1.  Title: Male condoms protect against bacterial vaginosis. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2009]. [1] p. (Research Briefs on the Male Condom) Abstract: Consistent condom use can reduce a woman's risk of acquiring bacterial vaginosis (BV), according to a study in Madagascar. Language: English Keywords: MADAGASCAR | SUMMARY REPORT | MULTIVARIATE ANALYSIS | SEX WORKERS | VAGINOSIS | PREVALENCE | RISK FACTORS | CONDOM USE | PREGNANCY COMPLICATIONS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Data Analysis | Research Methodology | Sex Behavior | Behavior | Vaginal Abnormalities | Diseases | Measurement | Health | Risk Reduction Behavior Document Number: 331749 |
2.  Peer Reviewed Title: Term extrauterine pregnancy in a Nigerian mother: a complication of uterine dehiscence. Author: Adesiyun AG; Audu AI Source: Archives of Gynecology and Obstetrics. 2009 Jan;279(1):75-7. Abstract: Abdominal pregnancy is an uncommon but life-threatening form of ectopic pregnancy. It is associated with high maternal/fetal morbidity and mortality. We present a rare case of term abdominal pregnancy resulting from anterior uterine wall dehiscence, in a 36-year-old woman with three previous caesarean sections. The diagnosis was made at laparotomy for the fourth "caesarean section". Language: English Keywords: NIGERIA | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | PREGNANCY, ABDOMINAL | PREGNANCY COMPLICATIONS | TREATMENT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy, Ectopic | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341008 |
| 3. Title: Sonographic findings of uterine rupture with expulsion of the fetus into broad ligament. Author: Attarde VY; Patil P; Chaudhari R; Zope N; Apte A Source: Journal of Clinical Ultrasound. 2009 Jan;37(1):50-2. Abstract: We report the sonographic findings of a rare case of uterine rupture with extrusion of the fetus into the broad ligament during a second-trimester abortion. Sonography revealed the empty uterus with an indistinct defect on the side wall and the dead fetus lying outside, surrounded by a thin membrane. At surgery, the uterine rupture was confirmed with the fetus lying in the broad ligament. This study shows the importance of timely sonography in second-trimester abortion, enabling immediate management and preventing further complications. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | WOMEN | UTERINE PERFORATION | PREGNANCY, SECOND TRIMESTER | ULTRASONICS | UTERINE EFFECTS | ABORTION | MEDICAL PROCEDURES | PREGNANCY COMPLICATIONS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Perforations | Diseases | Pregnancy | Reproduction | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Fertility Control, Postconception | Family Planning Document Number: 330846 Notification |
| 4. Title: Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. Author: Chowdhury JR; Chaudhuri S; Bhattacharyya N; Biswas PK; Panpalia M Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):119-125. Abstract: Objectives: Our objective was to compare intramuscular (i.m.) magnesium sulfate with a low dose intravenous (i.v.) magnesium sulfate regimen in prevention of convulsion recurrence and maternal deaths in women with eclampsia. Methods: This prospective trial was conducted in Nilratan Sircar Medical College, India from January 2001 to December 2005. All women with a clinical diagnosis of eclampsia were included in the trial. Magnesium sulfate (4 gm) was given as an i.v. loading dose, followed by either i.m. injections as recommended by Pritchard or low dose i.v. infusions (0.6 gm/h). Primary measures of outcome were recurrence of convulsions and maternal death. Secondary measures of outcome were potentially life threatening events, events related to labor and delivery as well as perinatal mortality and morbidity. Results: Of the 630 women participating in the trial, 480 women received i.m. magnesium sulphate according to the Pritchard regimen and 150 women were subjected to a low dose i.v. regimen ofmagnesium sulphate. There was no significant difference in recurrence of convulsion (3.3% in the i.m. and 2% in the i.v. groups P = 0.586). Maternal deaths were not significantly lower in the i.v. group than the i.m. group (5% in the i.m. and 3.3% in the i.v. groups, P = 0.506) There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality. Conclusion: Low dose i.v. magnesium sulfate regimen is equally effective in prevention of convulsion recurrence and maternal deaths in eclamptic women when compared with an i.m. magnesium sulfate regimen. Language: English Keywords: INDIA | RESEARCH REPORT | COMPARATIVE STUDIES | PREECLAMPSIA | PREGNANCY COMPLICATIONS | DRUGS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 340214 |
