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Title: [Association between pre-gestational nutritional status and prediction of the risk of adverse pregnancy outcome] Associacao entre o estado nutricional pre-gestacional e a predicao do risco de intercorrencias gestacionais.
Author: Padilha PD; Saunders C; Machado RC; da Silva CL; Bull A
Source: Revista Brasileira de Ginecologia e Obstetricia. 2007 Oct;29(10):511-518.
Abstract: Purpose: to analyze the association between maternal pre-gestational nutritional status and maternal outcomes -hypertensive disorders of pregnancy, gestational diabetes, vitamin A deficiency, and anemia -and the newborn outcome -low birth weight. Methods: cross-sectional study, with 433 adult puerperal women (>20 years old) and their newborns, attending the Maternidade Escola of Universidade Federal do Rio de Janeiro (UFRJ). Data was collected through interviews and access to their medical records. Maternal pre-gestational nutritional status was established through pre-gestational body mass index according to the cut-offs for adult women defined by the World Health Organization (WHO), in 1995. The association between gestational outcomes and pre-gestational nutritional status was estimated through odds ratio (OR) and a 95% confidence interval (95%CI). Results: frequency of pre-gestational weight deviation (low weight, overweight and obesity) was 31.6%. Considering the pre-gestational nutritional status, overweight and obese women presented a lower weight gain than eutrophic and low-weight women (p<0.05). Women with pre-gestational obesity presented a higher risk of developing hypertensive disordens of pregnancy (OR=6.3; 95%CI=1.9-20.5) and those with low pre-gestational weight were more likely to give birth to low birth weigh infants (OR=7.1; 95%CI=1.9-27.5). There was no evidence of the association between pre-gestational nutritional status and the development of anemia, vitamin A deficiency and gestational diabetes. The mean weight gain among overweight and obese pregnant women was significantly lower when compared to eutrophic and low-weight pregnant women (p=0.002, p=0.049, p=0.002, p=0.009). Conclusions: the high number of women with pre-gestational weight deviation reinforces the importance of a nutritional guidance that favors a good nutritional state and reduces the risks of maternal and newborn adverse outcomes.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | POSTPARTUM WOMEN | PUERPERIUM | DIABETES | PREGNANCY COMPLICATIONS | INFANT NUTRITION | MATERNAL NUTRITION | BODY WEIGHT | LOW BIRTH WEIGHT | OBESITY | HYPERTENSION | DEFICIENCY DISEASES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Reproduction | Diseases | Nutrition | Health | Physiology | Biology | Birth Weight | Vascular Diseases | Nutrition Disorders
Document Number: 325240

2.
Peer Reviewed

Title: Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil.
Author: Rudge MV; Atallah AN; Peracoli JC; Tristao AD; Mendonca Neto M
Source: Acta Obstetrica et Gynecologica Scandinavica. 2006 Jul;85(8):945-948.
Abstract: There is a need to assess the effects of different antibiotic administration models on infectious complications among women from low-income populations who undergo cesarean delivery, and the cost benefit. Randomized, blinded controlled clinical trial study of a single preoperative dose of cephalothin, versus a postcesarean scheme for infection prophylaxis, versus no antibiotics. The setting was a tertiary Brazilian center with 1,500 deliveries annually. Pregnant women (n = 600) with an indication for emergency or elective cesarean section were randomly allocated consecutively to one of three groups and treated as follows: Group 1 (n = 200), no antibiotics; Group 2 (n = 200), the standard antibiotics scheme followed at this center; Group 3 (n = 200), a single dose of intravenous cephalothin 2 g, intraoperatively. Main outcome measurements. Prevalences of wound infection, puerperal and postcesarean infections, and costs of antibiotics used. Antibiotics reduced the incidence of puerperal infection, but did not change the percentages of wound and postcesarean infections and no use of antibiotics increased the puerperal infection risk six-fold. Cephalothin reduced the relative risk of puerperal infection by 89% (95% confidence interval: 7-87%). Penicillin reduced it by 78%, but this was not statistically significant. No deaths occurred. The costs of the two schemes were similar (almost US $1.00). Prophylactic cephalothin use was associated with decreased postcesarean puerperal infection and presented a cost benefit. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLIENTS | LOW INCOME POPULATION | CLINICAL TRIALS | CESAREAN SECTION | INFECTION PREVENTION | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | PUERPERIUM | INCIDENCE | Developing Countries | South America, Eastern | South America | Latin America | Americas | Program Activities | Programs | Organization and Administration | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Clinical Research | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Drugs | Reproduction | Measurement
Document Number: 303614

3.
Peer Reviewed

Title: Seizure frequency during pregnancy and the puerperium. [Frecuencia de las crisis convulsivas durante el embarazo y el puerperio]
Author: Costa AL; Lopes-Cendes I; Guerreiro CA
Source: International Journal of Gynecology and Obstetrics. 2005 Feb;88(2):148-149.
Abstract: Several studies have focused on a possible worsening of epilepsy during pregnancy, especially a possible increase in seizure frequency and the associated risk factors for poor seizure control. However, most of these studies were retrospective, and they had methodological limitations or conflicting findings. We prospectively followed 50 pregnant women with epilepsy. The patients were seen in the outpatient clinic according to a previously determined clinical protocol. The diagnosis of epilepsy was established before pregnancy in all patients, 41 of whom were using monotherapy. Only 7 patients (14%) had the dosage of their antiepileptic medication increased in the second trimester. (excerpt)
Spanish Abstract: Diversos estudios se han centrado en un posible agravamiento de la epilepsia durante el embarazo, especialmente en un aumento de la frecuencia y los factores de riesgo asociados a un control inadecuado de las crisis. No obstante, la mayor�a de dichos estudios fueron retrospectivos y estuvieron signados por limitaciones metodol�gicas o resultados contradictorios. Se realiz� un estudio prospectivo de 50 embarazadas epil�pticas; se las evalu� en consultorio externo seg�n un protocolo cl�nico designado previamente. El diagn�stico de epilepsia se estableci� antes del embarazo en todas las pacientes, 41 de las cuales recib�an monoterapia. S�lo 7 pacientes (14%) incrementaron la dosis de su medicaci�n antiepil�ptica en el segundo trimestre. (extracto)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | NEUROLOGIC EFFECTS | PREVALENCE | RISK FACTORS | PREGNANCY | PREGNANCY COMPLICATIONS | DRUGS | PUERPERIUM | Developing Countries | South America, Eastern | South America | Latin America | Americas | Studies | Research Methodology | Demographic Factors | Population | Physiology | Biology | Measurement | Reproduction | Diseases | Treatment
Document Number: 280401

4.
Peer Reviewed

Title: Re-laparotomy after cesarean section.
Author: Seffah JD
Source: International Journal of Gynecology and Obstetrics. 2005 Mar;88(3):253-257.
Abstract: The objective of the study was to find out the indications for management and the outcomes of reopening the abdomen during the puerperium after Cesarean section. This was a retrospective descriptive survey at the Korle Bu Teaching Hospital in Accra, Ghana. There were 6120 Cesarean sections (17%) out of a total of 36,010 deliveries. Re-laparotomy was done in 44 patients (0.7%) of the Cesarean sections. The indications were: hemorrhage from uterine atony, hemorrhage from placental bed after operation for placenta previa, uterine sepsis with hemorrhage, hemorrhage after Cesarean section, myomectomy and hemorrhage from anterior abdominal wound dehiscence. The main surgeries performed were: hysterectomy, ligation of ascending branches of uterine arteries, ligation of hypogastric arteries, debridement and re-suturing of the uterine incision and secondary suturing of anterior abdominal wall. There were 6 near missed fatalities. There were 4 mortalities caused by excessive hemorrhage and severe sepsis. The case fatality rate for re-laparotomy after Cesarean section is high (9%). Near missed-fatalities are common. To reduce the unfavorable outcomes, instituting more intensive education on the use of the partograph should prevent prolonged labor. Centers carrying out Cesarean section should have efficient blood transfusion service in place. (author's)
Language: English
Keywords:
GHANA | RESEARCH REPORT | PREGNANT WOMEN | CESAREAN SECTION | BLEEDING | MATERNAL MORTALITY | PUERPERIUM | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Signs and Symptoms | Diseases | Mortality | Population Dynamics | Reproduction
Document Number: 281462

