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Objectives: To assess and enhance the efficiency of transfusion services in maternity hospitals. Methods: A case control study was conducted from January to December 2016. A corrective policy of replacing preoperative type and hold step with blood transfusion request (BTR) hold was used only on healthy patients undergoing elective cesarean sections (c-section). The crossmatch/transfusion (C:T) ratio and a cost comparison were the evaluating factors. Data were analyzed using an Excel spreadsheet and SPSS statistical software. Results: A total of 1,200 BTRs were analyzed, comprising 659 before implementation of the corrective policy and 541 blood transfusion requests after implementation of the corrective policy. From January to March, the C:T ratio of c-sections was nearly 7 times the American Association of Blood Banks recommended limit of 2.5. Most of the blood units (94%) were damaged due to repeated booking. After implementation, the cost-effectiveness of erythrocyte transfusion was greatly enhanced as all the ordered blood units were used and the C:T ratio was reduced to the ideal limit of one. The number of destroyed units was drastically decreased from 450 units to zero; as a result, 83% of the transfusion costs were saved. Conclusion: The policy enhances the cost-effectiveness of erythrocyte transfusion and laboratory testing, and saves on additional, unnecessary costs.

On January 2020, the French College of Gynecologists and Obstetricians (CNGOF) issued new Clinical Practice Guidelines (CPG) "Breech Presentation". Since then, it is recommended to use a tocolytic agent to improve the success rate of External Cephalic Version (ECV). The aim of this study, one year after these CPG, is to compare ECV without (before CPG) and with (after CPG) tocolysis in a type III maternity hospital. We intend to assess its effects on immediate success rate of ECV and obstetrical and neonatal outcomes.This is a single-center retrospective study conducted in Nantes University Hospital. We collected patient characteristics, immediate success rate, and maternal and neonatal outcomes at delivery of all ECV over two periods: the first one during 2019 (before CPG) and the second one from June 2020 to June 2021 (after CPG).We included 253 patients: 126 in the first period and 127 in the second period. Immediate success rate of ECV was significantly higher since the use of tocolysis: 38.6 % (period 2) vs 23.8 % (period 1) (P=0.011). However, there was not significant difference found for cephalic presentation at birth, mode of delivery or obstetrical and neonatal outcomes.The immediate success rate is significantly improved with the widespread use of tocolysis during ECV, with no change in obstetrical and neonatal outcomes.

Background Induction of labour, a very common obstetric procedure, affects about one in five pregnant women in most developed countries. Induction of labour is medically indicated, is subject to risks and additional costs, and is often poorly experienced by patients. The practices concerning induction vary widely from centre to centre and therefore need to be evaluated. Our aim was to develop a tool for evaluating induction of labour which would facilitate geographical and temporal comparisons. Methods We have created a classification based on the principles of the internationally known Robson classification. It should be simple, robust, reproducible and require readily available data in each file. The groups are fully inclusive and mutually exclusive. This classification has been validated by a Delphi method. Results Our classification includes 8 clinically relevant groups according to 5 obstetrical criteria. In order to classify each patient into a group, a simple system based on a maximum of 7 successive questions (from 1 to 7 questions) is used. Our classification has been validated by 13 national experts with satisfactory overall approval. Conclusions With a view to improving the quality of care, our Grenoble classification would allow a standardization of the evaluation of practices of the induction of labour over time in the same maternity hospital. It would also allow the comparison of practices within different maternity hospitals in a network, a country or even different countries.

Our study aimed to examine pregnancy, neonatal and psychosocial outcomes for women treated with LAIs at tertiary maternity hospital. A retrospective review of all women who were treated with LAIs between 1999 and 2017. Cases were identified via the hospital dispensary system and outcome data were extracted case notes as well as the midwifery notification system. Measures included sociodemographic data, smoking, alcohol and illicit substance use, pregnancy complications such as gestational diabetes, and neonatal outcomes. Psychosocial profiles such as psychiatric admission during pregnancy and statutory child protection involvement were also assessed. Where available, outcomes were compared with state population data. The study found 38 pregnancies to 36 women, who had LAI treatment. Two congenital malformations (5.7%) were recorded. Compared to general population data, pregnant women treated with LAIs were more likely to have obstetric complications including gestational diabetes and pregnancy hypertension and special care nursery admission for their babies. They also had elevated rates of psychiatric admissions during pregnancy and statutory child protection involvement. Outcomes were similar first and second generation LAIs exposure. As women on LAI have limited options for treatment of their psychotic disorders, the findings point towards a need for enhanced multidisciplinary pregnancy care for this vulnerable cohort.

To assess whether there are associations between driving distance from the patient residence to the delivery hospital and adverse maternal and perinatal health outcomes.We performed a retrospective cohort study using 2011-2015 Pennsylvania birth records of live births at 20 weeks of gestation or more, excluding inpatient hospital transfers or implausible distances. The shortest driving distance from patient residence to the delivery hospital was calculated in ArcGIS and was evaluated in association with a composite of adverse maternal outcomes (blood transfusion, unplanned operation, ruptured uterus, unplanned hysterectomy, or intensive care unit admission) and neonatal intensive care unit (NICU) admission. Multivariable-adjusted Poisson models were used to estimate relative risks with 95% CIs with a referent difference of 1 km distance to the delivery hospital.A total 662,245 birth records were included, and the median driving distance to the hospital was 11.3 km (interquartile range 5.4-21.6 km). The overall rate of the composite maternal outcome was 0.6% and of NICU admission was 8.4%. Compared with the referent distance, increasing driving distance was significantly associated with increased adjusted risks of the maternal composite outcome (adjusted relative risk [aRR] 1.22, 95% CI 1.07-1.36 for 60 km; aRR 1.36, 95% CI 1.19-1.53 for 70 km; and 1.53, 95% CI 1.31-1.75 for 80 km) and NICU admission (aRR 1.70, 95% CI 1.65-1.76 for 60 km; aRR 1.96, 95% CI 1.90-2.02 for 70 km; and aRR 2.25, 95% CI 2.18-2.33 for 80 km).Longer distances to the delivery hospital were associated with greater risk of adverse maternal outcomes and NICU admission. Whether these findings reflect health care delivery deficits or simply serve as a marker of social deprivation requires further study.

