Perinatal Outcomes and Level of Labour Difficulty in Deliveries with Right and Left Foetal Position-A Preliminary Study

BACKGROUND

Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty.

METHODS

The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women.

FINDINGS

When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult.

CONCLUSIONS

The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly.

Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

BACKGROUND

Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions.

METHODS

We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time.

RESULTS

The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2  = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2  = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period.

CONCLUSIONS

The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.

Evidence of Placental Aging in Late SGA, Fetal Growth Restriction and Stillbirth-A Systematic Review

During pregnancy, the placenta undergoes a natural aging process, which is considered normal. However, it has been hypothesized that an abnormally accelerated and premature aging of the placenta may contribute to placenta-related health issues. Placental senescence has been linked to several obstetric complications, including abnormal fetal growth, preeclampsia, preterm birth, and stillbirth, with stillbirth being the most challenging. A systematic search was conducted on Pubmed, Embase, and Scopus databases. Twenty-two full-text articles were identified for the final synthesis. Of these, 15 presented original research and 7 presented narrative reviews. There is a paucity of evidence in the literature on the role of placental aging in late small for gestational age (SGA), fetal growth restriction (FGR), and stillbirth. For future research, guidelines for both planning and reporting research must be implemented. The inclusion criteria should include clear differentiation between early and late SGA and FGR. As for stillbirths, only those with no other known cause of stillbirth should be included in the studies. This means excluding stillbirths due to congenital defects, infections, placental abruption, and maternal conditions affecting feto-maternal hemodynamics.

The Experience of Women Giving Birth after Cesarean Section-A Longitudinal Observational Study

Natural childbirth after a previous cesarean section is a debated issue despite scientific research and international recommendations. This study aimed to examine the experiences of women giving birth after a previous cesarean section, their preferences, and changes in attitudes towards childbirth after labor. This longitudinal study involved 288 pregnant women who had a previous cesarean section and completed a web-based questionnaire before and after labor, including information about their obstetric history, birth beliefs, and preferred mode of delivery. Among women who preferred a vaginal birth, nearly 80% tried it and 49.78% finished delivery by this mode. Among women declaring a preference for an elective cesarean section, 30% attempted a vaginal birth. Choosing a hospital where staff supported their decision (regardless of the decision) was the most helpful factor in preparing for labor after a cesarean section (63.19%). Women's birth preferences changed after labor, with women who had a vaginal birth after a cesarean section preferring this mode of delivery in their next pregnancy (89.34%). The mode of birth did not always follow the women's preferences, with some women who preferred a natural childbirth undergoing an elective cesarean section for medical reasons. A variety of changes were noticeable among women giving birth after a cesarean section, with a large proportion preferring natural birth in their next pregnancy. Hospitals should support women's birth preferences after a cesarean section (if medically appropriate), providing comprehensive counseling, resources, and emotional support to ensure informed decisions and positive birth experiences.

Anxiety and depressive symptoms in pregnant women during the COVID-19 pandemic in the Czech Republic-Broader sociodemographic causes, connections and implications

INTRODUCTION

Our study (part of multicentric "MindCOVID") investigates risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic in the Czech Republic.

MATERIAL AND METHODS

The study used a prospective cross-sectional design. Data was collected using an online self-administered questionnaire. Standardized scales, general anxiety disorder (GAD)-7 and patient health questionnaire (PHQ)-9 were administered online. Multivariate regression analysis was employed to evaluate the relationship between sociodemographic, medical and psychological variables.

RESULTS

The Czech sample included 1830 pregnant women. An increase of depressive and anxiety symptoms measured by PHQ-9 and GAD-7 in pregnant women during the COVID-19 pandemic was associated with unfavorable financial situation, low social and family support, psychological and medical problems before and during pregnancy and infertility treatment. Fear of being infected and adverse effect of COVID-19, feeling of burden related to restrictions during delivery and organization of delivery and feeling of burden related to finances were associated with worse anxiety and depressive symptoms.

CONCLUSIONS

Social and emotional support and lack of financial worries are protective factors against mood disorders in pregnant women in relation to COVID-19 pandemic. In addition, adequate information about organization of delivery and additional support from healthcare professionals during the delivery are needed. Our findings can be used for preventive interventions, given that repeated pandemics in the future are anticipated.