Title: Active management of the third stage of labor: a simple practice to prevent postpartum hemorrhage.
Author: Stephenson P
Source: Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2005 May 16. [2] p. (Global Health Technical Briefs)
Abstract: Postpartum hemorrhage (PPH) is the leading direct cause of maternal death in developing countries. Most cases of PPH occur within 24 hours after delivery. About 70 percent of cases of PPH are due to uterine atony, which can be prevented with Active Management of the Third Stage of Labor (AMTSL). Any woman can face life-threatening blood loss at the time of delivery; women with anemia are particularly vulnerable since they may not tolerate even moderate blood loss. AMTSL reduces the incidence of PPH, quantity of blood loss, need for blood transfusion, and need for medical intervention to stop bleeding. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | PREGNANT WOMEN | PROVIDERS WITH CLIENTS | MIDWIVES AND MIDWIFERY | CHILDBIRTH | PUERPERIUM | POSTPARTUM | BLEEDING | PREVENTION AND CONTROL | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Health Personnel | Pregnancy Outcomes | Pregnancy | Reproduction | Signs and Symptoms | Diseases
Document Number: 290897

6.
Peer Reviewed

Title: Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration.
Author: Strand RT; Da Silva F; Jangsten E; Bergstrom S
Source: Acta Obstetrica et Gynecologica Scandinavica. 2005;84:260-265.
Abstract: Background: Postpartum hemorrhage (PPH) is the single most common cause of maternal death in the world, oxytocin is known to be effective for its prevention and treatment. The use of syringes can be problematic in areas affected by HIV. The aim of this study was to introduce Uniject(TM) (a new disposable device for administration of 10IU oxytocin) as part of active management of the third stage of labor (AMTL) and try to reduce PPH. Methods: A prospective, comparative study was performed between March 1998 and May 2000 in Luanda. Seven hundred and eighty-two parturient women with physiological management were compared to 814 with AMTL. Postpartum lost blood was collected using a plastic sheet during labor and a bucket placed under a cholera bed for 2h postpartum. Student's t-test and ?(2)test were used. Result: PPH was reduced from 40.4 to 8.2% and severe PPH (=1000ml) from 7.5 to 1% in the AMTL group (P<0.001). Conclusions: Uniject(TM) was well tolerated and offers an alternative for oxytocin administration. AMTL should be implemented also in resource-poor settings as a routine management to reduce PPH. (author's)
Language: English
Keywords:
ANGOLA | RESEARCH REPORT | COMPARATIVE STUDIES | POSTPARTUM WOMEN | BLEEDING | DRUGS | ADMINISTRATION AND DOSAGE | PUERPERIUM | CHILDBIRTH | MATERNAL MORTALITY | FETAL MEMBRANES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Reproduction | Signs and Symptoms | Diseases | Treatment | Pregnancy Outcomes | Pregnancy | Mortality | Population Dynamics | Demographic Factors | Population | Fetus
Document Number: 282053

7.
Peer Reviewed

Title: Local understandings of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh: a qualitative study.
Author: Winch PJ; Alam MA; Akther A; Afroz D; Ali NA
Source: Lancet. 2005 Aug 6;366(9484):478-485.
Abstract: Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them. We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth. Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother�s bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia. Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care. (author's)
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | QUALITATIVE RESEARCH | POSTPARTUM WOMEN | TRADITIONAL BIRTH ATTENDANTS | PUERPERIUM | KNOWLEDGE | BELIEFS | CULTURE | NEONATAL MORTALITY | TRADITIONAL HEALTH PRACTICES | UTILIZATION OF HEALTH CARE | Asia, Southern | Asia | Developing Countries | Research Methodology | Reproduction | Health Personnel | Delivery of Health Care | Health | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | Population | Health Services
Document Number: 289324

8.
Title: A multicentre evaluation of the two-layered repair of postpartum perineal trauma.
Author: Oboro VO; Tabowei TO; Loto OM; Bosah JO
Source: Journal of Obstetrics and Gynaecology. 2003 Jan;23(1):5-8.
Abstract: We set out to compare a policy of two-layered postpartum perineal repair leaving the skin unsutured with a policy of three-layered repair, which involved skin closure. Parturients who sustained a second-degree tear or an episiotomy in four Nigerian centers were randomised to have either a two-layered repair (417 women) or a three-layered repair (406 women). Fewer women in the two-layered group reported perineal pain at 48 hours (57% vs. 65%, relative risk [RR] 0.87, 95% confidence interval [CI] 0.78-0.97)and 14 days postpartum (22% vs. 28%, RR 0.77, CI 0.61-0.98). The two-layered repair was also associated with reduced risk of suture removal (6% vs. 10%, RR 0.62, CI 0.39-0.99), and less superficial dyspareunia at 3 months (6% vs. 12%, RR 0.52, CI 0.33-0.81). The rates of wound healing were similar between the two groups. Leaving the skin unsutured during postpartum perineal repair reduces perineal pain and dyspareunia. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL TRIALS | POSTPARTUM WOMEN | CHILDBIRTH | GENITAL EFFECTS, FEMALE | PUERPERIUM | TREATMENT | PAIN | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Reproduction | Pregnancy Outcomes | Pregnancy | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases
Document Number: 297716

9.
Title: Sexual practices of women within six months of childbirth in Mulago hospital, Uganda.
Author: Odar E; Wandabwa J; Kiondo P
Source: African Health Sciences. 2003 Dec;3(3):117-123.
Abstract: The objectives were to establish the sexual practices and their associated morbidity among women within 6 months of childbirth in Kampala Uganda. Design: Cross-sectional descriptive study. Setting: The three Mulago hospital child immunization clinics. Participants: Two hundred and seventeen eligible mothers took part in the study from November to December 2001. Outcome measures: Time to resumption of sexual intercourse after childbirth, reasons for resumption and problems associated with it. Methods: Partially coded questionnaires Sexual intercourse was resumed by 66.4% of the women within six months of childbirth. Of these 49.3% did so during the puerperium. The main reasons for early resumption of sexual intercourse were husbands' demands, cultural demands and inherent inability to do without sexual intercourse but not level of education of mothers. Of the mothers who resumed sexual intercourse 22.2% had sexual problems. The problems included vaginal pain (62.5%), discharge (18.8%), bleeding (15.6%) and bruises or tears (3.1%). Perineal or genital damage at the time of delivery was not associated with a delayed resumption of sexual intercourse with (OR1.08, 95% CI 0.51-2.30). Of those who had sexual intercourse and had problems only 59.4% sought medical assistance. The reasons for not resuming sexual intercourse within six months of delivery included advise from health workers (38.4%), husbands were away (21.9%), no interest (21.9%) and not feeling well(17.8%). Most women resumed sexual intercourse within six months of childbirth and had high morbidity. There is need for appropriate postpartum sexual practice advice. (author's)
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | POSTPARTUM WOMEN | SEXUAL INTERCOURSE | PUERPERIUM | CHILDBIRTH | MORBIDITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Reproduction | Pregnancy Outcomes | Pregnancy | Diseases
Document Number: 301926

