed method and the program based on Talbot and Verrinder model. Different steps of this research include determination of a specific topic for planning (needs assessment), initial design of the program, finalization of the program (using the views of experts in this area), implementation of the program, monitoring of the implementation of the program and evaluation of the program. To perform the first step of Talbot’s program, the first phase of the study will be conducted. At first, through a qualitative study, the items of the questionnaire are designed and then its psychometric steps will be performed by a cross-sectional study. In the second and third steps, the classic Delphi technique will be used in four-round for initiation and finalization of the program, and the second phase will be completed. The fourth, fifth and sixth steps of the program including implementation, monitoring of the implementation and evaluation of the program in the future will be performed. Designing an appropriate program based on the documentations of the qualitative study and evidence can improve the mental health and quality of life of the couples undergoing oocyte donation. The program, based on the measurement of needs, will be implemented using a tool designed specifically for the target population and can be useful in the processes of treatment, education, policymaking and legislation as well as research.

    更新日期:2020-01-23
  • Non-communicable diseases and reproductive health in sub-Saharan Africa: bridging the policy-implementation gaps
    Reprod. Health (IF 2.295) Pub Date : 2020-01-23
    Sanni Yaya; K. Srikanth Reddy; José M. Belizán; Verónica Pingray

    Sub-Saharan Africa (SSA) region is a home for over one billion population distributed in 46 different countries. Over the decades, this region has confronted with high disease burden accounting around 24% of the global disease burden [1]. Traditionally, communicable diseases such as HIV, TB, and Malaria have long been the most prominent contributors to the disease burden. However, in the last two decades, the region has witnessed an epidemiological transition to non-communicable diseases (NCDs) [2]. Around 80% of all NCDs deaths occur in low and middle-income countries. It is projected that by 2020, NCDs will account for 27% of mortality in SSA [3]. Majority of NCDs related deaths can be prevented by addressing the common modifiable risk factors for NCDs include tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diet [4]. The NCDs and reproductive health morbidity and mortality, has become a significant part of the disease burden in the region requiring a rethink on policy prioritisation and implementation to minimise the burden. The WHO defines reproductive health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes.” This implies that people are able to have a satisfying and safe sex life and that they can reproduce and the freedom to decide if, when, and how often to do so [5]. However, reproductive health among women was often constrained by socio-cultural and economic factors across the societies, particularly in SSA. The access to abortion and contraception are severely restricted, contributing to high maternal mortalities and poor sexual and reproductive health outcomes [6,7,8,9]. Reproductive and maternal morbidities increase the risk of maternal mortality, stillbirth, neonatal death. Women facing pregnancy related complications are predisposed to immediate and long-term disabilities and infertility as well as adverse psychological and socio-economic consequences. SSA region faces high burden of maternal mortality, stillbirth and neonatal mortality rates [10]. In 2015, two-thirds of all maternal deaths worldwide occurred in SSA (546 maternal deaths per 100,000 live births [11]. SSA women in reproductive age (15–49 years) have low contraceptive prevalence rate (28%), and about half of them do not receive four or more antenatal check-ups (54%), and do not give birth in health facilities (52%). Further, adolescent girls and young women in the region face high risk of unintended pregnancies, sexually transmitted infections, HIV, and exposure to violence [12]. Further, 244,000 infants in the region annually become infected with HIV during pregnancy and delivery (115,000) or breast-feeding (129,000) [13]. The unmet needs of sexual and reproductive health services among SSA women are coupled with the rising burden of non-communicable diseases. NCDs account for almost 65% of women’s deaths globally, and the majority of these deaths occur in LMICs and are premature. In recent years, NCDs among women of reproductive age has doubled in many African countries [14]. Also, there are established linkages between NCDs and reproductive health. Several NCDs risk factors adversely affect the reproductive health of women. For example, obesity, CVDs, hypertension, hyperglycemia, and gestational diabetes predispose pregnant women at higher risk of menstrual problems, hypertension in pregnancy, caesarean sections, post-natal complications and maternal mortality [10]. Obesity also increases the odds of developing CVDs and cancers in women [15, 16]. In a recent study, the prevalence of obesity across 32 Sub-Saharan African countries ranged from 1.1% in Madagascar to 23.0% in Swaziland [17]. A study shows that that women at the beginning of pregnancy 73.7% and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) [18]. Epidemiological, clinical and animal studies have shown the modelling effect of fetal life on NCDs diseases of adult life, like hypertension, coronary heart disease and diabetes [19]. Furthermore, nutrients restriction during fetal life have shown higher blood pressure in the progeny. Animal studies have shown that protein restriction and calcium restriction during pregnancy involved hypertension of the progeny [20]. In humans, calcium supplementation during pregnancy involved a reduction of hypertension of children whose mothers were supplemented in comparison with a placebo group [21]. In a previous mentioned study done in South Africa and Zimbabwe the prevalence of inadequate micronutrient intake from food sources was high in both countries. For the most basic micronutrients like iron, calcium, folate and zinc, the percentage of women below requirements was above 90% in both countries [18]. Further, research suggests that obesity is linked to polycystic ovary syndrome (PCOS) in women. Moreover, obese women with PCOS have worse metabolic and reproductive outcomes [22]. The hypertensive disorders of pregnancy is one of the major cause of maternal deaths and stillbirths in the region [10]. African Union (AU) is at the forefront of shaping the national health priorities including women and child health. The AU, despite being the first to develop African Charter of Human and People’s Rights on the Rights of Women in Africa that mandates state provision of comprehensive reproductive and sexual health services, is yet to be a reality and achieve the objective [23]. Building on Millennium Development Goal’s (MDGs) progress on reducing maternal and child mortality and malnutrition, combating infectious diseases, an updated Global Strategy for Women’s and Children’s Health (2016–2030) was launched in 2016 [24, 25]. This universal and equity-based strategy aims to end preventable deaths among women by reducing global maternal mortality to less than 70 per 100,000 live births and reduce by one-third premature mortality from NCDs and promote mental health and well-being. The reproductive health policies must be in alignment with this global strategy to minimize the mortalities due to NCDs risk factors linked to reproductive health. And also, to optimize better sexual and reproductive health in the SSA. At the individual level, prevention and continuum of care approach through “life-course” are essential for the prevention of NCDs. While most NCD related health outcomes cause morbidity and mortality during adulthood, exposure to risk factors begins early in life, and these behaviours often get established for the lifetime. WHO recommends that NCD prevention and control measures to consider health and social needs and reduce exposure to risk factors at all stages of the life course. Similarly, improving reproductive health outcomes calls for a comprehensive understanding of women’s health throughout the life course. The global strategy for women’s health adopts an integrated life course approach and underscores the need for investment in child and adolescent health and development [24]. At the systemic level, a comprehensive approach requires multipronged strategies focussing on prevention within primary care through community-based programs, health promotion, and cost-effective policies that target the whole population as well as high-risk individuals. Both NCDs and reproductive health thus needs to be addressed through both “population-based” and “high-risk individual” based approaches to empower individuals and populations to make healthier choices and access to health services. The global strategy recommends integrating NCDs prevention and treatment with women’s, children’s, and adolescents’ health care [24, 25]. The population-level approaches include increasing awareness, creating a conducive environment and instituting public health policies while high-risk individual-level approaches include early diagnosis and management and treatment of disease and need to integrate into the health systems in SSA. At the policy level, various bodies have emphasised the need for a collective response towards addressing health issues as it cuts across the sectors. The WHO has emphasized that effective NCD prevention and control require “health-in-all policies and whole-of-government approaches” across sectors, involving a range of ministries outside health such as health, agriculture, communication, education, employment, social welfare, social and economic development, sports, trade and industry transport, urban planning and others. Similarly, Global Strategy for Women’s and Children’s Health also emphasise the adoption of a multi-sectoral approach to develop and monitor interventions outside the health sector and asserts the countries to build governance mechanisms and capacity to facilitate multisector actor and cross-sector collaborations [25]. Most risk behaviours for NCDs and reproductive health are modifiable, and the related morbidity and mortality is preventable. Yet, the progress is largely determined by socioeconomic, demographic, political factors. Strengthening national policies, health systems, country-level surveillance, and monitoring systems, and creating sustainable partnerships and advocacy are key strategies towards addressing these health issues. However, implementation gaps remain contributing not only NCDs mortality, but also reproductive health. Identification of common risk factors and linkages among the NCDs and reproductive, would help intersectoral action and integration of health care services for the prevention of mortalities in respective sub-Saharan African counties. Such an effort, while contributing to better health outcome in region, also help accelerating the Sustainable Development Goals and targets, particularly SDG 3.4, 3.6, 3.7 and SDG11.2. Therefore, the journal encourages global public health scholars, particularly from sub-Saharan African countries to reflect upon these considerations and submission of manuscripts. 1. International Finance Corporation. World Bank Group. Health and Education. 2019; Available at: https://www.ifc.org/wps/wcm/connect/REGION__EXT_Content/IFC_External_Corporate_Site/Sub-Saharan+Africa/Priorities/Health+and+Education/. Accessed 30 Dec 2019. 2. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017. Lancet Glob Health. 2019;7(10):e1375–87. Article Google Scholar 3. Juma PA, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Mapa-Tassou C, Oluwasanu M, et al. Non-communicable disease prevention policy process in five African countries. BMC Public Health. 2018;18(Suppl 1):961-018-5825-7. Google Scholar 4. World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Google Scholar 5. World Health Organization. Health topics: Reproductive health. 2019; Available at: http://origin.who.int/topics/reproductive_health/en/. Accessed 30 Dec 2019. Google Scholar 6. Hall KS, Manu A, Morhe E, Dalton VK, Challa S, Loll D, et al. Bad girl and unmet family planning need among sub-Saharan African adolescents: the role of sexual and reproductive health stigma. Qual Res Med Healthc. 2018;2(1):55–64. Article Google Scholar 7. Alemayehu B, Addissie A, Ayele W, Tiroro S, Woldeyohannes D. Magnitude and associated factors of repeat induced abortion among reproductive age group women who seeks abortion Care Services at Marie Stopes International Ethiopia Clinics in Addis Ababa, Ethiopia. Reprod Health. 2019;16(1):76-019-0743-4. Article Google Scholar 8. Harries J, Orner P, Gabriel M, Mitchell E. Delays in seeking an abortion until the second trimester: a qualitative study in South Africa. Reprod Health. 2007;4:7–4755-4-7. Article Google Scholar 9. Vallely LM, Homiehombo P, Kelly-Hanku A, Whittaker A. Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea--a descriptive study of women's and health care workers' experiences. Reprod Health. 2015;12:22–015-0015-x. Article Google Scholar 10. Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297–308. Article Google Scholar 11. World Health Organization. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. ISBN 978 92 4 156514 1. 2015. Google Scholar 12. Naidoo K, Adeagbo O, Pleaner M. Sexual and reproductive health needs of adolescent girls and young women in sub-saharan africa: research, policy, and practice. SAGE Open. 2019;9(3):1-3. Article Google Scholar 13. Singh S, Darroch J, Vlassoff M, Nadeau J. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. New York: The Alan Guttmacher Institute and the United Nations Population Fund; 2004. p. 30. 14. Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Socioeconomic inequalities in the risk factors of noncommunicable diseases among women of reproductive age in sub-saharan Africa: a multi-country analysis of survey data. Front Public Health. 2018;6:307. Article Google Scholar 15. Kapur A. Links between maternal health and NCDs. Best Pract Res Clin Obstet Gynaecol. 2015;29(1):32–42. Article Google Scholar 16. Nkoka O, Ntenda PAM, Senghore T, Bass P. Maternal overweight and obesity and the risk of caesarean birth in Malawi. Reprod Health. 2019;16(1):40-019-0700-2. Article Google Scholar 17. Yaya S, Ekholuenetale M, Bishwajit G. Differentials in prevalence and correlates of metabolic risk factors of non-communicable diseases among women in sub-Saharan Africa: evidence from 33 countries. BMC Public Health. 2018;18(1):1168-018-6085-2. Article Google Scholar 18. Cormick G, Betran AP, Harbron J, Dannemann Purnat T, Parker C, Hall D, et al. Are women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe? BMC Pregnancy Childbirth. 2018;18(1):236–018-1885-z. Article Google Scholar 19. Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989;2(8663):577–80. CAS Article Google Scholar 20. Langley-Evans SC, Phillips GJ, Jackson AA. In utero exposure to maternal low protein diets induces hypertension in weanling rats, independently of maternal blood pressure changes. Clin Nutr. 1994;13(5):319–24. CAS Article Google Scholar 21. Belizan JM, Villar J, Bergel E, del Pino A, Di Fulvio S, Galliano SV, et al. Long-term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trial. BMJ. 1997;315(7103):281–5. CAS Article Google Scholar 22. Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev. 2013;14(2):95–109. CAS Article Google Scholar 23. Ngwena CG. Protocol to the African charter on the rights of women: implications for access to abortion at the regional level. Int J Gynaecol Obstet. 2010;110(2):163–6. Article Google Scholar 24. Kuruvilla S, Bustreo F, Kuo T, Mishra CK, Taylor K, Fogstad H, et al. The global strategy for women's, children's and adolescents' health (2016-2030): a roadmap based on evidence and country experience. Bull World Health Organ. 2016;94(5):398–400. Article Google Scholar 25. High-Level Working Group on the Health and Human Rights of Women, Children and Adolescents. World Health Organization. Leading the realization of human rights to health and through health. Report of the High-Level Working Group on the Health and Human Rights of Women, Children and Adolescents. Geneva: World Health Organization; 2017. Google Scholar Download references Affiliations School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada Sanni Yaya The George Institute for Global Health, The University of Oxford, Oxford, UK Sanni Yaya Bruyere Research Institute, University of Ottawa, Ottawa, Canada K. Srikanth Reddy Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica PingrayAuthors Search for Sanni Yaya in: PubMed • Google Scholar Search for K. Srikanth Reddy in: PubMed • Google Scholar Search for José M. Belizán in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions SY and KSR conceptualized and wrote the initial draft. JB and VP provided comments and edits. All authors commented on the first draft and signed off on the final version. Corresponding author Correspondence to Sanni Yaya. Competing interests Sanni Yaya and José M. Belizán are Editors-in-Chief of Reproductive Health. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Yaya, S., Reddy, K.S., Belizán, J.M. et al. Non-communicable diseases and reproductive health in sub-Saharan Africa: bridging the policy-implementation gaps. Reprod Health 17, 8 (2020). https://doi.org/10.1186/s12978-020-0857-8 Download citation Published: 23 January 2020 DOI: https://doi.org/10.1186/s12978-020-0857-8

