60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

CONTEXT: Birth asphyxia contributes substantially to neonatal mortality in low- and middle-income countries (LMICs). The effects of training birth attendants in neonatal resuscitation (NR) on mortality are limited by falloff of skills and knowledge over time and transference of learned skills into clinical practice. OBJECTIVE: This review examined acquisition and retention of NR knowledge and skills by birth attendants in LMICs and the effectiveness of interventions to improve them. DATA SOURCES: Medline, Cochrane, Embase, CINAHL, Bireme, and African Index Medicus databases were searched. We reviewed Web pages and reports from non–peer-reviewed (or “gray”) literature sources addressing NR training in LMICs. STUDY SELECTION: Articles on acquisition and retention of NR knowledge and skills, and interventions to improve them, were limited to LMICs. RESULTS: The initial search identified 767 articles, of which 45 met all inclusion criteria. Of these, 31 articles analyzed acquisition of knowledge and skills, and 19 analyzed retention. Most studies found high acquisition rates, although birth attendants struggled to learn bag-mask ventilation. Although significant falloff of knowledge and skills occurred after training, refresher training seemed to improve retention. Results of the gray literature analysis suggest that formal, structured practice sessions improve retention. LIMITATIONS: This review did not analyze training’s direct impact on mortality. CONCLUSIONS: Knowledge and skills falloff is a significant barrier to the success of NR training programs and possibly to reducing newborn mortality in LMICs. Refresher training and structured practice show significant promise. Additional research is needed to implement and assess retention improvement strategies in classroom and clinical settings.

https://pediatrics.aappublications.org/content/pediatrics/early/2016/07/05/peds.2015-4490.full.pdf

Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

https://opus.lib.uts.edu.au/bitstream/10453/112928/1/Turkmani1.pdf

Midwives are the backbone of our health system: Lessons from Afghanistan to guide expansion of midwifery in challenging settings.

Antenatal care and skilled birth attendance in Bangladesh are influenced by female education and family affordability: BDHS 2014.

Background Improved access to skilled health personnel for childbirth is a priority strategy to improve maternal health. This study investigates interventions to achieve this where traditional birth attendants were providers of childbirth care and asks what has been done and what has worked? Methods and Findings We systematically reviewed published and unpublished literature, searching 26 databases and contacting experts to find relevant studies. We included references from all time periods and locations. 132 items from 41 countries met our inclusion criteria and are included in an inventory; six were intervention evaluations of high or moderate quality which we further analysed. Four studies report on interventions to deploy midwives closer to communities: two studies in Indonesia reported an increase in use of skilled health personnel; another Indonesian study showed increased uptake of caesarean sections as midwives per population increased; one study in Bangladesh reported decreased risk of maternal death. Two studies report on interventions to address financial barriers: one in Bangladesh reported an increase in use of skilled health personnel where financial barriers for users were addressed and incentives were given to skilled care providers; another in Peru reported that use of emergency obstetric care increased by subsidies for preventive and maternity care, but not by improved quality of care. Conclusions The interventions had positive outcomes for relevant maternal health indicators. However, three of the studies evaluate the village midwife programme in Indonesia, which limits the generalizability of conclusions. Most studies report on a main intervention, despite other activities, such as community mobilization or partnerships with traditional birth attendants. Many authors note that multiple factors including distance, transport, family preferences/support also need to be addressed. Case studies of interventions in the inventory illustrate how different countries attempted to address these complexities. Few high quality studies that measure effectiveness of interventions exist.

/pdf/increasing-the-use-of-skilled-health-personnel-where-veq95olsz5.pdf

Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: a systematic review.

Evaluation of a Skilled Birth Attendant pilot training program in Bangladesh

Introduction: Both maternal nutritional status and GDM have impact on pregnancy outcome. But, data from Bangladesh in this issue is still scarce. To design and utilize national obstetric health care, nutritional status of GDM women and its impact in the birth weight of babies should be evaluated and therefore, this study was designed.
Methods: This prospective cohort study was conducted in the department of Obstetrics and Gynecology at BIRDEM General Hospital-2, Dhaka to evaluate the nutritional status of GDM women and its impact on pregnancy outcomes.
Results: The mean age of the patients in the study was 29.71± 5.06 years. The mean age, Mid Upper Arm Circumference (MUAC,) and Body Mass Index (BMI) were significantly higher in GDM mothers (p <0.05). Additionally, gestational weight gain between 28 weeks and before delivery was significantly higher in GDM mothers (p <0.001). The mean birth weight of the newborns was also higher in the GDM group (3.23±0.46vs. 2.97±0.37 kg) (p <0.05). Macrosomic neonates were observed only in the GDM group (4.36%). APGAR score was significantly better in non-GDM mothers’ babies (p <0.05). Babies of GDM mothers had a significantly higher proportion of birth asphyxia, septicemia, pneumonia, Intrauterine Growth Retardation (IUGR), and Neonatal Intensive Care Unit (NICU) admissions (p <0.05). Macrosomic mothers had significantly higher BMI and higher gestational weight gain (p<0.05).
Conclusion: Mothers with GDM had a higher rate of bad pregnancy outcomes and that macrosomia was linked to a higher BMI.
J Bangladesh Coll Phys Surg 2023; 41: 63-74

Nutritional Status in a Patient with Gestational Diabetes Mellitus and Pregnancy Outcome