10.
Title: Essential obstetric care manual: for health service providers in Kenya. A safe motherhood initiative.
Author: Kenya. Ministry of Health. Division of Reproductive Health; Kenya. Ministry of Health. Division of Nursing; Population Council; University of Nairobi. Department of Obstetrics and Gynaecology
Source: Nairobi, Kenya, Population Council, 2002 Mar. ix, 182 p.
Abstract: This manual responds to provider competency and skill areas of safe motherhood that were found to be deficient among health providers during a baseline survey conducted in 2000: management of normal pregnancy; labor and delivery; postpartum care; complications of pregnancy including postabortion care; and management of the newborn and medical conditions in pregnancy. It also aims to provide clinical officers and nurses with skills that will enable them manage women with various pregnancy-related complications at different levels of service provision.
Language: English
Keywords:
KENYA | MANUAL | PROVIDERS WITH CLIENTS | SAFE MOTHERHOOD | MATERNAL HEALTH | REPRODUCTIVE HEALTH | OBSTETRICAL SURGERY | PREGNANCY COMPLICATIONS | PREGNANCY OUTCOMES | PUERPERIUM | NEONATAL DISEASES AND ABNORMALITIES | POSTPARTUM PROGRAMS | COMPLICATIONS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Diseases | Pregnancy | Reproduction | Family Planning Programs | Family Planning
Document Number: 169976

11.
Peer Reviewed

Title: Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere district, Eastern Province, Kenya.
Author: Mwaniki PK; Kabiru EW; Mbugua GG
Source: East African Medical Journal. 2002 Apr;79(4):184-187.
Abstract: Background: Utilisation of antenatal and maternity services is an important maternal health indicator. Increasing the proportion of mothers who are cared for in health facilities during pregnancy, childbirth and puerperium reduces the health risks to mothers and their children. Objective: To determine the utilisation of antenatal and maternity services by mothers of Mbeere District bringing their children to the child welfare clinic. Design: Cross-sectional, descriptive study. Setting: Four rural health centres in Mbeere district. Subjects: Two hundred mothers bringing their children aged one year and below to the child welfare clinic between September and December 2000. Results: The proportion of mothers who utilised health facilities for antenatal and maternity services was 97.5% and 52%, respectively. Utilisation of health facilities for maternity services was significantly influenced by number of children and distance to health facility in that, as number of children increased, utilisation of maternity services reduced (Chi2=8.99; p=0.027; df=l). Mothers living less than 5km to a health facility utilised the services better than those living 5 km and beyond (Chi2=7.57; p=0.0059; df=l). Among the reasons given by the mothers (individual respondents and through Focus Group Discussions) regarding dissatisfaction with the services offered included shortage of drugs and essential supplies, lack of commitment by staff, poor quality of food and lack of cleanliness in the health facilities. Conclusion: Coverage for antenatal services was high among mothers during their last pregnancy. However, only about half of the mothers interviewed utilised health facilities for maternity services (labour and delivery). The major constraints experienced by the mothers as they sought for the services (as reported by individual respondents and through Focus Group Discussions) included lack of transport, lack of money for transport and hospital fee and delay in admission to health facility once mothers report in labour. Lack of satisfaction with quality of care given could be the major demotivating factor in the use of health facilities for maternity services. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | KAP SURVEYS | FOCUS GROUPS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | INFANT | UTILIZATION OF HEALTH CARE | ANTENATAL CARE | MATERNAL HEALTH SERVICES | TRANSPORTATION | SATISFACTION | FEES | MOTIVATION | QUALITY OF HEALTH CARE | PUBLIC ASSISTANCE | RURAL HEALTH CENTERS | CHILDBIRTH | PUERPERIUM | CHILD HEALTH SERVICES | CLINICS | DISTANCE | FAMILY SIZE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Surveys | Sampling Studies | Studies | Data Collection | Reproduction | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Psychological Factors | Behavior | Financial Activities | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Government Financing | Health Facilities | Pregnancy Outcomes | Pregnancy | Geographic Factors | Family Characteristics | Family and Household
Document Number: 185508

12.
Peer Reviewed

Title: The effects of labour and delivery on the pelvic floor.
Author: Fitzpatrick M; O'Herlihy C
Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2001;15(1):63-79.
Abstract: Increasing public and professional attention has recently been focused on the issue of both faecal and urinary incontinence following childbirth and these symptoms are sometimes being cited as indications for elective caesarean section. Faecal incontinence has a female-to-male preponderance of 8:1, consistent with childbirth as the principal causative factor, although most symptomatic women do not seek medical advice until after the menopause. Similarly, urinary stress incontinence is almost an exclusively female phenomenon. Obstetric injury may take the form of direct muscular damage to the anal sphincter, as occurs during a third-degree tear, and/or may be the result of cumulative damage to the pudendal nerves. Mechanical, neural and endocrine factors may all play a causative role in faecal incontinence. Symptoms are rarely volunteered by the patient, and may be present for many years after the index pregnancy, and clinical examination alone may fail to detect specific abnormalities. The performance of anal manometry, endoanal ultrasound, urodynamics and neurophysiology studies of the pelvic floor may help to increase the diagnostic yield. Treatment for both urinary and faecal incontinence is available in the form of physiotherapy, fluid and dietary manipulation and in more severe cases, surgery. Adequate primary management of third-degree tears requires careful appraisal as this injury, in particular, is the most important risk factor for subsequent faecal incontinence symptoms. In this chapter we aim to outline the mechanism of damage to the pelvic floor during childbirth, concentrating primarily on anal sphincter damage. We describe the necessary investigations, follow-up and treatment which women with significant pelvic floor damage should receive following delivery, and we finally discuss the issue of further deliveries and, specifically, the current place of caesarean section. (author's)
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | STUDIES | CHILDBIRTH | CESAREAN SECTION | PREGNANCY COMPLICATIONS | PUERPERIUM | RISK FACTORS | PERFORATIONS | Research Methodology | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Biology
Document Number: 296894

13.
Title: Postpartum bleeding and lochia in breastfeeding women. [Hemorragia puerperal y loquios en mujeres que amamantan]
Source: Progress in Reproductive Health Research. 2000;(55):7.
Abstract: This paper discusses postpartum lochia as analyzed in a multinational study. The analysis was performed to investigate and compare the duration of lochia in women at 7 participating centers, and to investigate factors that might influence duration. The factors included age, parity, birth weight, and amount of breast-feeding. The analysis also looked at a possible "end-of-puerperium" bleeding and at post-lochia bleeding before the 56th day. 3955 of the 4118 women admitted to the study reported a date on which lochia ended. Among them, the median duration of lochia was 27 days (22 days in China, 23 in Nigeria, 24 in Guatemala, 25 in Chile, 26 in India, 31 in Australia, and 34 in Sweden). In Australia and Guatemala, the infant's weight was related to the length of lochia. The duration of the mothers' lochia did not vary significantly in relation to their age, number of live births, or frequency of breast-feeding within a 24-hour period. 1.5% of the 3792 women who kept a menstrual diary reported lochia until at least the 56th day postpartum, while 25% of the rest reported at least 1 episode of bleeding between the end of lochia and the 56th day.
Spanish Abstract: Este trabajo discute los loquios post parto y su an�lisis en un estudio multinacional. El an�lisis se llev� a cabo para investigar y comparar la duraci�n de los loquios en las mujeres en 7 centros participantes, y para investigar los factores que puedan influenciar la duraci�n. Los factores incluyen edad, paridad, peso al nacer y la cantidad de lactancia materna dada. El an�lisis tambi�n revis� el posible sangrado "al final del puerperio" y al sangrado post loquios antes del 56� d�a. De las 4,118 incluidas en el estudio, 3,955 reportaron la fecha cuando los loquios terminaron. Entre ellas, la Mediana de la duraci�n fu� 27 d�as (22 d�as en China, 23 en Nigeria, 24 en Guatemala, 25 en Chile, 26 en India, 31 en Australia y 34 en Suecia). En Australia y Guatemala, se encontr� una relaci�n entre el peso del infante y la duraci�n de los loquios. La duraci�n de los loquios de la madre no vari� significativamente con relaci�n a su edad, n�mero de partos vivos o frecuencia de amamantamiento en un per�odo de 24 horas. Un 1.5% de las 3,792 que mantuvieron un diario menstrual reportaron loquios hasta por lo menos el 56� d�a post parto, mientras un 25% del resto report� por lo menos un episodio de sangrado entre el final de los loquios y el 56� d�a post parto.
Language: English
Keywords:
AUSTRALIA | CHINA | CHILE | INDIA | NIGERIA | SWEDEN | GUATEMALA | POSTPARTUM WOMEN | BLEEDING | WOMEN | PUERPERIUM | POSTPARTUM AMENORRHEA | Developed Countries | Oceania | Developing Countries | Asia, Eastern | Asia | South America, Southern | South America | Latin America | Americas | Asia, Southern | Africa, Western | Africa, Sub Saharan | Africa | Europe, Northern | Europe | Central America | Reproduction | Signs and Symptoms | Diseases | Demographic Factors | Population
Document Number: 159517

