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Maternal and Perinatal Death Surveillance and Response in Balochistan, Pakistan - Causes & Contributory Factors of Maternal Deaths
Anaam Arif,
Asfandyar Sherani,
Qudsia Uzma,
Babar Alam,
Ellen Thom,
Attiya Abro,
Naila Ehsan,
Ismail Mirwani,
Aisha Siddiqa,
Uzma Sohail,
Najma Ghaffar,
Shazia Saeed,
Rehana Kamal,
Fozia Muhammad Bukhsh,
Safia Bibi,
Fozia Baloch
Issue:
Volume 10, Issue 1, January 2022
Pages:
1-5
Received:
7 June 2021
Accepted:
19 July 2021
Published:
8 January 2022
Abstract: Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Non-medical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.
Abstract: Pakistan is the sixth most populous country in the world & is ranked 53rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest ...
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Post Abortion Family Planning Utilization and Associated Factors Among Women Received Abortion Services at Adama Hospital Medical College, Oromia, Ethiopia
Usmael Mohammed,
Hunde Lemi,
Ephrem Manekullih
Issue:
Volume 10, Issue 1, January 2022
Pages:
6-13
Received:
14 December 2021
Accepted:
5 January 2022
Published:
14 January 2022
Abstract: Worldwide post abortion contraceptive prevalence varies within a range of from 69% in Eastern and Southern Europe to 78% in Northern Europe. In Asia, South America and Africa post-abortion family planning utilization variation is ranging from 61 to 97%. In Ethiopia 48– 59% of clients left their institution with post-abortion family planning services which showed wide variations in the percentage of women who received post-abortion contraception. Post-abortion family planning has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. Now it is important to investigate the level post abortion family planning and act on the factors accordingly. So this study aimed to assess post abortion family planning utilization and associated factors among women getting abortion services at Adama Hospital Medical College, 2021. Method: Institutional based cross-sectional study was conducted from january-1 to february-28, 2021. A sample of 471 women were enrolled consecutively. Data was collected by semi-structured questionnaires which were administered via face to face interview. Data was entered using Epi-Info version 7 then exported to SPSS version 20 for processing and analysis. Descriptive statistics was used to explore the participant’s characteristics. Binary & multiple logistic regression was used to assess the association between dependent & independent variables. The magnitude of association between dependent & independent variables were measured by odds ratios along with estimated 95% confidence interval. Finally the significance of association was declared by p-value of less than 0.05. Results: The magnitude of post abortion contraceptive was found to be 73.9% (95% CI: 70.1-77.9). The odds of using post abortion family planning for women having diploma level of education was 28.37 (AOR=28.37; 95% CI: 4.09-196.834) times higher than those having no formal educations. After surgical termination the odds of post abortion contraceptive use was 58.9% (AOR=0.411; 95% CI: 0.169-0.991) times lesser than for medical abortion. Conclusion & recommendations: The magnitude of post abortion family planning in this study seems lesser. Independent predictors like maternal education, procedure done, counseling, reason of termination and knowledge status were significantly associated with the outcome variable. So attention should be given for counseling & level of education for consistent & efficient use.
Abstract: Worldwide post abortion contraceptive prevalence varies within a range of from 69% in Eastern and Southern Europe to 78% in Northern Europe. In Asia, South America and Africa post-abortion family planning utilization variation is ranging from 61 to 97%. In Ethiopia 48– 59% of clients left their institution with post-abortion family planning service...
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The Usage of Antenatal Care Visit and Its Determinant Factors Using 2016 EDHS Data: Application of Count Regression Models
Tigist Tefera Worku,
Cheru Atsmegiorgis
Issue:
Volume 10, Issue 1, January 2022
Pages:
14-25
Received:
6 December 2021
Accepted:
5 January 2022
Published:
20 January 2022
Abstract: Antenatal care gives women and their families the information and advice they need to have a healthy pregnancy, have safe childbirth, and recover postpartum. ANC is an important intervention for lowering maternal and newborn mortality. There have been some studies done on determinants that affect the number of the minimum recommended antenatal care visits attendance, and it would be interesting to see the number of antenatal care visits and its determinant factor among pregnant women in Ethiopia from the 2016 Ethiopia Demographic Health Survey. The data was exported to STATASE 14 (64-bit) software was used for analysis and a weighted sample of 7575 women who gave birth in the last five years before the survey was included in the final analysis. A multivariable Negative Binomial regression analysis approach was carried out to identify the number of ANC visits and the determinants that affect the number of ANC visits, because the response variable was over dispersed. The aim of this study to assess the use of antenatal care visits and the factors affecting it using the 2016 EDHS Data through the application of count regression models. Finally, the IRR was used to report the relationship between the frequency of ANC and explanatory variables, along with its 95 percent confidence interval. According to the analysis (62.79%) of mothers had at least one antenatal care visit, (37.21%) had no antenatal care visit and only 31.88% attended four or more ANC visits during their pregnancy in Ethiopia. Maternal age, residence, maternal education, wealth quintile, place of ANC, ANC providers, and first ANC visit were significantly associated with level of antenatal care visits. Generally, frequency of antenatal care visits is low in Ethiopia. Its recommended to all concerned bodies should focus on their program on the number of ANC visits in all Ethiopia to improve both maternal and child health.
