Search

Background: Obstetric violence (OV) is a critical issue that is often overlooked and makes pregnant women reluctant to get proper access to maternity services. In Palestine, and particularly in Gaza strip, there is limited knowledge about the rates or experiences of OV during delivery. This study aimed to assess the prevalence, determinants and common types of OV among women who had given birth during the last four years at different hospitals in the Gaza strip. Methods: We conducted an online survey through social media and groups in a time period during January and February 2022 to explore women’s experiences of giving birth in Gaza Strip. Women who delivered between 2017-2021 in Gaza hospitals were invited to share their experiences by completing the questionnaire. Women were asked to share the experience of their most recent delivery if they had more than one delivery during the period. Consent was taken at the beginning of the questionnaire, which has with a full explanation of the research and the objectives of the study. The confidentiality and anonymity of the data handling were emphasized to encourage women to freely express their feelings and experiences. Results: A total of 722 women completed the online questionnaire. Most of them (67%) were aged between 21-30 years, and almost half were from low socioeconomic households. Governmental hospitals were the place of delivery for 70% of respondents. One in three women reported they had experienced at least one form of OV. Amongst these women, the types of OV reported were physical (47.8%), psychological (40.8%), verbal (36.4%), and sexual (4.4%). Delivery in private facilities (OR 0.45, 95% CI 0.32-0.74) and the woman knowing their care provider before birth (OR 0.37, 95% CI 0.23-0.59) were both independently protective for OV. In contrast, women who reported they had been aware of OV before birth were more likely to report it happening (OR 3.45, 95% CI 2.37-5.01). Conclusion: We found a concerningly high prevalence of reported OV among women in Gaza Strip in Palestine. Promoting awareness of these findings and the issue of OV amongst maternity staff, identifying the root causes and developing locally led initiatives to eliminate these practices needs to be a priority.

This paper aims to inform those involved in the care of pregnant women in the UK about the relationship between social determinants of health and the risk of maternal death. Social determinants are the social conditions in which people are born, grow, live, work and age. These conditions can shape a person's health, their exposure to illness and access to care. The worse social and economic positions people are in, the worse their health outcomes are likely to be. Exploring these issues in relation to maternal outcomes is timely because the profile\ud of mothers giving birth in the UK is changing. Increasingly, babies are being born to older or obese mothers, or to women born outside of the UK. The evidence suggests a strong relationship between social determinants and poor maternal outcomes, including an increased risk of maternal death. Despite the provision of free reproductive and maternity services, current models of care are still failing those pregnant women living in adverse social circumstances prior to, during\ud and after pregnancy. The reasons are complex but maternal outcomes are particularly poor for socially disadvantaged women affected by pre- existing physical or mental health problems, those who misuse substances, have a low level of education, are overweight, undernourished or poorly sheltered, and those who are at increased risk because of abusive and unsupportive partners, families and peers. Some traditional, cultural and social norms, and reproductive laws and policies, also appear to influence a pregnant woman's relationships, behaviour and access to healthcare services. These factors can reinforce a web of social disadvantage and poor outcomes for some\ud pregnant women, which can persist for future generations. Public awareness of these issues has increased as a result of the COVID- 19 pandemic which has highlighted the ways in which health inequalities can adversely affect health outcomes beyond an individual's control. However, addressing the relationship between COVID- 19 and social determinants of health is outside the scope of this paper. While social determinants of maternal health also have an impact on offspring health, this is also outside the remit of this paper. Healthcare professionals have limited power on their own to modify social determinants of health, but this paper concludes with recommendations to improve the maternal outcomes of vulnerable pregnant women residing in the UK and proposes improvements to the collection and reporting of maternal outcome data, with further investment in prevention and intervention measures to better support these women. \ud \ud Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.

Background: Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance(AMR). Objectives: A scoping review comparing peripartum prophylactic antimicrobial use in low and middle-income countries(LMICs) with World Health Organization(WHO) recommendations for prevention and treatment of maternal peripartum infection. Search strategy:Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. Selection criteria:Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for Group B Streptococcus(GBS), preterm-prelabour rupture of membranes(PPROM), caesarean section(CS), manual placental removal(MROP) and 3rd/4th degree perineal tears[1]. Data collection and analysis: Publications were screened, and duplicates removed. A scoping review was conducted using PRISMA guidelines[9]. Owing to study heterogeneity, a narrative synthesis was performed. Main results: Of 1886 studies, 27 met eligibility criteria from 13 countries involving 43,774 women. Polymerase Chain Reaction (PCR) screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance[2]. Evidence around CS antimicrobial prophylaxis largely supports WHO recommendations, however prolonged or multidrug regimes were reported. Conclusions: There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist. Given the emergence of AMR, research is needed to ensure peripartum prophylactic antimicrobial choices remain effective.

The number of ascospores caught by automatic volumetric spore traps differed widely in six orchards where the air was sampled in some or all of the years 1955 to 1959. To compare amounts of inoculum in different orchards the total catch in each was expressed as the ‘relative ascospore dose’. The reason for the much smaller doses in the later years is uncertain. The results confirmed earlier work on the phenology of ascospore liberation and stressed the practical need to decrease their number as much as possible. Because conidia have previously been trapped almost only on wet and windy days, they have been considered to be rarely air‐dispersed. Our apparatus, which efficiently traps dry conidia but catches water‐borne ones only when in very small droplets, caught airborne conidia in all orchards when they operated during summer. Traps among heavily infected, unsprayed trees caught most conidia around noon on warm dry days and the highest concentration measured exceeded 1300 per m.3of air.

The prevalence of Venturia inaequalis ascospores in orchards was compared both in terms of the number of spores per volume of air (dose) and the number produced per area of dead leaf (productivity). The two parameters often gave divergent estimates, probably because dose depends on total leaf per unit area of ground whereas productivity does not. Differences in the amount of dead leaf surviving until bud‐burst in different orchards or years were enough to explain the anomalies and suggested that because earthworms often removed over 90% of the fallen leaves by spring, they exercised an important control of ascospore number. Assessments of fruit surface scabbed, an accepted way of judging scab control, were not related to ascospore productivity the following spring, but estimates on the percentage of all leaves infected at leaf‐fall were. Other natural variables, like the dates when leaves were formed or fell, seemed of minor importance, especially when compared with effects of earthworms or chemicals. Applying dinitro‐ortho‐cresol to dead leaves in spring decreased the number of ascospores liberated by at least 90% and there is evidence of a similar effect from broadcast ammonium sulphate. The spring and summer spray programmes were also important. Measurements in several orchards during an 8‐year period showed that dose and productivity both declined to less than a hundredth of the highest levels, but in a single wet year productivity in sprayed orchards increased several times and by 40‐fold on unsprayed trees. Ways to prevent high ascospore doses occurring are discussed, together with possible causes of past severe attacks of apple scab at Wisbech.