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Svallfors, S., Båge, K., Ekström, A. M., Elimian, K., Gayawan, E., Litorp, H. & Kågesten, A. (2024). Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. Social Science and Medicine, 348, Article ID 116777.
Open this publication in new window or tab >>Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria
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2024 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 348, article id 116777Article in journal (Refereed) Published
Abstract [en]

Background: Armed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria.

Methods: We conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017-2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decisionmaking, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED.

Results: Exposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict -affected men were more likely to support a delay in girls' childbearing.

Conclusion: Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk -aversion strategies in response to mortality threats, livelihood losses, and conflict -driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict -affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-528667 (URN)10.1016/j.socscimed.2024.116777 (DOI)001220892400001 ()38569280 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation, 2021.0331Bill and Melinda Gates Foundation, OPP1186559
Available from: 2024-05-29 Created: 2024-05-29 Last updated: 2024-05-29Bibliographically approved
Kukka, A. J., Sundelin, H. E. K., Basnet, O., Paudel, P., Subedi, K. U., Svensson, K., . . . KC, A. (2024). NeuroMotion Smartphone Application for Remote General Movements Assessment: a Feasibility Study in Nepal. BMJ Open, 14(3), Article ID e080063.
Open this publication in new window or tab >>NeuroMotion Smartphone Application for Remote General Movements Assessment: a Feasibility Study in Nepal
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2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 3, article id e080063Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening of infants for cerebral palsy in Kathmandu, Nepal. 

METHOD: Thirty-one term born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women’s Hospital, 1st October 2021 to 7th January 2022. Parents filmed their children at home using the app at 3 months’ age and the videos were assessed for technical quality using a standardized form and for fidgety movements by Prechtl’s General Movements Assessment. Usability of the app was evaluated through a parental survey. 

RESULTS: Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive. 

INTERPRETATION: Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
cerebral palsy, general movements assessment, neonatal follow-up, low- and middle income countries, pilot projects
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-523703 (URN)10.1136/bmjopen-2023-080063 (DOI)001179427300001 ()38431302 (PubMedID)
Funder
Promobilia foundation, 21009Linnéa och Josef Carlssons stiftelseStiftelsen Folke Bernadottes minnesfondInsamlingsstiftelsen Födelsefonden - Perinatalmedicinska forskningsfonden i UppsalaRegion Stockholm, 2019-1138Knut and Alice Wallenberg Foundation
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-04-03Bibliographically approved
Gerde, P., Sjöberg, C.-O., Bäckroos, H., Englund, J., Wangheim, M. & Litorp, H. (2024). Regional lung targeting with a fluticasone/salmeterol aerosol using a bolus breath hold method of the PreciseInhale® system: A first evaluation in humans. European Journal of Pharmaceutical Sciences, 196, Article ID 106742.
Open this publication in new window or tab >>Regional lung targeting with a fluticasone/salmeterol aerosol using a bolus breath hold method of the PreciseInhale® system: A first evaluation in humans
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2024 (English)In: European Journal of Pharmaceutical Sciences, ISSN 0928-0987, E-ISSN 1879-0720, Vol. 196, article id 106742Article in journal (Refereed) Published
Abstract [en]

Background

In development of inhaled drugs- and formulations the measured concentration in the systemic circulation is often used as a surrogate for local dosimetry in the lungs. To further elucidate regional differences in the fate of drugs in the lungs, different aerodynamic sizes of aerosols have been used to target major airway regions. An alternative approach to achieve regional targeting of aerosols, is to use a defined aerosol bolus together with a bolus breath hold strategy. A small volume of test aerosol is intercalated and stopped at different penetration depths, to achieve increased drug deposition at chosen lung locations. Drug permeation from the lung regions is then investigated by repeatedly sampling venous blood from the systemic circulation.

