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Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.
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Background: Policies and programs aimed at giving access to healthcare free of charge for some segments of the population are increasingly being put in place by low and middle-income countries. The impact of such policies has so far been rather mixed.Objective:This study sought to determine the pattern of obstetrics clinic attendance, deliveries and neonatal outcome during and after a Free Medical Care (FMC) Programme. Was there any significant difference during and after the FMC programme? Methodology:This was a retrospective population-based study involving the three years of a free medical care programme (2012-2014) and the three years after the programme (2015-2017). Data on antenatal/postnatal clinic attendance, method of deliveries and neonatal outcome were retrieved from the hospital records. The Epi-Info 7 statistical software was used for analysis and statistical significance was set at p<0.05.Results:Mean antenatal attendance was 20763.67±6085.71 and 14269.00±1932.71 during and after the programme respectively, but this difference was not significant (P = 0.143). The mean postnatal attendance of 1457.7±447.69 during and 1025.7±193.52 after was not significant (P=0.200). There was more total number of deliveries during (8596) than after (5989) but this was not significant (P=0.171). There were more operative deliveries during (51.9%) than after (39.3%) and this was significant (P=0.0001). The CS rate was 43.1% with previous CS and CPD both responsible for over 40%. Livebirths were 8,272 (58.8%) duringand 5,796 (41.2%) after, which was significant (P=0.0001). There was significant difference (P=0.006) in the macerated stillborn (MSB) rate during (44.2%) and after (55.8%). The stillborn rate was 66.9 during and 98.2 after the programme.Conclusion: There were more clinic attendance and deliveries during the programme, but it was not statistically significant. There was however statistically significant increase in operative delivery, total births and livebirths, and reduced MSB rate during the programme
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Background: Caesarean section is one of the commonly performed surgical procedures in obstetrics. An increasing trend has been observed in both primary and repeat caesarean sections. The reasons for its increase are multifaceted. So, this study was carried out to compare the rates of caesarean delivery and to analyse various indications contributing to it.Methods: This retrospective study was conducted over a period of three year from 1st January 2016 to 31st December 2018 at the department of obstetrics and gynaecology, tertiary care hospital Pune, Maharashtra, India. All caesarean delivery (primary and repeat) taken place during the study period. The rate and indications of caesarean section was calculated over the study period to find out the trends in caesarean delivery. The data so collected was presented with graphical representation. Statistical analysis was performed with SPSS software and t-test was used for continuous data and pearson chi square test for discrete data.Results: There were a total of 12373 deliveries during the study period out of which, 3701 had delivered via Caesarean Section. So, the rate of caesarean section in the study was found to be 29.91%.Conclusions: Being a tertiary care hospital, a high rate of caesarean deliveries was observed, Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit caesarean section rates.
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Objectives: In this study our main aim is to evaluate fetomaternal outcome of teenage pregnancy in a PeripheralMilitary Hospital.Methods: This Cross-sectional study was done at CombinedMilitary Hospital, Bogura, 1 year from August 2017 to July2018. 100 Teenage pregnant ladies between 18 to 20 yearswere taken up as a case group for the study. 108 control grouppregnant women of 21 to 35 years age, without any preexistingco-morbidities and history of previous caesarean section.Results: In the study, 23% had vaginal deliveries whereas77% cases had caesarean deliveries. Failed induction wascommon in both case and control group, 14.5% and 9.25%.Also, in case group 12.8% neonates were suffered from fetaldistress, where as in control group it was 9.2%.Conclusion: From our study we can say that, in order toimprove the teenage health periodic information, education,community activities, ANC camps to be held at primary healthcare centers. Further study is needed for better outcome
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Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children's Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children's Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.
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Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage.
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Background: High caesarean birth rates are an issue of international public health concern. Worries over such increases have led the WHO to advice that caesarean section rate should not be more than 15%. WHO proposes that the health care facilities to use the Robson’s 10 group classification system to audit their CS rates. Our aim was to investigate the CS rates in a period of 6 months using Robso’s 10 group classification.Methods: This was a cross sectional study conducted for a period of 6 months from July 2018 to December 2018 in Department of Obstetrics and Gynecology, Siddhartha medical college which is a tertiary care center .All women delivered during this period in labour ward were included. All relevant obstetric information (parity, mode of previous deliveries, previous CS and indications, gestational age, onset of labor) was entered on a questionnaire and classified into Robson’s 10 classes and percentages were calculated.Results: Total number of deliveries in 6 months is 4719 out of which C-sections are 1816 which accounts for 38.48%. Highest contribution was by group 5 and group 2. Together these two groups contribute to 62.4% of the total caesarean sections. Group 6 and group 9 by themselves did not contribute much but within their groups had 100% C-section rates.Conclusions: Robson’s 10 group classification provides easy way in collecting information about caesarean section rate which obtains good insight into certain birth groups. Number of women who attempt VBAC has declined over recent years due to fear of uterine rupture. Reducing primary C-section rates, adequate counseling and changing norms for non-reassuring fetal status could reduce contribution of Robson’s groups towards absolute C-section rates.
