Maria Delius - Academia.edu (original) (raw)

Papers by Maria Delius

SSRN Electronic Journal, 2021

PLOS ONE, 2021

BackgroundInvestment Case is a participatory approach that has been used over the years for bette... more BackgroundInvestment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services.MethodsThis study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of l...

Background Different areas of disparities remain a concern in developing countries like Nepal reg... more Background Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal. Methods The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjus...

The Journal of Maternal-Fetal & Neonatal Medicine, 2020

Wellcome Open Research, 2019

Background:Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Th... more Background:Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. To determine whether TXA has pro-thrombotic effects in women with PPH, we measured endogenous thrombin potential (ETP), coagulation factors V, VIII, von Willebrand (vW), fibrinogen, D-Dimers and platelet function.Methods: We conducted a sub-study within the WOMAN trial, an international randomized, parallel-group, double blind, placebo-controlled trial. Women with primary PPH were randomly allocated to receive 1 gram of tranexamic acid or matching placebo. Baseline blood samples were collected just prior to the first dose and a follow up sample was collected 30±15 minutes afterwards. We compared before and after changes in coagulation parameters between treatment groups using repeated measurement ANOVA. Change in ETP was the primary outcome. We did an intention-to-treat analysis using ANCOVA ...

RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, Jan 19, 2018

Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluate... more Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental findings noted by different clinicians and assessed potential reference values. In this monocentric study, the radiologic database was searched for obstetric MR pelvimetries with singleton breech pregnancies between 1999 and 2016. 99 consecutive MR pelvimetries were included. A structured, independent review was performed by six observers with three clinical experience levels (attending, fellow, junior resident from the departments of radiology and obstetrics). Image analysis entailed the quantitative assessment of conjugata vera (CV) and diameter transversalis (DT), image quality and incidental findings. Obstetric data was retrieved from the obstetric database for reference value assessment. Interobserver agreement was strong throughout (mean intraclass correlation coefficient range: 0.889 - 0.968). The individual ...

Reproductive health, Jan 20, 2018

Giving birth assisted by skilled care in a health facility plays a vital role in preventing mater... more Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery. Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis. Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quali...

Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society, Jan 14, 2017

To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in mat... more To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up. A highly sensitive hGH-V specific immunoassay was used to analyse serum samples collected before treatment, day 1 post surgery samples and serial samples for medical treatment. In EP patients' sera hGH-V was shown to be measurable for the first time (n=18). HGH-V however could not be detected in all patients' sera. HCG levels were significantly higher in the hGH-V serum positive group (p 0.001). HGH-V was localiz...

Zeitschrift für Geburtshilfe und Neonatologie, 2004

Geburtshilfe und Frauenheilkunde, 2008

Wellcome open research, Jan 15, 2016

Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women... more Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women, and the leading cause of maternal mortality. Tranexamic acid (TXA) is an antifibrinolytic used worldwide to treat uterine haemorrhage and to reduce blood loss in general surgery. TXA may have effects on thrombin generation, platelet function and coagulation factors as a result of its inhibition on the plasmin. Methods. WOMAN ETAPlaT is a sub-study of the World Maternal Antifibrinolitic trial (WOMAN trial). All adult women clinically diagnosed with PPH after a vaginal delivery or caesarean section, are eligible for inclusion in the study. Blood samples will be collected at the baseline and 30 minutes after the first dose of study treatment is given. Platelet function will be evaluated in whole blood immediately after sampling with Multiplate® tests (ADPtest and TRAPtest). Thrombin generation, fibrinogen, D-dimer, and coagulation factors vW, V and VIII will be analysed using platelet poo...

