Devenir périnatal issu des grossesses rapprochées étude retrospective Marocaine / Perinatal outcome of closely spaced pregnancies: a Moroccan retrospective study

Introduction: déterminer les complications périnatales associées aux grossesses rapprochées. Méthodes: une étude cas-témoin rétrospective menée du 1er juin 2020 au 1er juin 2021 au centre hospitalier provincial de Settat. Au total, 670 patients ont été recrutés. Six cent trente personnes ont été réparties en deux groupes. Un groupe de patientes avec des intervalles intergénésique <9 mois (N = 443) et un groupe témoin >9 mois (N = 187). Résultats: la prématurité, la dénutrition et l'anémie p<0,05 étaient les principales complications et les principaux facteurs de risque de grossesse imminente étaient l'âge >35 ans (OR = 19,079 (4,98; 73,06) p<0,005) et le milieu rural (OR = 0,468)) (0,28; 0,78) p<0,005), niveau socio-économique bas (OR = 3,465 (2,06; 5,81) p<0,005); absence de prescriptions contraceptives postnatales (OR = 15,77 [7,31; 33,99]; p<0,005); absence d´allaitement avant la grossesse (OR = 49,462 [15,78; 155,03]; p<0,05). Conclusion: des soins préventifs et ciblés sont nécessaires en matière de planification familiale pour éviter les complications périnatales.

Introduction: the purpose of this study is to provide Moroccan data, study maternal risk factors and identify perinatal complications related to closely-spaced pregnancies. Methods: we conducted a retrospective case-control study at the Provincial Hospital Center in the city of Settat since June 1, 2020 to June 1, 2021. A total of 1,200 patients were admitted, but only 630 were included in the study. They were divided into 2 groups: a group of patients whose interpregnancy interval was <9 months (N = 443) and a control group whose interpregnancy interval was >9 months (N = 187). Results: prematurity, hypotrophy and anemia p<0,05 were the main complications, the main risk factors for closely-spaced pregnancies were age >35 years (OR =19,079 (4,98; 73,06) p < 0,005), coming from a rural area (OR = 0,468 [0,28; 0,78] p < 0,005), having a low socioeconomic status (OR =3,465 [2,06; 5,81]; p < 0,005); the absence of contraceptive prescription in the postpartum period (OR =15,77 [7,31; 33,99]; p < 0,005); and breastfeeding breaks before getting pregnant (OR = 49,462 [15,78; 155,03]; p<0,05). Conclusion: prevention and specific family planning methods are necessary to avoid perinatal complications.

Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde / Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care

SILVEIRA, L. M. Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde. 2022. 96p. Dissertação (Mestrado em Enfermagem) - Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, 2022. Introdução: A contracepção após o parto é estratégia essencial para prevenir gestações não planejadas e garantir o intervalo interpartal recomendado, visto que engravidar em um espaço de tempo menor do que 12 meses aumenta os riscos maternos, neonatais e infantis. Sabe-se ainda que características sociodemográficas e assistenciais podem influenciar o início precoce ou tardio de métodos contraceptivos (MC) após o parto. Objetivos: Verificar se as características sociodemográficas e assistenciais estão associadas ao tempo até o início do uso de contraceptivos no primeiro ano após o parto em usuárias da Atenção Primária à Saúde. Metodologia: Estudo longitudinal, do tipo coorte prospectiva, de gestantes e puérperas cuja linha de base foi aninhada a um projeto multicêntrico de abrangência nacional e Belo Horizonte foi um centro colaborador. Contou com amostra de 236 mulheres na linha de base, 108 na primeira onda e 68 na segunda onda. As entrevistas da linha de base foram realizadas presencialmente com as gestantes. As entrevistas da linha de base foram interrompidas devido à pandemia de COVID-19. O seguimento deu-se por meio de ligações telefônicas, 6 meses após o parto e 1 ano após o nascimento do bebê. Foram analisados os tipos de MC iniciados e calculado o tempo até o início dos mesmos segundo características sociodemográficas e assistenciais. A fração de mulheres que permaneceram sem usar o método contraceptivo ao longo do primeiro ano após o parto foi calculada usando a estimativa de Kaplan Meier. O teste log-rank foi utilizado para analisar se havia diferença entre os grupos (p<0,05). O Modelo de Riscos Proporcionais de Cox com cálculo do risco relativo (RR) não ajustado e ajustado e seus intervalos de 95% de confiança (IC95%) foi usado para estimar os determinantes sociodemográficos e assistenciais associados ao início do uso de métodos. Resultados: Das 108 mulheres, mais de 90% relataram utilizar algum MC, sendo o injetável o mais utilizado (25,9%), seguido das camisinhas (25,0%), das pílulas (23,2%) e do DIU (13,0%). Mais de 48% das mulheres iniciaram o uso de MC 40 dias após o parto. Ou seja, os outros 50% iniciaram após e outras nem iniciaram. A mediana do tempo até o início do MC foi: 39,5 dias (IC95%: 32,1-44). Essa mediana foi menor para mulheres com idade igual ou maior que 35 anos (12,5 dias; IC95%: 0,5-37,3), pardas/pretas (22 dias; IC95%: 4,1-54,1) e que recebiam bolsa família (33 dias; IC95%: 20,3-67,4). Observou ainda que as mulheres que iniciaram o uso de MC mais rapidamente receberam orientações na maternidade (23 dias; IC95% 7,1-42,6) ; foram atendidas por enfermeiros (32 dias; IC95%: 0,71-48,3), e realizaram mais de 6 consultas de pré-natal (33 dias; IC95%: 27,4-41,0). Após ajuste de todas as variáveis, a idade das mulheres e o número de consultas de pré-natal (PN) foram determinantes do início de uso de MC. Mulheres mais jovens (18 até 34 anos) se associaram ao início mais tardio do uso de MC e o maior número de consultas PN ao início mais rápido do uso de MC. Conclusão: Apesar da alta prevalência do uso de MC, persistem desigualdades sociodemográficas e assistenciais em relação ao tempo até o início da contracepção após o parto, como também, uma insegurança contraceptiva. Ressalta-se a necessidade de uma política de promoção do uso de MC eficazes nesse período para reduzir os desfechos adversos associados ao curto intervalo interpartal e os riscos relacionados a ocorrência de gestações pouco espaçadas. Descritores: Planejamento Familiar; Anticoncepção; Período Pós-Parto; Intervalo entre os nascimentos; Saúde da Mulher; Saúde Sexual e Reprodutiva; Enfermagem.