15.
Title: [Epidemiological risk factors associated with maternal mortality] Factores de riesgos epidemiologicos asociados a mortalidad materna.
Author: Ulloa Gonzalez A; Ulloa Gonzalez C; Moreno Castillo J
Source: Salud Sexual y Reproductiva. 1999 Oct;1(1):5-12.
Abstract: A study was conducted of 43 women admitted to the Berta Calderon Roque Hospital in Managua between January 1996 and December 1997 to identify the principal reproductive and obstetric risk factors associated with maternal mortality. 103 unpaired controls were selected by systematic sampling from patients admitted to the high obstetric risk section. Direct obstetric causes accounted for 70% of deaths, with 25.5% due to sepsis, 23.3% to eclampsia, and 20.9% to hemorrhage. 74.4% of deaths occurred during the puerperium. The principal reproductive risk factors associated with maternal mortality were illiteracy (odds ratio (OR) = 3.7), rural origin (OR = 2.82), no prenatal care (OR = 2.21), short birth interval (OR = 1.63), multiparity (OR = 2.13), and history of malnutrition (OR = 3.51). Obstetric risk factors during pregnancy that were associated with maternal mortality were eclampsia (OR = 2.61), septic abortion (OR = 2.27), and anemia (OR = 1.99). Obstetric risk factors during delivery were eclampsia (OR = 4.54), hemorrhage (OR = 3.51), and birth at home (OR = 2.84). Obstetric risk factors during the puerperium were hemorrhage (OR = 6.67), puerperal sepsis (OR = 4), complicated septic abortion (OR = 3), and eclampsia (OR = 3.78). It was concluded that the most significant risk for maternal mortality occurred in the puerperium. The most important risk factors were hemorrhage, followed by puerperal infection and eclampsia, which might be subject to prevention at the primary level of care through early diagnosis and appropriate medical care. A review committee should be established in the hospital to reduce maternal mortality.
Spanish Abstract: Se realiz� un estudio con 43 mujeres que fueron ingresadas en el hospital Berta Calder�n Roque, en Managua, entre enero de 1996 y diciembre de 1997, para saber cu�les eran los principales factores de riesgo reproductivos y obst�tricos relacionados con la mortalidad materna. Un total de 103 controles no apareados fueron seleccionados mediante un muestreo sistem�tico de las pacientes ingresadas en la secci�n de alto riesgo obst�trico. Las causas obst�tricas directas constituyeron el 70% de las muertes, 25,5% por sepsis, 23,3% por eclampsia y 20,9% por hemorragia. El 74,4% de las muertes ocurrieron durante el puerperio. Los principales factores de riesgo reproductivo relacionados con la mortalidad materna fueron el analfabetismo (raz�n de posibilidades (OR) = 3,7), origen rural (OR = 2,82), falta de atenci�n prenatal (OR = 2,21), poco espaciamiento entre un nacimiento y otro (OR = 1,63), multiparidad (OR = 2,13) y antecedentes de malnutrici�n (OR = 3,51). Los factores de riesgo obst�trico durante el embarazo que estaban relacionados con la mortalidad materna fueron los siguientes: eclampsia (OR = 2,61), aborto s�ptico (OR = 2,27) y anemia (OR = 1,99). Los factores de riesgo obst�trico durante el parto fueron: eclampsia (OR = 4,54), hemorragia (OR = 3,51) y nacimiento en el hogar (OR = 2,84). Los factores de riesgo obst�trico durante el puerperio fueron: hemorragia (OR = 6,67), sepsis puerperal (OR = 4), aborto s�ptico complicado (OR = 3) y eclampsia (OR = 3,78). Se concluy� que el riesgo m�s significativo para la mortalidad materna ocurri� en el puerperio. Los factores de riesgo m�s importantes fueron la hemorragia, seguida de la infecci�n puerperal y la eclampsia, que podr�a prevenirse en el nivel primario de atenci�n mediante el diagn�stico temprano y la atenci�n m�dica apropiada. Se deber�a establecer un comit� de revisi�n en el hospital para reducir la mortalidad materna.
Language: Spanish
Keywords:
NICARAGUA | SUMMARY REPORT | CASE CONTROL STUDIES | MATERNAL MORTALITY | RISK FACTORS | PUERPERIUM | Developing Countries | Central America | Latin America | Americas | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Biology | Reproduction
Document Number: 159777

16.
Title: [Manual for trainers of traditional midwives in Honduras] Manual para capacitadores de parteras tradicionales en Honduras.
Author: Honduras. Secretaria de Salud. Departamento Salud Materno Infantil. Unidad Atencion a la Mujer
Source: Tegucigalpa, Honduras, Secretaria de Salud, Departamento Salud Materno Infantil, Unidad Atencion a la Mujer, 1998. [6], 117 p. (USAID Contract No. HRN-C-00-93-00038-00)
Abstract: This trainers manual approaches training of traditional midwives in Honduras with nonconventional methodologies whose primary goals are to assist midwives in recognizing reproductive risk factors in pregnant and nonpregnant women, and to conduct safe and clean deliveries to avoid infection and hemorrhage, the two main causes of maternal mortality in Honduras. The work begins with a description of the evolution of government relations with traditional midwives since the 1950s, when the Ministry of Health made the first overtures in their direction. A glossary of key terms, statements of objectives, and a general description of the course methodology follow. An initial workshop attended by no more than 13 persons with a ratio of no more than 3 midwives per institutional representative is recommended. The roles of the facilitators and institutional participants are described, and procedures for follow-up to ensure that the midwives have internalized the training are detailed. The educational plan is next presented. Initial training should be developed in modules that permit the midwife to internalize the importance of the reproductive risk focus. Presentation of each topic includes a statement of objectives, a brief description of its methodology, and instructions for developing the theme using participatory techniques and avoiding exclusive reliance on written materials. The topics covered include the risk focus, the reproductive risk focus, prenatal care, care during delivery, immediate care of the newborn, newborn care in the first 10 days, puerperal care, family planning, and monitoring and follow-up. Training techniques and exercises emphasizing participation are included in an annex.
Spanish Abstract: Este manual para capacitadores aborda la capacitaci�n de parteras tradicionales en Honduras con m�todos no convencionales cuyas metas principales consisten en ayudar a las parteras a reconocer los factores de riesgo de salud reproductiva en las mujeres embarazadas y no embarazadas, y atender partos seguros y en condiciones de higiene a fin de evitar infecciones y hemorragia, que son las dos causas principales de mortalidad materna en Honduras. El trabajo comienza con una descripci�n de la evoluci�n de las relaciones entre el gobierno y las parteras tradicionales desde los a�os 50, cuando el Ministerio de Salud hizo los primeros contactos con ellas. Luego se presentan un glosario de t�rminos clave, una declaraci�n de objetivos y una descripci�n general del m�todo del curso. Se recomienda un taller inicial en el que participe un m�ximo de 13 personas con una raz�n de un m�ximo de 3 parteras por representante institucional. Se describen las funciones de los facilitadores y los participantes institucionales, y se presentan detalladamente los procedimientos para el seguimiento a fin de que las parteras asimilen la capacitaci�n. Luego se presenta el plan educacional. La capacitaci�n inicial debe elaborarse en m�dulos que permitan que la partera asimile la importancia del enfoque en los riesgos de la reproducci�n. La presentaci�n de cada tema incluye una declaraci�n de los objetivos, una descripci�n breve de la metodolog�a e instrucciones para desarrollar el tema usando t�cnicas participativas y evitando el uso exclusivo de material escrito. Los temas tratados incluyen el enfoque en los riesgos, el enfoque en los riesgos de la reproducci�n, la atenci�n prenatal, la atenci�n durante el parto, los cuidados del reci�n nacido inmediatamente despu�s de su nacimiento, cuidados del reci�n nacido en los primeros 10 d�as, atenci�n en el puerperio, planificaci�n familiar y monitoreo y seguimiento. En un anexo se incluyen t�cnicas de capacitaci�n y ejercicios que hacen hincapi� en la participaci�n.
Language: Spanish
Keywords:
HONDURAS | MANUAL | TRAINING OF TRAINERS | MIDWIVES AND MIDWIFERY | CURRICULUM | ANTENATAL CARE | CHILDBIRTH | PUERPERIUM | NEONATAL DISEASES AND ABNORMALITIES | TREATMENT | Central America | Latin America | Americas | Developing Countries | Training Programs | Education | Health Personnel | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases
Document Number: 144066

