Obstetric Correlates of Maternal Falls in Southern Nigeria

Scoping Review of Fall Risk Assessment Tools for Women Who Receive Maternity Care

OBJECTIVE

To identify and describe fall risk assessment tools used for women who receive maternity care.

DATA SOURCES

PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Library, Scopus, SciELO, and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP).

STUDY SELECTION

We considered reports published until November 28, 2022, that included women during pregnancy, childbirth, or the postpartum period; involved the use of fall risk assessment tools, regardless of context; and were published in English, French, Portuguese, or Spanish.

DATA EXTRACTION

We extracted the following data from the included reports: author(s)/year/country, aim/sample, research design/type of report, tool (i.e., the fall risk assessment tool used), findings, reliability, and validity.

DATA SYNTHESIS

We found 13 reports in which the authors addressed nine fall risk assessment tools. Seven of these tools were applied during pregnancy (Kyle's tool, Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Obstetric Fall Risk Assessment System), labor (Obstetric Fall Risk Assessment System), the postpartum period (Cooksey-Post Obstetric Delivery Fall Risk Assessment, Kyle's tool, Risk of Falling in Post-partum Women (SLOPE), Obstetric Fall Risk Assessment System, Post-epidural Fall Risk Assessment Score, and Maternal Fall Risk Assessment Scale). The Dionne's Egress Test and the Motor Strength Scale do not address the characteristics of the women who receive maternity care. Psychometric characteristics were available for the Pregnant Women Information Form and Assessment Scale for Risk of Falling in Pregnant Women, Post-epidural Fall Risk Assessment Score, Maternal Fall Risk Assessment Scale, and Risk of Falling in Post-partum Women.

CONCLUSION

Some fall risk assessment tools are used to assess women who receive maternity care without proper validation in this specific population. The use of fall risk assessment tools that are validated for women who receive maternity care may help nurses make clinical judgments when assessing fall risk and implement measures for fall prevention.

Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

ÜÇÜNCÜ TRİMESTERDA AYAKKABI UYGUNLUĞU, DÜŞME KORKUSU VE FİZİKSEL AKTİVİTE ARASINDAKİ İLİŞKİ

Purpose: Pregnancy is a time of intense physiologic and physical changes, especially in third trimester. The aim of this study was to investigate the relationship between the footwear suitability, fear of falling and physical activity in third trimester of pregnancy. Methods: One hundred twenty-three pregnant women aged between 18-40 years and a gestational age of 28 weeks and above were included the study. The Footwear Assessment Score was used to assess the suitability of the footwear. The fear of falling of the participants was measured using the Falls Efficacy Scale-International, and the physical activity level was measured using the International Physical Activity Questionnaire - short form. Results: A low negative correlation (r = -0.215; p < 0.05) was found between physical activity and fear of falling, and a low positive correlation (r = 0.256; p < 0.01) was found between footwear suitability and physical activity in pregnant women. There was no statistically significant relationship (r = -0.120; p = 0.185) between footwear suitability and fear of falling. Conclusion: According to the findings of the current study, it can be concluded that a more appropriate choice of shoes as the level of physical activity increases among pregnant women, and physical activity may reduce the fear of falling during pregnancy. Future studies are needed to investigate footwear suitability during pregnancy in more detail.

Risk factors for accidental falls during pregnancy - a systematic literature review

INTRODUCTION

Falls during pregnancy occur in 25-27% of women and can cause serious harm to both the mother and the fetus. The objective of this systematic review was to identify intrinsic and extrinsic risk factors for falls during pregnancy by reviewing original studies and addressing possible forms of prevention.

METHODS

We searched PubMed, Cochrane library, and Web of Science databases for studies assessing risk factors for falling after a fall has occurred or by using posturographic assessment.

RESULTS

Fourteen studies were included in the review. The identified extrinsic risk factors include slippery floors, cluttered areas, uneven ground, inappropriate shoes, hurrying, walking on stairs, carrying additional loads, poor lighting or obstructed view, sedentary lifestyle and working in physically demanding jobs. The identified intrinsic factors include age less than 30, height more than 160 cm, advanced pregnancy, unintended pregnancy, multiparity, hyperemesis gravidarum, low back pain, gestational diabetes, increase in abdominal circumference, lower ankle stiffness and joint laxity. Physical activity, maternity support belts, and education are possible strategies for fall prevention.

CONCLUSION

Our systematic review identified 13 intrinsic and 11 extrinsic risk factors for falling during pregnancy. With the knowledge of risk factors and the optimal prevention strategy, healthcare providers could incorporate this information in the treatment of pregnant women and reduce the risk of falling.