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Roman A. Screening and Prevention of Preterm Birth in Twin Pregnancies. Clin Obstet Gynecol 2023; 66:804-824. [PMID: 37910049 DOI: 10.1097/grf.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Twins represent 3.2% of all live births. However, they account for 20% of all preterm deliveries, 60% delivering <37 weeks, 10.7% <32 weeks, and 5 times higher risk of infant death. Risk factors for preterm birth (PTB) include the history of preterm delivery, monochorionic twins, short cervical length, and cervical surgery. Transvaginal cervical length <24 weeks is the best tool to predict PTB. Only vaginal progesterone in women with transvaginal cervical length <25 mm and physical exam indicated cerclage in women with cervical dilation >1 cm have shown a significant decrease in PTB and improvement in neonatal outcomes.
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Affiliation(s)
- Amanda Roman
- Obstetrics and Gynecology Department, Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Kent-Marvick J, Simonsen S, Pentecost R, Taylor E, McFarland MM. Loneliness in pregnant and postpartum people and parents of children aged 5 years or younger: a scoping review. Syst Rev 2022; 11:196. [PMID: 36071448 PMCID: PMC9451126 DOI: 10.1186/s13643-022-02065-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite evidence that loneliness increases during times of transition, and that the incidence of loneliness is highest in young adults, loneliness during pregnancy and new parenthood has not been developed as a program of research. Because loneliness research has primarily focused on older adults and other high-risk populations, the concept of loneliness and its effects on this population are not well understood, leaving a gap in our understanding of the psychosocial needs and health risks of loneliness on pregnant people and new parents. A scoping review has been completed in order to map and synthesize the literature on loneliness experienced during pregnancy and the first 5 years of parenthood prior to the COVID-19 pandemic. METHODS To address the aim of this review, a wide net was cast in order to detect experiences of perinatal or parental loneliness and/or instances where loneliness was measured in this population. Among the inclusion criteria were loneliness in people who were pregnant, who were parents in the postpartum period, or who had children aged 5 years or younger. A search for literature was conducted in December 2020 using nine databases: MEDLINE (Ovid), EMBASE (Elsevier), SCOPUS (Elsevier), Cochrane Library including CENTRAL (Wiley), CINAHL (Ebscohost), PsycINFO (Ebscohost), Dissertations & Theses Global (ProQuest) and Sociological Abstracts (ProQuest), and the Web of Science Core Collection (Clarivate). RESULTS Perinatal and parental loneliness studies are limited and have rarely been targeted and developed through a program of research. Loneliness inquiry in this population was frequently studied in relation to other concepts of interest (e.g., postpartum depression). Alternatively, the importance of loneliness emerged from study participants as relevant to the research topic during qualitative inquiry. Across studies, the prevalence of loneliness ranged from 32 to 100%. Loneliness was commonly experienced alongside parenting difficulties, with parents feeling as though they were alone in their struggles. CONCLUSIONS As loneliness has been called a sensitive indicator of mental wellbeing, we believe screening will help healthcare professionals identify common difficulties and early signs of depression experienced during pregnancy and parenthood. SYSTEMATIC REVIEW REGISTRATION The protocol is available on Open Science Framework at DOI 10.17605/OSF.IO/BFVPZ.
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Affiliation(s)
- Jacqueline Kent-Marvick
- University of Utah College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 USA
| | - Sara Simonsen
- University of Utah College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 USA
| | - Ryoko Pentecost
- University of Utah College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 USA
| | - Eliza Taylor
- University of Utah College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT 84112 USA
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Roman A, Ramirez A, Fox NS. Prevention of preterm birth in twin pregnancies. Am J Obstet Gynecol MFM 2021; 4:100551. [PMID: 34896357 DOI: 10.1016/j.ajogmf.2021.100551] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
Twins represent 3.2% of all livebirth, however they account for 20% of all preterm deliveries, with 60% of then deliver before 37 weeks, and 10.7% before 32 weeks. Twin pregnancies have five times higher risk of early neonatal and infant death related to prematurity. Monochorionic twins have higher incidence of both indicated and spontaneous preterm delivery compared with dichorionic twins. Transvaginal cervical length before 24 weeks is the best tool to predict preterm birth, independent of other risk factors. Among all the evaluated therapies to decrease or prevent preterm birth in twin pregnancies, vaginal progesterone in women with transvaginal cervical length < 25mm decreased neonatal morbidity and physical exam indicated cerclage in women with cervical dilation > 1 cm have shown a significant decrease in preterm birth at different gestational ages and decreased perinatal mortality.
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Affiliation(s)
- Amanda Roman
- Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
| | - Alexandra Ramirez
- Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
| | - Nathan S Fox
- Maternal Fetal Medicine Associates, PLLC, and The Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 70 East 90th Street, New York, NY 10128, USA.