SILVEIRA, L. M. Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care. 2022. 96p. Dissertation (Master in Nursing) ­ School of Nursing, Federal University of Minas Gerais, Belo Horizonte, 2022. Introduction: The postpartum contraception is an essential strategy to prevent unplanned pregnancies and ensure the recommended interpregnancy interval, since becoming pregnant in a period of time of less than 12 months increases maternal, neonatal and infant risks. It is also known that sociodemographic and health assistance characteristics can influence the early or late initiation of contraceptive methods (CM) after the giving birth. Objective: To verify whether sociodemographic and assistance characteristics are associated with the time until the initiation of contraceptive use in the first year after giving birth in users of Primary Health Care service. Methods: Longitudinal, prospective cohort type of study of pregnant and postpartum women whose baseline was nested in a nationwide multicenter project and Belo Horizonte was a collaborative center. It had a sample of 236 women at baseline, 108 in the first wave and 68 in the second wave. The baseline interviews were conducted face-to-face with pregnant women. The baseline interviews were discontinued due to the COVID-19 pandemic. The follow-up was conducted through phone calls, 6 months after they gave birth and 1 year after the baby's birth. The types of CM that were initiated were analyzed, and the time until the initiation was calculated according to sociodemographic and assistance characteristics. The fraction of women who remained not using a contraceptive method throughout the first year after giving birth was calculated using Kaplan Meier estimation. The log-rank test was used to analyze if there was a difference between the groups (p<0.05). The Cox Proportional Risk Model with unadjusted and adjusted relative risk (RR) calculation and its 95% confidence intervals (95% CI) was used to estimate the sociodemographic and assistance determinants associated with the beginning of the use of methods. Results: Out of the 108 women, over 90% reported using some CM, with the injectable one being the most commonly used (25.9%), followed by condoms (25.0%), pills (23.2%) and IUD (13.0%). More than 48% of women started using CM 40 days after giving birth. This means the other 50% started after and others did not start at all. The median time to the start of CM was: 39.5 days (95%CI: 32.1-44). This average was lower for women aged 35 years or older (12.5 days; 95%CI: 0.5-37.3), brown/black (22 days; 95%CI: 4.1-54.1) and receiving family allowance (33 days; 95%CI: 20.3-67.4). It was also noted that women who started using CM more quickly received orientation at the maternity hospital (23 days; 95%CI 7.1-42.6); were seen by nurses (32 days; 95%CI: 0.71-48.3), received, and had more than 6 prenatal visits (33 days; 95%CI: 27.4-41.0). After the adjustment of all variables, women's age and the number of prenatal (PN) appointments were determinants of the beginning of CM use. Younger women (18 up to 34 years old) were associated with a later beginning of CM use, and more prenatal visits were associated with a faster beginning of CM use. Conclusion: Despite the high prevalence of CM use, sociodemographic and assistance inequalities persist regarding the time until the beginning of contraception after delivery, as well as contraceptive insecurity. We emphasize the need for a policy to promote the use of effective CM in this period to reduce the adverse outcomes associated with the short intrapartum interval and the risks related to the occurrence of poorly spaced pregnancies. Keywords: Family Planning; Contraception; Postpartum Period; Interval between births; Women's Health; Sexual and Reproductive Health; Nursing.