The PreciseInhale® (PI) exposure platform was developed to allow generation of aerosols from different sources, including clinical inhalers, into a holding chamber, for subsequent use with alternative exposure modules in vitro and in vivo. In the current first-in-human study was investigated the feasibility of a new clinical exposure module added to the PI system. By extracting aerosol puffs from a medical inhaler for subsequent delivery to volunteers, it was possible to administer whole lung exposures, as well as regional targeting exposures.

Methods

Aerosols containing 250 µg/25 µg fluticasone propionate (FP)/salmeterol xinafoate (SMX) were automatically actuated and extracted from the pressurized Metered Dose Inhaler (pMDI) Evohaler Seretide forte into the PI system's holding chamber, then administered to the healthy volunteers using controlled flowrate and volume exposure cycles.

Two main comparisons were made by measuring the systemic PK response: I. One label dose directly from the inhaler to the subject was compared to the same dose extracted from the pMDI into the PI system and then administered to the subject. II A small aerosol bolus at a penetration level in the central airways was compared to a small aerosol bolus at a penetration level in the peripheral lung.

Results and Conclusions

When one inhaler dose was administered via the PI system, the absorbed dose, expressed as AUC24, was approximately twice as high and the CV was less than half, compared to direct inhalation from the same pMDI. Bolus breath hold targeting of drugs from the same aerosol mixture to the peripheral lung and the central airways showed a difference in their appearance in the systemic circulation. Normalized to the same deposited dose, SMX had a 57 % higher Cmax in the peripheral lung compared to the central airways. However, from 6 to 24 h after dosing the systemic concentrations of SMX from both regions were quite similar. FP had parallel concentrations curves with a 23 % higher AUC24 in the peripheral lung with no noticeable elevation around Cmax. The permeability of these two substances from similar sized aerosols was indeed higher in the thinner air/blood barriers of the peripheral lung compared to the central airways, but differences as measured on the venous side of the circulation were not dramatic. In conclusion, the PI system provided better control of actuation, aspiration, and dispensation of aerosols from the clinical inhaler and thereby delivered higher quality read outs of pharmacokinetic parameters such as tmax, Cmax, and AUC. Improved performance, using PI system, can likely also be employed for studying regional selectivity of other responses in the lungs, for use in drug development.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
PreciseInhale, Fluticasone propionate, Salmeterol xinafoate, Regional targeting, Bolus breath hold, Pharmacokinetics
National Category
Pharmacology and Toxicology Physiology
Identifiers
urn:nbn:se:uu:diva-527979 (URN)10.1016/j.ejps.2024.106742 (DOI)001208417600001 ()38460609 (PubMedID)
Available from: 2024-05-15 Created: 2024-05-15 Last updated: 2024-05-15Bibliographically approved
Kukka, A. J., Bhattarai, P., Sundelin, H. E. K., Gurung, R., Brown, N. J. W., Litorp, H., . . . KC, A. (2024). 'We did everything by phone': a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal. BMC Pediatrics, 24, Article ID 357.
Open this publication in new window or tab >>'We did everything by phone': a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal
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2024 (English)In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 24, article id 357Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers’ perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal.

METHODS: This is an explorative qualitative study that used focus group discussions (n=2) and individual interviews (n=4) with mothers of term-born infants surviving birth asphyxia or neonatal seizures. Parents used the NeuroMotion™ smartphone app to film their children at home and the videos were analysed using General Movements Assessment. Sekhon et al.’s framework on the acceptability of health care interventions guided the design of the interviews and the deductive qualitative content analysis.

RESULTS: Mothers were interested in engaging with the programme and expressed hope it would benefit their children. Most felt use of the app was intuitive. They were, however, unclear about the way the analysis was performed. Support from the research team was often needed to overcome an initial lack of self-confidence in using the technology and to reduce anxiety related to the follow-up. The intervention was overall perceived as recommendable but should be supplemented by a face-to-face consultation.

