Browsing by Author "Saswati Sanyal Choudhury"

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Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
(John Wiley and Sons Ltd, 2024) Tuck Seng Cheng; Farzana Zahir; Carolin Solomi; Ashok Verma; Sereesha Rao; Saswati Sanyal Choudhury; Gitanjali Deka; Pranabika Mahanta; Swapna Kakoty; Robin Medhi; Shakuntala Chhabra; Anjali Rani; Amrit Bora; Indrani Roy; Bina Minz; Omesh Kumar Bharti; Rupanjali Deka; Charles Opondo; David Churchill; Marian Knight; Jennifer J. Kurinczuk; Manisha Nair
Objective: To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy. Methods: In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders. Results: PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29–9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42–3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia. Conclusion: The risk of PPH is higher in women who have moderate–severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively. © 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: A prospective cohort study
(BMJ Publishing Group, 2021) Manisha Nair; Shakuntala Chhabra; Saswati Sanyal Choudhury; DIpika Deka; Gitanjali Deka; Swapna D Kakoty; Pramod Kumar; Pranabika Mahanta; Robin Medhi; Anjali Rani; Seeresha Rao; Indrani Roy; Carolin Solomi V; Ratna Kanta Talukdar; Farzana Zahir; Nimmi Kansal; Anil Arora; Charles Opondo; Jane Armitage; Michael Laffan; Simon Stanworth; Maria Quigley; Colin Baigent; Marian Knight; Jennifer J Kurinczuk
Objectives To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7-9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth. Design A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth. Setting Ten hospitals across four states in India. Participants 1342 pregnant women. Intervention Not applicable. Methods Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models. Outcomes measures Adjusted OR with 95% CI. Results In women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×10 9 /L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH. Conclusion Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India
(Elsevier Ltd, 2024) Tuck Seng Cheng; Farzana Zahir; Solomi V. Carolin; Ashok Verma; Sereesha Rao; Saswati Sanyal Choudhury; Gitanjali Deka; Pranabika Mahanta; Swapna Kakoty; Robin Medhi; Shakuntala Chhabra; Anjali Rani; Amrit Bora; Indrani Roy; Bina Minz; Omesh Kumar Bharti; Rupanjali Deka; Charles Opondo; David Churchill; Marian Knight; Jennifer J. Kurinczuk; Manisha Nair
Background: Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3–43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4–28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42–0.58) or no indication (aOR 0.24, 95% CI 0.20–0.28) or with contraindications (aOR 0.12, 95% CI 0.07–0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner's occupation) were independently associated with labour induction and augmentation. Interpretation: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research. Funding: The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1). © 2024 The Author(s)
Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data
(BMJ Publishing Group, 2020) Geneviève Horwood; Charles Opondo; Saswati Sanyal Choudhury; Anjali Rani; Manisha Nair
Objective To examine the risk factors for pregnancy-related death in India’s nine Empowered Action Group (EAG) states. Design Secondary data analysis of the Indian Annual Health Survey (2010–2013). Setting Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. Participants 1 989 396 pregnant women. Methods Maternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model. Outcome measures MMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI. Results MMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC. Conclusions Maternal mortality in India’s EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth. © Author(s) (or their employer(s)) 2020.
Stillbirth among women in nine states in India: Rate and risk factors in study of 886,505 women from the annual health survey
(BMJ Publishing Group, 2018) Noon Altijani; Claire Carson; Saswati Sanyal Choudhury; Anjali Rani; Umesh C Sarma; Marian Knight; Manisha Nair
Objectives To assess the rate of stillbirth and associated risk factors across nine states in India. Design Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010-2013). Setting Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh. Participants 886 505 women, aged 15-49 years. Main outcome measures Stillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position). Results The overall rate of stillbirth was 10 per 1000 total births (95% CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95% CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95% CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95% CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95% CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95% CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95% CI 1.25 to 1.43); Christian (aOR 1.42, 95% CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95% CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95% CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95% CI 1.21 to 1.37) and ≥35 years (aOR 1.16, 95% CI 1.04 to 1.29), multigravida (aOR 3.06, 95% CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95% CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95% CI 3.02 to 3.93), caesarean section (aOR 1.73, 95% CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95% CI 1.33 to 1.51). Conclusion India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women's socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the 'at-risk' population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
Unsafe abortion and abortion-related death among 1.8 million women in India
(BMJ Publishing Group, 2019) Ryo Yokoe; Rachel Rowe; Saswati Sanyal Choudhury; Anjali Rani; Farzana Zahir; Manisha Nair
Introduction Unsafe abortion is a preventable cause of maternal mortality. While studies report high number of abortions in India, the population-level rates of unsafe abortion and their risk factors are not well understood. Our objective was to analyse the rates of and risk factors for unsafe abortion and abortion-related maternal death in India. Methods We conducted a secondary analysis of data from 1 876 462 pregnant women aged 15-58 years from nine states in the Indian Annual Health Survey (2010-2013). We calculated the rate of unsafe abortion and abortion-related mortality with 95% CI. Multivariable logistic regression models examined the associations of sociodemographic characteristics, health seeking behaviours and family planning with unsafe abortion and abortion-related mortality. Results There were 89 447 abortions among 1 876 462 pregnant women in 2007-2011 (4.8%; 95% CI 4.8 to 4.9). Of these, 58 266 were classified as unsafe (67.1%; 95% CI 66.7 to 67.5). There were 253 abortion-related maternal deaths (0.3%; 95% CI 0.2 to 0.3). Factors associated with unsafe abortion: maternal age 20-24 years (adjusted OR (aOR): 1.13; 95% CI 1.09 to 1.18), illiteracy (aOR: 1.48; 95% CI 1.39 to 1.59), rural residence (aOR: 1.26; 95% CI 1.21 to 1.32), Muslim religion (aOR: 1.16; 95% CI 1.12 to 1.22), Schedule caste social group (aOR: 1.08; 95% CI 1.04 to 1.12), poorest asset quintile (aOR: 1.45; 95% CI 1.38 to 1.53), antenatal care (aOR: 0.69; 95% CI 0.67 to 0.72), no surviving children (aOR: 1.30; 95% CI 1.16 to 1.46), all surviving children being female (aOR: 1.12; 95% CI 1.07 to 1.17), use of family planning methods (aOR: 0.69; 95% CI 0.66 to 0.71). Factors associated with abortion-related deaths: maternal age 15-19 (aOR: 7.79; 95% CI 2.73 to 22.23), rural residence (aOR: 3.28; 95% CI 1.76 to 6.11), Schedule tribe social group (aOR: 4.06; 95% CI 1.39 to 11.87). Conclusion Despite abortion being legal, the high estimated prevalence of unsafe abortion demonstrates a major public health problem in India. Socioeconomic vulnerability and inadequate access to healthcare services combine to leave large numbers of women at risk of unsafe abortion and abortion-related death. © 2019 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC.