AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV inf...AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.展开更多
Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, ...Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.展开更多
Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of...Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. Descriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that;the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.展开更多
Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices a...Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.展开更多
Objective:To investigate the effects of immediate post-partum infection with Trypanosoma brucei（T.brucei） on dam and offspring.Methods:Sixty female Albino rats（Rattus norvegicus） weighing between 130-170 g were us...Objective:To investigate the effects of immediate post-partum infection with Trypanosoma brucei（T.brucei） on dam and offspring.Methods:Sixty female Albino rats（Rattus norvegicus） weighing between 130-170 g were used as animal model.The animals were divided as follows: 25 infected between 1-5 days post partum;10 infected unbred as positive controls;and 25 uninfected as negative controls.The following parameters were evaluated:packed cell volume （PCV）,level of parasitaemia,survival time,litter size and litter weight at birth and on days 7, 14 and 21 post delivery,using conventional methods.Possible trans-mammary transmission of infection to litter through milk was also assessed.Results:The results showed a comparatively （P【0.05） higher mean PCV value for the uninfected negative control on the 8 day post infection compared with the infected groups which corresponded with the increasing level of parasitaemia in the two infected groups.Mean litter size and litter weights were higher（P【0.05） in the uninfected controls on the 21<sup>st</sup> day.Survival time in the infected groups were similar.No evidence of trans-mammary transfer of infection was recorded.Conclusion:T.brucei infection during immediate post partum period is detrimental to the dam and impairs growth of the offspring.展开更多
Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fou...Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.展开更多
Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outc...Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.展开更多
<strong>Objective:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""> This work aimed to evaluate the epidemiological clinical aspects and evolu...<strong>Objective:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""> This work aimed to evaluate the epidemiological clinical aspects and evolutionary aspects of peri partum cardiomyopathy (PPCM) in the cardiology department of the CHU Point G. <b>Materials and Methods:</b> This was a descriptive cross-sectional study from </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">1 January 2019 to 31 December 2019, including all patients admitted for heart failure during this period.<b> Results:</b> The study involved 40 patients out of 1187 admissions, a hospital prevalence of PPCM was 3.36%. The average age was 26 years plus or minus 7 years with extremes of 16 years and 38 years. The age group between 16 and 20 years was the most represented with 32.5% of cases. Housewives were in the majority with 87.6%;residing in rural areas 62.5%, with a low socio-economic standard of living 32.5% of cases. Multiparous in our context were dominant 42.5%, followed by pauci pares and primiparous with 32.5% and 25% frequency respectively. All our patients, 100% had their first symptom after childbirth, functional signs were dominated by dyspnea of effort present in 100% of patients, followed cough (40%) and chest pain (27.5%). On physical examination there was Tachycardia in 82.5%, Galop B3 (45%) and auscultatory arrhythmia in 5%. Signs of pulmonary condensation (82.5%) and pleural fluid effusion (25%). Hepatomegaly was present in 72.5% of patients. It was overall heart failure in 72.5% of cases. On the electrocardiogram there was sinus tachycardia (75%) and atrial fibrillation arrhythmia (5%). On cardiac Doppler ultrasound the left ventricle was dilated with a low systolic ejection fraction in 100% of patients, the four cavities were dilated in 32.5%, a left intraventricular thrombus in 7.5% of cases and a pericardial fluid effusion in 5% of cases. Biology noted anemia in 22.5% of patients. Treatment was classic for heart failure. The course was punctuated by complications in 42.5% of cases, such as thromboembolic disease (22.5%), ischemic stroke (12.5%), complete arrhythmia by atrial fibrillation (ACFA 5%) and cardiogenic shock (2.5%). Hospital mortality was 7.5% with 67% of deaths observed in the 16</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">22 age group. </span><span style="white-space:normal;font-size:10pt;font-family:;" "=""><b>Conclusion:</b> PPCM is a common sub-Saharan pathology, low socioeconomic status, young age and multiparity were factors dominant in our context.</span>展开更多
