1
|
Rubio-Alvarez A, Jiménez-Ramos C, Bravo-Vaquero C, Pulgarín-Pulgarín B, Rodríguez-Almagro J, Hernández-Martínez A. Professional approach to the care of women who have suffered a perinatal loss. Nurs Health Sci 2024; 26:e13116. [PMID: 38566393 DOI: 10.1111/nhs.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
To understand the experience, training, and needs of midwives in their approach to perinatal grief. A descriptive cross-sectional study was carried out using an online questionnaire with 26 questions related to institutional management and individual clinical practices in the care of a perinatal loss was developed by a team of midwives from the Hospital "La Mancha-Centro" of Alcazar de San Juan (Ciudad Real). Strobe checklist was followed. A total of 267 midwives participated. A total of 92.1% (246) of the centers had specific protocols for action, but each professional applied their own criteria. The presence of a perinatal psychology team was nonexistent according to 88% (235) of those surveyed. Regarding their training and professional experience, 16.5% (44) of the midwives had never received training. Only 4.1% (11) of the midwives felt very prepared to care for women with a perinatal loss. Among the factors associated with greater application of recommended practices in the face of perinatal death by midwives were being a woman, having prior training on care during perinatal death, and a greater perception of preparation (p < 0.05). The perception of lack of preparation on the part of midwives in the accompaniment of these families was high.
Collapse
Affiliation(s)
- Ana Rubio-Alvarez
- Department of Obstetrics & Gynaecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Carmen Jiménez-Ramos
- Department of Obstetrics & Gynaecology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain
| | - Carolina Bravo-Vaquero
- Department of Obstetrics & Gynaecology, Gerencia de Atencion Primaria Alcázar de San Juan, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | | |
Collapse
|
2
|
Ranchoff BL, Paterno MT, Attanasio LB. Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California. J Midwifery Womens Health 2024; 69:224-235. [PMID: 38164766 DOI: 10.1111/jmwh.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type. METHODS For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences. RESULTS Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences. DISCUSSION Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.
Collapse
Affiliation(s)
- Brittany L Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Mary T Paterno
- Baystate Midwifery and Women's Health, Springfield, Massachusetts
| | - Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| |
Collapse
|
3
|
Pimienta J, Guruge S, St-Amant O, Catallo C, Hart C. Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada. Can J Nurs Res 2023; 55:333-344. [PMID: 36632015 PMCID: PMC10416549 DOI: 10.1177/08445621221150620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period. PURPOSE To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada. METHODS This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design. RESULTS The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period. CONCLUSIONS Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.
Collapse
Affiliation(s)
- Jessica Pimienta
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sepali Guruge
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Oona St-Amant
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Cristina Catallo
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Corinne Hart
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| |
Collapse
|
4
|
Laureij LT, Depla AL, Kariman SS, Lamain-de Ruiter M, Ernst-Smelt HE, Hazelzet JA, Franx A, Bekker MN. Women's experiences with using patient-reported outcome and experience measures in routine perinatal care in the Netherlands: a mixed-methods study. BMJ Open 2023; 13:e064452. [PMID: 36898740 PMCID: PMC10008176 DOI: 10.1136/bmjopen-2022-064452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES To gain insight into the experiences of women with completing and discussing patient-reported outcome measures (PROM) and patient-reported experience measures (PREM), and tailoring their care based on their outcomes. DESIGN A mixed-methods prospective cohort study. SETTING Seven obstetric care networks in the Netherlands that implemented a set of patient-centred outcome measures for pregnancy and childbirth (PCB set), published by the International Consortium for Health Outcomes Measurement. PARTICIPANTS All women, receiving the PROM and PREM questionnaires as part of their routine perinatal care, received an invitation for a survey (n=460) and an interview (n=16). The results of the survey were analysed using descriptive statistics; thematic inductive content analysis was applied on the data from open text answers and the interviews. RESULTS More than half of the survey participants (n=255) felt the need to discuss the outcomes of PROM and PREM with their care professionals. The time spent on completing questionnaires and the comprehensiveness of the questions was scored 'good' by most of the survey participants. From the interviews, four main themes were identified: content of the PROM and PREM questionnaires, application of these outcomes in perinatal care, discussing PREM and data capture tool. Important facilitators included awareness of health status, receiving personalised care based on their outcomes and the relevance of discussing PREM 6 months post partum. Barriers were found in insufficient information about the goal of PROM and PREM for individual care, technical problems in data capture tools and discrepancy between the questionnaire topics and the care pathway. CONCLUSIONS This study showed that women found the PCB set an acceptable and useful instrument for symptom detection and personalised care up until 6 months post partum. This patient evaluation of the PCB set has several implications for practice regarding the questionnaire content, role of care professionals and congruity with care pathways.
Collapse
Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Anne L Depla
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Shariva S Kariman
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, UMC Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Bruney TL, Zhang X. Improving perinatal depression screening and management: results from a federally qualified health center. J Public Health (Oxf) 2022; 44:910-917. [PMID: 34379113 DOI: 10.1093/pubmed/fdab317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/03/2021] [Accepted: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Perinatal depression affects 8.5-20% of women. In a systematic review 22% of women with a positive depression screen use mental health services. The objective of this study was to examine the effectiveness of on-site management in the perinatal setting and barriers to care. METHODS This is a retrospective chart review of 1042 women who received perinatal care between 1 January to 31 December 2019. Primary outcome was percentage of patients who were assessed after a positive depression screen. The secondary outcome was to determine factors affecting patients' receptiveness to assessment/treatment. RESULTS 9.52% of women screened positive. Sixty-two (63.9%) met with an on-site social worker for assessment, 6 (6.2%) misunderstood the screening questions, and 33 (34.0%) met criteria for depression. Of those, 9 (27.3%) attended at least one follow-up, 8 (24.2%) were referred to or already in care, 7 (21.2%) no-showed, and 9 (27.3%) declined further care. English speaking patients were more likely to meet with a social worker for diagnostic assessment (69.9% versus 45.8%, P = 0.033). CONCLUSION On-site management of a positive depression screen yielded a follow-up rate of 64% versus 49% in other studies. Non-English language may be a barrier to accessing mental health car.
Collapse
Affiliation(s)
- Talitha L Bruney
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Xueting Zhang
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| |
Collapse
|
6
|
Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
| |
Collapse
|
7
|
Kinney PL, Asante KP, Lee AG, Ae-Ngibise KA, Burkart K, Boamah-Kaali E, Twumasi M, Gyaase S, Quinn A, Oppong FB, Wylie BJ, Kaali S, Chillrud S, Yawson A, Jack DW, Owusu-Agyei S. Prenatal and Postnatal Household Air Pollution Exposures and Pneumonia Risk: Evidence From the Ghana Randomized Air Pollution and Health Study. Chest 2021; 160:1634-1644. [PMID: 34298005 PMCID: PMC8628168 DOI: 10.1016/j.chest.2021.06.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Nearly 40% of the world's population is exposed daily to household air pollution. The relative impact of prenatal and postnatal household air pollution exposure on early childhood pneumonia, a leading cause of mortality, is unknown. RESEARCH QUESTION Are prenatal or postnatal household air pollution, or both, associated with pneumonia risk in the first year of life? STUDY DESIGN AND METHODS The Ghana Randomized Air Pollution and Health Study enrolled 1,414 nonsmoking, pregnant women before 24 weeks' gestation with prospective follow-up to the child's age of 1 year. We measured 72-h personal household air pollution exposures, indexed by carbon monoxide (CO), four times prenatally and three times postnatally. Weekly fieldworker surveillance identified ill-appearing children for physician pneumonia assessment. We used quasi-Poisson models to examine associations between prenatal and postnatal CO and physician-diagnosed pneumonia and severe pneumonia. Sex-specific effects were examined. RESULTS Of the 1,306 live births, 1,141 infants were followed up with 55,605 child-weeks of fieldworker surveillance. The estimated risk for pneumonia and severe pneumonia in the first year of life increased by 10% (relative risk [RR], 1.10; 95% CI, 1.04-1.16) and 15% (RR, 1.15; 95% CI, 1.03-1.28), respectively, per 1-part per million (ppm) increase in average prenatal CO exposure and by 6% (RR, 1.06; 95% CI, 0.99-1.13) per 1-ppm increase in average postnatal CO exposure. Sex-stratified analyses suggest that in girls, higher prenatal CO exposure was associated with pneumonia risk, while no association was seen in boys. INTERPRETATION Prenatal household air pollution exposure increased risk of pneumonia and severe pneumonia in the first year of life. Clean-burning interventions may be most effective when begun prenatally. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01335490; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA.
