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V Filippi

Publications and source records attributed to V Filippi.

16 recordsLinked to original sources
PubMed2006

Caesarean section and subsequent fertility in sub-Saharan Africa.

OBJECTIVE: To determine the impact of caesarean section on fertility among women in sub-Saharan Africa. DESIGN: Analysis of standardised cross-sectional surveys (Demographic and Health Surveys). SETTING: Twenty-two countries in sub-Saharan Africa, 1993-2003. SAMPLE: A total of 35 398 women of childbearing age (15-49 years). METHODS: Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models. MAIN OUTCOME MEASURES: Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery. RESULTS: The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P < 0.01; controlling for age, parity, level of education, urban/rural residence and young age at first intercourse). Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval > or =3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P= 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth. CONCLUSIONS: Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in sub-Saharan Africa are emergency procedures for maternal indication.

Adolescent↗
PubMed2006

Seasonal patterns and preterm birth: a systematic review of the literature and an analysis in a London-based cohort.

OBJECTIVE: The objectives of this study included a systematic review of the countries in which a seasonal pattern of preterm birth has been reported and an analysis on the seasonal variability of preterm birth in a London-based cohort. DESIGN: Cross-sectional study. SETTING: Eighteen maternity units in a London health region from 1988 to 2000. POPULATION: The study population comprised 482,765, live singleton births born after 24 weeks of gestation and weighing more than 200 g. METHODS: Systematic review and secondary analysis of seasonality over 13 years of births from the St Mary's Maternity Information System (SMMIS). MAIN OUTCOME MEASURE: Annual patterns of preterm birth and a comparison of risk by seasons. RESULTS: Three studies from developing countries and three from developed countries reported a seasonal pattern of preterm birth. One study from the USA reported no seasonal pattern of preterm birth. No British studies were located. Rates of preterm birth in developed countries were highest twice a year (once in winter and again in summer). In London (SMMIS data set), however, preterm births peaked only once a year, in winter. Babies born in winter were 10% more likely to be preterm compared with those born in spring (OR 1.10, 95% CI 1.07-1.14). CONCLUSION: Establishing a seasonal pattern of birth can have important implications for the delivery of healthcare services. Most studies from both developed and developing countries support the existence of preterm birth seasonality. This study has shown that the seasonality of preterm births in this London-based cohort differs from other developed countries that have previously reported a seasonal pattern of preterm birth.

Cohort Studies↗
PubMed2004

Responsiveness to life-threatening obstetric emergencies in two hospitals in Abidjan, Côte d'Ivoire.

OBJECTIVES: To document the frequency of severe obstetric illness, and the intervals between admission or decision and life-saving surgery and the factors contributing to delays, which were reported during case reviews in two hospitals in Abidjan, Côte d'Ivoire. METHODS: The study was conducted in the teaching hospital in Cocody (CHUC) and the district hospital in Abobo (FSAS) in 2000-01. All severe obstetric cases were inventoried over a period of 1 year, and a subset of cases selected for in-depth review. For the 23 audited cases requiring emergency surgery, the interval between admission/decision and surgery was determined and reasons for the delays examined. FINDINGS: The yearly incidence of severe obstetric morbidity was 224.5 and 11.8 per 1000 live births in the CHUC and FSAS respectively. In CHUC, the decision-to-delivery time was extremely long (median 4.8 h) and this was largely determined by the time needed to obtain a complete surgical kit (median 2.8 h), either because the family had to pay for it in advance or because the kit lacked some essential components, which had to be bought separately. In FSAS, the decision-to-delivery time was much shorter (median 1.0 h). CONCLUSION: The interval between decision and emergency obstetric surgery substantially exceeded the 30 min generally advocated in industrialized countries. The reasons for the long delays were multiple and complex, but the main factors governing them were the huge case load of severe cases and the absence of any clear policy towards ensuring prompt and adequate treatment for life-threatening emergencies. In-depth reviews of cases of severe obstetric morbidity focusing in particular on the timing of emergency treatment could increase the responsiveness of the health system and providers to the needs of women requiring emergency obstetric care.