<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">OVT is rare, with an incidence of 0.05% to 0.18% a...<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">OVT is rare, with an incidence of 0.05% to 0.18% and occur</span><span style="font-family:Verdana;">ring preferentially in postpartum period. Any delay in management may</span><span style="font-family:Verdana;"> compromise the patient’s vital prognosis.</span><b><span style="font-family:Verdana;"> Observation:</span></b><span style="font-family:Verdana;"> We report a case of a 34-year-old patient, G2P3, who delivered twins by cesarean section at 39 weeks of amenorrhea. She presented abdominal pain and fever on the 4</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> day of postpartum. Biological tests showed a biological inflammatory syndrome and a positive blood culture with gram-positive </span><i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;">. After 72 hours of antibiotics with no clinical or biological improvement, a CT scan revealed a 12 mm thrombus in the lumen of the right ovarian vein’s connection to the inferior vena cava. Antibiotic treatment was continued, associated with an a</span><span><span style="font-family:Verdana;">nticoagulant. The evolution was been favorable. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Rare and se</span></span><span style="font-family:Verdana;">rious pathology, the diagnosis is made using medical imaging. The outcome is generally favorable with antibiotic therapy and anticoagulant therapy.</span></span></span></span>展开更多
We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 ...We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 weeks. She had irregular contractions. The EFM showed a low-frequency, sinusoidal rhythm. The cycle of the sine curve increased in time from 90 seconds to 160 seconds gradually. A severely asphyxiated newborn was successfully resuscitated after an emergency Cesarean Section. The mother and child were discharged from our hospital in a good general condition seven days later. Upon examination it was proven that this was a case of a placental abruption. This is an original case study report about how to diagnose a placental abruption according to an EFM reading. We propose a definition of a low-frequency, sinusoidal rhythm having: 1) a stable baseline FHR (fetal heart rate) of 120 - 160 bpm;2) a possible variation of 20 - 30 bpm;3) a frequency of 90 - 160 seconds per cycle;4) fixed or flat short-term variability;5) oscillation of the sinusoidal wave from above and below a baseline;6) no areas of normal FHR variability or reactivity. What is more, the lengths of the fluctuation cycle and the greater the amplitude has a close relationship with the prognosis of both mother and child. This pre-partum, low-frequency, sinusoidal rhythm is an ominous sign of fetal jeopardy needing immediate intervention. The medical literature has never reported such an association. Therefore, our case study report is possibly the first to mention this observation.展开更多
This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or)...This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.展开更多
Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mort...Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.展开更多
目的:比较电针联合透灸与生物反馈电刺激治疗产后盆腔器官脱垂的临床疗效。方法:将60例产后6周盆腔器官脱垂的患者随机分为观察组和对照组,各30例。观察组采用电针联合透灸治疗,穴取子宫、次髎、会阳等,透灸腹部及腰骶部腧穴,腹部及腰...目的:比较电针联合透灸与生物反馈电刺激治疗产后盆腔器官脱垂的临床疗效。方法:将60例产后6周盆腔器官脱垂的患者随机分为观察组和对照组,各30例。观察组采用电针联合透灸治疗,穴取子宫、次髎、会阳等,透灸腹部及腰骶部腧穴,腹部及腰骶部腧穴交替使用;对照组采用生物反馈电刺激治疗,均隔日治疗1次,每周3次,连续治疗6周。于治疗前、治疗后、产后6个月采用盆底肌力检测、盆腔器官脱垂定量(pelvic organ prolapse quantitation,POP-Q)评估、盆底功能障碍影响问卷简表(pelvic floor impact questionnaire short form-7,PFIQ-7)进行疗效评价。结果:两组患者治疗后、产后6个月盆底肌持续收缩力、快速收缩力均较治疗前增强(P<0.05),且观察组增强幅度大于对照组(P<0.05);观察组治疗后、产后6个月的盆腔器官脱垂程度较对照组减轻(P<0.05);两组患者治疗后、产后6个月PFIQ-7评分均较治疗前降低(P<0.05),且观察组降低幅度大于对照组(P<0.05)。结论:电针联合透灸可提高产后盆腔器官脱垂患者的盆底肌收缩力,在改善盆腔器官脱垂程度和患者生活质量方面优于生物反馈电刺激治疗。展开更多
文摘AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.