    更新日期:2020-01-23
  • Pattern and correlates of out-of-pocket payment (OOP) on female sterilization in India, 1990–2014
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-22
    Sanjay K. Mohanty; Suyash Mishra; Sayantani Chatterjee; Niranjan Saggurti

    Large scale public investment in family welfare programme has made female sterilization a free service in public health centers in India. Besides, it also provides financial compensation to acceptors. Despite these interventions, the use of contraception from private health centers has increased over time, across states and socio-economic groups in India. Though many studies have examined trends, patterns, and determinants of female sterilization services, studies on out-of-pocket payment (OOP) and compensations on sterilisation are limited in India. This paper examines the trends and variations in out-of-pocket payment (OOP) and compensations associated with female sterilization in India. Data from the National Family Health Survey - 4, 2015–16 was used for the analyses. A composite variable based on compensation received and amount paid by users was computed and categorized into four distinct groups. Multivariate analyses were used to understand the significant predictors of OOP of female sterilization. Public health centers continued to be the major providers of female sterilization services; nearly 77.8% had availed themselves of free sterilization and 61.6% had received compensation for female sterilization. About two-fifths of the women in the economically well-off state like Kerala and one-third of the women in a poor state like Bihar had paid but did not receive any compensation for female sterilization. The OOP on female sterilization varies from 70 to 79% across India. The OOP on female sterilization was significantly higher among the educated and women belonging to the higher wealth quintile linking OOP to ability to pay for better quality of care. Public sector investment in family planning is required to provide free or subsidized provision of family welfare services, especially to women from a poor household. Improving the quality of female sterilization services in public health centers and rationalizing the compensation may extend the reach of family planning services in India.

    更新日期:2020-01-23
  • Neonatal, infant, and child mortality among women exposed to intimate partner violence in East Africa: a multi-country analysis
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-23
    Peter Memiah; Tristi Bond; Yvonne Opanga; Caroline Kingori; Courtney Cook; Michelle Mwangi; Nyawira Gitahi-Kamau; Deus Mubangizi; Kevin Owuor

    Most neonatal, infant, and child deaths occur in low- and middle-income countries (LMICs), where incidence of intimate partner violence (IPV) is highest in the world. Despite these facts, research regarding whether the two are associated is limited. The main objective was to examine associations between IPV amongst East African women and risk of death among their neonates, infants, and children, as well as related variables. Analysis was conducted on data drawn from the Demographic and Health Surveys (DHS) conducted by ICF Macro/MEASURE DHS in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. The analytical sample included 11,512 women of reproductive age (15–49 years). The outcome variables, described by proportions and frequencies, were the presence or absence of neonatal, infant, and under-five mortality. Our variable of interest, intimate partner violence, was a composite variable of physical, sexual, and emotional abuse; chi-square tests were used to analyze its relationship with categorical variables. Adjusted odds ratios (aOR) were also used in linking sexual autonomy to independent variables. Children born to women who experienced IPV were significantly more likely to die as newborns (aOR = 1.3, 95% confidence interval [CI]: 1.4–2.2) and infants (aOR = 1.9, 95% CI: 1.6–2.2), and they were more likely to die by the age of five (aOR = 1.5, 95% CI: 1.01–1.55). Socioeconomic indicators including area of residence, wealth index, age of mother/husband, religion, level of education, employment status, and mass media usage were also significantly associated with IPV. After regression modelling, mothers who were currently using contraceptives were determined less likely to have their children die as newborns (aOR = 0.5, 95% CI: 0.3–0-7), as infants (aOR = 0.5, 95% CI: 0.3–06), and by age five (aOR = 0.4, 95% CI: 02–0.6). Understanding IPV as a risk indicator for neonatal, infant, and child deaths can help in determining appropriate interventions. IPV against women should be considered an urgent priority within programs and policies aimed at maximizing survival of infants and children in East Africa and the wellbeing and safety of their mothers.

    更新日期:2020-01-23
  • Retraction Note: Factors associated with induced abortion in Nepal: data from a nationally representative population-based cross-sectional survey
    Reprod. Health (IF 2.295) Pub Date : 2020-01-21
    Suresh Mehata; Jamie Menzel; Navaraj Bhattarai; Sharad Kumar Sharma; Mukta Shah; Erin Pearson; Kathryn Andersen

    The authors have retracted this article [1] because it contains significant conceptual and textual overlap with unpublished work from another group. Suresh Mehata, Jamie Menzel, Erin Pearson and Kathryn Andersen agree with this retraction. Navaraj Bhattarai, Sharad Kumar Sharma and Mukta Shah did not respond to correspondence regarding this retraction.

    更新日期:2020-01-22
  • Every woman in the world must have respectful care during childbirth: a reflection
    Reprod. Health (IF 2.295) Pub Date : 2020-01-22
    José M. Belizán; Suellen Miller; Caitlin Williams; Verónica Pingray