Clinically feasible multiparameter continuous physiological monitoring technologies are needed for use in resource-constrained African healthcare facilities to allow for early detection of critical events and timely intervention for major morbidities in high-risk neonates. We conducted a prospective clinical feasibility study of a novel multiparameter continuous physiological monitoring technology in neonates at Pumwani Maternity Hospital in Nairobi, Kenya. To assess feasibility, we compared the performance of Sibel’s Advanced Neonatal Epidermal (ANNE) technology to reference technologies, including Masimo’s Rad-97 pulse CO-oximeter with capnography technology for heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) measurements and Spengler’s Tempo Easy non-contact infrared thermometer for temperature measurements. We evaluated key performance criteria such as up-time, clinical event detection performance, and the agreement of measurements compared to those from the reference technologies in an uncontrolled, real-world setting. Between September 15 and December 15, 2020, we collected and analyzed 503 h of ANNE data from 109 enrolled neonates. ANNE’s up-time was 42 (11%) h more for HR, 77 (25%) h more for RR, and 6 (2%) h less for SpO2 compared to the Rad-97. However, ANNE’s ratio of up-time to total attached time was less than Rad-97’s for HR (0.79 vs 0.86), RR (0.68 vs. 0.79), and SpO2 (0.69 vs 0.86). ANNE demonstrated adequate performance in identifying high and low HR and RR and high temperature events; however, showed relatively poor performance for low SpO2 events. The normalized spread of limits of agreement were 8.4% for HR and 52.2% for RR and the normalized root-mean-square deviation was 4.4% for SpO2. Temperature agreement showed a spread of limits of agreement of 2.8 °C. The a priori-identified optimal limits were met for HR and temperature but not for RR or SpO2. ANNE was clinically feasible for HR and temperature but not RR and SpO2 as demonstrated by the technology’s up-time, clinical event detection performance, and the agreement of measurements compared to those from the reference technologies.

Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB. Differences were compared using chi-square test, with significance level set at p

Introduction Mistreatment during childbirth is an issue of global magnitude that not only violates fundamental human rights but also seriously impacts women’s well-being. The purpose of this study was to gain a better understanding of the phenomenon by exploring the individual experiences of women who reported mistreatment during childbirth in Switzerland. Materials and methods This project used a mixed methods approach to investigate women’s experiences of mistreatment during childbirth in general and informal coercion specifically: The present qualitative study expands on the findings from a nationwide online survey on childbirth experience. It combines inductive with theoretical thematic analysis to study the 7,753 comments women wrote in the survey and the subsequent interviews with 11 women who reported being mistreated during childbirth. Results The women described a wide range of experiences of mistreatment during childbirth in both the survey comments and the interviews. Out of all survey participants who wrote at least one comment (n = 3,547), 28% described one or more experiences of mistreatment. Six of the seven types of mistreatment listed in Bohren and colleagues’ typology of mistreatment during childbirth were found, the most frequent of which were ineffective communication and lack of informed consent. Five additional themes were identified in the interviews: Informal coercion, risk factors for mistreatment, consequences of mistreatment, examples of good care, and what’s needed to improve maternity care. Conclusion The findings from this study show that experiences of mistreatment are a reality in Swiss maternity care and give insight into women’s individual experiences as well as how these affect them during and after childbirth. This study emphasises the need to respect women’s autonomy in order to prevent mistreatment and empower women to actively participate in decisions. Both individual and systemic efforts are required to prevent mistreatment and guarantee respectful, dignified, and high-quality maternity care for all.

Objectives: to develop a booklet as an educational technology, together with health professionals, patients and companions, aiming at their involvement in patient safety in maternity hospitals. Methods: a qualitative convergent care study, carried out in three stages at a maternity hospital in Belo Horizonte. The booklet construction took place between February and April 2021, with 13 professionals, 06 companions and 11 patients. Results: data content analysis was performed, creating three categories: Knowledge and experiences about patient and newborn safety in maternity hospitals; Challenges for involving patient and companion in safety actions; Assessment of patients, companions and professionals on the booklet construction process. The booklet construction involved the participation of health professionals, users and companions in all stages of the process. Final considerations: the participatory process enabled the creation of educational technology for the involvement of patients and companions in patient safety actions. RESUMEN Objetivos: desarrollar una cartilla como tecnología educativa, junto a profesionales de la salud, pacientes y acompañantes, con el objetivo de involucrarlos en la seguridad del paciente en la sala de maternidad. Métodos: estudio cualitativo convergente-asistencial, realizado en tres etapas en una maternidad de Belo Horizonte. La construcción de la cartilla ocurrió entre febrero y abril de 2021, con 13 profesionales, 06 acompañantes y 11 pacientes. Resultados: se realizó un análisis de contenido de los datos, creando tres categorías: Conocimientos y experiencias sobre la seguridad del paciente y del recién nacido en la sala de maternidad; Desafíos para involucrar al paciente y acompañante en acciones de seguridad; Evaluación de pacientes, acompañantes y profesionales sobre el proceso de construcción del cuadernillo. La construcción de la cartilla implicó la participación de profesionales de la salud, usuarios y acompañantes en todas las etapas del proceso. Consideraciones finales: el proceso participativo posibilitó la creación de tecnología educativa para el envolvimiento de pacientes y acompañantes en acciones de seguridad del paciente. RESUMO Objetivos: desenvolver uma cartilha como tecnologia educacional, juntamente com profissionais de saúde, pacientes e acompanhantes, visando ao envolvimento destes na segurança do paciente na maternidade. Métodos: estudo qualitativo convergente-assistencial, realizado em três etapas em uma maternidade de Belo Horizonte. A construção da cartilha ocorreu entre fevereiro e abril de 2021, com 13 profissionais, 06 acompanhantes e 11 pacientes. Resultados: realizou-se análise de conteúdo dos dados, criando-se três categorias: Saberes e experiências sobre a segurança da paciente e do recém-nascido na maternidade; Desafios para o envolvimento da paciente e acompanhante nas ações de segurança; Avaliação das pacientes, acompanhantes e profissionais sobre o processo de construção da cartilha. A construção da cartilha envolveu a participação profissionais de saúde, usuários e acompanhantes em todas as etapas do processo. Considerações finais: o processo participativo possibilitou a criação da tecnologia educacional para o envolvimento das pacientes e acompanhantes nas ações de segurança do paciente.