文摘Introduction: Sexuality in the postpartum period is a taboo subject that raises many questions, especially among women. The aim of this study was to evaluate the influence of factors such as mode of delivery, parity, type of household and level of education on the resumption of sexuality, by comparing our results with those in the literature. Methods: This is a prospective descriptive and analytical study, which took place from 3 April to 2 June 2023 in the maternity ward of the Ignace Deen National Hospital of the University Hospital Centre of Conakry. The sample included married women who had given birth once or several times. Results: Of 118 married women who had given birth once or several times and who were questioned about their sexuality in the postpartum period, 75.42% (89 cases) stated that they had resumed sexual activity in the postpartum period. (The majority were aged 20 - 29 years (46.61%), pauci pares (51.69%), living in a monogamous household (88.14%), with secondary education (44.92%) and self-employed (38.98%). More than half (58.47%) of these women had a normal vaginal delivery with vulvo-perineal tear (5.80%), episiotomy (15.94%) and instrumental extraction (8.69%). The main reasons for resuming sexual activity were the desire to satisfy their partner (50.56%) and to maintain the harmony of the couple (29.21%). Resumption of sexual activity was more common in patients who had given birth by caesarean section (p = 0.007) and in patients with a higher level of education (p = 0.03). However, it was not influenced by parity or household type. Conclusion: Sexuality remains a taboo subject, and its resurgence in the postpartum period is influenced by the mode of delivery and the level of education and perception of women. Certain practices and complications related to childbirth can also influence the resumption of sexuality in the postpartum period.
文摘Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. Descriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that;the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.
文摘Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.
文摘Objective:To investigate the effects of immediate post-partum infection with Trypanosoma brucei（T.brucei） on dam and offspring.Methods:Sixty female Albino rats（Rattus norvegicus） weighing between 130-170 g were used as animal model.The animals were divided as follows: 25 infected between 1-5 days post partum;10 infected unbred as positive controls;and 25 uninfected as negative controls.The following parameters were evaluated:packed cell volume （PCV）,level of parasitaemia,survival time,litter size and litter weight at birth and on days 7, 14 and 21 post delivery,using conventional methods.Possible trans-mammary transmission of infection to litter through milk was also assessed.Results:The results showed a comparatively （P【0.05） higher mean PCV value for the uninfected negative control on the 8 day post infection compared with the infected groups which corresponded with the increasing level of parasitaemia in the two infected groups.Mean litter size and litter weights were higher（P【0.05） in the uninfected controls on the 21<sup>st</sup> day.Survival time in the infected groups were similar.No evidence of trans-mammary transfer of infection was recorded.Conclusion:T.brucei infection during immediate post partum period is detrimental to the dam and impairs growth of the offspring.
文摘Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.
文摘Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.
文摘<strong>Objective:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""> This work aimed to evaluate the epidemiological clinical aspects and evolutionary aspects of peri partum cardiomyopathy (PPCM) in the cardiology department of the CHU Point G. <b>Materials and Methods:</b> This was a descriptive cross-sectional study from </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">1 January 2019 to 31 December 2019, including all patients admitted for heart failure during this period.<b> Results:</b> The study involved 40 patients out of 1187 admissions, a hospital prevalence of PPCM was 3.36%. The average age was 26 years plus or minus 7 years with extremes of 16 years and 38 years. The age group between 16 and 20 years was the most represented with 32.5% of cases. Housewives were in the majority with 87.6%;residing in rural areas 62.5%, with a low socio-economic standard of living 32.5% of cases. Multiparous in our context were dominant 42.5%, followed by pauci pares and primiparous with 32.5% and 25% frequency respectively. All our patients, 100% had their first symptom after childbirth, functional signs were dominated by dyspnea of effort present in 100% of patients, followed cough (40%) and chest pain (27.5%). On physical examination there was Tachycardia in 82.5%, Galop B3 (45%) and auscultatory arrhythmia in 5%. Signs of pulmonary condensation (82.5%) and pleural fluid effusion (25%). Hepatomegaly was present in 72.5% of patients. It was overall heart failure in 72.5% of cases. On the electrocardiogram there was sinus tachycardia (75%) and atrial fibrillation arrhythmia (5%). On cardiac Doppler ultrasound the left ventricle was dilated with a low systolic ejection fraction in 100% of patients, the four cavities were dilated in 32.5%, a left intraventricular thrombus in 7.5% of cases and a pericardial fluid effusion in 5% of cases. Biology noted anemia in 22.5% of patients. Treatment was classic for heart failure. The course was punctuated by complications in 42.5% of cases, such as thromboembolic disease (22.5%), ischemic stroke (12.5%), complete arrhythmia by atrial fibrillation (ACFA 5%) and cardiogenic shock (2.5%). Hospital mortality was 7.5% with 67% of deaths observed in the 16</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">22 age group. </span><span style="white-space:normal;font-size:10pt;font-family:;" "=""><b>Conclusion:</b> PPCM is a common sub-Saharan pathology, low socioeconomic status, young age and multiparity were factors dominant in our context.</span>
文摘<strong>Introduction: </strong><span><span><span style="font-family:""><span style="font-family:Verdana;">OVT is rare, with an incidence of 0.05% to 0.18% and occur</span><span style="font-family:Verdana;">ring preferentially in postpartum period. Any delay in management may</span><span style="font-family:Verdana;"> compromise the patient’s vital prognosis.</span><b><span style="font-family:Verdana;"> Observation:</span></b><span style="font-family:Verdana;"> We report a case of a 34-year-old patient, G2P3, who delivered twins by cesarean section at 39 weeks of amenorrhea. She presented abdominal pain and fever on the 4</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> day of postpartum. Biological tests showed a biological inflammatory syndrome and a positive blood culture with gram-positive </span><i><span style="font-family:Verdana;">Staphylococcus</span></i><span style="font-family:Verdana;">. After 72 hours of antibiotics with no clinical or biological improvement, a CT scan revealed a 12 mm thrombus in the lumen of the right ovarian vein’s connection to the inferior vena cava. Antibiotic treatment was continued, associated with an a</span><span><span style="font-family:Verdana;">nticoagulant. The evolution was been favorable. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Rare and se</span></span><span style="font-family:Verdana;">rious pathology, the diagnosis is made using medical imaging. The outcome is generally favorable with antibiotic therapy and anticoagulant therapy.</span></span></span></span>
文摘We consider that a low-frequency, sinusoidal rhythm detected by Electronic Fetal Monitoring (EFM) is a typical manifestation of a placental abruption. We present the case of a 26-year-old woman who was gestational 36 weeks. She had irregular contractions. The EFM showed a low-frequency, sinusoidal rhythm. The cycle of the sine curve increased in time from 90 seconds to 160 seconds gradually. A severely asphyxiated newborn was successfully resuscitated after an emergency Cesarean Section. The mother and child were discharged from our hospital in a good general condition seven days later. Upon examination it was proven that this was a case of a placental abruption. This is an original case study report about how to diagnose a placental abruption according to an EFM reading. We propose a definition of a low-frequency, sinusoidal rhythm having: 1) a stable baseline FHR (fetal heart rate) of 120 - 160 bpm;2) a possible variation of 20 - 30 bpm;3) a frequency of 90 - 160 seconds per cycle;4) fixed or flat short-term variability;5) oscillation of the sinusoidal wave from above and below a baseline;6) no areas of normal FHR variability or reactivity. What is more, the lengths of the fluctuation cycle and the greater the amplitude has a close relationship with the prognosis of both mother and child. This pre-partum, low-frequency, sinusoidal rhythm is an ominous sign of fetal jeopardy needing immediate intervention. The medical literature has never reported such an association. Therefore, our case study report is possibly the first to mention this observation.
文摘This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.
文摘Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.
文摘目的:比较电针联合透灸与生物反馈电刺激治疗产后盆腔器官脱垂的临床疗效。方法:将60例产后6周盆腔器官脱垂的患者随机分为观察组和对照组,各30例。观察组采用电针联合透灸治疗,穴取子宫、次髎、会阳等,透灸腹部及腰骶部腧穴,腹部及腰骶部腧穴交替使用;对照组采用生物反馈电刺激治疗,均隔日治疗1次,每周3次,连续治疗6周。于治疗前、治疗后、产后6个月采用盆底肌力检测、盆腔器官脱垂定量(pelvic organ prolapse quantitation,POP-Q)评估、盆底功能障碍影响问卷简表(pelvic floor impact questionnaire short form-7,PFIQ-7)进行疗效评价。结果:两组患者治疗后、产后6个月盆底肌持续收缩力、快速收缩力均较治疗前增强(P<0.05),且观察组增强幅度大于对照组(P<0.05);观察组治疗后、产后6个月的盆腔器官脱垂程度较对照组减轻(P<0.05);两组患者治疗后、产后6个月PFIQ-7评分均较治疗前降低(P<0.05),且观察组降低幅度大于对照组(P<0.05)。结论:电针联合透灸可提高产后盆腔器官脱垂患者的盆底肌收缩力,在改善盆腔器官脱垂程度和患者生活质量方面优于生物反馈电刺激治疗。