    Every woman has the right to the highest attainable standard of health, which includes the right to respectful maternity care [1]. We—as pregnant and birthing individuals and the care providers, public health professionals, and researchers serving them—know instinctually what constitutes dignified treatment. Yet the systems and structures within which we birth and work are not designed to ensure respectful, evidence-based care. To help the reader see this more clearly, we invite you to do a thought experiment. Imagine you are a woman in labour. You come to a facility in order to receive quality obstetric care. What type of treatment would you expect? Timely attention? Clear and detailed information from a caring health provider about what to expect and why? Recognition of your role as an active decision-maker and protagonist in your own birthing experience, with the choice to consent to or refuse any procedures once you understand them and their implications? Perhaps having a chosen companion with you at all times or deciding on birth position(s) based on your own comfort? Or maybe having the privacy to experience your newborn’s first hours without sharing a bed with a stranger? What other expectations would you have? Viewed in this way, conceptualizing dignified treatment is simple. Yet such timely, respectful and consensual obstetric care is not the norm in many healthcare settings across the globe. There is a wide-spread belief that ensuring safe birth requires placing the needs and priorities of health providers over those of birthing women. This sets up and perpetuates a power imbalance, privileging providers and contributing to obstetric violence. The power imbalance between women and providers is echoed and exacerbated by similar power dynamics between providers (across cadre and seniority) that can produce counterproductive and even toxic interactions between members of the care team, undermining quality of care and contributing to provider burnout [2]. It is critical that we all reflect individually on these issues, because we—collectively as society—create the written and unwritten rules and norms that govern institutions (be they health facilities; schools of medicine, midwifery, and nursing; or safe motherhood initiatives); therefore, we can also be the driving force to change them. Clear your mind of the idea that the power dynamics in the institutions under which we live are natural. They are not; and making such a dangerous mistake misleads us into believing that we are exempt from acting. In the Millennium Development Goal-era push to reduce maternal and newborn mortality and morbidity, strong recommendations and actions were taken to reduce home births and encourage women to instead give birth in health facilities. Unfortunately, there was a large missing element. While we have seen rates of facility delivery increase dramatically, we have not seen a concomitant improvement in women’s experience of childbirth. The shift from birthing at home to birthing in facilities helped increase access to life-saving care for complications, but also introduced new challenges, including overcrowding of facilities, an excess of procedures, and over-medicalization of birth. In fact, we now know that facility birth does not on its own lead to improved outcomes; these rely on quality, respectful, evidence-based care [3]. The foundations for the contemporary focus on respectful care were laid in Latin America in the 1970s and 1980s. The publication (in Spanish) of Physiological and Psychological Bases for the Humanized Management of Natural Birth by Roberto Caldeyro-Barcia in the Latin American Centre for Perinatology, along with the jointly-led WHO and PAHO 1985 Fortaleza Declaration foregrounded the importance of dignified treatment [4, 5]. Subsequent work focused this new global attention on centring maternal satisfaction with the birthing process, uplifting positive traditional and indigenous practices, and identifying the health system conditions that contribute to mistreatment [6,7,8]. Within the last decade, respectful care in childbirth has garnered renewed attention, this time among a broader range of global health actors. For example, in Latin America, advocates pushed for legal frameworks addressing the issue [9]. The articles published in the Respectful Care series of this Journal reflect this, documenting the lack of dignified treatment in many countries: Tunisia, Nigeria, Guinea, Brazil, Tanzania, Ethiopia, India, South Africa, the United States, and among Romani women in Europe [10,11,12,13,14,15,16,17,18,19]. Yet today we find ourselves at an inflection point: it is time for us to move from merely documenting the problem towards engaging women, their families, and communities in jointly designing and testing effective, meaningful interventions. It is imperative that we provide the most respectful, humane, careful, friendly, effective, evidence-based childbirth care in our health facilities. At Reproductive Health, we are eager to receive and publish manuscripts to help achieve such care. Contributions from women and their families would be greatly appreciated, such as submissions describing their vision for respectful care and experiences, as well as offering suggestions for increasing respectful care in facilities. We welcome manuscripts from health facility staff from all levels—administration, nursing, midwifery, medicine, program managers, and decision makers—as well as manuscripts from social scientists on interventions to help providers change their attitudes and practices, and to encourage communities to demand their right to respectful care. We also seek articles from human rights activists and policymakers on actions to protect the right to respectful care during childbirth. As is stated in one of the articles published in the Journal’s Respectful Care Series: “The compassion and evidence based medicine agenda in healthcare is interconnected with human rights in healthcare, feeding into the principles of decision making and patient centred care” ( [20], abstract). As disrespect and abuse in childbirth has gained public traction, an interesting global semiotic discussion has arisen on the terminology that best defines it. For this series, we have selected the use of Respectful Care over the negative terms (“disrespect and abuse”, “mistreatment during childbirth”, or “obstetric violence”), in order to focus on the positive aspects of care and caring as a broader concept that encompasses all of what pregnant and childbearing people and their families deserve, and not just the absence of mistreatment [21]. By employing the term respectful care, we intend to set a shared goal for all actors, from lay individuals and health providers to researchers and policymakers. We expect that by joining efforts we can achieve a change in the delivery of dignified obstetric care. The Chilean writer, Isabel Allende, thoroughly narrates in her book De Amor y de Sombra, Digna’s first experience giving birth in a hospital, after having had five home deliveries: “Digna had gone to Los Riscos Hospital, where she felt she had been treated worse than a criminal. When she entered a numbered band was strapped around her wrist, they shaved her private parts, bathed her with cold water and antiseptic, (…) and placed her beside a woman in the same condition on a bed without sheets. After poking around, without her permission, in all her bodily orifices, they made her give birth beneath a bright lamp in full view of anyone who might happen by. She bore it all without a sigh, but when she left that place carrying a baby that was not hers in her arms and with her unmentionable places painted red like a flag, she swore that for the rest of her life she would never again set foot in a hospital.” (Translation by Margaret Sayer Peden) ( [22], p., 20). In order to continue efforts to improve maternal and newborn health, it is our responsibility to ensure that no woman in the world leaves a health facility feeling like Digna. We call on all readers to work together to achieve universal respectful care for every woman, everywhere. 1. The White Ribbon Alliance for Safe Motherhood. Respectful maternity care: The universal rights of childbearing women. White Ribb Alliance Safe Mother [Internet]; 2011. p. 1–6. Available from: http://whiteribbonalliance.org/wp-content/uploads/2013/10/Final_RMC_Charter.pdf Google Scholar 2. Sadler M, Santos MJ, Ruiz-Berdún D, Rojas GL, Skoko E, Gillen P, et al. Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence. Reprod Health Matt. 2016;24(47):47–55. Article Google Scholar 3. Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388:2176–219. Article Google Scholar 4. Caldeyro-Barcia R. Bases fisiológicas y psicológicas Para el manejo humanizado del parto normal [physiological and psychological bases for the humanized management of normal birth]. Centro Latinoamericano de Perinatologia y Desarollo Humano: Montevideo; 1979. Google Scholar 5. World Health Organization. Appropriate technology for birth. Lancet. 1985;326:436–7. Article Google Scholar 6. Misago C, Umenai T, Onuki D, Haneda K, Wagner M. Humanised maternity care. Lancet. 1999;354:1391–2. CAS PubMed Article Google Scholar 7. Belizán J, Villar J, Belizán M, Garrote N. Care of pregnant women in prenatal services in public maternity hospitals of Rosario, Argentina. Bol Of Sanit Panam. 1979;86:121–30. Google Scholar 8. Jewkes R, Abrahams N, Mvo Z. Why do nurses abuse patients? Reflections from south African obstetric services. Soc Sci Med. 1998;47(11):1781–95. CAS PubMed Article Google Scholar 9. Williams CR, Jerez C, Klein K, Correa M, Belizán JM, Cormick G. Obstetric violence: a Latin American legal response to mistreatment during childbirth. BJOG An Int J Obstet Gynaecol. 2018;125:1208–11. CAS Article Google Scholar 10. Amroussia N, Hernandez A, Vives-Cases C, Goicolea I. “Is the doctor God to punish me?!” An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia. Reprod Health. 2017;14(1):32. PubMed PubMed Central Article Google Scholar 11. Bohren MA, Vogel JP, Tunçalp Ö, Fawole B, Titiloye MA, Olutayo AO, et al. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reprod Health. 2017;14(1):239–44. Article Google Scholar 12. Balde MD, Bangoura A, Diallo BA, Sall O, Balde H, Niakate AS, et al. A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea. Reprod Health. 2017;14(1):1045–9. Google Scholar 13. Mesenburg MA, Victora CG, Serruya SJ, De León RP, Damaso AH, Domingues MR, et al. Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort. Reprod Health. 2018;15(1):1–8. Article Google Scholar 14. Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, et al. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016;13(1):79. PubMed PubMed Central Article Google Scholar 15. Sheferaw ED, Bazant E, Gibson H, Fenta HB, Ayalew F, Belay TB, et al. Respectful maternity care in Ethiopian public health facilities. Reprod Health. 2017;14(1):60. PubMed PubMed Central Article Google Scholar 16. Sharma G, Penn-Kekana L, Halder K, Filippi V. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study. Reprod Health. 2019;16(7):1–16. Google Scholar 17. Oosthuizen SJ, Bergh A, Pattinson RC, Grimbeek J. It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa. Reprod Health. 2017;14(151):1–11. Google Scholar 18. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(77). 19. Watson HL, Downe S. Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review. Reprod Health. 2017;14(1):1. PubMed PubMed Central Article Google Scholar 20. Lokugamage AU, Pathberiya SDC. Human rights in childbirth, narratives and restorative justice: a review. Reprod Health. 2017;14(17):1–8. Google Scholar 21. Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Pileggi VN. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG An Int J Obstet Gynaecol. 2018;125:932–42. CAS Article Google Scholar 22. Allende I. De Amor y de Sombra. Editorial Sudamericana; 1984. p. 336. Google Scholar Download references We wish to thank writer Isabel Allende, for her kind provision of the translation of the paragraph of her book. Affiliations Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica Pingray Safe Motherhood Program, University of California, San Francisco, USA Suellen Miller Department of Maternal & Child Health Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA Caitlin WilliamsAuthors Search for José M. Belizán in: PubMed • Google Scholar Search for Suellen Miller in: PubMed • Google Scholar Search for Caitlin Williams in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions All authors read and approved the final manuscript. Corresponding author Correspondence to José M. Belizán. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Belizán, J.M., Miller, S., Williams, C. et al. Every woman in the world must have respectful care during childbirth: a reflection. Reprod Health 17, 7 (2020) doi:10.1186/s12978-020-0855-x Download citation Published: 22 January 2020 DOI: https://doi.org/10.1186/s12978-020-0855-x

    更新日期:2020-01-22
  • A potential new mechanism for pregnancy loss: considering the role of LINE-1 retrotransposons in early spontaneous miscarriage
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-21
    Chao Lou; John L. Goodier; Rong Qiang

    LINE1 retrotransposons are mobile DNA elements that copy and paste themselves into new sites in the genome. To ensure their evolutionary success, heritable new LINE-1 insertions accumulate in cells that can transmit genetic information to the next generation (i.e., germ cells and embryonic stem cells). It is our hypothesis that LINE1 retrotransposons, insertional mutagens that affect expression of genes, may be causal agents of early miscarriage in humans. The cell has evolved various defenses restricting retrotransposition-caused mutation, but these are occasionally relaxed in certain somatic cell types, including those of the early embryo. We predict that reduced suppression of L1s in germ cells or early-stage embryos may lead to excessive genome mutation by retrotransposon insertion, or to the induction of an inflammatory response or apoptosis due to increased expression of L1-derived nucleic acids and proteins, and so disrupt gene function important for embryogenesis. If correct, a novel threat to normal human development is revealed, and reverse transcriptase therapy could be one future strategy for controlling this cause of embryonic damage in patients with recurrent miscarriages.

    更新日期:2020-01-22
  • Vaginal leiomyoma: medical imaging and diagnosis in a resource low tertiary hospital: case report
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-21
    Thomas Obinchemti Egbe; Fidelia Mbi Kobenge; Junette Arlette Mbengono Metogo; Emmanuella Manka’a Wankie; Paul N. Tolefac; Eugene Belley-Priso

    In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon. A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma. Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.

    更新日期:2020-01-22
  • Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-21
    Berlington M. J. Munkhondya; Tiwonge Ethel Munkhondya; Ellen Chirwa; Honghong Wang

    In resource-limited settings, childbirth remains a matter of life and death. High levels of childbirth fear in primigravid women are inevitable. To date, few studies have explored interventions to reduce childbirth fear in primigravid women. This study aimed to evaluate the efficacy of companion-integrated childbirth preparation (C-ICP) during late pregnancy for reducing childbirth fear and improving childbirth self-efficacy, birth companion support, and other selected pregnancy outcomes in primigravid women. A quasi-experimental study was carried out using a non-equivalent control group design to recruit a sample of 70 primigravid women in hospital maternity waiting homes in the intervention and control groups, with 35 in each group. The primigravid women and their birth companions in the intervention group received two sessions of companion-integrated childbirth preparation, whereas the control group received routine care. A questionnaire that incorporated the childbirth attitude questionnaire (CAQ), the childbirth self-efficacy inventory (CBSEI), the birth companion support questionnaire (BCSQ), and a review checklist of selected pregnancy outcomes was used to collect data. Pretest and post-test data were analyzed using simple linear regression. Beta coefficients were adjusted at a 95% confidence interval with statistical significance set at a P-value of < 0.05 using Statistical Package for the Social Sciences version 25. At pretest, mean scores were similar in the intervention and control groups. At post-test, being in the intervention group significantly decreased childbirth fears (β: = − .866, t (68) = − 14.27, p < .001) and significantly increased childbirth self-efficacy (β: = .903, t (68) = 17.30, p < .001). In addition, being in the intervention group significantly increased birth companion support (β: = − 0.781, t (68) = 10.32, p < .001). However, no statistically significant differences regarding pregnancy outcomes were observed between the study groups (Mann–Whiney U test, p > .05). The findings of our study suggest that C-ICP is a promising intervention to reduce childbirth fear while increasing childbirth self-efficacy and maternal support. We recommend the inclusion of C-ICP for primigravid women during late pregnancy in resource-limited settings.

    更新日期:2020-01-22
  • Utilization of Partograph and its associated factors among midwives working in public health institutions, Addis Ababa City Administration,Ethiopia,2017
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-21
    Azeb Abrham Hagos; Eshetu Cherinet Teka; Genet Degu

    Partograph is cost effective and affordable tool designed to provide a continuous pictorial overview and labour progress used to prevent prolonged and obstructed labour. It consists of key information about progress of labour, fetal condition and maternal condition. Its role is to improve outcomes and predict the progress of labour. The aim of this study was to assess utilization of partograph and its predictors among midwives working in public health facilities, Addis Ababa city administration, Ethiopia, 2017. An institution based cross-sectional study design was conducted in Addis Ababa, Ethiopia from 15/10/2017–15/12/2017.Simple random sampling under multistage sampling technique was applied to select a total of 605 midwives working in maternity unit of selected public health facilities. Data were collected using structured self-administered questionnaire. Checklist based direct observations were made to all midwife participants to determine the actual practical use of partograph. Data first entered in to EpiInfo version 3.5.1 and transported to SPSS Version 21.Descriptive statistics such as frequency, percentage, mean, and median were calculated. Biviriate and multivariable logistic regression analysis were applied. Any personal identification of the study participants was not recorded during data collection to ensure confidentiality of information. In this study, the utilization of partograph was 409(69%) out of 594 study participants. Being mentored(AOR = 3.1; 95% CI: 1.7, 5.3),received training (AOR = 2.4; 95% CI:1.5,3.6),being knowledgeable about partograph (AOR = 1.6; 95% CI: 1.1, 2.5), health center workers(AOR = 12.6; 95% CI:5.1,31.6),supportive supervision 4 times per year (AOR = 18.6; 95% CI: 6.6,25),supportive supervision twice per a year (AOR = 4.7; 95% CI: 1.9, 11.3),supportive supervision once per year (AOR =3.8;95% CI:1.7,8.8) were positive predictors of partograph utilization. Two midwives per shift (AOR = 0.101; 95% CI: 0.05, 0.65), and 4 per shift (AOR = 0.105, 95% CI: 0.03, 0.40) were protective predictors of partograph utilization. More than half of the respondents utilized partograph. All public health institutions avail partograph in their laboring room but didn’t utilize it according to WHO recommended standard. Working facility, supportive supervision, mentoring, training on partograph, number of midwives working per shift, and knowledge were factors affecting partograph utilization. Encouraging interventions are recommended to the response of the above significantly associated factors.

