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Women in research
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
Gender health inequalities are in part caused by unequal distribution of the social determinants of health. These are the conditions in which people are born, grow, live, work and age; they include socioeconomic status, education and employment, physical environment and social networks, as well as access to healthcare (Marmot and Allen 2014). Globally girls and women are likely to experience reduced access to educational opportunities, greater poverty, higher health burden, vulnerability to domestic abuse and the silencing of their political voice. Girls and women experience specific health burdens relating to reduced access to nutrition and healthcare, reproductive risk, as well as from exposure to house and workplace environmental hazards. Men by comparison are more likely to experience and die from physical workplace injuries (Stergiou-Kita et al. 2015; U.S. Bureau of Labor Statistics 2019). Maternal morbidity remains high in many countries of the Global South, due to limited health infrastructure, a lack of trained birth attendants and unsafe abortions (Macklin 2001). Women are more likely to live in poverty than men, and globally women are paid 23% less than men on average. Gender intersects with other forms of inequality such as race, income and class. For example, as a group, low-income women of color are disproportionately exposed to hazardous chemicals in the places where they work and live (UNDP 2011).
Critical Care
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jaimie Maines, Lauren A. Plante
Reviews of severe acute maternal morbidity [1–16, 43–58] suggest the following conditions are of most concern: Hemorrhage, eclampsia, cardiac arrest, pulmonary edema, respiratory failure, renal failure, sepsis, shock (multiple types), cerebrovascular event, coma, anesthetic complications (e.g., aspiration, difficult/failed intubation), and other cardiac conditions. Most obstetricians will be familiar with hemorrhage, pre-eclampsia, and eclampsia—in fact, more familiar than most intensivists—and these conditions are frequently handled on a labor and delivery unit without transfer to ICU. The remainder of the chapter will address a few critical care topics with which the obstetrician may be less familiar. With the understanding that critical care medicine, like any other branch of medicine, is constantly evolving, current evidence-based practice in critical care is described later.
Preparation Before Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Daniele Di Mascio, Leen Al-Hafez
Compared to the conventional hospital ward, allocation to an alternative hospital setting increased the likelihood of the following: no intrapartum analgesia/anesthesia (RR 1.18, 95% CI 1.05–1.33), spontaneous vaginal delivery (SVD) (RR 1.03, 95% CI 1.01–1.05), breastfeeding at 6–8 weeks (RR 1.04, 95% CI 1.02–1.06), and very positive views of care (RR 1.96, 95% CI 1.78–2.15). Allocation to an alternative setting decreased the likelihood of epidural analgesia (RR 0.80, 95% CI 0.74–0.87), oxytocin augmentation of labor (RR 0.77, 95% CI 0.67–0.88), and episiotomy (RR 0.83, 95% CI 0.77–0.90) [26]. There was no apparent effect on maternal morbidity and mortality, serious perinatal morbidity/mortality (RR 1.17, 95% CI 0.51–2.67), perinatal mortality (RR 1.67, 95% CI 0.93–3.00), other adverse neonatal outcomes, or postpartum hemorrhage. The 4% increase in SVD may be secondary to less epidural anesthesia, which may in turn be secondary to less availability in homelike settings and/or to less intrapartum monitoring. The trend for a 67% higher perinatal mortality should be weighed against the significant 4% increase in SVD and 96% higher satisfaction during counseling. No firm conclusions can be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings [33]. A birth center in the hospital is a safe location for birth [30].
Increased maternal mortality in unvaccinated SARS-CoV-2 infected pregnant patients
Published in Journal of Obstetrics and Gynaecology, 2022
Zeliha Atak, Sakine Rahimli Ocakoglu, Serra Topal, Aslı Ceren Macunluoglu
It is now clearly known that COVID-19 infection is associated with increased maternal and perinatal mortality (Villar et al. 2021). According to the Turkish Statistical Institute 2019 data, the maternal mortality rate in our country was 13.1 per 100,000, reflecting the pre-pandemic period. Achieving low maternal mortality rates is a public health problem related to the development levels of countries. Above all, the world is faced with an infection that causes an increase in maternal mortality (Di Guardo et al. 2021; Mullins et al. 2021). Many organisations worldwide aim to reduce maternal morbidity and mortality. During the study period in our institution, one maternal mortality case due to a cause other than COVID-19 infection has been encountered, while there were nine maternal deaths related to COVID-19 infection. The maternal mortality rate associated with COVID-19 infection in period between April 2021 and November 2021 was found to be 156.28/100,000. We lost unvaccinated nine patients in these 8 months, despite all the interventions we applied in our pandemic hospital.
A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa
Published in South African Family Practice, 2019
I Govender, C Steyn, O Maphasha, AT Abdulrazak
Intraoperative causes of maternal morbidity are haemorrhage due to extension of tears and lacerations, adherent placenta and atonic uterus, and injury to adjacent viscera, difficult intubations and aspiration of gastric contents.11 The most common postoperative causes of maternal morbidity are anaemia, urinary tract infections, blood transfusions, prolonged maternal hospital stay due to prolonged catheterisation, infections requiring antibiotics, wound dehiscence and sepsis. The number of women requiring a hysterectomy after a CS is four times higher than for those who deliver vaginally.10,11 In countries such as Saudi Arabia where large families are encouraged by social and cultural factors, it is not uncommon for women to have as many as six or seven CSs. This high number can lead to uterine scar rupture with significant maternal and foetal morbidity and even mortality. There is, however, no clear evidence to inform clinicians on the number of CSs a woman can safely undergo.12
Comparison of ‘push method’ with ‘Patwardhan’s method’ on maternal and perinatal outcomes in women undergoing caesarean section in second stage
Published in Journal of Obstetrics and Gynaecology, 2019
Anish Keepanasseril, Nafeez Shaik, NS Kubera, B Adhisivam, Dilip K Maurya
Various complications causing maternal morbidity occurred in 118 (38.44%) women in the study. Table 2 shows the maternal outcomes in the study population based on the method of delivery of the foetus. Both methods of delivering the foetal head had similar rates of extension of uterine incision (24.9% vs. 26.0%, p = .850). The extensions to the lower uterine flap (42 (19%) vs. 9 [11.7%]), uterine artery (10 [4.5%] vs. 5 [6.5%]), broad ligament (6 [2.7%] vs. 6 [7.8%] and into the vagina (6 [2.7%] vs. 3 [3.9]) occurred similarly while delivering the foetal head using both of the methods. Other maternal complications such as a postpartum haemorrhage, need of an additional surgical procedure, and an intraoperative bladder/bowel injury were also similar both groups. Twenty women (6.7%) received a blood transfusion in view of a postpartum haemorrhage, five of them (2.5%) had a massive postpartum haemorrhage (blood loss >1500 mL). The need for transfusion was similar in both of the groups. A surgical site infection (n = 27 [8.8%]) was the most common type of sepsis; which was significantly higher in those who were delivered by Patwardhan’s method, and 14 of them required a secondary suturing of the wound dehiscence.