Browsing by Subject "Fetal Death"

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    Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon
    (2016) Djomhou, Manuella; Sobngwi, Eugène; Noubiap, Jean Jacques N; Essouma, Mickael; Nana, Philip; Fomulu, Nelson J
    Abstract Background Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. Methods A prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. Results One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. Conclusions The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series.
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    Stillbirth : a psychosocial crisis
    (1986) Friedlander, Anne; Orten, James
    This study is an investigation of the psychosocial trauma of stillbirth and the implications of that trauma for case management. Stillbirth is considered a crisis for parents that calls for immediate intervention and constructive management. It strains family coping mechanisms and can overwhelm them if not properly handled. Additionally, a grief response follows a stillbirth which must be recognised, accepted, and treated therapeutically if needed. Parents' problems and needs have not been adequately met by medical, social or community services. There is also little recognition of the training needed by medical personnel in the management of stillbirths. Stillbirth is also a crisis for medical personnel as the delivery of a dead baby evokes feelings of confusion and stress for those dealing with the confinement and aftercare. By highlighting the psychological and emotional sequelae of stillbirths for parents, the needs of parents after the event, and the needs of personnel providing care, the writer intended to contribute to an improved understanding of the issues related to stillbirth and, ultimately, to more compassionate care for those who experience this unhappy event. Issues analyzed and recorded are as follows: The emotional and physical reactions of mothers following a stillbirth; the assistance that parents need in order to adjust constructively; the impact that the stillbirth has upon the family; the mothers' interpretation of their management in hospital; and the hospital and community services rendered and needed to assist with constructive adjustment. Study data was collected over a six month period. Subjects were selected from one hospital and were residents of the municipal areas of Cape Town. Two face-to-face interviews were conducted with each respondent using a semi-structured interview schedule. The first interview, which took place within a week of the mothers' discharge from hospital, gathered data on the reactions of the respondents to stillbirth, the impact of stillbirth on the family, and respondents' interpretation of their management in hospital. This interview was tape-recorded. The second interview followed the interview schedule and obtained information on the needs of families after a stillbirth. Data was coded on the interview schedules and statistical analysis was done by computer. The findings of this study agreed with previous ones, that mothers display typical grief reactions after a stillbirth. The stillbirth was experienced as a disappointment that caused significant distress for the majority of mothers. Management was found to be satisfactory with the exception of post-natal placement. The need for options in this area became evident. A lack of social and psychological services, both within the hospital and in the community, was found. Using knowledge gained from this study, a support organization for parents experiencing stillbirths has been organized with the writer's assistance. A breakdown in communication between the hospital and the local authority health nursing services, in terms of knowledge about the stillbirth, was apparent, and improvement in this area is needed. Recommended guidelines for management based on the research findings and literature review have been proposed. The role of the social worker, doctor and nursing sister have been outlined.