    更新日期:2020-01-22
  • The diagnosis and treatment of adrenocortical carcinoma in pregnancy: a case report
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-21
    Yuanli Zhang; Zeng Yuan; Chunping Qiu; Shuyi Li; Shiqian Zhang; Yan Fang

    Pregnancy complicated with adrenocortical carcinoma (ACC) is a sporadic syndrome that is characterized by hypertension, uncontrolled hypokalemia, severe heart failure, premature delivery and other adverse effects. The clinical presentation of adrenocortical carcinoma is vague and nonspecific, it is challenging to identify complications of pregnancy with adrenocortical carcinoma. Here we present a case of adrenocortical carcinoma during pregnancy. We describe how to distinguish secondary hypertension from other conditions and the importance of timely detection and treatment of such patients. A 22-year-old woman 30 weeks pregnant was hospitalized with uncontrolled hypertension and hypokalemia. An ultrasound examination of the right adrenal gland revealed a large mass. She underwent transabdominal adrenalectomy, and histopathology from the sample removed revealed an adrenocortical carcinoma. Five days after surgery, the patient had a premature rupture of the fetal membranes and gave birth to a newborn girl via vaginal delivery at 32 weeks of gestation. The newborn was transferred to the neonatal pediatrics ward, and the woman started receiving chemotherapy. Pregnancy with adrenocortical carcinoma is a rare condition. This case alerts the obstetricians that analysis of hypertension, hypokalemia, the plasma level and circadian rhythm of plasma cortisol provides a strategy to diagnose adrenocortical carcinoma during pregnancy.

    更新日期:2020-01-22
  • Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol
    Reprod. Health (IF 2.295) Pub Date : 2020-01-20
    Khadije Hajizadeh; Maryam Vaezi; Shahla Meedya; Sakineh Mohammad Alizadeh Charandabi; Mojgan Mirghafourvand

    Disrespect and abuse (D&A) can violate human rights, affect women’s decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) assess the status of D&A and respectful maternity care (RMC) during childbirth and their relationships with childbirth experience, socio-demographic and obstetrics characteristics; b) explain women’s perceptions of various RMC aspects and determinants during childbirth; and c) present a guideline for promoting of RMC. A mixed methods sequential explanatory design will be used to conduct this study in 3 phases. The first phase is a quantitative study with a longitudinal descriptive-analytical design to identify any D&A and RMC and their relationships with childbirth experience among 334 women who have given birth in public and private hospitals in Tabriz, Iran. The sample will be selected proportional to each population. The second phase is a qualitative study to explore women’s perceptions of various RMC aspects and their determinants during childbirth. The conventional content analysis approach will be used to analyze the data. The third phase is focused on developing a guideline to improve the quality of maternity care. The literature review, findings of phase one and two, and focus group discussion (FGDs) with staff in the labour ward and using a Delphi technique will be used to complete the final phase. Considering the vulnerability of women during labor and delivery and the effect of D&A on cesarean section rates, a supportive guideline can improve the quality of maternity care and reduce D&A during childbirth, and improve women’s childbirth experiences. IR.TBZMED.REC.1398.202.

    更新日期:2020-01-21
  • A mental health intervention program for the oocyte donors: protocol for a mixed methods study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-20
    Elham Adib Moghaddam; Ashraf Kazemi; Gholamreza Kheirabadi; Seyyed Mehdi Ahmadi

    Oocyte donation is one of the assisted reproductive techniques that can undermine the mental health of the women donor. As such, the aim of this study is to design a mental health promotion program for oocyte donors. This is an exploratory mixed methods study (qualitative-quantitative) that consists of three phases. In the first phase, a qualitative study will be conducted to identify the needs and strategies of the mental health promotion program for the women donors. In this phase, the participants will be selected using purposeful sampling method and the data will be collected through semi-structured interviews. In the second phase, the initial draft of the program is designed and validated in the panel of experts and using the classic Delphi technique and, then, the program is finalized. In the third phase, the designed program will be implemented as a quasi-experimental study in two groups of program recipients (intervention) and control, and the effectiveness of the intervention program will be evaluated. In order to design a documentation-based mental health promotion program for the oocyte donors, their experience during the process of oocyte donation should be evaluated. Doing so, the program will be developed based on the specific circumstances of the target population and their social and cultural context and, hence, will have the highest impact.

    更新日期:2020-01-21
  • Identifying the needs and problems of those left behind, and working with them to address inequities in sexual and reproductive health: a key focus of Reproductive Health for 2020
    Reprod. Health (IF 2.295) Pub Date : 2020-01-21
    José M. Belizán; Suellen Miller; Venkatraman Chandra-Mouli; Verónica Pingray

    One of the key messages of the Sustainable Development Goals is to ensure that no one is left behind in development efforts, and to focus these efforts on those who are most likely to be left behind [1]. We are well aware that there are enormous inequalities and inequities in sexual and reproductive health [2]. The huge differences in the rates of maternal mortality between and within countries, speak to this [3]. What this means is that some individuals, families, groups, communities, and countries are much more likely than others to experience sexual and reproductive health problems, and when they do are less likely to be able to obtain the health and social services they need to overcome these problems and to get back to good health. These inequalities and inequities exist in situations of peace and security, even in high-income countries [4,5,6,7]. However, in situations of conflict and natural disasters, they are greatly exacerbated [8,9,10,11,12,13,14]. The editorial team of the Reproductive Health Journal wants to contribute to efforts to shed light on the sexual and reproductive health needs and problems of the most vulnerable, those most likely to be left behind, and on efforts being made to address inequalities and inequities. Given this, the Journal will prioritize articles that describe efforts addressing such population groups. We are convinced that solutions must come from the most affected populations and from those who work with and for them. That is why we will welcome articles that articulate the needs and problem, hopes and expectations, fears and concerns, by members of these populations themselves, and the solutions that they propose. We also welcome articles from individuals who work directly with these populations. Two other areas will be prioritized in the Reproductive Health journal. One is Adolescent Sexual and Reproductive Health and Rights (ASRHR). Adolescents were largely neglected in the context of the Millennium Development Goals [15]. In the context of the Sustainable Development Goals, they are receiving the attention they deserve [16, 17]. Our journal wants to contribute to sharing and learning between adolescents and with researchers, programmers, policy makers, and funders together, and thereby help ensure that focus is put to the best possible use. The second area is the delivery of interventions in the pre-conception period. In an Editorial published in Reproductive Health introducing a Supplement on Preconception Care we stated: "The preconception window has been recognized as one of the earliest sensitive windows of human development, and interventions that focus on this period have the potential to affect not only pregnancy but long term outcomes as well" [18]. Given that the preconceptual period has been identified as a critically important stage that influences maternal and perinatal health, interventions that are being developed to improve the coverage of preconceptual care, such as family planning, contraception, nutrition, lifestyle factors (e.g. smoking, alcohol, caffeine, weight) vaccinations, reduction of harmful exposures, prevention and treatment of chronic and infectious diseases, and environmental exposures are of interest [18,19,20]. We will continue with the two special sections on Female Genital Mutilation/Cutting and on Respectful Care during Childbirth at Health Facilities, as we believe that these issues reflect great inequality and inequity, with powerful implications for reproductive health. Health providers must have an active role to end female genital mutilation/cutting and achieving a respectful care, by adapting or creating behavioral change strategies including their own evaluation of their behavior and its change [21, 22]. As previously stated, these two sections will prioritize the needs, problems, and the solutions developed and implemented to improve them. In summary, as we move towards the start of the third decade of the twenty-first century, the priority of the Reproductive Health journal is to publish contributions highlighting the plight of those who are worst affected by sexual and reproductive health problems, and showcasing actions taken by those affected and those who work with them to overcome this unacceptable situation of inequality and inequity. 1. United Nations Committee for Development Policy. Leaving no one behind. Report on records of the Economic and Social Council. 2018. Supplement No 13. Available from: https://undocs.org/pdf?symbol=en/E/2018/33 Google Scholar 2. World Health Organization. State of inequality: reproductive, maternal, newborn and child health I. World Health Organization Report. 2015. Available from: https://www.who.int/docs/default-source/gho-documents/health-equity/state-of-inequality/state-of-inequality-reproductive-maternal-new-born-and-child-health.pdf?sfvrsn=f4034289_2 Google Scholar 3. UNFPA, World Health Organization, UNICEF, World Bank Group, the United Nations Population Division. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization Report. 2019. Available from: https://www.unfpa.org/featured-publication/trends-maternal-mortality-2000-2017 ISBN: 978–92–4-151648-8. Google Scholar 4. Shaw D, Guise JM, Shah N, et al. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet. 2016;388:2282–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27642026. https://doi.org/10.1016/S0140-6736(16)31527-6.Epub. Article PubMed Google Scholar 5. Thomson K, Hillier-Brown F, Todd A, et al. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018;18(1):869. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30005611. https://doi.org/10.1186/s12889-018-5677-1. Article PubMed PubMed Central Google Scholar 6. WHO Regional Office for Europe. Women’s health and well-being in Europe: beyond the mortality advantage: World Health Organization; 2016. Report Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/318147/EWHR16_interactive2.pdf?ua=1 ISBN 978 92 890 5191 0 7. Knight M, Nair M, Tuffnell D, Shakespeare J, Kenyon S, Kurinczuk JJ. Saving lives, improving mothers’ care - lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2013–15. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017. Available from: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202017%20-%20Web.pdf Google Scholar 8. Askew I, Khosla R, Daniels U, et al. Sexual and reproductive health and rights in emergencies. Bull World Health Organ. 2016;94:311. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850544/. https://doi.org/10.2471/BLT.16.173567. Article PubMed PubMed Central Google Scholar 9. Davis JR, Wilson S, Brock-Martin A, Glover S, Svendsen E. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;1:30–8. Article Google Scholar 10. Shalash A, Alsalman HM, Hamed A, et al. The range and nature of reproductive health research in the occupied Palestinian territory: a scoping review. Reprod Health. 2019;16:41. Article Google Scholar 11. Sami S, Kerber K, Kenyi S, et al. State of newborn care in South Sudan’s displacement camps: a descriptive study of facility-based deliveries. Reprod Health. 2017;14:161. Article Google Scholar 12. Ivanova O, Rai M, Mlahagwa W, et al. A cross-sectional mixed-methods study of sexual and reproductive health knowledge, experiences and access to services among refugee adolescent girls in the Nakivale refugee settlement, Uganda. Reprod Health. 2019;16:35. Article Google Scholar 13. Roxo U, Mobula ML, Walker D, Ficht A, Yeiser S. Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda. Reprod Health. 2019;16(Suppl 1):57. Article Google Scholar 14. Bartels SA, Michael S, Roupetz S, et al. Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon. BMJ Glob Health. 2018;3:e000509. Available from: https://gh.bmj.com/content/3/1/e000509. https://doi.org/10.1136/bmjgh-2017-000509. Article PubMed PubMed Central Google Scholar 15. United Nations Development Programme. From the MDGs to Sustainable Development for All: Lessons from 15 years of practice. United Nations Development Programme. 2016. Report. Available from: https://www.undp.org/content/dam/undp/library/SDGs/English/From%20the%20MDGs%20to%20SD4All.pdf Google Scholar 16. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. Nations Development Programme. 2015 Main Committee Report A/70/L.1. Available from: https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf Google Scholar 17. Chandra-Mouli V, Plesons M, Barua A, Mohan A, Melles-Brewer M, Engel D. Adolescent sexual and reproductive health and rights: a stock-taking and call-to-action on the 25th anniversary of the international conference on population and development. Sexual Reprod Health Matter. 2009;27:1 Available from: https://www.ncbi.nlm.nih.gov/pubmed/31701814. Google Scholar 18. Mumford SL, Michels KA, Salaria N, Valanzasca P, Belizán JM. Preconception care: it's never too early. Reprod Health. 2014;11:73. Article Google Scholar 19. Dean SV, Lassi ZS, Imama AM, Bhutta ZA. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod Health. 2014;11(Suppl 3):S1. Article Google Scholar 20. Preconception Interventions. Reproductive health supplement. 2014. Available from: https://reproductive-health-journal.biomedcentral.com/articles/supplements/volume-11-supplement-3 Google Scholar 21. Doucet M, Pallitto C, Groleau D. Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature. Reprod Health. 2017;14:46 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364567/. Article Google Scholar 22. Bohren MA, Mehrtash H, Fawole B, et al. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet. 2019; (published online Oct 8). Available from: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2931992-0. Download references Affiliations Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica Pingray Safe Motherhood Program, University of California, San Francisco, USA Suellen Miller Department for Reproductive Health Research, World Health Organization, Geneva, Switzerland Venkatraman Chandra-MouliAuthors Search for José M. Belizán in: PubMed • Google Scholar Search for Suellen Miller in: PubMed • Google Scholar Search for Venkatraman Chandra-Mouli in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions All authors read and approved the final manuscript. Corresponding author Correspondence to José M. Belizán. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Belizán, J.M., Miller, S., Chandra-Mouli, V. et al. Identifying the needs and problems of those left behind, and working with them to address inequities in sexual and reproductive health: a key focus of Reproductive Health for 2020. Reprod Health 17, 6 (2020) doi:10.1186/s12978-020-0856-9 Download citation Published: 21 January 2020 DOI: https://doi.org/10.1186/s12978-020-0856-9