As falhas no registro de crianças no Censo de 1872: o caso fluminense / Errors in child registration in the Census of 1872: the case of Rio de Janeiro, Brazil / Errores en los registros infantiles del censo de 1872: el caso de Río de Janeiro, Brasil

O Censo de 1872 apresenta relevantes incoerências demográficas nas idades infantis. Identificamos esses problemas, para as freguesias do Município Neutro e da província do Rio de Janeiro, a partir da aplicação de padrões demográficos gerais: a razão de sexo ao nascer e as proporções entre o número de anos-pessoa vividos nas primeiras idades segundo a tábua de vida Brasil 1870-1890. Ficam claras, nessa faixa etária, as inconsistências nos dados entre os sexos e em cada sexo, nas proporções relativas entre as idades. Mostramos, além disso, a grande diversidade nas formas e intensidades dessas incoerências, freguesia a freguesia. Em consequência, cremos que qualquer análise historiográfica a partir dos dados do Censo de 1872 requer o ajuste prévio dos totais publicados para as idades infantis para se tornar minimamente precisa.

The Census of 1872 contains relevant inconsistencies among young ages. We identified these problems, for the parishes of the Município Neutro and the Province of Rio de Janeiro, through the use of general demographic patterns: the sex ratio at birth and the proportions among the number of person-year lived during the first years of life, according to the life table Brazil 1870-1890. The inconsistencies among the data for each sex, in the young ages, and in the relative proportions among ages, for each sex, are clear. Furthermore, we show the great diversity of forms and intensities of these incoherencies among parishes. As a consequence, we believe that, to be precise, any historiographical analysis based on the data of the Census of 1872 requires previous adjustment of the totals published for young ages.

El Censo de 1872 presenta inconsistencias demográficas relevantes en las edades infantiles. Identificamos estos problemas en las parroquias del municipio Neutro y de la provincia de Río de Janeiro a partir de la aplicación de indicadores demográficos generales: razón de sexo al nacimiento y proporciones entre el número de personas según años vividos en las edades tempranas de acuerdo a la tabla de vida de Brasil para 1870-1890. En este grupo de edad son claras las inconsistencias de los datos sobre sexos y, en cada género, en las proporciones relativas a las edades. Se muestra también la gran diversidad de formas e intensidades de estas inconsistencias, parroquia por parroquia. En consecuencia, se entiende que cualquier análisis historiográfico a partir de los datos del Censo de 1872 requiere un ajuste previo de los totales publicados para las edades infantiles para que sean mínimamente precisas.

Autodétermination des femmes dans la santé sexuelle et reproductive à Lubumbashi, République Démocratique du Congo / NA

ntroduction.La santé reproductive est caractérisée par une vie sexuelle satisfaisante, sûre et la capacité de se reproduire et de prendre des décisions. La vie de beaucoup de femmes estmarquée par les capacités d'action réduites quant aux décisions portant sur leur propre vie. L'objectif était d'évaluer l'autodétermination des femmes en matière de la santésexuelle et reproductive.Matérieletméthodes.Il s'agit d'une étude descriptive transversale effectuée dans 5 maternités de la ville de Lubumbashi au mois de juillet 2021 au près des 46 accouchées ayant accepté librement de participer à cette étude basée sur le questionnaire préétabli. Résultats.L'analyse des données montre que la moyenne d'âge était de 27,8 ± 3,6 ans avec les extrêmes entre 17 et 41 ans, dont 58,7% d'entre elles avaient le niveau de secondaire et paucipares dans 52,17%. La décision des rapports sexuels revenait au couple dans 58,70%. La décision d'avoir les enfantsrevenait au couple alors que celle de nommer les enfants revenait au mari dans 45,65% et 45,65%. Le nombre d'enfants était déterminé par le couple dans 45,65%. L'espacement des naissances était déterminé par la femme dans 45,65%. Le début de la CPN était décidé par la femme dans 86,6% et le choix du lieu des consultation prénatales(CPN) étaient décidés par la femme dans 89,13%. Le moment de se rendre à la maternité était décidé par la femme dans 73,91%. Le retour à domicile était décidé par le couple dans 39,13% et la décision des rapports sexuels après l'accouchement revenait à l'homme dans 52,17%.Conclusion.La femme congolaise n'a pas toujours une autodétermination maximale dans la santé reproductive. Ainsi des efforts supplémentaires sont nécessairespour laisser la liberté aux femmes de prendre des décisions qui conviennent mieux pour leur santé

Factors associated with unmet need for birth spacing among Angolan women

Unmet need for family planning (UNFP) remains a public health concern in Angola. The objective of this study was to analyze the factors associated with UNFP among Angolan women aged 15-49 years in 2015-2016. This was an analytical cross-sectional study. A multiple logistic regression model using data from the Angola Demographic and Health Survey 2015-2016 was performed to determine the associated factors. In total, the study involved 8033 women, 22% of whom were between 25-29 years of age. A large number (65%) lived in urban areas and 39% had primary education. About 1/4 of the women(26%) had UNFP for birth spacing. Associated factors were multiple. Age, credible source of information on family planning were protective factors against UNFP for birth spacing while economic level, the woman's level of education were risk factors for NFP. (Afr J Reprod Health 2022;26[6]:22-26).

