ORCID Profile
0000-0002-3214-7096
Current Organisations
Monash University
,
Burnet Institute
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Publisher: Public Library of Science (PLoS)
Date: 28-02-2022
DOI: 10.1371/JOURNAL.PGPH.0000102
Abstract: Companionship during labour and birth is a critical component of quality maternal and newborn care, resulting in improved care experiences and better birth outcomes. Little is known about the preferences and experiences of companionship in Papua New Guinea (PNG), and how it can be implemented in a culturally appropriate way. The aim of this study was to describe perspectives and experiences of women, their partners and health providers regarding labour and birth companionship, identify enablers and barriers and develop a framework for implementing this intervention in PNG health facilities. A mixed methods study was conducted with five facilities in East New Britain, PNG. Data included 5 facility audits, 30 labour observations and 29 in-depth interviews with women who had recently given birth, partners and maternity care providers. A conceptual framework was developed drawing on existing quality care implementation frameworks. Women and partners wanted companions to be present, whilst health providers had mixed views. Participants described benefits of companionship including encouragement and physical support for women, better communication and advocacy, improved labour outcomes and assistance with workforce issues. Adequate privacy and space constraints were highlighted as key barriers to address. Of the women observed, only 30% of women had a companion present during labour, and 10% had a companion at birth. A conceptual framework was used to highlight the interconnected inputs required at community, facility and provincial health system levels to improve the quality of care. Key elements to address included attitudes towards companionship, the need for education and training and restrictive hospital policies. Supporting women to have their companion of choice present during labour and birth is critical to improving women’s experiences of care and improving the quality of maternal and newborn care. In order to provide companionship during labour and birth in PNG, a complex, intersecting, multi-faceted approach is required.
Publisher: Research Square Platform LLC
Date: 28-07-2023
DOI: 10.21203/RS.3.RS-3175470/V1
Abstract: The World Health Organization’s Labour Care Guide (LCG) is the “next generation” partograph, designed to improve the quality of intrapartum care and enhance women’s experiences. However, the effects of the LCG on maternal and newborn outcomes have not been evaluated. We developed a novel strategy to introduce the LCG into routine intrapartum care, comprising a co-designed training program for labour ward clinicians, alongside monthly audit and feedback. We implemented the strategy and measured its effects using a stepped-wedge, randomised trial in four hospitals in India. We captured data from 26,331 women who gave birth at =20 weeks’ gestation, over a 54-week period. Following implementation, a 5.5% crude absolute reduction in the Caesarean section rate amongst women in Robson Group 1 was observed (45.2% vs 39.7% relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care measures were not significantly different, though labour augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for maternal, fetal or newborn health outcomes, or women’s birth experiences. This “proof of concept” study provides important evidence on the effects of introducing LCG into routine practice, suggesting a 15% relative risk reduction in Caesarean section use amongst women in Robson Group 1. Larger trials are warranted, particularly in settings where urgent reversal of the Caesarean section epidemic is needed.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 04-2014
Publisher: Public Library of Science (PLoS)
Date: 23-08-2022
DOI: 10.1371/JOURNAL.PMED.1004074
Abstract: Preterm birth-related complications are the leading cause of death in newborns and children under 5. Health outcomes of preterm newborns can be improved with appropriate use of antenatal corticosteroids (ACSs) to promote fetal lung maturity, tocolytics to delay birth, magnesium sulphate for fetal neuroprotection, and antibiotics for preterm prelabour rupture of membranes. However, there are wide disparities in the rate and consistency in the use of these interventions across settings, which may underlie the differential health outcomes among preterm newborns. We aimed to assess factors (barriers and facilitators) affecting the appropriate use of ACS, tocolytics, magnesium sulphate, and antibiotics to improve preterm birth management. We conducted a mixed-methods systematic review including primary qualitative, quantitative, and mixed-methods studies. We searched MEDLINE, EMBASE, CINAHL, Global Health, and grey literature from inception to 16 May 2022. Eligible studies explored perspectives of women, partners, or community members who experienced preterm birth or were at risk of preterm birth and/or received any of the 4 interventions, health workers providing maternity and newborn care, and other stakeholders involved in maternal care (e.g., facility managers, policymakers). We used an iterative narrative synthesis approach to analysis, assessed methodological limitations using the Mixed Methods Appraisal Tool, and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. Behaviour change models (Theoretical Domains Framework Capability, Opportunity, and Motivation (COM-B)) were used to map barriers and facilitators affecting appropriate use of these interventions. We included 46 studies from 32 countries, describing factors affecting use of ACS (32/46 studies), tocolytics (13/46 studies), magnesium sulphate (9/46 studies), and antibiotics (5/46 studies). We identified a range of barriers influencing appropriate use of the 4 interventions globally, which include the following: inaccurate gestational age assessment, inconsistent guidelines, varied knowledge, perceived risks and benefits, perceived uncertainties and constraints in administration, confusion around prescribing and administering authority, and inadequate stock, human resources, and labour and newborn care. Women reported hesitancy in accepting interventions, as they typically learned about them during emergencies. Most included studies were from high-income countries (37/46 studies), which may affect the transferability of these findings to low- or middle-income settings. In this study, we identified critical factors affecting implementation of 4 interventions to improve preterm birth management globally. Policymakers and implementers can consider these barriers and facilitators when formulating policies and planning implementation or scale-up of these interventions. Study findings can inform clinical preterm birth guidelines and implementation to ensure that barriers are addressed, and enablers are reinforced to ensure these interventions are widely available and appropriately used globally.
Publisher: Wiley
Date: 03-2014
Abstract: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Twenty-nine countries in Africa, Latin America, Asia and the Middle East. Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Risk of adverse pregnancy outcomes among adolescent mothers. A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of ecl sia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries.
Publisher: Public Library of Science (PLoS)
Date: 07-01-2022
DOI: 10.1371/JOURNAL.PONE.0261479
Abstract: The Australian National COVID-19 Clinical Evidence Taskforce is producing living, evidence-based, national guidelines for treatment of people with COVID-19 which are updated each week. To continually improve the process and outputs of the Taskforce, and inform future living guideline development, we undertook a concurrent process evaluation examining Taskforce activities and experience of team members and stakeholders during the first 5 months of the project. The mixed-methods process evaluation consisted of activity and progress audits, an online survey of all Taskforce participants and semi-structured interviews with key contributors. Data were collected through five, prospective 4-weekly timepoints (beginning first week of May 2020) and three, fortnightly retrospective timepoints (March 23, April 6 and 20). We collected and analysed quantitative and qualitative data. An updated version of the guidelines was successfully published every week during the process evaluation. The Taskforce formed in March 2020, with a nominal start date of March 23. The first version of the guideline was published two weeks later and included 10 recommendations. By August 24, in the final round of the process evaluation, the team of 11 staff, working with seven guideline panels and over 200 health decision-makers, had developed 66 recommendations addressing 58 topics. The Taskforce website had received over 200,000 page views. Satisfaction with the work of the Taskforce remained very high ( % extremely or somewhat satisfied) throughout. Several key strengths, challenges and methods questions for the work of the Taskforce were identified. In just over 5 months of activity, the National COVID-19 Clinical Evidence Taskforce published 20 weekly updates to the evidence-based national treatment guidelines for COVID-19. This process evaluation identified several factors that enabled this achievement (e.g. an extant skill base in evidence review and convening), along with challenges that needed to be overcome (e.g. managing workloads, structure and governance) and methods questions (pace of updating, and thresholds for inclusion of evidence) which may be useful considerations for other living guidelines projects. An impact evaluation is also being conducted separately to examine awareness, acceptance and use of the guidelines.
Publisher: Springer Science and Business Media LLC
Date: 06-2022
DOI: 10.1186/S12884-022-04735-7
Abstract: Renewed attention and investment is needed to improve the quality of care during the early newborn period to address preventable newborn deaths and stillbirths in Papua New Guinea (PNG). We aimed to assess early newborn care practices and identify opportunities for improvement in one province (East New Britain) in PNG. A mixed-methods study was undertaken in five rural health facilities in the province using a combination of facility audits, labour observations and qualitative interviews with women and maternity providers. Data collection took place between September 2019 and February 2020. Quantitative data were analysed descriptively, whilst qualitative data were analysed using content analysis. Data were triangulated by data source. Five facility audits, 30 labour observations (in four of the facilities), and interviews with 13 women and eight health providers were conducted to examine early newborn care practices. We found a perinatal mortality rate of 32.2 perinatal deaths per 1000 total births and several barriers to quality newborn care, including an insufficient workforce, critical infrastructure and utility constraints, and limited availability of essential newborn medicines and equipment. Most newborns received at least one essential newborn care practice in the first hour of life, such as immediate and thorough drying (97%). We observed high rates of essential newborn care practices including immediate skin-to-skin and delayed cord cl ing. We also identified multiple barriers to improving the quality of newborn care in East New Britain, PNG. These findings can inform the development of effective interventions to improve the quality of newborn care. Further, this study demonstrates that multi-faceted programs that include increased investment in the health workforce, education and training, and availability of essential equipment, medicines, and supplies are required to improve newborn outcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 03-2014
Abstract: To assess the incidence of hypertensive disorders of pregnancy and related severe complications, identify other associated factors and compare maternal and perinatal outcomes in women with and without these conditions. Secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) database. Cross-sectional study implemented at 357 health facilities conducting 1000 or more deliveries annually in 29 countries from Africa, Asia, Latin America and the Middle East. All women suffering from any hypertensive disorder during pregnancy, the intrapartum or early postpartum period in the participating hospitals during the study period. We calculated the proportion of the pre-specified outcomes in the study population and their distribution according to hypertensive disorders' severity. We estimated the association between them and maternal deaths, near-miss cases, and severe maternal complications using a multilevel logit model. Hypertensive disorders of pregnancy. Potentially life-threatening conditions among maternal near-miss cases, maternal deaths and cases without severe maternal outcomes. Overall, 8542 (2.73%) women suffered from hypertensive disorders. Incidences of pre-ecl sia, ecl sia and chronic hypertension were 2.16%, 0.28% and 0.29%, respectively. Maternal near-miss cases were eight times more frequent in women with pre-ecl sia, and increased to up to 60 times more frequent in women with ecl sia, when compared with women without these conditions. The analysis of this large database provides estimates of the global distribution of the incidence of hypertensive disorders of pregnancy. The information on the most frequent complications related to pre-ecl sia and ecl sia could be of interest to inform policies for health systems organisation.
Publisher: Wiley
Date: 11-11-2020
DOI: 10.1002/IJGO.13424
Publisher: Springer Science and Business Media LLC
Date: 11-01-2017
Publisher: Wiley
Date: 19-12-2018
Publisher: Springer Science and Business Media LLC
Date: 18-05-2021
DOI: 10.1186/S12978-021-01148-1
Abstract: Uterine fundal pressure involves a birth attendant pushing on the woman’s uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4–27.0, I 2 = 99.97%). There were significant differences in prevalence between country income level (p 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women’s self-report). The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.
Publisher: BMJ
Date: 09-2023
Publisher: Elsevier BV
Date: 11-2022
Publisher: Springer Science and Business Media LLC
Date: 17-02-2022
DOI: 10.1038/S41598-022-06672-Z
Abstract: Postnatal care (PNC) is an essential component of maternity care. Appropriate and timely care immediately after childbirth can save lives and help to prevent or treat comorbidities resulting from pregnancy and childbirth. Despite its importance, PNC coverage is still low in Bangladesh. The aim of this study was to analyse the trends, inequalities, and factors associated with PNC for mothers in Bangladesh. Data from the last five Bangladesh Demographic and Health Surveys (BDHS) were used. Descriptive statistics were used to report PNC outcome rates and trends across six inequality indicators. Modified Poisson regression analyses were used to identify factors associated with PNC use in the most recent BDHS. A total of 21,240 women were included for the analysis. The rate of PNC by ‘medically trained provider’ within 2 days of birth increased between 2004 and 2017, from 16 to 52%. There were wide inequalities across socio-demographic factors. The regression analyses found women giving birth at home, women from the poorest wealth quintile and women receiving no antenatal care (ANC) were least likely to receive PNC. The findings emphasize the need to improve public health programs supporting women who have the least access to PNC. The identified inequalities can inform policy formulation to ensure more equitable provision of PNC to women in Bangladesh.
Publisher: Wiley
Date: 03-2014
Abstract: To assess the relationship between education and severe maternal outcomes among women delivering in healthcare facilities. Cross-sectional study. Twenty-nine countries in Africa, Asia, Latin America, and the Middle East. Pregnant women admitted to 359 facilities during a period of 2-4 months of data collection between 2010 and 2011. Data were obtained from hospital records. Stratification was based on the Human Development Index (HDI) values of the participating countries. Multivariable logistic regression analyses were conducted to assess the association between maternal morbidity and education, categorised in quartiles based on the years of formal education by country. Coverage of key interventions was assessed. Severe maternal outcomes (near misses and death). A significant association between low education and severe maternal outcomes (adjusted odds ratio, aOR, 2.07 95% confidence interval, 95% CI, 1.46-2.95), maternal near miss (aOR 1.80 95% CI 1.25-2.57), and maternal death (aOR 5.62 95% CI 3.45-9.16) was observed. This relationship persisted in countries with medium HDIs (aOR 2.36 95% CI 1.33-4.17) and low HDIs (aOR 2.65 95% CI 1.54-2.57). Less educated women also had increased odds of presenting to the hospital in a severe condition (i.e. with organ dysfunction on arrival or within 24 hours: aOR 2.06 95% CI 1.36-3.10). The probability that a woman received magnesium sulphate for ecl sia or had a caesarean section significantly increased as education level increased (P < 0.05). Women with lower levels of education are at greater risk for severe maternal outcomes, even after adjustment for key confounding factors. This is particularly true for women in countries that have poorer markers of social and economic development.
