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Vowles Z, Lovell H, Black M, Sandall J, Easter A. Models of care for pregnant women with multiple long-term conditions and the role of the midwife: A scoping review. Women Birth 2024; 37:101645. [PMID: 39013274 DOI: 10.1016/j.wombi.2024.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND More women are experiencing pregnancy with two or more long-term health conditions such as hypertension, depression or HIV (MLTC). Care can be complex and include multiple teams, health professionals and services. The type and range of maternity care models for these women and the role of the midwife within such models is unknown. AIM To provide an overview of the literature on models of care for pregnant, birthing, and postnatal women with MLTC and the role of the midwife. METHODS We conducted a scoping review guided by the Joanna Briggs Institute scoping review methodology. Five databases MEDLINE, CINAHL Plus, PsycINFO, EMBASE and The Maternity and Infant Care database were searched from inception until August 2022. A total of 3458 titles and abstracts and 56 full text papers were screened independently by two researchers. Data was extracted from five papers and synthesised narratively. FINDINGS Multidisciplinary care models are described or recommended in all five papers. Midwives have a varied and core role in the multidisciplinary care of women with MLTC. DISCUSSION Models of care for those with MLTC covered part or all the maternity journey, primarily antenatal and postnatal care. A focus on delivering high-quality holistic care throughout the maternity journey, including postnatally is needed. There is a lack of evidence on how midwifery continuity of care models may impact experiences of care and outcomes for this group. CONCLUSION There is a lack of empirical evidence on how best to provide midwifery and multi-disciplinary care for those with MLTC and a need for research to understand this. INCLUSIVITY STATEMENT Our aims refer to 'pregnant, birthing, and postnatal women and birthing people with MLTC'. We acknowledge that not all those accessing maternity services will identify as a woman. We continually strive to ensure that our research and public involvement is inclusive and sensitive to the needs of everyone. Our search terms did not narrow to either women or birthing people specifically and used broad terms of pregnancy, antenatal, prenatal, childbirth and postnatal care. All included papers use the term woman or women throughout therefore, we have used this terminology when describing their findings. Where the term 'woman' is used this should be taken to include women and people who do not identify as women but are pregnant or have given birth. This builds on our Patient and Public Involvement and Engagement work which has highlighted the need to use inclusive language.
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Affiliation(s)
- Zoë Vowles
- King's College London, Department of Women & Children's Health, School of Life Course & Population Sciences, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK; Reproductive Health and Childbirth, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, 10th Floor North Wing, London SE1 7EH, UK.
| | - Holly Lovell
- King's College London, Department of Women & Children's Health, School of Life Course & Population Sciences, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK; Reproductive Health and Childbirth, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, 10th Floor North Wing, London SE1 7EH, UK
| | - Mairead Black
- University of Aberdeen, Aberdeen Centre for Women's Health Research, The School of Medicine, Medical Sciences and Nutrition, UK
| | - Jane Sandall
- King's College London, Department of Women & Children's Health, School of Life Course & Population Sciences, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Abigail Easter
- King's College London, Department of Women & Children's Health, School of Life Course & Population Sciences, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK
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Dande A, Pajai S, Gupta A, Dande S, Sethi N. Unraveling the Role of Maternal Serum Ferritin Levels in Preterm Delivery: A Comprehensive Review. Cureus 2024; 16:e54515. [PMID: 38516441 PMCID: PMC10955505 DOI: 10.7759/cureus.54515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/11/2024] [Indexed: 03/23/2024] Open
Abstract
Preterm delivery remains a critical global health concern, with numerous adverse consequences for both neonate and healthcare systems. Understanding the relationship between maternal ferritin levels, as a marker of iron status, and the risk of preterm birth is the focal point of this comprehensive review. We provide insights into the multifaceted nature of this connection, highlighting factors that influence maternal ferritin levels, including dietary intake, genetic and physiological variations, comorbidities, and iron supplementation. While evidence suggests an association between low maternal ferritin levels and preterm birth, causality remains elusive, necessitating further research with robust study designs. The potential mechanisms linking maternal iron status to preterm birth, such as inflammation, infection, and oxidative stress, are explored, underscoring the need for in-depth investigations. This comprehensive review emphasizes the clinical importance of assessing and monitoring maternal ferritin levels in prenatal care and advocates for public health initiatives to raise awareness and provide targeted interventions, particularly in high-risk populations. As we strive to address these unanswered questions and embark on innovative research directions, the aim is to ultimately enhance our understanding of the complex relationship between maternal iron status and preterm birth, leading to improved maternal and child health outcomes.
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Affiliation(s)
- Anubha Dande
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Seema Dande
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Sethi
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Roy P, Sah V, Deb N, Jaiswal V. Navigating the path of TOF- A Literature review unveiling maternal-fetal dynamics, treatment strategies and psychological dimensions. Dis Mon 2024; 70:101659. [PMID: 37951837 DOI: 10.1016/j.disamonth.2023.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Tetralogy of Fallot (TOF) is a complex congenital heart defect that poses unique challenges for both mothers and their unborn children. This comprehensive review, aims to provide a holistic exploration of the maternal-fetal dynamics, treatment strategies, and psychological dimensions involved in navigating the path of TOF during pregnancy. It delves into the physiological changes that occur during pregnancy in TOF patients, including pulmonary regurgitation, right ventricular hypertrophy, and the overriding aorta. By understanding these dynamics, healthcare professionals can tailor treatment strategies to optimize maternal and fetal outcomes. The review further investigates the treatment strategies employed in managing TOF during pregnancy, encompassing medical interventions, cardiac monitoring, and multidisciplinary care. It explores the role of advanced imaging techniques, such as echocardiography and cardiac magnetic resonance imaging, in assessing TOF severity and guiding treatment decisions. The psychological factors influencing maternal adaptation, coping strategies, and the long-term implications on the child's psychological development are also examined. The integration of multidisciplinary approaches, including cardiac care, psychosocial support, and mental health interventions, can orchestrate a harmonious symphony of maternal-fetal well-being in the challenging journey of TOF pregnancies. Future research endeavours should continue to explore these dimensions, further refining treatment strategies and enhancing the understanding of TOF pregnancies for improved outcomes.
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Affiliation(s)
- Poulami Roy
- Department of Medicine, North Bengal Medical College and Hospital, India
| | - Viraj Sah
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai
| | - Novonil Deb
- Department of Medicine, North Bengal Medical College and Hospital, India.
| | - Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Mishra A, Hirani S, Hirani S, Shaikh MYD, Khanholkar S, Prasad R, Wanjari M. Arnold-Chiari Malformations in Pregnancy and Labor: Challenges and Management Strategies. Cureus 2023; 15:e43688. [PMID: 37724202 PMCID: PMC10505272 DOI: 10.7759/cureus.43688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Arnold-Chiari malformations (ACMs) present unique challenges in pregnancy and labor, requiring a comprehensive understanding and multidisciplinary approach to care. This review article provides an overview of ACMs, including their definition, classification, and prevalence. The challenges in diagnosing ACMs during pregnancy, the available imaging modalities, and screening recommendations are discussed. The impact of ACMs on maternal health, fetal development, and the management strategies employed during pregnancy and labor are explored. Emphasis is placed on the importance of a multidisciplinary approach involving neurologists, obstetricians, and other specialists. Medical management options for symptom relief, surgical interventions, and anesthetic considerations during labor and delivery are also addressed. The importance of postpartum care, breastfeeding considerations, and long-term follow-up for women with ACMs who desire future pregnancies are highlighted. Finally, areas for further research and advancements in ACM management are identified. By improving our understanding and management of ACMs in pregnancy and labor, healthcare professionals can optimize care and improve outcomes for mothers and babies affected by this condition.