Intervalo de nacimiento entre gemelos como determinante del resultado neonatal precoz / Inter-twin delivery interval as a determinant of early neonatal outcome

INTRODUCCIÓN Y OBJETIVOS: La mayoría de las sociedades científicas recomiendan el parto vaginal del segundo gemelo siempre que el primer gemelo esté en presentación cefálica. En estos casos existe controversia cuánto tiempo transcurrido entre el parto de ambos es determinante en el resultado adverso del segundo gemelo. El objetivo de este estudio es examinar cómo influye dicho intervalo en el resultado perinatal precoz en nuestro Centro y el coste de las estancias neonatales y maternas. MÉTODOS: Estudio de cohortes retrospectivo entre mayo de 2014 y diciembre de 2018. Se comparó el resultado neonatal adverso estableciendo puntos de corte de intervalo entre el nacimiento de 10 y 30 minutos. Así mismo, se examinó la relación de otras variables del parto con el desenlace neonatal y se calcularon los costes de las estancias neonatales y maternas. RESULTADOS: Se incluyeron 128 partos gemelares vaginales asistidos en el Hospital Universitario Nuestra Señora de la Candelaria. Se evidenció triple tasa de resultado neonatal adverso en el grupo de más de 10 minutos (p=0,026 y OR 2,4) y tres veces peor en el de más de 30 minutos (p=0,013 y OR 6,4). Se obtuvo una correlación lineal negativa significativa entre el intervalo intergemelar y el pH umbilical. La prematuridad y el bajo peso al nacer fueron predictores de un mal desenlace neonatal. CONCLUSIONES: No parece recomendable que el intervalo intergemelar se prolongue más allá de los 30 minutos. Es seguro recomendar el parto vía vaginal en gestaciones gemelares siempre que el primero esté en presentación cefálica.

INTRODUCTION AND OBJECTIVES: Most scientific societies recommend vaginal delivery of the second twin when the first twin is in cephalic presentation. In these cases, there is controversy over how much inter-twin interval is decisive in the adverse outcome of the second twin. The aim of this study is to examine whether inter-twin delivery interval affects immediate perinatal outcome and the cost of neonatal and maternal stays. METHODS: Retrospective cohort study including 128 twin vaginal births attended in the Hospital Universitario Nuestra Señora de la Candelaria between May 2014 and December 2018. We compared the presence of composite adverse neonatal outcome by establishing interval cut-off points between birth of 10 and 30 minutes. Likewise, the relationship of other delivery associated variables with neonatal outcome was examined. Health care costs were calculated. RESULTS: There was a higher rate of composite adverse neonatal outcome in the 10 minute-group (p = 0.026, OR 2.4) and three times higher in the 30 minute-group (p = 0.013, OR 6.4). A significant negative linear correlation was obtained between birth interval and umbilical artery pH. Prematurity and low birth weight were predictors of a poor neonatal outcome. CONCLUSION: Our data suggests that inter-twin delivery interval shouldn't be prolonged beyond 30 minutes. Vaginal delivery is a safe option in twin gestations providing the first twin is in a cephalic presentation, regardless of the second twin presentation.

Periodo intergenésico: Revisión de la literature / Intergenesis period: Literature review

RESUMEN ANTECEDENTES: El período intergenésico es importante para la planificación de embarazos subsecuentes a partos, cesáreas y abortos. Actualmente existe falta de consenso en cuanto a las definiciones e importancia clínica de la duración del periodo intergenésico; por lo que se realiza esta revisión de la literatura para definir conceptos. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed y Medline, con periodo de búsqueda del 19992017, con el propósito de identificar publicaciones de relevancia relacionadas a periodo intergenésico. RESULTADOS: Entre los artículos seleccionados, se incluyeron de tipo revisión, originales y guías de práctica clínica. Se considera periodo intergenésico aquel que se encuentra entre la fecha del último evento obstétrico y el inicio del siguiente embarazo. Se sugiere como tiempo recomendado de espera para iniciar un siguiente embarazo mínimo 18 meses (Periodo intergenésico corto, PIC) y no más de 60 meses (Periodo intergenésico largo, PIL), para reducir el riesgo de eventos adversos maternos, perinatales y neonatales. Se debe enfatizar que aunque la dehiscencia de histerorrafia es una grave complicación del PIC menor a 6 meses posterior a una cesárea, no es su única complicación. De igual manera es importante tomar en cuenta el PIL durante la evaluación obstétrica, debido a su asociación con preeclampsia. CONCLUSIONES: Es relevante conocer la terminología adecuada en período intergenésico para evitar complicaciones asociadas a PIC como a PIL. Existe necesidad de estudios clínicos sobre período intergenésico que permitan conocer más consecuencias a corto y largo plazo en nuestra población y tomar medidas para mejorar el desenlace materno-fetal.