Publisher: Wiley
Date: 03-2014
Abstract: We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). A total of 359 participating facilities in 29 countries. A total of 308 392 singleton deliveries. We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs. The LFD rate was 17.7 per 1000 births 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-ecl sia, ecl sia, and severe anaemia. Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
Publisher: Springer Science and Business Media LLC
Date: 30-10-2017
Publisher: Wiley
Date: 03-2014
Abstract: To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-ecl sia/ecl sia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2022
DOI: 10.1186/S12916-022-02582-Z
Abstract: The Accelerating Innovation for Mothers (AIM) project established a database of candidate medicines in research and development (R& D) between 2000 and 2021 for five pregnancy-related conditions, including pre-ecl sia. In parallel, we published target product profiles (TPPs) that describe optimal characteristics of medicines for use in preventing/treating pre-ecl sia. The study objective was to use systematic double screening and extraction to identify all candidate medicines being investigated for pre-ecl sia prevention/treatment and rank their potential based on the TPPs. Adis Insight, Pharmaprojects, WHO international clinical trials registry platform (ICTRP), PubMed and grant databases were searched (Jan–May 2021). The AIM database was screened for all candidates being investigated for pre-ecl sia. Candidates in clinical development were evaluated against nine prespecified criteria from TPPs identified as key for wide-scale implementation, and classified as high, medium or low potential based on matching to the TPPs. Preclinical candidates were categorised by product type, archetype and medicine subclass. The AIM database identified 153 candidates for pre-ecl sia. Of the 87 candidates in clinical development, seven were classified as high potential ( prevention : esomeprazole, l -arginine, chloroquine, vitamin D and metformin treatment : sulfasalazine and metformin) and eight as medium potential ( prevention : probiotic lactobacilli, dalteparin, selenium and omega-3 fatty acid treatment : sulforaphane, pravastatin, rosuvastatin and vitamin B3). Sixty-six candidates were in preclinical development, the most common being amino acid eptides, siRNA-based medicines and polyphenols. This is a novel, evidence-informed approach to identifying promising candidates for pre-ecl sia prevention and treatment — a vital step in stimulating R& D of new medicines for pre-ecl sia suitable for real-world implementation.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.BPOBGYN.2018.04.003
Abstract: This article is a part of a series that focuses on the current state of evidence and practice related to preterm birth prevention. We provide an overview of current knowledge (and limitations) on the global epidemiology of preterm birth, particularly around how preterm birth is defined, measured, and classified, and what is known regarding its risk factors, causes, and outcomes. Despite the reported associations between preterm birth and a wide range of socio-demographic, medical, obstetric, fetal, and environmental factors, approximately two-thirds of preterm births occur without an evident risk factor. Efforts to standardize definitions and compare preterm birth rates internationally have yielded important insights into the epidemiology of preterm birth and how it could be prevented.
Publisher: Wiley
Date: 03-2014
Abstract: To evaluate how the effect of maternal complications on preterm birth varies between spontaneous and provider-initiated births, as well as among different countries. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. 299 878 singleton deliveries of live neonates or fresh stillbirths. Countries were categorised into very high, high, medium and low developed countries using the Human Development Index (HDI) of 2012 by the World Bank. We described the prevalence and risk of maternal complications, their effect on outcomes and their variability by country development. Preterm birth, fresh stillbirth and early neonatal death. The proportion of provider-initiated births among preterm deliveries increased with development: 19% in low to 40% in very high HDI countries. Among preterm deliveries, the socially disadvantaged were less likely, and the medically high risk were more likely, to have a provider-initiated delivery. The effects of anaemia [adjusted odds ratio (AOR), 2.03 95% confidence interval (CI), 1.84 2.25], chronic hypertension (AOR, 2.28 95% CI, 1.94 2.68) and pre-ecl sia/ecl sia (AOR, 5.03 95% CI, 4.72 5.37) on preterm birth were similar among all four HDI subgroups. The provision of adequate obstetric care, including optimal timing for delivery in high-risk pregnancies, especially to the socially disadvantaged, could improve pregnancy outcomes. Avoiding preterm delivery in women when maternal complications, such as anaemia or hypertensive disorders, are present is important for countries at various stages of development, but may be more challenging to achieve.
Publisher: Wiley
Date: 03-2014
Abstract: To develop and test markers of neonatal severe morbidity for the identification of neonatal near-miss cases. This is a database analysis of two World Health Organization cross-sectional studies: the Global Survey on Maternal and Perinatal Health (WHOGS) and the Multicountry Survey on Maternal and Newborn Health (WHOMCS). The WHOGS was performed in 373 health facilities in 24 countries (2004-2008). The WHOMCS was conducted in 359 health facilities in 29 countries (2010-2011). Data were collected from hospital records of all women admitted for delivery and their respective neonates. Pragmatic markers (birthweight <1750 g, Apgar score at 5 minutes <7, and gestational age <33 weeks) were developed with WHOGS data and validated with WHOMCS data. The diagnostic accuracy of neonatal characteristics and management markers of severity was determined in the WHOMCS. This analysis included 290 610 liveborn neonates from WHOGS and 310 436 liveborn neonates from WHOMCS. The diagnostic accuracy of pragmatic and management markers of severity for identifying early neonatal deaths was very high: sensitivity, 92.8% (95% CI 91.8-93.7%) specificity, 92.7% (95% CI 92.6-92.8%) positive likelihood ratio, 12.7 (95% CI 12.5-12.9) negative likelihood ratio, 0.08 (95% CI 0.07-0.09) diagnostic odds ratio, 163.4 (95% CI 141.6-188.4). A positive association was found between the frequency of neonatal near-miss cases and Human Development Index. Newborn infants presenting selected markers of severity and surviving the first neonatal week could be considered as neonatal near-miss cases. This definition and criteria may be seen as a basis for future applications of the near-miss concept in neonatal health. These tools can be used to inform policy makers on how best to apply scarce resources for improving the quality of care and reducing neonatal mortality.
Publisher: Wiley
Date: 03-2014
Abstract: To explore the clinical practices, risks, and maternal outcomes associated with postpartum haemorrhage (PPH). Secondary analysis of cross-sectional data. A total of 352 health facilities in 28 countries. A total of 274 985 women giving birth between 1 May 2010 and 31 December 2011. We used multivariate logistic regression to examine factors associated with PPH among all births, and the Pearson chi-square test to examine correlates of severe maternal outcomes (SMOs) among women with PPH. All analyses adjust for facility- and country-level clustering. PPH, SMOs, and clinical practices for the management of PPH. Of all the women included in the analysis, 95.3% received uterotonic prophylaxis and the reported rate of PPH was 1.2%. Factors significantly associated with PPH diagnosis included age, parity, gestational age, induction of labour, caesarean section, and geographic region. Among those with PPH, 92.7% received uterotonics for treatment, and 17.2% had an SMO. There were significant differences in the incidence of SMOs by age, parity, gestational age, anaemia, education, receipt of uterotonics for prophylaxis or treatment, referral from another facility, and Human Development Index (HDI) group. The rates of death were highest in countries with low or medium HDIs. Among women with PPH, disparities in the incidence of severe maternal outcomes persist, even among facilities that report capacity to provide all essential emergency obstetric interventions. This highlights the need for better information about the role of institutional capacity, including quality of care, in PPH-related morbidity and mortality.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.EJOGRB.2019.01.021
Abstract: To identify research priorities of interventions for the primary prevention of preterm birth (PTB), by conducting an international stakeholder survey. A prospective cross-sectional online survey was conducted in November 2016. Fifteen interventions to prevent spontaneous PTB were identified and ranked by stakeholders (n = 159) in the field of maternal and perinatal health research, using nine equally weighted criteria. Medians and interquartile ranges (IQRs) were calculated and the interventions ranked accordingly. Respondents to the survey were from 46 different countries, mostly from low and middle-income countries (62%, 99/159) and were mainly clinicians (80%, 127/159). Of the fifteen interventions ranked, the following five were identified as research priorities in the primary prevention of PTB: dietary counselling and nutritional education, risk scoring, vitamin D supplementation, exercise and antioxidant supplementation. We have identified research priorities of interventions to prevent spontaneous PTB through a global stakeholder survey. The interventions prioritized in this exercise can be used by researchers, grant funding bodies and research-policy decision makers to inform calls on future clinical trials or in idual patient data meta-analyses on the primary prevention of PTB.
Publisher: Wiley
Date: 03-2014
Abstract: To describe the mode and timing of delivery of twin pregnancies at ≥34 weeks of gestation and their association with perinatal outcomes. Secondary analysis of a cross-sectional study. Twin deliveries at ≥34 weeks of gestation from 21 low- and middle-income countries participating in the WHO Multicountry Survey on Maternal and Newborn Health. Descriptive analysis and effect estimates using multilevel logistic regression. Stillbirth, perinatal mortality, and neonatal near miss (use of selected life saving interventions at birth). The average length of gestation at delivery was 37.6 weeks. Of all twin deliveries, 16.8 and 17.6% were delivered by caesarean section before and after the onset of labour, respectively. Prelabour caesarean delivery was associated with older maternal age, higher institutional capacity and wealth of the country. Compared with spontaneous vaginal delivery, lower risks of neonatal near miss (adjusted odds ratio, aOR, 0.63 95% confidence interval, 95% CI, 0.44-0.94) were found among prelabour caesarean deliveries. A lower risk of early neonatal mortality (aOR 0.12 95% CI 0.02-0.56) was also observed among prelabour caesarean deliveries with nonvertex presentation of the first twin. The week of gestation with the lowest rate of prospective fetal death varied by fetal presentation: 37 weeks for vertex-vertex 39 weeks for vertex-nonvertex and 38 weeks for a nonvertex first twin. The prelabour caesarean delivery rate among twins varied largely between countries, probably as a result of overuse of caesarean delivery in wealthier countries and limited access to caesarean delivery in low-income countries. Prelabour delivery may be beneficial when the first twin is nonvertex. International guidelines for optimal twin delivery methods are needed.
Publisher: Wiley
Date: 23-11-2020
DOI: 10.1002/IJGO.13431
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJGH-2019-001683
Abstract: How should the WHO most efficiently keep its global recommendations up to date? In this article we describe how WHO developed and applied a ‘living guidelines’ approach to its maternal and perinatal health (MPH) recommendations, based on a systematic and continuous process of prioritisation and updating. Using this approach, 25 new or updated WHO MPH recommendations have been published in 2017–2018. The new approach helps WHO ensure its guidance is responsive to emerging evidence and remains up to date for end users.
Publisher: Wiley
Date: 24-11-2020
Publisher: Springer Science and Business Media LLC
Date: 26-01-2017
Publisher: Research Square Platform LLC
Date: 25-01-2021
DOI: 10.21203/RS.3.RS-96851/V2
Abstract: Background While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF. Methods We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. Results A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries. Conclusions Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
Publisher: Wiley
Date: 04-12-2020
Publisher: Wiley
Date: 05-01-2015
Publisher: Springer Science and Business Media LLC
Date: 20-07-2023
DOI: 10.1186/S12913-023-09723-X
Abstract: Quality maternal and newborn care is essential for improving the health of mothers and babies. Low- and middle-income countries, such as Papua New Guinea (PNG), face many barriers to achieving quality care for all. Efforts to improve the quality of maternal and newborn care must involve community in the design, implementation, and evaluation of initiatives to ensure that interventions are appropriate and relevant for the target community. We aimed to describe community members’ perspectives and experiences of maternal and newborn care, and their ideas for improvement in one province, East New Britain, in PNG. We undertook a qualitative descriptive study in partnership with and alongside five local health facilities, health care workers and community members, using a Partnership Defined Quality Approach. We conducted ten focus group discussions with 68 community members (identified through church, market and other community-based groups) in East New Britain PNG to explore perspectives and experiences of maternal and newborn care, identify enablers and barriers to quality care and interventions to improve care. Discussions were transcribed verbatim. A mixed inductive and deductive analysis was conducted including application of the World Health Organisation (WHO) Quality Maternal and Newborn Care framework. Using the WHO framework, we present the findings in accordance with the five experience of care domains. We found that the community reported multiple challenges in accessing care and facilities were described as under-staffed and under resourced. Community members emphasised the importance of good communication and competent, caring and respectful healthcare workers. Both women and men expressed a strong desire for companionship during labor and birth. Several changes were suggested by the community that could immediately improve the quality of care. Community perspectives and experiences are critical for informing effective and sustainable interventions to improve the quality of maternal and newborn care and increasing facility-based births in PNG. A greater understanding of the care experience as a key component of quality care is needed and any quality improvement initiatives must include the user experience as a key outcome measure.