| | - Kwaku-Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth A Ae-Ngibise
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Katrin Burkart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Mieks Twumasi
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Felix B Oppong
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Seyram Kaali
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY
| | - Abena Yawson
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| |
Collapse
|
8
|
Maskatia SA, Kwiatkowski D, Bhombal S, Davis AS, McElhinney DB, Tacy TA, Algaze C, Blumenfeld Y, Quirin A, Punn R. A Fetal Risk Stratification Pathway for Neonatal Aortic Coarctation Reduces Medical Exposure. J Pediatr 2021; 237:102-108.e3. [PMID: 34181988 DOI: 10.1016/j.jpeds.2021.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that a fetal stratification pathway will effectively discriminate between infants at different levels of risk for surgical coarctation and reduce unnecessary medicalization. STUDY DESIGN We performed a pre-post nonrandomized study in which we prospectively assigned fetuses with prenatal concern for coarctation to 1 of 3 risk categories and implemented a clinical pathway for postnatal management. Postnatal clinical outcomes were compared with those in a historical control group that were not triaged based on the pathway. RESULTS The study cohort comprised 109 fetuses, including 57 treated along the fetal coarctation pathway and 52 historical controls. Among mild-risk fetuses, 3% underwent surgical coarctation repair (0% of those without additional heart defects), compared with 27% of moderate-risk and 63% of high-risk fetuses. The combined fetal aortic, mitral, and isthmus z-score best discriminated which infants underwent surgery (area under the curve = 0.78; 95% CI, 0.66-0.91). Compared with historical controls, infants triaged according to the fetal coarctation pathway had fewer delivery location changes (76% vs 55%; P = .025) and less umbilical venous catheter placement (74% vs 51%; P = .046). Trends toward shorter intensive care unit stay, hospital stay, and time to enteral feeding did not reach statistical significance. CONCLUSIONS A stratified risk-assignment pathway effectively identifies a group of fetuses with a low rate of surgical coarctation and reduces unnecessary medicalization in infants who do not undergo aortic surgery. Incorporation of novel measurements or imaging techniques may improve the specificity of high-risk criteria.
Collapse
Affiliation(s)
- Shiraz A Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA.
| | - David Kwiatkowski
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Shazia Bhombal
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| | - Alexis S Davis
- Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| | - Doff B McElhinney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Theresa A Tacy
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| | - Claudia Algaze
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Yair Blumenfeld
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| | - Amy Quirin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Fetal and Pregnancy Health Program, Stanford Children's Health, Stanford, CA
| |
Collapse
|
9
|
Kunde F, Thomas S, Sudhakar A, Kunjikutty R, Kumar RK, Vaidyanathan B. Prenatal diagnosis and planned peripartum care improve perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum in low-resource settings. Ultrasound Obstet Gynecol 2021; 58:398-404. [PMID: 33030746 DOI: 10.1002/uog.23146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To report on the feasibility of establishing a regional prenatal referral network for critical congenital heart defects (CHDs) and its impact on perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum (TGA-IVS) in low-resource settings. METHODS This was a retrospective study of consecutive fetuses with a diagnosis of TGA-IVS between January 2011 and December 2019 in Kochi, Kerala, India. A regional network for prenatal diagnosis and referral of patients with critical CHDs was initiated in 2011. Pregnancy and early neonatal outcomes were reported. The impact of the timing of diagnosis (prenatal or after birth) on age at surgery, perinatal mortality and postoperative recovery was evaluated. RESULTS A total of 82 fetuses with TGA-IVS were included. Diagnosis typically occurred later on in gestation, at a median of 25 (interquartile range (IQR), 21-32) weeks. The majority (78.0%) of affected pregnancies resulted in live birth, most (84.4%) of which occurred in a specialist pediatric cardiac centers. Delivery in a specialist center, compared with delivery in a local maternity center, was associated with a significantly higher rate of surgical correction (98.1% vs 70.0%; P = 0.01) and overall lower neonatal mortality (3.7% vs 50%; P = 0.001). The proportion of cases undergoing arterial switch operation after prenatal diagnosis of TGA-IVS increased significantly, along with the prenatal detection rate, over the study period (2011-2015, 11.1% vs 2016-2019, 29.4%; P = 0.001). Median age at surgery was significantly lower in the prenatally diagnosed group than that in the postnatally diagnosed group (4 days (IQR, 1-23 days) vs 10 days (IQR, 1-91 days); P < 0.001). There was no significant difference in postoperative mortality (2.0% vs 3.6%; P = 0.49) between the two groups. CONCLUSIONS This study demonstrates the feasibility of creating a network for prenatal diagnosis and referral of patients with critical CHDs, such as TGA, in low-resource settings, that enables planned peripartum care in specialist pediatric cardiac centers and improved neonatal survival. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- F Kunde
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Thomas
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Kunjikutty
- Department of Obstetrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R K Kumar
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Vaidyanathan
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| |
Collapse
|
10
|
Vo VD. Planning pregnancy during the COVID-19 pandemic: Are the risks worth taking? JAAPA 2021; 34:1-4. [PMID: 34320546 DOI: 10.1097/01.jaa.0000758264.31916.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This literature review assesses recent research highlighting the clinical characteristics of COVID-19 in pregnant patients and children. With better understanding, clinicians can offer risk assessment for those planning pregnancies amid the pandemic while using the best practice guidelines to reassure and assist pregnant patients throughout all spectrums of perinatal care, delivery, and postpartum care.
Collapse
Affiliation(s)
- Veronica Dieuhien Vo
- Veronica Dieuhien Vo practices in rural health medicine at Family Healthcare Network in Hanford, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
11
|
Abstract
To study the dynamic changes in perinatal coagulation function in patients with preeclampsia (PE).The general data and coagulation indexes of 290 PE patients during the perinatal period (prenatal and 1 and 3 days postpartum) and 256 healthy pregnant women in the third trimester of pregnancy were investigated, and the data were analyzed.Compared with healthy pregnant women, prothrombin time (PT), fibrinogen (FIB), platelet count (PLT), mean platelet volume (MPV), thrombocytocrit (PCT), maximum amplitude (MA), and coagulation index (CI) of PE patients decreased, and activated partial thrombin time (APTT), thrombin time (TT), D-dimer (DD), platelet distribution width (PDW) and K values increased before delivery (P < .05). APTT and FIB in PE patients were lower in the day 1 postpartum group than in the prenatal and postpartum day 3 groups, and TT, DD, and fibrin degradation products (FDP) were higher (P < .05). PCT and MPV were highest in the prenatal group (P < .05).Compared with that of healthy pregnant women, the coagulation function of PE patients is in a relatively low-coagulation and high-fibrinolysis state on postpartum day 1, which increases the risk of postpartum hemorrhage and other adverse outcomes.
Collapse
Affiliation(s)
- Chang Xu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | | | | | | |
Collapse
|
12
|
|
13
|
Dixon-Shambley K, Gabbe PT. Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes. Clin Obstet Gynecol 2021; 64:333-344. [PMID: 33882522 DOI: 10.1097/grf.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.
Collapse
Affiliation(s)
| | - Patricia T Gabbe
- Departments of Obstetrics and Gynecology
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
14
|
Lang G, Farnell EA, Quinlan JD. Out-of-Hospital Birth. Am Fam Physician 2021; 103:672-679. [PMID: 34060788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Since the 1970s, most births in the United States have been planned to occur in a hospital. However, a small percentage of Americans choose to give birth outside of a hospital. The number of out-of-hospital births has increased, with one in every 61 U.S. births (1.64%) occurring out of the hospital in 2018. Out-of-hospital (or community) birth can be planned or unplanned. Of those that are planned, most occur at home and are assisted by midwives. Patients who choose a planned community birth do so for multiple reasons. International observational studies that demonstrate comparable outcomes between planned out-of-hospital and planned hospital birth may not be generalizable to the United States. Most U.S. studies have found statistically significant increases in perinatal mortality and neonatal morbidity for home birth compared with hospital birth. Conversely, planned community birth is associated with decreased odds of obstetric interventions, including cesarean delivery. Perinatal outcomes for community birth may be improved with appropriate selection of low-risk, vertex, singleton, term pregnancies in patients who have not had a previous cesarean delivery. A qualified, licensed maternal and newborn health professional who is integrated into a maternity health care system should attend all planned community births. Family physicians are uniquely poised to provide counseling to patients and their families about the risks and benefits associated with community birth, and they may be the first physicians to evaluate and treat newborns delivered outside of a hospital.
