Sophie Graner

Pregnancies and births among adolescents: A population-based prospective study in rural Vietnam

OBJECTIVE To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam. MATERIAL AND METHOD Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15-19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors. RESULT A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18 years. The estimated adolescent birth rate during 1999-2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW. CONCLUSION Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.

Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999–2005

Population-based estimations of perinatal and neonatal outcomes are sparse in Vietnam. There are no previously published data on small for gestational age (SGA) infants. A rural population in northern Vietnam was investigated from 1999 to 2005 (n=5521). Based on the birthweight distributions within the population under study, reference curves for intrauterine growth for Vietnamese infants were constructed and the prevalence and distribution of SGA was calculated for each sex. Neonatal mortality was estimated as 11.6 per 1000 live births and the perinatal mortality as 25.0 per 1000 births during the study period. The mean birthweight was 3112 g and the prevalence of low birthweight was 5.0%. The overall prevalence of SGA was 6.4%. SGA increased with gestational age and was 2.2%, 4.5% and 27.1% for preterm, term and post-term infants, respectively. Risk factors for SGA were post-term birth: adjusted odds ratio (AOR) 7.75 [95% CI 6.02, 9.98], mothers in farming occupations AOR 1.72 [95% CI 1.21, 2.45] and female infant AOR 1.61 [95% CI 1.27, 2.03]. There was a pronounced decrease in neonatal mortality after 33 weeks of gestation. Suggested interventions are improved prenatal identification of SGA infants by ultrasound investigation for fetal growth among infants who do not follow their expected clinical growth curve at the antenatal clinic. Other suggestions include allocating a higher proportion of preterm deliveries to health facilities with surgical capacity and neonatal care.

‘Women think pregnancy management means obstetric ultrasound’: Vietnamese obstetricians’ views on the use of ultrasound during pregnancy

Objective To explore Vietnamese obstetricians’ experiences and views on the role of obstetric ultrasound in clinical management of complicated pregnancy and in situations where maternal and fetal health interests conflict. Design Seventeen obstetricians in northern Vietnam were interviewed as part of the CROss-Country Ultrasound Study (CROCUS) project in 2013. Data were analysed using qualitative content analysis. Results The participants described ultrasound as a central tool in prenatal care, although they called for increased training and resources to prevent inappropriate management. A prevailing overuse driven by womens request and increased commercialisation was described. Other clinical examinations were seen as being disregarded by women in favour of ultrasound, resulting in missed opportunities for identifying potential pregnancy complications. The use of ultrasound for sex selection purposes raised concern among participants. Visualisation of human features or heartbeat during ultrasound was commonly described as the point where the fetus became regarded as a ‘person’. Women were said to prioritise fetal health interests over their own health, particularly if a woman had difficulties becoming pregnant or had undergone assisted fertilisation. The womans husband and his family were described as having an important role in decision-making in situations of maternal and fetal health conflicts. Conclusions This study provides insight into issues surrounding ultrasound use in contemporary Vietnam, some of which may be specific to this low-income context. It is clear that ultrasound has become a central tool in prenatal care in Vietnam and that it has also been embraced by women. However, there seems to be a need to balance womens demands for obstetric ultrasound with better recognition of the valuable contribution to be made by the full range of clinical examinations in pregnancy, along with a more strategic allocation of resources, that is, use of obstetric ultrasound based on clinical indications. Better regulation of private obstetric practice also appears to be needed. While the root causes of sex selection need to be addressed at societal level, efforts are also required more immediately to find ways to combat the inappropriate use of ultrasound for the purpose of sex selection.

Pregnant women's perception on signs and symptoms during pregnancy and maternal health care in a rural low-resource setting

Womens understanding of pregnancy and antenatal care is influenced by their cultural context. In low‐income settings women may have limited influence over their reproductive health, including when to seek health care. Awareness of signs of pregnancy complications is essential for timely care. The use of antenatal care services in Vietnam has been studied with quantitative methods but there are few qualitative studies on the perceptions of pregnancy and maternal health care among Vietnamese women.

Two sides of the same coin - an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management

BackgroundThe extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman’s reproductive freedom. The purpose of this study was to explore Swedish obstetricians’ experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict.MethodsA qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis.ResultsThe theme that emerged in the analysis ‘Two sides of the same coin’ depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman’s health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety.ConclusionsThe widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician’s position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.

Risk factors for intrapartum acidemia – a cohort study

Abstract Purpose: Birth acidemia is associated with short- and long-term morbidity in the child. Optimal intrapartum surveillance and timely interventions may reduce the incidence of these outcomes. Knowledge about conditions which increase the risks might be beneficial for optimal care. The aim with this study was to identify factors which increased the risk for lactacidemia in fetal scalp blood. Materials and methods: A secondary analysis of a cohort study performed at Karolinska University Hospital Stockholm Sweden between February 2009 and February 2011. The study population included 1070 women in labor where fetal scalp blood sampling (FBS) was performed. Results: In a univariate logistic regression analysis for lactate >4.8 mmol/L at FBS, minor language barriers (OR 2.54; 95%CI 1.26–5.11), active bearing down (OR 2.46; 95%CI 1.12–5.39) and maternal height <155 cm (OR 2.15; 95%CI 1.08–4.26) were found as risk factors. In a multivariate logistic regression analysis, minor language barriers (OR 2.21; 95%CI 1.05–4.67) and active pushing (OR 2.68; 95%CI 1.20–6.00) remained significant. Conclusions: Language barriers, active pushing and short stature were found to be significant risk factors for intrapartum lactacidemia. In the group with minor language problems better use of interpreters might be beneficial.