Publisher: Public Library of Science (PLoS)
Date: 08-05-2019
Publisher: Springer Science and Business Media LLC
Date: 12-02-2021
DOI: 10.1186/S12978-021-01088-W
Abstract: While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF. We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow 20 weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries. Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
Publisher: BMJ
Date: 07-2022
DOI: 10.1136/BMJOPEN-2021-059473
Abstract: To identify and map all trials in maternal health conducted in low and middle-income countries (LMIC) over the 10-year period from 2010 to 2019, to identify geographical and thematic trends, as well as comparing to global causes of maternal death and preidentified priority areas. Systematic scoping review. Extracted data included location, study characteristics and whether trials corresponded to causes of mortality and identified research priority topics. We searched the Cochrane Central Register of Controlled Trials database, a combined registry of trials from multiple sources. Our search identified 7269 articles, 874 of which were included for analysis. Between 2010 and 2019, maternal health trials conducted in LMICs more than doubled (50–114). Trials were conducted in 61 countries—231 trials (26.4%) were conducted in Iran. Only 225 trials (25.7%) were aligned with a cause of maternal mortality. Within these trials, pre-existing medical conditions, embolism, obstructed labour and sepsis were all under-represented when compared with number of maternal deaths globally. Large numbers of studies were conducted on priority topics such as labour and delivery, obstetric haemorrhage and antenatal care. Hypertensive disorders of pregnancy, diabetes and health systems and policy—despite being high-priority topics—had relatively few trials. Despite trials conducted in LMICs increasing from 2010 to 2019, there were significant gaps in geographical distribution, alignment with causes of maternal mortality and known research priority topics. The research gaps identified provide guidance and insight for future research conduct in low-resource settings. 10.17605/OSF.IO/QUJP5.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.AJOG.2014.05.022
Abstract: We sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low- and middle-income countries. We conducted secondary analysis of 719 health facilities, in 26 countries in Africa, the Pacific, Asia, and the Mediterranean, using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. A total of 531 (73.8%) facilities reported performing CD. In all, 126 (17.5%) facilities did not perform but referred CD the most common reasons for doing so were lack of skills (53.2%) and nonfunctioning equipment (42.9%). All health facilities surveyed had at least 1 operating room. Of the facilities performing CD, 47.3% did not report the presence of any type of anesthesia provider and 17.9% did not report the presence of any type of obstetric/gynecological or surgical care provider. In facilities reporting a lack of functioning equipment, 26.4% had no access to an oxygen supply, 60.8% had no access to an anesthesia machine, and 65.9% had no access to a blood bank. Provision of CD in facilities in low- and middle-income countries is hindered by a lack of an adequate anesthetic and surgical workforce and availability of oxygen, anesthesia, and blood banks.
Publisher: Hindawi Limited
Date: 13-02-2019
DOI: 10.1155/2019/7596165
Abstract: Aim . To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods . Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then ided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results . From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions . The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2020
DOI: 10.1186/S12961-020-00641-6
Abstract: An amendment to this paper has been published and can be accessed via the original article.
Publisher: Public Library of Science (PLoS)
Date: 11-02-2016
Publisher: Elsevier BV
Date: 11-2019
Publisher: Springer Science and Business Media LLC
Date: 15-11-2018
Publisher: Wiley
Date: 16-08-2016
Abstract: To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases. Retrospective application of ICD-PM. South Africa, UK. Perinatal death databases. Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case. Causes of perinatal mortality, associated maternal conditions. In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n = 74) intrapartum and 39% (n = 271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%) neonatal deaths followed consequences of low birthweight/ prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes. The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015. ICD-PM is a global system that classifies perinatal deaths and links them to maternal conditions.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2016
Publisher: Wiley
Date: 16-08-2016
Abstract: We explore preterm-related neonatal deaths using the WHO application of the International Classification of Disease (ICD-10) to deaths during the perinatal period: ICD-PM as an informative case study, where ICD-PM can improve data use to guide clinical practice and programmatic decision-making. Retrospective application of ICD-PM. South Africa, and the UK. Perinatal death databases. Descriptive analysis of neonatal deaths and maternal conditions present. Causes of preterm neonatal mortality and associated maternal conditions. We included 98 term and 173 preterm early neonatal deaths from South Africa, and 956 term and 3248 preterm neonatal deaths from the UK. In the South African data set, the main causes of death were respiratory/cardiovascular disorders (34.7%), low birthweight rematurity (29.2%), and disorders of cerebral status (25.5%). Amongst preterm deaths, low birthweight rematurity (43.9%) and respiratory/cardiovascular disorders (32.4%) were the leading causes. In the data set from the UK, the leading causes of death were low birthweight rematurity (31.6%), congenital abnormalities (27.4%), and deaths of unspecified cause (26.1%). In the preterm deaths, the leading causes were low birthweight rematurity (40.9%) and deaths of unspecified cause (29.6%). In South Africa, 61% of preterm deaths resulted from the maternal condition of preterm spontaneous labour. Among the preterm deaths in the data set from the UK, no maternal condition was present in 36%, followed by complications of placenta, cord, and membranes (23%), and other complications of labour and delivery (22%). ICD-PM can be used to appraise the maternal and newborn conditions contributing to preterm deaths, and can inform practice. ICD-PM can be used to appraise maternal and newborn contributors to preterm deaths to improve quality of care.
Publisher: Wiley
Date: 14-05-2019
Abstract: To compare severe maternal outcomes (SMOs) from two multi-centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care. Two facility-based surveys of women experiencing SMO (maternal near-miss or maternal deaths). Sixteen secondary and five tertiary facilities in Nigeria [WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS)] and 42 public tertiary facilities in Nigeria (Nigeria Near-Miss and Maternal Death Survey). 371 women in WHOMCS-Nigeria and 2449 women in Nigeria Near-Miss and Maternal Death Survey who experienced SMO. Secondary analysis and comparison of SMO data from two surveys, stratified by facility level. Maternal mortality ratio (MMR) per 100 000 livebirths (LB), maternal near-miss (MNM) ratio per 1000 LB, SMO ratio per 1000 LB and mortality index (deaths/SMO). Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS-Nigeria (706 per 100 000 26.7%) and the Nigeria Near-Miss and Maternal Death Survey (1088 per 100 000 40.8%), and lower in secondary facilities of the WHOMCS-Nigeria (593 per 100 000 17.9%). The MNM ratio and SMO ratio were highest in secondary WHOMCS-Nigeria facilities (27.2 per 1000 LB 33.1 per 1000 LB). Tertiary-level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary-level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, ecl sia, and infectious morbidities) should be prioritised for action. Surveillance using SMO indicators can guide quality improvement efforts and assess changes over time. 2820 Nigerian women with severe maternal outcomes: high mortality in tertiary level hospitals, higher burden in secondary level.
Publisher: Wiley
Date: 16-08-2016
Abstract: The WHO application of the tenth edition of the International Classification of Diseases (ICD-10) to deaths during the perinatal period (ICD Perinatal Mortality, ICD-PM) captures the essential characteristics of the mother-baby dyad that contribute to perinatal deaths. We compare the capture of maternal conditions in the existing ICD-PM with the maternal codes from the WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD Maternal Mortality, ICD-MM) to explore potential benefits in the quality of data received. Retrospective application of ICD-PM. South Africa and the UK. Perinatal death databases. The maternal conditions were classified using the ICD-PM groupings for maternal condition in perinatal death, and then mapped to the ICD-MM groupings of maternal conditions. Main maternal conditions in perinatal deaths. We reviewed 9661 perinatal deaths. The largest group (4766 cases, 49.3%) in both classifications captures deaths where there was no contributing maternal condition. Each of the other ICD-PM groups map to between three and six ICD-MM groups. If the cases in each ICD-PM group are re-coded using ICD-MM, each group becomes multiple, more specific groups. For ex le, the 712 cases in group M4 in ICD-PM become 14 different and more specific main disease categories when the ICD-MM is applied instead. As we move towards ICD-11, the use of the more specific, applicable, and relevant codes outlined in ICD-MM for both maternal deaths and the maternal condition at the time of a perinatal death would be preferable, and would provide important additional information about perinatal deaths. Improving the capture of maternal conditions in perinatal deaths provides important actionable information.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2018
Publisher: Wiley
Date: 16-08-2016
Publisher: Wiley
Date: 03-2014
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOPEN-2022-065538
Abstract: Low dietary calcium intake is a risk factor for pre-ecl sia, a major contributor to maternal and perinatal mortality and morbidity worldwide. Calcium supplementation can prevent pre-ecl sia in women with low dietary calcium. However, the optimal dose and timing of calcium supplementation are not known. We plan to undertake an in idual participant data (IPD) meta-analysis of randomised trials to determine the effects of various calcium supplementation regimens in preventing pre-ecl sia and its complications and rank these by effectiveness. We also aim to evaluate the cost-effectiveness of calcium supplementation to prevent pre-ecl sia. We will identify randomised trials on calcium supplementation before and during pregnancy by searching major electronic databases including Embase, CINAHL, MEDLINE, CENTRAL, PubMed, Scopus, AMED, LILACS, POPLINE, AIM, IMSEAR, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, without language restrictions, from inception to February 2022. Primary researchers of the identified trials will be invited to join the International Calcium in Pregnancy Collaborative Network and share their IPD. We will check each study’s IPD for consistency with the original authors before standardising and harmonising the data. We will perform a series of one-stage and two-stage IPD random-effect meta-analyses to obtain the summary intervention effects on pre-ecl sia with 95% CIs and summary treatment–covariate interactions (maternal risk status, dietary intake, timing of intervention, daily dose of calcium prescribed and total intake of calcium). Heterogeneity will be summarised using tau 2 , I 2 and 95% prediction intervals for effect in a new study. Sensitivity analysis to explore robustness of statistical and clinical assumptions will be carried out. Minor study effects (potential publication bias) will be investigated using funnel plots. A decision analytical model for use in low-income and middle-income countries will assess the cost-effectiveness of calcium supplementation to prevent pre-ecl sia. No ethical approvals are required. We will store the data in a secure repository in an anonymised format. The results will be published in peer-reviewed journals. CRD42021231276.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 14-07-2021
DOI: 10.1186/S12978-021-01162-3
Abstract: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. When PPH occurs, early identification of bleeding and prompt management using evidence-based guidelines, can avert most PPH-related severe morbidities and deaths. However, adherence to the World Health Organization recommended practices remains a critical challenge. A potential solution to inefficient and inconsistent implementation of evidence-based practices is the application of a ‘clinical care bundle’ for PPH management. A clinical care bundle is a set of discrete, evidence-based interventions, administered concurrently, or in rapid succession, to every eligible person, along with teamwork, communication, and cooperation. Once triggered, all bundle components must be delivered. The E-MOTIVE project aims to improve the detection and first response management of PPH through the implementation of the “E-MOTIVE” bundle, which consists of (1) E arly PPH detection using a calibrated drape, (2) uterine M assage, (3) O xytocic drugs, (4) T ranexamic acid, (5) I ntra V enous fluids, and (6) genital tract E xamination and escalation when necessary. The objective of this paper is to describe the protocol for the formative phase of the E-MOTIVE project, which aims to design an implementation strategy to support the uptake of this bundle into practice. We will use behavior change and implementation science frameworks [e.g. capability, opportunity, motivation and behavior (COM-B) and theoretical domains framework (TDF)] to guide data collection and analysis, in Kenya, Nigeria, South Africa, Sri Lanka, and Tanzania. There are four methodological components: qualitative interviews surveys systematic reviews and design workshops. We will triangulate findings across data sources, participant groups, and countries to explore factors influencing current PPH detection and management, and potentially influencing E-MOTIVE bundle implementation. We will use these findings to develop potential strategies to improve implementation, which will be discussed and agreed with key stakeholders from each country in intervention design workshops. This formative protocol outlines our strategy for the systematic development of the E-MOTIVE implementation strategy. This focus on implementation considers what it would take to support roll-out and implementation of the E-MOTIVE bundle. Our approach therefore aims to maximize internal validity in the trial alongside future scalability, and implementation of the E-MOTIVE bundle in routine practice, if proven to be effective. Trial registration: ClinicalTrials.gov: NCT04341662
Publisher: Wiley
Date: 24-03-2021
DOI: 10.1002/IJGO.13654
Abstract: Postpartum hemorrhage (PPH) is responsible for nearly one quarter of maternal deaths. A 2017 multicountry trial found that incorporating tranexamic acid (TXA) into the PPH management package was effective in reducing maternal death due to bleeding. To systematically review studies assessing the cost‐effectiveness of tranexamic acid for PPH treatment. Nine databases were searched using variations of keywords ‘tranexamic acid’, ‘postpartum hemorrhage’ and ‘cost effectiveness’. Eligible studies were any type of economic or effectiveness evaluation studies on tranexamic acid for treating women with PPH. Two reviewers independently screened citations and extracted data on cost effectiveness measures. Quality was assessed using the Consensus on Health Economic Criteria list. Four studies were included, of which two were abstracts. Three studies concluded that early administration of TXA was cost‐saving or cost‐effective. One abstract reported TXA was not cost‐effective in the USA unless the probability of death due to hemorrhage is higher. Available evidence (four studies in three countries) suggests that this life‐saving intervention may be below willingness to pay thresholds (cost‐effective) or cost saving. Further studies conducted in different populations and settings are needed to inform health policy decision‐making to reduce PPH‐associated morbidity and mortality.
Publisher: Wiley
Date: 19-12-2023
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 07-08-2013
Abstract: To investigate the risk of adverse pregnancy outcomes and caesarean section among adolescents in low- and middle-income countries. Secondary analysis using facility-based cross-sectional data from the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health. Twenty-three countries in Africa, Latin America, and Asia. Women admitted for delivery in 363 health facilities during 2-3 months between 2004 and 2008. We constructed multilevel logistic regression models to estimate the effect of young maternal age on risks of adverse pregnancy outcomes. Risk of adverse pregnancy outcomes among young mothers. A total of 78 646 nulliparous mothers aged ≤24 years and their singleton infants were included in the analysis. Compared with mothers aged 20-24 years, adolescents aged 16-19 years had a significantly lower risk of caesarean section (adjusted OR 0.75, 95% CI 0.71-0.79). When the analysis was restricted to caesarean section indicated for presumed cephalopelvic disproportion, the risk of caesarean section was significantly higher among mothers aged ≤15 years (aOR 1.27, 95% CI 1.07-1.49) than among those aged 20-24 years. Higher risks of low birthweight and preterm birth were found among adolescents aged 16-19 years (aOR 1.10, 95% CI 1.03-1.17 aOR 1.16, 95% CI 1.09-1.23, respectively) and ≤15 years (aOR 1.33, 95% CI 1.14-1.54 aOR 1.56, 95% CI 1.35-1.80, respectively). Adolescent girls experiencing pregnancy at a very young age (i.e. <16 years) have an increased risk of adverse pregnancy outcomes.