ABSTRACT BACKGROUND: Interpregnancy interval is a topic of importance when planning new pregnancies after previous vaginal delivery, cesarean section or abortion. There is currently a lack of consensus in terms of definitions and the clinical importance of interpregnancy interval length, which is the reason to perform a literature review to clarify concepts. METHODS: Published papers from 1999 to 2017 from PubMed/MEDLINE were searched with the purpose of identifying those related to interpregnancy interval. Review articles, original papers, and clinical guidelines in relation to short and long interpregnancy interval were considered. RESULTS: Interpregnancy interval is defined as the period between the last obstetric event and the beginning of the next pregnancy (last menstrual period). Recommended time to initiate the next pregnancy must be at least 18 months (short interpregnancy interval, SII) and no more than 60 months (long interpregnancy interval, LII) to reduce the risk of adverse maternal, perinatal and neonatal outcomes. It is important to emphasize that even though uterine scar dehiscence is a serious complication of SII less than 6 months after a cesarean section, it is not the only complication. It is important to consider LII during obstetric evaluation, due to its association with preeclampsia. CONCLUSION: It is clinically relevant to know the correct definitions of SII and LII to avoid their complications. There is also a need for clinical trials about interpregnancy interval within our population in order to better understand the consequences of SII and LII, thus taking the necessary measures to improve maternal and fetal outcomes.

Reembarazo en la adolescencia: análisis de la población perteneciente a la Red del Hospital Padre Hurtado, entre los años 2005-2015 / Teenage pregnancy: analysis of the population belonging to the Padre Hurtado Hospital Network, between 2005-2015

OBJETIVO PRINCIPAL: Evaluar prevalencia de adolescentes multíparas >2, en la población atendida en Hospital Padre Hurtado. MATERIALES Y MÉTODO: Estudio de cohorte retrospectivo, con información extraída de la ficha electrónica de partos e intervenciones, realizados entre 2005-2015 HPH. Los datos fueron tabulados en Microsoft Excel y luego analizados en el paquete estadístico IBM SPSS versión 22. RESULTADOS: Se atendieron 62.656 partos y hubo 5.770 eventos gestacionales que requirieron alguna intervención, de éstas, 14.030 (20,5%) ocurrieron en pacientes menores de 20 años y 356 (0,52%) en menores de 15 años. El número de multíparas fue de 940 (10,3% de mujeres con embarazo adolescente). En el caso de primigestas <15 años, 68 presentaron más de un embarazo durante su adolescencia (19,3% de embarazadas). El período intergestacional tuvo una mediana en 3 años (rango 1 - 6 años). Cuando una adolescente <15 años se embaraza por primera vez, tiene un OR de 2,25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) de volver a embarazarse durante su adolescencia, en relación a las adolescentes que se embarazan por primera vez después de los 15 años. En cuanto a intervenciones, al comparar ambos grupos, las menores de 15 años tienen un OR 2,75 de que al embarazarse, requieran cirugía. CONCLUSIÓN: La frecuencia de embarazo adolescente evaluada, es superior a la nacional y mundial. Cuando el primer embarazo ocurre <15 años, éstas tienen mayor riesgo de presentar un segundo embarazo durante la adolescencia. Una medida de prevención secundaria, es la utilización de MAC en el puerperio inmediato, idealmente LARCs.

OBJECTIVE: To evaluate the prevalence of multiparous adolescents, in the population that had their births at Hospital Padre Hurtado. METHODS: Retrospective cohort study, with information taken from the electronic database of the center, Birth data and Interventions, between 2005 and 2015. The data was tabulated in Microsoft Excel and the analysis was done with IBM SPSS 22 version. RESULTS: It occurred 62,656 deliveries and 5,770 pregnancies that ended in an intervention, from the total, 14,030 (20.5%) occurred in girls under 20 years and 356 (0.52%) under 15 years old (yo). The number of multiparous was 940 (10.3% of all of the adolescent pregnancies). For first time pregnants under 15 yo, 68 had a reiterative pregnancy among their adolescence (19.3% of pregnant <15 yo). The median time between pregnancies was 3 years (range 1- 6 years). When a girl <15 yo gets pregnant for the first time, she has an OR of 2.25 (IC 95%: 1.71-2.95; X2: 35,46; p<0,001) of getting pregnant again during adolescence compared to girls that get pregnant between 15-18 yo. About interventions, the group under 15yo had an OR 2.75 (in Chile all forms of abortions are illegal) compared with the group above 15 years, of requiring surgery when pregnant. CONCLUSIONS: The frequency of adolescent pregnancy analized, is above the national and international publications. Plus, if the pregnancy occurs under 15 yo, they have a greater chance of having another teenage pregnancy. An effective secondary prevention could be administration of contraception during immediate postpartum, ideally LARCs.