Abstract: Antenatal care gives women and their families the information and advice they need to have a healthy pregnancy, have safe childbirth, and recover postpartum. ANC is an important intervention for lowering maternal and newborn mortality. There have been some studies done on determinants that affect the number of the minimum recommended antenatal care...
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Post-Cesarean Parietal Suppurations in a Level II Maternity Hospital in Guinea: Sociodemographic, Clinical, Therapeutic and Prognostic Aspects
Ibrahima Koussy Bah,
Abdourahmane Diallo,
Sekouba Kouyate,
Thierno Souleymane Diallo,
Oumar Diawara,
Ibrahima Amadou Diallo,
Yero Diouma Sow,
Abdoul Karim Bangoura,
Telly Sy
Issue:
Volume 10, Issue 1, January 2022
Pages:
26-31
Received:
24 December 2021
Accepted:
15 January 2022
Published:
24 January 2022
Abstract: Surgical site infections are frequently encountered in developing countries. In the world, cesarean section is one of the most performed surgical procedures for women. The objective of this study was to describe the socio-demographic, clinical, therapeutic and prognostic aspects of post-cesarean suppurations in the gynecology-obstetrics department of the Communal Medical Center of Ratoma. This was a descriptive study carried out in the gynecology-obstetrics department of the Communal Medical Center of Ratoma (maternity level II) in Guinea extended over six months from April 1 to September 30, 2020. The patients who presented with post suppuration - cesarean section and accepted to participate in the study were included. The variables were socio-demographic, clinical, therapeutic and prognostic. Forty-eight cases of suppurations were recorded out of 1090 cesarean sections, i.e. a frequency of 4.4%. The 31 to 36 age group was the most represented (41.67%). The average age was 23.29±4.76 years with extremes of 16 and 36 years. These were mainly housewives (41.66%), married women (95.84%) and residents mostly in the municipality of Ratoma (75.01%). The time to rupture of the membranes was less than 12 hours in 62.50% of cases and cesarean section was performed urgently in 83.33% of cases and the most frequent indication was foeto-pelvic disproportion in 33.34% of cases. The mean duration of the operation was 37.78±9.10 minutes with extremes of 20 and 75 minutes in the majority of cases. Suppuration was diagnosed at week 1 (60%) and the identified germ was staphylococcus aureus in 61, 53% of cases. No revision surgery had been performed and no maternal deaths were recorded. Post-cesarean parietal suppuration remains frequent; thus a better identification of the factors favoring this affection could make it possible to significantly reduce their incidence and consequently improve the maternal prognosis.
Abstract: Surgical site infections are frequently encountered in developing countries. In the world, cesarean section is one of the most performed surgical procedures for women. The objective of this study was to describe the socio-demographic, clinical, therapeutic and prognostic aspects of post-cesarean suppurations in the gynecology-obstetrics department ...
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Effect of Maximum Repetition of Pelvic Floor Stabilization Exercise in Stress Urinary Incontinence
Iren Khatun,
Mohammad Anwar Hossain,
K. M. Amran Hossain,
Nadia Afrin Urme
Issue:
Volume 10, Issue 1, January 2022
Pages:
32-38
Received:
10 December 2021
Accepted:
24 December 2021
Published:
28 January 2022
Abstract: Introduction: Stress urinary incontinence (SUI) in females is a common gynecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence. Aim: The aim of the study is to determine if maximum repetition of pelvic stabilization exercise impacts the management of stress urinary incontinence in females. Methodology: One arm quasi-experimental study design was used. 40 patients having SUI and associated musculoskeletal complaints were recruited from the outpatient unit of Physiotherapy department of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. The study was conducted over 4weeks. Outcome measurement was included pelvic floor and abdominal muscle strength, endurance, and incontinence measurement. Result: Pelvic floor muscle and abdominal strength, and endurance had a positive and significant result in maximum repetition (P.001). Pelvic floor strength has been significantly improvement in week 2 (P.001), and week 3 (P.01). Interference in activities (P.003), and ICIQ total (P.001) had improvement but majority of the improvement was noted in weeks 2-3. There was a significant improvement in the frequency of urine leakage in the first week (P.001), and week 3 (P.005) and week 4 (P.001). Conclusion: Pelvic floor exercise with increasing repetition is an effective approach to improve stress urinary incontinence in women. The study also found its significant impact on incontinence frequency, amount, and associated quality of life for women with stress urinary incontinence with pelvic floor exercise with maximum repetition.