Publisher: Wiley
Date: 24-07-2014
DOI: 10.1016/J.IJGO.2014.05.026
Abstract: To assess the prevalence of the use of prenatal corticosteroids (PCS) in the management of preterm delivery and the factors associated with PCS administration. A secondary analysis was performed of a cross-sectional study conducted in 21 Chinese healthcare facilities between November 2010 and January 2011. The medical records of women who delivered preterm were reviewed. Associations between PCS administration and in idual and organizational-level factors were determined. The study population comprised 659 women who delivered at 20 facilities. PCS were given to 158 (68.1%) of 232 women delivering after 27-34 weeks of pregnancy and 119 (27.9%) of 427 delivering after 35-36 weeks. Teenaged girls were less likely to receive PCS after 27-34 weeks than were women aged 20-35 years (odds ratio [OR] 0.22 95% confidence interval [CI] 0.07-0.70). Among women who delivered after 35-36 weeks, the odds of receiving PCS were lower in urban hospitals than in periurban or rural hospitals (OR 0.04 95% CI 0.00-0.44), and there was significant hospital-level variance with regard to the administration of PCS (P<0.05). Generally, PCS were underprescribed to women at risk of preterm delivery and many women received the treatment after 35-36 weeks of pregnancy, when it might not have been effective.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Elsevier BV
Date: 05-2015
Publisher: Elsevier BV
Date: 09-2021
Publisher: SAGE Publications
Date: 24-06-2021
DOI: 10.1177/10105395211026099
Abstract: Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.
Publisher: Wiley
Date: 13-09-2017
Publisher: Wiley
Date: 07-03-2017
Publisher: Public Library of Science (PLoS)
Date: 16-01-2018
Publisher: Elsevier BV
Date: 05-2013
Publisher: Springer Science and Business Media LLC
Date: 21-03-2017
DOI: 10.1038/SREP44868
Abstract: Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors h ering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 12-2017
DOI: 10.1002/IJGO.12378
Abstract: To explore what "quality of care" means to childbearing women in Nigeria and Uganda, as a means of ensuring that women's voices and opinions are prioritized when developing interventions to improve quality in maternity care provision. Qualitative methods, with a purposive s le of women in Nigeria and Uganda. Participants were asked to define quality of care and to provide ex les of when it was and was not provided. Thematic analysis was used to synthesize findings based on an a priori framework (the WHO quality of care framework). 132 in-depth interviews and 21 focus group discussions are included. Participants spontaneously discussed each of the WHO framework domains of quality of care. Data were richest across the domains of effective communication, respect and dignity, emotional support, competent and motivated human resources, and essential physical resources. Women believed that good quality of care ensured optimal psychological and physiological outcomes for the woman and her baby. Positive interpersonal relationships between women and health providers were important. These included supportive care, building rapport, and using positive and clear language. To provide good quality of care, maternity services should consider and act on the expectations and experiences of women and their families.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 29-03-2022
DOI: 10.1186/S12978-022-01372-3
Abstract: Globally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities. A qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0. Health workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women’s non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment. Health workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities.
Publisher: Wiley
Date: 22-11-2020
DOI: 10.1111/BIRT.12511
Publisher: Public Library of Science (PLoS)
Date: 13-01-2023
DOI: 10.1371/JOURNAL.PONE.0279990
Abstract: The provision of maternity services in Australia has been significantly disrupted in response to the COVID-19 pandemic. Many changes were initiated quickly, often with rapid dissemination of information to women. The aim of this study was to better understand what information and messages were circulating regarding COVID-19 and pregnancy in Australia and potential information gaps. This study adopted a qualitative approach using social media and interviews. A data analytics tool (TIGER-C19) was used to extract data from social media platforms Reddit and Twitter from June to July 2021 (in the middle of the third COVID-19 wave in Australia). A total of 21 in idual semi-structured interviews were conducted with those who were, or had been, pregnant in Australia since March 2020. Social media data were analysis via inductive content analysis and interview data were thematically analysed. Social media provided a critical platform for sharing and seeking information, as well as highlighting attitudes of the community towards COVID-19 vaccines in pregnancy. Women interviewed described wanting further information on the risks COVID-19 posed to themselves and their babies, and greater familiarity with the health service during pregnancy, in which they would labour and give birth. Health providers were a trusted source of information. Communication strategies that allowed participants to engage in real-time interactive discussions were preferred. A real or perceived lack of information led participants to turn to informal sources, increasing the potential for exposure to misinformation. It is vital that health services communicate effectively with pregnant women, early and often throughout public health crises, such as the COVID-19 pandemic. This was particularly important during periods of increased restrictions on accessing hospital services. Information and communication strategies need to be clear, consistent, timely and accessible to reduce reliance on informal and potentially inaccurate sources.
Publisher: Public Library of Science (PLoS)
Date: 03-06-2013
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
Publisher: Wiley
Date: 11-07-2014
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJGH-2020-004512
Abstract: Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation. Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full artial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices. Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047. FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.
Publisher: Public Library of Science (PLoS)
Date: 30-06-2015
Publisher: Wiley
Date: 06-2022
DOI: 10.1002/IJGO.14200
Abstract: A significant barrier to improving prevention and treatment of postpartum hemorrhage (PPH) is a lack of innovative medicines that meet the needs of women and providers, particularly those in low‐and middle‐income countries (LMICs). The Accelerating Innovation for Mothers (AIM) project established a new database of candidate medicines under development for five pregnancy‐related conditions between 2000 and 2021. To systematically identify and rank candidates for prevention and treatment of PPH. Adis Insight, Pharmaprojects, WHO ICTRP, PubMed, and grant databases were searched to develop the AIM database. AIM database was searched for candidates being evaluated for PPH prevention and treatment, regardless of phase. Candidates were ranked as high, medium, or low potential based on prespecified criteria. Analysis was primarily descriptive, describing candidates and development potential. Of the 444 unique candidates, only 39 pertained to PPH. One was high potential (heat‐stable/inhaled oxytocin) and three were medium potential (melatonin, vasopressin and dofetilide via nanoparticle delivery). The pipeline for new PPH medicines is concerningly limited, lacking ersity, and showing little evidence of novel technologies. Without significant investment in early‐phase research, it is unlikely that new products will emerge.
Publisher: Springer Science and Business Media LLC
Date: 12-04-2013
Publisher: Research Square Platform LLC
Date: 29-10-2021
DOI: 10.21203/RS.3.RS-96851/V1
Abstract: Background: While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF. Methods: We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. Results: A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries. Conclusions: Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier BV
Date: 12-2022
Publisher: Springer Science and Business Media LLC
Date: 22-03-2021
DOI: 10.1186/S12978-021-01074-2
Abstract: The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide. Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG. A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status. Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2016
Publisher: Elsevier BV
Date: 2017
Publisher: BMJ
Date: 06-2018
DOI: 10.1136/BMJGH-2018-000906
Abstract: Gentle assisted pushing (GAP) is an innovative method of applying gentle, steady pressure to a woman’s uterine fundus during second stage of labour. This randomised trial evaluated GAP in an upright position, compared with upright position alone or routine practice (recumbent posture). An open-label, hospital-based, randomised trial was conducted in Eastern Cape, South Africa. Randomisation occurred following at least 15 min in second stage of labour. Participants were randomly assigned (1:1:1) using computer-generated block randomisation of variable size using opaque, sealed, numbered envelopes. Primary analysis was intention to treat. Participants were healthy, nulliparous, consenting women with a singleton pregnancy in cephalic presentation where vaginal birth was anticipated. The primary outcome was mean time from randomisation to birth. 1158 participants were randomly allocated to GAP (n=388), upright position (n=386) and routine practice (n=384), with no loss to follow-up. Baseline characteristics were largely similar. In the experimental arm, GAP was applied a median of two times (IQR 1.0–3.0). Women in upright position alone spent a median of 6 min (IQR 3.0–10.0) upright. Mean duration from randomisation to birth was not different across groups (mean (SD) duration: 24.1 (34.9) min in GAP group, 24.6 (30.5) min in upright group, 25.0 (39.3) min in routine practice group). There were no differences in secondary outcomes, except that at two sites maternal discomfort was greater for both GAP and upright position compared with routine practice at the other sites there were no differences. No benefit was identified from GAP in the second stage some women found the position uncomfortable. The use of fundal pressure should be limited to further research to determine techniques or settings in which it can safely assist vaginal birth. Women should be encouraged to assume the position they find most comfortable. PACTR201502001034448.
Publisher: BMJ
Date: 14-09-2015
DOI: 10.1136/BMJ.H4255
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOPEN-2022-068713
Abstract: To identify current and emerging self-care interventions to improve maternity healthcare. Scoping review. MEDLINE, Embase, EmCare, PsycINFO, Cochrane CENTRAL/CDSR, CINAHL Plus (last searched on 17 October 2021). Evidence syntheses, interventional or observational studies describing any tool, resource or strategy to facilitate self-care in women preparing to get pregnant, currently pregnant, giving birth or post partum. Screening and data collection were conducted independently by two reviewers. Self-care interventions were identified based on predefined criteria and inductively organised into 11 categories. Characteristics of study design, interventions, participants and outcomes were recorded. We identified eligible 580 studies. Many included studies evaluated interventions in high-income countries (45%) and during antenatal care (76%). Self-care categories featuring highest numbers of studies were diet and nutrition (26% of all studies), physical activity (24%), psychosocial strategies (18%) and other lifestyle adjustments (17%). Few studies featured self-care interventions for sexual health and postpartum family planning (2%), self-management of medication (3%) and self-testing/s ling (3%). Several venues to introduce self-care were described: health facilities (44%), community venues (14%), digital platforms (18%), partner eer support (7%) or over-the-counter products (13%). Involvement of health and community workers were described in 38% and 8% of studies, who supported self-care interventions by providing therapeutics for home use, training or counselling. The most common categories of outcomes evaluated were neonatal outcomes (eg, birth weight) (31%), maternal mental health (26%) and labour outcomes (eg, duration of labour) (22%). Self-care interventions in maternal care are erse in their applications, implementation characteristics and intended outcomes. Many self-care interventions were implemented with support from the health system at initial stages of use and uptake. Some promising self-care interventions require further primary research, though several are matured and up-to-date evidence syntheses are needed. Research on self-care in the preconception period is lacking.
Publisher: Public Library of Science (PLoS)
Date: 02-03-2023
DOI: 10.1371/JOURNAL.PONE.0282477
Abstract: Antenatal corticosteroids (ACS) are widely prescribed to improve outcomes following preterm birth. Significant knowledge gaps surround their safety, long-term effects, optimal timing and dosage. Almost half of women given ACS give birth outside the “therapeutic window” and have not delivered over 7 days later. Overtreatment with ACS is a concern, as evidence accumulates of risks of unnecessary ACS exposure. The Consortium for the Study of Pregnancy Treatments (Co-OPT) was established to address research questions surrounding safety of medications in pregnancy. We created an international birth cohort containing information on ACS exposure and pregnancy and neonatal outcomes by combining data from four national rovincial birth registers and one hospital database, and follow-up through linked population-level data from death registers and electronic health records. The Co-OPT ACS cohort contains 2.28 million pregnancies and babies, born in Finland, Iceland, Israel, Canada and Scotland, between 1990 and 2019. Births from 22 to 45 weeks’ gestation were included 92.9% were at term (≥ 37 completed weeks). 3.6% of babies were exposed to ACS (67.0% and 77.9% of singleton and multiple births before 34 weeks, respectively). Rates of ACS exposure increased across the study period. Of all ACS-exposed babies, 26.8% were born at term. Longitudinal childhood data were available for 1.64 million live births. Follow-up includes diagnoses of a range of physical and mental disorders from the Finnish Hospital Register, diagnoses of mental, behavioural, and neurodevelopmental disorders from the Icelandic Patient Registers, and preschool reviews from the Scottish Child Health Surveillance Programme. The Co-OPT ACS cohort is the largest international birth cohort to date with data on ACS exposure and maternal, perinatal and childhood outcomes. Its large scale will enable assessment of important rare outcomes such as perinatal mortality, and comprehensive evaluation of the short- and long-term safety and efficacy of ACS.
Publisher: Wiley
Date: 20-02-0050
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.PREGHY.2018.06.001
Abstract: Hypertensive disorders during pregnancy are one of main causes for maternal and perinatal morbidity and mortality in developing countries. This study is to determine whether specific types of anemia are risk factors for hypertensive disorders during pregnancy in developing countries. Using data from the World Health Organization Global Survey for Maternal and Perinatal Health, collected in hospitals in six African and six Latin American countries from 2007 to 2008 and in four Asian countries from 2004 to 2005, we examined the associations between severe anemia, sickle cell disease and thalassemia, and gestational hypertension or preecl sia/ecl sia. A total of 214,067, 112,531, and 9,325 women were included in the analyses on severe anemia, sickle cell disease, and thalassemia, respectively. Multiparous women with severe anemia were at an increased risk of gestational hypertension (adjusted odds ratio (aOR): 1.73 95% confidence interval (Cl): 1.25-2.39). Severe anemia had a significant association with preecl sia/ecl sia for nulliparous (aOR: 3.74 95% Cl: 2.90-4.81) and multiparous (aOR: 3.45 95% Cl: 2.79-4.25) women. Sickle cell disease exhibited a significant association with gestational hypertension among nulliparous (aOR: 2.41 95% Cl: 1.42-4.10) and multiparous (aOR: 3.26 95% Cl: 2.32-4.58) women. No significant associations were found between sickle cell disease and preecl sia/ecl sia, or between thalassemia and either gestational hypertension or preecl sia/ecl sia. Severe anemia appears to be a risk factor for preecl sia/ecl sia, while sickle cell disease may be a risk factor for gestational hypertension among women seeking hospital care in developing countries.