Epidural analgesia: effect on labor duration and delivery mode - a single-center cohort study

OBJECTIVES

Parturients in labor experiencing severe pain may develop several complications, which could be avoided using various forms of labor analgesia. Researchers hold divergent opinions about the effect of epidural analgesia (EA) on labor duration and delivery mode. This paper aims to establish if EA affects the duration of the 1st and the 2nd phase of labor and the percentage of emergency Cesarean sections (CS) and instrumental delivery.

MATERIAL AND METHODS

The patients in this cohort study were recruited at St. Sophia's Specialist Hospital in Warsaw, between 1/1/2020 and 6/1/2020. We used following inclusion criteria: patients aged 18-40 with singleton pregnancies and cephalic presentation of the fetus who gave live birth at a gestational age of 37-42 weeks to neonates with birthweight 2500-4250 g and received EA at the cervical dilation between three and six centimeters. The control group didn't receive anesthesia. We excluded planned CS and vaginal births after CS. Data analysis was performed for all parturients and separately for multiparas and nulliparas. Results Out of 2550 deliveries, we included 1052 patients - 443 participants with EA and 609 in the control group. Patients with epidural analgesia experienced longer labor 415 vs 255 min (p < 0.01), longer 1st and 2nd stage (p < 0.01). They had a lower risk of emergency CS (OR = 0.56) (p < 0.01) but were more likely to have instrumental delivery.

CONCLUSIONS

EA prolongs the first and the second stage of labor yet doesn't affect neonatal outcomes. Moreover, the risk of emergency CS in nulliparas with EA is three times lower.

The Experiences of Midwives Who Attend Births by Women with Life-Limiting Fetal Conditions (LLFC): A Phenomenological Research Study

Providing care to a woman after a Life-Limiting Fetal Conditions (LLFC) diagnosis is a difficult experience for midwives. This study's aim is to describe the experience of midwives assisting in births following an LLFC diagnosis. It is a qualitative study using Interpretative Phenomenological Analysis (IPA). Semi-structured in-depth interviews were conducted with 15 midwives with experience in caring for women giving birth following an LLFC diagnosis. The data was analyzed through coding using the MAXQDA tool. The main theme emerging from the experience of midwives concerned difficulty in interacting with the woman giving birth. The analysis singled out four subthemes containing the most significant issues arising from the experience of midwives in caring for a woman giving birth to a lethally ill child: in relation with the woman giving birth; in relation with the child and the family; in relation with oneself; and in relation with the workplace. Midwives should have access not only to solid knowledge about this question, but also to courses developing skills in dealing with difficult situations, in coping with stress, in expressing compassion and, most importantly, in communicating with women and their families in such difficult circumstances.

Did everyone change their childbirth plans due to the COVID-19 pandemic? A web-based cross-sectional survey of Polish pregnant women

BACKGROUND AND AIM

With the worldwide outbreak of coronavirus, a significant impact has been observed on the functioning of healthcare systems and the process of childbirth. Women probably did not even have a choice to adjust their plans accordingly to the current situation. The aim of the study was to examine how the outbreak of the SARS CoV-2 pandemic state affected the decisions of pregnant women about their childbirth plan.

DESIGN

This cross-sectional study was performed using a web-based survey published on social media in Poland.

METHODS

The cross-sectional study was performed using web-based questionnaires. The study group included Polish women who changed their childbirth plans, compared to a group of women not sure about delivery plan change and those whose plans had not changed. The data were collected from 4 March 2020 to 2 May 2020, when the first rising count of new infections was observed in Poland and worldwide. Statistical analysis was performed using STATISTICA Software, Inc., 13.3 (2020).

RESULTS

Of 969 women who completed the questionnaire and were enrolled into the study, 57.2% had not changed their childbirth plans (group I), 28.4% had changed their plans (group II), and 14.4% of respondents answered "not sure" to this question (group III). The majority of women changed their birth plans during the pandemic because of the potential absence of their partner during labour (56% of women who had changed their plans and 48% of those whose answer was "I am not sure", p < .001). Another reason was the fear of separation from the child after delivery (33% of women who had changed their plans and 30% of those whose answer was "I am not sure", p < .001).

CONCLUSION

Restrictions due to the COVID-19 outbreak have influenced the childbirth plans of pregnant women. The changes were independent of women's vision of birth before the pandemic.

IMPACT

The restriction on births with accompanying person and the risk of separation from their infant after childbirth significantly influenced the decision-making process. As a result, some women were more likely to opt for a home birth with or even without medical assistance.