Amoxicillin (AMO) and amikacin (AMK) are broad-spectrum antibiotics that are most preferably given post-delivery (normal and cesarian) in the maternity hospitals located in Sagar city (Madhya Pradesh), India. Both the antibiotics make their way through sewage/drainage systems into the environment in the form of metabolized and unmetabolized compounds. Growing concern about the contamination of wastewater by antibiotics requires fast, sensitive and eco-friendly techniques. Therefore a simple, rapid and environmental friendly chromatographic method has been developed for simultaneous determination of AMO and AMK in maternity hospital wastewater samples. A micellar liquid chromatographic (MLC) method was developed with a C18 column (250 mm × 4.6 mm), sodium dodecyl sulphate (SDS; 0.15 M), 1-butanol (7%) as a modifier, pH 5 and photo diode detector (PDA) at 270 nm and 256 nm for AMO and AMK respectively. The method was fast with analysis time below 9 min. In the present MLC method, linearities (r > 0.998), limits of quantification in the range of 0.02–0.04 μg/mL, repeatabilities, and intermediate precision below 4.9% were adequate for the quantification of AMO and AMK. The proposed method can be utilized to detect and quantify both the antibiotics in various samples by hospitals, pharmaceutical companies, pollution control board, municipal corporations, etc.

Background and objectives The aim of the study was to use the United States Optimality Index (OI-US) to assess the feasibility of its application in making decisions for more optimal methods of delivery and for more optimal postpartum and neonatal outcomes. Numerous worldwide associations support the option of women giving birth at maternity outpatient clinics and also at home. What ought to be met is the assessments of requirements and what could be characterized as the birth potential constitute the basis for making the right decision regarding childbirth. Materials and methods The study is based on a prospective follow-up of pregnant women and new mothers (100 participants) who were monitored and gave birth at the hospital maternity ward (HMW) and pregnant women and new mothers (100 participants) who were monitored and gave birth at the outhospital maternity clinics (OMC). Selected patients were classified according to the criteria of low and medium-risk and each of the parameters of the OI and the total OI were compared. Results The results of this study confirm the benefits of intrapartum and neonatal outcome, when delivery was carried out in an outpatient setting. The median OI of intrapartum components was significantly higher in the outpatient setting compared to the hospital maternity ward (97 range from 24 to 100 vs 91 range from 3 to 100). The median OI of neonatal components was significantly higher in the outpatient compared to the inpatient delivery. (99 range from 97 to 100 vs 96 range from 74 to 100). Certain components from the intrapartum and neonatal period highly contribute to the significantly better total OI in the outpatient conditions in relation to hospital conditions. Conclusion Outpatient care and delivery provide multiple benefits for both the mother and the newborn.

Objective: To identify the associated factors of neonatal near miss among newborns of Brazilian adolescents and to compare their occurrence in young women aged 12 to 16 years and 17 to 19 years. Method: Cross-sectional, hospital-based study, using data from the study Nascer no Brasil (“Birth in Brazil”) on puerperal adolescents and their newborns in all regions of Brazil. Multiple and univariate logistic regression were employed to identify the associated factors of neonatal near miss. Results: The following factors were found to be associated to neonatal near miss among newborns of adolescent mothers: public source of payment (OR = 4.57, 95% CI = 2.02–10.32), having to seek help in different maternity hospitals (OR = 1.52; 95% CI = 1.05–2.20), and maternal near miss (OR = 5.92; 95% CI = 1.94–18.05), in addition to a record of low weight in a previous pregnancy (OR = 3.12; 95% CI = 1.61–6.04) and twin pregnancy (OR = 7.49; 95% CI = 3.28–16.82). Conclusion: Neonatal near miss affected newborns of adolescent mothers in both age groups equally. Also, the determinant factors of neonatal near miss can be mostly reduced with qualified prenatal, labor, and birth care. RESUMEN Objetivo: Identificar los factores asociados al near miss neonatal en recién nacidos de adolescentes brasileñas y comparar su ocurrencia entre las jóvenes de 12 a 16 años y las de 17 a 19 años. Método: Estudio transversal, de base hospitalaria, con datos de la investigación Nascer no Brasil, compuesta por puérperas adolescentes y sus recién nacidos en todas las regiones de Brasil. Se utilizó regresión logística univariante y múltiple para identificar los factores asociados al near miss neonatal. Resultados: Se asociaron al near miss neonatal los factores fuente de pago pública (OR = 4,57, IC95% = 2,02–10,32), peregrinación por hospitales de maternidad (OR = 1,52; CI95% = 1,05–2,20) y la presencia de near miss materno (OR = 5,92; CI95% = 1,94–18,05), además de los antecedentes de bajo peso en el embarazo anterior (OR = 3,12; CI95% = 1,61–6,04) y el embarazo gemelar (OR = 7,49; CI95% = 3,28–16,82). Conclusión: El near miss neonatal afectó igualmente a los recién nacidos de madres adolescentes de ambos grupos de edad. Además, los factores determinantes del near miss neonatal, en su mayoría, pueden reducirse con la atención cualificada al prenatal, al parto y al nacimiento. RESUMO Objetivo: Identificar os fatores associados ao near miss neonatal em recém-nascidos de adolescentes brasileiras e comparar sua ocorrência entre as jovens de 12 a 16 anos e as de 17 a 19 anos. Método: Estudo transversal, de base hospitalar, com dados da pesquisa “Nascer no Brasil”, composto por puérperas adolescentes e seus recém-nascidos em todas as regiões do país. Utilizou-se regressão logística univariada e múltipla para identificar os fatores associados ao near miss neonatal. Resultados: Mostraram-se associados ao near miss neonatal de recém-nascidos de mães adolescentes os fatores fonte de pagamento público (OR = 4,57, IC95% = 2,02–10,32), peregrinação por maternidades (OR = 1,52; IC95% = 1,05–2,20) e presença de near miss materno (OR = 5,92; IC95% = 1,94–18,05), além de histórico de baixo peso em gestação anterior (OR = 3,12; IC95% = 1,61–6,04) e gemelaridade (OR = 7,49; IC95% = 3,28–16,82). Conclusão: O near miss neonatal acometeu igualmente os recém-nascidos de mães adolescentes de ambas as faixas etárias. Além disso, os determinantes do near miss neonatal, em sua maioria, podem ser reduzidos com atenção qualificada ao pré-natal, parto e nascimento.

