Linda Mason

Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan

BackgroundLow birthweight is a widely used indicator of newborn health. This study investigates the association of birthweight <2.5 kg (LBW) with a wide range of factors related to geo-demographics, maternal health and pregnancy history in public hospitals at Peshawar, North West Frontier Province (NWFP) Pakistan. It is noted that that Low birthweight may arise for two different reasons, one related to gestational age and the other corresponding to births that are small for gestational age (SGA).MethodsData on geo-demographics, maternal health indicators, pregnancy history and outcome scores for newborn babies and their families (n = 1039) were collected prospectively between August and November 2003 in a cross-sectional survey of four public hospitals in Peshawar, NWFP-Pakistan. Crude and adjusted odds ratios were used to investigate the factors affecting incidence of LBW, by multivariate logistic regression. Gestational age was included as an explanatory variable therefore the additional covariates identified by model selection are expected to account for SGA.ResultsThe main geo-demographic risk factors for SGA identified in this study, controlling for gestational age of less than 37 weeks, are maternal age, nationality and consanguinity. Presentation with anaemia and the history of previous abortion/miscarriage were also found to be significant independent factors. The adjusted odds ratio for gestational age showed the largest effect in explaining the incidence of LBW. The next highest odds ratio was for maternal age below 20 years. The explanatory model included two pairwise interactions, for which the predicted incidence figures for LBW show an increase among the Tribal area with presentation of anaemia, and among full term babies with their mothers having a previous history of abortion/miscarriage.ConclusionIn addition to gestational age, specific factors related to geo-demographics (maternal age, consanguinity and nationality), maternal health (anaemia) and pregnancy history (abortion/miscarriage) were significantly associated with the incidence of LBW observed at the four hospitals surveyed in Peshawar. These results indicate that cultural factors can adversely affect the incidence of SGA in this area of Pakistan.

Do Women Practise Pelvic Floor Exercises during Pregnancy or following Delivery

Summary Background and Purpose The present study was carried out to investigate whether women chose to perform pelvic floor muscle exercises PFME) following routine instruction from health professionals, during pregnancy or following delivery. The motivation to exercise or not was also investigated. Methods As described in the previous paper, questionnaires were sent out at 34 weeks of pregnancy to 918 women, and at eight weeks post-partum, to 894 women at two hospitals in the north-west of England. The questionnaire determined the prevalence of stress incontinence, and the frequency with which women performed PFME. Semi-structured interviews were also carried out with a sample of 42 women who reported symptoms of incontinence at eight weeks after delivery. The interviews collected information on instruction received in PFME and carrying out the exercises. Results While most women exercised their PFM, this was usually done on an irregular basis. Just 17% of women undertook daily PFME during pregnancy, and following delivery the figure was 20%. Women were motivated to exercise if they had a current problem with stress incontinence, however some asymptomatic women also exercised to prevent future symptoms from occurring. Knowing an incontinence sufferer and receiving instructions to exercise were also motivational factors. Conclusions Few women exercised regularly enough for maximum benefit to be obtained. Many were keen to exercise their pelvic floor muscles (PFM) yet had a problem remembering to do the exercises. If PFME are to be taught as part of the routine care of women during pregnancy and childbirth, health professionals should also provide cues to exercise, as well as emphasising the need for regular exercise.

The relationship between ante-natal pelvic floor muscle exercises and post-partum stress incontinence

Summary Background and Purpose The present study was undertaken to investigate whether there is any relationship between ante-natal pelvic floor muscle exercises (PFME) and post-partum stress incontinence. Methods Questionnaires were sent out at 34 weeks of pregnancy, and at eight weeks post-partum, to all women booked in at two hospitals in the North West of England. At 34 weeks, 717 women out of 918 who were sent the questionnaire responded (78%). At eight weeks post-partum, 572 women out of 894 women who were sent a questionnaire returned it (64%). The questionnaires were used to determine the prevalence of reported symptoms of stress incontinence and the frequency with which the women performed PFME. Maternal and obstetric data were obtained from every participants medical record. The SPSS PC statistical package was used to determine relationships between PFME and stress incontinence, and to look for any differences between exercisers and non-exercisers. Results Women who performed ante-natal PFME several times per week, or on a daily basis, were less likely to report stress incontinence following delivery in comparison to women who exercised infrequently. Women who did not exercise their pelvic floor muscles were also less likely to report stress incontinence compared to infrequent exercisers. Exercisers were found to differ from non-exercisers with respect to a number of maternal and obstetric variables. Conclusions There appears to be a relationship between ante-natal PFME and post-partum stress incontinence: women who exercise daily or several times per week are significantly less likely to report symptoms of stress incontinence (χ 2 = 14.5, df=1, p=0.006). This has implications for the provision of instruction in PFME to women during their child-bearing years.

Referral to a National Health Service-funded abortion clinic

Objective To investigate the referral process from two Primary Care Trusts to a National Health Service-funded abortion clinic in the North West of England. Methods The study comprised a survey of all clinic attendees from within the study area during a 6-month period. All attending women were asked to complete an anonymous questionnaire. A total of 202 questionnaires were given out and 143 were returned completed (a 71% response rate). Results At least 90% of the women were referred directly from the first health professional they consulted to the abortion clinic. Five percent of the women were either referred to another health professional or not referred anywhere. Twelve percent of the women had to wait longer than the 3 weeks recommended by the Royal College of Obstetricians and Gynaecologists guideline. In a minority of cases this wait extended up to 7 weeks. However, most women were satisfied with the length of wait, the health professional they consulted with and, in particular, the care they received at the abortion clinic itself. Conclusions In a minority of cases the referral system failed to meet the guidelines and recommendations made by professional bodies. Changes are necessary to ensure that all women receive a prompt and efficient referral to ensure that their procedure occurs at the earliest possible gestation.