CONCLUSION: Smartphone aided remote screening of cerebral palsy is acceptable in a lower middle-income population but requires additional technical support.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
cerebral palsy, qualitative research, general movements assessment, neonatal follow-up, low- and middle-income countries, telemedicine
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-523708 (URN)10.1186/s12887-024-04829-5 (DOI)
Available from: 2024-02-22 Created: 2024-02-22 Last updated: 2024-05-22Bibliographically approved
Kiruja, J., Osman, F., Egal, J. A., Klingberg-Allvin, M. & Litorp, H. (2023). Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital. Global Health Action, 16(1), Article ID 2207862.
Open this publication in new window or tab >>Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital
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2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2207862Article in journal (Refereed) Published
Abstract [en]

Background In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. Objective To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored. Methods Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Results Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). Conclusions In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Delayed caesarean section, severe maternal outcomes, adverse newborn outcomes, barriers, Somaliland
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-503237 (URN)10.1080/16549716.2023.2207862 (DOI)000983597100001 ()37158206 (PubMedID)
Available from: 2023-06-14 Created: 2023-06-14 Last updated: 2023-06-14Bibliographically approved
Holmbäck, U., Gruden, S., Litorp, H., Willhems, D., Kuusk, S., Alderborn, G., . . . Forslund, A. (2022). Effects of a novel weight-loss combination product containing orlistat and acarbose on obesity: A randomized, placebo-controlled trial. Obesity, 30(11), 2222-2232
Open this publication in new window or tab >>Effects of a novel weight-loss combination product containing orlistat and acarbose on obesity: A randomized, placebo-controlled trial
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2022 (English)In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 30, no 11, p. 2222-2232Article in journal (Refereed) Published
Abstract [en]

Objective The aim of this study was to evaluate the effect of a novel, oral, modified-release formulation of the lipase inhibitor orlistat and the glucosidase/amylase inhibitor acarbose (denoted EMP16) on relative body weight after 26 weeks compared with placebo. Methods The randomized, double-blind, placebo-controlled trial had a 26-week treatment period, with dose escalation up to 6 weeks. Participants, adults between ages 18 and 75 years, with BMI >= 30 kg/m(2) or >= 28 kg/m(2) with risk factors, were randomly assigned to EMP16 120-mg orlistat/40-mg acarbose (EMP16-120/40), EMP16-150/50, or placebo. The primary end point was relative weight loss from baseline to week 26 assessed in participants with at least one post-baseline weight measurement. Results Of 156 randomized participants, 149 constituted the intention-to-treat population. The mean (95% CI) estimated treatment difference to placebo in relative weight loss after 26 weeks in the intention-to-treat population was -4.70% (-6.16% to -3.24%; p < 0.0001) with EMP16-120/40 and -5.42% (-6.60% to -4.24%; p < 0.0001) with EMP16-150/50. Conclusions This trial indicates that orlistat and acarbose can be successfully combined in a modified-release formulation to provide efficacious weight loss with no unexpected safety issues. EMP16 may be a promising candidate among other medications for improved weight management.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2022
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-492533 (URN)10.1002/oby.23557 (DOI)000858391900001 ()36123783 (PubMedID)
Available from: 2023-01-09 Created: 2023-01-09 Last updated: 2024-01-15Bibliographically approved
Litorp, H., Kågesten, A., Båge, K., Uthman, O., Nordenstedt, H., Fagbemi, M., . . . Ekström, A.-M. (2022). Gender norms and women’s empowerment as barriers to facility birth: A population-based cross-sectional study in 26 Nigerian states using the World Values Survey. PLOS ONE, 17(8), Article ID e0272708.
Open this publication in new window or tab >>Gender norms and women’s empowerment as barriers to facility birth: A population-based cross-sectional study in 26 Nigerian states using the World Values Survey
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 8, article id e0272708Article in journal (Refereed) Published
Abstract [en]

Background

Central and western Africa struggle with the world’s lowest regional proportion of facility birth at 57%. The aim of the current study was to compare beliefs related to maternal health care services, science/technology, gender norms, and empowerment in states with high vs. low proportions of facility birth in Nigeria.