| 5. Title: Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Author: Christian P; Khatry SK; Leclerq SC; Dali SM Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 13; Abstract: OBJECTIVE: To examine the effect of supplemental prenatal folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrients on maternal morbidity in rural Nepal. METHODS: A cluster-randomized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation. Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity. RESULTS: A total of 3986 (97.3%) women completed an interview regarding labor and delivery; morbidity history was available for 3564 (87.0%) women. Folic acid-iron reduced the risk of postpartum hemorrhage (relative risk [RR] 0.59; 95% confidence interval [CI] 0.35-0.98). Risk of dysfunctional labor increased with multiple micronutrient supplementation (RR 1.28; 95% CI, 1.01-1.60), although preterm premature rupture of membrane decreased (RR 0.40; 95% CI, 0.21-0.79). Puerperal sepsis was lower in those receiving folic acid-iron, folic acid-iron-zinc, and multiple micronutrients compared with controls (P<0.05). CONCLUSION: Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | CHILDBIRTH | PREGNANCY COMPLICATIONS | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | PUERPERAL DISORDERS | VITAMINS AND MINERALS | FOLIC ACID | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Physiology | Biology Document Number: 341459 |
| 6. Title: [Czech model for decrease of maternal mortality in Uganda] Cesky model pro snizeni materske umrtnosti v Ugande. Author: Donat J Source: Casopis Lekaru Ceskych. 2009;148(7):338-41. Abstract: High maternal and perinatal mortality is the leading problem of the health care in developing countries of Sub-Saharan Africa, including Uganda. The main condition for decrease of maternal mortality is availability of an emergency obstetrical care in hospital accompanied by skilled team of specialists (gynaecologist, anaesthesiologist, paediatrician), which are able to treat all obstetrical complications and provide an intensive care to risk newborns. The Czech Hospital and School for midwives in Uganda was founded and build with the aim to accomplish a grant project for the decrease of maternal, perinatal and child mortality. Our project to connect emergency obstetrical care in hospital to villages and traditional delivery attendants by mobile phones shows a simple and original model, which can help to decrease maternal mortality in Uganda and in the other countries of Sub-Saharan Africa as well. The Czech-Uganda Hospital started its work on 19th February 2007 with a team of Slovak doctors; however, till now, after 2 years of work, it doesn't fulfil its role of a specialised obstetrical department, which would be able to join its partners in villages and start the grant project for decrease of maternal and perinatal mortality. Language: Czech Keywords: UGANDA | AFRICA, SUB SAHARAN | RESEARCH REPORT | MATERNAL MORTALITY | PERINATAL MORTALITY | EMERGENCY SERVICES | PREGNANCY COMPLICATIONS | MIDWIVES AND MIDWIFERY | PREVENTION AND CONTROL | Africa, Eastern | Africa | Developing Countries | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Diseases | Health Personnel Document Number: 342652 |
| 7. Peer Reviewed Title: Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries. Author: Filippi V Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):389-400. Abstract: Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | INCIDENCE | PREGNANT WOMEN | PREGNANCY COMPLICATIONS | EMERGENCY SERVICES | QUALITY OF HEALTH CARE | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 341304 |
| 8. Peer Reviewed Title: Saving mother's lives: programs that work. Author: Fortney JA; Leong M Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):224-36. Abstract: Maternal mortality is a complex problem requiring complex responses. Nevertheless, every intervention must operate through one of 3 pathways: preventing pregnancy, preventing complications, or preventing death when obstetric complications occur. We describe interventions following each pathway and assess their evidence base. In general, the more specific the intervention (such as procedures) the stronger the evidence. Broad interventions ("programs" for example) have a weaker evidence base although evidence is accumulating. The potential for robust evidence for effective programs is limited by epidemiologic design-the logistic difficulties of randomization, blinding, and single impact variables. Language: English Keywords: GLOBAL | RECOMMENDATIONS | POLICYMAKERS | COMMUNITY | SAFE MOTHERHOOD | MATERNAL MORTALITY | INTERVENTIONS | PREGNANCY COMPLICATIONS | OBSTETRICS | EMERGENCY SERVICES | MATERNAL HEALTH SERVICES | PROGRAM EFFECTIVENESS | FAMILY PLANNING PROGRAMS | Administrative Personnel | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Population | Maternal Health | Health | Mortality | Population Dynamics | Demographic Factors | Programs | Diseases | Medicine | Health Services | Delivery of Health Care | Maternal-Child Health Services | Primary Health Care | Program Evaluation | Family Planning Document Number: 342175 |
| 9. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
| 10. Peer Reviewed Title: Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease. Author: Gaffield ME; Kapp N; Curtis KM Source: Contraception. 2009 Oct;80(4):363-71. Abstract: BACKGROUND: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy. STUDY DESIGN: We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated. RESULTS: Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies. CONCLUSIONS: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method. Language: English Keywords: GLOBAL | LITERATURE REVIEW | CLINICAL RESEARCH | NEOPLASMS | FETAL MEMBRANES | PREGNANCY COMPLICATIONS | CANCER | GONADOTROPINS, CHORIONIC | ORAL CONTRACEPTIVES, COMBINED | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | CONTRACEPTIVE SAFETY | Research Methodology | Diseases | Fetus | Pregnancy | Reproduction | Gonadotropins | Hormones | Endocrine System | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | IUD | Safety | Public Health | Health Document Number: 342770 |