17.
Title: Healthy mother and healthy newborn care: a guide for care givers.
Author: Beck D; Buffington ST; McDermott J; Berney K
Source: Washington, D.C., American College of Nurse-Midwives, 1998. iv, 104 p. (USAID Contract No. HRN-Q-00-93-00039-00)
Abstract: Healthy Mother and Healthy Newborn Care--A Guide for Care Givers is intended for midwives and other care providers, and has been produced together with Healthy Mother and Healthy Newborn Care--A Reference for Care Givers to serve as a quick reference for use in the care of mothers and babies during pregnancy, childbirth and the puerperium. The latter book presents the Midwifery Problem Solving Process: 1) ask and listen during history taking; 2) look and feel during physical examination; and 3) identify problems and needs. The fourth step--taking appropriate actions--is explained in this booklet. It presents guidelines on proper management of abnormalities during antenatal and postpartum care; several procedures and tests the midwife may need to perform; and important information on commonly dispensed medicines. Lastly, skill checklists are provided that allow midwives to monitor their own performance in providing quality care.
Language: English
Keywords:
UNITED STATES OF AMERICA | MANUAL | HEALTH PERSONNEL | MATERNAL-CHILD HEALTH SERVICES | ANTENATAL CARE | PUERPERIUM | MIDWIVES AND MIDWIFERY | DELIVERY OF HEALTH CARE | Developed Countries | North America | Americas | Health | Primary Health Care | Health Services | Maternal Health Services | Reproduction
Document Number: 143961

18.
Title: Puerperal morbidity: a neglected area of maternal health in Sri Lanka.
Author: De Silva WI
Source: SOCIAL BIOLOGY. 1998 Fall-Winter;45(3-4):223-45.
Abstract: A large proportion of women in developing countries put most of their personal needs, including food consumption, behind those of their children, husband, and sometimes, other family members. In so doing, many mothers experience serious health problems requiring professional care, but they are unaware of the serious nature of their illness. The period of 42 days following delivery is known as the puerperium. Care during the puerperium receives less research attention than antepartum and intrapartum care in many developing countries, even though it is the period during which most maternal mortality occurs. A study on maternal morbidity was conducted in 3 Medical Officers of Health (MOH) areas of Kalutara District, Sri Lanka, to assess the prevalence of puerperal morbidity and to identify the characteristics of those women with high levels of morbidity. 600 of the mothers registered by the Public Health Midwives (PHM) in the study area were chosen to participate in this study. Data were collected using structured interviews conducted during the first week after puerperium, 43-50 days after delivery. Excessive bleeding from the vagina was reported by 40% of mothers, while minor symptoms such as breast engorgement and chills were reported by many mothers. 11% of the mothers in the study had neither symptoms nor signs of ill health, while the rest reported 1 or more illnesses. Primigravidae and women who had experienced pregnancy wastage had higher morbidity.
Language: English
Keywords:
SRI LANKA | RESEARCH REPORT | MORBIDITY | MATERNAL HEALTH | POSTPARTUM WOMEN | PUERPERIUM | BLEEDING | VAGINA | PRIMIPARITY | ABORTION, SPONTANEOUS | Asia, Southern | Asia | Developing Countries | Diseases | Health | Reproduction | Signs and Symptoms | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Pregnancy Complications
Document Number: 140346

19.
Title: [Mother-child hospital rooming-in and exclusive breastfeeding] Alojamiento conjunto madre-hijo y lactancia humana exclusiva.
Author: Flores-Huerta S; Cisneros-Silva I
Source: SALUD PUBLICA DE MEXICO. 1997 Mar-Apr;39(2):110-6.
Abstract: 178 mothers and their healthy, full-term infants participated in a study of the influence of rooming-in on the frequency and duration of exclusive breast feeding through the fourth month of life. The study was conducted at a Mexican Institute of Social Security hospital between January 1993 and October 1994. 90 of the mothers and infants roomed together, including 29 with cesarean deliveries, and the mothers received instruction on breast feeding. The remaining 88 mother-infant pairs, including 31 delivered by cesarean, were separately lodged and cared for, and the mothers received no specific breast feeding instructions. Breast feeding began during the hospital stay for the rooming-in group, but the infants in the other group remained in the nursery and were fed with infant formula until discharge. The 4 maternal subgroups were similar in age, education, employment, and marital status, except that separately lodged mothers with cesarean deliveries were more likely to be single. Mothers with or without cesarean deliveries who roomed or did not room with their infants had similar overall rates of breast feeding including exclusive and mixed feeding of about 90% through the first 2 months and 70% at 4 months. Exclusive breast feeding was more common at 15 and 30 days for infants rooming with the mother. 61% in the rooming-in group versus 42% in the separately lodged group were exclusively breast fed at 1 month, regardless of the type of delivery. The only study variable found to influence exclusive breast feeding was rooming with the mother. The results shed little light on whether sharing a room or receiving instruction on breast feeding is more influential in encouraging exclusive breast feeding. Most differences in exclusive breast feeding between the groups lost significance by 2 months and nearly disappeared by 4 months.
Spanish Abstract: Se realiz� un estudio con 178 madres y sus reci�n nacidos de t�rmino y sanos relativo a la influencia que tiene compartir la habitaci�n en la frecuencia y duraci�n del amamantamiento exclusivo hasta el cuarto mes de vida. El estudio se realiz� en un hospital del Instituto Mexicano de Seguridad Social entre enero de 1993 y octubre de 1994. Noventa madres con sus beb�s compartieron la habitaci�n, incluidas 29 que hab�an tenido ces�rea, y recibieron instrucciones relativas al amamantamiento. Las 88 d�adas, incluidas 31 madres que hab�an dado a luz por ces�rea, no compartieron la habitaci�n y recibieron atenci�n por separado, y no recibieron instrucciones espec�ficas de amamantar. Las que compartieron la habitaci�n comenzaron a amamantar durante la estad�a en el hospital, y los beb�s del otro grupo se quedaron en la guarder�a y fueron alimentados con f�rmula infantil hasta que se les dio de alta. Los cuatro subgrupos maternos eran semejantes en cuanto a edad, educaci�n, empleo y estado civil, excepto que hab�a m�s madres solteras entre las alojadas separadamente que hab�an dado a luz por operaci�n ces�rea. Las madres con beb�s nacidos por ces�rea o por v�a natural que compartieron la habitaci�n o que no la compartieron con sus beb�s tuvieron tasas generales de amamantamiento an�logas, incluida la alimentaci�n exclusiva y mixta de aproximadamente 90% hasta los primeros 2 meses y de 70% a los 4 meses. El amamantamiento exclusivo fue m�s com�n a los 15 y 30 d�as en los beb�s que compartieron la habitaci�n con la madre. El 61% del grupo que comparti� la habitaci�n frente al 42% del grupo que estuvo en habitaciones separadas recib�a amamantamiento exclusivo al primer mes, independientemente del tipo de alumbramiento. La �nica variable del estudio que influy� en el amamantamiento exclusivo fue el haber compartido la habitaci�n con la madre. Los resultados no dejan muy en claro si el haber compartido la habitaci�n o haber recibido instrucciones sobre el amamantamiento ejerce m�s influencia en la promoci�n del amamantamiento exclusivo. La mayor�a de las diferencias en el amamantamiento exclusivo entre los grupos perdi� significado a los 2 meses y casi hab�a desaparecido a los 4 meses.
Language: Spanish
Keywords:
MEXICO | RESEARCH REPORT | PROSPECTIVE STUDIES | COMPARATIVE STUDIES | MOTHERS | POSTPARTUM WOMEN | INFANT | PUERPERIUM | POSTCESAREAN SECTION | BREASTFEEDING | HOSPITALS | PROCEDURES | North America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Reproduction | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Cesarean Section | Obstetrical Surgery | Surgery | Treatment | Infant Nutrition | Nutrition | Health | Health Facilities | Delivery of Health Care | Organization and Administration
Document Number: 127351