Collapse
Affiliation(s)
- Gregory Lang
- Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | | |
Collapse
|
15
|
Arnolds M, Laventhal N. Perinatal Counseling at the Margin of Gestational Viability: Where We've Been, Where We're Going, and How to Navigate a Path Forward. J Pediatr 2021; 233:255-262. [PMID: 33567323 DOI: 10.1016/j.jpeds.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Marin Arnolds
- Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL.
| | - Naomi Laventhal
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
| |
Collapse
|
16
|
Babore GO, Aregago TG, Ermolo TL, Nunemo MH, Habebo TT. Determinants of pregnancy-induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. PLoS One 2021; 16:e0250548. [PMID: 33979338 PMCID: PMC8115896 DOI: 10.1371/journal.pone.0250548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, 292,982 women die due to the complications of pregnancy and
childbirth per year, out of those deaths 85% occurs in Sub Saharan Africa.
In Ethiopia, pre-eclampsia accounts for 11% of direct maternal deaths. Objective To determine maternal and foetal outcomes of pregnancy-induced hypertension
among women who gave birth at health facilities in Hossana town
administration. Methods Institutional based unmatched case-control study was conducted among women,
who gave birth at health facilities from May 20 to October 30, 2018. By
using Epi-Info version 7; 207 sample size was estimated, for each case two
controls were selected. Two health facilities were selected using a simple
random sampling method. Sample sizes for each facility were allocated
proportionally. All cleaned & coded data were entered into Epi-info
version 3.5.1 and analysis was carried out using SPSS version 20.
Multivariate analysis was performed to determine predictors of
pregnancy-induced hypertension at a p-value of <0.05. Result Women between 18 to 41 years old had participated in the study with the mean
age of 26.00(SD ±4.42), and 25.87(SD ±5.02) for cases and controls
respectively. Out of participants 21(30.4%) among cases and 21(15.2%) among
controls had developed at least one complication following delivery. 12
(17.4%) and 8 (5.7%) foetal deaths were found in cases and controls groups
respectively whereas 15.6% from cases and 3.6% from controls groups women
gave birth to the foetus with intra-uterine growth retardation. Women
gravidity AOR = 0.32 [95% CI (0.12 0.86)], Previous history of
pregnancy-induced hypertension AOR = 22.50 [95% CI (14.95 16.52)] and
educational status AOR = 0.32[95% CI (0.12, 0.85)] were identified as
predictor of pregnancy-induced hypertension. Conclusion Women with a previous history of pregnancy-induced hypertension had increased
risk of developing pregnancy-induced hypertension, whilst ≥ 3 previous
pregnancies and informal educational status decrease odds of developing
pregnancy-induced hypertension.
Collapse
Affiliation(s)
- Getachew Ossabo Babore
- Department of Nursing College of Medicine and Health Science, Wachemo
University, Hossana, Ethiopia
- * E-mail:
| | - Tsegaye Gebre Aregago
- Department of Nursing College of Medicine and Health Science, Wachemo
University, Hossana, Ethiopia
| | - Tadesse Lelago Ermolo
- Department of Nursing College of Medicine and Health Science, Wachemo
University, Hossana, Ethiopia
| | - Mangistu Handiso Nunemo
- Department of Public Health College of Medicine and Health Science,
Wachemo University, Hossana, Ethiopia
| | - Teshome Tesfaye Habebo
- Department of Health Management and Economics, School of Public Health,
Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
17
|
Stephens EH, Dearani JA, Qureshi MY, Segura LG, Arendt KW, Bendel-Stenzel EM, Ruano R. Toward Eliminating Perinatal Comfort Care for Prenatally Diagnosed Severe Congenital Heart Defects: A Vision. Mayo Clin Proc 2021; 96:1276-1287. [PMID: 33958058 DOI: 10.1016/j.mayocp.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/25/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
Over the past 40 years, the medical and surgical management of congenital heart disease has advanced considerably. However, substantial room for improvement remains for certain lesions that have high rates of morbidity and mortality. Although most congenital cardiac conditions are well tolerated during fetal development, certain abnormalities progress in severity over the course of gestation and impair the development of other organs, such as the lungs or airways. It follows that intervention during gestation could potentially slow or reverse elements of disease progression and improve prognosis for certain congenital heart defects. In this review, we detail specific congenital cardiac lesions that may benefit from fetal intervention, some of which already have documented improved outcomes with fetal interventions, and the state-of-the-science in each of these areas. This review includes the most relevant studies from a PubMed database search from 1970 to the present using key words such as fetal cardiac, fetal intervention, fetal surgery, and EXIT procedure. Fetal intervention in congenital cardiac surgery is an exciting frontier that promises further improvement in congenital heart disease outcomes. When fetuses who can benefit from fetal intervention are identified and appropriately referred to centers of excellence in this area, patient care will improve.
Collapse
Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Leal G Segura
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ellen M Bendel-Stenzel
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN; Division of Neonatal Medicine, Mayo Clinic, Rochester, MN
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
18
|
Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, Liu CA, He F, Chen DJ. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:332. [PMID: 33902475 PMCID: PMC8077797 DOI: 10.1186/s12884-021-03818-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage (SPPH) remains a major problem. To determine the prevalence and risk factors of SPPH, we analyzed data of women who gave birth in Guangzhou Medical Centre for Critical Pregnant Women, which received a large quantity of critically ill obstetric patients who were transferred from other hospitals in Southern China. METHODS In this study, we conducted a retrospective case-control study to determine the prevalence and risk factors for SPPH among a cohort of women who gave birth after 28 weeks of gestation between January 2015 and August 2019. SPPH was defined as an estimated blood loss ≥1000 mL and total blood transfusion≥4 units. Logistic regression analysis was used to identify independent risk factors for SPPH. RESULTS SPPH was observed in 532 mothers (1.56%) among the total population of 34,178 mothers. Placenta-related problems (55.83%) were the major identified causes of SPPH, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for SPPH were maternal age < 18 years (adjusted OR [aOR] = 11.52, 95% CI: 1.51-87.62), previous cesarean section (aOR = 2.57, 95% CI: 1.90-3.47), history of postpartum hemorrhage (aOR = 4.94, 95% CI: 2.63-9.29), conception through in vitro fertilization (aOR = 1.78, 95% CI: 1.31-2.43), pre-delivery anemia (aOR = 2.37, 95% CI: 1.88-3.00), stillbirth (aOR = 2.61, 95% CI: 1.02-6.69), prolonged labor (aOR = 5.24, 95% CI: 3.10-8.86), placenta previa (aOR = 9.75, 95% CI: 7.45-12.75), placenta abruption (aOR = 3.85, 95% CI: 1.91-7.76), placenta accrete spectrum (aOR = 8.00, 95% CI: 6.20-10.33), and macrosomia (aOR = 2.30, 95% CI: 1.38-3.83). CONCLUSION Maternal age < 18 years, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS, and macrosomia were risk factors for SPPH. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent SPPH.
Collapse
Affiliation(s)
- Chen-Ning Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Fu-Bing Yu
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Yun-Zhe Xu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Jin-Sheng Li
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Zhi-Hong Guan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Man-Na Sun
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | | | - Fang He
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China.
- Guangzhou Medical Centre for Critical Pregnant Women, Guangzhou, China.
| | - Dun-Jin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China.
