UNASSIGNED: Every expectant mother is at risk of complications during pregnancy, delivery, or after delivery. Delays in receiving care with accompanying maternal morbidity and mortality can be significantly reduced with adequate birth preparedness and complication readiness (BPCR). This study aims to determine the factors affecting BPCR among antenatal attendees in Gusau, Zamfara State, a security-challenged setting.
UNASSIGNED: A cross-sectional study was conducted among pregnant women attending the antenatal clinic at Federal Medical Center, Gusau, Nigeria. Data were collected using a pretested questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) Version 26. Descriptive data using means, percentages, and frequency were presented in tables. Statistical testing using Chi-square for bivariate analysis and binary logistic regression for multivariate analysis was carried out with a significance level of p < 0.05.
UNASSIGNED: One hundred and forty-seven women were recruited; 111 (75.5%) had good knowledge of the danger signs of pregnancy, labor, and the postpartum period. One hundred and fourteen (77.6%) were birth-prepared and complications-ready. One hundred and ten (75%) identified insecurity as the most important hindrance to BPCR. The respondents with higher educational levels were thrice more likely to be birth-prepared and complications-ready (OR: 2.95, 95% CI: [1.65-5.27]). The women were twice more likely to be birth-prepared and complications-ready with an increase of ₦20,000 ($46.3) in monthly income (OR: 2.53, 95% CI: 1.97-5.29).
UNASSIGNED: Education and wealth status are the key determinants of BPCR. Low educational status, financial constraints, and security challenges were identified as barriers that must be addressed to improve maternal and infant well-being.

BACKGROUND: Obstetric fistulas are abnormal open connection(s) between the vagina and the urinary tract or the rectum resulting from tragic injuries sustained by mothers during childbirth that lead to urine and/or faecal incontinence. Due to the rapidly growing middle class in sub-Saharan Africa (SSA) and the corresponding quest for hospital delivery and caesarean section, surgery-related (iatrogenic) obstetric fistulas are on the rise. Worryingly, there is scanty data on surgery-related fistulas. This review aims to collate empirical evidence on the magnitude of iatrogenic obstetric fistulas in SSA, generate country-specific data and explore factors that influence obstetric surgery-related fistulas.
METHODS: All relevant databases, PubMed, LILACS, CINAHL, SCOPUS and Google Scholar will be searched from 1st January 2000 to 31st March 2024 using search terms developed from the major concepts in the title without restrictions by language. The Cochrane Library, African Journals Online, Data Base of African Thesis and Dissertations Including Research (DATAD-R D Space) and preprint repositories will also be searched. Reference lists of relevant studies will be searched and experts in the field will be contacted for additional (unpublished) studies. The search output will be exported to Endnote where duplicate studies will be removed. The deduplicated studies will be exported to Rayyan where study screening and selection will be conducted. At least two authors will independently select studies, extract data and assess quality in the included studies using pretested tools. Disagreements between reviewers will be resolved through discussion. Data analysis will be performed with RevMan 5.4. Comparative binary outcomes will be reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference and standard deviations (SDs) will be used. Non-comparative studies will be analysed as weighted proportions. Heterogeneity between studies will be assessed graphically and statistically, and where a significant level is detected, the random-effects model meta-analysis will be performed. All estimates will be reported with their 95% confidence intervals (CIs). Where data permit, we will conduct subgroup and sensitivity analyses to test the robustness of the estimates on key quality domains. The overall quality of the evidence will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
UNASSIGNED: This systematic review and meta-analysis uses rigorous methods and best practices to attempt to collate all empirical evidence and estimate country-specific proportions of iatrogenic (surgery-related) fistulas among obstetric fistula patients across countries in SSA. This review will explore context-specific variables, provide insights into their impact and relate them to the type and experience of personnel performing the obstetric procedures that lead to obstetric fistulas. The findings of the full review are expected to inform the development of national and regional Training Programs for Medical Officers, support the development of a consensus \"minimum acceptable standard of care\" and inform quality assurance standards for clinicians involved in the provision of surgical obstetric care.

BACKGROUND: Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence.
METHODS: We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs.
RESULTS: Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group \"public hospital\"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group \"age between 13 and 24 years old\") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group \"age between 13 and 24 years old\") were factors associated with OASIS complication repairs.
CONCLUSIONS: Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient\'s follow-up in order to prevent complications, repairs and maternal distress.

