Abstract: The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.
Abstract: The quality of prenatal care is key to reduce maternal morbidity and mortality. Communication between the health service and users can stimulate prevention and care. M-health has been an important and low cost strategy to health education. The PRENACEL programme (prenatal in the cell phone) was developed. It consists of a programme of information via SMS from the 20th week of pregnancy up to 12th week after delivery. Messages were about prenatal care, birth, contraception and breastfeeding. Communication of the pregnant woman asking questions about their health was possible. The objective of this study was to evaluate the implementation of PRENACEL as a useful complement to the standard prenatal care. Twenty health clinics were selected and randomized by cluster, 10 as the intervention group and 10 as the control group. In the intervention group, women and their partner were invited to participate. The control group received the standard prenatal care. All women were interviewed in the immediate post-partum and in the 12th and 24th week post-partum. Most women were married, had more than 8 years of schooling and visit the clinic more than 6 times during prenatal care. The intervention group presented lowest percentage of higher economic participants (5.6%), less single mothers and no drug user. It also presented more prenatal care visits than the control group and it was less likely to present Severe Acute Maternal Mortality when compared to control group as well as higher percentage of partners (75.4%) was present at the birth compared to control group. Although the study is still being carried out, preliminary data are showing positive results of the compliance of women to prenatal care.
Abstract: Young people today has sexual activities differing from those of earlier generations, in that teenagers are likely to have multiple partners, and are frequently in short-term relationships or with partners that are not well known to them. The proportion of teenage mothers in Thailand has increased. Young people were not specifically addressed during the overall very successful HIV-prevention campaigns. Because of this missed opportunity, they are still unaware of the risk of unsafe sexual behavior. Aims: To describe the reproductive health care services in perspectives of rural Thai teenagers Methods: This survey was one part of a mixed method approach taken using survey and focus groups with 439 teenagers aged 12-18 years in 5 villages, Udon Thani, Thailand. The standard questionnaire survey had been used for collecting data. The numeric data was checked and analyzed by using descriptive statistics. Results: Most teenager respondents stated that they do not know where sexual reproductive health services provided for them. Most teenagers felt difficult to access and talk with health staff about sexual related issues. They stated that discussing, or consulting with health providers might not be safe. Teenagers might lose opportunities to access and get advice from health care services. The mean knowledge score of contraception and condom reproductive was 6.34 from a total score 11. Most teenagers especially girls expressed a need for counseling services and reported a need for telephone services. Conclusions: The need of appropriate information focusing on sexual relationships and contraception should be designed to help young people make wise decisions and there should be set health care services for Thai teenagers to make sure that teenagers could access easily. Health care providers need to be trained to improve their knowledge, attitudes and skills in reproductive health care practices for Thai teenagers.
Abstract: This paper is concerned with the ways in which
Assisted Reproductive Technologies (ARTs) affect women’s lives
and perceptions regarding their infertility, contraception and
reproductive health. The paper is based on a qualitative feminist
survey study to explore and analyze issues arising from the use of
ARTs by women in New Delhi, the capital of India. A rapid growth in
the number of fertility clinics has been noticed recently. A critical
analysis of interviews revealed that these technologies are used and
developed for making profits at the cost of women’s lives. In this
way, these technologies are influencing and changing the traditional
patterns of motherhood requiring a rethinking about new ways of
reproduction introduced through the use of ARTs.
Abstract: Introduction: There are multiple social, individual and
cultural factors that influence an individual’s decision to adopt family
planning methods especially among non-users in patriarchal societies
like Pakistan. Non-users, if targeted efficiently, can contribute
significantly to country’s CPR. A research study showed that nonusers
if convinced to adopt lactational amenorrhea method can shift
to long term methods in future. Research shows that if non users are
targeted efficiently a 59% reduction in unintended pregnancies in
Saharan Africa and South-Central and South-East Asia is anticipated.
Methods: We did secondary data analysis on Pakistan
Demographic Heath Survey (2012-13) dataset. Use of contraception
(never-use/ever-use) was the outcome variable. At univariate level
Chi-square/Fisher Exact test was used to assess relationship of
baseline covariates with contraception use. Then variables to be
incorporated in the model were checked for multicollinearity,
confounding and interaction. Then binary logistic regression (with an
urban-rural stratification) was done to find relationship between
contraception use and baseline demographic and social variables.
Results: The multivariate analyses of the study showed that
younger women (≤ 29 years)were more prone to be never users as
compared to those who were >30 years and this trend was seen in
urban areas (AOR 1.92, CI 1.453-2.536) as well as rural areas (AOR
1.809, CI 1.421-2.303). While looking at regional variation, women
from urban Sindh (AOR 1.548, CI 1.142-2.099) and urban
Balochistan (AOR 2.403, CI 1.504-3.839) had more never users as
compared to other urban regions. Women in the rich wealth quintile
were more never users and this was seen both in urban and rural
localities (urban (AOR 1.106 CI .753-1.624); rural areas (AOR 1.162,
CI .887-1.524)) even though these were not statistically significant.
Women idealizing more children (>4) are more never users as
compared to those idealizing less children in both urban (AOR 1.854,
CI 1.275-2.697) and rural areas (AOR 2.101, CI 1.514-2.916).
Women who never lost a pregnancy were more inclined to be nonusers
in rural areas (AOR 1.394, CI 1.127-1.723) .Women familiar
with only traditional or no method had more never users in rural areas
(AOR 1.717, CI 1.127-1.723) but in urban areas it wasn’t significant.
Women unaware of Lady Health Worker’s presence in their area
were more never users especially in rural areas (AOR 1.276, CI
1.014-1.607). Women who did not visit any care provider were more
never users (urban (AOR 11.738, CI 9.112-15.121) rural areas (AOR
7.832, CI 6.243-9.826)).
Discussion/Conclusion: This study concluded that government,
policy makers and private sector family planning programs should
focus on the untapped pool of never users (younger women from underserved provinces, in higher wealth quintiles, who desire more
children.). We need to make sure to cover catchment areas where
there are less LHWs and less providers as ignorance to modern
methods and never been visited by an LHW are important
determinants of never use. This all is in sync with previous literate
from similar developing countries.