PATIENT OR PUBLIC CONTRIBUTION

The study participants were women who were pregnant at the time of completing the questionnaire, were over 18 years old and spoke Polish.

Anxiety of pregnant women in time of catastrophic events, including COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

In March 2020, daily life was disrupted by the new virus SARS-CoV-2, which causes COVID-19. Pandemic-related prenatal anxiety could lead to depression, a risk factor for adverse pregnancy outcomes and abnormal neonatal development. This study aimed to investigate the impact of anxiety on the mental health of pregnant women exposed to catastrophic events as compared to those without such exposure.

MATERIALS AND METHODS

PubMed/MEDLINE, Web of Science, Cochrane Library, Scopus, and EMBASE were searched for relevant studies. This study compared the prevalence of anxiety among pregnant women during a catastrophic event.

RESULTS

Fifteen full texts were assessed for inclusion, with 3 included, 10 excluded for not meeting criteria, and 2 excluded for other reasons. The included studies were published before the current COVID-19 pandemic but included the SARS 2003 outbreak. During the current COVID-19 pandemic, 10 further studies were conducted, but they failed to meet the inclusion criteria. A meta-analysis of two studies using STAI revealed that women exposed to a catastrophic event had a higher mean STAI score of 1.82 points (95% CI: 0.47-3.18 points).

CONCLUSION

Women with complications during pregnancy should be assessed for anxiety independently from catastrophic events. During financial crises, environmental or other disasters, special attention should be given to women with low risk, normal pregnancies.

Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study

Background

Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland.

Methods

This was a prospective, observational study. In phase 1, 411 women were recruited 24–72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report.

Results

In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43–48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04–4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01–1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34–48.72).

Conclusion

Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.

Epidural anesthesia during childbirth - retrospective analysis of maternal and neonatal results

OBJECTIVES

In Poland, in accordance with applicable regulations, every woman should have access to epidural anesthesia. The advantage of this type of analgesia is primarily analgesic effectiveness. The aim of the study is to identify variables related to epidural anesthesia and to verify the relationship between them and the occurrence of perinatal complications in the mother and the child.

MATERIAL AND METHODS

This was a single-center retrospective cohort study. Electronic documentation of patients of the Hospital of St. Sofia in Warsaw was used to create an anonymous retrospective database of all births in the years 2015-2020. 27,340 cases were qualified for the analysis.

RESULTS

The logistic regression model showed that the risk of episiotomy (OR = 5.539; CI = 5.169-5.935) increases more than fivefold and perineal laceration (OR = 2.190; CI= 2.036-2.356) increases twice in the case of epidural anesthesia application. There is also an increased risk of operative delivery (OR = 2.668; CI = 2.255-3.156), at the same time the risk of performing a cesarean section decreases more than fivefold (OR = 0.043; CI = 0.036-0.052).

CONCLUSIONS

Epidural anesthesia affects the delivery mechanism leading to an increase in the number and intensity of additional medical procedures - episiotomy, perineal laceration, operative delivery. The rationale for the routine use of this method of anesthesia should be considered in the context of the implications for the woman's reproductive health and research on the effectiveness of other methods of birth anesthesia should be conducted.

Intrapartum cardiotocography in pregnancies with and without fetal CHD

OBJECTIVES

Congenital heart defects (CHD) are the most common inherited abnormalities. Intrapartum cardiotocography (CTG) is still considered a "gold standard" during labor. However, there is a lack of evidence regarding the interpretation of intrapartum CTG in fetuses with CHD. Therefore, the study aimed to compare intrapartum CTG in normal fetuses and fetuses with CHD and describe the association between CTG and neonatal outcomes.

METHODS

The present study is a retrospective analysis of the CTG of 395 fetuses. There were three study groups: Group 1: 185 pregnancies with a prenatal diagnosis of CHD, Group 2: 132 high-risk pregnancies without CHD, and Group 3: 78 low-risk pregnancies without CHD.

RESULTS

Abnormal CTG was present statistically OR=3.4 (95%CI: 1.61-6.95) more often in Group 1. The rate of the emergency CS was higher in this group OR=3 (95%CI: 1.3-3.1). Fetuses with CHD and abnormal CTG were more often scored ≤7 Apgar, with no difference in acidemia. The multivariate regression model for Group 1 does not show clinical differences between Apgar scores or CTG assessment in neonatal acidemia prediction.

