Background Episiotomy is the surgical enlargement of the vaginal orifice during the last part of the second stage of labor or childbirth by an incision to the perineum. The World Health Organization advises the use of episiotomy on a restricted and selective basis. Indeed, the rate of episiotomy in developed countries is decreasing, but in developing countries, including Ethiopia, it still remains high. Therefore, this study tried to assess the proportion and factors associated with episiotomy among women who gave birth at Felege Hiwot Referral Hospital, Bahir Dar City, North West Ethiopia, 2017. Methods An institution-based cross-sectional study was conducted among 411 mothers from February to April 2017. Data were collected through face-to-face interviews and supported by observation using standard checklist with systematic random sampling technique. Data was entered by Epi Info and analyzed by SPSS version 23. The association between variables was analyzed using bivariable and multivariable logistic regression model. P-value <0.05 at 95% CI was considered to be statistically significant. Results The proportion of episiotomy was 41.1% with 95% CI (36.5%, 46.2%). Multivariable logistic regression showed that primiparity (AOR=6.026, 95% CI (3.542,10.253)), prolonged second stage of labor (AOR=4.612, 95% CI (2.247,9.465)), instrument delivery (AOR =3.933, 95% CI (1.526,10.141)), using oxytocin (AOR=2.608, 95% CI (1.431,4.751)), medical resident attendant (AOR =3.225, 95% CI (1.409,7.382)) and birth weight ≥4000 grams (AOR=5.127,95% Cl (1.106,23.772)) were significantly associated with episiotomy practice. Conclusion The proportion of episiotomy was high. Parity, using oxytocin, second-stage labor duration, instrument delivery, birth weight, and delivery attendant were statistically significant factors for episiotomy practice. Therefore, as per our findings, we suggest awareness creation, and the setting and use of new national guidelines, the practice of routine episiotomy should be abandoned, and selective and restrictive use of episiotomy is highly advised.

Introduction. Nonreassuring fetal heart rate patterns (NRFHRP) suggest fetal conciliation or a deteriorating ability to handle the stress of labor. Nearly half of stillbirths occurring worldwide are due to hypoxia which is primarily manifested by NRFHRP. Hence, this study assessed the proportion and associated factors of NRFHRP in the Finote Selam primary hospital, North West Ethiopia. Methods. An institution-based retrospective cross-sectional study was conducted from March 1 to April 1, 2019, on 364 charts of mothers who gave birth from January 2017 to January 2018 at the Finote Selam primary hospital. A computer-based simple random sampling technique was used to select charts. A secondary data was collected using a structured questionnaire adapted from different literatures. The data was entered and analyzed using Epi Info version 7 and Statistical Package for the Social Sciences (SPSS) version 23.0. Binary logistic regression was executed, and all explanatory variables with p value < 0.2 were entered into multivariable logistic regressions. Multivariable logistic regression was used to control the effect of confounding variables and to identify factors affecting NRFHRP. Odds ratios with 95% confidence intervals were computed, and statistical significance was declared if p<0.05. Result. Out of 364 total deliveries, NRFHRP was detected on 55 (15.1%) fetuses, and the commonest NRFHRP detected was bradycardia 44 (80%). Most NRFHRP (38.18%) occurred on the deceleration phase of labor. There was no identified possible cause for NRFHRP on 34.5% of cases. Referral from nearby health institutions [AOR=2.832 (95% CI 1.457, 5.503)], primigravida [AOR=2.722 (95% CI 1.377, 5.381)], augmentation of labor [AOR=3.664 (95% CI 1.782, 7.534)], and meconium-stained amniotic fluid [AOR=6.491 (95% CI 3.198, 13.173)] were significantly associated with NRFHRP. Conclusion. The proportion of NRFHRP is high. Referral from nearby health institutions, primigravida mothers, augmentation of labor, and meconium-stained amniotic fluid were significantly associated with NRFHRP. Implementing a better referral link and close monitoring during follow-up could minimize NHFHRP.