BACKGROUND: Birth preparedness and complication readiness is a holistic approach that empowers mothers and families with the knowledge, attitude, and resources to alleviate potential challenges during childbirth. Despite its benefits, husbands\' participation in maternal care differs significantly between countries and regions. There is a lack of previous studies that look at husbands\' responses to birth preparedness and complication readiness in the research area. Thus, the primary goal of this study is to find out how husbands who have wives with infants under 12 months old feel about birth preparation, readiness for problems, and its associated factors.
METHODS: A community-based cross-sectional study design was conducted from May 30 to July 29, 2022. Simple random sampling was employed to select 499 husbands. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. Data entry and analysis were performed using Epi Data version 4.6 and SPSS version 25, respectively. We used multivariable logistic regression to find statistically significant factors. P-values less than 0.05, 95% confidence intervals, and adjusted odds ratios are used to declare statistical significance. The findings were shown in figures, tables, and text.
RESULTS: The study found that 55.9% (95% CI: 51.4 to 61.4%) of husbands responded to birth preparedness and complication readiness. This response was significantly associated with being employed (AOR = 3.7, 95% CI: 2.27-5.95), engaging in self-business (AOR = 5.3, 95% CI: 2.34-12.01), having wives who delivered in health facilities (AOR = 7.1, 95% CI: 3.92-12.86), accompanying wives for antenatal care (AOR = 2.2, 95% CI: 1.39-3.56), possessing good knowledge of danger signs during labor (AOR = 2.0, 95% CI: 1.08-3.74) and the postnatal period (AOR = 7.1, 95% CI: 3.14-16.01). Interestingly, residents living near a health facility (AOR = 0.6, 95% CI: 0.39-0.97) were less likely to respond.
CONCLUSIONS: The present study found that nearly 6 out of 10 husbands actively responded in terms of birth preparedness and complication readiness. While husbands in this study showed some involvement in birth preparedness and complications, it is good when compared to studies carried out nationally. To improve this, educating husbands by focusing on the danger signs and their role in childbirth is recommended.

BACKGROUND: Obstructed labor (OL) and uterine rupture (UR) are common obstetric complications. This study explored the burden, risk factors, decomposition, and health inequalities associated with OL and UR to improve global maternal health.
METHODS: This was a cross-sectional analysis study including data on OL and UR from the Global Burden of Diseases, and Risk Factors Study (GBD) 2019. The main outcome measures included the number and age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), prevalence, and deaths.
RESULTS: The global burden of OL and UR has declined, with a decrease in incidence (number in 2019: 9,410,500.87, 95%UI 11,730,030.94 to 7,564,568.91; ASR in 2019: 119.64 per 100,000, 95%UI 149.15 to 96.21; estimated annual percentage change [EAPC] from 1990 to 2019: -1.34, 95% CI -1.41 to -1.27) and prevalence over time. However, DALYs (number in 2019: 999,540.67, 95%UI 1,209,749.35 to 817,352.49; ASR in 2019: 12.92, 95%UI 15.63 to 10.56; EAPC from 1990 to 2019: -0.91, 95% CI -1.26 to -0.57) and deaths remain significant. ASR of DALYs increased for the 10-14 year-old age group (2.01, 95% CI 1.53 to 2.5), the 15-19 year-old age group (0.07, 95% CI -0.47 to 0.61), Andean Latin America (3.47, 95% CI 3.05 to 3.89), and Caribbean (4.16, 95% CI 6 to 4.76). Iron deficiency was identified as a risk factor for OL and UR, and its impact varied across different socio-demographic indices (SDIs). Decomposition analysis showed that population growth primarily contributed to the burden, especially in low SDI regions. Health inequalities were evident, the slope and intercept for DALYs were - 47.95 (95% CI -52.87 to -43.02) and - 29.29 (95% CI -32.95 to -25.63) in 1990, 39.37 (95%CI 36.29 to 42.45) and 24.87 (95%CI 22.56 to 27.18) in 2019. Concentration indices of ASR-DALYs were - 0.2908 in 1990 and - 0.2922 in 2019.
CONCLUSIONS: This study highlights the significant burden of OL and UR and emphasizes the need for continuous efforts to reduce maternal mortality and morbidity. Understanding risk factors and addressing health inequalities are crucial for the development of effective interventions and policies to improve maternal health outcomes globally.