CONCLUSIONS

CTG in fetuses with CHD should be interpreted individually according to the type of CHD and conduction abnormalities. Observed abnormalities in CTG are associated with the fetal heart defect itself. Preterm delivery and rapid cesarean delivery lead to a higher rate of neonatal complications. Health practitioners should consider this fact during decision-making regarding delivery in cases complicated with fetal cardiac problems.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study

OBJECTIVE

To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies.

METHODS

A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9).

RESULT

Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances.

CONCLUSIONS

According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Implementation of the Publicly Funded Prenatal Screening Programme in Poland during the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic in 2020 affected the entire healthcare system in Poland, causing medical personnel to be relocated to other duties and limiting patients’ contacts with healthcare professionals. A large part of the planned diagnostics and treatment was delayed due to lack of equipment and personnel. Against this background, we analysed the implementation of the publicly funded prenatal screening programme (PSP) in Poland compared to the previous year. This is a cross-sectional study. We used nationwide datasets on the implementation of the prenatal testing programme over the period 2019−2020, datasets from the Statistics Poland on birth and the data on the development of the COVID-19 epidemic in Poland. In the year 2020, we observed a 12.41% decrease in woman enrolled to the programme compared to 2019. However, the decrease concerned only women under 35 years of age. With respect to the number of deliveries in the calendar year, the number of patients enrolled in the programme decreased by 3% (31% vs. 34%, p < 0.001). We also observed an increase in estriol measurements per the number of patients included in the programme, and a reduction in the number of PAPP-A tests in the first trimester, which proves an increased share of the triple test in the prenatal diagnosis of chromosomal aberrations. With respect to the number of deliveries, the number of amniocentesis procedures performed under PSP decreased by 0.19% (1.8% vs. 1.99%, p < 0.0001). In 2020, compared to the previous year, the number of patients included in the prenatal testing programme in Poland decreased. In terms of the number of births in Poland, the number of integrated screening tests also decreased, at the expense of increasing the percentage of triple tests. There were also significant reductions in the number of invasive diagnostic tests.

"This pregnancy makes sense": Experiences of women who have decided to continue pregnancy after lethal fetal diagnosis

Lethal fetal diagnosis defines severe developmental disorders that lead to the death of a fetus or newborn. Using semi-structured interviews, we explored the experiences of women in Poland who actively decided to continue with the pregnancy after diagnosis. We thematically analyzed data collected from 10 women. We identified four themes: pregnancy as an experience of prenatal motherhood; the child as person; birth as encounter and farewell; and the mother experience in retrospect. This study was conducted while the termination of pregnancy due to the irreversible fetal abnormality was legal in Poland. Since October 2021, it is no longer legal.

Oxytocin administration for induction and augmentation of labour in polish maternity units - an observational study

BACKGROUND

There is not enough data regarding practices and protocols on the dose of oxytocin administrated to women during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The study aimed to evaluate practices of oxytocin provision for labour induction and augmentation in two maternity units in Poland.

METHODS

The article presents a prospective observational study. Data from 545 (n = 545) labours was collected in two maternity units. First, the total dose (the total amount of oxytocin provided from the beginning in the labour ward until delivery including the III and IV stage of labour) and cumulative dose of oxytocin (the amount of oxytocin given until the birth of the neonate) administered to women during labour was calculated. Then, the relationship between the cumulative dose of oxytocin and short term perinatal outcomes (mode of delivery, use of epidural anaesthesia, Apgar scores, birth weight and postpartum blood loss) was analysed. Finally, the compliance of oxytocin supply during labour with national guidelines in the following five criteria: medium, start dose, escalation rate, interval, the continuation of infusion after established labour was examined.

RESULTS

The average cumulative dose of oxytocin administrated to women before birth was 4402 mU following labour induction and 2366 mU following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93.6% of all observed labours (mainly because of continuation of infusion after established labour). We found no statistically significant correlation between the cumulative dose of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of cumulative dose oxytocin on short-term perinatal outcomes. The two units participating in the study had similar protocols and did not differ significantly in terms of total oxytocin dose, rates of induction and augmentation - the only observed difference was the mode of delivery.