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Background: Cesarean section is the most commonly performed surgery in the department of gynecology. However, it has its own merits and demerits which affect the mother and the baby in the present as well as subsequent pregnancies. There is a rising trend of cesarean deliveries not only in India but worldwide. So, there is a dire need to audit these cesarean sections and make necessary recommendations accordingly to curb the rising incidence of cesarean deliveries in near future. Hence, the present study analysed the leading groups contributing to high cesarean rates at a tertiary hospital of Armed Forces using Robson ten group classification.Methods: This study was conducted in a Tertiary Hospital of Armed Forces at Chandigarh. All patients who delivered in this hospital between January 2016 to December 2018 were included in this study as per the Robson ten group classification.Results: number of patients who delivered during the time period January 2016 to December 2018 was 3136. Number of patients who delivered vaginally during the same period was 1865. Number of patients who delivered through cesarean section were 1271. Group 5 was the leading contributor to cesarean deliveries followed by groups 2 and 4 subsequently. However, there was significant contribution by group10 to the list.Conclusions: Groups 5, 2 and 4 are the leading contributors to cesarean sections at our institute. So, author need to introspect the labour room protocols and change our norms especially about fetal distress based on CTG monitoring and perform versions in mal-presentations if not contra-indicated to reduce cesarean section rates in near future. Even rising rates of cesarean section in elderly primis, patients conceived after infertility treatment and increasing trends of cesarean delivery on maternal request needs to be checked to reduce the rates of primary cesarean sections.
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Background: Obstetric haemorrhage accounts for 20-25% of maternal mortality and morbidity. Anti-fibrinolytics are being widely used in field of surgery. It is also used to reduce heavy menstrual blood loss. The aim of this study was to analyse the effectiveness of TXA in reducing blood loss during normal vaginal delivery.Methods: The randomized double-blind control study was done in the Labour ward. It was conducted on 100 women undergoing Normal vaginal delivery. They were allocated to either Study or Control group by randomization. TXA was given during the Third stage of delivery in study group in addition to the routine care whereas the control group had routine care alone. Blood loss was measured in both groups by bag method.Results: The significant of reduction in blood loss calculated from placental delivery to 2hrs. 141.9 ml in study group versus 270.4 ml in control group. Among primi patients, the control group average blood loss was 325ml, the study group avg blood loss was 169ml. Among G2 patients, the control group average blood loss was 248.5ml. The study group average blood loss was 128.25ml. Among G3 patients, the control group average blood loss was 203ml, the study group average blood loss was 115ml.Conclusions: TXA significantly reduced the amount of blood loss during normal vaginal delivery. Thus, TXA can be used safely and effectively in subjects undergoing normal vaginal delivery.
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Resumen OBJETIVO: Estimar la prevalencia de desgarro perineal en pacientes a quienes se aplicó vacuum e identificar los factores de riesgo de lesión del esfínter anal. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, retrospectivo y observacional. Se seleccionaron todos los partos en los que se aplicó vacuum del total de partos instrumentados en un hospital de segundo nivel de la Ciudad de México. Se incluyeron mujeres con embarazo de término, únicos y de evolución normal. Las lesiones perineales se clasificaron según la OMS. Se calcularon la prevalencia y el intervalo de confianza. Las variables se describen mediante medias y desviaciones estándar o frecuencias absolutas y relativas. Los desgarros se compararon con χ22 y los valores con significación estadística fueron los de p < 0.05. RESULTADOS: Se estudiaron 74 partos instrumentados en 708 partos totales, de los que 70 de 74 fueron con vacuum. En relación solo con estos últimos, los desgarros más prevalentes fueron de primer y segundo grado con valores de 40.0% (IC95%: 29-51) y 38.6% (IC95%: 27-50), respectivamente. No se identificaron factores de riesgo asociados con desgarros perineales severos. CONCLUSIONES: La prevalencia en la población estudiada fue similar a la de países industrializados y los desgarros moderados fueron los de mayor prevalencia.