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Lawrence ME, Carr L, Hart K, Whitaker KM. Perceived stress and support preferences during bed rest in twin pregnancies: A cross-sectional online survey. Midwifery 2021; 104:103189. [PMID: 34749124 DOI: 10.1016/j.midw.2021.103189] [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: 05/13/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the most prominent sources of stress, examine correlates of stress, and assess support preferences to inform future interventions among women pregnant with twins who are on bed rest. MATERIALS AND METHODS A cross-sectional online survey was administered to pregnant and postpartum women who were recommended bed rest during their twin pregnancy. Total stress while on bedrest was assessed using an adapted version of the Antepartum Hospital Stressors Inventory (AHSI). Bivariate analyses were used to compare total stress scores across participant characteristics using linear regression, Spearman's correlation, and one-way ANOVA. Qualitative content regarding women's bed rest experiences and future intervention preferences was analyzed into themes. FINDINGS Women's (N = 104, mean age 30.6 years ± 4.6) most prominent sources of stress while on bed rest included thinking about babies' health, feeling dependent on others, and feeling uncertain about the outcome. Women who were recommended bed rest earlier in their pregnancy or were recommended both home and hospital bedrest had higher stress scores, while women with monochorionic/monoamniotic pregnancies had lower stress scores. Approximately 64% of women indicated interest in a bed rest support program, with 88% indicating a preference for online support and 70% wanting support from family. KEY CONCLUSIONS Women pregnant with twins who are recommended bed rest identify many sources of stress. Our findings suggest a need for stress-management interventions targeting this population.
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Affiliation(s)
- Madeline E Lawrence
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States.
| | - Lucas Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States.
| | - Kimberly Hart
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.
| | - Kara M Whitaker
- Department of Health and Human Physiology and Department of Epidemiology, University of Iowa, Iowa City, IA, United States.
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Abstract
Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.
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Jain V, Bos H, Bujold E. Guideline No. 402: Diagnosis and Management of Placenta Previa. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:906-917.e1. [PMID: 32591150 DOI: 10.1016/j.jogc.2019.07.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. OPTIONS To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. OUTCOMES Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality. INTENDED USERS Family physicians, obstetricians, midwives, and other maternal care providers. TARGET POPULATION Pregnant women with placenta previa or low-lying placenta. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to October 2018. Medical Subject Heading (MeSH) terms and key words related to pregnancy, placenta previa, low-lying placenta, antepartum hemorrhage, short cervical length, preterm labour, and cesarean. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS This guideline has been reviewed by the Maternal-Fetal Medicine and Diagnostic Imaging committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and approved by the SOGC Board of Directors. BENEFITS, HARMS, AND/OR COSTS Women with placenta previa or low-lying placenta are at increased risk of maternal, fetal and postnatal adverse outcomes that include a potentially incorrect diagnosis and possibly unnecessary hospitalization, restriction of activities, early delivery, or cesarean delivery. Optimization of diagnosis and management protocols has potential to improve maternal, fetal and postnatal outcomes. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Lauder J, Sciscione A, Biggio J, Osmundson S, Osmundson S. Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am J Obstet Gynecol 2020; 223:B2-B10. [PMID: 32360110 DOI: 10.1016/j.ajog.2020.04.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite current recommendations against its use, activity restriction remains a common intervention used to prevent preterm birth in multiple clinical settings. Hypertensive disorders of pregnancy, preterm premature rupture of membranes, multiple gestations, vaginal bleeding, short cervical length, placenta previa, and fetal growth restriction are also common reasons for antepartum hospital admission and frequently lead to a recommendation for activity restriction. However, numerous reports have shown that activity restriction does not prevent adverse obstetrical outcomes but does confer significant physical and psychosocial risks. This consult reviews the current literature on activity restriction and examines the evidence regarding its use in obstetrical management. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend against the routine use of any type of activity restriction in pregnant women at risk of preterm birth based on preterm labor symptoms, arrested preterm labor, or shortened cervix (GRADE 1B); (2) we recommend against the use of routine inpatient hospitalization and activity restriction for the prevention of preterm birth in women with multiple gestations (GRADE 1A); and (3) given the lack of data definitively demonstrating that activity restriction improves perinatal outcome in pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive diseases of pregnancy, coupled with evidence of adverse effects of activity restriction, we suggest that activity restriction not be prescribed for the treatment of pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive disease (GRADE 2B).
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Affiliation(s)
| | | | | | | | - Sarah Osmundson
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Jain V, Bos H, Bujold E. Directive clinique no 402 : Placenta prævia : Diagnostic et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:918-930.e1. [DOI: 10.1016/j.jogc.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jain V. Choosing Wisely: Bedrest-A Panacea for All That Ails the Gravida? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:971-973. [PMID: 31053565 DOI: 10.1016/j.jogc.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
Abstract
Bedrest has been frequently prescribed for various high-risk conditions during pregnancy. A common indication cited is concern regarding increased risk of spontaneous preterm birth, known to be associated with gestations with twins or higher-order multiples, polyhydramnios, presence of preterm contractions with or without evidence of cervical change, sonographic cervical shortening, presence of a dilated cervix with bulging membranes, or preterm premature rupture of membranes. In some cases, there is concern that excessive movement may increase the risk of antepartum hemorrhage, as may be with placenta previa, with or without a higher risk of a morbidly adherent placenta or a vasa previa. It is also thought that improved splanchnic perfusion with bedrest may enhance blood supply to the uterus with possible benefit in conditions such as preeclampsia (or gestational hypertension) or fetal growth restriction. However, there is no evidence of any benefit of bedrest or reduced activity during pregnancy for either of these conditions. On the contrary, there is evidence of harm, in addition to the fact that exercise is known to be beneficial in pregnancy.
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Affiliation(s)
- Venu Jain
- Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Edmonton, AB.