Abstract: Introduction: Stress urinary incontinence (SUI) in females is a common gynecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence. Aim: The aim of the study is to determine if maximum repetition o...
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Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1)
Vesna Harni,
Damir Babic,
Suzana Ljubojevic-Hadzavdic,
Dubravko Barisic
Issue:
Volume 10, Issue 1, January 2022
Pages:
39-47
Received:
3 January 2022
Accepted:
24 January 2022
Published:
5 February 2022
Abstract: Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of the specificity and localization of the lesion relative to the vulvar ring. This paper evaluated the sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index in detecting vulvar dermatosis compared with histopathology as a reference test. Structured ISSVD vulvodynia pattern questionnaire and TRIV form data were utilized for the study. The data obtained were analyzed using StatSoft (Dell, Austin, Texas), Statistica 12 (TIBCO®, Palo Alto, CA), and SPSS 20 (IBM, Armonk, NY). Ethical approval for the study was obtained from the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. The histopathological diagnosis of vulvar dermatosis was confirmed in 72 patients at first biopsy. Lesions specific for vulvar dermatosis were visible by TRIV in 82 patients. The resulting difference of ten patients were participants with early vulvar dermatosis. In six of them, vulvar dermatosis was confirmed at a later biopsy during the study period. There was no statistically significant difference between the scores of points (median and range), frequency and relative frequency of vulvar findings within one item of the vulvoscopy index and histopathology, except for ten patients with early forms of vulvar dermatoses. The sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index for detecting vulvar dermatosis were 100%, 96.1%, and 96.9%, respectively. The positive and negative predictive values were 0.88 and 1.00, respectively. The vulvoscopy index represents a compelling clinical test for detecting vulvar dermatoses. Differences between vulvoscopic and histopathological diagnostics implicate the impossibility of histopathology in recognizing early forms of vulvar dermatoses. Accordingly, early dermatoses could represent a key area for applying this test. ClinicalTrials.gov Identifier: NCT02732145.
Abstract: Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of...
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The Complication of Ureteral Injury Induced by Gynecological Laparoscopic Surgery
Zhiyong Dong,
Mengyue Chen,
Junling Liu,
Zhenyue Qin,
Huihui Wang,
Mingyue Bao,
Ruxia Shi,
Jiming Chen
Issue:
Volume 10, Issue 1, January 2022
Pages:
48-51
Received:
12 January 2022
Accepted:
4 February 2022
Published:
16 February 2022
Abstract: Compared with traditional laparotomy, laparoscopic surgery has obvious advantages (smaller incisions, shorter hospital stays, and reduced blood loss). At present, more and more gynecological surgeries can be completed under laparoscopy. With the increasement of clinical treatment of gynecological laparoscopic surgery, the complications related to gynecological laparoscopic surgery and their prevention measures have become a continuous concern in the field of gynecology. The risk of injury to the lower urinary tract, consisting of the bladder and ureters, is inherent to gynecologic surgery regardless of operative technique, because the bladder and ureters lie adjacent to other critical structures. Ureteral injury caused by gynecological laparoscopic surgery is a relatively rare complication. Clinicians do not pay enough attention to it because of its low incidence. However, once it happens, the consequences are often serious. The clinical manifestations of ureteral injury caused by gynecological laparoscopic surgery vary greatly according to the location and severity of the injury. Patients with mild injury can heal themselves after conservative treatment, and patients with severe injury can have serious consequences such as peritonitis and acute renal insufficiency, and even lead to death. This paper will focus on ureteral anatomy, common causes, clinical manifestations, key points of diagnosis, treatment measures and prevention strategies of ureteral injury caused by laparoscopic surgery.
Abstract: Compared with traditional laparotomy, laparoscopic surgery has obvious advantages (smaller incisions, shorter hospital stays, and reduced blood loss). At present, more and more gynecological surgeries can be completed under laparoscopy. With the increasement of clinical treatment of gynecological laparoscopic surgery, the complications related to g...
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