The purpose of this NIH-funded protocol is to adapt (Aim 1) and pilot test (Aim 2) an mHealth intervention to improve maternal and child health in Cameroon. We will adapt the 24/7 University of ...Alabama at Birmingham Medical Information Service via Telephone (MIST) provider support system to mMIST (mobile MIST) for peripheral providers who provide healthcare to pregnant and postpartum women and newborns in Cameroon.
In Aim 1, we apply qualitative and participatory methods (in-depth interviews and focus groups with key stakeholders) to inform the adaptation of mMIST for use in Cameroon. We use the sequential phases of the ADAPT-ITT framework to iteratively adapt mMIST incorporating qualitative findings and tailoring for local contexts. In Aim 2, we test the adapted intervention for feasibility and acceptability in Ndop, Cameroon.
This study is ongoing at the time that this protocol is published.
The adaptation, refinement, and pilot testing of mMIST will be used to inform a larger-scale stepped wedged cluster randomized controlled effectiveness trial. If successful, this mHealth intervention could be a powerful tool enabling providers in low-resource settings to deliver improved pregnancy care, thereby reducing maternal and fetal deaths.
This randomized trial of RSV F protein nanoparticle vaccination during pregnancy did not show efficacy (according to the prespecified success criterion) against RSV-associated, medically significant ...lower respiratory tract infection but suggested possible benefits with respect to other RSV-related outcomes.
Background
Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective.
Objective
To determine, using individual patient data (IPD) meta‐analysis, whether ...the outcome of triplet pregnancy is affected by prophylactic administration of 17‐hydroxyprogesterone caproate (17OHPc).
Search strategy
We searched literature databases, trial registries and references in published articles.
Selection criteria
Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies.
Data collection and analysis
Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre‐specified outcomes included randomisation‐to‐delivery interval and rates of birth at <24, <28 and <34 weeks of gestation.
Main results
Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk‐of‐bias scores and between‐study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34 and 35%, respectively; risk ratio RR 0.98, 95% confidence interval 95% CI 0.79–1.2). The rate of birth at <32 weeks was also similar in the two groups (35 and 38%, respectively; RR 0.92, 95% CI 0.55–1.56). There were no significant between‐group differences in perinatal mortality rate, randomisation‐to‐delivery interval, or other specified outcomes.
Conclusion
Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration.
Tweetable
17‐Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.
Tweetable
17‐Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.
•Few data on neurologic outcomes after in utero exposure to general anesthesia (GA).•Secondary analysis of randomized trial of maternal magnesium and cerebral palsy.•Exposure to GA was not associated ...with impaired neurodevelopment overall.•Only severe motor delay was significantly more common among infants exposed to GA.•Findings are reassuring regarding a single, short in utero exposure to GA.
In 2016, the U.S. Food and Drug Administration expressed concern that neurodevelopment may be negatively affected by anesthesia or sedation exposure in pregnancy or before three years of age. We examined the association between general anesthesia at the time of cesarean delivery and early childhood neurodevelopment.
A secondary analysis of a multicenter randomized controlled trial assessing magnesium for prevention of cerebral palsy in infants at risk for preterm delivery. Exposure was general compared to neuraxial anesthesia. The primary outcome was motor or mental delay at two years of age, assessed by Bayley Scales of Infant Development II (BSIDII). Secondary outcomes included BSIDII subdomains and perinatal outcomes. Multivariable logistic regression models were performed to control for confounders.
Of 557 women undergoing cesarean delivery, 119 (21%) received general anesthesia. There were no differences in the primary composite outcome of developmental delay (aOR 0.93, 95% CI 0.61 to 1.43) or the BSIDII subdomains of mild, moderate, or severe mental delay, or mild or moderate motor delay. Severe motor delay was more common among infants exposed to general anesthesia (aOR 1.98, 95% CI 1.06 to 3.69). Infants exposed to general anesthesia had longer neonatal intensive care stays (51 vs 37 days, P=0.010).
General anesthesia for cesarean delivery was not associated with overall neurodevelopmental delay at two years of age, except for greater odds of severe motor delay. Future studies should evaluate this finding, as well as the impact on neurodevelopment of longer or multiple anesthetic exposures across all gestational ages.
Objective
To determine whether β2‐adrenoceptor (β2AR) genotype is associated with shortening of the cervix or with preterm birth (PTB) risk among women with a short cervix in the second trimester.
...Design
A case–control ancillary study to a multicentre randomised controlled trial.
Setting
Fourteen participating centres of the Maternal‐Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Population
Four hundred thirty‐nine women, including 315 with short cervix and 124 with normal cervical length.
Methods
Nulliparous women with cervical length <30 mm upon a 16–22‐week transvaginal sonogram and controls frequency‐matched for race/ethnicity with cervical lengths ≥40 mm were studied. β2AR genotype was determined at positions encoding for amino acid residues 16 and 27.
Main outcome measures
Genotype distributions were compared between case and control groups. Within the short cervix group, pregnancy outcomes were compared by genotype, with a primary outcome of PTB <37 weeks.