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Yeager J. Relaxation Interventions for Antepartum Mothers on Hospitalized Bedrest. Am J Occup Ther 2019; 73:7301205110p1-7301205110p7. [PMID: 30839266 DOI: 10.5014/ajot.2019.025692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Women with a high-risk pregnancy on hospitalized bedrest engaged in relaxation interventions, including guided imagery, visual imagery, and listening to music. Qualitative interviews gathered their perspectives on the effects of hospitalized bedrest on well-being and the subjective experiences related to the relaxation interventions. Benefits identified included improved physical well-being and sleep. Such relaxation interventions were concluded to have the potential to positively influence the occupational well-being of this population, resulting in more positive outcomes for mothers.
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Affiliation(s)
- Jenna Yeager
- Jenna Yeager, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD;
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Abstract
This study was to examine the effects of support interventions on anxiety, depression, and quality of life in women hospitalized with preterm labor. A randomized, single-blind experimental design was used. Participants were recruited from maternity wards of one medical center in Taiwan. The control group ( n = 103) received routine nursing care, and intervention group ( n = 140) received interventional support during hospitalization. The Beck Anxiety Inventory, Edinburgh Postnatal Depression Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire were used at admission and 2 weeks of hospitalization. For the control group, anxiety and depression scores increased significantly and quality of life decreased 2 weeks after hospitalization. Participants who received 2 weeks of support intervention had significantly lower anxiety and depression scores than controls. Thus, clinical nurses can offer support interventions to improve anxiety and depression for women with preterm labor during hospitalization.
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Abstract
The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t =– 2.14,p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M= 22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27)= 15.68, p = .00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.
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Affiliation(s)
- Judith A Maloni
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44109-4904, USA.
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Gray BA. Hospitalization History and Differences in Self-Rated Pregnancy Risk. West J Nurs Res 2016; 28:216-29; discussion 230-3. [PMID: 16513920 DOI: 10.1177/0193945905282305] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-risk pregnancies affect a significant number of women each year. Limited information exists on how these women appraise the risk to their pregnancy. This descriptive study of expectant women who were medically categorized as high risk examined differences in women's self-appraisal of risk to themselves and their babies, based on hospitalization history, and differences among risk appraisals made by women and their health care providers. Women who were currently hospitalized had significantly lower self-appraised mother risk scores than both the women who were previously hospitalized and those never hospitalized. Women who were never hospitalized had significantly lower self-appraised baby risk scores than the women in both the currently and previously hospitalized groups. Women who were previously hospitalized scored highest on self-appraised risk to mother and risk to baby. Women reported significantly lower self-appraised risk to mother scores than their nurses.
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Affiliation(s)
- Bobbe Ann Gray
- Wright State University College of Nursing and Health, Dayton, OH, USA
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14
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Abstract
Preterm birth is a major concern in modern obstetrics, and an important source of morbidity and mortality in newborns. Among twin pregnancies, especially, preterm birth is highly prevalent, and it accounts for almost 50% of the complications observed in this obstetrical population. In this article, we review the existing literature regarding the prediction and prevention of preterm birth in both symptomatic and asymptomatic twin pregnancies. In asymptomatic twin pregnancies, the best two predictive tests were cervical length (CL) measurement and cervicovaginal fetal fibronectin (fFN) testing. A single measurement of transvaginal CL at 20-24 weeks of gestation <20 mm or <25 mm is a good predictor of spontaneous preterm birth at <28, <32, and <34 weeks of gestation. A CL beyond 25 mm is associated with a 2% risk for birth before 28 weeks and with a 65% chance for a term pregnancy. Cervicovaginal fFN may be slightly less accurate than CL; however, it has a high negative predictive value in women presenting with threatened preterm labor, as <2% of these women will deliver within one week if the fFN is negative. In symptomatic twin pregnancies, no tests have proven accurate in predicting the risk of preterm birth. For the prevention of preterm birth in asymptomatic twins, regardless of CL, no treatment including bed rest, limitation of home activities, prophylactic tocolysis, progesterone, or cerclage has been shown to reduce the rate of preterm birth. Cervical pessaries might be of interest in cases where there is a short cervix (<25 mm and <38 mm, respectively) but these results need to confirmed in future trials.
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Affiliation(s)
- F Fuchs
- Departement de Gynécologie-Obstétrique, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin Bicêtre, France; INSERM, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, Villejuif, France; Université Paris-Sud, UMRS 1018, Villejuif, France
| | - M-V Senat
- Departement de Gynécologie-Obstétrique, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin Bicêtre, France; INSERM, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, Villejuif, France; Université Paris-Sud, UMRS 1018, Villejuif, France.
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What can inactivity (in its various forms) reveal about affective states in non-human animals? A review. Appl Anim Behav Sci 2015. [DOI: 10.1016/j.applanim.2015.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lynch CE, Magann EF, Barringer SN, Ounpraseuth ST, Eastham DG, Lewis SD, Stowe ZN. Pet therapy program for antepartum high-risk pregnancies: a pilot study. J Perinatol 2014; 34:816-8. [PMID: 24968176 DOI: 10.1038/jp.2014.120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/05/2014] [Accepted: 05/19/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This pilot study evaluated the potential benefits of pet therapy on symptoms of anxiety and depression in antepartum hospitalized women with high-risk pregnancies. STUDY DESIGN Eighty-two women in a hospital-based setting completed the State-Trait Anxiety Inventory and the Beck Depression Inventory before and after the pet therapy visit. For both questionnaires, paired t-test was used and adjusted P-values were obtained using the Hochberg step-up Bonferroni method. RESULT The mean scores for depressive symptoms significantly improved from the pre-pet therapy (10.1 ± 6.3) compared with the post-pet therapy (6.3 ± 5.9) (P<0.0001). Likewise mean scores of the state anxiety significantly improved from the pre-pet therapy test (44.8 ± 11.7) compared with the post-pet therapy (34.5 ± 10.5) (P<0.001). CONCLUSION Pet therapy significantly reduced anxiety and depression in antepartum hospitalized women with high-risk pregnancies.
