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- Lazarus, Jeffrey, et al.
(författare)
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A survey of midwives' views on providing aspects of antenatal care in Estonia.
- 2008
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Ingår i: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 24:4, s. 399-404
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to survey the views of midwives in Estonia about who they considered should have responsibility for carrying out certain aspects of antenatal care (ANC) in Estonia. DESIGN, SETTING AND STUDY POPULATION: in collaboration with key stakeholder organisations, the authors developed eight statements on aspects of ANC and five combinations of possible professionals (including midwives obstetrician-gynaecologists and various combinations of the two) who could have responsibility for carrying out those aspects of ANC and included them in a self-administered questionnaire. The questionnaire was sent with a covering letter and stamped addressed return envelope to all 366 midwives in Estonia. Two postal reminders were sent to non-responders. RESULTS: the response rate was 73.5%. There was no consensus among respondents about whose responsibility it was to diagnose pregnancy, carry out the risk assessment of a pregnancy, or carry out fetal monitoring during pregnancy. There was consensus among respondents that either midwives or obstetrician-gynaecologists could have responsibility for referring for further tests and examinations if a pregnancy was thought to be at risk. There was also consensus that counselling, biometry and blood pressure monitoring should be the sole responsibility of midwives. KEY CONCLUSIONS: despite national policy to shift ANC towards being midwifery-led and despite provisions in a European Directive permitting most roles in ANC to be performed autonomously by trained midwives, there is no consensus among Estonian midwives that all aspects of ANC should be their responsibility at present. Thorough research is required to establish which specific ANC roles Estonian midwives are not willing to take responsibility for, and to examine why they are not willing to take on such roles.
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| 2. |
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| 3. |
- Rasch, Vibeke
(författare)
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Unsafe abortion in Tanzania : an empathetic approach to improve post-abortion quality of care
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Unsafe abortion constitutes a major public health problem throughout the world, leading to high levels of maternal morbidity and mortality. To address the problem of unsafe abortion, there is need of reliable data that document the magnitude of the problem and describe the population at risk. In addition there is a need of well-documented and evaluated intervention studies that focus on reducing the high maternal mortality, which is associated with unsafe abortion. Objective: i) to describe the magnitude of the problem of hospitalised unsafe abortion, ii) to characterise and compare socio-economic characteristics among women having unsafe abortion, spontaneous abortions and women receiving antenatal care, iii) to develop a method of providing post abortion family planning that is designed to the interests and needs of women having unsafe abortion, and iv) to evaluate if it is possible to make women having unsafe abortion use a contraceptive method, which prevents them from repeated, unwanted pregnancy. Study population: Sub-study one. The study population comprised 1125 women with incomplete abortion and 307 women receiving antenatal care, who attended Dodoma Regional Hospital, Dodoma, Muhimbili National Hospital and Temeke Municipal Hospital, Dar es Salaam, during the period Dec 1996- May 1997. Sub-study two: The study population comprised 1357 women with incomplete abortion, who attended Temeke Municipal Hospital, Dar es Salaam during the period Jan 2001 -July 2002. Method: Sub-study one. Women with incomplete abortion were interviewed with an empathetic approach and were classified as having either admitted unsafe abortion or spontaneous abortion. A reference group of pregnant women receiving antenatal care were recruited consecutively. The three groups were compared by use of a case-referent design. The variables studied comprise data on age, civil status, education, occupation, dwelling characteristics, religion, and reproductive characteristics. Sub-study two: Women having unsafe abortion were identified by using the empathetic approach and thereafter provided with ward-based contraceptive counselling and service. Follow-up information was retrieved after 1-6 months and the women's contraceptive compliance was assessed. Results: Sub-study one. 60 % of women with incomplete abortion admitted unsafe abortion. Women having unsafe abortion were younger, more often single and more often students than women attending antenatal care. Sub-study two: 90% of the approached women with admitted unsafe abortion accepted contraceptives; follow-up information was retrieved among 315 (65%) women, of whom 204 returned spontaneously, whereas 111 were visited at home. In all, 271 (86%) stated use of contraception 1-6 months after discharge, 79% stated use of hormonal contraception, 7% stated reliance on condom only, and 14% stated no contraceptive use. Among the 44 women, who stated no contraceptive use, 45% intended to become pregnant again, 20% had no sexual partner, 18% feared side effects, whereas 16% stated other reasons. Conclusion: By use of an empathetic approach it is possible to identify women having unsafe abortion and thus define the population at risk. In addition, the study has proven, that it is possible, by high quality contraceptive counselling combined with an empathetic approach, to address the unmet contraceptive need among women having unsafe abortion.
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| 4. |
- Schmiegelow, Christentze, et al.
(författare)
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Factors associated with and causes of perinatal mortality in northeastern Tanzania
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:9, s. 1061-1068
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To identify factors associated with perinatal mortality in northeastern Tanzania. Design. Prospective cohort study. Setting. Northeastern Tanzania. Population. 872 mothers and their newborns. Methods. Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.2364.86, p < 0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.1810.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.8956.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.0030.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality.
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| 5. |
- Schmiegelow, Christentze, et al.
(författare)
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Malaria and Fetal Growth Alterations in the 3rd Trimester of Pregnancy : A Longitudinal Ultrasound Study
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:1, s. e53794-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pregnancy associated malaria is associated with decreased birth weight, but in-utero evaluation of fetal growth alterations is rarely performed. The objective of this study was to investigate malaria induced changes in fetal growth during the 3rd trimester using trans-abdominal ultrasound. Methods: An observational study of 876 pregnant women (398 primi- and secundigravidae and 478 multigravidae) was conducted in Tanzania. Fetal growth was monitored with ultrasound and screening for malaria was performed regularly. Birth weight and fetal weight were converted to z-scores, and fetal growth evaluated as fetal weight gain from the 26th week of pregnancy. Results: Malaria infection only affected birth weight and fetal growth among primi- and secundigravid women. Forty-eight of the 398 primi- and secundigravid women had malaria during pregnancy causing a reduction in the newborns z-score of -0.50 (95% CI: -0.86, in -0.13, P = 0.008, multiple linear regression). Fifty-eight percent (28/48) of the primi- and secundigravidae had malaria in the first half of pregnancy, but an effect on fetal growth was observed in the 3rd trimester with an OR of 4.89 for the fetal growth rate belonging to the lowest 25% in the population (95% CI: 2.03-11.79, P<0.001, multiple logistic regression). At an individual level, among the primi- and secundigravidae, 27% experienced alterations of fetal growth immediately after exposure but only for a short interval, 27% only late in pregnancy, 16.2% persistently from exposure until the end of pregnancy, and 29.7% had no alterations of fetal growth. Conclusions: The effect of malaria infections was observed during the 3rd trimester, despite infections occurring much earlier in pregnancy, and different mechanisms might operate leading to different patterns of growth alterations. This study highlights the need for protection against malaria throughout pregnancy and the recognition that observed changes in fetal growth might be a consequence of an infection much earlier in pregnancy.
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