Velamentous Cord Insertion: Interest of Antenatal Diagnosis and Review of the Literature

Velamentous insertion of the umbilical cord corresponds to the insertion of the cord directly on amniotic membranes. It is a rare situation whose frequency varies from 0.5% to 1.69% of single pregnancies. It must be diagnosed during the morphological ultrasound of the 2nd trimester, actively looking for the association with a vasa previa, due to the risk of fetal haemorrhagic threat. We report an antenatal diagnosis of velamentous cord insertion and its management with literature review.

Unintended Pregnancy Determinants among Antenatal Clinic Attendees: A University of Port Harcourt Teaching Hospital Experience

An unintended pregnancy is a pregnancy that is either mistimed or unplanned. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinics at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria. It was a descriptive, cross-sectional study of 215 women attending the antenatal clinic of UPTH from July to August 2022. Information on socio-demographic characteristics, reproductive history, desirability of the current pregnancy at the time of conception, knowledge and use of contraceptive methods were collected using a pretested questionnaire and analyzed using SPSS version 26.0. Chi-square test was used for test of associations with the level of significance set at P < 0.05. The prevalence rate of unintended pregnancy from the study was 16.28% (≈16%). The contraceptive awareness was very high (209, 97.21%), however, 101 (46.98%) participants had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unintended pregnancy (P = 0.042), level of education and unwanted pregnancy (P = 0.033) as well as parity and unintended pregnancy (P = 0.019). The prevalence of unintended pregnancy among women attending antenatal clinics was high, possibly due to low contraceptive usage. More efforts should be geared towards ensuring access to comprehensive contraceptive care and contraceptive methods, this will enhance uptake and reduce the rate of unintended pregnancy.

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Aim: To investigate impact of antenatal squatting activities on labour outcomes. Methods: All eligible primigravida women, with singleton cephalic fetuses, who presented to ward 18 of Colombo South Teaching Hospital, Sri Lanka, during the period 1st of February to 28th of May 2017 were invited into the study. Those who were already in active stage of labor (at least more than two moderate contractions per 10 minutes) on admission were excluded. Demographic data such as age, ethnicity, religion, educational level, occupation, latrine type in use, and booking Body mass index (BMI) were collected via an interviewer administered questionnaire. Data related to labor (modified Bishop score at onset of active labor, labor augmentation, pain relief, labor duration, mode of delivery, episiotomy or tears) and neonatal outcome (birth weight, APGAR score at 1, 5, 10 minutes) were collected from delivery notes. A pre tested interviewer administered questionnaire was used to obtain data regarding routine squatting activities during the previous 6 months. Pain visual analogue scale was used on day after delivery to assess the degree of labour pain. Duration of each squatting activity per day and number of days engaged with the activity per week;were used to calculate total squatting hours per week. In the absence of an accepted threshold for adequate squatting, we employed the sample mean as an operational data-driven threshold to define “more” against “less” squatting activities. Women who did not have squatting activities were considered as the controls. We used chi-square and Fisher’s exact tests to compare characteristics and outcomes between those engaging in more and less levels of squatting activity. We fitted a series of logistic regression models with each dichotomized outcome as the dependent variable, more/less squatting activity as the main independent variable of interest, and age, gestation period, BMI and patient’s occupation as covariates. The resulting adjusted odds ratios (AOR) and their 95% confidence intervals (CI) and statistical significance (p < 0.05) were used to draw conclusions of adjusted associations. Results: We recruited 430 women into this study. Overall, 68% of the women were of 20 - 30 years old, 47% had normal body mass index and 65% were housewives. The most frequent squatting activities were for urination/defecation and clothes washing (146 and 62 minutes/week, respectively). Mean total time was 246 minutes per week, of which more than 147 women (34%) achieved above this level of squatting activities. Those with more squatting activities had a greater modified Bishop Score ≥ 6/10 (92% vs 82%;p < 0.01);labor duration of <6 hours (82% vs 56%;p < 0.01), less likely for labour augmentation (39% vs 51%;p < 0.01) and pain relief (53% vs 65%;p = 0.013). Similar results were obtained after adjustments for maternal age, BMI, gestational age and occupation. However, there were no significant differences in the mode of delivery (normal vaginal vs instrumental vs caesarean), episiotomy rate, birth weight and neonatal Apgar scores. Conclusion: Squatting activities of more than 246 minutes per week may improve labor outcome. Women should be encouraged to increase squatting exercises or incorporate more habitual squatting activities antenatally.