Publisher: Elsevier BV
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 07-04-2023
DOI: 10.1186/S12978-023-01600-4
Abstract: The World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 to support the implementation of its 2018 recommendations on intrapartum care. The WHO LCG promotes evidence-based labour monitoring and stimulates shared decision-making between maternity care providers and labouring women. There is a need to identify critical questions that will contribute to defining the research agenda relating to implementation of the WHO LCG. This mixed-methods prioritization exercise, adapted from the Child Health and Nutrition Research Initiative (CHNRI) and James Lind Alliance (JLA) methods, combined a metrics-based design with a qualitative, consensus-building consultation in three phases. The exercise followed the reporting guideline for priority setting of health research (REPRISE). First, 30 stakeholders were invited to submit online ideas or questions (generation of research ideas). Then, 220 stakeholders were invited to score "research avenues" (i.e., broad research ideas that could be answered through a set of research questions) against six independent and equally weighted criteria (scoring of research avenues). Finally, a technical working group (TWG) of 20 purposively selected stakeholders reviewed the scoring, and refined and ranked the research avenues (consensus-building meeting). Initially, 24 stakeholders submitted 89 research ideas or questions. A list of 10 consolidated research avenues was scored by 75/220 stakeholders. During the virtual consensus-building meeting, research avenues were refined, and the top three priorities agreed upon were: (1) optimize implementation strategies of WHO LCG, (2) improve understanding of the effect of WHO LCG on maternal and perinatal outcomes, and the process and experience of labour and childbirth care, and (3) assess the effect of the WHO LCG in special situations or settings. Research avenues related to the organization of care and resource utilization ranked lowest during both the scoring and consensus-building process. This systematic and transparent process should encourage researchers, program implementers, and funders to support research aligned with the identified priorities related to WHO LCG. An international collaborative platform is recommended to implement prioritized research by using harmonized research tools, establishing a repository of research priorities studies, and scaling-up successful research results.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Massachusetts Medical Society
Date: 22-04-2021
DOI: 10.1056/NEJMC2102042
Publisher: F1000 Research Ltd
Date: 24-02-2022
DOI: 10.12688/F1000RESEARCH.76833.1
Abstract: Background Evidence on the affordability and cost-effectiveness of interventions is critical to decision-making for clinical practice guidelines and development of national health policies. This study aimed to develop a repository of primary economic evaluations to support global maternal health guideline development and provide insights into the body of research conducted in this field. Methods A scoping review was conducted to identify and map available economic evaluations of maternal health interventions. We searched six databases (NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo) on 20 November 2020 with no date, setting or language restrictions. Two authors assessed eligibility and extracted data independently. Included studies were categorised by subpopulation of women, level of care, intervention type, mechanism, and period, economic evaluation type and perspective, and whether the intervention is currently recommended by the World Health Organization. Frequency analysis was used to determine prevalence of parameters. Results In total 923 studies conducted in 72 countries were included. Most studies were conducted in high-income country settings (71.8%). Over half pertained to a general population of pregnant women, with the remainder focused on specific subgroups, such as women with preterm birth (6.2%) or those undergoing caesarean section (5.5%). The most common interventions of interest related to non-obstetric infections (23.9%), labour and childbirth care (17.0%), and obstetric complications (15.7%). Few studies addressed the major causes of maternal deaths globally. Over a third (36.5%) of studies were cost-utility analyses, 1.4% were cost-benefit analyses and the remainder were cost-effectiveness analyses. Conclusions This review provides a navigable, consolidated resource of economic evaluations in maternal health. We identified a clear evidence gap regarding economic evaluations of maternal health interventions in low- and middle-income countries. Future economic research should focus on interventions to address major drivers of maternal morbidity and mortality in these settings.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2023
DOI: 10.1186/S12884-023-05614-5
Abstract: In Australia, maternity care services provide care for pregnant and postpartum women and their newborns. The COVID-19 pandemic forced these services to quickly adapt and develop policies and procedures for dealing with transmission in health care facilities, as well as work under public health measures to counter its spread within the community. Despite well-documented responses and adaptations by healthcare systems, no studies have examined the experiences of maternity service leaders through the pandemic. This study aimed to explore the experiences of maternity service leaders, to understand their perspectives on what happened in health services and what was required of a leader during the COVID-19 pandemic in one Australian state. A longitudinal qualitative study collected data from 11 maternity care leaders during the pandemic in the state of Victoria. Leaders participated in a series of interviews over the 16-month study period, with a total of 57 interviews conducted. An inductive approach to developing codes allowed for semantic coding of the data, then a thematic analysis was conducted to explore patterned meaning across the dataset. One overarching theme, ‘challenges of being a maternity service leader during the pandemic’, encompassed participant’s experiences. Four sub-themes described the experiences of these leaders: (1) needing to be a rapid decision-maker, (2) needing to adapt and alter services, (3) needing to filter and translate information, and (4) the need to support people. At the beginning of the pandemic, the challenges were most acute with slow guideline development, rapid communications from the government and an urgent need to keep patients and staff safe. Over time, with knowledge and experience, leaders were able to quickly adjust and respond to policy change. Maternity service leaders played an important role in preparing and adapting services in accordance with government directives and guidelines while also developing strategies tailored to their own health service requirements. These experiences will be invaluable in designing high quality and responsive systems for maternity care in future crises.
Publisher: F1000 Research Ltd
Date: 16-05-2023
DOI: 10.12688/F1000RESEARCH.76833.2
Abstract: Background Evidence on the affordability and cost-effectiveness of interventions is critical to decision-making for clinical practice guidelines and development of national health policies. This study aimed to develop a repository of primary economic evaluations to support global maternal health guideline development and provide insights into the body of research conducted in this field. Methods A scoping review was conducted to identify and map available economic evaluations of maternal health interventions. We searched six databases (NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo) on 20 November 2020 with no date, setting or language restrictions. Two authors assessed eligibility and extracted data independently. Included studies were categorised by subpopulation of women, level of care, intervention type, mechanism, and period, economic evaluation type and perspective, and whether the intervention is currently recommended by the World Health Organization. Frequency analysis was used to determine prevalence of parameters. Results In total 923 studies conducted in 72 countries were included. Most studies were conducted in high-income country settings (71.8%). Over half pertained to a general population of pregnant women, with the remainder focused on specific subgroups, such as women with preterm birth (6.2%) or those undergoing caesarean section (5.5%). The most common interventions of interest related to non-obstetric infections (23.9%), labour and childbirth care (17.0%), and obstetric complications (15.7%). Few studies addressed the major causes of maternal deaths globally. Over a third (36.5%) of studies were cost-utility analyses, 1.4% were cost-benefit analyses and the remainder were cost-effectiveness analyses. Conclusions This review provides a navigable, consolidated resource of economic evaluations in maternal health. We identified a clear evidence gap regarding economic evaluations of maternal health interventions in low- and middle-income countries. Future economic research should focus on interventions to address major drivers of maternal morbidity and mortality in these settings.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2017
Publisher: Wiley
Date: 20-12-2021
Abstract: Pharmacological pain management options can relieve women’s pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta‐analyses, consensus about key outcomes and the development of a core outcome set is essential. To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. A review of systematic reviews and their included randomised controlled trials was undertaken. Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included ‘pain management’, ‘labour’ and variants, with no limits on year of publication or language. Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of in idual outcomes reported. Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider’s perspective or economic outcome domains. Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta‐analyses for best clinical practice. Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.
Publisher: Wiley
Date: 05-02-2023
Abstract: The Accelerating Innovation for Mothers project established a new database of candidate medicines under development between 2000 and 2021 for five pregnancy‐related conditions, including fetal growth restriction. The objective was to assess medicines for fetal growth restriction and their potential for clinical use globally. Landscape analysis. Global (focus on low‐ and middle‐income countries, LMICs). Drugs, dietary supplements and biologics under investigation for prevention or treatment of fetal growth restriction. A research pipeline database of medicines was created through searching AdisInsight, PubMed and various grant and clinical trial databases. Analysis of clinical and preclinical candidates were descriptive. Fetal growth restriction candidates in clinical development were identified and ranked as high, medium or low potential based on prespecified criteria, including efficacy, safety and accessibility. Of the 444 unique candidates in the database across all five pregnancy‐related conditions, 63 were for fetal growth restriction. Of these, 31 were in clinical development (phases I, II or III) and 32 were in preclinical development. Three candidates, aspirin, l ‐arginine and vitamin D, were ranked as having high potential as preventive agents. There were no high‐potential candidates for treating fetal growth restriction, although five candidates were ranked as having medium potential: allylestrenol, dalteparin, omega‐3 fatty acids, tadalafil, and United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP). l ‐Arginine, aspirin and vitamin D are promising, high‐potential preventative agents for fetal growth restriction. Based on the medicines pipeline, new pharmacological agents for fetal growth restriction are unlikely to emerge in the near future.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2017
DOI: 10.1038/SREP44093
Abstract: Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.
Publisher: Springer Science and Business Media LLC
Date: 20-11-2018
Publisher: Wiley
Date: 29-08-2019
DOI: 10.1002/IJGO.12929
Publisher: MDPI AG
Date: 24-02-2023
Abstract: This systematic review aimed to identify the benefits and possible harms of tocolytic therapy for preterm labour management in the context of pregnant women with extremely preterm birth, multiple gestations, or growth-restricted foetuses. A comprehensive search using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO Global Index Medicus databases was conducted from 10 to 15 July 2021. We included randomized controlled trials and non-randomized studies that assessed the effects of tocolysis compared with placebo or no treatment. We found 744 reports and, finally, nine studies (three randomized controlled trials and six cohort studies) pertaining to women with weeks of gestation were included. No eligible studies were identified among women with a multiple pregnancy or a growth-restricted foetus. A meta-analysis of the trial data showed that there were no clear differences in perinatal death nor for a delay in birth. Non-randomized evidence showed that tocolysis delayed birth by 7 days, though there was no clear difference for preterm birth. In summary, it remains unclear whether tocolytic therapy for inhibiting preterm labour is beneficial for these subgroups of women and their newborns. Further well-designed randomized controlled trials and observational studies are needed to address the lack of evidence regarding tocolytic agents in these populations.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJGH-2020-003688
Abstract: Experiences of care and satisfaction are intrinsically linked, as user’s experiences of care may directly impact satisfaction, or indirectly impact user’s expectations and values. Both experiences of care and satisfaction are important to measure so that quality can be monitored and improved. Globally, women experience mistreatment during childbirth at facilities however, there is limited evidence exploring the mistreatment and women’s satisfaction with care during childbirth. This is a secondary analysis of a cross-sectional survey within the WHO study ‘How women are treated during facility-based childbirth’ exploring the mistreatment of women during childbirth in Ghana, Guinea, Myanmar and Nigeria. Women’s experiences of mistreatment and satisfaction with care during childbirth was explored. Multivariable logistic regression modelling was conducted to evaluate the association between mistreatment, women’s overall satisfaction with the care they received, and whether they would recommend the facility to others. 2672 women were included in this analysis. Despite over one-third of women reporting experience of mistreatment (35.4%), overall satisfaction for services received and recommendation of the facility to others was high, 88.4% and 90%, respectively. Women who reported experiences of mistreatment were more likely to report lower satisfaction with care: women were more likely to be satisfied if they did not experience verbal abuse (adjusted OR (AOR) 4.52, 95% CI 3.50 to 5.85), or had short waiting times (AOR 5.12, 95% CI 3.94 to 6.65). Women who did not experience any physical or verbal abuse or discrimination were more likely to recommend the facility to others (AOR 3.89, 95% CI 2.98 to 5.06). Measuring both women’s experiences and their satisfaction with care are critical to assess quality and provide actionable evidence for quality improvement. These measures can enable health systems to identify and respond to root causes contributing to measures of satisfaction.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2015
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 28-12-2022
DOI: 10.1186/S12961-022-00941-Z
Abstract: The WHO ACTION-I trial, the largest placebo-controlled trial on antenatal corticosteroids (ACS) efficacy and safety to date, reaffirmed the benefits of ACS on mortality reduction among early preterm newborns in low-income settings. We discuss here lessons learned from ACTION-I trial that are relevant to a strategy for ACS implementation to optimize impact. Key elements included (i) gestational age dating by ultrasound (ii) application of appropriate selection criteria by trained obstetric physicians to identify women with a likelihood of preterm birth for ACS administration and (iii) provision of a minimum package of care for preterm newborns in facilities. This strategy accurately identified a large proportion of women who eventually gave birth preterm, and resulted in a 16% reduction in neonatal mortality from ACS use. Policy-makers, programme managers and clinicians are encouraged to consider this implementation strategy to effectively scale and harness the benefits of ACS in saving preterm newborn lives.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.EJOGRB.2018.09.025
Abstract: In twin pregnancies, which are at high risk of preterm birth, it is not known if maternal clinical characteristics pose additional risks. We undertook a systematic review to assess the risk of both spontaneous and iatrogenic early (<34 weeks) or late preterm birth (<37 weeks) in twin pregnancies based on maternal clinical predictors. We searched the electronic databases from January 1990 to November 2017 without language restrictions. We included studies on women with monochorionic or dichorionic twin pregnancies that evaluated clinical predictors and preterm births. We reported our findings as odds ratio (OR) with 95% confidence intervals (CI) and pooled the estimates using random-effects meta-analysis for various predictor thresholds. From 12, 473 citations, we included 59 studies (2,930,958 pregnancies). The risks of early preterm birth in twin pregnancies were significantly increased in women with a previous history of preterm birth (OR 2.67, 95% CI 2.16-3.29, I
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJGH-2020-003564
Abstract: Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool. We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment. Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9). Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.
Publisher: Wiley
Date: 05-05-2017
DOI: 10.1111/PPE.12363
Abstract: Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries. The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome. A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not. In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.