Abstract OBJECTIVES: To estimate the prevalence of perineal tears in patients which delivery was instrumented by vacuum and to identify the risk factors that lead to a tear in the anal sphincter. MATERIAL AND METHOD: Descriptive, cross-sectional, retrospective and observational study. All vacuum deliveries were selected among the instrumental deliveries of the population in a secondary care hospital in Mexico City. The inclusion criteria were women who delivered vaginally at term with sole and normoevolutive pregnancies. The perineal tears were classified according to WHO. The statistical analysis included the estimation of prevalences with their corresponding confidence intervals. Variables were described by means and standard deviations or absolute and relative frequencies. Tears were compared using χ2 tests considering a statistical significance of p < 0.05. RESULTS: The number of instrumented deliveries was 74 out of 708 cases of total deliveries, those with vacuum were 70 out of 74. Considering the instrumented deliveries with vacuum, the most prevalent tears were those of first and second degree with values of 40.0% (CI 29-51) and 38.6% (CI 27-50) respectively. There were not associated risk factors to severe perineal tears. CONCLUSIONS: Prevalence in the studied population was similar to developed countries and moderate tears are the most prevalent.
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Background: Compared to cephalic presentation with respect to fetal morbidity and mortality, breech delivery management was a high risk. Aim: To evaluate the outcome of breech deliveries in nulliparous women. Materials and methods: This was a retrospective study conducted from October 2012 till September 2015 .The study was conducted at Government hospital Nizabmabad and CKM hospital, Warangal. The selection criteria were gestational age ≥ 32 weeks which was validated by ultrasound examination performed before 20 weeks gestation when calculated from last menstrual period, a singleton with breech presentation and normal fetal heart beats in nulliparous women. Adequate pelvis, frank or complete breech, estimated weight of foetus lesser than 3500 grams, no other obstetric complication were the inclusion criteria. Results: During these 3 years survey, 12000 deliveries were done. Out of which, 3000 were nulliparous, and there were 400 cases of breech presentation, and there was an incidence of 3.33%. A total of 250 women met the inclusion criteria and had undergone delivery by VBD or by Caesarean section. There were 120 caesarean deliveries, of which 56 (46.66%) were elective and 64 (53.33%) were emergencies. The main indication for emergency CS was acute foetal distress accounting to 42 (65.63%) cases. The main indication for elective CS was foetal birth weight ≥3500 grams accounting to 25 (44.64%) cases. Out of 130, 15 (11.54%) neonates had poor APGAR score (<7) at the 5th minute of birth. In elective caesarean section, none had poor APGAR score at 5th minute. In emergency, caesarean section, 6 (9.38%) had a poor APGAR score at the 5th minute. Out of the 6 cases, the indication for the emergency caesarean section was acute foetal distress, 2 in 35 years old patients carrying foetus of 3300 grams and 3200 grams, others had cord prolapsed. In APGAR score between Allanki Suneetha Devi, Jalem Anuradha. Outcome of breech deliveries in nulliparous women. IAIM, 2017; 4(7): 33-38. Page 34 the group of elective and emergency caesarean section, there was a statistically significant difference in the mean 5th minute. Conclusion: It can be concluded from this study that in cases of inadequate pelvis, foetal weight ≥3500 grams or ≤1800 grams, footling breech presentation, post term pregnancies, vaginal breech delivery is unsafe.
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Background & objectives: In developed countries, efforts have been made to restrict episiotomy practice. However, in developing countries the episiotomy rates continue to be high. This study was conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India. Methods: Prospective data of all women undergoing vaginal delivery including instrumental delivery were collected daily from the labour room registers of the 18 tertiary care hospitals on a structured proforma. Weekly data from all sites were sent to a central unit for compilation and analysis. Odds ratio was used to compare the proportion of genital trauma among women with and without episiotomy both in nulliparous and multiparous women. Results: Among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent (n=76,305) cases. Nulliparaous women were 8.8 times more likely to undergo episiotomy than multiparous women. The various genital tract injuries reported were first degree perineal tear (n=4805, 3.9%), second degree perineal tear (n=1082, 0.9%), third and fourth degree perineal tear (n=186, 0.2%), anterior vaginal trauma requiring suturing (n=490, 0.4%), extension of episiotomy/vaginal laceration/excessive bleeding from episiotomy or tear (n=177, 0.15%), vulval/vaginal haematoma (n=70, 0.06%) and cervical tear (n=108, 0.08%). The combined rate of third and fourth degree perineal tears was observed to be significantly lower (P<0.001) among nullipara who received episiotomy (0.13%) compared to those who delivered without episiotomy (0.62%). Interpretations & conclusions: Significantly lower rates of third or fourth degree perineal tear were seen among nulliparous women undergoing episiotomy. The risk and benefit of episiotomy and its complications need to be evaluated through randomized clinical trials in the Indian context.