- Quality Control Center of Obstetrics of Guangdong Province, Guangzhou, China.
| |
Collapse
|
19
|
Vardhelli V, Pandita A, Pillai A, Badatya SK. Perinatal COVID-19: review of current evidence and practical approach towards prevention and management. Eur J Pediatr 2021; 180:1009-1031. [PMID: 33184730 PMCID: PMC7660544 DOI: 10.1007/s00431-020-03866-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
The clinical spectrum of the perinatal COVID-19 and prospective data on neonatal outcomes remains largely unexplored. Most of the existing literature is in the form of case series or single-centre experience. In this review, we aim to summarize available literature on the clinical spectrum of COVID-19 in neonates and mothers and suggest a practical approach towards management of clinical scenarios. This review explores the clinical characteristics and outcomes of COVID-19 in neonates born to mothers who were detected with the virus during the pregnancy. We conducted a comprehensive search of PubMed, Google Scholar and Cochrane Database of Systematic Review between November 2019 and June 2020 and screened articles related to perinatal COVID-19. This review included 786 mothers, among which 64% (504) were delivered by caesarian section. There were 3 still births and 107 (14%) were delivered preterm. Out of 793 neonates born, 629 neonates (79%) were tested after birth. The commonest symptom in neonates was respiratory distress. Respiratory support was needed in 60 neonates (7.6%), with 14 babies needing mechanical ventilation (1.8%), 25 needing non-invasive ventilation and 21 needing nasal oxygen. Only 35 of the 629 tested neonates (5.5%) were positive for COVID-19. Of the 35 positive neonates, 14 (40%) were symptomatic. The COVID-19 seems to have favourable neonatal outcomes. Majority of neonates are asymptomatic. Respiratory distress is the most common manifestation. What is known: •COVID-19 affects all ages. •Neonatal disease is usually mild. What is new: •Vertical transmission is a possible route of infection in neonates. •Breast milk and skin-to-skin contact are safe in COVID-19-infected mothers if performed with appropriate use of precautions such as hand and breast hygiene and masking.
Collapse
|
20
|
Abstract
The Covid-19 pandemic has further illuminated the already existing need for methods of building resilience in perinatal caregivers. Using a scoping review approach, literature was examined to identify evidence-based models of resilience building in a cohort of perinatal clinicians. Research published between January 2015 and 2020 was evaluated using PubMed, CINAHL, EMBASE, and PsycINFO databases. Of the initial 3399 records reviewed, 2 qualitative studies met the inclusion criteria. Given the deleterious effects of Covid-19 on perinatal care providers, and in light of the paucity of available studies, personnel, time, and funding should be allocated for research to address these issues.
Collapse
Affiliation(s)
- Erin M Wright
- Johns Hopkins University, Baltimore, Maryland (Dr Wright); Thomas Jefferson University, Philadelphia, Pennsylvania (Ms Kriebs); and The Johns Hopkins University School of Nursing, Baltimore, Maryland (Ms Carson)
| | | | | |
Collapse
|
21
|
Ogamba I, Kliss A, Rainville N, Chuang L, Panarelli E, Petrini J, Zilberman D. Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection. J Perinat Med 2021; 49:263-268. [PMID: 33141109 DOI: 10.1515/jpm-2020-0446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Data regarding the pathogenesis and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, however, there's limited data in regard to maternal and neonatal outcomes. Therefore, we conducted a retrospective analysis of all pregnant women who tested positive for SARS-CoV-2 within Nuvance Health system. METHODS Data were abstracted from the medical records of each patient and descriptive analysis was performed. Variables included demographics, COVID testing results, symptoms, management, labor course, neonatal information, and complications. RESULTS Total of 40 patients were identified. Average age was 29.6 years old, 35% were Hispanic, and approximately one in three patients had comorbidities. Of the patients who had repeated testing, the average number of days between first positive test and negative test was 36.8 days (± 19.9 days). Three out of four women reported symptoms. Of the 40 pregnant women who were positive for SARS-CoV-2, 25 of them delivered. About 84% of the women delivered after 37 weeks. Twelve percent of the women delivered under 33 and 6/7 weeks. Most patients had vaginal deliveries (68%) and the remaining had cesarean deliveries. Neonatal outcomes included: mean 1 and 5 min Apgar scores of 8 and 8.8, respectively and the mean birth weight was 3212 g. Twenty neonates were tested for SARS-CoV-2 and were all found to be negative. CONCLUSIONS Overall, with routine prenatal care and preventive measures, pregnant patients and neonates in our study had good outcomes. At this time, there appears to be no evidence of vertical transmission.
Collapse
Affiliation(s)
- Ifeoma Ogamba
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Andrea Kliss
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Nicole Rainville
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
| | - Erin Panarelli
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Joann Petrini
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Dimitry Zilberman
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
| |
Collapse
|
22
|
Dharni N, Essex H, Bryant MJ, Cronin de Chavez A, Willan K, Farrar D, Bywater T, Dickerson J. The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation. BMC Pregnancy Childbirth 2021; 21:205. [PMID: 33711957 PMCID: PMC7955626 DOI: 10.1186/s12884-021-03671-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. METHODS Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. RESULTS For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives' job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. CONCLUSIONS Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.
Collapse
Affiliation(s)
- N. Dharni
- Royal College of Obstetricians & Gynaecologists, London, UK
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - H. Essex
- Department of Health Sciences, University of York, York, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M. J. Bryant
- Department of Health Sciences, University of York, York, UK
| | - A. Cronin de Chavez
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - K. Willan
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - D. Farrar
- Maternal and Infant Health, Bradford Institute for Health Research, Bradford, UK
| | - T. Bywater
- Department of Health Sciences, University of York, York, UK
| | - J. Dickerson
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
| | - on behalf of the Better Start Bradford Innovation Hub
- Royal College of Obstetricians & Gynaecologists, London, UK
- Better Start Bradford Innovation Hub, Bradford Institute for Health Research, Bradford, York, UK
- Department of Health Sciences, University of York, York, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
- Maternal and Infant Health, Bradford Institute for Health Research, Bradford, UK
| |
Collapse
|
23
|
Sharaby R, Peres H. Between a woman and her fetus: Bedouin women mediators advance the health of pregnant women and babies in their society. BMC Pregnancy Childbirth 2021; 21:190. [PMID: 33676439 PMCID: PMC7937305 DOI: 10.1186/s12884-021-03661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bedouin women in Israel confront a challenging circumstance between their traditional patriarchal society and transition to modernity. In terms of reproductive health, they face grave disparities as women, pregnant women and mothers. In this article we aim to understand the challenges of Bedouin women who work as mediators in the promotion of Bedouin women's perinatal health. We explore their challenges with the dual and often conflictual role as health peer-instructors-mediators in mother-and-child clinics, and also as members of a Bedouin community, embodying a status as women, mothers, and family caretakers. Drawn upon a feminist interpretative framework, the article describes their challenges in matters of perinatal health. Our research question is: how do women who traditionally suffer from blatant gender inequality utilize health-promotion work to navigate and empower themselves and other Bedouin women. METHODS Based on an interpretive feminist framework, we performed narrative analysis on eleven in-depth interviews with health mediators who worked in a project in the Negev area of Israel. The article qualitatively analyses the ways in which Bedouin women mediators narrate their challenging situations. RESULTS This article shows how difficult health mediators' task may be for women with restricted education who struggle for autonomy and better social and maternal status. Through their praxis, women mediators develop a critical perspective without risking their commitments as women who are committed to their work as well as their society, communities, and families. These health mediators navigate their ways between the demands of their employer (the Israeli national mother and child health services) and their patriarchal Bedouin society. While avoiding open conflictual confrontations with both hegemonic powers, they also develop self-confidence and a critical and active approach. CONCLUSIONS The article shows the ways by which the mediator's activity involved in perinatal health-promotion may utilize modern perinatal medical knowledge to increase women's awareness and autonomy over their pregnant bodies and their role as caregivers. We hope our results will be applicable for other women as well, especially for women who belong to other traditional and patriarchal societies.
Collapse
|
24
|
Nunno Paillard C, Godard C, Wahl C, Martinez De Tejada B, Humair JP. [Gynécology-obstretric - Perinatal smoking cessation support : why and how ?]. Rev Med Suisse 2021; 17:38-41. [PMID: 33443829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In Switzerland, tobacco smoking is a major public health problem, especially among pregnant women. Health problems encountered by pregnant women and their fetuses require specific care to assist smoking cessation. A specific consultation to support smoking cessation during pregnancy was created in May 2019 at the maternity ward of the University Hospitals of Geneva, with the support of the Fondation Privée des Hôpitaux Universitaires de Genève and Carrefour addictionS/CIPRET-Genève. The creation of a network of health professionnals trained in smoking cessation is an important step to support women during their cessation process.
