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Hospital Delivery (hospital + delivery)

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Medical Sciences	100%

Selected Abstracts

Maternal mortality in Yunnan, China: recent trends and associated factors

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2007
J Li
Objective, Yunnan Province, located in southwest China, is one of the poorest province in China. The maternal mortality ratio (MMR) is about twice the national average (56.2/100 000 live births), and in remote mountainous regions, the rate is five times higher. This study aimed to examine the progress in reduction of maternal mortality in the 1990s and early 2000s and the factors associated with this reduction in Yunnan. Design, A population-based, longitudinal, ecological correlation study. Setting, A remote province of China with a proportionately large indigenous population. Population, Populations at county, prefecture and provincial level. Methods, Using maternal mortality data collected at the province, prefecture/region and county levels, trend and time series analyses and multivariate linear regression analyses were performed using SPSS (Version 13). Main outcome measure, MMR and its change over time. Results, MMR declined substantially in the 1990s at a rate of 3.0% per year. Utilisation of prenatal and obstetric care increased and was significantly correlated with the declining trend in MMR. Hospital delivery was a strong predictor of MMR, independent of social and economic development. Both low income and illiteracy were significantly associated with increased MMR. Conclusions, Declines in maternal mortality in Yunnan over the past 14 years appear to reflect health, social and economic interventions implemented in the 1990s. The association of hospital delivery with maternal mortality may be due to the effective management of severe pregnancy and birth complications. Low income and illiteracy were associated with MMR but primarily through their impact on the use of prenatal and obstetric care. [source]

The recurrence risk of severe de novo pre-eclampsia in singleton pregnancies: a population-based cohort

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2009
SD McDonald
Objective, Previous studies have found recurrence risks of severe pre-eclampsia as high as 40%. Our objective was to determine both the recurrence risk of severe de novo pre-eclampsia and risk factors associated with it in a contemporaneous population. Study design, Population-based retrospective cohort study. Population, Women who had two or more singleton liveborn or stillborn hospital deliveries in Ontario, Canada between April 1994 and March 2002 and without a history of chronic hypertension Methods, International Classification of Disease codes were used to identify patients in the Canadian Institute for Health Information Discharge Abstract Database. Main outcome measures, The absolute and adjusted risks of recurrent severe de novo pre-eclampsia were determined. Results, Between 1 April 1994 and 30 March 2002, there were 185 098 women with two or more singleton deliveries >20 weeks in the province of Ontario, Canada. There were 1954 women who had severe de novo pre-eclampsia in the index pregnancy, 133 of whom had recurrent severe pre-eclampsia, for a risk of recurrent severe pre-eclampsia of 6.8% (95% CI 5.7,7.9%). The risk of recurrent severe de novo pre-eclampsia was increased in women with pre-existing renal disease (adjusted OR 17.98, 95% CI 3.50,92.52) and those >35 years of age (adjusted OR 3.79, 95% CI 2.04,7.04, reference 20,25 years). Conclusions, The recurrence risk of severe de novo pre-eclampsia in our population-based cohort study (6.8%) is lower than previously published reports in selected populations. [source]

,+ -Thalassaemia and pregnancy in a malaria endemic region of Papua New Guinea

BRITISH JOURNAL OF HAEMATOLOGY, Issue 2 2006
A. O'Donnell
Summary The effect of maternal ,+ -thalassaemia on pregnancy was assessed in the north coastal region of Papua New Guinea (PNG), where malaria is hyperendemic and ,+ -thalassaemia is extremely common. In a prospective study of 987 singleton hospital deliveries, we correlated maternal , -globin genotype with markers of reproductive fitness (age in primigravidae, gravidity, pregnancy interval and the number of miscarriages and stillbirths), Plasmodium falciparum(P. falciparum) infection of the mother and placenta, maternal haemoglobin, preterm delivery and birthweight. The frequency of the ,, genotype in mothers was 0·61. Markers of reproductive fitness were similar in women with and without ,+ -thalassaemia. Median haemoglobin concentration during pregnancy and after delivery was about 1·0 g/dl lower in homozygous ,+ -thalassaemia than in women with a normal , - globin genotype (P , 0·001). The frequency of placental P. falciparum infection and systemic malaria infection after delivery showed no consistent relationship to , -globin genotype. The frequency of preterm delivery and low birthweight did not vary significantly according to maternal , -globin genotype. Maternal ,+ -thalassaemia does not affect reproductive fitness or susceptibility to malaria during pregnancy. Although median haemoglobin concentration was significantly lower in mothers homozygous for ,+ -thalassaemia than those with a normal , -globin genotype, this did not result in an adverse outcome of pregnancy. [source]

Safe motherhood in Jamaica: from slavery to self-determination

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2005
Affette McCaw-Binns
Summary The development of maternal health care in Jamaica is reviewed by examining government documents and publications to identify social and political factors associated with maternal mortality decline. Modern maternity services began with the 1887 establishment of the Victoria Jubilee Hospital and Midwifery School. Community midwives were deployed widely by the 1930s and community antenatal care expanded in the 1950s. Social policies in the 1970s increased women's access to primary health care, education and social support; improved transportation in the 1990s facilitated hospital delivery. Maternal mortality declined rapidly from ,600/100 000 in the 1930s to 200/100 000 in 1960, led by a 69% decline in sepsis by 1950, and a 72% decline from all causes thereafter, settling at ,100/100 000 in the 1980s. Skilled birth attendant deliveries moved from 39% in 1950 to 95% in 2001 and hospital births from 31% in 1960 to 91% in 2001. Maternal mortality plateaued at 70,80% prevalence of skilled delivery care. Deployment of midwives into rural communities and social development focused on women and children were associated with the observed improvements. Further reductions will require greater attention to the quality of emergency obstetric care. [source]

Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008
MP Amelink-Verburg
Objective, To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design, Descriptive study. Setting, Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001,03). Population, Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods, Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures, Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results, In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001). On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions, Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. [source]