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Background: Low birth weight has been defined by the WHO as weight at birth less than 2500gms. More common in developing than developed countries, LBW contributes to a range of poor health outcomes. Objectives: To know the prevalence of low birth weight neonates and the effect of maternal age and parity on birth weight. Methods: It was a hospital based cross sectional study conducted in Era’s Lucknow Medical College and Hospital over a period of six months i.e from July 2014 to December 2014. A total of 356 women who had their deliveries conducted at Era’s Lucknow Medical College and Hospital were included in the study. Data was collected, compiled and tabulated using Microsoft Excel and analysed using SPSS 17.0 version for calculation of percentages. Results: The prevalence of LBW neonates was found to be 29.65%. 40.19% of the LBW neonates were preterm. Majority of the LBW neonate’s i.e 72.54% weigh between 2.0 to 2.5 kg. Percentage of LBW neonates was found to be highest among women aged between 36 to 40 years (50%) and in primi para (46%). Conclusions: The prevalence of LBW was found to be slightly higher than that for the state of Uttar Pradesh (25.1%). It is closely associated with foetal and neonatal mortality and morbidity. The prevalence can be lowered if women start pregnancy healthy and well nourished, which can be assured by educating the mother about proper nutrition, birth spacing and antenatal care.
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Background: Health inequity is becoming an emerging issue all over the world. Improving maternal health is one of the UN Millennium Development goals. Pregnant women inhabiting urban slums are a “high risk” group with limited access to health facility. Objective: To study the socio economic profile of the mothers and to study the differentials in utilization of maternal health care by the beneficiaries. Study Design: Descriptive, observational cross-sectional field based study in two purposively selected urban slums of district Dehradun. Results: About 70.9% of mothers belonged to social class II and III and 66% of them belonged to nuclear families. Teenage pregnancy was seen in 8.5%. 93.8% of women received complete antenatal care, majority preferring government hospitals. 93.2% of the women received 100 IFA tablets or more but only 63.7% consumed them for 100 days. Majority of the deliveries were institutional and 79.9% were conducted by trained personnel. About 68.5 % received postnatal care. Conclusion: Although usage of ANC service was high, opportunity to deliver important health services was not fully utilized. Policy and programme to improve the quality and care of antenatal mothers, especially for the poor and under privileged are essential to improve maternal health care. Special interventions should be undertaken on priority basis so as to achieve millennium developmental goals in all population groups.
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Background: The use of routine episiotomy is now less favoured among obstetricians. Given considerable evidence, it use increases maternal morbidity without evidence to support maternal or neonatal benefit. Objectives: To determine the current rate of episiotomy among parturients delivering at Federal Medical Centre, Owo, Ondo State, Nigeria and to identify factors associated with episiotomy. Methods: The retrospective study was conducted using the delivery records between 1st January 2012 and 31st December 2012. Information was obtained from the delivery register and medical records. There were 802 booked patients who had singleton vaginal deliveries between the studied periods. A total of 728 of these patients’ case records were obtained for analysis using SPSS 17. Results: The incidence of episiotomy was 9.3%. Those age <20 years, nulliparous, those who had assisted breech and instrumental deliveries had more episiotomy (P <0.0001). All the instrumental deliveries and most assisted breech deliveries (67%) were taken by the doctors. Episiotomies were more common when doctors took deliveries (Doctor vs. Nurses: 28.6% vs. 5.8%) (P <0.0001). Conclusion: While this study has identified factors associated with episiotomy, the episiotomy rate remain within normal rate at the studied centre. It is pertinent that health care providers always bear in mind the standard indications for episiotomy. This will go a long way in reducing the episiotomy rate and maintaining the recommended WHO rate of 10%.
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Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs.
