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      Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study

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          We investigated associations between maternal characteristics, access to care, and obstetrical complications including near miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons.


          We prospectively collected data on inborn singletons at two hospitals in East Java. Data included socio-demographics, reproductive, obstetric and neonatal variables. Reduced multivariable models were constructed. Outcomes of interest included low and very low birthweight (LBW/VLBW), asphyxia and death.


          Referral from a care facility was associated with a reduced risk of LBW and VLBW [AOR = 0.28, 95% CI = 0.11–0.69, AOR = 0.18, 95% CI = 0.04–0.75, respectively], stillbirth [AOR = 0.41, 95% CI = 0.18–0.95], and neonatal death [AOR = 0.2, 95% CI = 0.05–0.81]. Mothers age <20 years increased the risk of VLBW [AOR = 6.39, 95% CI = 1.82–22.35] and neonatal death [AOR = 4.10, 95% CI = 1.29–13.02]. Malpresentation on admission increased the risk of asphyxia [AOR = 4.65, 95% CI = 2.23–9.70], stillbirth [AOR = 3.96, 95% CI = 1.41–11.15], and perinatal death [AOR = 3.89 95% CI = 1.42–10.64], as did poor prenatal care (PNC) [AOR = 11.67, 95%CI = 2.71–16.62]. Near-miss on admission increased the risk of neonatal [AOR = 11.67, 95% CI = 2.08–65.65] and perinatal death [AOR = 13.08 95% CI = 3.77–45.37].


          Mothers in labor should be encouraged to seek care early and taught to identify early danger signs. Adequate PNC significantly reduced perinatal deaths. Improved hospital management of malpresentation may significantly reduce perinatal morbidity and mortality. The importance of hospital-based prospective studies helps evaluate specific areas of need in training of obstetrical care providers.

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          The online version of this article (doi:10.1186/s12884-017-1280-1) contains supplementary material, which is available to authorized users.

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          Most cited references 22

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          Socioeconomic disparities in adverse birth outcomes: a systematic review.

          Adverse birth outcomes, such as preterm birth and low birth weight, have serious health consequences across the life course. Socioeconomic disparities in birth outcomes have not been the subject of a recent systematic review. The aim of this study was to systematically review the literature on the association of socioeconomic disadvantage with adverse birth outcomes, with specific attention to the strength and consistency of effects across socioeconomic measures, birth outcomes, and populations. Relevant articles published from 1999 to 2007 were obtained through electronic database searches and manual searches of reference lists. English-language studies from industrialized countries were included if (1) study objectives included examination of a socioeconomic disparity in a birth outcome and (2) results were presented on the association between a socioeconomic predictor and a birth outcome related to birth weight, gestational age, or intrauterine growth. Two reviewers extracted data and independently rated study quality; data were analyzed in 2008-2009. Ninety-three of 106 studies reported a significant association, overall or within a population subgroup, between a socioeconomic measure and a birth outcome. Socioeconomic disadvantage was consistently associated with increased risk across socioeconomic measures, birth outcomes, and countries; many studies observed racial/ethnic differences in the effect of socioeconomic measures. Socioeconomic differences in birth outcomes remain pervasive, with substantial variation by racial or ethnic subgroup, and are associated with disadvantage measured at multiple levels (individual/family, neighborhood) and time points (childhood, adulthood), and with adverse health behaviors that are themselves socially patterned. Future reviews should focus on identifying interventions to successfully reduce socioeconomic disparities in birth outcomes. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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            Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.

            Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.
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              Severe acute maternal morbidity: a pilot study of a definition for a near-miss


                Author and article information

                646-364-9775 ,
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                28 March 2017
                28 March 2017
                : 17
                [1 ]ISNI 0000000120191471, GRID grid.9581.5, Center for Family Welfare, Faculty of Public Health, , University of Indonesia, ; Depok, Indonesia
                [2 ]ISNI 0000 0001 0666 4105, GRID grid.266813.8, School of Public Health, , University of Nebraska Medical Center, ; Omaha, NE USA
                [3 ]ISNI 0000000122985718, GRID grid.212340.6, , CUNY Graduate School of Public Health and Health Policy, ; 55 West 125th St., Room 714, New York, NY 10027 USA
                [4 ](Formerly) John Snow, Inc., Arlington, VA USA
                [5 ]ISNI 0000 0000 9343 1467, GRID grid.420559.f, , John Snow, Inc., ; Boston, MA USA
                [6 ]ISNI 0000 0001 1955 0561, GRID grid.420285.9, , U.S. Agency for International Development, ; Washington, District of Columbia, USA
                [7 ]ISNI 0000000120191471, GRID grid.9581.5, School of Public Health, , University of Indonesia, ; Depok, Indonesia
                [8 ]ISNI 0000 0004 1936 9510, GRID grid.253615.6, , George Washington University School of Medicine and Health Science, ; Washington, District of Columbia, USA
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, United States Agency for International Development (US);
                Award ID: 497-A-00-05-00031-00
                Research Article
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                © The Author(s) 2017

                Obstetrics & Gynecology

                obstetrical, perinatal death, asphyxia, prematurity, indonesia


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