Archives of gynecology and obstetrics, 2017

The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of ... more The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of delivery and neonatal outcome in patients with suspected fetopelvic disproportion or breech presentation. For this retrospective monocentric study, 237 consecutive MR pelvimetry reports (1999-2016) of pregnant women due to either suspected fetopelvic disproportion, pelvic deformation after trauma, or persistent breech presentation were retrieved from the radiologic database and matched with corresponding information from the obstetric database. Of 223 included women, 95 (42.6%) underwent planned cesarean section (pCS) and 128 (57.4%) underwent a trial of vaginal labour (TOL), of whom 93 (72.7%) delivered vaginally. Vaginal delivery was successful in 45 out of 64 (70.3%) cephalic cases and in 48 out of 64 (75.0%) breech cases. We found statistically significant differences in conjugata vera obstetrica (CV) and diameter transversalis (DT) between the groups TOL and pCS (CV: 12.5 ± 1.0 vs 1...

Geburtshilfe und Frauenheilkunde, 2016

Geburtshilfe und Frauenheilkunde, 2008

Zeitschrift für Geburtshilfe und Neonatologie, 2008

Geburtshilfe Basics, 2006

Geburtshilfe Basics

In der Regel werden heute 3 Formen der psychischen Storungen im Wochenbett unterschieden: der Bab... more In der Regel werden heute 3 Formen der psychischen Storungen im Wochenbett unterschieden: der Baby Blues (postpartale affektive Dysphorie, »Heultage«), die Wochenbettdepression und die postpartale Psychose. Der Baby Blues gilt als harmlose, vorubergehende Verstimmung, wahrend die Depression und die Psychose klinische Bedeutung haben, auch im Hinblick auf die kindliche Entwicklung. Verschiedenste Faktoren werden als Ursache der Storungen diskutiert, die allgemein angenommene Genese durch Hormonveranderungen konnte nicht einheitlich nachgewiesen werden. In schweren Fallen der Depression und immer im Fall der Psychose muss ein Psychiater herangezogen werden.

SSRN Electronic Journal, 2021

PLOS ONE, 2021

BackgroundInvestment Case is a participatory approach that has been used over the years for bette... more BackgroundInvestment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services.MethodsThis study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of l...

Background Different areas of disparities remain a concern in developing countries like Nepal reg... more Background Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal. Methods The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjus...

The Journal of Maternal-Fetal & Neonatal Medicine, 2020

Wellcome Open Research, 2019

Background:Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Th... more Background:Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. To determine whether TXA has pro-thrombotic effects in women with PPH, we measured endogenous thrombin potential (ETP), coagulation factors V, VIII, von Willebrand (vW), fibrinogen, D-Dimers and platelet function.Methods: We conducted a sub-study within the WOMAN trial, an international randomized, parallel-group, double blind, placebo-controlled trial. Women with primary PPH were randomly allocated to receive 1 gram of tranexamic acid or matching placebo. Baseline blood samples were collected just prior to the first dose and a follow up sample was collected 30±15 minutes afterwards. We compared before and after changes in coagulation parameters between treatment groups using repeated measurement ANOVA. Change in ETP was the primary outcome. We did an intention-to-treat analysis using ANCOVA ...

RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, Jan 19, 2018

Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluate... more Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental findings noted by different clinicians and assessed potential reference values. In this monocentric study, the radiologic database was searched for obstetric MR pelvimetries with singleton breech pregnancies between 1999 and 2016. 99 consecutive MR pelvimetries were included. A structured, independent review was performed by six observers with three clinical experience levels (attending, fellow, junior resident from the departments of radiology and obstetrics). Image analysis entailed the quantitative assessment of conjugata vera (CV) and diameter transversalis (DT), image quality and incidental findings. Obstetric data was retrieved from the obstetric database for reference value assessment. Interobserver agreement was strong throughout (mean intraclass correlation coefficient range: 0.889 - 0.968). The individual ...

Reproductive health, Jan 20, 2018

Giving birth assisted by skilled care in a health facility plays a vital role in preventing mater... more Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery. Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis. Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quali...

Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society, Jan 14, 2017

To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in mat... more To investigate human placental growth hormone (hGH-V) in ectopic pregnancy (EP): detection in maternal blood, correlation with immunohistochemistry and possible role as a marker for the course of EP. Women presenting in the outpatient or emergency department of a tertiary care university hospital with a positive pregnancy test and strong suspicion of EP by ultrasound and/or symptoms were eligible for the study (n=70). Tissue specimens from the surgically treated patients (n=50) were examined by histopathology as well as by a hGH-V specific immohistochemistry set-up. A highly sensitive hGH-V specific immunoassay was used to analyse serum samples collected before treatment, day 1 post surgery samples and serial samples for medical treatment. In EP patients' sera hGH-V was shown to be measurable for the first time (n=18). HGH-V however could not be detected in all patients' sera. HCG levels were significantly higher in the hGH-V serum positive group (p 0.001). HGH-V was localiz...

Zeitschrift für Geburtshilfe und Neonatologie, 2004

Geburtshilfe und Frauenheilkunde, 2008

Wellcome open research, Jan 15, 2016

Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women... more Background. Postpartum haemorrhage (PPH) is a potentially life-threatening complication for women, and the leading cause of maternal mortality. Tranexamic acid (TXA) is an antifibrinolytic used worldwide to treat uterine haemorrhage and to reduce blood loss in general surgery. TXA may have effects on thrombin generation, platelet function and coagulation factors as a result of its inhibition on the plasmin. Methods. WOMAN ETAPlaT is a sub-study of the World Maternal Antifibrinolitic trial (WOMAN trial). All adult women clinically diagnosed with PPH after a vaginal delivery or caesarean section, are eligible for inclusion in the study. Blood samples will be collected at the baseline and 30 minutes after the first dose of study treatment is given. Platelet function will be evaluated in whole blood immediately after sampling with Multiplate® tests (ADPtest and TRAPtest). Thrombin generation, fibrinogen, D-dimer, and coagulation factors vW, V and VIII will be analysed using platelet poo...

Archives of gynecology and obstetrics, 2017

The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of ... more The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of delivery and neonatal outcome in patients with suspected fetopelvic disproportion or breech presentation. For this retrospective monocentric study, 237 consecutive MR pelvimetry reports (1999-2016) of pregnant women due to either suspected fetopelvic disproportion, pelvic deformation after trauma, or persistent breech presentation were retrieved from the radiologic database and matched with corresponding information from the obstetric database. Of 223 included women, 95 (42.6%) underwent planned cesarean section (pCS) and 128 (57.4%) underwent a trial of vaginal labour (TOL), of whom 93 (72.7%) delivered vaginally. Vaginal delivery was successful in 45 out of 64 (70.3%) cephalic cases and in 48 out of 64 (75.0%) breech cases. We found statistically significant differences in conjugata vera obstetrica (CV) and diameter transversalis (DT) between the groups TOL and pCS (CV: 12.5 ± 1.0 vs 1...

Geburtshilfe und Frauenheilkunde, 2016

Geburtshilfe und Frauenheilkunde, 2008

Zeitschrift für Geburtshilfe und Neonatologie, 2008

Geburtshilfe Basics, 2006

Geburtshilfe Basics

In der Regel werden heute 3 Formen der psychischen Storungen im Wochenbett unterschieden: der Bab... more In der Regel werden heute 3 Formen der psychischen Storungen im Wochenbett unterschieden: der Baby Blues (postpartale affektive Dysphorie, »Heultage«), die Wochenbettdepression und die postpartale Psychose. Der Baby Blues gilt als harmlose, vorubergehende Verstimmung, wahrend die Depression und die Psychose klinische Bedeutung haben, auch im Hinblick auf die kindliche Entwicklung. Verschiedenste Faktoren werden als Ursache der Storungen diskutiert, die allgemein angenommene Genese durch Hormonveranderungen konnte nicht einheitlich nachgewiesen werden. In schweren Fallen der Depression und immer im Fall der Psychose muss ein Psychiater herangezogen werden.