Predictors of antenatal health service utilization among left-behind wives of male outmigrants:Evidence from Patna District,India

Objective:To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care(ANC)services utilization.Methods:A cross-sectional survey was conducted in rural regions of the Patna district,India.The sample size(n=328)was estimated using Cochran’s formula.Five parameters of the social support system were identified(autonomy,spousal support,family support,social circle support,and government support).The score for each was calculated as a composite score using multiple variables;these served as independent variables.The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.Results:The regression results showed that four out of five social parameters had a significant effect on ANC behavior.Spousal support was the strongest predictor(standardized regression coefficient β=0.57,OR 1.16,95%CI 1.08-1.79,P=0.007).Government support was found to be the second strongest predictor(β=0.40,OR 1.49,95%CI 1.04-2.14,P=0.027),followed by family support(β=0.31,OR 1.36,95%CI 1.23-2.57,P=0.034)and autonomy(β=0.11,OR 1.32,95%CI 1.11-2.26,P=0.030).The social circle support was found to be non-significant in predicting ANC behavior(P>0.05).Conclusions:The policymakers could focus on the identified predictors to strengthen and modify the existing policies for leftbehind wives of male outmigrants.The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net.One strategy we suggest is to launch an awareness campaign focusing on husbands(male outmigrants)and family members.

Investigation of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic

Objective:The aim of this study was to examine of the effects of perceived stress on antenatal care behaviors and the labor process during the COVID-19 pandemic.Methods:This study was conducted with a descriptive design.The data were collected using an“Introductory Information Form”and the“Antenatal Perceived Stress Inventory”.Descriptive statistics were analyzed using Kruskal-Wallis,Mann-Whitney U,and multinomial logistic regression tests.Results:The sample of the study included 487 women.The mean total Antenatal Perceived Stress Inventory score of the participants was found as 2.30±0.80.The mean medical and obstetric risks/fetal health,psychosocial changes during pregnancy,and prospect of childbirth subscale scores of the participants were determined to be 2.29±1.08,2.26±0.87,and 2.34±0.86,respectively.It was determined that as the antenatal perceived stress levels of the participants who frequently attended physical examinations increased,they became 1.535 times more likely to perceive the care they received to be adequate(Odds ratio(OR):1.535;1.045–2.254 Confidence interval(CI);P=0.029).It was found that as the antenatal perceived stress levels of the participants whose clinical tests were frequently analyzed increased,they were 1.518 times more likely to perceive the care they received to be adequate(OR:1.518;1.080–2.135 CI;P=0.016).Moreover,as the antenatal perceived stress levels of the participants who frequently underwent fetal health follow-ups increased,they were 1.573 more likely to perceive the care they received to be adequate(OR:1.573;1.042–2.375 CI;P=0.031).Conclusion:It was concluded that as the antenatal perceived stress levels of the women who frequently underwent physical examinations,clinical test analyses,and fetal health follow-ups increases,they were more likely to consider that they received adequate care.

Risk factors for antenatal depression: A review

Depression is the most prevalent mental disorder in pregnancy, and yet it is lessstudied than postpartum depression despite the consequences it may have onboth the pregnant woman and her offspring. Therefore, it would be important toknow which risk factors may favour the appearance of antenatal depression inorder to carry out appropriate prevention interventions. The aim of the presentreview was to identify the main risk factors of antenatal depression. We searchedin databases PubMed and PsycINFO for articles published about the factorsassociated with antenatal depression from January 2010 through December 2020.The literature review identified three main groups of antenatal depression riskfactors: sociodemographic, obstetric, and psychological. First, among thesociodemographic variables, the low level of studies and the economic incomeclearly stood out from the rest. Then, not having planned the pregnancy was themain obstetric variable, and finally, the main psychological risk factors werehaving a history of psychological disorders and/or depression as well aspresenting anxiety, stress, and/or low social support during pregnancy. Thisreview shows that the antenatal depression is affected by multiple factors. Mostcan be identified at the beginning of the pregnancy, and some are risk factorspotentially modifiable through appropriate interventions, such as psychologicalfactors. For this reason, it is important to carry out a good screening for depressionduring pregnancy and consequently, be able to prevent its appearance ortreat it if necessary.