Collapse
Affiliation(s)
- Catia Nunno Paillard
- Carrefour addictionS/CIPRET Genève, Rue Agasse 45, 1208 Genève
- Haute École de santé de Genève, Avenue de Champel 47, 1206 Genève
| | - Claudie Godard
- Haute École de santé de Genève, Avenue de Champel 47, 1206 Genève
- Service de médecine de premier recours, HUG, 1211 Genève 14
| | - Corinne Wahl
- Carrefour addictionS/CIPRET Genève, Rue Agasse 45, 1208 Genève
| | - Begoña Martinez De Tejada
- Service de médecine de premier recours, HUG, 1211 Genève 14
- Faculté de médecine, Département de santé communautaire, Université de Genève, 1211 Genève 4
| | - Jean-Paul Humair
- Carrefour addictionS/CIPRET Genève, Rue Agasse 45, 1208 Genève
- Service de médecine de premier recours, HUG, 1211 Genève 14
- Faculté de médecine, Département de santé communautaire, Université de Genève, 1211 Genève 4
| |
Collapse
|
25
|
Young LW, Hu Z, Annett RD, Das A, Fuller JF, Higgins RD, Lester BM, Merhar SL, Simon AE, Ounpraseuth S, Smith PB, Crawford MM, Atz AM, Cottrell LE, Czynski AJ, Newman S, Paul DA, Sánchez PJ, Semmens EO, Smith MC, Turley CB, Whalen BL, Poindexter BB, Snowden JN, Devlin LA. Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal. Pediatrics 2021; 147:e2020008839. [PMID: 33386337 PMCID: PMC7780957 DOI: 10.1542/peds.2020-008839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Variation in pediatric medical care is common and contributes to differences in patient outcomes. Site-to-site variation in the characteristics and care of infants with neonatal opioid withdrawal syndrome (NOWS) has yet to be quantified. Our objective was to describe site-to-site variation in maternal-infant characteristics, infant management, and outcomes for infants with NOWS. METHODS Cross-sectional study of 1377 infants born between July 1, 2016, and June 30, 2017, who were ≥36 weeks' gestation, with NOWS (evidence of opioid exposure and NOWS scoring within the first 120 hours of life) born at or transferred to 1 of 30 participating hospitals nationwide. Site-to-site variation for each parameter within the 3 domains was measured as the range of individual site-level means, medians, or proportions. RESULTS Sites varied widely in the proportion of infants whose mothers received adequate prenatal care (31.3%-100%), medication-assisted treatment (5.9%-100%), and prenatal counseling (1.9%-75.5%). Sites varied in the proportion of infants with toxicology screening (50%-100%) and proportion of infants receiving pharmacologic therapy (6.7%-100%), secondary medications (1.1%-69.2%), and nonpharmacologic interventions including fortified feeds (2.9%-90%) and maternal breast milk (22.2%-83.3%). The mean length of stay varied across sites (2-28.8 days), as did the proportion of infants discharged with their parents (33.3%-91.1%). CONCLUSIONS Considerable site-to-site variation exists in all 3 domains. The magnitude of the observed variation makes it unlikely that all infants are receiving efficient and effective care for NOWS. This variation should be considered in future clinical trial development, practice implementation, and policy development.
Collapse
Affiliation(s)
- Leslie W Young
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, Vermont;
| | | | - Robert D Annett
- Department of Pediatrics, Medical Center, University of Mississippi, Jackson, Mississippi
| | - Abhik Das
- Research Triangle Institute International, Rockville, Maryland
| | - Janell F Fuller
- Health Sciences Center, The University of New Mexico, Albuquerque, New Mexico
| | - Rosemary D Higgins
- National Institute of Child Health and Human Development, Bethesda, Maryland
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Barry M Lester
- Department of Pediatrics and Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University and
| | - Stephanie L Merhar
- Division of Neonatology and Perinatal Institute and
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alan E Simon
- Environmental Influences on Child Health Outcomes Program and Office of the Director, National Institutes of Health, Rockville, Maryland
| | | | - P Brian Smith
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina;
| | | | - Andrew M Atz
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lesley E Cottrell
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Adam J Czynski
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
| | | | - David A Paul
- Division of Neonatology, Department of Pediatrics, ChristianaCare, Newark, Delaware
| | - Pablo J Sánchez
- Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - M Cody Smith
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia;
| | - Christine B Turley
- Department of Pediatrics, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Bonny L Whalen
- Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | | | - Jessica N Snowden
- Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lori A Devlin
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
26
|
Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-Flores E, Vigil-Vázquez S, Rodríguez-Corrales E, Sánchez-Luna M. [Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection]. An Pediatr (Barc) 2020; 94:173-178. [PMID: 33431332 PMCID: PMC7833088 DOI: 10.1016/j.anpedi.2020.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.
Collapse
Affiliation(s)
- Gonzalo Solís-García
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Gutiérrez-Vélez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Elena Zamora-Flores
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Sara Vigil-Vázquez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|
27
|
Garcia-Herrero S, Simon B, Garcia-Planells J. The Reproductive Journey in the Genomic Era: From Preconception to Childhood. Genes (Basel) 2020; 11:genes11121521. [PMID: 33352697 PMCID: PMC7767043 DOI: 10.3390/genes11121521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023] Open
Abstract
It is estimated that around 10–15% of the population have problems achieving a pregnancy. Assisted reproduction techniques implemented and enforced by personalized genomic medicine have paved the way for millions of infertile patients to become parents. Nevertheless, having a baby is just the first challenge to overcome in the reproductive journey, the most important is to obtain a healthy baby free of any genetic condition that can be prevented. Prevention of congenital anomalies throughout the lifespan of the patient must be a global health priority. Congenital disorders can be defined as structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth, or sometimes may only be detected later during childhood. It is considered a frequent group of disorders, affecting 3–6% of the population, and one of the leading causes of morbidity and mortality. Congenital anomalies can represent up to 30–50% of infant mortality in developed countries. Genetics plays a substantial role in the pathogenesis of congenital anomalies. This becomes especially important in some ethnic communities or populations where the incidence and levels of consanguinity are higher. The impact of genetic disorders during childhood is high, representing 20–30% of all infant deaths and 11.1% of pediatric hospital admissions. With these data, obtaining a precise genetic diagnosis is one of the main aspects of a preventive medicine approach in developed countries. The field of reproductive health has changed dramatically from traditional non-molecular visual microscope-based techniques (i.e., fluorescence in situ hybridization (FISH) or G-banding karyotype), to the latest molecular high-throughput techniques such as next-generation sequencing (NGS). Genome-wide technologies are applied along the different stages of the reproductive health lifecycle from preconception carrier screening and pre-implantation genetic testing, to prenatal and postnatal testing. The aim of this paper is to assess the new horizon opened by technologies such as next-generation sequencing (NGS), in new strategies, as a genomic precision diagnostic tool to understand the mechanisms underlying genetic conditions during the “reproductive journey”.
Collapse
|
28
|
Abstract
Depression and anxiety are common during pregnancy and are experienced at higher rates among women who are racial and ethnic minorities. Because depression and anxiety influence maternal and infant outcomes, intervening to improve perinatal mental health should be a priority for all healthcare providers. However, in the United States, a number of barriers including lack of mental health providers, lack of perinatal behavioral health systems, and stigma, limit access to care. Universal screening has been recommended and here we examine how universal screening can help nurses improve the mental health of childbearing women. Interventions that are currently in use to improve perinatal anxiety and depression are reviewed and include: psychopharmacology, cognitive behavioral therapy, interpersonal psychotherapy, and mindfulness. Recommendations for future research and healthcare system changes are made.