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Aims: The study was conducted to estimate the proportion of eligible women for Janani Suraksha Yojana and to understand the factors affecting receipt of benefits in Maharashtra State, India. Methodology: It was as comparative observational study conducted in Maharashtra State having a population of 112.37 million. Each district was divided into five strata tribal, rural, Municipal Council, slum and non-slum in Municipal Corporation. In each district about 2400 household were surveyed comprising proportionate quotas from each stratum. Surveying unit from each stratum was randomly selected. The study population consisted women delivered in 2008-2009 year. Firstly Head of household was interviewed for confirming child delivery in the reference period. Then delivered woman was interviewed for checking eligibility to JSY and then details of receipt of benefits were obtained from her. Receivers and non-receivers of benefits were compared with respect to some variables. The study was undertaken with the help of Community Medicine Department from Government Medical Colleges. Results: In the reference period 4,544 women delivered children and 41.15% were found eligible for the scheme. But only 52.57% certainly received cash benefits. About 24% surely did not receive and 23% were not sure about receipt or the scheme and hence included in non-receiver group for further analysis. Non-earning women, not delivered in public health care institutions and un-aware about the scheme were unlikely to receive the benefits. Ante Natal Care visits, immunization, receipt and consumption of Iron and Folic Acid tablets were better among beneficiaries then non-receivers of the benefits. The benefits were not received immediately after delivery. About 10% women had problems in receiving the benefits, particularly requirement of certain certificates. Conclusion: The uptake of the scheme may be slightly higher than 53% and there are many factors responsible for not reaching to entire eligible population. Modifiable risk factors like delivery in government health institution and awareness about the scheme are playing major role in receiving the benefits.
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Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and statistical limitations. Consistent with economic theories, the studies identified a positive relationship between health insurance and the use of maternal health services. However, more rigorous causal methods are needed to identify the extent to which the use of these services increases among the insured. Better measurement of quality and the use of cross-country analyses would solidify the evidence on the impact of insurance on the quality of maternal health services and maternal and neonatal health outcomes.
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The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.
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OBJECTIVES: The aim of this study was to identify significant and modifiable risk factors associated with obstetric third and fourth degree perineal lacerations and to produce recommendations that may reduce their morbidity and prevalence. METHODS: This is a retrospective case control study performed between March 2004 and March 2008. All patients diagnosed with third and fourth degree perineal lacerations were identified (cases) along with randomly assigned controls who delivered during the same time period. Nineteen cases and 38 controls were identified giving a total of 57 patients. Each patient's hospital record was collected and the data extracted. RESULTS: When analysed for weight greater than or equal to 3.5 kg versus birthweight of less than 3.5 kg, the difference between cases and controls was found to be statistically significant, with a p value of 0.012. Of the cases, 21% had an operative delivery (forceps or vacuum) whereas only 2.6% of the controls had an operative delivery. This was found to be statistically significant (p = 0.011). CONCLUSIONS: This study has shown that the two main factors related to the obstetric third and fourth degree perineal lacerations were babies weighing more than 3.5 kg and the use of forceps or vacuum to assist with deliveries. These high risk patients should be attended to by the most senior staff that is available.
OBJETIVOS: El objetivo de este estudio fue identificar factores de riesgo modificables y significativos asociados con las laceraciones perineales obstétricas de 3er y 4to grado, y producir recomendaciones que puedan reducir su morbilidad y prevalencia. MÉTODOS: Se trata de un estudio de caso control retrospectivo realizado entre marzo de 2004 y marzo de 2008. Todas las pacientes diagnosticadas con laceraciones perineales de 3er y 4to grado fueron identificadas (casos) con controles asignados de manera aleatoria, que tuvieron el parto en el mismo período de tiempo. Diecinueve casos y 38 controles fueron identificados, para un total de 57 pacientes. Se recogieron y se extrajeron los datos de las historias clínicas de cada paciente. RESULTADOS: Al analizárseles en términos de peso superior o igual a 3.5 kg frente a un peso al nacer por debajo de 3.5 kg, la diferencia entre los controles y los casos resultó ser estadísticamente significativa, con un valor p de 0.012. De los casos, el 21% tuvo un parto operativo (fórceps o vacío), mientras que sólo el 2.6% de los controles tuvo un parto operativo. Esto resultó ser estadísticamente significativo (p = 0.011). CONCLUSIONES: Este estudio ha demostrado que los dos factores principales relacionados con las laceraciones perineales obstétricos de 3er y 4to grado, eran bebés con un peso de más de 3.5 kg y el uso de fórceps o vacío en la asistencia a los partos. Estos pacientes de alto riesgo deben ser atendidos por el personal disponible de mayor experiencia.