20.
Title: Maternal and child health indicators: implications of the tenth revision of the International Classification of Diseases.
Author: Laurenti R; Buchalla CM
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 1997 Jul;2(1):13-7.
Abstract: This article describes the World Health Organization's most recent decennial revision of its International Statistical Classification of Diseases and Related Health Problems (ICD-10). Obstetrical tetanus is now included in the chapter on infectious diseases, which facilitates the recording of this cause of maternal death. The revision also includes new definitions, such as later maternal death (>42 days and <1 year after delivery), and the perinatal period as starting at 22 completed weeks of gestation and ending 7 completed days after birth. This change will have consequences for statistics involving stillbirths and perinatal mortality. Accordingly, perinatal mortality will increase, with corresponding consequences for trend studies. Chapter XV deals with pregnancy, childbirth, and the puerperium, with the number of categories increasing from 45 to 75. Other important categories are: obstetrical death of unspecified cause, and death from sequelae of direct obstetric causes. Chapter XVI pertains to certain conditions originating in the perinatal period and was expanded from 20 categories to 58, including "disorders related to length of gestation and fetal growth" and "infections specific to the perinatal period". The grouping "hemorrhagic and hematological disorders of fetus and newborn" was expanded from 2 categories to 12. Chapter XVII (Congenital malformations, deformations, and chromosomal aberrations) is also noteworthy. Maternal mortality rates and ratios continue to be calculated on the basis of the current definition, which limits this period to 42 days following childbirth. Another new concept is the definition of pregnancy-related death: during pregnancy or within 42 days of the termination of pregnancy.
Language: English
Keywords:
WHO | CLASSIFICATION | DISEASES | CAUSES OF DEATH | MATERNAL MORTALITY | INFANT MORTALITY | OBSTETRICS | PUERPERIUM | TIME FACTORS | UN | International Agencies | Organizations | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Reproduction
Document Number: 126849

21.
Title: A postpartum IUD program in the Dominican Republic.
Author: Cordero CF; Barone MA; Calderon V
Source: International Journal of Gynecology and Obstetrics. 1996 Nov;55(2):181-2.
Abstract: A retrospective analysis of 1437 postpartum IUD insertions performed at a maternity hospital in Santo Domingo, Dominican Republic, confirmed the safety and effectiveness of this strategy when there is adequate coordination between the prenatal, family planning, and labor and delivery services. After prenatal counseling and clinical and sexually transmitted disease risk screening, Copper T 380A IUDs were inserted in these women within 24 hours of vaginal delivery. During the first year after insertion, 849 (59.1%) of these women returned for 1 or more follow-up visits related to the device. Expulsion occurred in 26 women (3.1%) and there were 47 removals (5.5%), 41 for personal and 6 for medical reasons. No pregnancies were reported. The low expulsion rate recorded in this study, comparable to that associated with interval IUD insertion, may be attributable to the use of Kelly placenta forceps to ensure high fundal placement.
Language: English
Keywords:
DOMINICAN REPUBLIC | RESEARCH REPORT | RETROSPECTIVE STUDIES | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | PUERPERIUM | IUD EXPULSION | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment
Document Number: 121469

22.
Title: The base of the iceberg: prevalence and perceptions of maternal morbidity in four developing countries. The Maternal Morbidity Network.
Author: Fortney JA; Smith JB
Source: Research Triangle Park, North Carolina, Family Health International [FHI], Maternal and Neonatal Health Center, 1996 Dec. vii, 104 p.
Abstract: To address the need for population-based studies on maternal morbidity--"the base of the iceberg"--the Ford Foundation sponsored surveys in Bangladesh, Egypt, India, and Indonesia. Prevalent morbidities across all sites were edema (10.3-22.9%), severe vomiting (19.2-23.3%), and urinary problems (12.3-29.4%). The percentage of respondents with at least 1 morbidity during the index pregnancy and puerperium ranged from 58.3% in India to 79.9% in Bangladesh. Long-term pregnancy-related morbidity was reported by 28.6% in Bangladesh, 25.5% in Egypt, 8.2% in India, and 19.7% in Indonesia. In each site, mothers who had experienced life-threatening or serious morbidities were more likely to want additional children, presumably because they were often primiparas. The ratios of women with morbidities to maternal mortality were 186:1 in Bangladesh, 374:1 in Egypt, and 251:1 in India. Even for very serious conditions, a significant proportion of women did not perceive the severity; in other cases, severity was perceived, but medical attention was not sought. A reduction in maternal mortality and disability requires a two-pronged strategy: 1) health education for women and their families about symptoms that require attention during pregnancy, labor, delivery, and the postpartum period (e.g., pelvic pain, foul discharge, fever, and bleeding), and 2) removal of geographic, financial, cultural, and psychological barriers to care-seeking.
Language: English
Keywords:
BANGLADESH | EGYPT | INDIA | INDONESIA | DEVELOPING COUNTRIES | TECHNICAL REPORT | MORBIDITY | PREVALENCE | PERCEPTION | MATERNAL HEALTH | REPRODUCTIVE HEALTH | PREGNANCY | PUERPERIUM | WOMEN | Asia, Southern | Asia | Africa, North | Africa | Asia, Southeastern | Diseases | Measurement | Research Methodology | Psychological Factors | Behavior | Health | Reproduction | Demographic Factors | Population
Document Number: 122096