    更新日期:2020-01-21
  • Is day 7 culture necessary for in vitro fertilization of cryopreserved/warmed human oocytes?
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-18
    Xiangli Niu; Cassie T. Wang; Richard Li; Ghassan Haddad; Weihua Wang

    Human embryos are usually cultured to blastocyst stage by Day 5 or 6 after insemination. However, some embryos grow slowly and reach blastocyst stage at Day 7. Acceptable live birth rates have been reported after transfer of Day 7 blastocysts resulted from fresh oocyte in vitro fertilization (IVF). It is unknown whether an extended embryo culture to Day 7 is necessary for cryopreserved oocyte IVF to obtain more transferrable blastocysts. In this study, 455 oocytes from 57 cycles were warmed, inseminated, and the resulting embryos were cultured by Day 7 to examine blastocyst development after extended culture. Fifty one blastocysts from 16 cycles were biopsied to examine embryo aneuploidies. It was found that 35.1% of the cycles had Day 7 blastocysts, and 3.5% of the cycles had only Day 7 blastocysts. Day 7 blastocysts accounted for 15.6% of total blastocysts. The proportion of top quality of blastocysts was lower at Day 7 than at Day 5 or 6. However, no differences were observed on aneuploid blastocyst rates among Days 5, 6 and 7. Similar clinical pregnancy, ongoing pregnancy and embryo implantation rates were obtained after Day 7 blastocyst transfer as compared with Day 5 or 6 blastocyst transfer. These results indicate that embryos from oocyte warming cycles should be cultured to Day 7 if they do not reach to blastocyst stage by Day 6 so that number of usable blastocysts can be increased.

    更新日期:2020-01-21
  • Effects of cyclic adenosine monophosphate modulators on maturation and quality of vitrified-warmed germinal vesicle stage mouse oocytes
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-20
    Dayong Lee; Hyang Heun Lee; Jung Ryeol Lee; Chang Suk Suh; Seok Hyun Kim; S. Samuel Kim

    It is still one of the unresolved issues if germinal vesicle stage (GV) oocytes can be successfully cryopreserved for fertility preservation and matured in vitro without damage after warming. Several studies have reported that the addition of cyclic adenosine monophosphate (cAMP) modulators to in vitro maturation (IVM) media improved the developmental potency of mature oocytes though vitrification itself provokes cAMP depletion. We evaluated whether the addition of cAMP modulators after GV oocytes retrieval before vitrification enhances maturation and developmental capability after warming of GV oocytes. Retrieved GV oocytes of mice were divided into cumulus-oocyte complexes (COCs) and denuded oocytes (DOs). Then, GV oocytes were cultured with or without dibutyryl-cAMP (dbcAMP, cAMP analog) and 3-isobutyl-l-methylxanthine (phosphodiesterase inhibitor) during the pre-vitrification period for 30 min. One hour after warming, the ratio of oocytes that stayed in the intact GV stage was significantly higher in groups treated with cAMP modulators. After 18 h of IVM, the percentage of maturation was significantly higher in the COC group treated with dbcAMP. The expression of F-actin, which is involved in meiotic spindle migration and chromosomal translocation, is likewise increased in this group. However, there was no difference in chromosome and spindle organization integrity or developmental competence between the MII oocytes of all groups. Increasing the intracellular cAMP level before vitrification of the GV oocytes maintained the cell cycle arrest, and this process may facilitate oocyte maturation after IVM by preventing cryodamage and synchronizing maturation between nuclear and cytoplasmic components. The role of cumulus cells seems to be essential for this mechanism.

    更新日期:2020-01-21
  • Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar - two cases report and literature review
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-20
    Song Xu; Wei Wang; Li Ping Sun

    Malignant endometriosis in an episiotomy scar is rare; only seven cases have been reported previously. Here, we compare two cases of benign endometriosis and clear cell carcinoma. The first case was a 54-year-old woman who presented with a large perineal lesion in her episiotomy scar with high 18F-fluorodeoxyglucose uptake. This location had a history of endometriosis many years ago. She underwent radical excision of the mass and bilateral inguinal lymph node dissection. Histological and immunohistochemical analysis confirmed the presence of clear cell carcinoma arising from endometriosis. Assisted radiotherapy was performed after surgery due to a positive lymph node. No recurrence was detected over a 1-year follow-up period. The second case deals with a 3 × 2 cm mass in the episiotomy scar of a 33-year-old woman. Part of the anal sphincter was resected because of the close proximity of the lesion. Because the disease lay very close to the anus, she received anal sphincter reconstruction combined with mass excision. Pathology result showed typical endometrial glands and interstitial tissues. Deleterious change only happens in patients experiencing perineal endometriosis. Complete excision is crucial for this form of disease; sometimes impairment of the anal sphincter is also necessary. Patients with malignancy required a combination of treatments in order to improve their prognosis.

    更新日期:2020-01-21
  • Nomogram for prediction of gestational diabetes mellitus in urban, Chinese, pregnant women
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-20
    Fei Guo; Shuai Yang; Yong Zhang; Xi Yang; Chen Zhang; Jianxia Fan

    This study sought to develop and validate a nomogram for prediction of gestational diabetes mellitus (GDM) in an urban, Chinese, antenatal population. Age, pre-pregnancy body mass index (BMI), fasting plasma glucose (FPG) in the first trimester and diabetes in first degree relatives were incorporated as validated risk factors. A prediction model (nomogram) for GDM was developed using multiple logistic regression analysis, from a retrospective study conducted on 3956 women who underwent their first antenatal visit during 2015 in Shanghai. Performance of the nomogram was assessed through discrimination and calibration. We refined the predicting model with t-distributed stochastic neighbor embedding (t-SNE) to distinguish GDM from non-GDM. The results were validated using bootstrap resampling and a prospective cohort of 6572 women during 2016 at the same institution. Advanced age, pre-pregnancy BMI, high first-trimester, fasting, plasma glucose, and, a family history of diabetes were positively correlated with the development of GDM. This model had an area under the receiver operating characteristic (ROC) curve of 0.69 [95% CI:0.67–0.72, p < 0.0001]. The calibration curve for probability of GDM showed good consistency between nomogram prediction and actual observation. In the validation cohort, the ROC curve was 0.70 [95% CI: 0.68–0.72, p < 0.0001] and the calibration plot was well calibrated. In exploratory and validation cohorts, the distinct regions of GDM and non-GDM were distinctly separated in the t-SNE, generating transitional boundaries in the image by color difference. Decision curve analysis showed that the model had a positive net benefit at threshold between 0.05 and 0.78. This study demonstrates the ability of our model to predict the development of GDM in women, during early stage of pregnancy.

    更新日期:2020-01-21
  • Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-20
    Valentina Bruno; Carlo Ticconi; Federica Martelli; Marzia Nuccetelli; Maria Vittoria Capogna; Roberto Sorge; Emilio Piccione; Adalgisa Pietropolli

    The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is through changes in uterine flow in pre-conceptional stage, by modifying endometrial receptivity in RPL. However, scant data are available, in pregnancy, about their role in RPL placental perfusion, also in relation to its potential treatments, such as low molecular weight heparin (LMWH). The aim of this study is to retrospectively further investigate the correlation between two-dimensional (2D) and three-dimensional (3D) uterine and placental flow indexes and the presence or the absence of ANA in women with unexplained RPL (uRPL), treated or not treated with LMWH. 2D Doppler measurement of pulsatility index (PI) of the uterine arteries and 3D ultrasonography determination of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) was carried out with the aid of the virtual organ computer-aided analysis (VOCAL) technique in LMWH treated (n 24) and not treated-uRPL patients (n 20) and in the relative control group (n 27), each group divided in ANA+ and ANA- subgroups. Serum assay for the presence of ANA was performed in all women. No differences were found in PI, VFI and VI values, by comparing the different groups. A difference in VI values was found for ANA- patients between RPL women not treated with LMWH and the treated ones (p = 0,01), which have lower VI values and similar to controls. By considering only ANA- treated and not treated RPL patients, the ROC curve shows an area of 0,80 and at the VI cut-off of 11,08 a sensitivity of 85% and a specificity of 67%. LMWH could exert a potential beneficial effect in restoring the physiological blood flow supply in terms of VI in uRPL ANA- status, suggesting to include ANA and VI investigations in the RPL diagnostic algorithm in a research context, since further studies are needed to clarify this challenging hypothesis in order to try to ameliorate ANA and abnormal placental vascularization negative influence on RPL pregnancy outcome .

    更新日期:2020-01-21
  • Identifying risk factors for perinatal death at Tororo District Hospital, Uganda: a case-control study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-20
    Martha A. Tesfalul; Paul Natureeba; Nathan Day; Ochar Thomas; Stephanie L. Gaw

    Sub-Saharan Africa faces a disproportionate burden of perinatal deaths globally. However, data to inform targeted interventions on an institutional level is lacking, especially in rural settings. The objective of this study is to identify risk factors for perinatal death at a resource-limited hospital in Uganda. This is a retrospective case-control study at a district hospital in eastern Uganda using birth registry data. Cases were admissions with stillbirths at or beyond 24 weeks or neonatal deaths within 28 days of birth. Controls were admissions that resulted in deliveries immediately preceding and following each case. We compared demographic and obstetric factors between cases and controls to identify risk factors for perinatal death. Subgroup analysis of type of perinatal death was also performed. Chi square, Fisher’s exact, t-test, and Wilcoxon-Mann-Whitney rank sum tests were utilized for bivariate analysis, and multiple logistic regression for multivariate analysis. From January 2014 to December 2014, there were 185 cases of perinatal death, of which 36% (n = 69) were macerated stillbirths, 40% (n = 76) were fresh stillbirths, and 25% (n = 47) were neonatal deaths. The rate of perinatal death among all deliveries at the institution was 35.5 per 1000 deliveries. Factors associated with increased odds perinatal death included: prematurity (adjusted odds ratio (aOR) 19.7, 95% confidence interval (CI) 7.2–49.2), breech presentation (aOR 7.0, CI 1.4–35.5), multiple gestation (aOR 4.0, CI 1.1–13.9), cesarean delivery (aOR 3.8, CI 2.3–6.4) and low birth weight (aOR 2.5, CI 1.1–5.3). Analysis by subtype of perinatal death revealed distinct associations with the aforementioned risk factors, in particular for antepartum hemorrhage, which was only associated with fresh stillbirths (aOR 6.7, CI 1.6–28.8), and low birth weight. The rate of perinatal death at our rural hospital site was higher than national targets, and these deaths were associated with prematurity, low birth weight, breech presentation, multiple gestation, and cesarean delivery. This data and the approach utilized to acquire it can be leveraged to inform targeted interventions to reduce the rate of stillbirths and neonatal deaths in similar low resource settings.

    更新日期:2020-01-21
  • Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-20
    Miguel Pugliese-Garcia; Emma Radovich; Oona M. R. Campbell; Nevine Hassanein; Karima Khalil; Lenka Benova

    Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010–2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women’s expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers’ behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.