Objective: To understand health professionals' values in the process of thinking and feeling about obstetric care, based on their experienced needs in the care process. Methods: Phenomenological study based on the Schelerian framework, with 48 health professionals from four maternity hospitals within the Metropolitan Region II of the state of Rio de Janeiro. Data collection was done through a phenomenological interview; and the analysis, with the Ricoeurian methodological framework. Results: The vital value was signified in care centered on physiological processes, for an individualized and safe monitoring. The ethical value was signified in the attitudes that provide women with autonomy in their way of giving birth, and recognize dialogue as a process of sympathy, affection, and bonding. Conclusion: The resignification of obstetric practice, articulated with public policies in the field of delivery and birth, supported by a vital ethical value, positively contributes to the humanization of care for women. RESUMEN Objetivo: Comprender valores de profesionales de salud en el proceso de pensar y sentir del cuidado obstétrico, basándose en sus carencias vividas en el proceso de cuidar. Métodos: Estudio fenomenológico fundamentado en el referencial scheleriano, con 48 profesionales de salud de cuatro maternidades de la Región Metropolitana II de Rio de Janeiro. Recolecta de datos fue por entrevista fenomenológica; y el análisis, con referencial metodológico ricoeuriano. Resultados: El valor vital fue significado en el cuidado centrado en procesos fisiológicos, para un acompañamiento individualizado y seguro. El valor ético fue significado en actitudes que posibilitan autonomía de la mujer en su manera de parir y reconocen el diálogo como proceso de relación de simpatía, afectividad y construcción de vínculo. Conclusión: La resignificación de la práctica obstétrica, articulada a políticas públicas en el campo del parto y nacimiento, sustentada por un valor vital-ético, contribuye positivamente en la humanización del cuidado a mujeres. RESUMO Objetivo: Compreender os valores dos profissionais de saúde no processo de pensar e sentir do cuidado obstétrico, baseando-se em suas carências vivenciadas no processo de cuidar. Métodos: Estudo fenomenológico fundamentado no referencial scheleriano, com 48 profissionais de saúde de quatro maternidades da Região Metropolitana II do estado do Rio de Janeiro. A coleta de dados foi por entrevista fenomenológica; e a análise, com o referencial metodológico ricoeuriano. Resultados: O valor vital foi significado no cuidado centrado nos processos fisiológicos, para um acompanhamento individualizado e seguro. O valor ético foi significado nas atitudes que oportunizam autonomia da mulher em sua forma de parir e reconhecem o diálogo como processo de relação de simpatia, afetividade e criação de vínculo. Conclusão: A ressignificação da prática obstétrica, articulada com as políticas públicas no campo do parto e nascimento, sustentada por um valor vitalético, contribui positivamente na humanização do cuidado às mulheres.

Introduction During the first year of the COVID-19 pandemic, international recommendations and guidelines regarding breastfeeding-supportive hospital practices changed frequently. For example, some recommended separation of mothers and infants; others, feeding pumped milk instead of milk fed directly from the breast. Many recommendations were inconsistent or in direct conflict with each other. Guidance from UENPS (the Union of European Neonatal and Perinatal Societies) published in April 2020 recommended rooming in and direct breastfeeding where feasible, under strict measures of infection control, for women who were COVID-19 positive or under investigation for COVID-19. Key findings Our study assessed data from respondents from 124 hospitals in 22 nations, with over 1000 births per year, who completed a survey on practices during the COVID-19 epidemic, as they related to the World Health Organization (WHO) Ten Steps to Successful Breastfeeding, considered to be the gold standard for breastfeeding support. The survey was conducted in the fall of 2020/winter of 2021. Overall 88% of responding hospitals had managed COVID positive mothers, and 7% had treated over 50 birthing women with confirmed COVID-19. The biggest change to hospital policy related to visitation policies, with 38% of hospitals disallowing all visitors for birthing women, and 19% shortening the postpartum stay. Eight hospitals (6%) recommended formula feeding instead of breastfeeding for women who tested positive for COVID-19 or were under investigation, whereas 73% continued to recommend direct, exclusive breastfeeding, but with some form of protection such as a mask or hand sanitizer for the mother or cleaning the breast before the feed. While 6% of hospitals discontinued rooming in, 31% strengthened their rooming in policy (keeping mothers and their babies together in the same room) to protect infants against possible exposure to the virus elsewhere in the hospital . Overall, 72% of hospitals used their country's national guidelines when making policy, 31% used WHO guidelines and 22% UENPS/SIN guidelines. Many European hospitals relied on more than one accredited source. Discussion Our most concerning finding was that 6% of hospitals recommended formula feeding for COVID positive mothers, a measure that was later shown to be potentially harmful, as protection against the virus is transmitted through human milk. It is encouraging to note that a third of hospitals strengthened rooming in measures. Especially given the emergence of the highly transmissible Delta variant, the situation around postnatal care in maternity hospitals requires ongoing monitoring and may require proactive investment to regain pre-COVID era practices.

Objectives Normal thyroid activity has an essential role in fetal development, its deficiency may hamper fetal neurodevelopment and neonatal growth. The quantitation of thyroid hormones although useful, still exposes differences on cut off levels to diagnose thyroid deficit accurately that can elicit under or over diagnosis of thyroid dysfuntion. Methods A total of 839 pregnant patients were studied for thyroidal clinical assessment through quantitation of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) circulating levels. Patients evaluated for prenatal and neonatal outcomes. Thyroid function deficiencies were determined with the American Thyroid Association (ATA) 2011 and 2017 values. Statistical analysis searched for associations between variables, odds ratios (OR) and correlations were calculated to evaluate the reliability of the cutoff values recommended by the ATA. Results Mean age of our cases was 27.5 + 5.83 years at diagnosis, mean gestational age at first consultation was 23.8 + 10.5 weeks. Mean TSH levels detected were: 2.5 + 1.89 mIU/L, total T3: 3.55 + 4.1 ng/dL, FT4: 3.14 + 4.4 ng/dL. The ATA 2011 values yielded 332 hypothyroidism cases vs. 507 euthyroid patients, a total incidence of 39.6% vs. the ATA 2017 values, diagnosing 100 hypothyroidism cases and 739 euthyroid patients, total incidence of 11.9%. Association with complications were not significant. Conclusions Using ATA 2017 values showed a decreased population with gestational hypothyroidism, hence preventing overdiagnosis and over-treatment. No significant complications were associated, requiring the determination of new regional values. Education and sensibilization of our population is needed to comply with early prenatal consultation and thyroid function testing.

