Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam

<p>Abstract</p> <p>Background</p> <p>Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam.</p> <p>Methods</p> <p>Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews.</p> <p>Results</p> <p>Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector.</p> <p>Conclusion</p> <p>Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.</p

Birth centre care : Reproduction and infant health

This thesis has two general aims, to investigate factors affecting women s decision to have a second baby and to study the effect of birth centre care on infant outcome. The specific aims were to investigate 1) whether birth centre care during a woman s first pregnancy had an effect on her future reproduction, 2) whether a negative experience of the first birth had en effect on future reproduction, and 3) whether birth centre care had an effect on perinatal mortality 4) and on morbidity during the infant s first month. Nulliparous women randomly allocated to in-hospital birth centre care (n=505) and to standard maternity care (n=479) in early pregnancy were followed during a period of 7-10 years after the birth. Information about a second birth was collected from the Swedish Medical Birth Register and analysed by the Kaplan Meier method. No statistically significant differences were found between the groups in terms of having a second baby and the time to second birth (median: 2.85 versus 2.82 years, log-rank 1.26; p=0.26). Experience of childbirth was assessed in 617 first-time mothers. Information relating women s global assessment of the birth experience (questionnaire two months postpartum) and various background variables (questionnaire in early pregnancy) was linked to the Swedish Medical Birth Register. Women with a negative experience had fewer subsequent children and a longer interval to the second baby. 38% of women with a negative experience did not have another baby during the following 8 10 years, compared with 17% of those with a less negative experience (p<0.001). Two studies investigated perinatal mortality and infant morbidity in all women (n=3256) admitted to an in-hospital birth centre from 1989 to 1999. Data were compared with the outcomes for all the other women in the Greater Stockholm who gave birth in standard care during the same period and who met the same medical low-risk criteria as in the birth centre group (n=180 380). Outcome data were collected from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register and medical records. Logistic regression analyses were performed to control for potential confounding background factors. No statistically significant difference in the overall perinatal mortality rate was found between the birth centre group and the standard care group (OR 1.5; 0.9 2.4), but the infants of primiparas were at higher risk in the birth centre group (OR 2.2; 1.3 3.9). Infants in the birth centre group had a higher risk of respiratory problems (OR 1.5; 1.2 1.8) and a lower risk of clavicle and other fractures (OR 0.4; 0.3 0.6). In conclusion, birth centre care during a woman s first pregnancy does not appear to affect future reproduction, but a negative overall childbirth experience does. Birth centre care might be associated with a higher risk of perinatal mortality in first-born babies, minor respiratory problems and a lower risk of birth trauma such as fractures. It is important to consider maternal and infant risk factors in the planning of models for childbirth care

Linjebalansering vid Scanias chassiverkstad i Södertälje : en modell för samarbete över avdelningsgränser

Validerat; 20101217 (root

A Swedish register-based study exploring primary postpartum hemorrhage in 405 936 full term vaginal births between 2005 and 2015

Objective: To explore diagnoses of postpartum haemorrhage following vaginal birth, in relation to socio-demographic and obstetrical data from women who gave birth at term, in Sweden, during the years 2005–2015. Study design: A register-based cohort study was carried out, describing and comparing socio-demographic variables, obstetric variables and infant variables in 52 367 cases of diagnosed postpartum haemorrhage compared to 353 569 controls without a postpartum haemorrhage diagnosis. Postpartum hemorrhage was identified in The Swedish Medical Birth Register by ICD-10 code O72. Variables for maternal characteristics were dichotomized and used to calculate odds ratios to find possible explanatory variables for postpartum haemorrhage. Results: Between 2005 and 2015 there was no statistically significant decrease in diagnoses of postpartum haemorrhage after vaginal birth at term. Primiparity was associated with the highest risk and women birthing their fifth or subsequent child were associated with the lowest risk of postpartum hemorrhage. Increased maternal age (> 35 years) and/or obesity (BMI > 30) were associated with higher odds of postpartum haemorrhage. The risk of postpartum hemorrhage was 55 % higher when vaginal birth followed induction as compared to vaginal birth after spontaneous onset. Some of the factors known to be associated with postpartum haemorrhage were poorly documented in The Swedish Medical Birth Register. Conclusions: Birthing women in a Swedish contemporary setting are, despite efforts to improve care, still at risk of birth being complicated by postpartum haemorrhage. Primiparity, increasing maternal age and/or obesity are found to provoke an increased risk and the reasons for these findings need to be further investigated. However, grand multi-parity did not increase the risk for postpartum hemorrhage. Codes for diagnoses require correct documentation in the birth records: only when local statistics are sound and correctly reported can intrapartum care be improved, and the incidence of postpartum haemorrhage reduced

Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam

Abstract Background The use of antenatal care (ANC) varies between countries and in different settings within each country. Most previous studies of ANC in Vietnam have been cross-sectional, and conducted in rural areas before the year 2000. This study aims to compare the pattern and the adequacy of ANC used in rural and urban Vietnam following two cohorts of pregnant women. Methods A comparative study with two cohorts comprising totally 2132 pregnant women were followed in two health and demographic surveillance sites, one rural and one urban in Hanoi province, Vietnam. The women were quarterly interviewed using a structured questionnaire until delivery. The primary information obtained was the number and the content of ANC visits. Results Almost all women reported some use of ANC. The average number of visits was much lower in the rural setting (4.4) than in the urban (7.7). In the rural area, 77.2% of women had at least three visits and 69.1% attended ANC during the first trimester. The corresponding percentages for the urban women were 97.2% and 97.2%. Only 20.3% of the rural women compared to 81.1% of the urban women received all core ANC services. As a result, the adequate use of ANC was 5.2 times in the urban than in the rural setting (78.3% compared to 15.2%). Nearly all women received ultrasound examination during pregnancy with a mean value of 6.0 scans per woman in the urban area and 3.5 in the rural. Most rural women used ANC at commune health centres and private clinics while urban women mainly visited public hospitals. Expenditure related to ANC utilization for the urban women was 7.1 times that for the urban women. Conclusion The women in the rural area attended ANC later, had fewer visits and received much fewer services than urban women. The large disparity in ANC adequacy between the two settings suggests special attention for the ANC programme in rural areas focusing on its content. Revision and enforcement of the national guidelines to improve the behaviour and practice of both users and providers are necessary.</p

National Rates of Uterine Rupture are not Associated with Rates of Previous Caesarean Delivery: Results from the Nordic Obstetric Surveillance Study.

To access publisher's full text version of this article click on the hyperlink belowPrevious caesarean delivery and intended mode of delivery after caesarean are well-known individual risk factors for uterine rupture. We examined if different national rates of uterine rupture are associated with differences in national rates of previous caesarean delivery and intended mode of delivery after a previous caesarean delivery.This study is an ecological study based on data from a retrospective cohort in the Nordic countries. Data on uterine rupture were collected prospectively in each country as part of the Nordic obstetric surveillance study and included 91% of all Nordic deliveries. Information on the comparison population was retrieved from the national medical birth registers. Incidence rate ratios by previous caesarean delivery and intended mode of delivery after caesarean were modelled using Poisson regression.The incidence of uterine rupture was 7.8/10 000 in Finland and 4.6/10 000 in Denmark. Rates of caesarean (21.3%) and previous caesarean deliveries (11.5%) were highest in Denmark, while the rate of intended vaginal delivery after caesarean was highest in Finland (72%). National rates of uterine rupture were not associated with the population rates of previous caesarean but increased by 35% per 1% increase in the population rate of intended vaginal delivery and in the subpopulation of women with previous caesarean delivery by 4% per 1% increase in the rate of intended vaginal delivery.National rates of uterine rupture were not associated with national rates of previous caesarean, but increased with rates of intended vaginal delivery after caesarean.NFOG (Nordic Federation of Societies of Obstetrics and Gynaecology) foundation TRYG Fonden, Copenhagen, Denmar