| 11. Title: Confidential inquiries into maternal deaths: Modifications and adaptations in Ghana and Indonesia. Author: Hussein J; D'Ambruoso L; Armar-Klemesu M; Achadi E; Arhinful D; Izati Y; Ansong-Tornui J Source: International Journal of Gynaecology and Obstetrics. 2009 May 8; Abstract: OBJECTIVE: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia. METHODS: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected. RESULTS: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours. CONCLUSION: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners. Language: English Keywords: GHANA | INDONESIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | CONFIDENTIAL INFORMATION | MATERNAL MORTALITY | PERCEPTION | MOTIVATION | TIME FACTORS | PREGNANCY COMPLICATIONS | ECONOMIC FACTORS | AUTOPSY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Research Methodology | Economic Development | Population Characteristics | Demographic Factors | Population | Ethics | Sociocultural Factors | Mortality | Population Dynamics | Psychological Factors | Behavior | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341454 |
| 12. Peer Reviewed Title: Emergency obstetric care and referral: experience of two midwife-led health centres in rural Rajasthan, India. Author: Iyengar K; Iyengar SD Source: Reproductive Health Matters. 2009 May;17(33):9-20. Abstract: This paper documents the experience of two health centres in a primary health service located in interior rural areas of southern Rajasthan, northern India, where trained nurse-midwives are providing skilled maternal and newborn care round the clock daily. The nurse-midwives independently detect and manage complications and decide when to refer women to the nearest hospital for emergency care, in telephonic consultation with a doctor if required. From 2000-2008, 2,771 women in labour and 202 women with maternal emergencies who were not in labour were attended by nurse-midwives. Of women in labour, 21% had a life-threatening complication or its antecedent condition and 16% were advised referral, of which two-thirds complied. Compliance with referral was higher for maternal conditions than fetal conditions. Among the 202 women who came with complications antenatally, post-abortion or post-partum, referral was advised for 70%, of whom 72% complied. The referral system included counselling, arranging transport, accompanying women, facilitating admission and supporting inpatient care, and led to higher referral compliance rates. There was only one maternal death in nine years. We conclude that trained nurse-midwives can significantly improve access to skilled maternal and neonatal care in rural areas, and manage maternal complications with and without the need for referral. Protocols must acknowledge that some families might not comply with referral advice, and also that initial care by nurse-midwives can reverse progression of certain complications and thereby avert the need for referral. Spanish Abstract: Este artículo documenta la experiencia de dos centros de salud de primer nivel situados en zonas rurales del interior de Rajasthan meridional, en la India septentrional, donde enfermeras-parteras profesionales capacitadas brindan atención calificada a madres y recién nacidos las 24 horas del día. Independientemente, ellas detectan y manejan complicaciones y deciden cuándo remitir a las mujeres al hospital más cercano para que reciban atención de urgencia, en consulta telefónica con un médico si es necesario. Desde 2000 a 2008, 2,771 mujeres en trabajo de parto y 202 con urgencias maternas, que no estaban de parto, fueron atendidas por enfermeras-parteras profesionales. De las que estaban de parto, el 21% presentó una complicación que puso en riesgo su vida, o su afección antecedente, y el 16% fueron aconsejadas referencia y, de éstas, dos terceras partes accedieron. El cumplimiento de la referencia fue más alto para las afecciones maternas que para las fetales. Entre las 202 mujeres que llegaron con complicaciones antenatales, se aconsejó referencia postaborto o posparto al 70%, de las cuales el 72% accedieron. El sistema de referencia incluyó consejería, planes de transporte, acompañar a las mujeres, facilitar admisión y atención con apoyo a las pacientes internadas, por lo cual aumentaron las tasas de cumplimiento de referencias. En nueve años hubo una sola muerte materna. Concluimos que las enfermeras-parteras profesionales capacitadas pueden mejorar considerablemente el acceso a la atención materna y neonatal calificada en zonas rurales, y manejar las complicaciones maternas con o sin la necesidad de referencias. Los protocolos deben reconocer la posibilidad de que algunas familias no sigan el consejo de referencia, y que la atención inicial brindada por enfermeras-parteras profesionales puede detener la evolución de algunas complicaciones y evitar la necesidad de referencia. French Abstract: Dans deux centres de santé d’un service de soins de santé primaires situé dans des zones rurales de l’intérieur du Rajasthan méridional, en Inde septentrionale, des infirmières sages-femmes formées assurent des soins de la mère et du nouveau-né tous les jours, 24 heures sur 24. Les infirmières sages-femmes décèlent et prennent en charge indépendamment les complications et décident