    更新日期:2020-01-21
  • Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-20
    Alfred Kwesi Manyeh; Alberta Amu; John Williams; Margaret Gyapong

    Pregnancy is an important period to promote healthy behaviors, prevent and identify diseases early and treat them to maximize the health and development of both the woman and her unborn child. A new World Health Organization antenatal care model recommends the initiation of antenatal care visit within the first trimester of gestation. This study sought to examine the timing of initiation of antenatal care among first-time mothers and associated factors in rural Southern Ghana. Information on gestational age, timing of antenatal care, demographic and socioeconomic status of 1076 first-time mothers who gave birth in 2011 to 2013 in the Dodowa Health and Demographic Surveillance System were included in the study. The time of initiation of antenatal clinic attendance was calculated. The associations between dependent and independent variables were explored using logistic regression at 95% confidence interval in STATA version 14.2. The mean gestational age at which the first-time mothers initiated antenatal care attendance was 3 month. Maternal age, level of education and household socioeconomic status were statistically significantly associated with timing of initiation of antenatal care attendance. Although more than half of the study participants initiated ANC visit in the first trimester of pregnancy, a high proportion also started ANC attendance after the World Health Organization recommended period. Maternal age is significantly associated with timing of initiation of antenatal care visit among first-time mothers; older women were more likely to initiate antenatal care visit in the first trimester of gestation compared to the younger women.

    更新日期:2020-01-21
  • Telemedicine, a tool for follow-up of infants discharged from the NICU? Experience from a pilot project
    J. Perinatol. (IF 2.046) Pub Date : 2020-01-20
    Anirudha Das; Luciana Cina; Ajith Mathew; Hany Aziz; Hany Aly
    更新日期:2020-01-21
  • Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal
    Reprod. Health (IF 2.295) Pub Date : 2020-01-17
    Alex Harsha Bangura; Isha Nirola; Poshan Thapa; David Citrin; Bishal Belbase; Bhawana Bogati; Nirmala B.K.; Sonu Khadka; Lal Kunwar; Scott Halliday; Nandini Choudhury; Ryan Schwarz; Mukesh Adhikari; S. P. Kalaunee; Sharon Rising; Duncan Maru; Sheela Maru

    Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

    更新日期:2020-01-17
  • Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: analysis of the 2006–2016 period
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-16
    Paulino Ariho; Allen Kabagenyi

    Uganda’s fertility was almost unchanging until the year 2006 when some reductions became visible. Compared to age at first marriage and contraceptive use, age at sexual debut and family size preferences are rarely examined in studies of fertility decline. In this study, we analyzed the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to change in fertility in Uganda between 2006 and 2016. Using data from the 2006 and 2016 Uganda Demographic and Health Survey (UDHS), we applied a nonlinear multivariate decomposition technique to quantify the contribution of age at first marriage, age at first sex, family size preference and contraceptive use to the change in fertility observed during the 2006–2016 period. The findings indicate that 37 and 63% of the change in fertility observed between 2006 and 2016 was respectively associated with changing characteristics and changing fertility behavior of the women. Changes in proportion of women by; age at first marriage, age at first sex, family size preferences and contraceptive use were respectively associated with 20.6, 10.5 and 8.4% and 8.2% of the change in fertility but only fertility behavior resulting from age at first sex was significantly related to the change in fertility with a contribution of 43.5%. The study quantified the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to the change in fertility observed between 2006 and 2016. We highlight that of the four factors, only age at sexual debut made a significant contribution on the two components of the decomposition. There is need to address the low age at first sex, accessibility, demand for family planning services and youth-friendly family planning services to young unmarried women such that they can achieve their desired fertility. The contribution of other factors such as education attainment by women and place of residence and their relationship with changes in fertility calls for addressing if further reduction in fertility is to be realised.

    更新日期:2020-01-17
  • Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-17
    Aileen Grant; Sinead Currie

    Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women’s health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland. We recruited women who had given birth within the last 5 years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, that were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique. A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA, with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants. Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances.

    更新日期:2020-01-17
  • Exploring preconception health beliefs amongst adults of childbearing age in the UK: a qualitative analysis
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-16
    Laura McGowan; Emer Lennon-Caughey; Cheryl Chun; Michelle C. McKinley; Jayne V. Woodside

    ‘Preconception health’ or ‘pre-pregnancy health’ are terms used to describe the health status of males and females prior to pregnancy. The goal of preconception health strategies is to optimise the health of future offspring via improved parental health, which may result from planned/unplanned pregnancies. Greater emphasis is being placed upon preconception health amongst research and public health, yet there is limited evidence on this topic from the perspective of UK adults. This research explored beliefs, knowledge and attitudes on preconception health amongst adults of childbearing age, drawn from the UK. A descriptive qualitative focus group study was undertaken with healthy males and females of childbearing age (18–45 years) between October 2018 and July 2019. Two groups were held in a rural location (one focus group, one mini focus group) and three groups held in an urban location (two focus groups, one mini focus group), with a range of males and females, with and without children. A semi-structured topic guide was devised based on previous literature. All groups were conducted with two researchers trained in qualitative research methods. Focus groups explored understanding/prior knowledge of preconception health, beliefs and attitudes towards preconception healthcare support and personal health. Focus groups were transcribed verbatim and analysed using thematic analysis. Twenty-one males and females of childbearing age (aged 18 to 45 years) participated in the research. Discussions revealed a lack of comprehensive awareness of the importance of preconception health and a sense of reluctance to visit a doctor regarding the issue, favouring the internet, unless having problems conceiving. Five themes identified included: preconception education, preconception awareness, wider knowledge networks/support, optimal parental health, and attitudes/emotions towards preconception health. The roles of males regarding positive preconception care was not well understood. This study highlighted a lack of detailed awareness surrounding the importance of preconception health per se, despite general agreement that health status should be optimal at this time. It identified a willingness to learn more about preconception health, creating an opportunity to improve preconception healthcare awareness via evidence-based education, social media campaigns, and within healthcare systems in a life course approach.

    更新日期:2020-01-17
  • Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: a cross-sectional study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-16
    Rizka Novia Atmadani; Owen Nkoka; Sendi Lia Yunita; Yi-Hua Chen

    Self-medication with over-the-counter (OTC) drugs is an important public health concern, especially in the vulnerable population of pregnant women due to potential risks to both the mother and fetus. Few studies have studied how factors, such as knowledge, affect self-medication. This study investigated self-medication and its associated factors among pregnant women attending healthcare services in Malang, Indonesia. A cross-sectional study was conducted from July to September 2018 in five healthcare services. A self-administered questionnaire was used and the data were analyzed using multiple regression models. Of 333 female participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of OTC medication were more likely to self-medicate—adjusted odds ratio (aOR) = 2.15, 95% confidence interval (CI) = 1.03–4.46. Compared with those with less knowledge, pregnant women with more correct knowledge of the possible risk of self-medication were less likely to self-medicate—aOR = 0.29; 95% CI = 0.14–0.60. The effect of a higher level of knowledge of OTC medication was significant among women who had middle school and lower education—aOR = 8.18; 95% CI = 1.70–39.35. The effect of correct knowledge on the possible risks of self-medication was significant only among women with high school and higher education—aOR = 0.17; 95% CI = 0.07–0.42. Imparting specific knowledge of the potential risks of using non-prescribed medication during pregnancy may help pregnant women navigate and more safely manage their OTC use. We also suggest further collecting data from more healthcare services, such as hospitals, to obtain more findings generalizable to the Indonesian community.

    更新日期:2020-01-17
  • Knowledge of obstetric danger signs and associated factors: a study among mothers in Shashamane town, Oromia region, Ethiopia
    Reprod. Health (IF 2.295) Pub Date : 2020-01-16
    Biresaw Wassihun; Berhanu Negese; Hunduman Bedada; Solomon Bekele; Agegnehu Bante; Tomas Yeheyis; Agere Abebe; Duro uli; Merima Mohammed; Salasebish Gashawbez; Emebet Hussen

    Child birth which is a special moment for parents, families and communities is also a time of intense vulnerability. In many developing countries including Ethiopia, maternal morbidity and mortality still pose a substantial burden. Raising awareness of women about the danger signs of pregnancy and childbirth is the first essential step in appropriate and timely obstetric care. To assess the knowledge of obstetric danger signs among mothers and associated factors in Shashamane town, oromia region, Ethiopia. A community based cross sectional study design was employed. All kebeles were included in study; the number of households was determined using proportionate-to-population size then systematic random sampling technique to select 422 women who gave birth in Shashamane town between April and May 2018. A structured questionnaire was used to collect data. Data was checked and entered into Epi data version 3.1 then exported to Statistical Package for Social Science version 23 for analysis. Univariate, bivariate and multivariable analysis with 95% CI was carried out. Women who spontaneously mentioned at least two danger signs of pregnancy from eight items were considered to have good knowledge of the obstetric danger signs. A total of 422 mothers were involved in the study. The mean age of the respondent was 25 with a standard deviation of 4.3 year. 59.5% of the respondents were found to have poor knowledge of obstetric danger signs. Majority of respondents mentioned vaginal bleeding (64.7%) as a danger sign of pregnancy. According to the result of the multivariable analysis, antenatal care was significantly associated with the knowledge of obstetric danger sign. Respondents who attended antenatal care were 1.26 times more likely to have good knowledge of obstetric danger signs than those who had no antenatal care [AOR = 1.26, 95%CI (1.08–1.85)]. Respondents who gave birth at health center were 3.57 time more likely to have good knowledge of obstetric danger signs than those who gave birth at home [AOR = 3.57, 95%CI (1.23–10.39)]. According to this study, the knowledge of obstetric danger signs was poor. Some of the factors associated with this knowledge were antenatal care attendance and place of delivery; therefore, it is recommended that mothers should have at least four antenatal visits; this may create good relationship with the providers and enhance their knowledge. In addition to this providing compassionate and respectful maternity care in health facility is also crucial steps to attract more women to health facilities, and to reduce home deliveries.

    更新日期:2020-01-16
  • The complex microbiome from native semen to embryo culture environment in human in vitro fertilization procedure
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-16
    Jelena Štšepetova; Juliana Baranova; Jaak Simm; Ülle Parm; Tiiu Rööp; Sandra Sokmann; Paul Korrovits; Madis Jaagura; Karin Rosenstein; Andres Salumets; Reet Mändar

    Only a few microbial studies have conducted in IVF (in vitro fertilization), showing the high-variety bacterial contamination of IVF culture media to cause damage to or even loss of cultured oocytes and embryos. We aimed to determine the prevalence and counts of bacteria in IVF samples, and to associate them with clinical outcome. The studied samples from 50 infertile couples included: raw (n = 48), processed (n = 49) and incubated (n = 50) sperm samples, and IVF culture media (n = 50). The full microbiome was analyzed by 454 pyrosequencing and quantitative analysis by real-time quantitative PCR. Descriptive statistics, t-, Mann-Whitney tests and Spearman’s correlation were used for comparison of studied groups. The study involved normozoospermic men. Normal vaginal microbiota was present in 72.0% of female partners, while intermediate microbiota and bacterial vaginosis were diagnosed in 12.0 and 16.0%, respectively. The decreasing bacterial loads were found in raw (35.5%), processed (12.0%) and sperm samples used for oocyte insemination (4.0%), and in 8.0% of IVF culture media. The most abundant genera of bacteria in native semen and IVF culture media were Lactobacillus, while in other samples Alphaproteobacteria prevailed. Staphylococcus sp. was found only in semen from patients with inflammation. Phylum Bacteroidetes was in negative correlation with sperm motility and Alphaproteobacteria with high-quality IVF embryos. Our study demonstrates that IVF does not occur in a sterile environment. The prevalent bacteria include classes Bacilli in raw semen and IVF culture media, Clostridia in processed and Bacteroidia in sperm samples used for insemination. The presence of Staphylococcus sp. and Alphaproteobacteria associated with clinical outcomes, like sperm and embryo quality.