Male involvement in maternal health

Traditionally, programs related to maternal health are regarded as purely a woman's domain. Nevertheless, the role of the male as the decision maker in the household gave way to the recognition of the male's role in maternal and reproductive health. This paper aimed to provide a review on male involvement strategies and their impact on maternal health based on related studies, discuss the strategies in the Philippine context and suggest interventions given the current state of the Philippine health care system. These strategies utilize the decision-making role of the male by positing itself on the reproductive, sexual and maternal health aspects encompassing important factors, such as birth spacing, first pregnancy, family planning, utilization of skilled birth attendants (SBAs), and delivery in health facilities, antenatal and postpartum care and nutrition. However, negative repercussions include stigmatization of single mothers and reinforcement of the notion of a man's control over a woman's body. Given the current state of the Philippine health care system, the suggested interventions try to veer away from it as much as possible. These include integration of the male involvement strategy into the Pantawid Pamilyang Pilipino Program (4Ps), coursing it through a public-private partnership (PPP) and non-government organizations (NGOs), involvement of educational institutions, strengthening of the health service delivery at the grassroots level, reinforcement of existing laws, and research on its institutionalization. With carefully-planned strategies that recognize existing gender norms and other sociocultural factors, male involvement in maternal health could be a possible catalyst in decreasing the Philippine maternal mortality rate (MMR). 

Length of First Birth Interval and Incidence of Twin Birth in Korea; 2010~2015

PURPOSE: To compare the incidence of twin births with the length of first birth interval (LFBI: from marriage to first birth) among primiparous women. METHODS: The birth certificated data of Korea Statistics from 2010 to 2015 were used for this analysis. There were 1,356,204 births of primiparous women from total birth cases (2,736,296 births). The data involving multiparous women, teenage birth, extra-marital birth, and triplet birth cases were excluded from all analyses. Odds ratio and 95 percent confidence intervals were calculated from logistic regression to examine the risk of twin birth by LFBI adjusted for year of birth, maternal age, paternal age, age difference between couples, and maternal education and occupation. RESULTS: The frequency of LFBI was 41.5 percent in ≤12 months, 30.7 percent in 13~24 months, 13.1 percent in 25~36 months, and 2.1 percent in LFBI of ≥85 months. The mean LFBI was 21.5 months. The incidence of twin birth increased with prolonged LFBI. The twin birth rates per LFBI were 0.8 percent, 3.1 percent, 7.9 percent, and 11.0 percent in LFBI of ≤12 months, 25~36 months, 49~60 months, and 73~84 months, respectively. Odds ratio of twin births rate by LFBI were 1.510 (95% confidence interval: 1.449~1.574) for the LFBI of 13~24 months, 9.839 (9.390~10.309) for 49~60 months, and 13.244 (12.458~14.080) for ≥73~84 months, each compared with LFBI of ≤12 months. Odds ratio of twin birth rate in LFBI of ≤72 months was higher in women aged 35 and older, as compared to women aged ≤34 years. Odds ratio of twin birth rate by maternal age (≤34 years versus ≥35 years) reversed in LFBI of ≥73 months. CONCLUSION: The risk of twin birth increased significantly with prolonged LFBI. There is a need to understand the factors (fertility therapy and etc.) to increased risk of twin birth in prolonged LFBI.

Reproductive health issues of mothers; a study in Faisalabad

In Pakistan maternal mortality rate is very high as compared to other low income countries. Maternal mortality rate in Pakistan 260/100,000 is the highest in South Asia. In developing countries one woman dies in sixteen from pregnancy related diseases

Objective: This study was aimed to explore reproductive health issues of mothers in Faisalabad

Study Design: A sample of 200 respondents was obtained from Faisalabad city through multistage sampling technique

Period: 2013-2014

Setting Area: Urban Area of district Faisalabad

Material and Method: Uni-variate [frequency distribution and percentage] and Bi-variate analysis [Chi square and Gamma Statistics] was carried out

Results: It was found that antenatal and postnatal care utilization services were poor. Majority of the respondents 79% got at least one antenatal care service but only more than one third 34% got the four recommended checkup during pregnancy. It was also investigated that only 60% women got postnatal visits and only 18% deliveries took place at homes. Two third of the respondents 66% had the positive attitude towards the contraceptive methods for birth spacing. The bi-variate analysis shows that age [p=.003], education [p=.013], income [p=.001], type of family [p=.002] were significantly associated with the positive attitude towards the contraceptive for birth spacing

Conclusion: It is suggested that mothers should be aware of the importance of antenatal and postnatal recommended visits to overcome the reproductive health issues through LHW's visits mass media compaigns and easy assess towards the health care centers

Boletín estadístico de nacimientos: Marzo 2012 - Agosto 2014. Registrados en línea / Statistical bulletin of birth: March 2012 - August 2014. Registered on line

El boletín estadístico de nacimientos, describe información de registro del certificado de nacido vivo en línea, periodo marzo 2012-agosto 2014, mediante sistema web que genera el Certificado de Nacido Vivo, requisito básico para el Acta de Nacimiento e inscripción del menor en los Registros Civiles. Detalla, asimismo, Número de establecimientos y condición del parto por regiones; los establecimientos implementados por subsectores; Nacidos vivos según financiador de la atención del parto, estado civil de la madre; porcentaje de nacidos vivos, número de hijos de la madre; grado de instrucción de la madre; duración del embarazo; por sexo, por peso al nacer y según grupo de edad de la madre; y factores de riesgo en madres adolescentes