Background Implementation science aims to embed evidence-based practice as ‘usual care’ using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). Method Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. Results This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. Conclusion This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.

As newborns are highly vulnerable, they require essential care for adequate child development. This study aimed to assess the care provided to newborns during the first 28 days of life and identify factors associated with adequate care. This was a longitudinal study conducted with 415 mothers and full-term newborns from 4 public maternity hospitals in Natal, Brazil, in 2019. Assistance, socioeconomic, and demographic data were collected 3 times: 48 hours, 7 days, and 28 days after birth. Pearson's chi-square and Poisson regression tests were used with a confidence interval of 95%. Most mothers were between 20 and 29 years old (46.5%), had a high school or higher education (65.3%), a partner (79%), an income of ≤ 1 minimum wage (64, 6%), and were multiparous (62.9%). A total of 29 actions performed in maternity hospitals and 11 in primary healthcare were evaluated. Among the first, 8 (27.6%) were satisfactory; 11 (37.9%), partially satisfactory; and 10 (34.5%), unsatisfactory. In primary care, 2 actions (18.2%) were considered satisfactory; 3 (27.3%) partially satisfactory; and 6 (54.5%) unsatisfactory. In the multivariate analysis of the composite indicators related to adequacy of care, women undergoing vaginal delivery, those who are multiparous, and maternity hospitals at usual risk were associated with better adequacy of care indicators (P ≤ .05). Maternity hospitals accredited to the Baby-Friendly Hospital Initiative had lower chances of the adequacy of promotion to exclusive breastfeeding. The sample loss rate was 13.7% in the first week and 16.6% at the end of the study period. There was inadequacy in the performance of care actions for newborns regarding access and comprehensiveness of care. These weaknesses highlight the need for reassessing skills and coordinating actions in the child's healthcare network.

To implement a vaginal delivery of the second twin simulation program for obstetric and gynecology residents, to reduce maternal-fetal mortality in the management of twin pregnancies in the delivery room.A prospective education program. The session consisted of a theoretical part, a practical part on a mannequin and an evaluation. The model was designed in a simple and reproducible way. The simulation evaluation was done at several levels according to the validated Kirkpatrick model.A tertiary level university maternity hospital.Ten obstetric and gynecology residents participated.The resident's personal feelings about their ability to perform the maneuvers increased significantly after participation in the simulation session. Their technical skills in performing the maneuvers were assessed in a second step. The majority of the participants considered the model realistic and the session useful. All agreed that the simulation was an essential part of their learning process.A simulated vaginal delivery of the second twin session allows residents to be safely trained in these obstetrical maneuvers, which can be difficult to teach and perform.

Multiparameter continuous physiological monitoring (MCPM) technologies are critical in the clinical management of high-risk neonates; yet, these technologies are frequently unavailable in many African healthcare facilities. We conducted a prospective clinical feasibility study of EarlySense’s novel under-mattress MCPM technology in neonates at Pumwani Maternity Hospital in Nairobi, Kenya. To assess feasibility, we compared the performance of EarlySense’s technology to Masimo’s Rad-97 pulse CO-oximeter with capnography technology for heart rate (HR) and respiratory rate (RR) measurements using up-time, clinical event detection performance, and accuracy. Between September 15 and December 15, 2020, we collected and analyzed 470 hours of EarlySense data from 109 enrolled neonates. EarlySense’s technology’s up-time per neonate was 2.9 (range 0.8, 5.3) hours for HR and 2.1 (range 0.9, 4.0) hours for RR. The difference compared to the reference was a median of 0.6 (range 0.1, 3.1) hours for HR and 0.8 (range 0.1, 2.9) hours for RR. EarlySense’s technology identified high HR and RR events with high sensitivity (HR 81%; RR 83%) and specificity (HR 99%; RR 83%), but was less sensitive for low HR and RR (HR 0%; RR 14%) although maintained specificity (HR 100%; RR 95%). There was a greater number of false negative and false positive RR events than false negative and false positive HR events. The normalized spread of limits of agreement was 9.6% for HR and 28.6% for RR, which met the a priori-identified limit of 30%. EarlySense’s MCPM technology was clinically feasible as demonstrated by high percentage of up-time, strong clinical event detection performance, and agreement of HR and RR measurements compared to the reference technology. Studies in critically ill neonates, assessing barriers and facilitators to adoption, and costing analyses will be key to the technology’s development and potential uptake and scale-up.

Foetal macrosomia is associated with high maternal and neonatal morbidity; however, obstetric management of suspected macrosomia has not been well defined. This study aimed to analyse obstetric management in a population of women who delivered macrosomic new-borns and assess maternal and neonatal outcomes and risk factors for complications in such cases.This two-centre retrospective study conducted in France over a 10-year period comprised 1724 women who had delivered macrosomic new-borns (defined as those whose weight was 90th percentile according to the Association of Users of Computerised Records in Perinatology, Obstetrics, and Gynaecology curve) from 37SA.In this study, the caesarean section and instrumental extraction rates were 24.1% and 15.7%, respectively, and the postpartum haemorrhage rate was 7%. The rate of shoulder dystocia was 23.1% (including brachial plexus injuries, 0.4%; and clavicular fractures, 2.0%). Significant risk factors for caesarean section were maternal height 160 cm, nulliparity, history of caesarean section, excessive uterine height, induction of labour and duration of labour 10 h. The risk factors for shoulder dystocia were maternal height 160 cm and instrumental extraction.The study findings may help determine predictive factors for an unfavourable outcome at the time of delivery of a macrosomic foetus, thus allowing clinical teams to better anticipate and manage potential complications.

Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

Objective: To identify the factors that influence the improvement of obstetric nurse care in the delivery process. Methods: Descriptive exploratory study with a qualitative approach conducted at a teaching maternity hospital located in the city of Salvador, Bahia, Brazil with 20 obstetric nurses from the Obstetric Center. Data was collected through semi-structured interviews between June and September 2017 and was then subjected to the Thematic-Categorical Content Analysis proposed by Franco. Results: Six categories emerged from the analysis, which presented factors that favor the improvement of obstetric care in the delivery process and factors unfavorable to this care. These factors address power and gender relations among health professionals; recognition of obstetric nurses; physical space and bed occupation; interaction between woman/ companion, among others. Final considerations: The factors indicated by obstetric nurses reveal the need for improvements in the working conditions by managers and changes of behavior and codes of conduct of health professionals. RESUMEN Objetivo: Conocer los factores que influyen en la mejora de la atención de la enfermera obstetra en el proceso de parto. Métodos: Estudio exploratorio cualitativo y descriptivo realizado en una escuela de maternidad ubicada en la ciudad de Salvador, Bahía, Brasil, con 20 enfermeras obstetras del Centro de Obstetricia. La recopilación de datos se realizó a través de entrevistas, guiadas por una forma semiestructurada entre los meses de junio y septiembre de 2017. Los datos se presentaron al análisis de contenido temático categórico propuesto por Franco. Resultados: Surgieron seis categorías, que presentaban factores que colaboran y dificultan el cuidado de la enfermera obstétrica en el proceso de parto. Estos abordan el poder y las relaciones de género entre los profesionales de la salud; reconocimiento de la enfermera obstétrica; espacio físico y ocupación de la cama; interacción entre mujer / acompañante, entre otros. Consideraciones finales: Los factores indicados por las enfermeras obstétricas revelan la necesidad de mejoras en las condiciones laborales por parte de los gerentes y los cambios en la conducta / comportamiento de los profesionales. RESUMO Objetivo: Conhecer os fatores que influenciam a melhoria do cuidado da enfermeira obstetra no processo de parto. Métodos: Estudo qualitativo, descritivo exploratório realizado em uma maternidade escola localizada no município de Salvador, Bahia, Brasil com 20 enfermeiras obstetras do Centro Obstétrico. A coleta de dados ocorreu por meio de entrevistas, guiadas por formulário semiestruturado entre os meses de junho e setembro de 2017. Os dados foram submetidos à Análise de Conteúdo Temático-Categorial proposta por Franco. Resultados: Emergiram seis categorias, as quais apresentaram fatores que colaboram e dificultam o cuidado da enfermeira obstetra no processo de parto. Estes abordam as relações de poder e gênero entre profissionais de saúde; reconhecimento da enfermeira obstetra; espaço físico e ocupação de leitos; interação entre mulher/acompanhante, dentre outros. Considerações finais: Os fatores sinalizados pelas enfermeiras obstetras revelam a necessidade de melhorias nas condições de trabalho por gestores e mudanças de condutas/comportamentos de profissionais.

Background Although the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19. Methods Implementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed. Results Response rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p p = 0.006), and breastfeeding support (78% vs 94%; p = 0.02). Practices were significantly less prevalent in COVID-19 mothers compared to pre-pandemic situation. A lower accompaniment rate was observed in non-COVID-19 group during delivery (24% vs 47.9%; p p = 0.01) and rooming-in (83.9% vs 57.9%; p Conclusion All mothers suffered restrictions in perinatal care during the COVID-19 pandemic. Women with COVID-19 infection suffered more restrictions in perinatal practices than women without infection. The degree of commitment to WHO-UNICEF perinatal quality standards, integrated into the BFHI, was associated with maintenance of good clinical practices.

This article deepens the current understanding of the sources of obstetric violence and iatrogenesis through an analysis of cesareans. The data are drawn from ethnographic research in 2018 at a public maternity hospital in Mexico. Data collection methods included observation, semi-structured interviews, and free lists with 12 senior obstetrics residents. Analysis of the data revealed that: (1) doctors used perceptions of high risk to justify their use of cesareans even when not clearly medically indicated; (2) doctors responded to scarcities of time and resources in the system by viewing cesareans as a less than ideal but acceptable solution; and (3) doctors practiced medicine defensively as a way to control their fear of risk and to pre-empt legal consequences from patients' demands. The discussion suggests that the relative ease of cesareans and the benefit they provided the doctor and medical system rather than the patient constituted forms of obstetric violence and iatrogenesis. These often arise as a consequence of either too much intervention or not enough in situations in which providers seized on unclear or presumed indications as pretexts to perform cesareans that were not clearly medically indicated.

Background Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Objectives: To investigate the indications of first (non-repeated) cesarean deliveries, to categorize those indications into absolute and relative according to established guidelines of cesarean deliveries, and to compare the women with absolute and relative indications by demography and pregnancy-related attributes. Methods: A cross-sectional analysis of delivery data between September and October 2018, at the Maternity and Children Hospital, Buraidah, Al-Qassim, Saudi Arabia. Indications for cesarean deliveries of 200 primary cases were abstracted and were categorized into ‘absolute’ and ‘relative’ according to the Association of the Scientific Medical Societies in Germany guidelines. Results: The leading indications were fetal distress (27.5%), non-progression of labor (22.5%), breech presentation (18%), and failed initiation of labor (4.5%). Of the 200 cases, 26.5% had absolute indications, 50% had relative indications, and 23.5% had indications that were neither absolute nor relative. Women with absolute indications had lower mean gestational age and a higher proportion with greater than 3 gravida than women with relative indications ( p less than 0.05). Conclusion: The most common indications for first time cesarean, in decreasing order of frequency, were fetal distress, non-progression of labor, and breech presentation. Saudi Med J 2019; Vol. 40 (12): 1251-1255 doi: 10.15537/smj.2019.12.24736 How to cite this article: Saraya YS, Alashkar AH, Ali MA, Rajab AM, Saquib N. Indications and rate of first cesarean delivery in central region’s maternity and children hospital. Saudi Med J 2019; 40: 1251-1255 doi: 10.15537/smj.2019.12.24736