Background and objectives: There are many newborns who suffer a life-threatening complication in many lowresource countries. Neonatal near miss has been proposed as a tool to evaluate and improve the quality of neonatal care. However, there has been limited evidence on magnitude of neonatal near miss and determinant factors in Ethiopia. The aim of this study was to assess proportion and associated factors of neonatal near miss among neonates delivered at

Background: Addressing, the target of sustainable development goals of reducing perinatal mortality, was still a global challenge, and the magnitude of newborn death in the first three days of life takes a significant role in Ethiopia. Therefore, this study planned to determine the incidence and determinants of neonatal mortality in the first three days among babies delivered in referral hospitals of Amhara Regional State, North-Western Ethiopia. Method: A hospital-based prospective cohort study design was conducted among 810 early neonates in the first three days of delivery between March 1 and August 30, 2018. The neonates were followed, starting from the time of admission to 72 hours. An interviewer-administered questionnaire and medical record review were conducted for data collection. Data were entered into Epi-data manager version 4.4 and analyzed using STATA™ version 16.0 for the analysis. Cox-Proportional hazard model was used to determine the survival time of the newborns. Results: The overall incidence of newborn mortality in this study was 151/1,000 births. Neonatal mortality was significantly high among newborns whose mothers came between 17 and 28 weeks of gestation for the first visit [AHR=1.67;95% CI: 1.02, 2.73], among those whose mothers labor was not monitored with a partograph [AHR=2.66; 95% CI: 1.70, 4.15], mothers experience postpartum hemorrhage [AHR 2.88; 95% CI: 1.69, 4.89], develop fistula in the first 24 hours [AHR=3.75; 95% CI: 1.23, 11.43], and experience obstructed labor [AHR=2.14; 95% CI: 1.35, 3.38]. However, it was 39% less risky among newborns whose mothers were directly admitted, and whose mothers had visited health facilities in less than 1-hour, both [AHR=0.61; 95% CI: 0.38, 0.97]. Conclusion: This study revealed that about 1 in 7 newborns died in the early three days of life. The timing of the first antenatal visit, quality of labor monitoring, maternal complications, and delay in seeking the care were found to be the determinants. Thus, scaling-up of evidence-based interventions, and harmonized efforts aimed to improve the quality of antenatal care, promote institutional deliveries, provide optimal essential and emergency obstetric care, and ensure immediate postnatal care may improve neonatal survival.

Background: Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more new-born who suffer a life-threatening complication but survive. Neonatal near miss has been proposed as a tool for assessment of quality of care in neonates who suffered any life-threatening condition. However, there was limited evidence on magnitude of neonatal near miss and determinant factors in Ethiopia. The aim of this study was to assess proportion and associated factors of neonatal near miss among deliveries at Injibara General Hospital, Awi Zone, Northwest Ethiopia, 2019. Methods: Institutional based cross sectional study was conducted from February 1, 2019 to April 30, 2019 among 404 live births. Structured and pretested questioner used for mothers and structured checklist for neonates. Bivariate and multivariate logistic regressions model were fitted to identify factors associated with neonatal near miss. An adjusted odds ratio with 95 % confidence interval (CI) was computed to determine the level of significant. Result: Proportion of neonatal near miss was found to be 23.3 % with 95% CI: (19.1% -27.7%). Primiparous[Adjusted odds ratio(AOR):2.01, 95%CI:(1.03-3.95)], referral linkage [AOR:3.23, 95%CI:(1.89-5.513)], maternal perception of reduced fetal movement[AOR:5.95, 95%CI:2.47-14.33], premature rupture of membrane [AOR: 3.10, 95%CI: (1.27-5.59)], prolonged labor [AOR: 3.00, 95%CI:(1.28-7.06)], obstructed labor/cephalo-pelvic disproportion [AOR: 4.05; 95%CI: (1.55-10.57)] and non-reassuring fetal heart rate pattern [AOR: 3.75, 95%CI: (1.69-8.33)] were significantly associated with neonatal near miss. Conclusion: Proportion of neonatal near miss in the study area was found to be higher than studies in WHO neonatal near miss systemic review. Strength referral linkage and efforts needed to continue compressive maternal and neonatal care to avoid preventable causes of neonatal morbidity and mortality.