quand transférer les femmes à l’hôpital le plus proche pour des soins d’urgence, si nécessaire en consultation téléphonique avec un médecin. De 2000 à 2008, les infirmières sages-femmes se sont occupées de 2771 femmes en couches et de 202 femmes avec d’autres urgences maternelles. Sur les femmes en couches, 21% présentaient une complication pouvant entraîner la mort ou son stade précédent ; et 16% se sont vu conseiller un transfert et les trois quarts l’ont accepté. L’acceptation du transfert était plus élevée pour les problèmes maternels que fœtaux. Un transfert a été conseillé à 70% des 202 femmes présentant des complications prénatales, post-avortement ou post-partum, et 72% d’entre elles l’ont accepté. Le système de transfert comprenait des conseils, l’organisation du transport, l’accompagnement des patientes, l’aide à l’admission et aux soins hospitaliers ; il a accru les taux d’acceptation du transfert. Un seul décès maternel a été enregistré en neuf ans. Nous en concluons que, dans les zones rurales, les infirmières sages-femmes formées peuvent notablement élargir l’accès à des soins maternels et néonatals compétents, et prendre en charge les complications maternelles nécessitant ou non un transfert. Les protocoles doivent reconnaître qu’il arrive que des familles ne suivent pas les recommandations de transfert et aussi que les soins donnés initialement par des infirmières sages-femmes peuvent régler certaines complications et éviter la nécessité d’un transfert de la patiente. Language: English Keywords: INDIA | EVALUATION REPORT | NURSE-MIDWIVES | EMERGENCY SERVICES | OBSTETRICS | PRIMARY HEALTH CARE | REFERRAL AND CONSULTATION | RURAL HEALTH CENTERS | MATERNAL-CHILD HEALTH SERVICES | PROGRAM ACCESSIBILITY | PREGNANCY COMPLICATIONS | COUNSELING | Asia, Southern | Asia | Developing Countries | Evaluation | Health Personnel | Delivery of Health Care | Health | Health Services | Medicine | Program Activities | Programs | Organization and Administration | Health Facilities | Program Evaluation | Diseases | Clinic Activities Document Number: 342011 |
| 13. Peer Reviewed Title: Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. Author: Iyengar K; Iyengar SD; Suhalka V; Dashora K Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):293-302. Abstract: In 2002-2003, all deaths (n=156) of women aged 15-49 years in a block of southern Rajasthan were investigated to determine the cause of death and care-seeking behaviour. Family members of 156 (98%) of 160 deceased women were interviewed following the comprehensive listing of all deaths among women of reproductive age. Of the 156 deaths, 31 (20%) were pregnancy-related; 77% of these women died during the postpartum period, and 74% of the deaths occurred in the home. Direct and indirect obstetric causes were responsible for 58% and 29% of the deaths respectively; 12% were injury-related deaths. Medical care was sought for 65% of the women, and 29% were hospitalized. Family perception of not being able to afford treatment at distant hospitals was a major barrier to seeking care, and 60% of those who sought care had to borrow money for treatment. Lack of skilled attendance and immediate postpartum care were major factors contributing to deaths. Improved access to emergency obstetric care facilities in rural areas and steps to eliminate costs at public hospitals would be crucial to prevent pregnancy-related deaths. Language: English Keywords: INDIA | RURAL AREAS | RESEARCH REPORT | CASE HISTORIES | LOW LITERATES | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | AUTOPSY | CAUSES OF DEATH | RURAL HEALTH SERVICES | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | OBSTACLES | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Data Collection | Research Methodology | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Organization and Administration Document Number: 341928 |
| 14. Peer Reviewed Title: Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps. Author: Jafarey SN; Rizvi T; Koblinsky M; Kureshy N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):170-83. Abstract: In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. Language: English Keywords: PAKISTAN | RESEARCH REPORT | MATERNAL MORTALITY | CAUSES OF DEATH | RISK FACTORS | AUTOPSY | DEATH RECORDS | SOCIOECONOMIC STATUS | PREGNANCY COMPLICATIONS | PREGNANCY OUTCOMES | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Mortality | Population Dynamics | Demographic Factors | Population | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Vital Statistics | Population Statistics | Research Methodology | Socioeconomic Factors | Economic Factors | Diseases | Pregnancy | Reproduction Document Number: 341936 |
| 15. Peer Reviewed Title: Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh. Author: Kalim N; Anwar I; Khan J; Blum LS; Moran AC; Botlero R; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):156-69. Abstract: In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care. Language: English Keywords: BANGLADESH | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | POSTPARTUM | BLEEDING | ECLAMPSIA | KNOWLEDGE | UTILIZATION OF HEALTH CARE | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | PERCEPTION | SOCIOCULTURAL FACTORS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Demographic Factors | Population | Puerperium | Reproduction | Signs and Symptoms | Diseases | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Psychological Factors | Behavior Document Number: 341993 |
