The objective of this study was to identify the sociocultural and economic factors that act as barriers to women's use of antenatal care services and hospital delivery in a rural community in Kano State, Northern Nigeria. The study was based on an interview of 107 pregnant women conducted by a trained midwife in the native language of the area. Findings indicate that the majority of women (88%) (CI = 81.8-94.2%) in the study area did not attend for antenatal care, and 96.3% (CI = 93.0-99.8%) had delivered or plan to deliver at home without a skilled attendant. Major barriers identified were economic, cultural and those related to the women's perception of their condition. The study recommends that poverty reduction and economic empowerment of rural women are prerequisites for any tangible improvement in the utilisation of antenatal care and obstetric delivery services.

Objective To examine the association between obesity subtypes and risk of early and late pre-eclampsia.Design Population-based retrospective study.Setting State of Missouri maternally linked birth cohort files.Population All singleton live births in the state of Missouri from 1989 to 2005.Methods The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5-24.9 kg/m 2 ), class I obesity (BMI = 30-34.9 kg/m 2 ), class II obesity (BMI = 35-39.9 kg/m 2 ), class III obesity (BMI = 40-49.9 kg/m 2 ) or super-obesity (BMI ‡ 50 kg/m 2 ). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between obesity and the risk of pre-eclampsia were obtained from logistic regression models with adjustment for intracluster correlation.Results The rate of pre-eclampsia increased with increasing BMI, with super-obese women having the highest incidence (13.4%).Compared with normal weight women, obese women (BMI ‡ 30 kg/m 2 ) had a higher risk for pre-eclampsia (OR = 2.59, 95% CI = 2.87-3.01). This risk remained approximately the same for late-onset pre-eclampsia (preeclampsia occurring at 34 weeks or more of gestation) and was slightly reduced for early-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or less of gestation). Within each BMI category, the risk of pre-eclampsia increased with the rate of weight gain. Compared with normal weight mothers with moderate weight gain, super-obese women with a high rate of weight gain had the greatest risk for pre-eclampsia (OR = 7.52, 95% CI = 2.70-21.0).Conclusion BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women.

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This review examines and summarises the literature regarding the mode of delivery of macrosomic infants and subsequent perinatal outcomes. A search of electronic databases was conducted and supplemented with investigation of the references cited in the original articles. Although the rates of obstetric complications differ among high birth weight infants delivered by caesarean section compared to those delivered vaginally, there is currently little evidence that perinatal mortality differs significantly by delivery method. Shoulder dystocia and birth injury occur with greater frequency among macrosomic infants, yet the relative inaccuracy of clinical and ultrasonographic estimates of birth weight among high birth weight infants indicates that a trial of labour may be warranted among non-diabetic mothers with a suspected macrosomic fetus. The majority of studies identified in this review utilised small sample sizes and observational design, thereby hindering valid assessments of the impact of delivery method on the mortality of this population. Consequently, an optimal management strategy has yet to be defined.

Objective To determine whether female genital mutilation (FGM) is a risk factor for intimate partner violence (IPV) and its subtypes (physical, sexual and emotional).Design Population-based cross-sectional study.Setting The study used the 2006 Demographic and Health Survey (DHS) conducted in Mali. Methods Multivariable logistic regression was used to compute adjusted odds ratios (aOR) and 95% confidence intervals (CI) to measure risk for IPV.Main outcome measures The outcomes of interest were IPV and its subtypes.Results Women with FGM were at heightened odds of IPV (aOR 2.71, 95% CI 2.17-3.38) and IPV subtypes: physical (aOR 2.85, 95% CI 2.22-3.66), sexual (aOR 3.24, 95% CI 1.80-5.82), and emotional (aOR 2.28, 95% CI 1.68-3.11). The odds of IPV increased with ascending FGM severity (P for trend <0.0001). The most elevated odds were observed among women with severe FGM, who were nearly nine times as likely to experience more than one IPV subtype (aOR 8.81, 95% CI 5.87-13.24).Conclusions Study findings underscore the need for multi-tiered strategies, incorporating policy and education, to reduce FGM and IPV, potentially improving the holistic health and wellbeing of Malian women.