Publisher: Public Library of Science (PLoS)
Date: 18-03-2021
DOI: 10.1371/JOURNAL.PONE.0248656
Abstract: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and severe morbidity globally. When PPH cannot be controlled using standard medical treatments, uterine balloon t onade (UBT) may be used to arrest bleeding. While UBT is used by healthcare providers in hospital settings internationally, their views and experiences have not been systematically explored. The aim of this review is to identify, appraise and synthesize available evidence about the views and experiences of healthcare providers using UBT to treat PPH. Using a pre-determined search strategy, we searched MEDLINE, CINAHL, PsycINFO, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996–2019, reporting qualitative data on the views and experiences of health professionals using UBT to treat PPH. Author findings were extracted and synthesised using techniques derived from thematic synthesis and confidence in the findings was assessed using GRADE-CERQual. Out of 89 studies we identified 5 that met our inclusion criteria. The studies were conducted in five low- and middle-income countries (LMICs) in Africa and reported on the use of simple UBT devices for the treatment of PPH. A variety of cadres (including midwives, medical officers and clinical officers) had experience with using UBTs and found them to be effective, convenient, easy to assemble and relatively inexpensive. Providers also suggested regular, hands-on training was necessary to maintain skills and highlighted the importance of community engagement in successful implementation. Providers felt that administration of a simple UBT device offered a practical and cost-effective approach to the treatment of uncontrolled PPH, especially in contexts where uterotonics were ineffective or unavailable or where access to surgery was not possible. The findings are limited by the relatively small number of studies contributing to the review and further research in other contexts is required to address wider acceptability and feasibility issues.
Publisher: Massachusetts Medical Society
Date: 24-12-2020
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JCLINEPI.2016.02.017
Abstract: To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings. Secondary analysis of qualitative data. Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.
Publisher: Elsevier BV
Date: 03-2021
Publisher: John Wiley & Sons, Ltd
Date: 23-09-2013
Publisher: BMJ
Date: 05-2017
Publisher: Elsevier BV
Date: 05-2021
Publisher: Springer Science and Business Media LLC
Date: 13-01-2017
Publisher: Springer Science and Business Media LLC
Date: 11-09-2015
Publisher: Wiley
Date: 14-05-2015
Publisher: Public Library of Science (PLoS)
Date: 02-11-2016
Publisher: Wiley
Date: 08-11-2015
DOI: 10.1111/AOGS.12807
Abstract: The optimal dosing regimen of magnesium sulfate for treating preecl sia and ecl sia is unclear. Evidence from the Cochrane review of randomized controlled trials (RCTs) was inconclusive due to lack of relevant data. To complement the evidence from the Cochrane review, we assessed available data from non-randomized studies on the comparative efficacy and safety of alternative magnesium sulfate regimens for the management of preecl sia and ecl sia. Sources included Medline, EMBASE, Popline, CINAHL, Global Health Library, African Index Medicus, Biological abstract, BIOSIS and reference lists of eligible studies. We selected non-randomized study designs including quasi-RCTs, cohort, case-control and cross-sectional studies that compared magnesium sulfate regimens in women with preecl sia or ecl sia. Of 6178 citations identified, 248 were reviewed in full text and five studies of low to very low quality were included. Compared with standard regimens, lower-dose regimens appeared equally as good in terms of preventing seizures [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.46-2.28, 899 women, four studies], maternal morbidity (OR 0.47, 95%CI 0.32-0.71, 796 women, three studies), and fetal and/or neonatal mortality (OR 0.87, 95%CI 0.38-2.00, 800 women, four studies). Comparison of loading dose only with maintenance dose regimens showed no differences in seizure rates (OR 0.99, 95%CI 0.22-4.50, 146 women, two studies), maternal morbidity (OR 0.53, 95%CI 0.15-1.93, 146 women, two studies), maternal mortality (OR 0.63, 95%CI 0.05-7.50, 146 women, two studies), and fetal and/or neonatal mortality (OR 0.49, 95%CI 0.23-1.03, 146 women, two studies). Lower-dose and loading dose-only regimens could be as safe and efficacious as standard regimens however, this evidence comes from low to very low quality studies and further high quality studies are needed.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2016
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Wiley
Date: 02-10-2022
DOI: 10.5694/MJA2.51729
Publisher: Springer Science and Business Media LLC
Date: 09-2013
Publisher: Wiley
Date: 30-10-2020
DOI: 10.1002/IJGO.13393
Publisher: F1000 Research Ltd
Date: 25-02-2017
DOI: 10.12688/WELLCOMEOPENRES.15661.1
Abstract: Background: Antenatal corticosteroid treatment (ACT) has been widely accepted as a safe, beneficial treatment which improves outcomes following preterm birth. It has been shown to reduce respiratory distress syndrome and neonatal mortality and is commonly used in threatened or planned preterm delivery, as well as prior to elective Caesarean-section at term. There are some concerns however, that in some cases, ACT is used in patients where clinical benefit has not been established, or may potentially increase harm. Many women who receive ACT do not deliver preterm and the long-term consequences of ACT treatment are unclear. This study aims to evaluate the benefits and harms of ACT using latest trial evidence to allow refinement of current practice. Methods: This study will compare ACT with placebo or non-treatment. Inclusion criteria are: Randomised Controlled Trials (RCT) comparing ACT vs. no ACT (with or without placebo) in all settings. Exclusion criteria are: non-randomised or quasi-randomised studies and studies comparing single vs. multiple courses of ACT. Main outcomes are to evaluate, for women at risk of preterm birth or undergoing planned Caesarean- section, the benefits and harms of ACT, on maternal, fetal, newborn, and long-term offspring health outcomes. The in idual participant data (IPD) of identified RCTs will be collected and consecutively synthesised using meta-analysis with both a one-stage model where all IPD is analysed together and a two-stage model where treatment effect estimates are calculated for each trial in idually first and thereafter pooled in a meta-analysis. Sub-group analysis will be performed to identify heterogeneous effects of ACT across predefined risk groups. Discussion: Co-opt is the Consortium for the Study of Pregnancy Treatments and aims to complete a robust evaluation of the benefits and harms of ACT. This IPD meta-analysis will contribute to this by allowing detailed interrogation of existing trial datasets. PROSPERO registration: CRD42020167312 (03/02/2020)
Publisher: BMJ
Date: 08-2017
Publisher: Elsevier BV
Date: 10-2022
Publisher: Public Library of Science (PLoS)
Date: 23-08-2023
DOI: 10.1371/JOURNAL.PGPH.0002222
Abstract: For women infected with Mycobacterium tuberculosis , pregnancy is associated with an increased risk of developing or worsening TB disease. TB in pregnancy increases the risk of adverse maternal and neonatal outcomes, however the detection of TB in pregnancy is challenging. We aimed to identify and summarise the findings of studies regarding the clinical presentation and diagnosis of TB during pregnancy and the postpartum period (within 6 months of birth) in low-and middle-income countries (LMICs). A systematic review was conducted searching Ovid MEDLINE, Embase, CINAHL and Global Index Medicus databases. We included any primary research study of women diagnosed with TB during pregnancy or the postpartum period in LMICs that described the clinical presentation or method of diagnosis. Meta-analysis was used to determine pooled prevalence of TB clinical features and health outcomes, as well as detection method yield. Eighty-seven studies of 2,965 women from 27 countries were included. 70.4% of women were from South Africa or India and 44.7% were known to be HIV positive. For 1,833 women where TB type was reported, pulmonary TB was most common (79.6%). Most studies did not report the prevalence of presenting clinical features. Where reported, the most common were sputum production (73%) and cough (68%). Having a recent TB contact was found in 45% of women. Only six studies screened for TB using diagnostic testing for asymptomatic antenatal women and included mainly HIV-positive women ‒ 58% of women with bacteriologically confirmed TB did not report symptoms and only two were in HIV-negative women. Chest X-ray had the highest screening yield 60% abnormal results of 3036 women tested. Screening pregnant women for TB-related symptoms and risk factors is important but detection yields are limited. Chest radiography and bacteriological detection methods can improve this, but procedures for optimal utilisation remain uncertain in this at-risk population. Trial registration: Prospero registration number : CRD42020202493 .
Publisher: Wiley
Date: 13-01-2017
Publisher: Springer Science and Business Media LLC
Date: 31-01-2014
Publisher: Wiley
Date: 20-05-2019
DOI: 10.1002/IJGO.12836
Abstract: Several uterotonic options exist for prevention of postpartum hemorrhage (PPH) hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice. To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update. We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation (NHS EED) database from inception (1995) to March 2015 for eligible studies. We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies. Two reviewers independently assessed studies and extracted data organized by birth mode and setting. We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low-resource contexts, we found reasonably good evidence that misoprostol was cost-effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. Evidence on the cost-effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2014
Publisher: Springer Science and Business Media LLC
Date: 03-2021
DOI: 10.1186/S12978-021-01106-X
Abstract: Approximately 2.6 million babies are stillborn each year globally, of which 98% occur in low- and middle-income countries (LMICs). A 2019 in idual participant data meta-analysis of 6 studies from high-income countries found that maternal supine going-to-sleep position increased the risk of stillbirth. It is not clear whether this impact would be the same in LMICs, and the normal sleep behaviour of pregnant women in LMICs is not well understood. Determine the prevalence of different sleeping positions among pregnant women in LMICs, and what (if any) positions were associated with stillbirth using a systematic review. We systematically searched the databases Medline, Embase, Emcare, CINAHL and Global Index Medicus for relevant studies, with no date or language restrictions on 4 April 2020. Reference lists of included studies were also screened. Observational studies of maternal sleep position during pregnancy in LMICs Recovered citations were screened and eligible studies were included for extraction. These steps were performed by two independent reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale. A total of 3480 citations were screened but only two studies met the inclusion criteria. The studies were conducted in Ghana and India and reported on different maternal sleep positions: supine and left lateral. In Ghana, a prevalence of 9.7% for supine sleeping position amongst 220 women was found. The primary outcome could not be extracted from the Indian study as sleep position information was only reported for women who had a stillbirth (100 of the 300 participants). There is limited information on maternal sleeping position in LMICs. Since sleep position may be a modifiable risk factor for stillbirth, there is a need for further research to understand the sleep practices and behaviours of pregnant women in LMICs. PROSPERO registration: CRD42020173314
Publisher: Wiley
Date: 15-03-2018
Publisher: Public Library of Science (PLoS)
Date: 08-2013
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.EJOGRB.2018.12.022
Abstract: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality. Interventions aimed at preventing PTB can be classified as primary, secondary, or tertiary prevention. To conduct a review of systematic reviews on the effectiveness and safety of primary and secondary preterm birth prevention interventions. A systematic literature search of the Cochrane, PubMed/Medline, EMBASE and CINAHL databases was conducted on 2 September 2015, and updated on 21 November 2016. We included any published systematic review of randomized controlled trials (RCTs) or in idual patient data (IPD) of RCTs related to primary or secondary prevention of PTB, published between 2005-2016 where gestational age at birth (of any interval) was a pre-specified outcome. In idual trials and non-systematic reviews were not eligible. The population of interest was all pregnant women, regardless of PTB risk. The primary outcome was PTB < 37 weeks. In total, 112 reviews were included in this study. Overall there were 49 Cochrane and 63 non-Cochrane reviews. Eight were in idual participant data (IPD) reviews. Sixty reviews assessed the effect of primary prevention interventions on risk of PTB. Positive effects were reported for lifestyle and behavioural changes (including diet and exercise) nutritional supplements (including calcium and zinc supplementation) nutritional education screening for lower genital tract infections. Eighty-three systematic reviews were identified relating to secondary PTB prevention interventions. Positive effects were found for low dose aspirin among women at risk of preecl sia clindamycin for treatment of bacterial vaginosis treatment of vaginal candidiasis progesterone in women with prior spontaneous PTB and in those with short midtrimester cervical length L-arginine in women at risk for preecl sia levothyroxine among women with tyroid disease calcium supplementation in women at risk of hypertensive disorders smoking cessation cervical length screening in women with history of PTB with placement of cerclage in those with short cervix cervical pessary in singleton gestations with short cervix and treatment of periodontal disease. The overview serves as a guide to current evidence relevant to PTB prevention. Only a few interventions have been demononstrated to be effective, including cerclage, progesterone, low dose aspirin, and lifestyle and behavioural changes. For several of the interventions evaluated, there was insufficient evidence to assess whether they were effective or not.
Publisher: Wiley
Date: 12-07-2020
DOI: 10.1002/IJGO.13241
Publisher: Springer Science and Business Media LLC
Date: 05-07-2019
DOI: 10.1038/S41598-019-46153-4
Abstract: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) was undertaken among 173,124 multiparous women to assess the association between previous caesarean sections (CS) and pregnancy outcomes. Maternal outcomes included maternal near miss (MNM), maternal death (MD), severe maternal outcomes (SMO), abnormal placentation, and uterine rupture. Neonatal outcomes were stillbirth, early neonatal death, perinatal death, neonatal near miss (NNM), neonatal intensive care unit (NICU) admission, and preterm birth. Previous CS was associated with increased risks of uterine rupture (adjusted Odds Ratio (aOR) 7.74 95% confidence interval (CI) 5.48, 10.92) morbidly adherent placenta (aOR 2.60 95% CI 1.98, 3.40), MNM (aOR 1.91 95% CI 1.59, 2.28), SMO (aOR 1.80 95% CI 1.52, 2.13), placenta previa (aOR 1.76 95% CI 1.49, 2.07). For neonatal outcomes, previous CS was associated with increased risks of NICU admission (aOR 1.31 95% CI 1.23, 1.39), neonatal near miss (aOR 1.19 95% CI 1.12, 1.26), preterm birth (aOR 1.07 95% CI 1.01, 1.14), and decreased risk of macerated stillbirth (aOR 0.80 95% CI 0.67, 0.95). Previous CS was associated with serious morbidity in future pregnancies. However, these findings should be cautiously interpreted due to lacking data on indications of previous CS.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Public Library of Science (PLoS)
Date: 22-09-2022
Publisher: Public Library of Science (PLoS)
Date: 18-11-2022
DOI: 10.1371/JOURNAL.PGPH.0001260
Abstract: Preecl sia and ecl sia are a leading cause of global maternal and newborn mortality. Currently, there are few effective medicines that can prevent or treat preecl sia. Target Product Profiles (TPPs) are important tools for driving new product development by specifying upfront the characteristics that new products should take. Considering the lack of investment and innovation around new medicines for obstetric conditions, we aimed to develop two new TPPs for medicines to prevent and treat preecl sia. We used a multi-methods approach comprised of a literature review, stakeholder interviews, online survey, and public consultation. Following an initial literature review, erse stakeholders (clinical practice, research, academia, international organizations, funders, consumer representatives) were invited for in-depth interviews and an online international survey, as well as public consultation on draft TPPs. The level of stakeholder agreement with TPPs was assessed, and findings from interviews were synthesised to inform the final TPPs. We performed 23 stakeholder interviews and received 46 survey responses. A high level of agreement was observed in survey results, with 89% of TPP variables reaching consensus (75% agree or strongly agree). Points of discussion were raised around the target population for preecl sia prevention and treatment, as well as the acceptability of cold-chain storage and routes of administration. There is consensus within the maternal health research community on the parameters that new medicines for preecl sia prevention and treatment must achieve to meet real-world health needs. These TPPs provide necessary guidance to spur interest, innovation and investment in the development of new medicines to prevent and treat preecl sia.
