The role of institutional factors in maternal mortality from obstructed labour

Udoma, EJ; John, ME; Ekanem, AD

doi:10.4314/gjms.v2i1.10089

Cited by 8 publications

(11 citation statements)

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“…This is in agreement with other studies which show the relationship between financial capability and supervised delivery in health care facility [25,26].The poorer the patient is the less likely she is to access skilled care.The study showed that most of the women delivered in churches or at traditional birth attendant. This is in agreement with other studies conducted in the Niger Delta Region of Nigeria [27][28][29][30].…”

Section: Discussionsupporting

confidence: 93%

The Discordance between Antenatal Care Attendance and Skilled Birth Attendant at Delivery in the Niger Delta Region of Nigeria.

Utuk¹,

Abasiattai²,

Ekanem³

2017

IOSR JNHS

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Section: Discussionsupporting

confidence: 93%

The Discordance between Antenatal Care Attendance and Skilled Birth Attendant at Delivery in the Niger Delta Region of Nigeria.

Utuk¹,

Abasiattai²,

Ekanem³

2017

IOSR JNHS

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“…But, a quarter of them in our study had good level of education. This latter group of women may be influenced by factors like adverse cultural and religious considerations to attempt delivery with unskilled personnel only to be referred when complications occur [9, 12, 20]. During the antenatal periods, the harmful effect of adverse practices and encouragement of good ones should form major part of the discussion as many of the patients in this study actually had antenatal care but attempt delivery outside the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the deaths from obstructed labour are largely associated with hemorrhage, ruptured uterus, infections, metabolic, and electrolyte derangements [10–12]. The fluid and electrolyte changes in obstructed labour are well documented and may be due to abnormal metabolic activities, prolonged starving of the patient from food and water, excessive uterine contractions and muscular activities, infections with associated high temperature and subsequent loss of fluids, and maternal exhaustion [13–16].…”

Section: Introductionmentioning

confidence: 99%

“…Generally, electrolyte derangements may be compounded by inefficient fluid management in labour in the hospitals [14, 15]. But, in the rural community, the majority of labour and deliveries are attended to by untrained personnel outside the hospital [6, 9, 12]. In these area, however, the fluid and electrolyte problem is largely affected by large intake of herbal/other medicinal preparations of unknown efficacy and safety given by the traditional birth attendants.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have been conducted in our environment [6, 7, 9, 12] on obstructed labour but none have been done in the rural area in Akwa Ibom State to assess the metabolic and electrolytes changes in this group of women hence the need for this study. …”

Section: Introductionmentioning

confidence: 99%

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Study of Electrolyte Changes in Patients with Prolonged Labour in Ikot Ekpene, a Rural Community in Niger Delta Region of Nigeria

Ekanem

Umoiyoho

Inyang-Otu

2012

ISRN Obstetrics and Gynecology

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Background. Prolonged obstructed labour is a major cause of maternal and perinatal morbidity and mortality especially in the developing countries of the world, where the incidence is high. These complications are partly attributed to the metabolic and electrolyte derangements that are often associated with this problem. It is, therefore, important to evaluate the metabolic and electrolyte changes of these patients in a rural community in a developing country. Objective. To compare the electrolyte changes, maternal, and perinatal outcomes in patients with prolonged obstructed labour with that of normal labour in General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Patients and Methods. This is a prospective cross-sectional case control study conducted in the Labour Ward of the General Hospital Ikot Ekpene to compare the electrolyte levels and perinatal outcome of 95 pregnant women who had prolonged labour with 105 women who had normal labour within the same period. Main Outcome Measures. Electrolyte changes, ketonuria, maternal complications, and perinatal outcome. Results. The majority of women with prolonged labour (91.6%) had major surgical interventions requiring anaesthesia. Perinatal death occurred in 12.6%, and a major life-threatening maternal complications (including two deaths) occurred in 13.7% of those with prolonged labour compared to 2.9% (with no death) in those with normal labour. Significant abnormal electrolyte changes included hyperkalemia, high urea, and creatinine as well as low bicarbonate levels were recorded. Metabolic abnormality was shown by ketonuria in 91.1% of the patients compared to 1.9% in women with normal labour. Conclusion. Women with prolonged labour in Ikot Ekpene have significant electrolyte and metabolic changes which impact adversely on the maternal and perinatal outcomes of the pregnancy. Effort should be made to correct these electrolyte and metabolic abnormalities during resuscitation of the woman in order to reduce the complications associated with such derangements.

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Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

Imran,

Kamran,

Fakih

et al. 2023

Intl J Gynecology & Obste

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BackgroundEvidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results.ObjectivesTo evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women.Search StrategyWe searched six databases for relevant studies through a search strategy containing the relevant keywords “IV hydration”, “IV fluids”, and “labor” from the inception of these databases to May 1, 2023, without any applied restrictions.Selection CriteriaSearch results were imported to Covidence for screening of eligible articles for this review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only.Data Collection and AnalysisData regarding the characteristics of included studies, participant's baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta‐analysis models using RevMan 5.4.Main resultsPooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56–0.88, P = 0.002), the first stage of labor duration (MD –46.97, 95% CI –81.79 to −12.14, P = 0.008), the second stage of labor duration (MD –2.69, 95% CI –4.34 to −1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58–0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02–1.12, P = 0.009) was higher with a 250 mL/h infusion rate.ConclusionIV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second‐stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed.

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The role of institutional factors in maternal mortality from obstructed labour

Cited by 8 publications

References 0 publications

The Discordance between Antenatal Care Attendance and Skilled Birth Attendant at Delivery in the Niger Delta Region of Nigeria.

The Discordance between Antenatal Care Attendance and Skilled Birth Attendant at Delivery in the Niger Delta Region of Nigeria.

Study of Electrolyte Changes in Patients with Prolonged Labour in Ikot Ekpene, a Rural Community in Niger Delta Region of Nigeria

Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

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