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Affiliation(s)
- C E Lynch
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S N Barringer
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S T Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D G Eastham
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S D Lewis
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Z N Stowe
- 1] Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA [2] Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA [3] Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Tocolysis for preterm labor: Expert opinion. Arch Gynecol Obstet 2014; 289:903-9. [DOI: 10.1007/s00404-013-3137-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
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Rode L, Tabor A. Prevention of preterm delivery in twin pregnancy. Best Pract Res Clin Obstet Gynaecol 2013; 28:273-83. [PMID: 24378186 DOI: 10.1016/j.bpobgyn.2013.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
The incidence of twin gestation has increased markedly over the past decades, mostly because of increased use of assisted reproductive technologies. Twin pregnancies are at increased risk of preterm delivery (i.e. birth before 37 weeks of gestation). Multiple gestations therefore account for 2-3% of all pregnancies but constitute at least 10% of cases of preterm delivery. Complications from preterm birth are not limited to the neonatal period, such as in retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, respiratory disorder and sepsis; they can also constitute sequelae such as abnormal neurophysiological development in early childhood and underachievement in school. Several treatment modalities have been proposed in singleton high-risk pregnancies. The mechanism of initiating labour may, however, be different in singleton and twin gestations. Therefore, it is mandatory to evaluate the proposed treatments in randomised trials of multiple gestations. In this chapter, we describe the results of trials to prevent preterm delivery in twin pregnancies.
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Affiliation(s)
- Line Rode
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, 2100 Rigshospitalet, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, 2100 Rigshospitalet, Denmark.
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Cannella D, Auerbach M, Lobel M. Predicting birth outcomes: together, mother and health care provider know best. J Psychosom Res 2013; 75:299-304. [PMID: 24119934 DOI: 10.1016/j.jpsychores.2013.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/16/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine contributors to perceived risk in pregnancy and its utility in predicting lower birth weight and earlier delivery in conjunction with health care providers' assessment of obstetric risk. METHODS 165 pregnant women at high (n=34) or low (n=131) obstetric risk completed assessments of perceived risk, stress, optimism, and health behaviors using well-validated instruments and measures designed for this study. Medical charts were abstracted for gestational age at delivery and birth weight. RESULTS 40% of the sample perceived their risk status differently than their health care provider. Stress, poor reproductive history, provider assigned risk, and unhealthful behaviors were significant, independent predictors of perceived risk (R(2)=.37). The greatest difference in birth weight (p=.003) and gestational age (p=.05) was between women considered at low risk by both self and provider and women considered at high risk by both. Perceived risk improved prediction of adverse birth outcomes, especially lower birth weight, in women considered by providers to be at low risk. CONCLUSION Women's perceptions of risk are an important contributor to prediction of birth outcomes, but the combination of information from both a woman and her health care provider is superior. Incorporating women's perceptions into obstetric risk determination may help to reduce the number of women identified as high risk who subsequently have a normal birth outcome (false positives), and more importantly, the number of women considered to be at low risk who ultimately experience an adverse outcome (false negatives).
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Effects of a Guided Imagery Intervention on Stress in Hospitalized Pregnant Women. Holist Nurs Pract 2013; 27:129-39. [DOI: 10.1097/hnp.0b013e31828b6270] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bauer CL, Victorson D, Rosenbloom S, Barocas J, Silver RK. Alleviating distress during antepartum hospitalization: a randomized controlled trial of music and recreation therapy. J Womens Health (Larchmt) 2013; 19:523-31. [PMID: 20141383 DOI: 10.1089/jwh.2008.1344] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pregnant women who are placed on hospitalized bed rest experience increased antepartum-related distress. We sought to examine the efficacy of a single session music or recreation therapy intervention to reduce antepartum-related distress among women with high-risk pregnancies experiencing extended antepartum hospitalizations. METHODS In a randomized, single-blinded study, participants (n = 80) received 1 hour of music or recreation therapy or were placed in an attention-control group. Antepartum-related distress was measured by the Antepartum Bedrest Emotional Impact Inventory, which was administered before and after the intervention and at a follow-up period between 48 and 72 hours. RESULTS Significant associations were found between the delivery of music and recreation therapy and the reduction of antepartum-related distress in women hospitalized with high-risk pregnancies. These statistically significant reductions in distress persisted over a period of up to 48-72 hours. CONCLUSIONS Single session music and recreation therapy interventions effectively alleviate antepartum-related distress among high-risk women experiencing antepartum hospitalization and should be considered as valuable additions to any comprehensive antepartum program.