Collapse
Affiliation(s)
- Susan Gennaro
- Dr. Susan Gennaro is Dean and Professor, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA. Dr. Gennaro can be reached via e-mail at Caitlin O'Connor is a Research Associate, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA. Anne McKay is a PhD Student, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA. Dr. Anne Gibeau is Director of Midwifery, Jacobi Medical Center, Bronx, NY. Melanie Aviles is a Research Coordinator, Jacobi Medical Center, Bronx, NY. Dr. Jacqueline Hoying is an Assistant Professor of Clinical Practice; Director, MINDSTRONG Program; and Director, Consumer Core at Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, College of Nursing, The Ohio State University, Columbus, OH. Dr. Bernadette Mazurek Melnyk is Vice President for Health Promotion; University Chief Wellness Officer; Dean and Professor, College of Nursing; Professor of Pediatrics & Psychiatry, College of Medicine; and Executive Director, the Helene Fuld Health Trust National Institute for Evidence-Based Practice, College of Nursing, The Ohio State University, Columbus, OH
| | | | | | | | | | | | | |
Collapse
|
29
|
Jehan F, Sazawal S, Baqui AH, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mitra DK, Mehmood U, Deb S, Mahmud A, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Moin MI, Muhammad S, Chauhan A, Begum N, Khan W, Das S, Ahmed S, Hasan T, Khalid J, Rizvi SJR, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum A, Manu A, Yoshida S, Bahl R, Rahman A, Pervin J, Winston J, Musonda P, Stringer JSA, Litch JA, Ghaemi MS, Moufarrej MN, Contrepois K, Chen S, Stelzer IA, Stanley N, Chang AL, Hammad GB, Wong RJ, Liu C, Quaintance CC, Culos A, Espinosa C, Xenochristou M, Becker M, Fallahzadeh R, Ganio E, Tsai AS, Gaudilliere D, Tsai ES, Han X, Ando K, Tingle M, Marić I, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Shaw GM, Stevenson DK, Snyder MP, Quake SR, Angst MS, Gaudilliere B, Aghaeepour N. Multiomics Characterization of Preterm Birth in Low- and Middle-Income Countries. JAMA Netw Open 2020; 3:e2029655. [PMID: 33337494 PMCID: PMC7749442 DOI: 10.1001/jamanetworkopen.2020.29655] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. OBJECTIVE To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. DESIGN, SETTING, AND PARTICIPANTS This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. EXPOSURES Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. MAIN OUTCOMES AND MEASURES The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. RESULTS Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. CONCLUSIONS AND RELEVANCE This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.
Collapse
Affiliation(s)
- Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Usha Dhingra
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Ilyas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Dipak K. Mitra
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory-Ivo de Carneri, Pemba Island, Zanzibar
| | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Sayedur Rahman
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sajid Muhammad
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Salahuddin Ahmed
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tarik Hasan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Jafar Raza Rizvi
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nabidul Haque Chowdhury
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fahad Aftab
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdul Quaiyum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexander Manu
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Sachiyo Yoshida
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Anisur Rahman
- Matlab Health Research Centre, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jennifer Winston
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - James A. Litch
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
| | - Mohammad Sajjad Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Digital Technologies Research Centre, National Research Council Canada, Toronto, Ontario, Canada
| | - Mira N. Moufarrej
- Department of Bioengineering, Stanford University, Stanford, California
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Songjie Chen
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Ina A. Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ghaith Bany Hammad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald J. Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Candace Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ramin Fallahzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Edward Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Amy S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dyani Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Xiaoyuan Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martha Tingle
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ivana Marić
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul H. Wise
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Gary L. Darmstadt
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K. Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Stephen R. Quake
- Department of Bioengineering, Stanford University, Stanford, California
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
30
|
Long MM, Cramer RJ, Bennington L, Morgan FG, Wilkes CA, Fontanares AJ, Sadr N, Bertolino SM, Paulson JF. Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population. Fam Syst Health 2020; 38:369-379. [PMID: 33119369 DOI: 10.1037/fsh0000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
INTRODUCTION The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Chervenak FA, McCullough LB, Grünebaum A, Bornstein E, Sen C, Stanojevic M, Degtyareva M, Kurjak A. Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine. J Perinat Med 2020; 48:867-873. [PMID: 32769228 DOI: 10.1515/jpm-2020-0329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023]
Abstract
The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.
Collapse
Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Laurence B McCullough
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Cihat Sen
- Department of Perinatology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey
| | - Milan Stanojevic
- Department of Neonatology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Marina Degtyareva
- Department of Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Asim Kurjak
- Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia
- University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
32
|
Moridi M, Pazandeh F, Hajian S, Potrata B. Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC). PLoS One 2020; 15:e0241219. [PMID: 33141835 PMCID: PMC7608882 DOI: 10.1371/journal.pone.0241219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC). Methods An exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed. Results The MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability. Conclusion The MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended.
Collapse
Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
33
|
White M, Connor KL. In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis. Nutrients 2020; 12:nu12113375. [PMID: 33147767 PMCID: PMC7692402 DOI: 10.3390/nu12113375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.
Collapse
|
34
|
Gracia PV, Caballero LC, Sánchez J, Espinosa J, Campana S, Quintero A, Luo C, Ng J. Pregnancies recovered from SARS-CoV-2 infection in second or third trimester: obstetric evolution. Ultrasound Obstet Gynecol 2020; 56:777-778. [PMID: 32996648 PMCID: PMC7537281 DOI: 10.1002/uog.23134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 05/23/2023]
Affiliation(s)
- P. Vigil‐De Gracia
- Investigador distinguido del Sistema Nacional de InvestigaciónComplejo Hospitalario Dr. AAM Caja de Seguro Social, SENACYTPanamaPanama
| | - L. C. Caballero
- Ginecología y ObstetriciaHospital Luis “Chico Fábrega”, Santiago‐VeraguasPanama
| | - J. Sánchez
- Ginecología y ObstetriciaHospital Santo TomásPanamaPanama
| | - J. Espinosa
- Ginecología y ObstetriciaHospital Santo TomásPanamaPanama
| | - S. Campana
- Ginecología y ObstetriciaComplejo Hospitalario Dr. AAM Caja de Seguro Social, PanamaPanama
| | - A. Quintero
- Ginecología y ObstetriciaHospital José Domingo de ObaldíaDavidChiriquíPanama
| | - C. Luo
- Ginecología y ObstetriciaComplejo Hospitalario Dr. AAM Caja de Seguro Social, PanamaPanama
| | - J. Ng
- Ginecología y ObstetriciaComplejo Hospitalario Dr. AAM Caja de Seguro Social, PanamaPanama
| |
Collapse
|
35
|
Sbrilli MD, Duncan LG, Laurent HK. Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial. BMC Pregnancy Childbirth 2020; 20:623. [PMID: 33059638 PMCID: PMC7559171 DOI: 10.1186/s12884-020-03318-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.
Collapse
Affiliation(s)
- Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, Psychology Building, 603 E Daniel St, Champaign, IL, 61820, USA.
| | - Larissa G Duncan
- School of Human Ecology, University of Wisconsin-Madison, Madison, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, USA
- Osher Center for Integrative Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Heidemarie K Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, Psychology Building, 603 E Daniel St, Champaign, IL, 61820, USA
| |
Collapse
|
36
|
Jardine J, Blotkamp A, Gurol-Urganci I, Knight H, Harris T, Hawdon J, van der Meulen J, Walker K, Pasupathy D. Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study. BMJ 2020; 371:m3377. [PMID: 33004347 PMCID: PMC7527835 DOI: 10.1136/bmj.m3377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. DESIGN Cohort study using linked electronic maternity records. PARTICIPANTS 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. MAIN OUTCOME MEASURE A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. RESULTS Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). CONCLUSIONS Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.
Collapse
Affiliation(s)
- Jennifer Jardine
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Andrea Blotkamp
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ipek Gurol-Urganci
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Hannah Knight
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Tina Harris
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | | | - Jan van der Meulen
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Kate Walker
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, King's Health Partners, King's College, London, UK
| |
Collapse
|
37
|
Eapen A, Ryan GL, Ten Eyck P, Van Voorhis BJ. Current evidence supporting a goal of singletons: a review of maternal and perinatal outcomes associated with twin versus singleton pregnancies after in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril 2020; 114:690-714. [PMID: 33040979 PMCID: PMC8577493 DOI: 10.1016/j.fertnstert.2020.08.1423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
With increasing use of in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) almost 2% of all babies born in the United States each year are now conceived with these technologies, making outcomes of IVF-ICSI extremely important not only to patients and families but to public health. Twin pregnancy rates after IVF-ICSI in the United States have declined since their peak in 2013 but remain at approximately 1 in 10 to 1 in 20 pregnancies. A review of the current international literature on twin versus singleton pregnancy outcomes after IVF-ICSI treatment confirms statistically significantly higher risks to maternal and perinatal health and statistically significantly higher health care costs. The field of infertility care should continue to work to develop practices that lower twin pregnancy rates to an absolute minimum to maximize the safety of these medical treatments.
