Maternal mortality in Nepal is estimated to be around 540 deaths per 100,000 births. 1 One major factor is low use of maternal health care, despite government efforts to improve services, including an expanded network of rural clinics and the training of auxiliary nurse midwives. 2 Fewer than 40% of women receive any antenatal care from a trained provider, and fewer than 10% of births take place in a health facility. 3 In seeking to explain these low levels of health care use, most research has focused on the provision and geographic accessibility of services. However, no studies have looked at how sociocultural factors, such as inequitable gender roles and women' s position within the household, have influenced use of services.Earlier work in South Asia has suggested various ways in which gender roles and relations may operate to restrict women' s access to health care during pregnancy and at the time of delivery. These include heightened restrictions on women' s movement because the pregnant state is considered "shameful," young women' s lack of say within the family and the fact that pregnancy-related knowledge and decision-making authority are commonly vested in older women, young women' s lack of influence over material resources, and the exclusion of men, who are often the primary decision makers in the use of material resources, from the "polluting" event of childbirth. 4 In addition, a growing body of literature has explored the links between indicators of women' s household position and contraceptive use in South Asia. 5 However, little of this research has examined whether and how dimensions of women' s position are related to their use of maternal health care services.It is widely asserted that increased gender equality is a prerequisite for achieving improvements in maternal health. The Programme of Action adopted at the 1994 International Conference on Population and Development claimed that "improving the status of women also enhances their decision-making capacity at all levels in all spheres of life, especially in the area of sexuality and reproduction." 6 In Nepal, the low social status of women has been identified as a hindrance to progress toward national health and population policy targets. 7 Although it seems reasonable to assume that greater equality within the household leads to higher use of maternal health care services, this factor has not been explored for Nepal. We know little about how intrahousehold relations constrain or facilitate access to health care, or about the dimensions of women' s position that are most critical for achieving increased use.In this study, we examine the influence of four indicators of women' s household position on the receipt of skilled antenatal and delivery care: their involvement in decision making about their own health care and about large house- Women's Position Within the Household as a Determinant Of Maternal Health Care Use in NepalCONTEXT: Although gender inequality is often cited as a barrier to improving maternal health in Nepal, little a...

To determine the value of high-resolution computed tomography (HRCT) in the diagnosis of diffuse pulmonary diseases, a direct HRCT-pathologic correlative study was performed using four inflated and fixed lungs from autopsy. In normal lungs, the smallest pulmonary artery resolved by HRCT was 200 microns in diameter; the artery was accompanied by the terminal bronchiole and the first-order respiratory bronchiole. The distance from the vessel to the corresponding lobular border ranged from 3 to 5 mm. These results suggest that the centrilobular area or the area around the terminal or respiratory bronchioles can be recognized with HRCT. In addition, the authors confirmed that centrilobular emphysema and centrilobular tuberculous nodules can be diagnosed with HRCT. Thus, HRCT can demonstrate the location of pathologic changes within a lobule and may be helpful in the differential diagnosis of diffuse pulmonary diseases.

BackgroundWorldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection.MethodsWe searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included ‘pertussis’, ‘whooping cough’, ‘pertussis vaccine,’ ‘tetanus, diphtheria and pertussis vaccines’ and ‘pregnancy’ and ‘perinatal’.ResultsWe included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19–37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n = 48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n = 103, RR = 0, meaning no case in the vaccine group), or preterm birth (two RCTs, n = 151, RR = 0.86, 95%CI: 0.14–5.21) related to administration of the vaccine during pregnancy.ConclusionGiven that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1559-2) contains supplementary material, which is available to authorized users.

BackgroundThe incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women’s experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms.MethodsRelevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", “pregnancy complications” “puerperal disorders”, "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia”. Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools.ResultsEleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition.ConclusionsDespite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity.

We did not find any high quality evidence to inform practice, with substantial heterogeneity being found between the studies conducted to date. There is little or no evidence to support either a positive or adverse effect of psychological debriefing for the prevention of psychological trauma in women following childbirth. There is no evidence to support routine debriefing for women who perceive giving birth as psychologically traumatic.Future research should provide greater detail of the outcome measures used, and with scales for measuring psychological trauma validated against clinical diagnostic interviews. High rates of obstetric intervention in some birth settings may mean that women require improved emotional care from health professionals to reduce the risk of childbirth being experienced as traumatic. As all included trials excluded women unable to communicate in the native language of the study setting, there is no information on the response of these women to psychological debriefing. No included studies were conducted in low or middle-income countries.