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Affiliation(s)
- Constance L Bauer
- NorthShore University HealthSystem, Perinatal Family Support Center, Evanston, Illinois, USA
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Rubarth LB, Schoening AM, Cosimano A, Sandhurst H. Women's experience of hospitalized bed rest during high-risk pregnancy. J Obstet Gynecol Neonatal Nurs 2012; 41:398-407. [PMID: 22537349 DOI: 10.1111/j.1552-6909.2012.01349.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the lived experience of the hospitalized pregnant woman on bed rest. DESIGN A qualitative, phenomenological design. SETTING Three high-risk antepartum units in the midwestern United States. PARTICIPANTS A self-selected, convenience sample of 11 high-risk pregnant women. METHOD Phenomenological study using thematic analysis of completed handwritten journals and/or online blogs. RESULTS Women described the battles that they fought each day for the lives of their unborn children. Using an imagery of war, three categories emerged: (a) the war within, (b) fighting each battle, and (c) bringing in reinforcements. CONCLUSIONS Women experience many different emotions and stressors during restricted bed rest. A nurse's understanding of this experience is essential to provide adequate care and coping strategies for women at this time.
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Denis A, Michaux P, Callahan S. Factors implicated in moderating the risk for depression and anxiety in high risk pregnancy. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.677020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nakamura Y, Takeishi Y, Atogami F, Yoshizawa T. Assessment of quality of life in pregnant Japanese women: Comparison of hospitalized, outpatient, and non-pregnant women. Nurs Health Sci 2012; 14:182-8. [DOI: 10.1111/j.1442-2018.2011.00676.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Smith V, Devane D, Murphy-Lawless J. Risk in Maternity Care: A Concept Analysis. INTERNATIONAL JOURNAL OF CHILDBIRTH 2012. [DOI: 10.1891/2156-5287.2.2.126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM: To analyze the concept of risk in maternity care.DATA SOURCES: MEDLINE (1966–2010), CINAHL (1980–2010), EMBASE (1980–2010), PsycINFO (1980–2010), and Social Science Citation Index were searched. Key text books were sourced. Media literature was reviewed by perusal of newspaper articles, health supplements, and popular Internet health care websites.REVIEW METHODS: The principle-based method of concept analysis was used to guide the analysis of risk in maternity care.RESULTS: The epistemological principle identified the ambiguous nature of the risk concept, with risk having diverse meanings for different individuals. The pragmatic principle demonstrated that the current systematic approach to risk assessment often fails to identify those who succumb to risk issues. The linguistic principle portrays the ambiguity of risk perception with “risk” considered according to past experiences, knowledge, and individual attitudes. The logical principle identified a strong link between safety and uncertainty revealing that the risk concept lacks integrity and may not “hold its own.”CONCLUSION: The concept of risk in maternity care is concerned with risk assessment, risk perception, and notions of safety and uncertainty. Risk in maternity care is diverse and dynamic. What constitutes as a risk today may not necessarily be viewed in the same light tomorrow.
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Eliasov L, Zalman D, Flechter E, Vorobeichik M, Halevi-Gurevich M, Levi I, Bar-Sela G. A preliminary report on innovative group therapy in an oncology in-patient department: a patient-family-staff community meeting. Psychooncology 2011; 20:1126-9. [DOI: 10.1002/pon.1813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 11/06/2022]
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Chuang LL, Lin LC, Cheng PJ, Chen CH, Wu SC, Chang CL. Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour. J Adv Nurs 2011; 68:170-80. [DOI: 10.1111/j.1365-2648.2011.05765.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Maloni JA. Lack of evidence for prescription of antepartum bed rest. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2011; 6:385-393. [PMID: 22140399 PMCID: PMC3226811 DOI: 10.1586/eog.11.28] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antepartum bed-rest treatment is based on assumptions that it is both effective and safe for mother and fetus. However, research indicates, that bed-rest treatment is ineffective for preventing preterm birth and fetal growth restriction, and for increasing gestational age at birth and infant birthweight. Studies of women treated with pregnancy bed-rest identify numerous side effects, including muscle atrophy, bone loss, weight loss, decreased infant birthweight in singleton gestations and gestational age at birth, and psychosocial problems. Studies conducted by aerospace scientists who have used bed rest as a model for the study of weightlessness in space using nonpregnant individuals report similar results. Antepartum bed-rest treatment should be discontinued until evidence of effectiveness is found.
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Affiliation(s)
- Judith A Maloni
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA, Tel.: +1 216 368 2912, ,
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Stevens NR, Hamilton NA, Wallston KA. Validation of the multidimensional health locus of control scales for labor and delivery. Res Nurs Health 2011; 34:282-96. [PMID: 21656786 DOI: 10.1002/nur.20446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2011] [Indexed: 11/07/2022]
Abstract
No current instrument assesses women's health locus of control beliefs in relation to childbirth. Form C of the Multidimensional Health Locus of Control Scales was used to develop items for a new instrument specific to labor and delivery (MHLC-LD). Psychometric analyses conducted with two independent samples of pregnant women supported a three-factor model of the new instrument, consisting of Internal, Powerful Others, and Chance subscales. Results revealed modest coefficient alphas (>.70) for the subscales and demonstrated construct validity in known group analyses. Future validation research will focus on improving the internal consistency reliability of the MHLC-LD, testing factorial invariance across demographic groups, and examining the relationships between obstetric risk, previous birth experiences, and beliefs about control over childbirth outcomes.