CONCLUSIONS

The study showed no effect of the mean cumulative oxytocin dose on short-term perinatal outcomes and high rate of non-compliance of the practice of oxytocin administration for labour induction and augmentation with the national recommendations. Cooperation between different professional groups of maternity care providers should be considered in building national guidelines for maternity care.. Further studies investigating possible long-term effects of the meant cumulative dose of oxytocin and the reasons for non-compliance of practice with guidelines should be carried out.

Women's views of birth after cesarean section

BACKGROUND

Vaginal birth is a safe mode of childbirth for the majority of women after cesarean section (CS). However, data show that women who have undergone a CS are more likely to have an elective CS (ECS) than a vaginal birth after CS (VBAC) in many areas of the world.

AIM

This study aimed to review the literature about women's mode of birth preferences and attitudes and the underlying reasons for, and factors associated with, their preferences.

METHODS

This is narrative literature review. PubMed/MEDLINE and Scopus databases were searched, limiting the results to non-interventional studies published between 1990 and 2020. Twenty-one articles were included in the analysis.

RESULTS

The review found 34 different factors that influence women's preferences. Five factors influenced both VBAC and ECS preference, depending on the study. The most common factors having a dualistic effect on preference were: medical staff recommendation, doctor's opinion, and fear of pain. The most common factors were: desire to experience natural childbirth, faster/easier recovery, support from doctor's, and midwife's opinion. Among the factors influencing the preference for ECS, two were particularly prominent: predictability, controllability and comfortability of CS and the belief that CS is safer for the baby and/or mother.

CONCLUSIONS

Our review showed that there are a variety of factors that influence women's preference for the mode of delivery after CS. Some of these have a dualistic effect according to the study. The key to making an informed decision regarding the mode of delivery is communication with medical professionals.

Growth Abnormalities as a Risk Factor of Adverse Neonatal Outcome in Hypertensive Pregnancies-A Single-Center Retrospective Cohort Study

(1) Background: Hypertensive disorders of pregnancy (HDP) include gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE), and preeclampsia superimposed on chronic hypertension (CH with PE). HDP is associated with several short and long-term perinatal and neonatal complications, such as newborn growth restriction and death. This study aimed to establish the association between HDP, newborn growth abnormalities, and neonatal outcome. (2) Methods: This is a single-center retrospective cohort study of 63651 singleton deliveries. (3) Results: Univariate analysis showed a significantly increased risk of intrauterine and neonatal death associated with maternal hypertension and growth disorders. There were differences between growth charts used, with the highest risk of stillbirth for SGA defined by the Intergrowth chart (OR 17.2) and neonatal death for newborn growth restriction (NGR) based on Intergrowth (OR 19.1). Multivariate analysis showed that NGR is a stronger risk factor of neonatal death than SGA only. (4) Conclusions: HDP is significantly associated with growth abnormalities and is an independent risk factor of adverse outcomes. The presence of newborn growth restriction is strongly associated with the risk of neonatal death. The choice of growth chart has a substantial effect on the percentage of diagnosis of SGA and NGR.

Compliance with gestational weight gain recommendations in a cross-sectional study of term pregnancies - how far reality falls from the standard?

OBJECTIVES

During pregnancy, two aspects are critical in the context of adverse perinatal outcomes (APO): preconception obesity and gestational weight gain. This study aimed to assess compliance with the 2009 IOM guidelines, compare GWG with and without correcting for gestation duration, and observe the relationship between pre-pregnancy BMI and GWG and neonatal birth weight.

MATERIAL AND METHODS

This is a cross-sectional study conducted from 2015-2018 at the St. Sophia's Specialist Hospital in Warsaw, Poland. Self-reported pre-pregnancy and predelivery weight were collected.

RESULTS

The presented data set amounts to 7820 records. Analysis of weight gain compliance with IOM recommendations showed that only 41-44% (depending on the calculation method) of women had weight gain in accordance with IOM guidelines (22-23% - below; 33-37% - above). Overweight and obese women with diabetes are more likely to comply with IOM than women without diabetes. In contrast, women with normal-weight and underweight with diabetes are less likely to achieve IOM weight gain in pregnancy than women without diabetes. Women who have GWG below recommendations significantly more often gave birth to SGA neonates, and women who exceeded GWG standards significantly more often gave birth to LGA neonates.

CONCLUSIONS

Less than half of women had GWG within the recommended norms. Statistically significant differences were found in methods of calculation of GWG, but it was not found clinically significant. Correction for pregnancy duration when calculating GWG reclassifies two percent of patients. We underestimate the risk of crossing the line between overweight and obesity during pregnancy.