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Affiliation(s)
- Aditi Mishra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shoyeb Hirani
- Medicine, Mahatma Gandhi Medical College and Hospital, Aurangabad, IND
| | - Sajid Hirani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mohammed Yusuf D Shaikh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Khanholkar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Nekuei N, Kohan S, Movahedi M, Sadeghi M. Identifying and responding to the sexual reproductive health needs of women with heart disease: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:221-228. [PMID: 36237959 PMCID: PMC9552580 DOI: 10.4103/ijnmr.ijnmr_230_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 11/29/2021] [Indexed: 11/06/2022]
Abstract
Background: Recognizing the needs of women with heart disease in the field of reproductive health and meeting them can reduce the related complications. The aim of this study was to identify the sexual and reproductive health needs of these women. Materials and Methods: The present study was conducted with qualitative approach (Content analysis). Ten married women of reproductive age with heart disease and 20 providers and managers in, Isfahan, Iran, were selected by using purposive and snowball methods (in 2020). The research setting included heart disease clinics, offices of health team, comprehensive health centers, and the Isfahan Maternal Health Department. Data were collected by semi-structured individual face-to-face interviews in the clinic or other appropriate locations. Some interviews were conducted virtually. Analysis was performed by Qualitative contentment analysis / Conventional content analysis. Results: Sexual and reproductive health needs of women with heart disease were emerged in five main categories, “planned childbearing,” “ssociocultural support,” “Early reproductive health care of girls,” “health team attention to sexual health,” and “health system revision.” Conclusions: Providing comprehensive reproductive health services before and during pregnancy, family planning, and sexual health for women with heart disease is necessary. It seems that using a multidisciplinary team approach could improve their reproductive health.
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Kohan S, Nekuei N, Sadeghi M, Movahedi M. A reproductive and sexual health promotion program for women with heart diseases: A protocol for mixed methods study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:346. [PMID: 34761032 PMCID: PMC8552279 DOI: 10.4103/jehp.jehp_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nowadays, for various reasons, the prevalence of heart diseases has increased in women during reproductive age. These diseases can lead to serious reproductive and sexual-related complications in the affected women. This study will conduct to develop a reproductive health promotion program for women with heart diseases. MATERIALS AND METHODS This is an exploratory sequential mixed methods study that will be conducted in four phases. The first phase is a qualitative research that is done using content analysis method and semi-structured individual interviews. The experiences of women with heart disease and health providers' team in educational hospitals, health centers, and private offices of physicians about reproductive health need will be explored. Purposive sampling will be continued until data saturation is reached and the conventional content analysis method will be used. In the second phase, the studies published from 2000 to 2020 will be reviewed by the matrix method and then will be analyzed by using thematic analysis. Integrating the results of these two stages, the draft of the program will be designed. In the third phase, the validation of the program will be checked by using the two-round modified Delphi method. In the fourth phase, the program will be implemented by the health system and its process will be monitored. CONCLUSION A life cycle reproductive health program for women with heart disease can help improve their preconception health, fertility planning, and sexual health and promote the well-being of these women in the long run.
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Affiliation(s)
- Shahnaz Kohan
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafisehsadat Nekuei
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Minoo Movahedi
- Department of Obstetrics and Gynaecology, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Yuliyanti S, Utarini A, Trisnantoro L. A protocol study of participatory action research: integrated care pathway for pregnant women with heart disease in Indonesia. BMC Health Serv Res 2020; 20:932. [PMID: 33036607 PMCID: PMC7547524 DOI: 10.1186/s12913-020-05769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Heart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. METHODS A participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software. DISCUSSION This research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality. TRIAL REGISTRATION Retrospectively registered in the ISRCTN registry with study ID ISRCTN82300061 on Feb 6, 2019.
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Affiliation(s)
- Suryani Yuliyanti
- Public Health Department, Faculty of Medicine, Universitas Islam Sultan Agung, Jl. Kaligawe Raya km 4, Semarang, 50122 Indonesia
- Doctoral Study Programme, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
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Mayer F, Bick D, Taylor C. To what extent does UK and Irish maternity policy and guidance address integration of services to meet needs of women with comorbidity? A policy document review. Midwifery 2020; 88:102758. [PMID: 32485503 DOI: 10.1016/j.midw.2020.102758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Felicity Mayer
- East London NHS Foundation Trust, City & Hackney Centre for Mental Health.
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwickshire.
| | - Cath Taylor
- School of Health Sciences, University of Surrey.
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