| 16. Title: Pregnancy and HIV-positive patients FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. Author: Milliez J Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 25; Abstract: This report contains background issues about pregnancy and HIV-positive patients and specific recommendations for each issue. Language: English Keywords: GLOBAL | CRITIQUE | EVALUATION | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | DISABLED PERSONS AND DISABILITIES | ETHICS | REPRODUCTIVE RIGHTS | HIV INFECTIONS | PREGNANCY COMPLICATIONS | SOCIAL DISCRIMINATION | WOMEN'S RIGHTS | LITIGATION | INTERNATIONAL COOPERATION | MATERNAL HEALTH SERVICES | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Sociocultural Factors | Human Rights | Political Factors | Social Problems | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 341458 |
| 17. Peer Reviewed Title: Obstetric fistulae in West Africa: patient perspectives. Author: Nathan LM; Rochat CH; Grigorescu B; Banks E Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e40-2. Abstract: OBJECTIVE: The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. STUDY DESIGN: At l'Hopital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. RESULTS: The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. CONCLUSION: Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients. Language: English Keywords: AFRICA, WESTERN | RESEARCH REPORT | WOMEN | CLIENTS | FISTULA | MORBIDITY | PUBLIC HEALTH | PREGNANCY COMPLICATIONS | Developing Countries | Africa, Sub Saharan | Africa | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Diseases | Health Document Number: 341240 |
| 18. Peer Reviewed Title: Adolescent pregnancies and deliveries: problems encountered. Author: Nkwabong E; Fomulu JN Source: Tropical Doctor. 2009 Jan;39(1):9-11. Abstract: Teenage pregnancies are increasing and need special attention. The aim of this retrospective study, conducted from 1 January 2004 to 31 December 2004 at the maternity department of the Yaounde University Teaching Hospital, Cameroon, was to analyze the evolution of pregnancy and delivery in primiparous teenagers. The medical files of 190 teenagers and 403 patients aged between 20 and 25 years were analyzed and compared. Mean gestational age, the rate of pregnancy-induced hypertensive disease and the caesarean section rate were similar in both groups. However, there were a greater number of low Apgar scores, vaginal tears and instrumental deliveries in teenagers. Those aged 15 years or less had the additional risk of an increased rate of preterm labour, low birth weight and early neonatal death. Therefore, pregnancies and deliveries among teenagers, especially those aged 15 years or less, should be monitored regularly. Language: English Keywords: CAMEROON | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | PREGNANT WOMEN | ADOLESCENTS, FEMALE | YOUTH | CHILDBIRTH | ADOLESCENT PREGNANCY | PRIMIPARITY | AGE FACTORS | PREGNANCY COMPLICATIONS | CESAREAN SECTION | PREMATURE BIRTH | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Adolescents | Pregnancy Outcomes | Pregnancy | Reproduction | Reproductive Behavior | Fertility | Population Dynamics | Parity | Fertility Measurements | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331070 |
| 19. Title: Influence of provider training on quality of emergency obstetric care in Kenya. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Author: Olenja J; Godia P; Kibaru J; Egondi T Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [33] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 3) Abstract: In addition to infectious diseases, maternal and neonatal conditions account for a substantial part of the health gap between rich and poor countries. For example, more than 99 percent of maternal deaths occur in the developing world. The majority of the deaths are caused by direct obstetric complications, including haemorrhage, sepsis, eclampsia, obstructed labour, and unsafe abortion practices. In Kenya, complications related to pregnancy and childbirth are leading causes of morbidity and mortality, translating to 414 maternal deaths per 100,000 live births. Although 88 percent of Kenyan women attend antenatal care, only 40 percent deliver in the health facilities, and only 42 percent of all deliveries have skilled attendance at delivery. In the Kenyan context, access to and use of quality emergency obstetric care (EmOC) are essential to efforts aimed at reducing maternal morbidity and mortality. We examine data from the 2004 Kenya Service Provision Assessment (KSPA) to assess the availability of EmOC services in Kenya, and to demonstrate the importance of health worker training in the delivery of these life-saving services. We find that less than 20 percent of maternal health workers interviewed had received training in focused antenatal or postnatal care in the last three years. Among caregivers providing delivery services, only 18 percent had received training in lifesaving skills, and only 37 percent had received training in the prevention of mother-to-child transmission of HIV during the last three years. Our analysis also demonstrates that training is a critical element in the detection and management of complications. Recent training in relevant subject matter was found to be significantly and positively