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Affiliation(s)
- Natalie R Stevens
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS 66045, USA
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31
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Fleury C, Parpinelly M, Makuch MY. Development of the mother–child relationship following pre‐eclampsia. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646831003729104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Flood JL, Dodgson JE. Health care and social service providers' descriptions of pacific islander mothers' breastfeeding patterns. J Midwifery Womens Health 2010; 55:162-70. [PMID: 20189135 DOI: 10.1016/j.jmwh.2009.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 04/22/2009] [Accepted: 04/22/2009] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite recommendations and numerous health benefits attributed to breastfeeding, rates in the United States are below desired levels, particularly within vulnerable populations. In Hawaií, breastfeeding rates are higher than national averages except in Native Hawaiian and other Pacific Islander populations. Health care and social service providers are integral to successful breastfeeding promotion efforts. They are in an ideal position to reflect on the context in which their clients live and on its relationship to breastfeeding activities. The aim of this study was to describe health care and social service providers' perceptions of the influences on the breastfeeding patterns of Pacific Islander women. METHODS Focus ethnographic methods were used to collect interview data from health care and social service providers (N=20) serving Native Hawaiian and Pacific Islander women in one rural community. An iterative analysis process of coding and categorizing, followed by conceptual abstraction into patterns, was completed. RESULTS Four patterns emerged: shaped by connections, lived unfamiliarity, stressed by circumstance, and missed opportunities. Participants' insights concerning the needs of this population yielded population-specific issues and health care system issues affecting breastfeeding promotion. A number of gaps in breastfeeding services were identified. DISCUSSION Sociocultural, maternal knowledge, and workload barriers to successful breastfeeding predominated providers' perspectives. Broader system and community level issues were implied, but not directly addressed. The nature of successful breastfeeding support and promotion requires inclusion of this broader level perspective.
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Affiliation(s)
- Jeanie L Flood
- University of Hawaií at Hilo, 200 W. Kawili Street UCB 237, Hilo, HI 96720, USA.
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33
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Heaman MI, Gupton AL. Psychometric testing of the Perception of Pregnancy Risk Questionnaire. Res Nurs Health 2009; 32:493-503. [PMID: 19606451 DOI: 10.1002/nur.20342] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pregnant women's perception of risk may influence their health behaviors during pregnancy; however, no validated instrument exists to measure those perceptions. The purpose of this study was to refine a new instrument, the Perception of Pregnancy Risk Questionnaire (PPRQ), and conduct psychometric assessment of the final 9-item version. Reliability and validity were assessed using a sample of 199 women in the third trimester of pregnancy. Exploratory factor analysis resulted in a two-factor solution. Evidence of construct validity was demonstrated using the known-groups technique and through convergent validity. Ratings of pregnancy risk correlated with state anxiety level, providing evidence of concurrent validity. The PPRQ had high internal consistency reliability and excellent test-retest reliability.
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Affiliation(s)
- Maureen I Heaman
- Helen Glass Centre for Nursing, University of Manitoba, Room 268, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
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35
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Kim MK, Lee YW, Cho IS, Lim JY. Change of Stress and Nursing Needs after Hospitalization in Preterm Labor Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2009. [DOI: 10.4069/kjwhn.2009.15.1.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Young Whee Lee
- Professor, Department of Nursing, Inha University, Korea
| | - In Sook Cho
- Assistant Professor, Department of Nursing, InHa University, Korea
| | - Ji Young Lim
- Assistant Professor, Department of Nursing, InHa University, Korea
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A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth. Eur J Obstet Gynecol Reprod Biol 2009; 142:3-11. [DOI: 10.1016/j.ejogrb.2008.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 05/12/2008] [Accepted: 09/04/2008] [Indexed: 11/18/2022]
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Barlow JH, Hainsworth J, Thornton S. Women's experiences of hospitalisation with hypertension during pregnancy: feeling a fraud. J Reprod Infant Psychol 2008. [DOI: 10.1080/02646830701691384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sprague AE, O’Brien B, Newburn-Cook C, Heaman M, Nimrod C. Bed Rest and Activity Restriction for Women at Risk for Preterm Birth: A Survey of Canadian Prenatal Care Providers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:317-326. [DOI: 10.1016/s1701-2163(16)32800-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
The choice of therapy for fetal growth restriction (FGR) depends on the nature of the insult that led to the development of FGR. Many etiologic factors are either not amenable to therapy or fetal growth has not been improved by treatments that benefit the mother. Many therapeutic approaches have been used to improve fetal condition. None of the approaches have been of value in a consistent manner. We present the numerous approaches, and their rationale for their use, that have been tried to treat the growth impaired fetus. The evidence from the randomized clinical trials is summarized and their conclusions given.
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Affiliation(s)
- Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Winthrop University Hospital, Mineola, New York, USA.
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40
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Dunn LL, Shelton MM. Spiritual well-being, anxiety, and depression in antepartal women on bedrest. Issues Ment Health Nurs 2007; 28:1235-46. [PMID: 17987479 DOI: 10.1080/01612840701651504] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This descriptive correlational study examined relationships among anxiety, depression, and spiritual well-being (SWB) in three groups of women (non-pregnant, normal pregnancy, high-risk pregnancy on bedrest). Women in each group completed a demographic survey, a Spiritual Well-Being Scale, and depression and anxiety subscales from the Abbreviated Scale for the Assessment of Psychosocial Status in Pregnancy. All groups (N = 180) demonstrated significant, inverse relationships among SWB, anxiety, and depression. Findings emphasize the importance of obstetrical nurses screening pregnant women to evaluate emotional health, especially in high risk pregnancies. Collaboration with mental health nurses may be useful in developing interventions to improve a woman's SWB, reduce anxiety and depression, and improve pregnancy outcomes.
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Affiliation(s)
- Linda L Dunn
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama 35487, USA.