Fetal Growth Diagnosis and Management among Perinatal Medical Professionals: A Survey of Practice and Literature Review

INTRODUCTION

This paper aimed to assess the knowledge of healthcare professionals (obstetric and gynecology residents, specialists, and midwives) in the field of perinatal medicine regarding fetal growth diagnosis and management.

METHODS

A questionnaire was created consisting of a set of questions regarding demographic data, methods of growth assessment, and management. It was a handout survey. The results were analyzed with the use of descriptive statistics and χ2 analysis using the program Statistica.

RESULTS

190 medical professionals have participated in the questionnaire. 86.3% of respondents agreed that pregnancy dating should be modified based on first-trimester ultrasound. 90.9% agreed that III trimester ultrasound has a ±15% margin of error. When asked which growth charts are best fit for assessing growth in a studied population, 10.7% marked standard, 37.4% reference, 26.2% customized, and 26.2% did not know the difference between the three choices. 60.3% stated that they use a growth chart to assess growth and qualify fetuses for monitoring. 70.2% used the 10th centile as a cutoff, 20.1% 5th centile, and 9.7% 3rd centile. Only 40.9% would diagnose fetal growth restriction based on fetal weight only. 28.7% using the 10th centile cutoff, 16.1% 5th centile, and 54.0% 3rd centile. Only a quarter of the respondents were able to name the growth chart or tool that they use for assessment. The most common responses were Yudkin, Hadlock, and online calculators of Fetal Medicina Barcelona and the Fetal Medicine Foundation.

DISCUSSION

A lot of confusion is observed primarily in the aspect of cutoff values for identification, subsequent monitoring, and management of fetal growth restriction. There is a need for extensive training and education in this field and uniform national recommendations.

Woman's Needs and Satisfaction Regarding the Communication with Doctors and Midwives during Labour, Delivery and Early Postpartum

The study aimed to identify the difference in communication needs of women giving birth and women during early postpartum. An additional goal includes the analysis of the experience and communication needs through the context of a woman's approach to childbirth. The study is a cross-sectional, self-report survey; 521 women between 5 and 10 days after birth participated in the study. Women perceived information provided by the medical staff as the most helpful aspect of verbal communication both during labour and early postpartum. Maintaining eye contact with the medical staff was perceived as the most helpful aspect of non-verbal communication. Women were more satisfied with communication during labour and birth than in the maternity ward and those after non-instrumental childbirth were more satisfied with communication compared to the instrumental birth group. Women perceiving childbirth as the natural, physiological process considered verbal and non-verbal communication during and after childbirth as less helpful than women perceiving birth as more risky and requiring interventions. The results of the study emphasize the importance of verbal and non-verbal communication during birth and early postpartum and at the same time different communication needs during these two time points. It also showed that women who perceive labour as a physiological process seem to be less dependent on the communication with the medical staff than women who accept medical interventions during labour and birth as necessary.

Fetal Growth Acceleration-Current Approach to the Big Baby Issue

Background and Objectives: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. Materials and Methods: For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. Results: This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. Conclusions: a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration.

What are the Critical Elements of Satisfaction and Experience in Labor and Childbirth-A Cross-Sectional Study

The labor experience and satisfaction with childbirth are affected by the care provided (external factors) and individual variables (internal factors). In this paper, we present a descriptive analysis that aims to indicate the strongest correlates of birth experience among a wide range of indicators. The study is a prospective, cross-sectional, self-report survey. It includes the experiences of women giving birth in public and private hospitals in Poland. The two main variables were birth experience and satisfaction with care. The analysis consists of three parts: data pre-processing and initial analysis, explorative investigation, and regression analysis. Among the 15 variables with the highest predictive value regarding birth experience were being informed by the medical personnel, communication, and birth environment. The most significant variables among 15 variables, with the highest predictive value regarding care, were those concerning support, information, and respectful care. The strongest predictor for both, birth experience and satisfaction with care, is the sense of information, with logit coefficients of 0.745 and 1.143, respectively, for birth experience and satisfaction (0.367 and 0.346 for standardized OLS coefficient). The findings demonstrate that by using explanatory variables, one can predict a woman’s description of her satisfaction with perinatal care received in the hospital. On the other hand, they do not have such a significant and robust influence on the birth experience examined by the variables. For both the birth experience and satisfaction with care, the sense of being informed is the highest predictor.