associated with the ability to provide quality care in the event of unsafe abortion and postpartum haemorrhage. Training was also positively associated with the ability to provide appropriate care in the event of a retained placenta. The obvious recommendation is to ensure that up-to-date, quality training is provided to a broad base of health workers at all types of facilities, particularly at the local facilities that are the first point of contact for women experiencing an obstetric emergency. It is recognized that there are logistical obstacles to increasing the number of health workers who receive training. Further, although we isolated the element of training for this analysis, it is clear from these findings that for optimal service outcome, quality-of-care training has to be undertaken within the context of improved infrastructure and as a support to service delivery. Language: English Keywords: KENYA | RESEARCH REPORT | HEALTH SURVEYS | HEALTH PERSONNEL | EMERGENCY PERSONNEL | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | EMERGENCY SERVICES | OBSTETRICS | QUALITY OF HEALTH CARE | EDUCATIONAL STATUS | PREGNANCY COMPLICATIONS | DELIVERY OF HEALTH CARE | HEALTH SERVICES EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Medicine | Program Evaluation | Programs | Organization and Administration | Socioeconomic Status | Socioeconomic Factors | Diseases Document Number: 329886 |
| 20. Title: Pregnancy after ureterosigmoidostomy for vesicovaginal fistula. Author: Opare-Addo HS; Danso KA; Turpin CA Source: International Journal of Gynaecology and Obstetrics. 2009 Mar 31; Abstract: This report describes a pregnancy and subsequent preterm delivery in a patient who underwent ureterosigmoidostomy for incurable vesicovaginal fistula at the Komfo Anokye Teaching Hospital, Ghana. The patient presented in 1990 at the age of 14 years with a vesicovaginal fistula caused by prolonged obstructed labor. The fistula involved the bladder neck and the distal urethra. Although the defect was successfully closed, the patient remained incontinent from a scarred "drained pipe" distal urethra and damaged bladder neck. The patient subsequently underwent a sling procedure using synthetic material but this did not improve the incontinence. In 1994, bilateral ureterosigmoidostomy was performed; although the patient regained continence, bowel movements occurred 5-6 times a day. The patient was put on oral alkalinizing agents, remained healthy, and returned to work. Four years later the patient presented with amenorrhea that had been ongoing for 3.5 months. Ultrasound confirmed an intrauterine fetus at 15 weeks of gestation. The patient's pregnancy remained uneventful until premature rupture of membranes at 33 weeks of gestation. The patient received 24 mg of dexamethasone over 24 hours in 2 divided doses and was started on a course of antibiotics. Labor began 2 days after admission and a cesarean delivery was performed because of low birth weight. The outcomew as a healthy female neonate weighing 1600 g. Ten years later, in 2008, the patient remained healthy and continent. Her daughter is alive and healthy. Published data on pregnancy after urinary diversion, especially after incurable vesicovaginal fistula, are scarce. Reporting such pregnancies and their outcomes is important to allow accumulation of data to improve counseling and patient management. Our patient, unlike in earlier reports, did not develop dilatation or infection of the kidneys and upper urinary tract, nor was the continence mechanism compromised during pregnancy. However, the patient suffered preterm rupture of membranes and subsequent preterm labor, which is a common occurrence in pregnancy after obstetric fistula repair. The potential effect of metabolic sequelae on fetal growth and preterm labor in pregnancy following ureterosigmoidostomy needs further investigation. (full-text) Language: English Keywords: GHANA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | VESICOVAGINAL FISTULA | PREGNANCY COMPLICATIONS | OBSTETRICAL SURGERY | CHILDBIRTH | AMENORRHEA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | LOW BIRTH WEIGHT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Urogenital Effects | Urogenital System | Physiology | Biology | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Menstruation Disorders | Drugs | Population Dynamics | Birth Weight | Body Weight Document Number: 341467 |
| 21. Title: Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India. Author: Patted SS; Goudar SS; Naik VA; Bellad MB; Edlavitch SA; Kodkany BS; Patel A; Chakraborty H; Derman RJ; Geller SE Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):24-8. Abstract: OBJECTIVE: To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH). METHODS: One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe. RESULTS: Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p < 0.001) and fever (4.2%vs. 1.1%, p < 0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p < 0.001) and fever (1.4%vs. 0.4%, p < 0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns. CONCLUSIONS: Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | COMMUNITY HEALTH SERVICES | SIDE EFFECTS | MISOPROSTOL | BLEEDING | PREVENTION AND CONTROL | PREGNANCY COMPLICATIONS | ORAL CONTRACEPTIVES, SIDE EFFECTS | SIGNS AND SYMPTOMS | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Puerperium | Reproduction | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Diseases | Contraceptive Safety | Safety | Public Health Document Number: 330717 |