Does Antenatal Fear of Childbirth Predict Postnatal Fear of Childbirth? A Study of Japanese Women

The study aimed to determine whether antenatal fear of childbirth (expectation) could predict postnatal fear of childbirth (experience) by taking account of other antenatal psychological variables (anxiety and depression) as well as birth outcomes in Japanese women. A longitudinal observational study was conducted at a clinic in Tokyo, Japan, in 2011. Self-report questionnaires were distributed to 240 Japanese women at 37 gestational weeks (Time 1) and on the second day after delivery (Time 2). Regression analyses by means of structural equation modelling were conducted in both the primiparous and the multiparous group. The models exhibited good fit (chisquare value/degree of freedom = 1.10 - 1.62, comparative fit index = 0.92 - 0.99 and root mean square error of approximation = 0.03 - 0.07). Antenatal fear of childbirth was the most predictive variable of postnatal fear of childbirth in both the primiparous (β = 0.58, p = 0.002) and the multiparous group (β = 0.62, p < 0.001). In conclusion, antenatal fear of childbirth was a significant predictor of postnatal fear of childbirth when other antenatal psychological variables and birth outcomes were taken into account. Pregnant women who are strongly afraid of childbirth need special attention before and after delivery.

Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum

Objective: Anxiety is common among pregnant women. However, research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given adverse outcomes of antenatal anxiety, there is an urgent need to fill the research gaps. The objectives of the present study were to determine the prevalence of antenatal anxiety symptoms and examine the risk factors and effects of anxiety symptoms in early pregnancy on anxiety and depressive symptoms in later pregnancy and early postpartum period. Methodology: A prospective longitudinal design with quantitative approach was adopted. A consecutive sample of 1470 Chinese pregnant women from hospitals in Hong Kong was invited to participate in the study and was assessed using standardized instruments on 3 time points including first and third trimesters of pregnancy and 6-week postpartum. Results: The results showed that 17.7% of pregnant women manifested anxiety symptoms in the first trimester of pregnancy. Single mothers, younger mothers, mothers who smoked before pregnancy and mothers who received low education level reported significantly higher levels of anxiety symptoms in the first trimester. Unwanted pregnancy, low self esteem, low marital satisfaction and perceived low social support were significant psychosocial risk factors for anxiety symptoms in the first trimester. Anxiety symptoms in the first trimester were independent predictors for anxiety symptoms in the third trimester ( QUOTE β = 0.26, t = 5.74, p < 0.001), however anxiety symptoms in the first trimester no longer significantly predicted anxiety and depressive symptoms in 6 weeks postpartum after adjusting for the effects of potential confounders. Discussions: The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem and has serious impacts on maternal well-being. Such findings also contribute to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical

Estimating the impact of antenatal care visits on institutional delivery in India: A propensity score matching analysis

Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutional delivery has been overlooked by the researchers. Therefore this paper aims to examine the net impact of ANC visits on subsequent utilization of institutional delivery after removing the presence of selection bias using recent round of National Family Health survey data. The analysis has been carried out in two separate models, in the first model 1-2 ANC visits been compared with no visit and in the second model three or more antenatal care visits with no visit. The propensity score matching analysis used in this study sheds new light into this line of research which provides an effective strategy for controlling the confounding influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher chance to deliver in an institution compared to women who made no visit. In addition, if a woman visited health centre three or more than three times, her chances were 31 percent higher to deliver in an institution. Result based on sensitivity analysis suggests that selection bias on unobserved covariates would have to be around 40 percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions which plan to increase institutional delivery should target pregnant women who come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of visits, as our results indicate that three or more ANC visits significantly change the women’s attitudes towards institutional delivery.

ANTENATAL DIAGNOSIS AND MANAGEMENT OF DANDY-WALKER SYNDROME

The Dandy-Walker syndrome (DWS) can be accurately diagnosed in utero by sonographic demonstration of characteristic morphologic changes of the fetus, which includes hydrocephalus, incomplete cerebellar vermis and a posterior fossa cyst. We present a case of Dandy-Walker syndrome diagnosed antenatally. The assoiacted anomalies are reviewed, and the value of antenatal diagnosis is discussed.

