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.

OBJECTIVE: Aim: To clarify the association between different types of uterine contractility dysfunction and the inflammation of the uterus and chorioamniotic membranes.
METHODS: Materials and Methods: The association between the inflammation of the uterine layers, chorioamniotic membranes, umbilical cord, and different types of labor activity abnormalities was examined in 382 patients with singleton pregnancies at 28-42 weeks\' gestation who underwent Caesarean section (CS) for abnormal uterine contractions and other complications. Statistical analyses included the Mann-Whitney U, Chi-squared test, and logistic regression.
RESULTS: Results: In the control group, slight infiltration with polymorphonuclear leukocytes (PMNs) and macrophages of the myometrium and decidua of the lower uterine segment at term pregnancy was found in 59.7% and 73.6% of cases. The main clinical risk factors for placental and decidual membrane inflammation in patients with excessive uterine activity (EUA) were prematurity, multiparity, group B streptococcus (GBS) colonization, and duration of ruptured fetal membranes before the CS. Moderate or marked myometrial inflammation of both uterine segments in the EUA group was diagnosed only in patients with cervical dilation of >6 cm and duration of labor of >8h. In women with hypotonic uterine activity (HUA), decidual and myometrial inflammation was significantly associated with nulliparity and intrapartum factors, such as protracted active first stage of labor, advanced cervical dilation, and number of vaginal examinations. In all cases, inflammation of the myometrium was accompanied by deciduitis.
CONCLUSIONS: Conclusions: Mild inflammation of the decidual membrane and myometrium of the lower segment at term pregnancy is a common physiological phenomenon contributing to labor initiation. Uterine hyperfunction comes as the response of the unaffected myometrium to the release of high concentrations of proinflammatory cytokines produced by the inflamed decidual and chorioamniotic membranes into the bloodstream. Marked myometrial inflammation that occurs in prolonged labor is an additional factor aggravating the hypotonic uterine activity.

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.

OBJECTIVE: To assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa.
METHODS: This retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis.
RESULTS: Reduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm3; OR: 0.993, 95 % CI: 0.990-0.995 and OR: 1.007, 95 % CI: 1.005-1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 - 0.88 and OR: 1.7, 95 % CI: 1.4 - 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2-250, p = 0.001).
CONCLUSIONS: Placental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.

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: Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark.
METHODS: Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression.
RESULTS: Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery.
CONCLUSIONS: In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.

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.

This study aimed to analyze factors associated with obstetric fistula care-seeking behavior in Guinea, based on data from the 2018 Demographic and Health Survey. Women aged 15-49 years who reported having obstetric fistula constituted the study population, statistical analysis was using Stata 16.0 software. Multivariate logistic regression was used to identify the factors associated with fistula care-seeking behavior. Among women with obstetric fistula, 78.9% sought care; 21.1% of those who sought care underwent repair. Factors associated with care-seeking behavior were being divorced (AOR =8.08; 95% CI:1.56-41.84), having a job (AOR =3.23; 95% CI: 1.11-9.44), being a member of a poor household (AOR =6.49; 95% CI:1.21-34.82) and whose fistula had appeared 6 days or more after the occurrence of the causal circumstance (AOR =3.63 95% CI: 1.28-10.28). This study suggests that the foundations on which fistula prevention and treatment programs are built should be reviewed, taking into account the factors highlighted by this study.
Cette étude visait à analyser les facteurs associés aux comportements de recherche de soins pour la fistule obstétricale en Guinée, partant des données de l\'enquête démographique et de santé de 2018. Les femmes âgées de 15 à 49 ans ayant déclaré avoir une fistule obstétricale ont constitué la population d\'étude, l’analyse statistique a été réalisée à l\'aide du logiciel Stata 16.0. La régression logistique multivariée a été utilisée pour identifier les facteurs associés aux comportements de recherche de soins pour la fistule. Parmi les femmes atteintes de fistule obstétricale, 78,9 % ont eu recours à des soins ; 21,1 % de celles qui ont recouru ont subi une réparation. Les facteurs associés aux comportements de recherche de soins étaient le fait d\'être divorcée (ORA=8.08 ; 95% IC :1.56-41.84), d\'avoir un travail (ORA =3.23 ; 95% IC : 1.11-9.44), d\'être membre d\'un ménage pauvre (ORA =6.49 ; 95% IC :1.21-34.82) et dont la fistule était apparue 6 jours ou plus après la survenue de la circonstance causale (ORA =3.63 95% IC : 1.28-10.28). Cette étude suggère de revoir les bases sur lesquelles les programmes de prévention et de traitement de la fistule sont construits, tout en prenant en compte les facteurs mis en évidence par cette étude.