| 22. Peer Reviewed Title: Human immunodeficiency virus co-infection increases placental parasite density and transplacental malaria transmission in Western Kenya. Author: Perrault SD; Hajek J; Zhong K; Owino SO; Sichangi M; Smith G; Shi YP; Moore JM; Kain KC Source: American Journal of Tropical Medicine and Hygiene. 2009 Jan;80(1):119-25. Abstract: Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90-15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80-3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59-505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection. Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVALENCE | HIV INFECTIONS | COMPLICATIONS | MALARIA | CONGENITAL ABNORMALITIES | PREGNANCY COMPLICATIONS | MOTHER-TO-CHILD TRANSMISSION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Parasitic Diseases | Neonatal Diseases and Abnormalities | Transmission | Infections Document Number: 330313 |
| 23. Peer Reviewed Title: Maternal mortality-reduction programme in Andhra Pradesh. Author: Prakasamma M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):220-34. Abstract: Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two decades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the disproportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weakening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services. Language: English Keywords: INDIA | RESEARCH REPORT | CASE STUDIES | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | CAUSES OF DEATH | MATERNAL HEALTH SERVICES | PROGRAM ACCESSIBILITY | HEALTH FACILITIES | SAFE MOTHERHOOD | PREGNANCY COMPLICATIONS | UTILIZATION OF HEALTH CARE | AWARENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Maternal Health | Diseases | Knowledge | Sociocultural Factors Document Number: 341933 |
| 24. Title: Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz. Author: Roost M; Altamirano VC; Liljestrand J; Essen B Source: BJOG. 2009 Aug;116(9):1210-7. Abstract: OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health. Language: English Keywords: BOLIVIA | URBAN AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | HOSPITALS | MATERNAL MORTALITY | MORBIDITY | PREGNANCY COMPLICATIONS | INFECTIONS | MATERNAL HEALTH SERVICES | REFERRAL AND CONSULTATION | Developing Countries | South America, Central | South America | Latin America | Americas | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Mortality | Population Dynamics | Demographic Factors | Diseases | Maternal-Child Health Services | Primary Health Care | Program Activities | Programs | Organization and Administration Document Number: 342832 |
| 25. Title: Contraception and thrombophilia. Author: Rott H; Krumpel A; Kappert G; Nowak-Gottl U; Halimeh S Source: Hamostaseologie. 2009 May;29(2):193-6. Abstract: The risk of thromboembolic events (TE) is increased by acquired or inherited thrombophilias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contraception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values . Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods. Language: English Keywords: FEDERAL REPUBLIC OF GERMANY | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | ADOLESCENTS, FEMALE | THROMBOEMBOLISM | CONTRACEPTIVE SAFETY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRAINDICATIONS | CONTRACEPTIVE AGENTS, PROGESTIN | PREGNANCY COMPLICATIONS | Developed Countries | Europe, Central | Europe | Research Methodology | Demographic Factors | Population | Adolescents | Youth | Age Factors | Population Characteristics | Embolism | Vascular Diseases | Diseases | Safety | Public Health | Health | Contraceptive Agents | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Contraceptive Agents, Female Document Number: 331280 |
| 26. Title: [Oral contraceptives in dermatology] Contracepcion hormonal oral en Dermatologia. Author: Sancho B; Guerra-Tapia A Source: Actas Dermo - Sifiliograficas. 2009 Jul-Aug;100(6):445-55. Abstract: Patients with hyperandrogenic syndromes and diseases exacerbated by pregnancy and those taking common dermatologic drugs associated with risk to the fetus require prescription of contraceptives by the dermatologist. In healthy, nonsmoking women, oral contraception does not increase the risk of cerebral or cardiac vascular disease and is associated with major benefits besides avoiding pregnancy. These include prevention of ovarian and endometrial carcinoma, ectopic pregnancy, pelvic inflammatory disease, ovulation pain, and menstrual cycle disorders. This article will review the mechanism of action, side effects, health risks, contraindications, initiation of the oral contraceptive regimen, and patient follow-up, as well as interactions between contraceptives and other drugs. Language: Spanish Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CLIENTS | WOMEN | ORAL CONTRACEPTIVES | DERMATOLOGICAL EFFECTS | RISK FACTORS | PREGNANCY | PREGNANCY COMPLICATIONS | DRUG INTERACTIONS | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Health | Reproduction | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342566 |