INTRODUCTION: In Flanders, Belgium, 78.2% of the women exclusively breastfeed their babies following birth. However, after three months just one third of those babies is breastfed exclusively. This is in contrast with the WHO recommendations of a minimum of six months. Studies reveal that women are not always satisfied with the breastfeeding support they receive from their midwives, which can lead to early cessation of breastfeeding. The general aim of this study is to gain an in-depth understanding of the supporting role of midwives in breastfeeding support during the first two weeks after birth and compare it to the needs of the breastfeeding women. METHODS: A qualitative approach was used with an observational design and a focus group study. Two researchers performed non-participative observations in both hospital and primary healthcare settings. Midwife-mother interactions during breastfeeding support (midwives, n = 21; mothers, n = 59) were observed. Analysis of the data gathered from two focus groups with midwives (n = 10) and two focus groups with mothers (n = 9) provides an in-depth understanding of the supporting role of midwives during breastfeeding and helps to investigate whether that role corresponds to the mothers' needs both from the mothers' and the midwives' perspective. Observations and focus groups were analyzed using thematic analysis. FINDINGS: The analysis showed that both midwives and mothers want the breastfeeding to be a success. Generally, the production of breastmilk is a priority, for both the midwives and the mothers. Overall a hands-on approach regarding breastfeeding support was observed, mainly in the hospital settings when compared with the findings from the primary healthcare settings. A hands-on approach often occurs without asking the mother's consent. During the breastfeeding support, a professional relationship between the midwife and the mother is fostered. In primary healthcare there is one - to - one support which is contrary to hospital care, resulting in a personalized relationship. Breastfeeding support is influenced by personal (e.g. negative belief in breastfeeding policies) and external context factors (e.g. time restraints). CONCLUSION: The research data revealed three topics on breastfeeding support by the midwife which were the focus, the approach and the relationship between the midwife and the mothers. The way the midwife provides this support varies due to the setting (hospital or primary health care) and due to personal convictions of midwives and mothers. The study shows the importance of providing breastfeeding support which is tailored to individual needs of the mother. ispartof: Midwifery vol:78 pages:50-57 ispartof: location:Scotland status: Published online

Introduction: Maternal and neonatal infections can be prevented, but they are still common in low and middle-developed countries. There is a connection between childbirth on one hand and postpartum and newborn care on the other. Globally, several efforts are being made to improve quality of childbirth by providing initial assessment of procedures, risk prevention and continuous monitoring of childbirth process and possible complications. The World Health Organization has developed Checklists for Safe Delivery with procedures to be implemented as routine care, in order to promptly detect and manage complications related to childbirth. Material and Methods: A retrospective study was conducted in the University Clinic of Gynecology and Obstetrics in Skopje, a maternity hospital in R. Macedonia from the tertiary level of the public health care system. In this study 300 obstetric and 307 neonatal histories from childbirths in February and March 2018 have been analyzed. The collected data refers to the care of the prepartum, intrapartum, early postpartum and early neonatal periods. Results: An initial assessment at admission proved that 14.7% of pregnant women had existing infection, in 93% of them the body temperature was measured and in only 9.3% urine analysis was made, 10.3% of the women had arterial hypertension, and 66.5% of them with hypertension had a headache. In the continuous monitoring and prevention of potential risk, arterial tension was measured in 33% of all mothers. In all women the placenta quality was checked up, as well as vaginal bleeding, application of oxytocin and hemoglobin level before discharge. Conclusion: The quality and quantity of documented data in the maternity hospital medical histories is high. There were no standard protocols for assessment of pregnant women. Certain procedures are conducted in every woman during childbirth. Standardized procedures are needed to be applied during every childbirth.

We aimed to identify the incidence and types of neonatal birth fractures in a single tertiary maternity hospital in the United Kingdom and to find possible associated factors, including all live births born between 2000 and 2016. We reviewed hospital records and imaging of all neonates who had any imaging done to identify birth fractures. We identified 87,461 consecutive live births. Sixty-six sustained a fracture during delivery: 46 clavicle-, 13 humerus-, four skull-, one femoral-, one rib- and one tibial fracture. Five neonates with a clavicle or humeral fracture had an Erb's palsy. Sixty-five fractures were in singletons. Twenty-five fractures were diagnosed after discharge. Binary logistic regression analysis with R-Studio showed a significant association between 'Fracture' and 'Birthweight' (

Biliary atresia is a rare neonatal disease and the most common indication for pediatric liver transplantation. Kasai portoenterostomy is the initial treatment, aiming to prevent liver transplantation. Beyond age at Kasai, few prognostic factors are known. Multiple countries have established screening methods to reduce the age at Kasai and recent analysis shows significant better outcomes for screening cohorts. In 2016, we established a decentralized stool color card screening in Lower Saxony and we present our first 2 years of experiences. In cooperation with a major German health insurance company and the Medical Association of Lower Saxony, we established the screening project, printed 120,000 color cards, and distributed them to all maternity hospitals. Program advertises were printed in newspapers and medical journals. After the first year, the project was evaluated. Thirty maternity hospitals and local practitioners were contacted via telephone, Internet, intranet, and pediatric journals. One out of seventy-six maternity hospitals (1.3%) refused to participate in the screening. 30 hospitals (40%) were contacted and 93.5% of the interviewed staff reported that stool color cards were handed out regularly and discussed with the parents. Only 20% of local practitioners assessed neonatal cholestasis to be a relevant problem during daily practice, and 55% regarded a stool color card screening to be useful. In the second year, we extended the screening project to outpatient maternity clinics. Based on the responses of local practitioners, we regard the voluntary screening as insufficient and we have contacted the Federal Joint Committee for the initiation of a nationwide obligatory stool color card screening.