OBJECTIVE: Hemorrhage risk assessment tools have been studied using estimated blood loss. We study the association between peripartum hemorrhage risk assessment score and peripartum quantified blood loss (QBL) in term vaginal and cesarean deliveries.
METHODS: This is a retrospective analysis conducted on 3,657 patients who underwent term vaginal and cesarean deliveries at a public hospital in New York City. Utilizing the risk assessment tool developed by the Association of Women\'s Health, Obstetric and Neonatal Nurses (AWHONN), patients were categorized into low-, medium-, or high-risk groups for postpartum hemorrhage.
RESULTS: Medium-risk (B=0.08, SE=0.01, p<0.001) and high-risk (B=0.12, SE=0.02, p<0.001) AWHONN scores were associated with significantly higher QBL as compared to low-risk AWHONN score. Medium-risk approached significance (OR: 1.67, 95 % CI: 1.00, 2.79, p=0.050) and high-risk AWHONN score was significantly associated (OR: 1.95, 95 % CI: 1.09, 3.48, p=0.02) with increased odds for postpartum hemorrhage (≥1,000 mL). Each individual factor comprising the AWHONN score whose percentage in our sample was seen in greater than 2.7 % of patients was independently significantly associated with increased QBL (six of nine factors) and postpartum hemorrhage (four of nine factors).
CONCLUSIONS: The AWHONN measure previously validated with estimated blood loss predicted obstetric blood loss with QBL. Although not on the basis of the data shown in our study, we believe that QBL should be routinely used to measure obstetric blood loss.

BACKGROUND: Obstetric anal sphincter injury is a complication of vaginal delivery, if left untreated, causes significant maternal morbidities; urinary problems and fecal/ flatus incontinence. The aim of this study was to determine the incidence and describe the obstetric characteristics and functional outcomes of women who had vaginal delivery at Paropakar Maternity and Women\'s Hospital Nepal and sustained Obstetric anal sphincter injury.
METHODS: This retrospective descriptive study included women who had vaginal delivery, irrespective of parity, in the labor room or birthing unit of Paropakar Maternity and Women\'s Hospital from April 2018 to September 2020, and sustained Grade III or IV Obstetric anal sphincter injury after 28 weeks period of gestation. Maternal characteristics, obstetric details and perineal status after vaginal delivery were noted after review of hospital records. The patients were further inquired via telephone for their current status of fecal and/or urinary incontinence.
RESULTS: The incidence of OASI was 106 (0.33%) among 31, 786 Nepalese women with vaginal birth over a 2-year period. The mean age women with Obstetric anal sphincter injury was 24.6 ± 4.3 years and 45(52.9%) cases belonged to Janajati ethnicity. Fifty two (61.2 %) were primipara and 77 (90.6%) had spontaneous vaginal deliveries. Episiotomy was not performed on most of the patients (63, 74.1%). Problems with flatus holding, stool holding and urine holding was reported by 28.3%, 13.2% and 22.6% women respectively.
CONCLUSIONS: The incidence of Obstetric anal sphincter injury among Nepalese women with vaginal birth over a 2-year period was 0.33%, which was lower than other South Asian studies. Grade III Obstetric anal sphincter injury was the frequent most type. The injuries were more common in women with Janajati ethnicity, primipara and women who did not have episiotomy. Problems with flatus holding and urine holding were present in almost one-fourth of the women with Obstetric anal sphincter injury at follow up.