Publisher: Wiley
Date: 24-11-2016
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 04-01-2023
DOI: 10.5694/MJA2.51831
Publisher: WHO Press
Date: 28-05-2019
Publisher: Informa UK Limited
Date: 27-08-2018
DOI: 10.1080/09688080.2018.1502020
Abstract: Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to "correct" disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman's experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Public Library of Science (PLoS)
Date: 09-2022
DOI: 10.1371/JOURNAL.PONE.0272982
Abstract: Over 10% of maternal deaths annually are due to sepsis. Prophylactic antibiotics and antiseptic agents are critical interventions to prevent maternal peripartum infections. We conducted a mixed-method systematic review to better understand factors affecting the use of prophylactic antibiotics and antiseptic agents to prevent peripartum infections. We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health, Global Index Medicus, and Maternity and Infant Care for studies published between 1 January 1990 and 27 May 2022. We included primary qualitative, quantitative, and mixed-methods studies that focused on women, families, and healthcare providers’ perceptions and experiences of prophylactic antibiotic and antiseptics during labour and birth in health facilities. There were no language restrictions. We used a thematic synthesis approach for qualitative evidence and GRADE-CERQual approach for assessing confidence in these review findings. Quantitative study results were mapped to the qualitative findings and reported narratively. We included 19 studies (5 qualitative, 12 quantitative and 2 mixed-methods studies), 16 relating to antibiotics, 2 to antiseptic use, and 1 study to both antibiotic and antiseptic use. Most related to providers’ perspectives and were conducted in high-income countries. Key themes on factors affecting antibiotic use were providers’ beliefs about benefits and harms, perceptions of women’s risk of infection, regimen preferences and clinical decision-making processes. Studies on antiseptic use explored women’s perceptions of vaginal cleansing, and provider’s beliefs about benefits and the usefulness of guidelines. We identified a range of factors affecting how providers use prophylactic antibiotics at birth, which can undermine implementation of clinical guidelines. There were insufficient data for low-resource settings, women’s perspectives, and regarding use of antiseptics, highlighting the need for further research in these areas. Implications for practice include that interventions to improve prophylactic antibiotic use should take account of local environments and perceived infection risk and ensure contextually relevant guidance.
Publisher: Elsevier BV
Date: 04-2019
Publisher: BMJ
Date: 04-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: WHO Press
Date: 29-11-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2020
Publisher: Elsevier BV
Date: 05-2018
Publisher: Wiley
Date: 15-01-2021
DOI: 10.1111/JPC.15333
Abstract: To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster‐randomised crossover trial in Papua New Guinea. Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty‐seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29% 10/35). Extreme multi‐organ immaturity (23% 8/35) and hypoxic ischaemic encephalopathy (17% 6/35) were the most common final causes of neonatal death. Forty‐six avoidable factors were identified among 26 deaths, including delays in care‐seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJGH-2021-006640
Abstract: Previous research on mistreatment of women during childbirth has focused on physical and verbal abuse, neglect and stigmatisation. However, other manifestations of mistreatment, such as during vaginal examinations, are relatively underexplored. This study explores four types of mistreatment of women during vaginal examinations: (1) non-consented care, (2) sharing of private information, (3) exposure of genitalia and (4) exposure of breasts. A secondary analysis of data from the WHO multicountry study ‘How Women Are Treated During Childbirth’ was conducted. The study used direct, continuous labour observations of women giving birth in facilities in Ghana, Guinea and Nigeria. Descriptive and multivariable logistic regression analyses were used to describe the different types of mistreatment of women during vaginal examinations and associated privacy measures (ie, availability of curtains). Of the 2016 women observed, 1430 (70.9%) underwent any vaginal examination. Across all vaginal examinations, 842/1430 (58.9%) women were observed to receive non-consented care 233/1430 (16.4%) women had their private information shared 397/1430 (27.8%) women had their genitalia exposed and 356/1430 (24.9%) had their breasts exposed. The observed prevalence of mistreatment during vaginal examinations varied across countries. There were country-level differences in the association between absence of privacy measures and mistreatment. Absence of privacy measures was associated with sharing of private information (Ghana: adjusted OR (AOR) 3.8, 95% CI 1.6 to 8.9 Nigeria: AOR 4.9, 95% CI 1.9 to 12.7), genitalia exposure (Ghana: AOR 6.7, 95% CI 2.9 to 14.9 Nigeria: AOR 6.5, 95% CI 2.9 to 14.5), breast exposure (Ghana: AOR 5.9, 95% CI 2.8 to 12.9 Nigeria: AOR 2.7, 95% CI 1.3 to 5.9) and non-consented vaginal examination (Ghana: AOR 2.5, 95% CI 1.4 to 4.7 Guinea: AOR 0.21, 95% CI 0.12 to 0.38). Our results highlight the need to ensure better communication and consent processes for vaginal examination during childbirth. In some settings, measures such as availability of curtains were helpful to reduce women’s exposure and sharing of private information, but context-specific interventions will be required to achieve respectful maternity care globally.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.AJOG.2012.10.003
Abstract: We sought to describe obstetric care capacity of nongovernment organization (NGO)-/faith-based organization (FBO)-run institutions compared to government-run institutions in 3 African countries using the World Health Organization Global Survey. We also compared delivery characteristics and outcomes. This is a descriptive analysis of the 22 NGO-/FBO-run institutions in Uganda, Kenya and Democratic Republic of Congo delivering 11,594 women, compared to 20 government-run institutions delivering 25,825 women in the same countries and period. Infrastructure, obstetric services, diagnostic facilities, and anesthesiology at NGO/FBO institutions were comparable to government institutions. Women delivering at NGO/FBO institutions had more antenatal care, antenatal complications, and cesarean delivery. NGO/FBO institutions had higher obstetrician attendance and lower rates of ecl sia, preterm birth, stillbirth, Apgar <7, and neonatal near miss. NGO/FBO institutions are comparable to government institutions in capacity to deliver obstetric care. NGO/FBOs have been found effective in providing delivery care in developing countries and should be appropriately recognized by stakeholders in their efforts to assist nations achieve international goals.
Publisher: Springer Science and Business Media LLC
Date: 20-09-2022
DOI: 10.1186/S12916-022-02508-9
Abstract: Non-communicable diseases (NCDs) are a leading cause of maternal mortality and morbidity worldwide. The World Health Organization is developing new recommendations focusing on the management of NCDs for pregnant, intrapartum, and postnatal women. Thus, to support the development of new guidelines and recommendations, we aimed to determine the availability, focus, and scope of recommendations of current guidelines for the management of NCDs during pregnancy, intrapartum, and postnatal period. PubMed, Global Index Medicus, TRIP, and Guideline International Network databases were searched on 31 May 2021, to identify any NCD-related guidelines published between 2011 and 2021 with no language or country restrictions. Websites of 165 professional organizations were also searched. Characteristics of included guidelines were analyzed, and recommendations were extracted from guidelines of five high-priority NCD conditions (diabetes, chronic hypertension, respiratory conditions, hemoglobinopathies and sickle cell disease, and mental and substance use disorders). From 6026 citations and 165 websites, 405 guidelines were included of which 132 (33%) were pregnancy-specific and 285 (88%) were developed in high-income countries. Among pregnancy-specific guidelines, the most common conditions for which recommendations were provided were gestational diabetes, circulatory diseases, thyroid disorders, and hypertensive disorders of pregnancy. For the five high-priority conditions, 47 guidelines were identified which provided 1834 recommendations, largely focused on antenatal care interventions (62%) such as early detection, screening tools, pharmacological treatment, and lifestyle education. Postnatal recommendations largely covered postnatal clinical assessments, lifestyle education, and breastfeeding. Health system recommendations largely covered multidisciplinary care teams and strengthening referral pathways. This study provides a robust assessment of currently available guidelines and mapping of recommendations on NCD management within maternal health services, which will inform the scope of the World Health Organization’s future guideline development activities. This study identified a need to develop guidelines that consider NCDs holistically, with an integrated approach to antenatal, intrapartum, and postnatal care, and that are relevant for resource-limited contexts. Any such guidelines should consider what interventions are most essential to improving outcomes for women with NCDs and their newborns, and how variations in quality of NCD-related care can be addressed.
Publisher: Public Library of Science (PLoS)
Date: 03-12-2020
DOI: 10.1371/JOURNAL.PONE.0243034
Abstract: The World Health Organization (WHO) recommends the administration of intramuscular antenatal corticosteroids to women at risk of preterm birth to prevent preterm-associated neonatal mortality and morbidity. Poor quality medicines are a major problem for health services in low- and middle-income countries (LMICs), however the quality of antenatal corticosteroids is not well understood. We aimed to conduct a systematic review of available studies describing the quality of recommended injectable antenatal corticosteroids (dexamethasone or betamethasone) in LMICs. Structured search strategy was applied to six databases (MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, Global Index Medicus, WHO Medicines Quality Database), without year or language restrictions. Any primary study reporting any medicine quality parameter (Active Pharmacological Ingredient, pH and sterility) for injectable dexamethasone or betamethasone was eligible. Two authors independently screened studies for eligibility, extracted data on included studies and applied Medicine Quality Assessment Reporting Guidelines tool to assess study quality. Results were reported narratively, stratified by country of manufacture, organisation type and level of care. In total, 15,547 citations were screened with two eligible studies identified that focussed on dexamethasone quality (no studies of betamethasone were identified). One study included 19 s les from 9 LMICs, and the other included “less than 100 s les” from India. The prevalence of failed dexamethasone s les ranged from 3.14% to 32.2% due to inadequate Active Pharmacological Ingredient. A higher prevalence of failed dexamethasone s les were seen at the point of care and the public sector. Poor quality maternal and newborn health medicines can endanger women and newborns. Though available evidence on antenatal corticosteroids quality in LMICs is limited, results suggested poor quality dexamethasone may be prevalent in some countries. More primary studies are required to confirm these findings and guide policymakers on procurement of good-quality maternal and newborn health medicines.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2014
Publisher: Informa UK Limited
Date: 2019
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4477236
Publisher: Elsevier BV
Date: 03-2022
Publisher: Public Library of Science (PLoS)
Date: 13-08-2012
Publisher: Springer Science and Business Media LLC
Date: 24-05-2013
Abstract: The DECIDE framework was developed to support evidence-informed health system decisions through evidence summaries tailored to health policymakers. The objective of this study was to determine policymakers’ perceptions regarding the criteria in the DECIDE framework and how best to summarise and present evidence to support health system decisions. We conducted an online survey of a erse group of stakeholders with health system decision experience from 15 countries and the World Health Organization. We asked about perceptions of criteria relevant to making health system decisions, use of evidence, grading systems, and evidence summaries. We received 112 responses (70% response rate). Most respondents had healthcare (85%) and research (79%) experience. They (99%) indicated that systematic consideration of the available evidence would help to improve health system decision-making processes and supported the use of evidence from other countries (94%) and grading systems (81%). All ten criteria in the DECIDE framework were rated as important in the decision-making process. Respondents had ergent views regarding whether the same (38%) or different (45%) grading systems should be used across different types of health decisions. All components of our evidence summary were rated as important by over 90% of respondents. Survey respondents were supportive of the DECIDE framework for health system decisions and the use of succinct summaries of the estimated size of effects and the quality of evidence. It is uncertain whether the findings of this survey represent the views of policymakers with little or no healthcare and research experience.
Publisher: Wiley
Date: 14-11-2018
Publisher: Springer Science and Business Media LLC
Date: 29-10-2019
DOI: 10.1038/S41598-019-52015-W
Abstract: Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our s le were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2023
DOI: 10.1186/S12978-022-01525-4
Abstract: The World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO’s latest guidelines for effective, respectful care during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women’s experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase) and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase). In the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women’s experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness. Findings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally. Trial registration: CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022).
Publisher: Wiley
Date: 04-10-2021
Abstract: Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO 4 ) is recommended for prevention and treatment of pre‐ecl sia/ecl sia. However, MgSO 4 remains underused, particularly in low‐ and middle‐income countries (LMICs). This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO 4 to prevent or treat pre‐ecl sia/ecl sia. We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021. Primary qualitative and mixed‐methods studies on factors affecting use of MgSO 4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion. We applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO 4 . We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO 4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO 4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation. These findings can inform policy and guideline development and improve implementation of MgSO 4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used. Global qualitative review identifies factors affecting underutilisation of MgSO 4 for pre‐ecl sia and ecl sia.