23.
Title: [Postpartum pathology] Puerperio patologico.
Author: Pozo Avalos A
Source: BOLETIN INFORMATIVO. 1996 May-Jun;(23):7-13.
Abstract: The puerperium is the 6-8 week period between childbirth and the disappearance of gestational changes. During the normal puerperium, the maternal organs except the mammary glands undergo a series of catabolic processes. The uterus returns by about the sixth week to its pre-pregnancy position and size, a process favored by oxytocics and lactation. Narrowing of the vaginal canal, occlusion of the cervix, and other changes simultaneously occur. The appearance and evolution of locchias corresponds to the curative process of the uterine wound. Normal prophylaxis in the puerperium includes early rising from the bed and progressive resumption of activity. Standards of puerperal care include assessing the pulse, temperature, quality of the locchias, evaluation of the perineum and breasts, and general condition. Possible complications of the puerperium include infections, circulatory disorders, mammary conditions, hemorrhage, and endocrine or psychic effects. Puerperal infection is defined as septic lesions either localized or generalized, arising from the genital apparatus after delivery. Predisposing causes include prolonged labor, premature rupture of membranes, repeated and septic touching of the vagina, excessive obstetric intervention, and pathologic delivery. Several different microorganisms may be involved.
Spanish Abstract: El puerperio es el per�odo de seis a ocho semanas comprendido entre el alumbramiento y la desaparici�n de los cambios gestacionales. Durante el puerperio normal, los �rganos maternos con la excepci�n de las gl�ndulas mamarias experimentan una serie de procesos catab�licos. Alrededor de la sexta semana, el �tero regresa a la posici�n y el tama�o que ten�a antes del embarazo, proceso que se ve favorecido por la oxitocia y la lactancia. El estrechamiento del canal vaginal, la oclusi�n del cuello uterino y otros cambios se producen simult�neamente. La apariencia y evoluci�n de las lochias corresponde al proceso curativo de la lesi�n uterina. La profilaxis normal en el puerperio incluye levantarse temprano de la cama y reanudar progresivamente las actividades. Entre las normas de atenci�n en el puerperio est�n las siguientes: evaluaci�n del pulso, temperatura, calidad de las lochias, evaluaci�n del perineo y las mamas, y el estado general. Entre las posibles complicaciones en el puerperio est�n las siguientes: infecciones, trastornos circulatorios, enfermedades mamarias, hemorragia y efectos endocrinos o ps�quicos. La infecci�n puerp�rea se define como lesiones s�pticas, ya sean localizadas o generalizadas, en el aparato genital despu�s del alumbramiento. Entre las causas de predisposici�n est�n las siguientes: parto prolongado, ruptura prematura de las membranas, exploraci�n manual s�ptica y repetida de la vagina, intervenci�n obst�trica excesiva y parto patol�gico. Es posible que intervengan varios microorganismos diferentes.
Language: Spanish
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | PUERPERIUM | PUERPERAL DISORDERS | Reproduction | Diseases
Document Number: 152996

24.
Title: Food habits during pregnancy among Saudi women.
Author: Al-Kanhal MA; Bani IA
Source: INTERNATIONAL JOURNAL FOR VITAMIN AND NUTRITION RESEARCH. 1995;65(3):206-10.
Abstract: During November-December 1991 in Saudi Arabia, interviews were conducted with 321 pregnant women (mean age, 27.2 years) attending three primary health care centers in Riyadh to determine their dietary practices and aversions during pregnancy. 38% craved and ate special foods (salty, sour foods, sweets, dates, milk, eggs, and meats). 33% of women during lactation ate special foods. During pregnancy 8.8% had pica cravings (the compulsion to consume non-food items) such as clay, ice, plaster, and paper. 66.4% of the women avoided milk, dates, beverages, and fungreek foods. 34.9% avoided tea, coffee, and cola beverages. 20.9% avoided meat. 33.6% listed no particular avoidances. Reasons given for avoiding foods were: unpleasant smell (9.4%), vomiting (28%), diarrhea (2.5%), undesirable effect on fetus (7.8%), heartburn (18.7%), and no particular reason (33.6%). Mother's age, mother's education, or husband's education were not associated with any of the food habits during pregnancy. Given the importance of nutritional value and composition of foods consumed during pregnancy and lactation, health workers should use these findings to provide appropriate nutrition counseling and education.
Language: English
Keywords:
SAUDI ARABIA | NUTRITION SURVEYS | PREGNANT WOMEN | DIET | ATTITUDES | PUERPERIUM | BREASTFEEDING | Developing Countries | Middle East | Nutrition | Health | Population Characteristics | Demographic Factors | Population | Psychological Factors | Behavior | Reproduction | Infant Nutrition
Document Number: 118305

25.
Title: Low birthweight and post partum endometritis-myometritis.
Author: Bergstrom S; Libombo A
Source: Acta Obstetrica et Gynecologica Scandinavica. 1995 Sep;74(8):611-3.
Abstract: Researchers compared data on 51 puerperal women with clinical signs of uterine tenderness and fever higher than 38 degrees Celsius who were admitted to the Maputo Central Hospital in Mozambique with data on 51 women with no signs of endometritis-myometritis attending the postnatal clinic to examine the association between low birth weight (LBW) and postpartum endometritis-myometritis (PPEM). Preterm births were more common among PPEM mothers than controls (odds ratio [OR] = 10.1; confidence interval [CI] = 2.1-94.5). PPEM mothers were more likely to deliver LBW neonates than control mothers (OR = 16.6; CI = 3.5-152.3). PPEM neonates were more likely to suffer serious neonatal morbidity than control neonates (OR = 14.3; CI = 1.9-626.7). Perinatal mortality occurred significantly more often to the PPEM group than the control group (CI = 1.93-infinity). These findings tend to support the view that ascending genital infections during pregnancy, which contribute to chorioamnionitis, preterm birth, and LBW, are linked to subsequent maternal PPEM. 95% of all 21 million LBW neonates are born in developing countries. Since malnutrition and HIV infection, both of which are common in poor countries, inhibit protection against infectious diseases, the number of LBW infants is expected to increase. Based on the findings, the researchers recommend, in case of high PPEM incidence, antibiotic prophylaxis for puerperal women with LBW newborns.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | CORRELATION STUDIES | ENDOMETRITIS | MYOMETRIAL EFFECTS | LOW BIRTH WEIGHT | PREMATURE BIRTH | PUERPERIUM | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Statistical Studies | Studies | Research Methodology | Reproductive Tract Infections | Infections | Diseases | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Birth Weight | Body Weight | Pregnancy Outcomes | Pregnancy | Reproduction
Document Number: 109335

26.
Title: A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization -- an update.
Author: Chi IC; Petta CA; McPheeters M
Source: ADVANCES IN CONTRACEPTION. 1995 Sep;11(3):187-206.
Abstract: Surgeons find tubal sterilization performed immediately after delivery or during the early puerperium to be easy to perform. Puerperal sterilization is safe and has no adverse effect on lactation. Yet, pregnancy rates tend to be higher in puerperal sterilization cases than in interval sterilization cases. This is especially true when surgeons use the mechanical tubal occlusion technique. During 1972-1978, depending on whether tubal rings or prototype spring-loaded clips were used, the 12-month life table pregnancy rates were, respectively, 20.5/1000 and 135.8/1000 for puerperal sterilization via laparoscopy and 4.3/1000 and 19.0/1000 for interval sterilization via laparoscopy. On the other hand, the puerperal and interval female sterilization pregnancy rates for electrocoagulation via laparoscopy were 4.7/1000 and 2.9/1000, respectively. The Pomeroy method via minilaparotomy has the highest efficacy rate and is very safe (e.g., no failures after 6 years in a US hospital), thus reproductive health specialists highly recommend it. Even though electrocoagulation via laparoscopy has high efficacy, it has a potential increased risk of complications and difficulties in tubal reanastomosis. Puerperal sterilization has advantages in terms of efficacy and efficiency over short-acting contraceptives for postpartum use. For example, these contraceptives require strict user compliance. Risk factors for post-sterilization regret that are related to puerperal sterilization include: abrupt decision before and/or after delivery, procedure performed for obstetrical reasons, and cesarean section. Physicians need to screen for all risk factors for post-sterilization regret and counsel women before puerperal sterilization. Other unresolved issues are motivation for puerperal sterilization; effect of long-acting, reversible contraceptive methods; and relationships between tubal sterilization and post-tubal ligation syndrome.
Language: English
Keywords:
LITERATURE REVIEW | TUBAL OCCLUSION | TUBAL LIGATION | PUERPERIUM | INTERVAL STERILIZATION | SAFETY | CONTRACEPTIVE METHOD ACCEPTABILITY | REGRET | OVARIAN CANCER | SIDE EFFECTS | Female Sterilization | Sterilization, Sexual | Family Planning | Reproduction | Public Health | Health | Contraceptive Usage | Contraception | Psychological Factors | Behavior | Cancer | Neoplasms | Diseases | Treatment
Document Number: 108795