    更新日期:2020-01-16
  • Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study
    BMC Womens Health (IF 1.592) Pub Date : 2020-01-16
    Gavin George; Cherie Cawood; Adrian Puren; David Khanyile; Annette Gerritsen; Kaymarlin Govender; Sean Beckett; Mary Glenshaw; Karidia Diallo; Kassahun Ayalew; Andrew Gibbs; Tarylee Reddy; Lorna Madurai; Tendesayi Kufa-Chakezha; Ayesha B. M. Kharsany

    Young women in sub-Saharan Africa remain at the epicentre of the HIV epidemic, with surveillance data indicating persistent high levels of HIV incidence. In South Africa, adolescent girls and young women (AGYW) account for a quarter of all new HIV infections. Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy introduced by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) aimed at reducing HIV incidence among AGYW in 10 countries in sub-Saharan Africa by 25% in the programme’s first year, and by 40% in the second year. This study will assess the change in HIV incidence and reduction in risk associated behaviours that can be attributed to the DREAMS initiative in South Africa, using a population-based cross-sectional survey. Data will be collected from a household-based representative sample of AGYW (between the ages 12–24 years) in four high prevalence districts (more than 10% of the population have HIV in these districts) in South Africa in which DREAMS has been implemented. A stratified cluster-based sampling approach will be used to select eligible participants for a cross-sectional survey with 18,500, to be conducted over 2017/2018. A questionnaire will be administered containing questions on sexual risk behaviour, selected academic and developmental milestones, prevalence of gender based violence, whilst examining exposure to DREAMS programmes. Biological samples, including two micro-containers of blood and self-collected vulvovaginal swab samples, are collected in each survey to test for HIV infection, HIV incidence, sexually transmitted infections (STIs) and pregnancy. This study will measure trends in population level HIV incidence using the Limiting antigen (LAg) Avidity Enzyme Immuno-Assay (EIA) and monitor changes in HIV incidence. Ending the HIV/AIDS pandemic by 2030 requires the continual monitoring and evaluation of prevention programmes, with the aim of optimising efforts and ensuring the achievement of epidemic control. This study will determine the impact DREAMS interventions have had on HIV incidence among AGYW in a ‘real world, non-trial setting’.

    更新日期:2020-01-16
  • Factors affecting utilization of health facilities for labour and childbirth: a case study from rural Uganda
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-16
    Jaya A. R. Dantas; Debra Singh; May Lample

    Since 2000 considerable attention has been placed on maternal health outcomes as the 5th Millennium Goal. In Uganda, only 65% of births are delivered by a skilled birth attendant, contributing to the 435 women that die in every 100,000 births from unattended complications. Factors that impact a women’s decision on where to deliver include cost and household barriers, poor health services and lack of education. Insight into factors impacting maternal health decision-making in two villages in South Eastern Uganda, were explored through a cross-sectional study using focus group discussions (FDGs) with men and women and administering a simple questionnaire. For men and women in the villages, cultural and community patterns of behavior have the strongest impact on delivery options. While women with no complications could often find options to deliver safely, lack of emergency obstetric care remains a strong factor in maternal deaths. This article proposes that communities be engaged in identifying and leveraging their strengths to find solutions for challenges facing women in achieving safe deliveries.

    更新日期:2020-01-16
  • Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-16
    Mi-La Kim; Yoon-Mi Hur; Hyejin Ryu; Min Jin Lee; Seok Ju Seong; Joong Sik Shin

    Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS). All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis. Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%. Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.

    更新日期:2020-01-16
  • Provider volume and maternal complications after Caesarean section: results from a population-based study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-14
    Philip S. J. Leonard; Dan L. Crouse; Jonathan G. Boudreau; Neeru Gupta; James T. McDonald

    A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

    更新日期:2020-01-15
  • Maternal age and educational level modify the association between chronic hepatitis B infection and preterm labor
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-14
    Songxu Peng; Hongyan Chen; Xiu Li; Yukai Du; Yong Gan

    Few studies have investigated whether maternal age and education level modify the association of chronic hepatitis B virus (HBV) infection with preterm labor. We hypothesized that the association of HBV infection with preterm labor is modified by maternal age and education level. A retrospective cohort study was conducted on the HBsAg-positive and HBsAg-negative pregnant women delivered from June 2012 to August 2017 at Wuhan Medical Care Center for Women and Children, Wuhan, China. A multivariate regression model was used in this study. This study included 2050 HBsAg-positive pregnant women and 2050 HBsAg negative women. In the stratified analyses, positive HBsAg status was associated with the increased risk of preterm labor in women aged < 30 years, having low educational level, with an odds ratio of 1.65(95% CI 1.07–2.54) and 2.59(95% CI 1.41–4.76), respectively. Breslow-Day test showed that there existed significant differences in the ORs for HBsAg carriage across each stratum of maternal age (p = 0.023), educational level (p = 0.002). After adjusting other co-variables, we observed maternal HBV infection (OR 1.60, 95% CI 1.03–2.49) was still associated with risk of preterm labor in pregnancy women with age < 30. Similarly, the significant association of HBV infection (OR 2.49, 95% CI 1.34–4.63) with preterm labor remained in low educated women. Our results indicated that HBV infection was associated with high risk of preterm labor, but maternal age and educational level could modify the association between HBV infection and preterm labor.

    更新日期:2020-01-15
  • Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey
    Reprod. Health (IF 2.295) Pub Date : 2020-01-13
    Fabiola V. Moshi; Stephen M. Kibusi; Flora Fabian

    According to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania. A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization. The vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = − 1.965 at 95% CI = -0.985 to − 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = − 0.091; p = 0.453); male partners (B = − 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = − 0.138; p = 0.244); male partners (B = − 0.155; p = 0.205)] scores increase among both pregnant women and their male partners. Despite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.

    更新日期:2020-01-14
  • Exploring women and traditional birth attendants’ perceptions and experiences of stillbirths in district Thatta, Sindh, Pakistan: a qualitative study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-13
    Sanam Zulfiqar Mcnojia; Sarah Saleem; Anam Feroz; Kausar S. Khan; Farnaz Naqvi; Shiyam Sunder Tikmani; Elizabeth M. McClure; Sameen Siddiqi; Robert L. Goldenberg

    Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women’s and Children’s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman‘s body and uterus. Further women are advised to conceive soon so that they get rid of infections. Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

    更新日期:2020-01-14
  • Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    C. Miani; A. Ludwig; J. Breckenkamp; O. Sauzet; I-M Doyle; C. Hoeller-Holtrichter; J. Spallek; O. Razum

    Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. In 2013–2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01–3.81; and aOR: 2.36, CI: 1.27–4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

    更新日期:2020-01-14
  • Different levels of associations between medical co-morbidities and preterm birth outcomes among racial/ethnic women enrolled in Medicaid 2014–2015: retrospective analysis
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Hyewon Lee; Ilya Okunev; Eric Tranby; Michael Monopoli

    The causes of preterm birth are multi-dimensional, including delayed and inadequate prenatal services as well as other medical and socioeconomic factors. This study aimed to examine the different levels of association between preterm birth and major medical co-morbidities among various racial/ethnic women enrolled in Medicaid. This is a retrospective analysis of 457,200 women aged between 15 and 44 with a single live birth from the IBM® MarketScan® Multi-State Medicaid Database from 2014 to 2015. Preterm birth, defined by delivery before 37 completed weeks of gestation, was the primary dependent variable. All births were dichotomously categorized as either preterm or full-term birth using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Independent variables included race/ethnicity, categorized as non-Hispanic white, non-Hispanic black, Hispanic, or other. Medical co-morbidities included smoking, drug dependence, alcohol dependence, diabetes, and hypertension. Total healthy prenatal visit count and high-risk prenatal visit encounters identified during 30 weeks prior to the delivery date were included in the analysis. A significantly higher preterm birth rate was found in black women after controlled for medical co-morbidities, age, prenatal visit count, and high-risk pregnancy. Different levels of association between preterm birth outcome and major medical co-morbidities were examined among various racial/ethnic women enrolled in Medicaid. Drug dependence was associated with higher odds of preterm birth in black (OR = 2.56, 95% CI [1.92–3.41]) and white women (OR = 2.12, 95% CI [1.91–2.34]), when controlled for other variables. In Hispanic women, diabetes (OR=1.44, 95% CI [1.27, 1.64]) and hypertension (OR=1.98, 95% CI [1.74, 2.26]) were associated with higher odds of preterm birth. White women diagnosed with drug dependence had a 14.0% predicted probability of preterm birth, whereas black women diagnosed with drug dependence had a predicted probability of preterm birth of 21.5%. The associations of medical co-morbidities and preterm births varied across racial and ethnic groups of women enrolled in Medicaid. This report calls for future research on racial/ethnic disparity in preterm birth to apply integrative and qualitative approaches to understand the disparity from a contextual perspective, especially for vulnerable pregnant women like Medicaid enrollees.

    更新日期:2020-01-14
  • A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Oluwakemi Adegoke; Sandra Danso-Bamfo; Margaret Sheehy; Vincent Tarimo; Thomas F. Burke; Lorraine F. Garg

    Postpartum hemorrhage (PPH) is the leading cause of maternal death in Tanzania. The Every Second Matters for Mothers and Babies- Uterine Balloon Tamponade (ESM-UBT) device was developed to address this problem in women with atonic uterus. The objective of this study was to understand the barriers and facilitators to optimal use of the device, in Dar es Salaam Tanzania 1 year after implementation. Semi-structured interviews of skilled-birth attendants were conducted between May and July 2017. Interviews were recorded, coded and analyzed for emergent themes. Among the participants, overall there was a positive perception of the ESM-UBT device. More than half of participants reported the device was readily available and more than 1/3 described ease and success with initial use. Barriers included fear and lack of refresher training. Finally, participants expressed a need for training and device availability at peripheral hospitals. The implementation and progression to optimal use of the ESM-UBT device in Tanzania is quite complex. Ease of use and the prospect of saving a life/preserving fertility strongly promoted use while fear and lack of high-level buy-in hindered utilization of the device. A thorough understanding and investigation of these facilitators and barriers are required to increase uptake of the ESM-UBT device.

    更新日期:2020-01-14
  • Perinatal outcomes of infants with congenital limb malformations: an observational study from a tertiary referral center in Central Europe
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Alex Farr; Eva Wachutka; Dieter Bettelheim; Karin Windsperger; Sebastian Farr

    Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%) patients. A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and transfer to the Neonatal Intensive Care Unit were 42.4 and 25.4%, respectively. Localization of the malformation was a determinant of perinatal outcome (P = .006) and preterm delivery (P = .046). Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.

    更新日期:2020-01-14
  • Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Lilian Teddy Mselle; Lucia Eustace

    Before the advent of Western medicine in Tanzania, women gave birth in an upright position either by sitting, squatting or kneeling. Birthing women would hold ropes or trees as a way of gaining strength and stability in order to push the baby with sufficient force. Despite the evidence supporting the upright position as beneficial to the woman and her unborn child, healthcare facilities consistently promote the use of the supine position. The purpose of this study was to explore the perceptions and experiences of mothers and nurse-midwives regarding the use of the supine position during labour and delivery. We used a descriptive qualitative design. We conducted seven semi-structured interviews with nurse-midwives and two focus group discussions with postnatal mothers who were purposively recruited for the study. Qualitative content analysis guided the analysis. Four themes emerged from mothers’ and midwives’ description of their experiences and perceptions of using supine position during childbirth. These were: women adopted the supine position as instructed by midwives; women experience of using alternative birthing positions; midwives commonly decide birthing positions for labouring women and supine position is the best-known birthing position. Women use the supine position during childbirth because they are instructed to do so by the nurse-midwives. Nurse-midwives believe that the supine position is the universally known and practised birthing position, and prefer it because it provides flexibility for them to continuously monitor the progress of labour and assist delivery most efficiently. Mothers in this study had no other choice than to labour and deliver their babies in the supine position as instructed because they trusted midwives as skilled professionals who knew what was best given the condition of the mother and her baby.

    更新日期:2020-01-14
  • Attenuation of sleep deprivation dependent deterioration in male fertility parameters by vitamin C
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-11
    Nermin I. Rizk; Mohamed S. Rizk; Asmaa S. Mohamed; Yahya M. Naguib

    Male fertility is multifaceted and its integrity is as well multifactorial. Normal spermatogenesis is dependent on competent testicular function; namely normal anatomy, histology, physiology and hormonal regulation. Lifestyle stressors, including sleep interruption and even deprivation, have been shown to seriously impact male fertility. We studied here both the effects and the possible underlying mechanisms of vitamin C on male fertility in sleep deprived rats. Thirty male Wistar albino rats were used in the present study. Rats were divided (10/group) into: control (remained in their cages with free access to food and water), sleep deprivation (SD) group (subjected to paradoxical sleep deprivation for 5 consequent days, rats received intra-peritoneal injections of vehicle daily throughout the sleep deprivation), and sleep deprivation vitamin C-treated (SDC) group (subjected to sleep deprivation for 5 consequent days with concomitant intra-peritoneal injections of 100 mg/kg/day vitamin C). Sperm analysis, hormonal assay, and measurement of serum oxidative stress and inflammatory markers were performed. Testicular gene expression of Nrf2 and NF-κβ was assessed. Structural changes were evaluated by testicular histopathology, while PCNA immunostaining was conducted to assess spermatogenesis. Sleep deprivation had significantly altered sperm motility, viability, morphology and count. Serum levels of cortisol, corticosterone, IL-6, IL-17, MDA were increased, while testosterone and TAC levels were decreased. Testicular gene expression of Nrf2 was decreased, while NF-κβ was increased. Sleep deprivation caused structural changes in the testes, and PCNA immunostaining showed defective spermatogenesis. Administration of vitamin C significantly countered sleep deprivation induced deterioration in male fertility parameters. Treatment with vitamin C enhanced booth testicular structure and function in sleep deprived rats. Vitamin C could be a potential fertility enhancer against lifestyle stressors.