BACKGROUND: In clinical experience, occiput posterior (OP) position is associated with longer labor duration than occiput anterior (OA) position, but few studies have investigated the association between labor duration and fetal position. We aimed to compare duration of the active phase of labor in OP deliveries with OA deliveries in a contemporary population using survival methods. Secondary aims were to compare the frequencies of operative interventions, obstetric anal sphincter injuries (OASIS), postpartum hemorrhage, and newborn outcomes in OP with OA deliveries.
METHODS: We did a historical cohort study in three university hospitals in Norway from 2012 to 2022. Women with a single fetus in cephalic presentation, no previous cesarean section and gestational age ≥37 weeks were eligible and stratified into the first four groups of the Robson ten-group classification system (TGCS). We estimated the mean duration and calculated the hazard ratio (HR) for delivery using survival analyses. Cesarean sections and instrumental vaginal deliveries were censored.
RESULTS: The study population comprised 112 019 women, 105 571 (94.2%) were delivered in OA and 6448 (5.8%) in OP position. The estimated mean duration of the active phase of labor was longer in women with the fetus in OP position in all four TGCS groups. The estimated duration was longer in the OP groups in analyses stratified with respect to epidural analgesia and oxytocin augmentation. The graphical abstract illustrates the probability of delivery in OP compared with OA position in merged TGCS groups 1 and 2a, as a function of time. The unadjusted HR was 0.33 (95% CI 0.31-0.36) for fetuses delivered in OP position compared with OA position in TGCS group 1, 0.25 (95% CI 0.21-0.27) in group 2a, 0.70 (95% CI 0.67-0.73) in group 3, and 0.61 (95% CI 0.55-0.67) in group 4a, respectively. Neither maternal age, gestational age, BMI nor birthweight had confounding effect. Operative delivery rates and OASIS rates were higher in OP position in all four groups.
CONCLUSIONS: We found longer duration of the active phase of labor in women with the fetus delivered in OP position in all four TGCS groups.

BACKGROUND: Childbirth-related mortality and morbidity affect many women globally, especially in low-income countries like Ethiopia. Obstetric fistula-a preventable condition mainly caused by prolonged and obstructed labor-can lead to physical, psychological, and social challenges, affecting women\'s social participation and inclusion.
OBJECTIVE: This study aims to understand women\'s social participation and inclusion experiences post-obstetric fistula surgery.
METHODS: This study is part of a larger research project investigating the social inclusion process of women who have had obstetric fistula surgery in Ethiopia. For this study, we conducted a qualitative exploration of women\'s experiences, guided by a constructivist grounded theory approach. Twenty-one women discharged from fistula treatment facilities following obstetric fistula surgery were interviewed using a semi-structured interview guide. Data was analyzed using Charmaz\'s inductive analysis approach, which involves an initial line-by-line coding followed by focused coding to identify the most significant codes. Subsequently, sub-themes and themes were developed from the focused codes.
RESULTS: The data analysis revealed four themes reflecting the women\'s experiences of social participation and inclusion. These are the experience of recovery and the journey toward social participation, participating in expected and meaningful activities, the continued challenge with a romantic relationship, and formal and informal support. Overall, the women who received fistula surgery reported positive life changes, especially regarding their physical well-being. However, they continued to face social challenges such as financial hardship, reproductive health problems, and issues with marriage and family life, which negatively impacted their social participation and inclusion experiences.
CONCLUSIONS: While more research is needed, the findings of this study suggest that the social aspects of obstetric fistula are crucial for healthcare professionals to consider. Providing appropriate care and support to address unmet social relationship, employment, and childcare needs could enable women to lead fulfilling lives.

OBJECTIVE: This study aimed to determine whether excessive maternal weight gain during pregnancy was associated with a higher risk of prolonged labor.
METHODS: We analyzed the data regarding maternal weight gain during pregnancy for the participants of Japan Environment and Children\'s Study (JECS), which is an ongoing nationwide prospective birth cohort study in Japan. After excluding participants with multiple pregnancies, with deliveries before 37 or beyond 42 weeks of gestation, or who had undergone cesarean section, 71,154 (nulliparous, n = 28,442) Japanese women were included. Prolonged labor was defined by a cutoff ranking at the 95th percentile and consequently defined as labor duration exceeding 12.7 h in multiparous women and exceeding 23.2 h in nulliparous women. These classifications were made according to labor curves established by the Japanese Society of Obstetrics and Gynecology Perinatal Committee developed in June 2021. Considering that no studies have conducted an investigation based on this new guideline, we analyzed the association between excessive maternal weight gain during pregnancy and prolonged labor by parity.
RESULTS: The overall incidence of prolonged labor was 10.2% (2,907/28,442) in nulliparous women and 6.1% (2,597/42,712) in multiparous women. Multivariable analysis indicated that excessive maternal weight gain was significantly associated with prolonged labor in nulliparous (adjusted odds ratio, 1.21; 95% confidence interval, 1.10-1.32) and multiparous women (adjusted odds ratio, 1.15; 95% confidence interval, 1.05-1.27). Kaplan-Meier survival analysis showed that as labor progressed, the percentage of women who had not yet delivered was higher among those with excessive maternal weight gain than among those with normal maternal weight gain in both the nulliparous (median labor duration 12.9 h vs 12.2 h, p<0.001) and multiparous (median labor duration 6.2 h vs 5.8 h, p<0.001) groups.
CONCLUSIONS: Excessive maternal weight gain was significantly associated with prolonged labor in Japanese women.