Application of artificial intelligence in screening for adverse perinatal outcomes: A protocol for systematic review

The article presents a systematic review protocol. The aim of the study is an assessment of current studies regarding the application of artificial intelligence and neural networks in the screening for adverse perinatal outcomes. We intend to compare the reported efficacy of these methods to improve pregnancy care and outcomes. There are more and more studies that describe the role of machine learning in facilitating the diagnosis of adverse perinatal outcomes, like gestational diabetes or pregnancy hypertension. A systematic review of available literature seems to be crucial to compare the known efficacy and application. Publication of a systematic review in this category would improve the value of future studies. The studies reporting on artificial intelligence application will have a major impact on future prenatal practice.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: A web-based cross-sectional survey

INTRODUCTION

The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants.

METHODS AND ANALYSIS

It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.

Freestanding Midwife-Led Units: A Narrative Review

Background

Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter.

Materials and Methods

A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977-2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers.

Results

Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman.

Conclusions

FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.

Is there respectful maternity care in Poland? Women's views about care during labor and birth

Background

Abuse against women in labor starts with subtle forms of discrimination that can turn into overt violence. Therefore it is crucial to work towards prevention and elimination of disrespect and ill-treatment in medical facility perinatal care in which staff allows such abuse.

The aim of the study was to analyze the experiences of women related to perinatal care. Special emphasis was put on experiences that had traits indicating disrespectful and offensive care during childbirth in medical facilities providing perinatal care.

Methods

This was a cross-sectional survey. A questionnaire was prepared for respondents who gave birth in medical facilities. Information about the study was posted on the website of a non-governmental foundation dealing with projects aimed at improving perinatal care. The respondents gave online consent for processing the submitted data. 8378 questionnaires were submitted. The study was carried out between February 06 and March 20, 2018. The results were analyzed using the Chi-square independence test. The analysis was carried out at the significance level of 0.05 in Excel, R and SPSS.

Results

During their hospital stay, 81% of women in the study experienced violence or abuse from medical staff on at least one occasion. The most common abuse was having medical procedures without prior consent. Inappropriate comments made by staff related to their own or a woman’s situation were reported in 25% of situations, whilst 20% of women experienced nonchalant treatment. In the study 19.3% of women reported that the staff did not properly care for their intimacy and 1.7% of the respondents said that the worst treatment was related to feeling anonymous in the hospital.

Conclusions

The study shows that during Polish perinatal care women experience disrespectful and abusive care. Most abuse and disrespect involved violation of the right to privacy, the right to information, the right to equal treatment, and the right to freedom from violence. The low awareness of abuses and complaints reported in the study may result from women’s ignorance about relevant laws related to human rights.

Extended Breastfeeding in Poland: Knowledge of Health Care Providers and Attitudes on Breastfeeding Beyond Infancy

BACKGROUND

Extended breastfeeding is rare in Poland, and lack of acceptance and understanding is often evident in public opinion. The ability to provide reliable information about breastfeeding beyond infancy depends on health professionals' levels of knowledge and attitudes. They are considered by most parents in Poland to be authorities in the field of child nutrition.

RESEARCH AIMS

To determine (1) the level of knowledge and the attitudes of Polish health professionals towards extended breastfeeding; (2) the relationship between personal breastfeeding experience and attitudes towards extended breastfeeding; and (3) the relationship between knowledge about breastfeeding beyond twelve months and attitudes towards breastfeeding beyond infancy.

METHODS

A one-group prospective, cross-sectional, self-report style survey was used. The convenience sample ( N = 495) comprised gynaecologists, neonatologists and midwives. Data were collected via an online questionnaire and the results were analyzed with the use of descriptive statistics, a chi-square independence test, Fisher's exact test, post-hoc testing, and two-part tables using SPSS.

RESULTS

Most of the respondents (76.7%; n = 384) had a low level of knowledge about the benefits of breastfeeding beyond twelve months and even emphasized that this nutritional choice could have negative impacts. There was a positive correlation ( F = 105.847; p = < .01) between levels of knowledge and respondents' attitudes towards breastfeeding beyond infancy. Attitudes were also influenced by the length of time respondents had breastfed.

CONCLUSION

Healthcare providers have an insufficient level of knowledge about extended breastfeeding and need further education in this area.