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O845 Role of anxiety during pregnancy in preterm delivery
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
mental health care and more research will aid prevention of mental disorder in pregnant mothers. O843 An assessment study of maternal morbidity and mortality statistics based on five year community based data from lady health workers in ten rural districts of Pakistan G. Shabbir, M. Malik. United Nations Population Fund Pakistan Objectives: To appraise maternal morbidity and mortality statistics during years 2004 to 2008 in LHW covered population in ten UNFPA supported districts of Pakistan. Material and Methods: Program interventions included strengthening of EmOC/FP services at 65 health facilities, skill development of 6197 LHWs in interpersonal communication, counseling skills and screening for complications and referrals. District level supervisors were trained to conduct verification of maternal deaths through verbal autopsy on structured pretested questionnaire. This was a quantitative retrospective cross sectional study for the period (2004–2008) conducted in ten districts of Pakistan. Secondary data from existing district LHW-MIS (2004–2008) was analyzed in MS Excel. Results: Deliveries by SBAs increased from 24% to 40% (n = 30036, 69011) of expected pregnancies, modern method contraceptive prevalence rate increased from 31% to 37%. Referral of women for skilled birth attendance increased from 14% to 24% (n = 190047, 247799) of expected women in reproductive age. In 2004, number of verified maternal deaths in 4.1 million LHW covered population was n = 110 and total live births were reported n = 44891 (estimate of maternal mortality ratio=245 per 100,000 live births). In 2008, number of verified maternal deaths in 6.4 million LHW covered population was n = 215 while total live births were reported n = 102,170 (estimate of maternal mortality ratio =210 per 100,000 live births). Conclusion: Strengthening of emergency obstetric care at health facilities including MIS, provision of skill based trainings to lady health workers and regular IEC activities for communities enhanced skilled birth attendance, contraceptive prevalence and referral to health facilities, and effectively contributed towards reduction in maternal mortality. O844 Influence of maternal birth status on her offspring: A systematic review and meta-analyses P. Shah, V. Shah. Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto Background: Maternal low birth weight (LBW), preterm (PTB) and small for gestational age (SGA) birth status have been suggested as precursor for infant being born LBW, PTB or SGA. Objective: To systematically review the risks of infant being born low birth weight (LBW)/preterm (PTB)/small for gestational age (SGA) among mothers who were LBW/PTB/SGA at birth. Methods: Medline, Embase, CINAHL (from inception till December 2008) and bibliographies of identified articles were searched for English language studies reporting on maternal LBW/PTB/SGA births and their association with either infant’s LBW, PTB or SGA. Data were extracted by two authors independently and discrepancies resolved by consensus. Study qualities were assessed for sample selection, exposure assessment, outcome assessment, confounder adjustment, attrition, and analytical biases. Random effect model was used for meta-analyses and Peto’s odds ratio (with 95% confidence intervals) and population attributable risks (PAR) were calculated. Results: Twenty two studies of low to moderate risk of biases were included. Maternal LBW was associated with infant being born LBW [12 studies, 525706 participants, odds ratio (OR) 2.23, 95% confidence interval (CI) 2.11, 2.35, PAR 7.1%], PTB (6 studies, 331121 participants OR 1.57, 95% CI 1.43, 1.71, PAR 4.3%) and SGA (3
studies, 324357 participants, OR 1.83, 95% CI 1.43, 2.33, PAR 6.6%). Maternal PTB was associated with infant’s PTB (7 studies, 282616 participants, OR 1.41, 95% CI 1.26, 1.59, PAR 6.2%), and SGA (3 studies, 41590 participants, OR 1.33, 95% CI 1.08, 1.64, PAR 3.6%) births. Maternal SGA status was associated with infant’s PTB (3 studies, 41614 participants, OR 1.58, 95% CI 1.06, 2.37, PAR 6.3%) and SGA (3 studies, 41586 participants, OR 2.64, 95% CI 2.28, 3.05, PAR 11.8%). Conclusions: Maternal LBW/PTB/SGA status at birth was associated with a significantly increased risk of LBW/PTB/SGA status in the index child. O845 Role of anxiety during pregnancy in preterm delivery Z. Shahhosseini1 , K. Abedian1 , H. Azimi2 . 