| 27. Title: Paternal age and reproduction. Author: Sartorius GA; Nieschlag E Source: Human Reproduction Update. 2009 Aug 20; Abstract: BACKGROUND Due to various sociological factors, couples in developed countries are increasingly delaying childbearing. Besides ethical, economical and sociological issues, this trend presents us with several complex problems in reproduction. Although it is well-known that maternal age has a negative effect on fertility and increases the risk of adverse outcome during pregnancy and in offspring, the paternal influence on these outcomes is less well researched and not well-known. METHODS We performed a systematic search of PubMed, and retrieved original articles and review articles to update our previous survey in this journal. RESULTS This review highlights the link between male age and genetic abnormalities in the germ line and summarizes the knowledge about the effects of paternal age on reproductive function and outcome. Increasing paternal age can be associated with decreasing androgen levels, decreased sexual activity, alterations of testicular morphology and a deterioration of semen quality (volume, motility, morphology). Increased paternal age has an influence on DNA integrity of sperm, increases telomere length in spermatozoa and is suggested to have epigenetic effects. These changes may, at least in part, be responsible for the association of paternal age over 40 years with reduced fertility, an increase in pregnancy-associated complications and adverse outcome in the offspring. CONCLUSION Although higher maternal age can be an indication for intensive prenatal diagnosis, including invasive diagnostics, consideration of the available evidence suggests that paternal age itself, however, provides no rationale for invasive procedures. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | COUPLES | MEN | GENETICS | PREGNANCY COMPLICATIONS | AGE FACTORS | SEMEN | RISK FACTORS | Family Characteristics | Family and Household | Sociocultural Factors | Demographic Factors | Population | Biology | Diseases | Population Characteristics | Seminal Vesicles | Genitalia, Male | Genitalia | Urogenital System | Physiology | Health Document Number: 342552 |
| 28. Peer Reviewed Title: Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Author: Say L; Souza JP; Pattinson RC Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):287-296. Abstract: Maternal mortality is still among the worst performing health indicators in resource-poor settings. For deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system and take corrective action. However, although a significant public health problem, maternal deaths are rare in absolute numbers especially within an individual facility. Studying cases of women who nearly died but survived a complication during pregnancy, childbirth or postpartum (maternal near miss or severe acute maternal morbidity) are increasingly recognized as useful means to examine quality of obstetric care. Nevertheless, routine implementation and wider application of this concept in reviewing clinical care has been limited due to the lack of a standard definition and uniform case-identification criteria. WHO has initiated a process in agreeing on a definition and developing a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases for monitoring and improving quality of obstetric care. A list of identification criteria was proposed together with one single definition. This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | MONITORING | CLIENTS | MOTHERS | PREGNANCY | SAFETY | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | MORBIDITY | RISK FACTORS | MATERNAL HEALTH | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Program Activities | Programs | Organization and Administration | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Reproduction | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases Document Number: 341302 |
| 29. Title: Maternal mortality in patients admitted to an intensive care unit in Jamaica. Author: Scarlett M; Isaacs MA; Fredrick-Johnston S; Kulkarni S; McCaw-Binns A Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):169-70. Abstract: A retrospective review was conducted of severe acute maternal morbidity (SAMM) admissions to the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI), Jamaica, between January 2001 and December 2006. UHWI has 550 beds and is one of three tertiary care referral centers on the island; it has two 8-bed ICUs. A total of 57 women with SAMM were admitted to the ICU over the study period, representing 2.8% of ICU admissions and 0.4% of total maternal admissions to the hospital. The mean age of the women was 30 years (range, 26-36 years) and the mean duration of stay in the ICU was 6 days (range, 1-35 days). The most common diagnoses were hypertensive disorders of pregnancy, sickle cell disease, and hemorrhagic disorders (Table 1). The cause of the admission in 32 (56.1%) patients was a direct obstetric cause, while for 25 (43.8%) patients the cause was non-obstetric. Only 2 patients with viable pregnancies had inadequate prenatal care. Twenty-five women were admitted after cesarean delivery, 11 after vaginal delivery, 6 following laparotomy, and 6 after induced abortion. Language: English Keywords: JAMAICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY COMPLICATIONS | MATERNAL MORTALITY | MORBIDITY | HOSPITALS | CAUSES OF DEATH | OBSTETRICS | Caribbean | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Medicine | Health Services Document Number: 341380 |
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