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41
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Richter MS, Parkes C, Chaw-Kant J. Listening to the Voices of Hospitalized High-Risk Antepartum Patient. J Obstet Gynecol Neonatal Nurs 2007; 36:313-8. [PMID: 17594405 DOI: 10.1111/j.1552-6909.2007.00159.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the needs of high-risk antepartum patients while hospitalized and to generate recommendations from the patients' perspective. DESIGN Qualitative descriptive. PARTICIPANTS/SETTING Thirteen female patients in a high-risk antepartum unit of a large tertiary hospital, Edmonton, Alberta. DATA ANALYSIS A qualitative data analysis process was followed. RESULTS The major themes and subthemes that emerged from interviews with participants included stressors associated with loss of control and feelings of being a burden. The need for privacy and sensitivity to family members was expressed. Participants' recommendations included being treated as a family unit, setting up accommodation for visiting family members, and wanting more organized activities to relieve boredom. CONCLUSIONS An understanding of the needs of high-risk antepartum patients while hospitalized from their perspective will help the primary caregiver such as the registered nurse improve the quality of the women's care, provide guidance about the management of stressors, and plan interventions to reduce stress and to involve their families.
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Affiliation(s)
- Magdalena S Richter
- Faculty of Nursing, University of Alberta, 7-50L Extension Centre, Edmonton, Alberta, Canada.
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42
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Abstract
According to Orem's self-care deficit nursing theory, helping people to maintain a balance between activity and rest (a universal self-care requisite) is a legitimate concern of nursing. The meaning of activity and rest, the requirements and potential measures for meeting this self-care requisite, and factors that might influence the process are explored. Criteria for determining a need for nursing, guides for a nursing clinical assessment, and guides for nursing action are suggested as potential ways to assist persons to meet the action demands associated with this self-care requisite.
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Moffat MA, Bell JS, Porter MA, Lawton S, Hundley V, Danielian P, Bhattacharya S. Decision making about mode of delivery among pregnant women who have previously had a caesarean section: A qualitative study. BJOG 2007; 114:86-93. [PMID: 17233863 DOI: 10.1111/j.1471-0528.2006.01154.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore prospectively women's decision making regarding mode of delivery after a previous caesarean section. MAIN OUTCOME MEASURES The evolution of decision making, women's participation in decision making, and factors affecting decision making. DESIGN AND METHODS A qualitative study using diaries, observations and semi-structured interviews. Data were analysed thematically from both a longitudinal and a cross-sectional perspective. SETTING An antenatal unit in a large teaching hospital in Scotland and participants' homes. SAMPLE Twenty-six women who had previously had a caesarean section for a nonrecurrent cause. RESULTS Women were influenced by their own previous experiences and expectations, and the final decision on mode of delivery often developed during the course of the pregnancy. Most acknowledged that any decision was provisional and might change if circumstances necessitated. Despite a universal desire to be involved in the process, many women did not participate actively and were uncomfortable with having responsibility for decision making. Feelings about the amount and quality of the information received regarding delivery options varied greatly, with many women wishing for information to be tailored to their individual clinical circumstances and needs. In contrast to the impression created in the media, there was no evidence of clear preferences or strong demands for elective caesarean section. CONCLUSION Women who have had a previous caesarean section do not usually have firm ideas about mode of delivery. They look for targeted information and guidance from medical personnel based on their individual circumstances, and some are unhappy with the responsibility of deciding how to deliver in the current pregnancy.
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Affiliation(s)
- M A Moffat
- Department of General Practice & Primary Care, University of Aberdeen, Foresterhill, Aberdeen, UK
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Price S, Lake M, Breen G, Carson G, Quinn C, O'Connor T. The Spiritual Experience of High‐Risk Pregnancy. J Obstet Gynecol Neonatal Nurs 2007; 36:63-70. [PMID: 17238948 DOI: 10.1111/j.1552-6909.2006.00110.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To uncover the spiritual beliefs and practices of women experiencing high-risk pregnancies. DESIGN Qualitative, naturalistic inquiry via face-to-face, semistructured interviews, with thematic analysis of interview transcripts. SETTING A prenatal special care unit of a tertiary health centre. PARTICIPANTS A purposeful sample of 12 women admitted for high-risk pregnancy complications. RESULTS Analysis of the women's interviews uncovered the following themes: high-risk pregnancy as a challenge, seeking a spiritual language, what makes you who you are, and everything will be OK. CONCLUSIONS Findings from this study highlight that within the challenges of a high-risk pregnancy, the women often struggled to define their spirituality yet recognized spiritual expression as key to their health and healing. Each woman identified aspects of their spirituality that enabled them and their families to deal with the stress of their high-risk pregnancy experience, which they believed enhanced outcomes for themselves and their unborn child.
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Affiliation(s)
- Sheri Price
- Research associate with Interdisciplinary Research at IWK Health Centre, adjunct faculty with School of Nursing, Dalhousie University, Halifax, Nova Scotia, and a PhD student (Nursing) at the Faculty of Nursing, University of Toronto, Ontario, Canada..
| | - Margaret Lake
- Spiritual Health at the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Glenn Breen
- Spiritual Health at the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Glenda Carson
- IWK Health Centre, Halifax, Nova Scotia, and PhD student (Nursing) at the Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Colleen Quinn
- Spiritual Health at the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Thomas O'Connor
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Markovic M, Manderson L, Schaper H, Brennecke S. Maternal identity change as a consequence of antenatal hospitalization. Health Care Women Int 2006; 27:762-76. [PMID: 17060177 DOI: 10.1080/07399330600880319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive "decision takers," complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated.