1 Department of Midwifery, Mazandaran University of Medical Science, Sari, Iran, 2 Department of Nursing, Mazandaran University of Medical Science, Sari, Iran Background and Objective: Preterm delivery has considerable social, economical and mental effects on neonate and related family. Factors predisposing to, and preventing preterm delivery are still not clearly recognized. However some studies have shown psychological factors to play some role. This study was conducted to evaluate the effect of anxiety in inducing preterm delivery. Materials and Methods: In this cohort study conducted in sari (2006–2007) in Iran a consecutive series of 282 pregnant women with singleton pregnancies referred for routine prenatal care were included. Anxiety was assessed using self-administered Spielberger’s state-trait anxiety questionnaire. The 75th percentile was used for anxiety scores. Results: Mean score of state and trait anxiety of cases was 38.5±9.9 (20–74) and 41.2±9.2 (20–77) respectively. There was a meaningful statistical relationship between state anxiety and preterm delivery (P = 0.02, RR = 2.71) and trait anxiety and preterm delivery (P = 0.009, RR = 1.59). Conclusion: Further studies incorporating multiple psychosocial domains, gaining information about women’s social environment, life circumstances and possible biologic pathways through which anxiety and stress operates may reinforce our understanding of the role of stress in pregnancy. O846 Parietal peritoneal closure and postcesarean pain A. Shahin1 , A. Osman. 1 Department of Obstetrics and Gynecology, Women’s Health Centre, Assiut University Objective: To assess the incidence of persistent pain after cesarean delivery. Methods: A total of 340 pregnant women with no history of abdominal surgery were randomized to undergo or not undergo parietal peritoneal closure following elective cesarean delivery. Pain scores were recorded on the 1st and 15th postoperative day and the women were followed up every 2 weeks up to 8 months after surgery. Results: Overall and epigastric abdominal pain were more frequent in the closure than in the nonclosure group. Pain scores on the 1st and 15th days and after 8 months were higher in the closure group, in which the incidence of persistent postcesarean pain was 17.8% after 8 months. Conclusion: Parietal peritoneal closure after cesarean delivery is associated with a higher incidence of early and persistent postoperative pain. A high pain score on the 1st day is a predictor of persistent pain.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
mental health care and more research will aid prevention of mental disorder in pregnant mothers. O843 An assessment study of maternal morbidity and mortality statistics based on five year community based data from lady health workers in ten rural districts of Pakistan G. Shabbir, M. Malik. United Nations Population Fund Pakistan Objectives: To appraise maternal morbidity and mortality statistics during years 2004 to 2008 in LHW covered population in ten UNFPA supported districts of Pakistan. Material and Methods: Program interventions included strengthening of EmOC/FP services at 65 health facilities, skill development of 6197 LHWs in interpersonal communication, counseling skills and screening for complications and referrals. District level supervisors were trained to conduct verification of maternal deaths through verbal autopsy on structured pretested questionnaire. This was a quantitative retrospective cross sectional study for the period (2004–2008) conducted in ten districts of Pakistan. Secondary data from existing district LHW-MIS (2004–2008) was analyzed in MS Excel. Results: Deliveries by SBAs increased from 24% to 40% (n = 30036, 69011) of expected pregnancies, modern method contraceptive prevalence rate increased from 31% to 37%. Referral of women for skilled birth attendance increased from 14% to 24% (n = 190047, 247799) of expected women in reproductive age. In 2004, number of verified maternal deaths in 4.1 million LHW covered population was n = 110 and total live births were reported n = 44891 (estimate of maternal mortality ratio=245 per 100,000 live births). In 2008, number of verified maternal deaths in 6.4 million LHW covered population was n = 215 while total live births were reported n = 102,170 (estimate of maternal mortality ratio =210 per 100,000 live births). Conclusion: Strengthening of emergency obstetric care at health facilities including MIS, provision of skill based trainings to lady health workers and regular IEC activities for communities enhanced skilled birth attendance, contraceptive prevalence and referral to health facilities, and effectively contributed towards reduction in maternal mortality. O844 Influence of maternal birth status on her offspring: A systematic review and meta-analyses P. Shah, V. Shah. Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto Background: Maternal low birth weight (LBW), preterm (PTB) and small for gestational age (SGA) birth status have been suggested as precursor for infant being born LBW, PTB or SGA. Objective: To systematically review the risks of infant being born low birth weight (LBW)/preterm (PTB)/small for gestational age (SGA) among mothers who were LBW/PTB/SGA at birth. Methods: Medline, Embase, CINAHL (from inception till December 2008) and bibliographies of identified articles were searched for English language studies reporting on maternal LBW/PTB/SGA births and their association with either infant’s LBW, PTB or SGA. Data were extracted by two authors independently and discrepancies resolved by consensus. Study qualities were assessed for sample selection, exposure assessment, outcome assessment, confounder adjustment, attrition, and analytical biases. Random effect model was used for meta-analyses and Peto’s odds ratio (with 95% confidence intervals) and population attributable risks (PAR) were calculated. Results: Twenty two studies of low to moderate risk of biases were included. Maternal LBW was associated with infant being born LBW [12 studies, 525706 participants, odds ratio (OR) 2.23, 95% confidence interval (CI) 2.11, 2.35, PAR 7.1%], PTB (6 studies, 331121 participants OR 1.57, 95% CI 1.43, 1.71, PAR 4.3%) and SGA (3
studies, 324357 participants, OR 1.83, 95% CI 1.43, 2.33, PAR 6.6%). Maternal PTB was associated with infant’s PTB (7 studies, 282616 participants, OR 1.41, 95% CI 1.26, 1.59, PAR 6.2%), and SGA (3 studies, 41590 participants, OR 1.33, 95% CI 1.08, 1.64, PAR 3.6%) births. Maternal SGA status was associated with infant’s PTB (3 studies, 41614 participants, OR 1.58, 95% CI 1.06, 2.37, PAR 6.3%) and SGA (3 studies, 41586 participants, OR 2.64, 95% CI 2.28, 3.05, PAR 11.8%). Conclusions: Maternal LBW/PTB/SGA status at birth was associated with a significantly increased risk of LBW/PTB/SGA status in the index child. O845 Role of anxiety during pregnancy in preterm delivery Z. Shahhosseini1 , K. Abedian1 , H. Azimi2 . 1 Department of Midwifery, Mazandaran University of Medical Science, Sari, Iran, 2 Department of Nursing, Mazandaran University of Medical Science, Sari, Iran Background and Objective: Preterm delivery has considerable social, economical and mental effects on neonate and related family. Factors predisposing to, and preventing preterm delivery are still not clearly recognized. However some studies have shown psychological factors to play some role. This study was conducted to evaluate the effect of anxiety in inducing preterm delivery. Materials and Methods: In this cohort study conducted in sari (2006–2007) in Iran a consecutive series of 282 pregnant women with singleton pregnancies referred for routine prenatal care were included. Anxiety was assessed using self-administered Spielberger’s state-trait anxiety questionnaire. The 75th percentile was used for anxiety scores. Results: Mean score of state and trait anxiety of cases was 38.5±9.9 (20–74) and 41.2±9.2 (20–77) respectively. There was a meaningful statistical relationship between state anxiety and preterm delivery (P = 0.02, RR = 2.71) and trait anxiety and preterm delivery (P = 0.009, RR = 1.59). Conclusion: Further studies incorporating multiple psychosocial domains, gaining information about women’s social environment, life circumstances and possible biologic pathways through which anxiety and stress operates may reinforce our understanding of the role of stress in pregnancy. O846 Parietal peritoneal closure and postcesarean pain A. Shahin1 , A. Osman. 1 Department of Obstetrics and Gynecology, Women’s Health Centre, Assiut University Objective: To assess the incidence of persistent pain after cesarean delivery. Methods: A total of 340 pregnant women with no history of abdominal surgery were randomized to undergo or not undergo parietal peritoneal closure following elective cesarean delivery. Pain scores were recorded on the 1st and 15th postoperative day and the women were followed up every 2 weeks up to 8 months after surgery. Results: Overall and epigastric abdominal pain were more frequent in the closure than in the nonclosure group. Pain scores on the 1st and 15th days and after 8 months were higher in the closure group, in which the incidence of persistent postcesarean pain was 17.8% after 8 months. Conclusion: Parietal peritoneal closure after cesarean delivery is associated with a higher incidence of early and persistent postoperative pain. A high pain score on the 1st day is a predictor of persistent pain.