Prevalence and Associated Factors of Anemia among Pregnant Women Receiving Antenatal Care (ANC) at Fatima Hospital in Jashore, Bangladesh: A Cross-Sectional Study

Since anemia is one of the most skyrocketed public health problems worldwide, an investigation has thus been conducted to assess the prevalence and associated factors of anemia among the pregnant women receiving antenatal care (ANC) at Fatima Hospital in Jashore, Bangladesh. Facility-based cross-sectional study was carried out among 384 pregnant women at Fatima hospital, Bangladesh from February to April, 2019. Data were obtained using a structured questionnaire and participant’s current medical record card. Binary logistic regression analysis was used to identify factors associated with anemia and a P-value < 0.05 was considered as statistically significance. The overall prevalence of anemia among pregnant women was 58.9% (226/384). Out of 226 anemic pregnant mothers, 36.3% (82/226) were mildly anemic, 62.4% (141/226) were moderately anemic and 1.3% (3/384) was severely anemic. Binary logistic regression analysis revealed that the following variables were significantly associated with anemia: Monthly family income (11,000 - 20,000 Taka) [AOR (95% CI) = 0.45 (0.21 - 0.98)], Family size (joint) [AOR (95% CI) = 1.59 (1.03 - 2.45)], Gestational age (third trimester) [AOR (95% CI) = 2.18 (1.40 - 3.40)], birth spacing < 2 years [AOR (95% CI) = 2.87 (1.51 - 5.44)], Excessive blood loss during previous surgery (Yes) [AOR (95% CI) = 2.08 (1.14 - 4.17)], Food group eaten 24 hours (1 - 4 groups) [AOR (95% CI) = 3.43 (1.84 - 6.39)], Breakfast regularly (No) [AOR (95% CI) = 3.64 (1.36 - 9.75)]. The results obtained showed that the prevalence of anemia among pregnant women is severe at Fatima Hospital in Jashore, Bangladesh.

Factors Affecting the Utilization of Antenatal Care among Married Women of Reproductive Age in Merca, Lower Shebelle, Somalia

Worldwide more than thousands of women and new born are at the danger of die from pregnancy and child delivery complications. Antenatal care (ANC)/ pregnancy care is the health care where expecting mothers and new born receive medical care or medical attention. The aim of this study is to examine factors affecting the utilization of antenatal care among married women of reproductive age in Merca, lower Shebelle, Somalia. Methodology: This is a descriptive cross-sectional and qualitative study design that was carried out from June to August 2022 and this study was carried out in Merca, district lower Shabelle, Somalia. Data were collected from 325 married women of reproductive age who have at least one child and more than living in Merca district. Result: Our study found that the magnitude of antenatal care uptake was 31.1% during the examined period. Very low utilization of antenatal care in Somali women is worrying in the face of high vulnerability of maternal complications. In terms of age diverse and utilization of antenatal care, women in younger age group 15 - 30 were more to utilize antenatal care services than with women in older age group 31 years above (p-value < 0.007). Our study also identified that there is association between level of education and level of utilization among women about antenatal care services (p-value < 0.001). In terms of level of awareness about antenatal care services, it is significantly associated with the level of utilization antenatal care (p-value < 0.001). Our study identified that the number of complaining complications related previous pregnancy that have no awareness about antenatal care services was higher than number of utilized antennal care awareness about antenatal care (p-value < 0.001). Based on these results, it is recommended to improve women’s awareness about antenatal care services by using health education program.

Socio-Demographics and Late Antenatal Care Seeking Behavior: A Cross Sectional Study among Pregnant Women at Kyenjojo General Hospital, Western Uganda

Background: Late antenatal care attendance among pregnant women at health facilities remains a significant public health problem. Globally, approximately 830 women die every day due to pregnancy-related complications and 99% of these deaths occur in developing countries whereby 86% of pregnant women access Antenatal Care (ANC) services at least once. Objective: The general objective of the study was to determine factors associated with late antenatal care seeking behavior among pregnant women at Kyenjojo general hospital. Methods: This was a descriptive cross sectional study design that considered quantitative data collection methods among pregnant women attending ANC. The sample size was determined using Kish and Leslie (1969) formula using a proportion of 37% (0.37) of women who sought late ANC. A systematic sampling technique was used to sample pregnant women on daily basis. Results: A total of 283 women participated in the study. Spouse’s occupation was significantly associated with late ANC attendance (p = 0.026). On the other hand, education level of respondent (Fisher’s = 8.363, p = 0.028*), religion (Fisher’s = 5.77, p = 0.048*) and parity (Fisher’s 10.312, p = 0.026*) revealed statistically significant association with late ANC attendance. In multivariate logistic regression, on occupation, women with unemployed spouses were significantly associated with 25% increase in attendance of late ANC compared to those in formal employment (AOR = 0.25, CI: 0.073 - 0.855, p = 0.027*). Conclusion: The Majority of pregnant women sought ANC at 90.1% (n = 255). There’s a need for government to strengthen health promotion targeting women in rural communities.