Publisher: Wiley
Date: 22-07-2015
Publisher: Wiley
Date: 04-07-2018
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJGH-2021-006872
Abstract: Women and children bear a substantial burden of the impact of conflict and instability. The number of people living in humanitarian and fragile settings (HFS) has increased significantly over the last decade. The provision of essential maternal and newborn healthcare by midwives is crucial everywhere, especially in HFS. There is limited knowledge about the interventions, support systems and enabling environments that enhance midwifery care in these settings. The aim of this paper is to identify the factors affecting an enabling environment for midwives in HFS and to explore the availability and effectiveness of support systems for midwives. A structured systematic review was undertaken to identify peer-reviewed primary research articles published between 1995 and 2020. In total, 24 papers were included from Afghanistan, Bangladesh, Nigeria, Democratic Republic of Congo, South Sudan and Sudan, Ethiopia, Pakistan, Uganda and Liberia. There were two broad themes: (1) the facilitators of, and barriers to, an enabling environment, and (2) the importance of effective support systems for midwives. Facilitators were: community involvement and engagement and an adequate salary, incentives or benefits. Barriers included: security and safety concerns, culture and gender norms and a lack of infrastructure and supplies. Support systems were: education, professional development, supportive supervision, mentorship and workforce planning. More efforts are needed to develop and implement quality midwifery services in HFS. There is an urgent need for more action and financing to ensure better outcomes and experiences for all women, girls and families living in these settings. CRD42021226323.
Publisher: Wiley
Date: 29-10-2020
DOI: 10.1111/AJO.13270
Publisher: Elsevier BV
Date: 11-2015
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-039303
Abstract: To update the WHO estimate of preterm birth rate in China in 1990–2016 and to further explore variations by geographic regions and years of occurrence. Systematic review and meta-analysis. Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018. Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case–control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses. Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990–1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015–2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016). The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.
Publisher: John Wiley & Sons, Ltd
Date: 22-07-2013
Publisher: Wiley
Date: 09-04-2021
Publisher: BMJ
Date: 22-01-2015
DOI: 10.1136/ARCHDISCHILD-2013-305514
Abstract: Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5 improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Elsevier BV
Date: 10-2016
Publisher: Elsevier BV
Date: 11-2014
Publisher: Wiley
Date: 03-2014
Abstract: To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. A total of 314 623 pregnant women admitted to the participating facilities. We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8 95% CI 3.5-4.1). Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJGH-2021-007954
Abstract: Pregnancy and childbearing among adolescents—especially younger adolescents—is associated with health complications and lost opportunities for education and personal development. In addition to established challenges adolescents and young women face in sexual and reproductive healthcare, evidence suggests that they also face mistreatment during childbirth. This is a secondary analysis of the WHO study ‘How women are treated during facility-based childbirth’ cross-sectional community survey in Ghana, Guinea, Myanmar and Nigeria. We used descriptive analysis to assess experiences of mistreatment among adolescents (15–19 years) and young women (20–24 years) and multivariable logistic regression models to assess the association between experiences of mistreatment and satisfaction with care during childbirth. 862 participants are included (15–19 years: 287, 33.3% 20–24 years: 575, 66.7%). The most common mistreatment was verbal abuse (15–19 years: 104/287, 36.2% 20–24 years: 181/575, 31.5%). There were high levels of poor communication (15–19 years: 92/287, 32.1% 20–24 years: 171/575, 29.7%), lack of supportive care (15–19 years: 22/287, 42.5% 20–24 years: 195/575, 33.9%) and lack of privacy (15–19 years: 180/287, 62.7% 20–24 years: 395/575, 68.7%). Women who were verbally abused were less likely to report satisfaction with care (adjusted OR (AOR): 0.19, 95% CI: 0.12 to 0.31) and less likely to recommend the facility (AOR: 0.24, 95% CI: 0.15 to 0.38). There were similar reports among those who were physically abused, had long waiting time, did not mobilise and did not give consent for vaginal examinations. Our study shows that adolescents and young women mistreatment during childbirth, contributing to low satisfaction with care. It is critical to recognise adolescents and young women’s unique needs in maternal healthcare and how their needs may intersect with social stigma around sex and pregnancy.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ
Date: 07-2017
Publisher: Springer Science and Business Media LLC
Date: 18-07-2023
DOI: 10.1186/S12884-023-05842-9
Abstract: There are few medicines in clinical use for managing preterm labor or preventing spontaneous preterm birth from occurring. We previously developed two target product profiles (TPPs) for medicines to prevent spontaneous preterm birth and manage preterm labor. The objectives of this study were to 1) analyse the research and development pipeline of medicines for preterm birth and 2) compare these medicines to target product profiles for spontaneous preterm birth to identify the most promising candidates. Adis Insight, Pharmaprojects, WHO international clinical trials registry platform (ICTRP), PubMed and grant databases were searched to identify candidate medicines (including drugs, dietary supplements and biologics) and populate the Accelerating Innovations for Mothers (AIM) database. This database was screened for all candidates that have been investigated for preterm birth. Candidates in clinical development were ranked against criteria from TPPs, and classified as high, medium or low potential. Preclinical candidates were categorised by product type, archetype and medicine subclass. The AIM database identified 178 candidates. Of the 71 candidates in clinical development, ten were deemed high potential ( Prevention : Omega-3 fatty acid, aspirin, vaginal progesterone, oral progesterone, L-arginine, and selenium Treatment : nicorandil, isosorbide dinitrate, nicardipine and celecoxib) and seven were medium potential ( Prevention : pravastatin and lactoferrin Treatment : glyceryl trinitrate, retosiban, relcovaptan, human chorionic gonadotropin and Bryophyllum pinnatum extract). 107 candidates were in preclinical development. This analysis provides a drug-agnostic approach to assessing the potential of candidate medicines for spontaneous preterm birth. Research should be prioritised for high-potential candidates that are most likely to meet the real world needs of women, babies, and health care professionals.
Publisher: Springer Science and Business Media LLC
Date: 31-03-2015
Publisher: Springer Science and Business Media LLC
Date: 27-05-2019
Publisher: Public Library of Science (PLoS)
Date: 13-08-2014
Publisher: Wiley
Date: 27-10-2022
Abstract: To develop target product profiles (TPPs) for new medicines for preterm birth prevention and preterm labour management that address the real‐world need of women and healthcare providers, informed by views and agreement amongst globally erse stakeholders. Mixed methods. Global (with a focus on low‐ and middle‐income countries, LMICs). Global stakeholders with erse expertise in preterm labour/birth and drug development. Following an initial literature review, erse stakeholders were invited to participate in an online international survey and in‐depth interviews. The level of stakeholder agreement with TPPs was assessed, and findings from interviews were synthesised to inform the final TPPs. Level of stakeholder agreement on the minimum and preferred requirements for preterm labour/birth medicines. We performed 21 interviews. Interview participants demonstrated strong agreement on room temperature stability, no additional drug‐specific clinical monitoring, and affordability in LMICs being the minimal acceptable requirements. Points of discussion were raised around the target population. Survey respondents included clinicians, researchers, funding agency staff, international public organisation staff, programme implementers, policymakers, representatives of consumer advocacy organisations and other relevant stakeholders from maternal health systems. Survey results indicated strong agreement amongst stakeholders, with only one variable in each TPP not reaching consensus (i.e. 25% disagree or strongly disagree). There is strong consensus within the preterm labour/birth community on the characteristics that new medicines for preterm birth prevention and preterm labour management must achieve. These TPPs provide necessary guidance to evaluate new candidates and their potential for implementation in a range of settings.
Publisher: Wiley
Date: 08-12-2017
Publisher: Springer Science and Business Media LLC
Date: 23-06-2020
DOI: 10.1038/S41598-020-66897-8
Abstract: Associations between anaesthetic techniques and pregnancy outcomes were assessed among 129,742 pregnancies delivered by caesarean section (CS) in low- and middle-income countries (LMICs) using two WHO databases. Anaesthesia was categorized as general anaesthesia (GA) and neuraxial anaesthesia (NA). Outcomes included maternal death (MD), maternal near miss (MNM), severe maternal outcome (SMO), intensive care unit (ICU) admission, early neonatal death (END), neonatal near miss (NNM), severe neonatal outcome (SNO), Apgar score at 5 minutes, and neonatal ICU (NICU) admission. A two‐stage approach of in idual participant data meta‐analysis was used to combine the results. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were presented. Compared to GA, NA were associated with decreased odds of MD (pooled OR 0.28 95% CI 0.10, 0.78), MNM (pooled OR 0.25 95% CI 0.21, 0.31), SMO (pooled OR 0.24 95% CI 0.20,0.28), ICU admission (pooled OR 0.17 95% CI 0.13, 0.22), NNM (pooled OR 0.63 95% CI 0.55, 0.73), SNO (pooled OR 0.55 95% CI 0.48, 0.63), Apgar score at 5 minutes (pooled OR 0.35 95% CI 0.29, 0.43), and NICU admission (pooled OR 0.53 95% CI 0.45, 0.62). NA therefore was associated with decreased odds of adverse pregnancy outcomes in LMICs.
Publisher: American Astronomical Society
Date: 20-09-1998
DOI: 10.1086/306150
Publisher: Springer Science and Business Media LLC
Date: 11-11-2020
DOI: 10.1186/S12884-020-03390-0
Abstract: To identify risk factors associated with a composite adverse maternal outcomes in women undergoing intrapartum cesarean birth. We used the facility-based, multi-country, cross-sectional WHO Global Survey of Maternal and Perinatal Health (2004–2008) to examine associations between woman-, labor/obstetric-, and facility-level characteristics and a composite adverse maternal outcome of postpartum morbidity and mortality. This analysis was performed among women who underwent intrapartum cesarean birth during the course of labor. We analyzed outcomes of 29,516 women from low- and middle-income countries who underwent intrapartum cesarean birth between the gestational ages of 24 and 43 weeks, 3.5% (1040) of whom experienced the composite adverse maternal outcome. In adjusted analyses, factors associated with a decreased risk of the adverse maternal outcome associated with intrapartum cesarean birth included having four or more antenatal visits (AOR 0.60 95% CI: 0.43–0.84 p = 0.003), delivering in a medium- or high-human development index country (vs. low-human development index country: AOR 0.07 95% CI: 0.01–0.85 and AOR 0.02 95% CI: 0.001–0.39, respectively p = 0.03), and malpresentation (vs. cephalic: breech AOR 0.52 CI: 0.31–0.87 p = 0.04). Women who were medically high risk (vs. not medically high risk: AOR 1.81 CI: 1.30–2.51, p 0.0004), had less education (0–6 years) (vs. 13+ years AOR 1.64 CI: 1.03–2.63 p = 0.01), were obstetrically high risk (vs. not high risk AOR 3.67 CI: 2.58–5.23 p 0.0001), or had a maternal or obstetric indication (vs. elective: AOR 4.74 CI: 2.36–9.50 p 0.0001) had increased odds of the adverse outcome. We found reduced adverse maternal outcomes of intrapartum cesarean birth in women with ≥ 4 antenatal visits, those who delivered in a medium or high human development index country, and those with malpresenting fetuses. Maternal adverse outcomes associated with intrapartum cesarean birth were medically and obstetrically high risk women, those with less education, and those with a maternal or obstetric indication for intrapartum cesarean birth.
Publisher: Wiley
Date: 05-12-2021
DOI: 10.5694/MJA2.51353
Publisher: Wiley
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 26-01-2023
DOI: 10.1186/S12884-022-05322-6
Abstract: Globally, 2.5 million babies die in the first 28 days of life each year with most of these deaths occurring in low- and middle-income countries. Early recognition of newborn danger signs is important in prompting timely care seeking behaviour. Little is known about women’s knowledge of newborn danger signs in Papua New Guinea. This study aims to assess this knowledge gap among a cohort of women in East New Britain Province. This study assessed knowledge of newborn danger signs (as defined by the World Health Organization) at three time points from a prospective cohort study of women in East New Britain Province, factors associated with knowledge of danger signs after childbirth were assessed using logistic regression. This study includes quantitative and qualitative interview data from 699 pregnant women enrolled at their first antenatal clinic visit, followed up after childbirth ( n = 638) and again at one-month post-partum ( n = 599). Knowledge of newborn danger signs was very low. Among the 638 women, only 9.4% knew three newborn danger signs after childbirth and only one knew all four essential danger signs defined by Johns Hopkins University ‘Birth Preparedness and Complication Readiness’ Index. Higher knowledge scores were associated with higher gravidity, income level, partner involvement in antenatal care, and education. Low levels of knowledge of newborn danger signs among pregnant women are a potential obstacle to timely care-seeking in rural Papua New Guinea. Antenatal and postnatal education, and policies that support enhanced education and decision-making powers for women and their families, are urgently needed.
Publisher: Wiley
Date: 03-2014
Abstract: To assess the association between advanced maternal age (AMA) and adverse pregnancy outcomes. Secondary analysis of the facility-based, cross-sectional data of the WHO Multicountry Survey on Maternal and Newborn Health. A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. A total of 308 149 singleton pregnant women admitted to the participating health facilities. We estimated the prevalence of pregnant women with advanced age (35 years or older). We calculated adjusted odds ratios of in idual severe maternal and perinatal outcomes in these women, compared with women aged 20-34 years, using a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. The confounding factors included facility and in idual characteristics, as well as country (classified by maternal mortality ratio level). Severe maternal adverse outcomes, including maternal near miss (MNM), maternal death (MD), and severe maternal outcome (SMO), and perinatal outcomes, including preterm birth (<37 weeks of gestation), stillbirths, early neonatal mortality, perinatal mortality, low birthweight (<2500 g), and neonatal intensive care unit (NICU) admission. The prevalence of pregnant women with AMA was 12.3% (37 787/308 149). Advanced maternal age significantly increased the risk of maternal adverse outcomes, including MNM, MD, and SMO, as well as the risk of stillbirths and perinatal mortalities. Advanced maternal age predisposes women to adverse pregnancy outcomes. The findings of this study would facilitate antenatal counselling and management of women in this age category.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2016
Publisher: Springer Science and Business Media LLC
Date: 22-07-2015
Publisher: Wiley
Date: 10-08-2015
No related grants have been discovered for Joshua Vogel.