Methods

Face-to-face interviews were performed as part of a nationally representative survey in Nigeria using a new module to measure values and beliefs related to gender and sexual and reproductive health and rights collected as part the 2018 World Values Survey. We compared beliefs related to maternal health care services, science/technology, gender norms, and empowerment between Nigerian states with facility birth proportions > 50% vs. < 25% as presented in the 2018 Nigerian Demographic Health Survey report. Pearson’s chi-squared test, the independent t-test, and univariable and multivariable logistic and linear regression were used for analyses. Results were also stratified by gender.

Results

Among the 1,273 participants interviewed, 653 resided in states with high and 360 resided in states with low proportions of facility birth. There were no significant differences between the groups in perceived safety of facility birth (96% vs. 94%) and confidence in antenatal care (91% vs 94%). However, in states with low proportions of facility birth, participants had higher confidence in traditional birth attendants (61% vs. 39%, adjusted odds ratio [aOR] 2.1, [1.5–2.8]), men were more often perceived as the ones deciding whether a woman should give birth at a clinic (56% vs. 29%, aOR 2.4 [1.8–3.3]), and participants experienced less freedom over their own lives (56% vs. 72%, aOR 0.56 [0.41–0.76]). Most differences in responses between men and women were not statistically significant.

Conclusions

In order to increase facility births in Nigeria and other similar contexts, transforming gender norms and increasing women’s empowerment is key.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-490976 (URN)10.1371/journal.pone.0272708 (DOI)000892314200040 ()35980968 (PubMedID)
Funder
Bill and Melinda Gates Foundation, OPP1186559
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2023-05-03Bibliographically approved
Egal, J. A., Kiruja, J., Litorp, H., Osman, F., Erlandsson, K. & Klingberg‐Allvin, M. (2022). Incidence and causes of severe maternal outcomes in Somaliland using the sub‐Saharan Africa maternal near‐miss criteria: A prospective cross‐sectional study in a national referral hospital. International Journal of Gynecology & Obstetrics, 159(3), 856-864
Open this publication in new window or tab >>Incidence and causes of severe maternal outcomes in Somaliland using the sub‐Saharan Africa maternal near‐miss criteria: A prospective cross‐sectional study in a national referral hospital
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2022 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 159, no 3, p. 856-864Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland.

Methods: A prospective cross-sectional study was conducted from April 15, 2019 to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data were collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions, and ratios.

Results: The MNM ratios were 56 (SSA criteria) and 13 (WHO criteria) per 1000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric hemorrhage (13%), pregnancy-related infection (10%), and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum hemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after 3 h.

Conclusion: There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for healthcare providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-490714 (URN)10.1002/ijgo.14236 (DOI)000798717300001 ()35490394 (PubMedID)
Available from: 2022-12-13 Created: 2022-12-13 Last updated: 2024-01-15Bibliographically approved
Kukka, A., Waheddoost, S., Brown, N., Litorp, H., Wrammert, J. & KC, A. (2022). Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Global Health, 7(12), Article ID e010294.
Open this publication in new window or tab >>Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis
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2022 (English)In: BMJ Global Health, E-ISSN 2059-7908, Vol. 7, no 12, article id e010294Article, review/survey (Refereed) Published
Abstract [en]

Aim: To examine the incidence of intrapartum-related neonatal encephalopathy, and neonatal mortality and neurodevelopmental outcomes associated with it in low-income and middle-income countries.

Methods: Reports were included when neonatal encephalopathy diagnosed clinically within 24 hours of birth in term or near-term infants born after intrapartum hypoxia-ischaemia defined as any of the following: (1) pH <= 7.1 or base excess <=-12 or lactate >= 6, (2) Apgar score <= 5 at 5 or 10 min, (3) continuing resuscitation at 5 or 10 min or (4) no cry from baby at 5 or 10 min. Peer-reviewed articles were searched from Ovid MEDLINE, Cochrane, Web of Science and WHO Global Index Medicus with date limits 1 November 2009 to 17 November 2021. Risk of bias was assessed using modified Newcastle Ottawa Scale. Inverse variance of heterogenicity was used for meta-analyses.