Results
Genotype data were available at position 16 for 433 women and at position 27 for 437. Using a recessive model testing for association between short cervix and genotype, and adjusted for ethnicity, there was no statistical difference between cases and controls for Arg16 homozygosity (OR 0.7, 95% CI 0.4–1.3) or Gln27 homozygosity (OR 0.9, 95% CI 0.3–2.7). Among cases, Arg16 homozygosity was not associated with protection from PTB or spontaneous PTB. Gln27 homozygosity was not associated with PTB risk, although sample size was limited.
Conclusions
β2AR genotype does not seem to be associated with short cervical length or with PTB following the second‐trimester identification of a short cervix. Influences on PTB associated with β2AR genotype do not appear to involve a short cervix pathway.
Pregnant women with mild chronic hypertension were randomly assigned to receive medication targeting a normal blood pressure (<140/90 mm Hg) or to receive no treatment unless severe hypertension ...(>160/105 mm Hg) developed. The incidence of adverse maternal and neonatal outcomes was significantly lower in the active-treatment group, without an increase in low birth weight.
ABSTRACT
Previous research has presented convincing evidence that the administration of tranexamic acid (TXA) after cesarean delivery can reduce the incidence of postpartum hemorrhage (PPH) and the ...associated mortality and morbidity. Although there have been several significant studies on this topic, they are limited by small sample sizes, which make the studies difficult to generalize and limit their statistical power. This study aimed to address that gap and assess clinical outcomes related to the administration of TXA in a large sample.
This was a multicenter, double-blind, randomized controlled trial including 31 hospitals participating in the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Eligibility criteria included scheduled or unscheduled cesarean delivery of a singleton or twin gestation. Exclusion criteria included maternal age younger than 18 years, blood transfusion before randomization, plan for transfusion after randomization, contraindications to TXA, patient decision not to use blood products, or administration of antifibrolytic agents or uterotonic agents other than oxytocin. The primary outcome was maternal death or blood transfusion before hospital discharge or 7 days after delivery, whichever came first. Secondary outcomes included intraoperative blood loss of more than 1 L and treatments or interventions in response to bleeding or related complications within 7 days of delivery, as well as infectious complications within 6 weeks of delivery.
Final analyses included 11,000 patients, with 5529 in the TXA group and 5471 in the placebo group. Baseline characteristics were not significantly different between groups, and no center-dependent differences were observed. The primary outcome was observed in 3.6% of patients in the TXA group and 4.3% of patients in the placebo group (adjusted relative risk, 0.89;
P
= 0.19). Intraoperative blood loss of more than 1 L was recorded in 7.3% and 8.0% in the tranexamic and placebo groups, respectively (relative risk, 0.90; 95% CI, 0.79–1.05). Treatments and interventions in response to bleeding occurred in 16.1% of individuals in the TXA group and 18.0% of those in the placebo group (relative risk, 0.90; 95% CI, 0.82–0.97). Infectious complications were reported in 3.2% and 2.5% in the TXA and placebo groups, respectively (relative risk, 1.28; 95% CI, 1.02–1.61). Sensitivity analysis showed similar results to initial analysis, and no significant differences were seen between groups in major safety outcomes.
This analysis indicates that the administration of TXA during cesarean delivery did not lower the risk of maternal death or blood transfusion. These results are in direct contradiction to previous research showing that TXA is effective at reducing these outcomes. This trial was stronger than any previous studies in sample size and careful randomization ensuring equal representation of scheduled and unscheduled cesarean deliveries, which makes the contradiction to previous research especially relevant. Some limitations of this trial included limitations in time of administration of TXA as well as dosage. Outcomes related to these 2 variables are still largely unknown. This trial also excluded patients at high risk of thromboembolic phenomena, and the effect of TXA in this population is still unknown. Further research should focus on more diverse populations, as well as understanding variations in outcomes with timing and dosage, which this study did not address.
Objective To identify the factors associated with important (≥50%) variation in awareness and practice of evidence‐based obstetric interventions in an African setting where we have previously ...reported poor awareness and use of evidence‐based reproductive interventions.
Design Cross‐sectional analysis of data from our Reproductive Health Interventions Study.
Setting North‐west province, Cameroon, Africa.
Population Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care.
Main outcome measures Prevalence ratios (PR) of uniform awareness and practice of four key evidence‐based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother‐to‐child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis.
Methods Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence‐based interventions.
Results A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence‐based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3–55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio aPOR = 8.3; 95% CI: 1.3–53.8) as was median work experience of 5–15 years (aPOR = 2.0; 95% CI: 1.0–3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0–11.8). Other potentially important variations were observed, although they did not attain statistical significance.
Conclusions Several factors including obstetric training and continuous education positively influence evidence‐based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.
We describe the complicated course of a rare pregnant woman with symptomatic Huntington disease (HD) and discuss multidisciplinary care issues that may be encountered. A 31-year-old gravida 2, para 1 ...with advanced HD was admitted at 30 weeks gestation for preterm labor. Her course was complicated by progressive cognitive and physical impairment, dysphagia, malnutrition, diabetes insipidus, aspiration pneumonia, chorioamnionitis, preterm delivery and pyelonephritis. Pregnant women with symptomatic HD may present multiple challenges requiring extensive multidisciplinary input.
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