This study aimed to describe demographic, socioeconomic and pregnancy-related characteristics associated with a caesarean delivery in Luanda.We conducted a cross-sectional study which included 995 puerperal women and who were assessed between December 2012 and February 2013 at Lucrécia Paím maternity hospital in Luanda, Angola. Data was collected using a structured questionnaire administered by trained interviewers. Logistic regression models were fitted to estimate the magnitude of associations (odds ratios-95% confidence intervals) between the type of delivery and variables showing a significant association in the bivariate analysis.The prevalence of caesarean section was 44%. Women with caesarean delivery were less educated, resided more often in a periurban area and were more likely to disclose lower family income when compared with women who had vaginal delivery. Living in a periurban area was significantly associated with a caesarean delivery regardless of all covariates considered, for primiparous women (adjusted odds ratios, 95% confidence intervals = 2.14, 1.27 - 3.62) and for multiparous women (1.78, 1.26 - 2.51). Among multiparous women, a lower family income was also significantly associated with caesarean delivery. Hypertensive disorders during the current pregnancy were associated with a caesarean delivery in the multivariate models fitted for primiparous (3.96, 1.57 - 9.98) and for multiparous women (1.68, 1.03 - 2.74).The associations between low socioeconomic position and high risk of caesarean delivery demonstrated in this study are consistent results in previous researches curried out in African contexts. The poorer and less educated women, who live far from health facilities, have few antenatal care visits and often arrive with complicated conditions, justifying a caesarean delivery. Lack of qualified human and material resources to manage emergencies in peripheral health centers and delaying in the reference system also leads to an increase in the number of caesareans performed in this particular maternity hospital.Sociodemographic differences were observed according to the type of delivery. Cesarean section was more prevalent among women with lower income and residents in periurban areas.Introdução: Este estudo teve como objetivo descrever as características socioeconómicas e demográficas associadas ao parto por cesariana em Angola. Material e Métodos: Estudo transversal que incluiu 995 participantes puérperas no período compreendido entre dezembro de 2012 a fevereiro de 2013 na Maternidade Lucrécia Paím, em Luanda, Angola. A informação foi recolhida através de um questionário estruturado aplicado por entrevistadores treinados. Foi utilizada regressão logística para estimar a magnitude da associação (odds ratios — intervalos de confiança a 95%) entre o tipo de parto e as covariáveis. Resultados: A prevalência de cesariana neste estudo foi de 44%. As mulheres que fizeram cesariana eram menos escolarizadas, residiam mais frequentemente em zonas periurbanas e com rendimentos mais baixos quando comparadas com as mulheres que tiveram parto vaginal. Residir numa área periurbana estava significativamente associado ao parto por cesariana independentemente de outros fatores, (odds ratios ajustado para mulheres primíparas, intervalos de confiança 95% = 2,14, 1,27 – 3,62) e mulheres multíparas (1,78, 1,26 – 2,51). Hipertensão durante a gravidez atual associou-se ao parto por cesariana tanto em primíparas (3,96; 1,57 – 9,98) como em multíparas (1,68; 1,03 – 2,74). Discussão: As associações entre baixa posição socioeconómica e o alto risco de cesariana demonstradas neste estudo são resultados consistentes em pesquisas prévias realizadas em contextos africanos. As mulheres mais pobres e menos instruídas, que residem longe das unidades de saúde, têm poucas consultas pré-natais e muitas vezes chegam com condições complicadas, justificando um parto por cesariana. A falta de recursos humanos e materiais qualificados para gestão de emergências em centros de saúde periféricos e o atraso no sistema de referência também leva a um aumento no número de cesarianas realizadas nesse hospital particular. Conclusão: Foram observadas diferenças sociodemográficas de acordo com o tipo de parto. O parto por cesariana foi mais frequente entre mulheres com rendimentos mais baixo e residentes em áreas periurbanas.

Introduction The Ebola virus disease epidemic was devastating to the West African region, particularly for pregnant women. Prior to the epidemic, maternal mortality in this region was among the highest in the world. Throughout the region, screening of patients with Ebola was difficult, as the symptoms of malaria or typhoid mimicked Ebola, but even more difficult for pregnant women, because of the large overlap between Ebola symptoms and pregnancy-related complications. In November 2014, the world's first maternity-specific isolation and screening system, to our knowledge, was created at the Princess Christian Maternity Hospital in Freetown to meet the emergent needs of the population of pregnant women during the epidemic. Process Starting in December 2014 through June 2016, in collaboration with hospital leadership and the Ministry of Health and Sanitation, Partners In Health supported Princess Christian Maternity Hospital in creating a safer health care environment with the shared goal of improving safety and health outcomes and of addressing the unique needs of pregnant women, by focusing on improving 4 key areas: 1) screening, 2) isolation, 3) laboratory diagnostics, and 4) clinical service delivery in isolation, including human resource management and training. Outcomes The screening guidelines were adapted to include maternal health care considerations, a new screening area was constructed, the laboratory result turnaround time was reduced, and the isolation unit was improved to enhance safety and care delivery. Human resources were supported with additional staff hired and trainings on infection prevention and control, overall resulting in better preparing Princess Christian Maternity Hospital to provide care for pregnant women during outbreaks. Discussion The authors' experience at Princess Christian Maternity Hospital provides a model of screening, isolation, and care specifically for maternity patients, and directly addresses infection risk and mortality. The recommendations we provide can be used in future outbreaks.

This study aims to determine the hospital practices implemented before, during, and after birth in Turkey, and to identify the support to families during this process. Purposive sampling was used in the study to identify the hospitals to be surveyed. Ankara, İstanbul, and İzmir, the provinces with the highest number of hospitals in Turkey, were selected for the collection of data. There were 178 eligible private hospitals in these provinces. The questionnaire form of the Canadian Hospitals Maternity Policies and Practices Survey was used to collect data and the necessary permissions were obtained. There are many restrictions and variations in maternity-related hospital practices in Turkey. 71.4% of the responding private hospitals identified themselves as baby-friendly. 57.1% had a policy facilitating families being together immediately after birth, 39.5% encouraged the presence of the father in the delivery room. 44.9% did not have any policy for assessing women who were going home to potentially violent situations. Eighty-five percent reported that they did not have a written policy or guidelines about procedures regarding labor, birth, or postpartum periods. This study recommended that private hospitals should review their maternal practices and routines in an evidence-based way that helps parents, culturally sensitive standards for mothers should be developed and supervised by related health authorities, and structures should be created to effectively deal with patients’ complaints.