Cote d'Ivoire↗
PubMed2003

Costs of near-miss obstetric complications for women and their families in Benin and Ghana.

This paper estimates the total cost to women and their families associated with a spontaneous vaginal delivery and five types of 'near-miss' obstetric complication in Benin and Ghana, and assesses affordability in relation to household cash expenditure. A retrospective evaluation of costs was carried out among 121 mothers in three hospitals in Ghana. A prospective evaluation of costs was undertaken among 420 pregnant women in two hospitals in Benin. Information was collected on the cost of travel to the facilities and of direct medical and non-medical costs incurred during their stay in hospital. In Benin, costs ranged from an average of 15 US dollars for a spontaneous delivery to 256 US dollars for a near-miss complication caused by dystocia. In Ghana, average costs ranged from 18 US dollars for a spontaneous vaginal delivery to 115 US dollars for a near-miss complication caused by haemorrhage. Medical costs accounted for the largest share of total costs, mainly drugs and medical supplies in Ghana and costs of the delivery and any surgical intervention in Benin. Payments associated with a spontaneous vaginal delivery amounted to at least 2% of annual household cash expenditure in both countries. In the case of severe obstetric complications, costs incurred reached a high of 34% of annual household cash expenditure in Benin. The economic burden of hospital-based delivery care in Ghana and Benin is likely to deter or delay women's use of health services. Should a woman develop severe obstetric complications while in labour, the relatively high costs of hospital care could have a potentially catastrophic impact on the household budget.

Benin↗
PubMed2001

Giving birth in maternity hospitals in Benin: testimonies of women.

In Benin, a Francophone country in West Africa, maternity mortality has been estimated at between 473 and 990 deaths per 100,000 live births. Yet 92 per cent of women gave birth in either a public or private health centre, and almost all of them received antenatal care. This paper reports on an exploratory, qualitative study in 1995, among 19 women aged 20-40 who had recently given birth in a referral hospital, of their experiences of antenatal and emergency obstetric care, as part of a larger study on measuring the prevalence of severe maternal morbidity in the community. Thirteen of the women had had obstetric complications and 11 had had a caesarean section. Pregnancy was described as a period of great vulnerability, and feelings of insecurity and fear of death were omnipresent in the women's accounts. Their primary motivation for seeking antenatal care was the appearance of symptoms or events they perceived as abnormal. Although a minority were lucky enough to have a kind midwife, many complained about not being able to ask questions or get any explanations, being mistreated and humiliated by health personnel and described the anguish they felt in the face of medical procedures they did not understand, especially caesarean section, which they were told were necessary to save their lives. Access to emergency obstetric care is a priority in the battle against maternal mortality, but it cannot be at the expense of improvements in the quality of the interaction between women and health personnel. The inclusion of women's voices in the objectives of safe motherhood programmes is necessary to better serve women's needs.

Adult↗
PubMed2000

Women's reports of severe (near-miss) obstetric complications in Benin.

This study examines the validity of a survey instrument on near-miss obstetric complications. Three groups of women--with severe complications, with mild complications, and with a normal delivery--were identified retrospectively in three hospitals in South Benin and interviewed at home. The concept of "near-miss" was used to identify women with severe episodes of morbidity. The questionnaire was able to detect, with some accuracy, eclamptic fits, abnormal bleeding in the third trimester for a recall period of at least three to four years, and all episodes of bleeding independent of timing within a period of two years. Questions concerning dystocia and infections of the genital tract generated disappointing results except when information on treatment was included. Overall, better results were achieved for antepartum and acute events. Severity made a positive difference only in the case of eclampsia, with an increase in sensitivity. The implications of the results for using women's recall of obstetric complications in surveys are discussed.

Benin↗
PubMed1997

Oral environment temperature changes induced by cold/hot liquid intake.