Impact of the Changes in Women’s Characteristics over Time on Antenatal Health Care Utilization in Egypt (2000-2008)

Objectives: This study empirically assesses the impact of the changes in women’s characteristics, empowerment, availability and quality of health services on woman’s decision to use antenatal care (ANC) and the frequency of that use during the period 2000-2008. Study Design: The study is a cross-sectional analytical study using 2000 and 2008 Egypt Demographic and Health Surveys. Methods: The assessment of the studied impact is conducted using the Zero-inflated Negative Binomial Regression. In addition, Factor Analysis technique is used to construct some of the explanatory variables such as women’s empowerment, the availability and quality of health services indicators. Results: Utilization of antenatal health care services is greatly improved from 2000 to 2008. Availability of health services is one of the main determinants that affect the number of antenatal care visits in 2008. Wealth index and quality of health services play an important role in raising the level of antenatal care utilization in 2000 and 2008. However, the impact of the terminated pregnancy on receiving ANC increased over time. Conclusions: Further research of the determinants of antenatal health care utilization is needed, using more updated measures of women’s empowerment, availability and quality of health services. In order to improve the provision of antenatal health care services, it is important to understand barriers to antenatal health care utilization. Therefore, it is advisable to collect information from women about the reasons for not receiving antenatal care.

Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study

Background: Pregnant women receive antenatal care (ANC) to ensure favorable pregnancy outcomes. Despite the high ANC coverage rate registered nationally in Cameroon;rural women, women with no formal education and those in the most deprived quintile still face difficulties in having access to quality ANC. The impact of the aforementioned factors on ANC use in the Muea Health Area (MHA) is unknown. The objective of this study was to determine the proportion of women attending ANC and the factors influencing ANC attendance in the MHA. Materials and Methods: This was a community based, analytical, cross sectional survey that involved pregnant women and women with children less than two years old who gave an informed consent or assent. Data were collected using a semi structured questionnaire. EPI info Version 7 and Stat Pac for Windows version 12??1998-2011 (Stat Pac Inc, Bloomington, USA) were used for data analysis. Associations were considered statistically significant for p values less than 0.05. Results: Two hundred and twenty women were interviewed. The mean age was 25 years (SD 5.28). Ninety-nine percent of women had at least one ANC visit meanwhile 84.8% had at least four ANC visits. Only 27.2% of women booked for ANC in the first trimester. Rural (Maumu) residence was associated with inappropriate ANC attendance (attending less than four times) (χ2?= 18.5;p = 0.001). Semi urban women (87%;95% C.I. = 85.10% - 89.0%) were more likely to attend four or more sessions than rural (Maumu) women (60.7%;95% C.I. = 44.2% - 77.3%) (p = 0.001). Participant’s educational level was a significant predictor of early booking for ANC (χ2?= 26.8;p = 0.0002). Semi urban wom- en (79.1%;95% C.I. = 76.0% - 82.2%) were significantly more likely to have a vaginal examination done than rural (Maumu) women (42.1%;95% C.I. = 17.5% - 68.2%) (p = 0.0001). Women who met a doctor during ANC (84.0%;95% C.I. = 80.8% - 87.0%) were more likely to have a vaginal examination done than women who only met a nurse or a midwife during ANC (65.0%;95% C.I. = 57.7% - 71.4%) (p = 0.002). One third of women did not have a vaginal examination performed?during ANC. 45.83% and 47.6% neither did a stool test nor received an insecticide treated net (ITN) respectively. Conclusion: Women in the MHA start their antenatal care late, so they should be encouraged to book early for antenatal surveillance. Furthermore, efforts should be made to increase the access of these women to quality ANC services and to adequately trained ANC providers.

The effect of urine pregnancy testing on timing of accessing antenatal care and abortion services in Western Nigeria

Objective: Effective confirmation of pregnancy is a basic component of reproductive health services. It is a determinant for accessing antenatal care (ANC) if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the effect of urine pregnancy testing in the timing of presentation for pregnancy care. Method: A cross-sectional study was conducted among 320 women presenting for antenatal care and 300 women presenting for abortion at private sector clinics in Western Nigeria. Results: The median age at first presentation was 20 weeks for ANC clients and 8 weeks for abortion clients. Obtaining urine pregnancy test of one’s accord was associated with a decrease in the gestational age at presentation of 3.7 weeks and 1.5 weeks for antenatal and abortion clients, respectively, independent of all other factors. Conclusion: Bearing in mind that the clinical benefit and public health impact of early presentation for antenatal and abortion services are unequivocal, strategies aimed at decreasing gestational age at presentation for pregnancy care should be given priority. “Fast-track” urine pregnancy testing services should be promoted in the private and public clinics in Nigeria.

