AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV inf...AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.展开更多
Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices a...Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.展开更多
This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or)...This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.展开更多
AIM： To explore the prevalence of post-partumdepression （PPD） in coeliac disease （CD）. METHODS： we performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet （GFD） comp...AIM： To explore the prevalence of post-partumdepression （PPD） in coeliac disease （CD）. METHODS： we performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet （GFD） compared to that of healthy subjects experiencing a recent delivery. All participants were interviewed about menstrual features, modality and outcome of delivery and were evaluated for PPD by Edinburgh Postnatal Depression Scale （EPDS）. RESULTS： The study included 70 CD patients on GFD （group A） and 70 controls （group B）. PPD was present in 47.1% of CD women and in 14.3% of controls （P 〈 0.01; OR = 3.3）. Mean EPDS score was higher in CD compared to the controls （mean score： group A 9.9 ± 5.9; group B 6.7 ± 3.7; P 〈 0.01）. A signifcant association was observed between PPD and menstrual disorders in CD （69.7% vs 18.9%; P 〈 0.001; OR = 3.6）.CONCLUSION： PPD is frequent in CD women on GFD, particularly in those with previous menstrual disorders. we suggest screening for PPD in CD for early detection and treatment of this condition.展开更多
Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence,...Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence, pubalgia and acute urine retention. A frontal radiograph of the pelvis confirmed the diagnosis, showing a symphyseal separation of 12 mm and 18 mm. In our case, management was mainly medical, with a favorable clinical outcome.展开更多
Introduction: The use of modern postpartum contraception not only reduces unplanned pregnancies but also improves the well-being of mother and child. The present study aims to identify the determinants of postpartum c...Introduction: The use of modern postpartum contraception not only reduces unplanned pregnancies but also improves the well-being of mother and child. The present study aims to identify the determinants of postpartum contraceptive use in a first level health facility. Methodology: This was a 6-month cross-sectional study conducted at the Urban Health Center of Castors. Postpartum women who presented within 42 days of delivery and who had a live child were included after informed consent. Results: Of 318 women enrolled during the study period, 106 were currently using a modern contraceptive method, for a prevalence of 33.3%. The mean age of the women was 25.3 years (±3.6), with extremes of 14 and 49 years. The age group [20 to 29] was the most represented with 52.8%. More than half of the women were in couples (54.7%) and had completed secondary education (53.8%). These women were mostly students (42.5%) and primiparous or pauciparous (70.7%). The most used contraceptive method was injectables (depot medroxyprogesterone acetate) (43.4%), followed by male condoms (23.6%) and oral contraceptives (17.9%). The unmet need for contraception was 40.6%. The main reasons for non-use were the desire to have more children (41.5%), fear of side effects (34.9%) and spousal opposition (12.3%). Factors associated with contraceptive non-use were educational level, occupation and parity. Conclusions: The rate of modern contraceptive use in the postpartum period is low in the study population. Interventions to increase the use of effective contraceptive methods are needed, especially among young women.展开更多
文摘AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus(HBV) reactivation and identify its pre-partum predictors. METHODS: Forty-one hepatitis B e antigen(HBe Ag)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28 th and the 32 nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction(Cobas Taq Man HBV Test) with a lower detection limit of 8 IU/m L. Post-partum reactivation(PPR) was defined as abnormal alanine aminotransaminase(ALT) levels and HBV DNA above 2000 IU/m L. RESULTS: Fourteen out of 41 women(34.1%) had prepartum HBV DNA levels > 2000 IU/m L, 18(43.9%) had levels < 2000 IU/m L and 9(21.9%) had undetectable levels. Fourteen women were lost to follow-up(failure to return). PPR occurred in 8 of the 27(29.6%) women evaluated, all within the first 6 mo after delivery(5 at month 3; 3 at month 6). Five of the 6(83.3%) women with pre-partum HBV DNA > 10000 IU/m L exhibited PPR compared with 3 of the 21(14.3%) women with HBV DNA < 10000 IU/m L(two with HBV DNA > 2000 and the third with HBV DNA of 1850IU/m L), P = 0.004. An HBV DNA level ≥ 10000 IU/m L independently predicted post-partum HBV infection reactivation(OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases(47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).CONCLUSION: In the present study, PPR occurred in approximately 30% of HBe Ag-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/m L predicted PPR.
文摘Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.
文摘This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.
文摘AIM： To explore the prevalence of post-partumdepression （PPD） in coeliac disease （CD）. METHODS： we performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet （GFD） compared to that of healthy subjects experiencing a recent delivery. All participants were interviewed about menstrual features, modality and outcome of delivery and were evaluated for PPD by Edinburgh Postnatal Depression Scale （EPDS）. RESULTS： The study included 70 CD patients on GFD （group A） and 70 controls （group B）. PPD was present in 47.1% of CD women and in 14.3% of controls （P 〈 0.01; OR = 3.3）. Mean EPDS score was higher in CD compared to the controls （mean score： group A 9.9 ± 5.9; group B 6.7 ± 3.7; P 〈 0.01）. A signifcant association was observed between PPD and menstrual disorders in CD （69.7% vs 18.9%; P 〈 0.001; OR = 3.6）.CONCLUSION： PPD is frequent in CD women on GFD, particularly in those with previous menstrual disorders. we suggest screening for PPD in CD for early detection and treatment of this condition.
文摘Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence, pubalgia and acute urine retention. A frontal radiograph of the pelvis confirmed the diagnosis, showing a symphyseal separation of 12 mm and 18 mm. In our case, management was mainly medical, with a favorable clinical outcome.
文摘Introduction: The use of modern postpartum contraception not only reduces unplanned pregnancies but also improves the well-being of mother and child. The present study aims to identify the determinants of postpartum contraceptive use in a first level health facility. Methodology: This was a 6-month cross-sectional study conducted at the Urban Health Center of Castors. Postpartum women who presented within 42 days of delivery and who had a live child were included after informed consent. Results: Of 318 women enrolled during the study period, 106 were currently using a modern contraceptive method, for a prevalence of 33.3%. The mean age of the women was 25.3 years (±3.6), with extremes of 14 and 49 years. The age group [20 to 29] was the most represented with 52.8%. More than half of the women were in couples (54.7%) and had completed secondary education (53.8%). These women were mostly students (42.5%) and primiparous or pauciparous (70.7%). The most used contraceptive method was injectables (depot medroxyprogesterone acetate) (43.4%), followed by male condoms (23.6%) and oral contraceptives (17.9%). The unmet need for contraception was 40.6%. The main reasons for non-use were the desire to have more children (41.5%), fear of side effects (34.9%) and spousal opposition (12.3%). Factors associated with contraceptive non-use were educational level, occupation and parity. Conclusions: The rate of modern contraceptive use in the postpartum period is low in the study population. Interventions to increase the use of effective contraceptive methods are needed, especially among young women.