Collapse
Affiliation(s)
- Abey Eapen
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
| | - Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | | |
Collapse
|
38
|
Leung V, Bryant C, Stafford L. Psychological aspects of gestational cancer: A systematic review. Psychooncology 2020; 29:1734-1745. [PMID: 32779263 DOI: 10.1002/pon.5502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer. METHODS Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis. RESULTS Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making. CONCLUSIONS These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.
Collapse
Affiliation(s)
- Vivien Leung
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Women's Mental Health, The Royal Women's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
39
|
Zhang H, Hu Y, Zhu Y, Chen X. Facing the SARS-CoV-2 Outbreak: What Should Obstetricians and Gynecologists Do? Disaster Med Public Health Prep 2020; 14:e19-e21. [PMID: 32713389 PMCID: PMC7445447 DOI: 10.1017/dmp.2020.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 11/06/2022]
Abstract
An outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. In this major outbreak, women are a special group, especially pregnant patients. Many problems faced by clinicians are still unclear and need to be solved. As the largest obstetrics and gynecology hospital in North China, here we summarize the diagnosis and treatment process and key points of obstetrics and gynecology patients in our hospital during the period of the COVID-19 pandemic, hoping to provide available information to inform care of obstetrics and gynecology patients.
Collapse
Affiliation(s)
- Hongyuan Zhang
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Department of Gynecology, Tianjin Central Gynecology and Obstetrics Hospital, Nankai University, Tianjin, China
| | - Yuanjing Hu
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Department of Gynecology, Tianjin Central Gynecology and Obstetrics Hospital, Nankai University, Tianjin, China
| | - Yingjun Zhu
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Department of Gynecology, Tianjin Central Gynecology and Obstetrics Hospital, Nankai University, Tianjin, China
| | - Xu Chen
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Department of Gynecology, Tianjin Central Gynecology and Obstetrics Hospital, Nankai University, Tianjin, China
| |
Collapse
|
40
|
Narang K, Enninga EAL, Gunaratne MDSK, Ibirogba ER, Trad ATA, Elrefaei A, Theiler RN, Ruano R, Szymanski LM, Chakraborty R, Garovic VD. SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review. Mayo Clin Proc 2020; 95:1750-1765. [PMID: 32753148 PMCID: PMC7260486 DOI: 10.1016/j.mayocp.2020.05.011] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infection-associated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the renin-angiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.
Collapse
Key Words
- ace2, angiotensin-converting enzyme 2
- acog, american college of obstetricians and gynecologists
- ang, angiotensin
- ards, acute respiratory distress syndrome
- cd, cesarean delivery
- cdc, centers for disease control and prevention
- cl, cervical length
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- cvs, chorionic villus sampling
- f2f, face to face
- fda, food and drug administration
- f/u, follow-up
- ga, general anesthesia
- gbs, group b streptococcus
- hcq, hydroxychloroquine
- hcw, health care worker
- hiv, human immunodeficiency virus
- icu, intensive care unit
- il, interleukin
- iol, induction of labor
- isuog, international society of ultrasound in obstetrics and gynecology
- naftnet, north american fetal therapy network
- nsaid, nonsteroidal anti-inflammatory drug
- nst, nonstress test
- ppe, personal protective equipment
- qrt-pcr, quantitative reverse transcriptase polymerase chain reaction
- raas, renin-angiotensin-aldosterone system
- rcog, royal college of obstetricians and gynaecologists
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- smfm, society for maternal-fetal medicine
- tmprss2, transmembrane serine protease 2
- us, ultrasonography
- vd, vaginal delivery
- who, world health organization
Collapse
Affiliation(s)
- Kavita Narang
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Elizabeth Ann L Enninga
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Madugodaralalage D S K Gunaratne
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Eniola R Ibirogba
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ayssa Teles A Trad
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Amro Elrefaei
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Regan N Theiler
- Obstetrics Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Rodrigo Ruano
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Linda M Szymanski
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN
| | - Rana Chakraborty
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN; Division of Pediatric and Adolescent Medicine, Department of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN; Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN.
| |
Collapse
|
41
|
Intrapartum Fetal Monitoring. Am Fam Physician 2020; 102:Online. [PMID: 32735445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
42
|
Navarro-Tapia E, Sebastiani G, Sailer S, Toledano LA, Serra-Delgado M, García-Algar Ó, Andreu-Fernández V. Probiotic Supplementation During the Perinatal and Infant Period: Effects on Gut Dysbiosis and Disease. Nutrients 2020; 12:E2243. [PMID: 32727119 PMCID: PMC7468726 DOI: 10.3390/nu12082243] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
The perinatal period is crucial to the establishment of lifelong gut microbiota. The abundance and composition of microbiota can be altered by several factors such as preterm delivery, formula feeding, infections, antibiotic treatment, and lifestyle during pregnancy. Gut dysbiosis affects the development of innate and adaptive immune responses and resistance to pathogens, promoting atopic diseases, food sensitization, and infections such as necrotizing enterocolitis (NEC). Recent studies have indicated that the gut microbiota imbalance can be restored after a single or multi-strain probiotic supplementation, especially mixtures of Lactobacillus and Bifidobacterium strains. Following the systematic search methodology, the current review addresses the importance of probiotics as a preventive or therapeutic tool for dysbiosis produced during the perinatal and infant period. We also discuss the safety of the use of probiotics in pregnant women, preterm neonates, or infants for the treatment of atopic diseases and infections.
Collapse
Affiliation(s)
- Elisabet Navarro-Tapia
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Valencian International University (VIU), 46002 Valencia, Spain
| | - Giorgia Sebastiani
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain
| | - Sebastian Sailer
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain
| | - Laura Almeida Toledano
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08950 Barcelona, Spain
| | - Mariona Serra-Delgado
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, 08950 Barcelona, Spain
| | - Óscar García-Algar
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Valencian International University (VIU), 46002 Valencia, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain
| |
Collapse
|
43
|
Chawla D, Chirla D, Dalwai S, Deorari AK, Ganatra A, Gandhi A, Kabra NS, Kumar P, Mittal P, Parekh BJ, Sankar MJ, Singhal T, Sivanandan S, Tank P. Perinatal-Neonatal Management of COVID-19 Infection - Guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of India (NNF), and Indian Academy of Pediatrics (IAP). Indian Pediatr 2020; 57:536-548. [PMID: 32238615 PMCID: PMC7340735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/12/2023]
Abstract
JUSTIFICATION During the current rapidly evolving pandemic of COVID-19 infection, pregnant women with suspected or confirmed COVID-19 and their newborn infants form a special vulnerable group that needs immediate attention. Unlike other elective medical and surgical problems for which care can be deferred during the pandemic, pregnancies and childbirths continue. Perinatal period poses unique challenges and care of the mother-baby dyads requires special resources for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. PROCESS The GRADE approach recommended by the World Health Organization was used to develop the guideline. A Guideline Development Group (GDG) comprising of obstetricians, neonatologists and pediatricians was constituted. The GDG drafted a list of questions which are likely to be faced by clinicians involved in obstetric and neonatal care. An e-survey was carried out amongst a wider group of clinicians to invite more questions and prioritize. Literature search was carried out in PubMed and websites of relevant international and national professional organizations. Existing guidelines, systematic reviews, clinical trials, narrative reviews and other descriptive reports were reviewed. For the practice questions, the evidence was extracted into evidence profiles. The context, resources required, values and preferences were considered for developing the recommendations. OBJECTIVES To provide recommendations for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. RECOMMENDATIONS A set of twenty recommendations are provided under the following broad headings: 1) pregnant women with travel history, clinical suspicion or confirmed COVID-19 infection; 2) neonatal care; 3) prevention and infection control; 4) diagnosis; 5) general questions.
Collapse
Affiliation(s)
| | - Dinesh Chirla
- Intensive Care Services, Rainbow Children's hospital group, Mumbai, India
| | - Samir Dalwai
- Department of Pediatrics, Nanavati and Hinduja Hospitals, Mumbai, India
| | | | | | - Alpesh Gandhi
- Department of Obstetrics and Gynecology, Arihant Women's hospital, Ahmedabad, India
| | | | - Praveen Kumar
- Department of Pediatrics, PGIMER, Chandigarh, India. Correspondence to: Dr Praveen Kumar, Professor, Department of Pediatrics, PGIMER, Chandigarh, India.