Results: There were 53 reports from 51 studies presenting data on 4181 children with intrapartum-related neonatal encephalopathy included in the review. Only five studies had data on incidence, which ranged from 1.5 to 20.3 per 1000 live births. Neonatal mortality was examined in 45 studies and in total 636 of the 3307 (19.2%) infants died. Combined outcome of death or moderate to severe neurodevelopmental disability was reported in 19 studies and occurred in 712 out of 1595 children (44.6%) with follow-up 1 to 3.5 years.

Conclusion: Though there has been progress in some regions, incidence, case mortality and morbidity in intrapartum-related neonatal encephalopathy has been static in the last 10 years.PROSPERO registration numberCRD42020177928.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
epidemiology, paediatrics, indices of health and disease and standardisation of rates, systematic review
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Identifiers
urn:nbn:se:uu:diva-495635 (URN)10.1136/bmjgh-2022-010294 (DOI)000906427500001 ()36581333 (PubMedID)
Available from: 2023-01-31 Created: 2023-01-31 Last updated: 2024-03-13Bibliographically approved
Litorp, H., Sunny, A. K. & KC, A. (2021). Augmentation of labor with oxytocin and its association with delivery outcomes: A large-scale cohort study in 12 public hospitals in Nepal.. Acta Obstetricia et Gynecologica Scandinavica, 100(4), 684-693
Open this publication in new window or tab >>Augmentation of labor with oxytocin and its association with delivery outcomes: A large-scale cohort study in 12 public hospitals in Nepal.
2021 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 100, no 4, p. 684-693Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The use of oxytocin to augment labor is increasing in many low-resource settings; however, little is known about the effects of such use in contexts where resources for intrapartum monitoring are scarce. In this study, we sought to assess the association between augmentation of labor with oxytocin and delivery outcomes.

MATERIAL AND METHODS: We conducted a cohort study in 12 public hospitals in Nepal, including all deliveries with and without augmentation of labor with oxytocin, but excluding elective cesarean sections, women with missing information on augmentation of labor, and women without fetal heart rate on admission. Bivariate and multivariate logistic regression calculating the crude and adjusted risk ratio (aRR) with corresponding 95% CI were performed, comparing (a) intrapartum stillbirth and first-day mortality (primary outcome); and (b) intrapartum monitoring, mode of delivery, postpartum hemorrhage, bag-and-mask ventilation of the newborn, Apgar score, and neonatal death before discharge (secondary outcomes) among women with and without oxytocin-augmented labor.

RESULTS: The total cohort consisted of 78 931 women, of whom 28 915 (37%) had labor augmented with oxytocin and 50 016 (63%) did not have labor augmented with oxytocin. Women with augmentation of labor had no increased risk of intrapartum stillbirth and first-day mortality (aRR 1.24, 95% CI 0.65-2.4), but decreased risks of suboptimal partograph use (aRR 0.71, 95% CI 0.68-0.74), suboptimal fetal heart rate monitoring (aRR 0.50, 95% CI 0.48-0.53), and emergency cesarean section (aRR 0.62, 95% CI 0.59-0.66), and increased risks of bag-and-mask ventilation (aRR 2.1, 95% CI 1.8-2.5), Apgar score <7 at 5 minutes (aRR 1.65, 95% CI 1.49-1.86), and neonatal death (aRR 1.93, 95% CI 1.46-2.56).

CONCLUSIONS: Although augmentation of labor with oxytocin might be associated with beneficial effects, such as improved monitoring and a decreased risk of caesarean section, its use may lead to an increased risk of adverse perinatal outcomes. We urge for a cautious use of oxytocin to augment labor in low-resource contexts, and call for evidence-based guidelines on augmentation of labor in low-resource settings.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
augmentation, cesarean section, intrapartum monitoring, labor, oxytocin, stillbirth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-416136 (URN)10.1111/aogs.13919 (DOI)000536986100001 ()32426852 (PubMedID)
Available from: 2020-07-10 Created: 2020-07-10 Last updated: 2024-01-15Bibliographically approved
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