    更新日期:2020-01-13
  • Research priorities of women at risk for preterm birth: findings and a call to action
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Linda S. Franck; Monica R. McLemore; Shanell Williams; Kathryn Millar; Anastasia Y. Gordon; Schyneida Williams; Nakia Woods; Lisa Edwards; Tania Pacheco; Artie Padilla; Fanta Nelson; Larry Rand

    Traditional hierarchical approaches to research give privilege to small groups with decision-making power, without direct input from those with lived experience of illness who bear the burden of disease. A Research Justice framework values the expertise of patients and communities as well as their power in creating knowledge and in decisions about what research is conducted. Preterm birth has persisted at epidemic levels in the United States for decades and disproportionately affects women of color, especially Black women. Women of color have not been included in setting the agenda regarding preterm birth research. We used the Research Priorities of Affected Communities protocol to elicit and prioritize potential research questions and topics directly from women of color living in three communities that experience disproportionately high rates of preterm birth. Women participated in two focus group sessions, first describing their healthcare experiences and generating lists of uncertainties about their health and/or healthcare during pregnancy. Women then participated in consensus activities to achieve ‘top-priority’ research questions and topic lists. The priority research questions and topics produced by each group were examined within and across the three regions for similarities and differences. Fifty-four women participated in seven groups (14 sessions) and generated 375 researchable questions, clustered within 22 topics and four overarching themes: Maternal Health and Care Before, During, and After Pregnancy; Newborn Health and Care of the Preterm Baby; Understanding Stress and Interventions to Prevent or Reduce Stress; and Interpersonal and Structural Health Inequities. The questions and topics represent a wide range of research domains, from basic science, translational, clinical, health and social care delivery to policy and economic research. There were many similarities and some unique differences in the questions, topics and priorities across the regions. These findings can be used to design and fund research addressing unanswered questions that matter most to women at high risk for preterm birth. Investigators and funders are strongly encouraged to incorporate women at the front lines of the preterm birth epidemic in research design and funding decisions, and more broadly, to advance methods to deepen healthcare research partnerships with affected communities.

    更新日期:2020-01-13
  • Correction to: Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Natnael Etsay Assefa; Hailemariam Berhe; Fiseha Girma; Kidanemaryam Berhe; Yodit Zewdie Berhe; Gdiom Gebreheat; Weldu Mamu Werid; Almaz Berhe; Hagos B. Rufae; Guesh Welu

    Following publication of the original article [1], we have been notified that the name of one author was spelled incorrectly as Kidanemariam Berhe, when the correct spelling is Kidanemaryam Berhe.

    更新日期:2020-01-13
  • The differences in the consumption of proteins, fats and carbohydrates in the diet of pregnant women diagnosed with arterial hypertension or arterial hypertension and hypothyroidism
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Wioletta Waksmańska; Rafał Bobiński; Izabela Ulman-Włodarz; Anna Pielesz

    Excessive body weight induces the occurrence of arterial hypertension. The risk associated with irregularities during the perinatal period is increased in women with diagnosed hypothyroidism. Disorders of thyroid functions during pregnancy may cause higher body weight gains. The aim of this project was to determine the differences in the average daily intake of proteins, fats and carbohydrates in women with arterial hypertension and with hypothyroidism. The control group (Group I) included healthy women. In this group, no complications during the course of pregnancy were observed and the delivery was on the due date. Group II was comprised of patients with arterial hypertension. Group III included patients with arterial hypertension, who were diagnosed with hypothyroidism before pregnancy. The women’s eating habits and dietary composition were analyzed based on a dietary assessment. Women with arterial hypertension (Group II) consumed the highest number of calories per day, while women with a normal pregnancy consumed the lowest amount of calories. The daily consumption of vegetable protein was similar in all study groups. The average daily consumption of fat, cholesterol and carbohydrates was the highest among women with diagnosed arterial hypertension. Women with arterial hypertension and hypothyroidism more frequently gave birth before the 38th week of pregnancy. The average daily intake of Arginine, Lysine, Methionine and Tryptophan was lower in the group of women with a normal pregnancy than in the two other groups. Excessive calorie intake causing significant body weight gain fostered the occurrence of arterial hypertension during pregnancy.

    更新日期:2020-01-13
  • Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    V. Naanyu; V. Mujumdar; C. Ahearn; M. McConnell; J. Cohen

    In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2–6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others’ perspectives on delivery location and lack of aides/escorts. Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women’s preferences.

    更新日期:2020-01-13
  • Midwives’ engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland: comparison of survey findings from 2008 and 2018
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-13
    Sakari Lemola; Anna Gkiouleka; Natalie Urfer-Maurer; Alexander Grob; Katharina Tritten Schwarz; Yvonne Meyer-Leu

    Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the “Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy” introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives’ engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed). Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed). An increase in midwives’ awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited. Seven years after its introduction, the effectiveness of the Guideline in increasing midwives’ engagement in smoking and alcohol use prevention appears limited despite midwives’ increased awareness.

    更新日期:2020-01-13
  • Current training in percutaneously inserted central catheter (PICC) placement and maintenance for neonatal–perinatal medicine fellows
    J. Perinatol. (IF 2.046) Pub Date : 2020-01-13
    Orly Levit; Veronika Shabanova; Matthew J. Bizzarro; Lindsay Johnston
    更新日期:2020-01-13
  • Delayed frozen embryo transfer failed to improve live birth rate and neonatal outcomes in patients requiring whole embryo freezing
    Reprod. Biol. Endocrinol. (IF 2.589) Pub Date : 2020-01-10
    Yuxia He; Haiyan Zheng; Hongzi Du; Jianqiao Liu; Lei Li; Haiying Liu; Mingzhu Cao; Shiping Chen

    Controlled ovarian stimulation (COS) has a negative effect on the endometrial receptivity compared with natural menstrual cycle. Whether it’s necessary to postpone the first frozen embryo transfer (FET) following a freeze-all strategy in order to avoid any residual effect on endometrial receptivity consequent to COS was inconclusive. The purpose of this retrospective study was to explore whether the delayed FET improve the live birth rate and neonatal outcomes stratified by COS protocols after a freeze-all strategy. A total of 4404 patients who underwent the first FET cycle were enrolled in this study between April 2014 to December 2017, and were divided into immediate (within the first menstrual cycle following withdrawal bleeding) or delayed FET (waiting for at least one menstrual cycle and the transferred embryos were cryopreserved for less than 6 months). Furthermore, each group was further divided into two subgroups according to COS protocols, and the pregnancy and neonatal outcomes were analyzed between the immediate and delayed FET following the same COS protocol. When FET cycles following the same COS protocol, there was no significant difference regarding the rates of live birth, implantation, clinical pregnancy, multiple pregnancy, early miscarriage, premature birth and stillbirth between immediate and delayed FET groups. Similarly, no significant differences were found for the mean gestational age, the mean birth weight, and rates of low birth weight and very low birth weight between the immediate and delayed FET groups. The sex ratio (male/female) and the congenital anomalies rate also did not differ significantly between the two FET groups stratified by COS protocols. Regardless of COS protocols, FET could be performed immediately after a freeze-all strategy for delaying FET failed to improve reproductive and neonatal outcomes.

    更新日期:2020-01-11
  • Risk factors for spontaneous miscarriage above 12 weeks or premature delivery in patients undergoing cervical polypectomy during pregnancy
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-09
    Kaori Fukuta; Satoshi Yoneda; Noriko Yoneda; Arihiro Shiozaki; Akitoshi Nakashima; Takashi Minamisaka; Johji Imura; Shigeru Saito

    It currently remains unknown whether the resection of cervical polyps during pregnancy leads to miscarriage and/or preterm birth. This study evaluated the risk of spontaneous PTB below 34 or 37 weeks and miscarriage above 12 weeks in patients undergoing cervical polypectomy during pregnancy. This was a retrospective monocentric cohort study of patients undergoing cervical polypectomy for clinical indication. Seventy-three pregnant women who underwent polypectomy were selected, and risk factors associated with miscarriage above 12 weeks or premature delivery below 34 or 37 weeks were investigated. A multivariable regression looking for predictors of spontaneous miscarriage > 12 weeks and PTB < 34 or 37 weeks were performed. Sixteen patients (21.9%, 16/73) had spontaneous delivery at < 34 weeks or miscarriage above 12 weeks. A univariate analysis showed that bleeding before polypectomy [odds ratio (OR) 7.7, 95% confidence interval (CI) 1.6–37.3, p = 0.004], polyp width ≥ 12 mm (OR 4.0, 95% CI 1.2–13.1, p = 0.005), the proportion of decidual polyps (OR 8.1, 95% CI 1.00–65.9, p = 0.024), and polypectomy at ≤10 weeks (OR 5.2, 95% CI 1.3–20.3, p = 0.01) were significantly higher in delivery at < 34 weeks than at ≥34 weeks. A logistic regression analysis identified polyp width ≥ 12 mm (OR 11.8, 95% CI 2.8–77.5, p = 0.001), genital bleeding before polypectomy (OR 6.5, 95% CI 1.2–55.7, p = 0.025), and polypectomy at ≤10 weeks (OR 5.9, 95% CI 1.2–45.0, p = 0.028) as independent risk factors for predicting delivery at < 34 weeks. Polyp width ≥ 12 mm and bleeding before polypectomy are risk factors for PTB < 37 wks. Our cohort of patients undergoing polypectomy in pregnancy have high risks of miscarriage or spontaneous premature delivery. It is unclear whether these risks are given by the underlying disease, by surgical treatment or both. This study establishes clinically relevant predictors of PTB are polyp size> 12 mm, bleeding and first trimester polypectomy. PTB risks should be exposed to patients and extensively discussed with balancing against the benefits of intervention in pregnancy.

    更新日期:2020-01-11
  • Men’s grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-10
    Kate Louise Obst; Clemence Due; Melissa Oxlad; Philippa Middleton

    Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men’s grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men’s grief, this systematic review sought to summarise and appraise the literature focusing on men’s grief following pregnancy loss and neonatal loss. A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men’s experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men’s grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men’s grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth. A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men’s grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience. There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men’s grief. PROSPERO registration number: CRD42018103981

    更新日期:2020-01-11
  • Anomalies of the oral cavity in newborns
    J. Perinatol. (IF 2.046) Pub Date : 2020-01-10
    Federico Mecarini; Vassilios Fanos; Giangiorgio Crisponi
    更新日期:2020-01-11
  • Natriuretic peptides in bronchopulmonary dysplasia: a systematic review
    J. Perinatol. (IF 2.046) Pub Date : 2020-01-10
    Tao Xiong; Madhulika Kulkarni; Ganga Gokulakrishnan; Binoy Shivanna; Mohan Pammi
    更新日期:2020-01-11
  • Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science
    BMC Pregnancy Childbirth (IF 2.413) Pub Date : 2020-01-09
    Jana Smith; Rachel Banay; Emily Zimmerman; Vivien Caetano; Maurice Musheke; Ameck Kamanga

    Recently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery. A qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology. Five key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers’ context – the environment in which they live and work, and their past experiences – which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features. Client experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider’s environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.

    更新日期:2020-01-09
  • Impact of vaccination during pregnancy and staphylococci concentration on the presence of Bacillus cereus in raw human milk
    J. Perinatol. (IF 2.046) Pub Date : 2020-01-09
    Veronique Demers-Mathieu; Gabrielle Mathijssen; Shawn Fels; Donald H. Chace; Elena Medo
    更新日期:2020-01-09
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