Facteurs associes aux longs intervalles intergenesiques au Senegal. Analyse approfondie de l'EDS-MICS 2010-2011

Cette etude examine comment certains couples senegalais atteignent un intervalle intergenesique long malgre une prevalence contraceptive de 13; toutes methodes; parmi les femmes en union et contribue a en determiner les facteurs explicatifs et leur poids relatif. Les facteurs les plus importants sont dans l'ordre: 1) desir de la derniere grossesse; 2) duree de l'amenorrhee post-partum; 3) age au deces de l'avant-dernier enfant; 4) abstinence post-partum; 5) niveau d'education du mari; et 6) survenance de deces fotal. Des recommandations sont faites par rapport a l'acces aux services de planification familiale et a la reduction de la mortalite infanto-juvenile. Des pistes de recherches futures sont aussi avancees

Age at First Marriage and First Birth Interval in Ethiopia: Analysis of the Roles of Social and Demographic Factors

The ages at which females establish marital union and give first birth depend on and result in varying demographic features. Utilizing the Ethiopian Demographic and Health Survey Data; this study examined determinants of first birth interval. The analysis was made using Cox proportional hazard model and Kaplan Meier plot based on data collected from 10;240 ever-married women in the age group 15 to 49. The result shows that first marriage at early age; lower level of education; older marriage cohort; and residence in Amhara region significantly elongated first birth interval. It reveals that timings of marriage and first birth are partly governed by social factors and marriage practices of the society although modernization factors have roles to play. The findings indicate the importance of considering the context within which marriage and first birth take place to address reproductive health problems of women and speed-up the achievement of the targets set in the National Population Policy of Ethiopia

Impact of Cesarean-pregnancy interval on maternal obstetric outcome

To evaluate the impact of Cesarean Pregnancy Interval [CPI] [The time in months between the prior cesarean delivery and the next pregnancy] on the maternal obstetrics outcomes. Prospective descriptive study. Assuit University Women's Health Center. Five hundred pregnant women with uncomplicated previous one or more lower segment transverse cesarean delivery were recruited for this study. They were divided into groups according to CPI and compared with in respect to maternal obstetric outcomes. Clinical assessment of all the participants was carried out at ante partum, intra partum and postpartum period. Ante partum maternal and fetal monitoring included, blood pressure, pulse rate, scar tenderness, vaginal bleeding, fetal heart rate, progress of labor and final maternal outcome. The mean interval of CPI with in all groups was [21.82 +/- 15.92] months and the majority of cases were among the CPI of 24-<60 months [171 women, 34.2%]. Cesarean section was carried out in [445/500. 89%], 37 women delivered vaginally [7.4%], 17 had abortions [3.4%] and one case laparotomy for ectopic pregnancy [0.2%]. For patients who underwent repeated cesarean section, the intraoperative assessment revealed that the uterine scar dehiscence was significantly higher among CPI of < 12 months. [P value=0.012] and on other hand the rate of adhesions was significantly higher among CPI of >/= 12 months, [P value= 0.006], and secondary to that the maternal hospital stay was significantly higher among those with CPI of >/= 60 months [3.5 days]. No reported cases of hysterectomy or maternal death among the studied women. Cesarean pregnancy Interval of less than 12 months was associated with the higher risk of uterine scar dehiscence and CPI more than 12 months was associated with increased rate for adhesions

Estudio de factores obstétricos, nutricionales y hormonales y su influencia en el desarrollo de cáncer de mama / Association between obstetric factors, hormone levels and nutritional status with the development of breast cancer

Background: Recent studies suggest that the age at first pregnancy, number of children and the lapse between births may protect against breast cancer. Furthermore, serum levels of estrogen, prolactin and progesterone appear to contribute to the development of this tumors in obese women. Aim: To verify whether the variables age at first pregnancy, number of children, birth interval, hormone levels and nutritional status are associated with the age at diagnosis of breast cancer. Material and Methods: Retrospective analysis of medical records of550female patients, diagnosed and treated for breast cancer at a hospital in Spain between 2009 and 2012. Results: We found a significant and positive association between age at diagnosis of cancer and the variables age at first pregnancy, parity and interval between pregnancies. There was also a significant correlation (p < 0.000) between serum levels of estrogen, prolactin and progesterone and nutritional status of patients. Conclusions: In this sample, age at first pregnancy or number of children, hormone levels and nutritional status are related to the age of onset of cancer.