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Affiliation(s)
- Milica Markovic
- School of Psychology, Psychiatry and Psychiatric Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia.
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Abstract
A high-risk pregnancy can be a stressful situation for a woman, her partner and her family. Many women utilize their spiritual beliefs as a way to make sense of their situation. Health care professionals, including nurses, midwives and physicians, can provide effective spiritual care and support consistent with their professional scopes of practice. Spiritually focused interventions can help to reduce stress and anxiety and create a more open and confident approach to the management of pregnancy complications.
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Liu S, Heaman M, Sauve R, Liston R, Reyes F, Bartholomew S, Young D, Kramer MS. An Analysis of Antenatal Hospitalization in Canada, 1991–2003. Matern Child Health J 2006; 11:181-7. [PMID: 17089198 DOI: 10.1007/s10995-006-0154-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. METHODS A population-based cohort study was conducted using the Canadian Institute for Health Information's Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. RESULTS The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20-24 years, respectively, compared to 11.5 per 100 for women aged 35-39 years. The antenatal hospitalization ratio varied greatly by province/territory--from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. CONCLUSIONS The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Tunney's Pasture, Ottawa, Ontario, Canada.
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MacKinnon K. Living With the Threat of Preterm Labor: Women’s Work of Keeping the Baby In. J Obstet Gynecol Neonatal Nurs 2006; 35:700-8. [PMID: 17105634 DOI: 10.1111/j.1552-6909.2006.00097.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the social organization of women's preterm labor experiences. DESIGN Institutional ethnography investigated how the woman's experience is socially organized and for patterns of how something is organized to recur. PARTICIPANTS/SETTING Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate. DATA ANALYSIS Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives. RESULTS Women spoke about their fear of going home and feeling alone with the responsibility for their work of "keeping the baby in." Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being "careful." CONCLUSIONS The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families.
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Affiliation(s)
- Karen MacKinnon
- Centre for Rural Health Research, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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Giurgescu C, Penckofer S, Maurer MC, Bryant FB. Impact of uncertainty, social support, and prenatal coping on the psychological well-being of high-risk pregnant women. Nurs Res 2006; 55:356-65. [PMID: 16980836 DOI: 10.1097/00006199-200609000-00008] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effects of uncertainty and social support on the psychological well-being of high-risk pregnant women may be influenced by their prenatal coping strategies. OBJECTIVE The purpose of this study was to investigate whether prenatal coping strategies (preparation for motherhood, avoidance, positive interpretation of events, and prayer) mediate the effects of uncertainty and social support on the psychological well-being of high-risk pregnant women. METHODS A cross-sectional, descriptive, correlational design was used. The convenience sample consisted of 105 high-risk pregnant women 18-34 years of age and at 24-36 weeks gestation. The main measures were Mishel Uncertainty in Illness Scale, Medical Outcomes Study Social Support Survey, Prenatal Coping Inventory, and Psychological General Well-Being Index. Data analysis included descriptive statistics, correlational techniques, and path analyses. RESULTS The women reported low levels of uncertainty, moderate levels of distress, and high levels of social support. Prayer was the most frequently used prenatal coping strategy, whereas avoidance was used least often. Women who reported higher levels of uncertainty also reported less social support (r = -.45, p < .01), less psychological well-being (r = -.48, p < .01), less positive interpretation (r = -.30, p < .01), and more use of avoidance (r = .43, p < .01). The modified path analysis showed good fit with the data. Avoidance significantly mediated the effects of uncertainty on psychological well-being (z = -2.74, p < .01). Social support had a significant direct effect on preparation for motherhood (beta = .43, z = 3.94, p < .001). DISCUSSION Avoidance mediated the effect of uncertainty on psychological well-being for the high-risk pregnant women in this sample. The results of the study may help perinatal nurses to better understand how high-risk pregnancy affects these women.
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Affiliation(s)
- Carmen Giurgescu
- Department of Maternal-Child Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL 60612, USA.
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Abstract
OBJECTIVE To compare the ability to direct attention in women having a high-risk pregnancy with those having an uncomplicated pregnancy. DESIGN Descriptive comparative. SETTING A tertiary-care hospital. PARTICIPANTS Women in the 3rd trimester of pregnancy receiving care from perinatologists were recruited for this study and comprised the high-risk group (n = 67). Women in their 3rd trimester of pregnancy with uncomplicated pregnancies and enrolled in prenatal classes were the comparison group (n = 57). MAIN OUTCOME MEASURES Objective measures of directed attention included digit span forward, digit span backward, Trailmaking A, and Trailmaking B. Subjective measures included the Attentional Function Index and Mental Effort in Tasks. RESULTS Women having a complicated pregnancy had significantly more difficulty directing attention on all measures than women having normal pregnancies. When all covariates were considered, women having a high-risk pregnancy had significantly more difficulty directing attention as measured by Trailmaking A, Trailmaking B, and Mental Effort in Tasks. CONCLUSIONS Women having high-risk pregnancies may have more difficulty with activities that require directed attention than women having normal pregnancies. Learning new information and skills, problem solving, and planning may require additional effort for women having complicated pregnancies.
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Affiliation(s)
- Mary Ann Stark
- Bronson School of Nursing, Western Michigan University, Kalamazoo, MI 49008, USA.
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