The use of NiTi shape memory alloys, introduced into orthodontics because of their ability to develop light continuous forces that prove more effective than heavy intermittent forces in the teeth movement, requires the mastering of the functional properties of NiTi wires. More specifically, the recovery force acting on the teeth is a sensitive function of temperature: knowledge of oral temperature modifications is therefore required to understand the stress state modification felt during orthodontic therapy. The temperature modifications induced by cold or hot drink intake in the oral cavity were investigated by using arch wires, fixed to removable Hawley retainers, similar to those currently used in orthodontic practice, by means of six temperature sensors placed in correspondence with specific teeth. Similarly, the temperature changes were detected on a metallic frame, fixed onto the palatal zone to a Hawley retainer, where a palatal expander was placed to correct unilateral or bilateral crossbites in deciduous or in early mixed dentition. The maximum temperature change was observed in the interincisor area: The temperature modification on other teeth depends on the modality of drink intake, with the highest temperature variations being detected in the palatal zone. Hence modifications in the stress state during orthodontic therapy with NiTi wires are to be expected.

Beverages↗
PubMed1997

Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul.

In countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Sepcificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the K coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions.

Adult↗
PubMed1997

Contraceptive choice and reproductive morbidity in Istanbul.

A cross-sectional survey was conducted in Istanbul to investigate the relationship between contraceptive choice and reproductive morbidity. Altogether, 918 women who had ever used any means of avoiding pregnancy were interviewed at home, and, among these, 694 parous nonpregnant women were examined by three female physicians. The women were aware of bearing a considerable burden of ill health, with 81 percent reporting at least one episode of illness in the three months prior to the interview. Current users of the intrauterine device were significantly more likely than users of other methods to report menstrual disorders, but pelvic relaxation and reproductive and urinary tract infections, whether perceived or diagnosed, were not significantly related to any of the contraceptive methods. The relatively small amount of switching between methods suggests that most users tended to stay with the same method once chosen and that health concerns played an important part only in the initial choice of the method.

Adolescent↗
PubMed1996

Clinical algorithms for the screening of Chlamydia trachomatis in Turkish women.

OBJECTIVE: To test the diagnostic validity of clinical algorithms for the detection of Chlamydia trachomatis in an urban population of married women in Turkey. DESIGN: Cross-sectional population-based survey. SUBJECTS: A systematic sample of 867 women who reported the use of contraceptive methods. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive predictive value of clinical algorithms for the diagnosis of C trachomatis. RESULTS: C trachomatis was diagnosed in 4.89% of the women. The WHO algorithm for use in settings where no vaginal examination could be performed had a sensitivity of 9% and a specificity of 96%. The corresponding figures for the WHO algorithm incorporating the findings of a speculum examination were 47% and 56% respectively. Algorithms incorporating symptoms or signs other than those suggested by the WHO did not yield satisfactory standards of validity. CONCLUSIONS: The findings of this study do not support the widespread introduction of the use of clinical decision models for screening of women for chlamydia infection in primary health care settings such as family planning or antenatal clinics. The large number of false positive results with the use of the clinical algorithms tested in this study would cause unnecessary costs to the health system and unnecessary interventions to the women treated.

Adult↗
PubMedDate not supplied

[Obstetric catastrophes barely just avoided: near misses in Moroccan hospitals].

A consensus definition of obstetric catastrophes barely only just avoided, called near miss cases in the recent scientific literature, has been elaborated during an international seminar held in Morocco. A near miss case was defined as "any pregnant or recently delivered - or aborted - woman, whose immediate survival is threatened and who survives by chance or because of the hospital care received". This definition was then operationalised using severity criteria combining clinical signs and types of intervention clear enough to easily screen near miss cases in hospital files. These criteria were then used to identify the near misses that occurred in 1998 in two public Moroccan hospitals (Tetouan and Sidi Kacem). A total of 81 cases of severe maternal complications (76 near misses and 5 deaths) were collected, a frequency of 11.9% among hospital admissions for delivery or pregnancy complications. The interest and limitations of such a near miss case definition are discussed. It seems that the criteria applied were operational in the Moroccan context. They are specific, i.e. they permitted to identify true cases of mother's life threatening complications. Finally, they generated a sufficiently great number of cases and a range of situations large enough to hold monthly audits and to identify sub-standard care.

Cesarean Section↗