27.
Title: A case-control study on post-caesarean endometritis-myometritis in Mozambique.
Author: Libombo A; Folgosa E; Bergstrom S
Source: GYNECOLOGIC AND OBSTETRIC INVESTIGATION. 1995;39(3):180-5.
Abstract: A case control study included 49 women diagnosed with post-cesarean endometritis-myometritis (PCEM) and 47 controls who had also undergone a cesarean section but had no PCEM. Controls were matched with cases by age, parity, and days postpartum. All cases and controls delivered at Maputo Central Hospital in Mozambique. The study aimed to define potential background PCEM risk factors of socioeconomic and obstetric origin and serological and microbiological correlates. Health workers took blood samples, endocervical swabs, and intracavitary cultures from all cases and controls. They administered intraoperative prophylactic antibiotics to all cases and controls. Cases were more likely to live in a household of at least 6 persons (odds ratio [OR] = 4.44). Other socioeconomic factors studied were not significantly different between the 2 groups. Number of live births, stillbirths, abortions, and previous low birth weight deliveries were similar among both cases and controls. Cases were significantly less likely to have undergone a previous cesarean section than controls (OR = 0.12). Anaerobic bacteria were isolated more often from cases than controls in vaginal, endocervical, and intrauterine cultures (OR = 1.65, 1.95, and 1.77, respectively). Yet, the observed cultures were not significantly different between the 2 groups. Syphilis seropositivity and Chlamydia trachomatis rates were similar in cases and controls. These findings did not reveal any easily recognizable background risk factors for PCEM or any etiologic agent for PCEM. Additional case control studies are needed to focus on surgical factors. They also need to take on a more comprehensive microbiology and serology approach.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | CASE CONTROL STUDIES | ENDOMETRITIS | MYOMETRIAL EFFECTS | RISK FACTORS | CESAREAN SECTION | PUERPERIUM | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Reproductive Tract Infections | Infections | Diseases | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Reproduction
Document Number: 104329

28.
Title: Towards the participation of traditional birth attendants in primary health care in Kenya.
Author: Sindiga I
Source: East African Medical Journal. 1995 Jul;72(7):459-64.
Abstract: During 1989-1990, interviews were conducted with 80 female traditional birth attendants (TBAs) in Kendu, Homa Bay district, Kenya, to examine their knowledge, functions, and participation in maternal and child health and family planning. Most TBAs learned through an apprenticeship with their mothers and grandmothers. All had been trained in primary health care. 79% provided prenatal care. 76% said pregnant women should not eat certain foods (e.g., meat, bananas) and use certain drugs (e.g., alcohol, cigarettes) and substances (e.g., soil). TBAs tended to administer herbal medicines to pregnant women. They watched for certain danger signals in pregnant women (e.g., body swelling, convulsions, persistent vomiting, vaginal bleeding). 70% had seen or known pregnant women who had convulsions. 14% considered convulsions to be normal in pregnancy. Only 14% would refer a pregnant woman with convulsions to a hospital. For tools, the TBAs had a tool for cutting the umbilical cord, gloves, cotton, and thread/string. 81% boiled the tools to sterilize them. 78% inserted their fingers in the vagina of a woman in labor to guide the baby's head. 12% admitted to ever having delivered a woman who died while giving birth. 84% delivered women who were pregnant for the first time. 93% put something (e.g., talcum powder) on the cord to hasten its drying and falling off. TBAs tended to care for the newborns and their mothers during the first month and sometimes thereafter. 34% gave newborns herbs (e.g., orange leaves). 76% gave new mothers herbs or special foods. All TBAs knew about family planning and had ever advised women to practice it. 95% knew that family planning limits or spaces pregnancies. 89% approved of family planning. 79% knew a method, especially the pill. Most TBAs promoted the pill and condom use. 97% had recommended their clients to go to a health facility for maternal care in the last year. All TBAs would work with the staff of the local health center on maternal and child health. 72% worked full-time. 70% had charged fees. 79% always kept record of deliveries.
Language: English
Keywords:
KENYA | KAP SURVEYS | MIDWIVES AND MIDWIFERY | ANTENATAL CARE | CHILDBIRTH | PUERPERIUM | KNOWLEDGE | REFERRAL AND CONSULTATION | TRADITIONAL MEDICINE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Program Activities | Programs | Organization and Administration | Medicine
Document Number: 119285

29.
Title: Maternal mortality in a maternity hospital in Turkey.
Author: Tuncer RA; Erkaya S; Sipahi T; Kutlar I
Source: Acta Obstetrica et Gynecologica Scandinavica. 1995 Sep;74(8):604-6.
Abstract: During 1983-1992 in Turkey, 17 maternal deaths occurred out of 100,531 live births at the Zubeyde Hanim Maternity Hospital in Ankara for a maternal mortality ratio (MMR) of 16.9/100,000 live births. Hemorrhage (41.2%) and pulmonary embolism (35.3%) were the leading causes of maternal death. Cases referred to the hospital after home deliveries accounted for 57% of the hemorrhage-related deaths. Other causes of maternal death were eclampsia (11.7%), puerperal infection (5.9%), and heart failure attributed to rheumatic heart disease (5.9%). The MMR fell over time from 22.6 (1983-1984) to 12.8 (1991-1992). Women younger than 20 and those 35 and older suffered from the highest MMRs. MMR increased with parity (8 for primigravida, 10 for parity 1-2, 27.3 for parity 3-4, and 62.1 for parity =or> 5). Cesarean delivery was associated with a higher MMR than vaginal delivery (44.7 vs. 14.1). This association was likely a result of pregnancy complications that led to a cesarean section rather than the cesarean section itself.
Language: English
Keywords:
TURKEY | RETROSPECTIVE STUDIES | MATERNAL MORTALITY | HOSPITALS | CAUSES OF DEATH | BLEEDING | PULMONARY EMBOLISM | INFECTIONS | ECLAMPSIA | PUERPERIUM | AGE FACTORS | MULTIPARITY | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Embolism | Vascular Diseases | Pregnancy Complications | Reproduction | Population Characteristics | Parity | Fertility Measurements | Fertility
Document Number: 109336

30.
Title: Caring for mothers: a manual for rural health workers.
Author: Everett J; McMahon R
Source: Nairobi, Kenya, African Medical and Research Foundation, 1994. viii, 180 p.
Abstract: This manual was written for village health workers and covers the major problems associated with pregnancy, delivery, and postpartum care. Part 1 deals with the prenatal clinic and includes information on how to conduct a prenatal clinic and how to advise a pregnant woman as well as the minor and serious problems of pregnancy. Part 2 describes normal and problematic labor and delivery. Part 3 discusses postpartum care of the mother and baby in both normal and problematic situations. This part also contains information on various methods of family planning. The annexes to the manual provide information on anatomy and physiology, medicines used to treat illness, legal abortion and menstrual regulation, an appropriate prenatal care, essential delivery kits, and procedures for emergency referral.
Language: English
Keywords:
DEVELOPING COUNTRIES | MANUAL | MIDWIVES AND MIDWIFERY | HEALTH PERSONNEL | MATERNAL HEALTH | ANTENATAL CARE | CHILDBIRTH | PUERPERIUM | PREGNANT WOMEN | INFANT | POSTPARTUM WOMEN | PREGNANCY COMPLICATIONS | MATERNAL PHYSIOLOGY | PUERPERAL DISORDERS | TREATMENT | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Diseases | Physiology | Biology
Document Number: 111084


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