Background: postpartum haemorrhage is one of the major contributors to maternal mortality and morbidity worldwide. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line choice of treatment.Carbetocin, a long acting oxytocin agonist, appears to be a promising agent for the prevention of PPH. This comparative study was between Carbetocin Versus Oxytocin for the Prevention of Postpartum Haemorrhage in Caesarean Section 
Objective: To determine the safety and effectiveness of carbetocin and oxytocin for the prevention of post-partum haemorrhage in caesarean section. 
Methods: Randomized controlled clinical trial was done in the department of Obstetrics and Gynaecology of Sir Salimullah Medical College Mitford Hospital, Dhaka, between February to July 2015. Study population were 64 pregnant women admitted for delivery and underwent caesarean section, who were randomly selected. Women in the intervention group (group I) received injection carbetocin a bolus of 100 mgm IV; women in the standard treatment group (group II) received 10 IU of oxytocin in IV.Both administered immediately after chiidbirth.This trial was registered in SSMC MH with reference no-SSMC/2014/76. 
Result: Difference of mean age,mean gestational age and indication of C/S were not statistically significant between two groups.Regarding haemodynamic effect,both drugs were almost similar.There was no significant difference in per-operetive blood loss,uterine tone, level of uterine fundus, urine output in urobag and hemoglobin level. Need for additional oxytocics required 0(0.0%) vs 5(16.7%) patients in group I and group II respectively and was found statistically significant.Blood transfusion needed was 0(0.0%) vs 3(10.0%) patients and primary PPH 0(0.0%) vs 3(9.4%),though both were not statistically significant. No significant difference regarding side effects and total expense was found. 
Conclusion: Administration of single bolus dose of carbetocin (100 μgIV) after delivery of the baby in caesarean section immediately reduces the need for additional oxytocics, occurrence of primary PPH and further blood transfusion. Side effects are mild and similar in both the groups. 
Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 63-67

https://www.banglajol.info/index.php/BJOG/article/download/58786/40655

Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section

Background & objectives: Postmenopausal bleeding is frequent in gynecology and occurs approximately in 5% to 10 % of postmenopausal women. About 10% women with postmenopausal bleeding have a primary or secondary malignancy. Common malignancies among them are endometrial or cervical carcinoma and rarely, ovarian cancer. The incidence of malignancy in postmenopausal period remains sufficiently high, so it requires immediate investigations for early diagnosis, prompt treatment and vigilant follow up. The objective of the present study is to evaluate the causes of postmenopausal bleeding based on histopathology of endometrium and the percentage of various benign, premalignant and malignant lesions in patients with post-menopausal bleeding. 
Methods: A retrospective study was undertaken on 78 women presenting with postmenopausal bleeding in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM) Hospital, Dhaka, from July 2018 to June 2019. Histopathological reports and patient’s profile were reviewed. Causes of bleeding were identified and related to patients’ age. 
Results: Among of 78 cases of postmenopausal bleeding, we found 8 cases of cancer (10.26%). Among them 2 cases were cancer of uterine cervix and 6 cases were cancer of uterine corpus. Benign pathology was more frequent (63 cases: 80.77%), essentially presented with endometrial hyperplasia without atypia 20.52% cases, endometrial polyp 16.67% cases, cervical polyp 14.11% cases, leiomyoma found in 9% cases and preinvasive disease about 9% cases. Histopathological findings in 2 cases of carcinoma cervix were invasive squamous cell carcinoma and 6 cases of endometrial cancer were endometrial adenocarcinoma. Cancer increased with increasing age while the incidence of bleeding decreased with age. 
Conclusion: Despite the fact that benign pathology is more frequent than malignancy as a cause of postmenopausal bleeding, we must always rule out a cancer by endometrial and cervical biopsy. 
Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 112-116

https://www.banglajol.info/index.php/BJOG/article/download/58796/40661

Histopathological Study of Endometrium in Postmenopausal Bleeding

Introduction: Spontaneous onsets of labour within expected date of delivery not always occur. Some pregnancies cross the expected date of delivery, and need induction of labour. Induction of Labor means initiation of uterine contraction that can be done by pharmacological or non-pharmacological method. Induction of labor is not risk- free. The present study aimed to investigate initiation of uterine contractions beyond the expected date of delivery. Methods: This Prospective cross-sectional study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical University, Hospital, from January 2008 to June 2008. A total of 50 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Result: Among the study population (N=50), one-fifth of the mothers’ (10,20.0%) age was under twenty. The majority of mothers were (34,68.0%) between 20-30 years old with a mean age of 25.4 ± 4.32 years. In seventeen patients (17,34.0%) labour induction was given by oxytocin drip followed by ARM, in ten patients labour induction was given by ARM followed by oxytocin drip & in twenty-three patients (23,46.0%) with unfavorable cervix prostaglandin was used and then followed by oxytocin drip and ARM. The total number of induction failures (who needed a caesarian section) was twenty (20,40.0%). Among the total number of caesarian sections, eleven (11,55.0%) were done due to fetal distress, nine (9,45.0%) were done due to abnormal uterine action, one (1,5.0%) was done due to cervical dystocia. Conclusion: Labor induction should be applied to improve birth consequences and when the potential aids outweigh the potential dangers. Researches point out that inducing labour lessens the risk of having a stillbirth, macrosomia and developing high blood pressure as the pregnancy advances.

/pdf/trial-of-vaginal-delivery-beyond-expected-date-of-delivery-a-3nafhxod.pdf

Trial of Vaginal Delivery Beyond Expected Date of Delivery-A Study of 50 Cases

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