Boletín estadístico de nacimientos: Marzo 2012 - Octubre 2013. Registrados en línea / Statistical bulletin of birth: March 2012 - October 2013: Registered in online

El boletín estadístico de nacimientos, de segunda edición, describe información del registro del certificado de nacido vivo en línea, periodo marzo 2012-octubre 2013, mediante sistema web que genera el Certificado de Nacido Vivo, requisito básico para el Acta de Nacimiento e inscripción del menor en los Registros Civiles. Detalla, asimismo, los establecimientos implementados por regiones; establecimientos de salud por subsectores; número de establecimientos implementados; nacidos vivos según peso, duración del embarazo, por sexo, y según grupo de edad de la madre; y factores de riesgo en madres adolescentes

The impact of the interpregnancy interval on birth weight and other pregnancy outcomes / O impacto do intervalo entre gestações no peso de recém-nascidos e outros desfechos da gravidez

To investigate the relationship between the interpregnancy interval and low birth weight and other pregnancy outcomes. METHODS: this case-control study was carried out in hospitals from January 2010 to April 2011. For cases, mothers of 1216 newborns with birth weight<2500 g were approached and 854 mothers participated (70.2 percent). For controls, mothers of 1158 newborns with >2500 g were approached and 854 mothers participated in this study (73.7 percent). Face-to-face interviews were conducted to complete the questionnaires. RESULTS: of the newborn babies with low birth weight, the risk was higher among mothers with a short interpregnancy interval (40.3 percent), whereas for infants with normal birth weight, the majority of the mothers had a longer interpregnancy interval of 24 months (44.7 percent). A short interpregnancy interval of 612 months was more common among women of <25years (49.4 percent; p<0.001) and those who were illiterate (13.1 percent; p=0.043) with a higher risk of low birth weight compared to the controls. Prenatal care during the 1st trimester was lower in women with low birth weight children (p<0.001). Normal delivery was observed less in women with a short birth interval among cases (58.7 percent) compared to controls (79 percent) (p=0.001). A J-shaped association was observed between low birth weight and the interpregnancy interval. CONCLUSIONS: a short interpregnancy interval is associated with an increased risk of low birth weight, especially in younger and illiterate women...

Investigar a relação entre o intervalo entre gestações e o baixo peso de recém-nascidos e outras conseqüências da gestação. MÉTODOS: este estudo caso-controle foi realizado em hospitais entre janeiro de 2010 e abril de 2011. Dentre as mães dos 1216 recém-nascidos com peso <2500 g, 854 (70,2 por cento) aceitaram participar do estudo de caso. No grupo controle, dentre as mães dos 1158 recém-nascidos com peso > 2500 g, participaram 854(73,7 por cento). Para completar os questionários, foram conduzidas entrevistas face a face. RESULTADOS: dos recém-nascidos com baixo peso, o fator de risco foi mais alto entre as mães com curto intervalo intergestacional (40,3 por cento), enquanto para recém-nascidos com peso normal a maioria das mães tinham uma boa margem de intervalo intergestacional de 24 meses (44,7 por cento). Curtos intervalo intergestacional (6 a 12 meses) foi mais comum entre mulheres de <25 anos (49,4 por cento; p<0,001) e analfabetas (13,1 por cento; p=0,043), com mais alto risco de baixo peso quando comparado aos controle. Cuidados pre-natais durante o primeiro trimestre foi menor nas mulheres com crianças de baixo peso (p<0,001). Menos partos normais foi observado em mulheres com curtos intervalos de nascimento para os casos (58,7 por cento) comparados aos controles (79 por cento) (p=0,001). Uma associação não monotônica tipo função J, foi observada entre o baixo peso e intervalo intergestacional. CONCLUSÕES: um curto intervalo entre gestações é associado a um risco maior de nascerem bebês de baixo peso, principalmente entre mulheres mais jovens e analfabetas...

Métodos de planificación familiar utilizados para alargar el periodo intergenésico y los factores que influyen en la elección de los mismos, por las mujeres que acuden al Centro de salud Cerro Verde, en el tercer trimestre del 2011 / Family planning methods used to lengthen the period between births and the factors that influence the choice of the same, for the women who come to the health center Cerro Verde, in the third quarter of 2011

Los métodos de planificación familiar ayudan a las mujeres a decidir el número de hijos que éstas desean tener, evitando los embarazos no deseados, previniendo los periodos intergenésicos cortos y las complicaciones de los mismos. La investigación tuvo un enfoque cualicuantitativo. El objetivo fue: determinar los métodos de planificación familiar, utilizados para alargar el periodo intergenésico y los factores que influyen en la elección de los mismos, por las mujeres que acuden al Centro de Salud Cerró Verde, la muestra fue conformada por cien mujeres en edad fértil con hijos.Los métodos más utilizados por las mujeres para alargar el periodo intertgenésico son la Depo-provera, T de cobre y los métodos naturales, la decisión de las mujeres, para el uso de métodos de planificación familiar está influenciada por su entorno social, en especial la familia (hermanas, cuñadas) y amigas. El 37% de las mujeres tienen hijos con periodos intergenésicos cortos de un año de edad, lo cual lleva a estas mujeres a cursar por las complicaciones del mismo, alterando su salud y la de sus hijos