UNASSIGNED: To assess and compare the level of Birth Preparedness and Complications Readiness (BPCR) and determine the predicting effect of socio-demographic factors on it among couples in rural and urban communities of Ekiti State.
UNASSIGNED: A community-based comparative cross-sectional study.
UNASSIGNED: The study was conducted in twelve rural and twelve urban communities in Ekiti State.
UNASSIGNED: Couples from rural and urban communities. Female partners were women of reproductive age group (15-49 years) who gave birth within twelve months before the survey.
UNASSIGNED: Proportion of couples that were well prepared for birth and obstetric emergencies, and its socio-demographic determinants.
UNASSIGNED: The proportion of couples that were well prepared for birth and its complications was significantly higher in urban (60.5%) than rural (48.4%) communities. The study also revealed that living above poverty line (95% CI=1.01-3.79), parity and spousal age difference less than five years (95% CI=1.09 - 2.40) were positive predictors of BPCR among respondents.
UNASSIGNED: Urban residents were better prepared than their rural counterparts. Living above poverty line, parity, and spousal age difference less than five years were positive predictors of BPCR. There is a need to emphasize on educating couples on the importance of identifying blood donors as a vital component of BPCR.
UNASSIGNED: None declared.

BACKGROUND: Maternal injury with any form of perineal trauma following vaginal delivery is very common which ranges globally from 16.2 to 90.4%. The frequency of Obstetric anal sphincter Injuries and the incidence of cervical laceration increases rapidly. However, in Ethiopia, there is limited evidence on the prevalence of maternal birth trauma and its determinant factors after vaginal delivery.
OBJECTIVE: To assess the magnitude and associated factors of Maternal Birth Trauma after vaginal delivery at University of Gondar Comprehensive Specialized Hospital, Gondar, North-West Ethiopia, 2022.
METHODS: An Institution based cross-sectional study was conducted among mothers with singleton vaginal delivery at University of Gondar Comprehensive Specialized Hospital from 9th May to 9th August 2022 among 424 study participants. Pre-tested semi-structured questioner was utilized. Epi-Data version 4.6 was used for data entry and exported to SPSS version 25 for data management and analysis. To identify the determinant factors, binary logistic regression model was fitted and variables with p-value < 0.2 were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, Variables with P-value < 0.05 were considered to have statistical significant association with the outcome variable. The Adjusted Odds Ratio (AOR) with 95% CI was reported to declare the statistical significance and strength of association between Maternal Birth Trauma and independent variables.
RESULTS: A total of 424 mothers who delivered vaginally were included. The mean age of participants was 26.83 years (± 5.220 years). The proportion of birth trauma among mothers after vaginal delivery was47.4% (95%CI: 43.1, 51.7). Of different forms of perineal trauma, First degree tear in 42.8%, OASIs in 1.5% and Cervical laceration in 2.5% study participants. In the multivariable binary logistic regression analysis being primiparous (AOR = 3.00; 95%CI: 1.68, 5.38), Gestational age ≥ 39 weeks at delivery (AOR = 2.96; 95%CI: 1.57, 5.57), heavier birth weight (AOR = 12.3; 95%CI: 7.21, 40.1), bigger head circumference (AOR = 5.45; 95%CI: 2.62, 11.31), operative vaginal delivery (AOR = 6.59; 95%CI: 1.44, 30.03) and delivery without perineum and/or fetal head support (AOR = 6.30; 95%CI: 2.21, 17.94) were significantly associated with the presence of maternal birth trauma.
CONCLUSIONS: Maternal birth trauma following vaginal delivery was relatively high in this study. Prim parity, gestational age beyond 39 weeks at delivery, heavier birth weight, bigger head circumference, operative vaginal delivery and delivery without perineum and/or fetal head supported were factors affecting perineal outcome. The Ministry of Health of Ethiopia should provide regular interventional training as to reduce maternal birth trauma.