Why pregnant women delay to initiate and utilize free antenatal care r service:a qualitative study in the Southern District of Mzimba,Malawi

Aim:The study aimed to explore factors related to the initiation and utilization of focused antenatal care(FANC)in the Southern District of Mzimba,Malawi.Methods:This study used an exploratory qualitative design.Total of 22 in-depth interviews with pregnant women and community midwife assistants were conducted from December 2015 to January 2016 in Mzimba.Thematic analysis approach was adopted to identify the facilitator and harriers of the FANC initiation and utilization.Results:Facilitator of FANC initiation and utilization included seeking pregnancy confirmation,medical treatment for an existing health problem and the support by community health extension workers.Barriers included the additional cost to free FANC service,lack of essential equipment,unfriendly adolescent reproductive health service,and HIV stigma.Conclusion:Early initiation of FANC relies on both woman’s awareness and community support.Promoting the use of FANC should focus on creating an enabling environment,e.g.,increasing investment of essential medical equipment,reducing additional costs of FANC services,eliminating the discrimination against adolescent pregnancy and people living with HIV,and strengthening health personnel’s training.

Postnatal management of antenatally detected hydronephrosis

With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.

A study of anemia in women with asymptomatic malaria parasitaemia at their first antenatal care visit at the General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria

Objective:To assess the prevalence of anemia and asymptomatia malaria parasitemia and the effect of prior antimalarials therapy on the parasite density in pregnant women at their first antenatal visit at the secondary level health care facility in Nigeria.Methods:This cross sectional observational study was carried out in the antenatal clinic of General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria for 3 months period(1st June to 31st August,2009).Five hundred and fourteen women attending their first antenatal registration visits in the hospital were recruited in the study.Socio-demographic information was obtained using pre-tested questionnaires.The malaria parasite was obtained by examining thick and thin blood films prepared on 2 glass slides while the hematocrit was obtained through 2 capillary tubes read by a Hawksleys microhematocrit reader.Results:A total of 514 pregnant women participated in the study with a mean maternal age of 21.4 years and a mean gestational age at booking of 18.3 weeks.The primigravid women booked at significantly lower gestational age than multigravidae （16.2 weeks vs 21.6 weeks）.Most of the women（59.3%） were anemic,out of which 60.4%were primigravida.More than half of the women had moderate to high parasite density and only 6.8% had no malaria parasitemia.All patients with severe anemia were parasitemic.Out of the 479 （93.2%） women with parasitemia,a third had taken antimalarial drugs.A majority（60.3%） of those without prior antimalarial drugs had moderate to high density parasitemia.Conclusions: This study shows high prevalence of anemia in women with asymptomatic malarial parasitemia, particularly the primigravida.The severity of anemia is directly related to the density of malaria parasitemia.Those with effective antimalarial therapy appear to have low density parasitemia and therefore mild anemia.Routine screening for anemia and malaria parasites at booking,prompt parasite clearance and correction of anemia would reduce the associated maternal and perinatal complications.

Determinants of Antenatal Health Care Utilization in Egypt (2000-2014) Using Binary and Count Outcomes

Aim: This study seeks to investigate the factors determining the utilization of antenatal care services, the frequency of that use, and the timing of receiving antenatal care among Egyptian women utilizing a national representative data from Egypt Demographic and Health Surveys (EDHS) in 2000 and 2014. Methods: The paper estimates the logistic regression model, zero-inflated negative binomial model (ZINB), and negative binomial regression model (NB) to identify the most important determinants of antenatal health care utilization. Results: The findings indicate that the period 2000-2014 has experienced a significant increase in the use of antenatal health care services. The use of the public sector antenatal care services relative to that of the private sector has been decreasing over time. Moreover, wealth index, women’s education and quality of health services play significant roles in increasing accessibility of antenatal health care services. On the other hand, women’s empowerment has shown a positive effect in 2000 only. Conclusion: The study highlights the most vulnerable groups that are less likely to have access to antenatal health care services, mainly women who are less educated, poor and living in rural areas especially Upper Egypt. This certainly requires a more targeted health strategy with an equity lens.