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, VMMC and SJH, New Delhi, India
| | | | | | - Tanu Singhal
- Department of Pediatrics and Infectious Diseases, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute (KDAHMRI), Mumbai, India
| | | | - Parikshit Tank
- Department of Obstetrics and Gynecology, Ashwini Maternity and Surgical Centre, Mumbai; India
| |
Collapse
|
44
|
Carlin E, Spry E, Atkinson D, Marley JV. Why validation is not enough: Setting the scene for the implementation of the Kimberley Mum's Mood Scale. PLoS One 2020; 15:e0234346. [PMID: 32530934 PMCID: PMC7292413 DOI: 10.1371/journal.pone.0234346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background The two part Kimberley Mum’s Mood Scale (KMMS) has been developed and validated as a culturally appropriate perinatal depression and anxiety screening tool for Aboriginal women living in the sparsely populated Kimberley region of North West Australia. As part of implementation aspects of user acceptability were explored to improve clinical utilisation of the KMMS. Methods Eighteen health professionals involved in perinatal care participated in an online survey or a qualitative semi-structured interview. Ten Aboriginal women (who held administrative, professional or executive roles) were subsequently interviewed in depth to further explore aspects of KMMS user acceptability. Results Many of the health professionals were not using the second part of the KMMS (the psychosocial discussion tool). Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to ‘yarn’ with health professionals about issues that are important to them. Conclusion Implementing the KMMS across the Kimberley region requires health professionals to be trained. It also requires strategic engagement with health services to ensure health professionals and mangers understand the rationale and significance of the KMMS and are engaged in its successful implementation.
Collapse
Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Erica Spry
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| |
Collapse
|
45
|
Tolu LB, Jeldu WG, Feyissa GT. Effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices and maternal and perinatal outcome: A systematic review and meta-analysis. PLoS One 2020; 15:e0234320. [PMID: 32530940 PMCID: PMC7292415 DOI: 10.1371/journal.pone.0234320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is a 29-item checklist based on essential childbirth practices to help health-care workers to deliver consistently high quality maternal and perinatal care. The Checklist was intended to reduce maternal and perinatal mortality and address the primary cause of maternal death, intrapartum stillbirth, and early neonatal death. The objective of this review was to locate international literature reporting on the effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices, early neonatal death, stillbirth, maternal mortality, and morbidity. Methods We searched MEDLINE, google scholar, Cochrane Central Register of Controlled Trials (CENTRAL), met-Register of Controlled Trials (m-RCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/stop/search/en) to retrieve all available comparative studieshttp://www.opengrey.eu/ published in English after 2008. Two reviewers did study selection, critical appraisal, and data extraction independently. We did a random or fixed-effect meta-analysis to pool studies together and effect estimates were expressed as an odds ratio. Quality of evidence for major outcomes was assessed using the Grading of Recommendations, Assessment, development, and evaluation(GRADE). Results We retained three cluster randomized trials and six pre-and-post intervention studies reporting on WHO SCC's. The WHO SCC utilization improved quality of preeclampsia management(moderate quality of evidence) (OR = 7.05 [95% CI 2.34–21.29]), maternal infection management(moderate quality of evidence) (OR = 7.29[95%CI 2.29–23.27]), Partograph utilization(moderate quality of evidence) (OR = 3.81 [95% 1.72–8.43]), postpartum counselling(low quality of evidence) (RR = 132.51[95% 49.27–356.36]) and still birth(moderate quality of evidence) (OR = 0.92[95% CI 0.87–0.96]). However, the utilization of the checklist had no impact on early neonatal death (very low quality of evidence) (OR = 1.07[95%CI [1.01–1.13]) and maternal death (low quality of evidence) (OR = 1.06[95% CI 0.77–1.45]). Conclusions Moderate quality of evidence indicates that WHO SCC utilization is effective in reducing stillbirth and Improving preeclampsia management, maternal infection management and partograph utilization Low quality of evidence indicates that WHO SCC is effective in enhancing postpartum danger sign counseling. Low and very low quality of evidence suggests that WHO SCC has no impact on maternal and early neonatal death, respectively.
Collapse
Affiliation(s)
- Lemi Belay Tolu
- Department of Obstetrics and Gynaecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Wondimu Gudu Jeldu
- Department of Obstetrics and Gynaecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | |
Collapse
|
46
|
Coxon K, Turienzo CF, Kweekel L, Goodarzi B, Brigante L, Simon A, Lanau MM. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe. Midwifery 2020; 88:102779. [PMID: 32600862 PMCID: PMC7286236 DOI: 10.1016/j.midw.2020.102779] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Kirstie Coxon
- Department of Midwifery, Faculty of Health, Social Care and Education, Kingston University and St.George's, University of London, 6th Floor, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK.
| | - Cristina Fernandez Turienzo
- Department of Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Brigante
- Department of Women's and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | |
Collapse
|
47
|
Abstract
The psychosocial needs of childbearing families drastically change after a disaster. Perinatal nurses providing postdisaster maternal-newborn care at community shelters, field hospitals, or acute care facilities must be prepared as "first responders" to address the immediate psychological distress and social needs of women and families in the first few chaotic days or weeks. The purpose of this article is to demonstrate ways nurses can integrate psychosocial and interpersonal interventions in perinatal disaster care using the framework of Psychological First Aid (PFA) developed by a team of mental health experts, along with The National Child Traumatic Stress Network and the United States (US) National Center for posttraumatic stress disorder (PTSD). The PFA framework offers evidence-informed stepwise approaches nurses can employ within their scope of practice aimed at reducing disaster survivors' initial distress and to promote short- and long-term adaptive functioning. Purposive interactions are suggested to provide emotional support, empathy, and guidance to reduce stress, restore coping skills, and help families use their strengths to begin the recovery process. Nurse leaders engaged in hospital disaster planning need to ensure that essential resources and community networks are available to provide mental health and psychosocial support for childbearing women and families in a postdisaster environment.
Collapse
|
48
|
Stephens AJ, Barton JR, Bentum NAA, Blackwell SC, Sibai BM. General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic. Am J Perinatol 2020; 37:829-836. [PMID: 32344441 PMCID: PMC7356067 DOI: 10.1055/s-0040-1710308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023]
Abstract
Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. KEY POINTS: • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.
Collapse
Affiliation(s)
- Angela J. Stephens
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John R. Barton
- Division of Maternal-Fetal Medicine, Baptist Health Lexington, Lexington, Kentucky
| | - Nana-Ama Ankumah Bentum
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sean C. Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha M. Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
49
|
Abstract
The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV-2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.
Collapse
MESH Headings
- Abortion, Legal/methods
- Betacoronavirus/isolation & purification
- Brazil
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques/methods
- Comorbidity
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Delivery, Obstetric/methods
- Disease Transmission, Infectious/prevention & control
- Female
- Humans
- Infection Control/methods
- Infection Control/organization & administration
- Pandemics/prevention & control
- Perinatal Care/methods
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/therapy
- Risk Assessment/methods
- SARS-CoV-2
- COVID-19 Drug Treatment
Collapse
Affiliation(s)
- Alberto Trapani Júnior
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Universidade do Sul de Santa Catarina (Unisul), Palhoça, SC, Brazil
| | - Laura Rassi Vanhoni
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Hospital Regional Homero de Miranda Gomes, São José, SC, Brazil
| | - Sheila Koettker Silveira
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Alessandra Cristina Marcolin
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| |
Collapse
|
50
|
Abstract
INTRODUCTION In Mauritania, as in other West African countries, a series of actions has been taken to combat neonatal mortality. Considering the mixed success of these programs, we wondered how health workers are investing in neonatal care. METHOD An anthropological study was carried out in a locality in the Senegal River Valley. The surveys consisted of an ethnography of a health center, which resulted in detailed observations of care and interviews with health workers. RESULTS Our observations reveal that in the crucial minutes and hours following a normal birth, the attention of caregivers tends to turn away from the newborn. Recommended care such as keeping warm, examining and monitoring the newborn is not provided, while early breast-feeding occurs in a fluctuating manner. The newborn is quickly handed over to the family. Newborn care is thus "forgotten", both in the sequence of actions around childbirth and in the collective distribution of professional responsibilities. DISCUSSION Newborn care at birth remains poorly medicalized. We analyze the least involvement of health workers with newborns in two aspects : the perception of the uncertainty of neonatal survival, and the predominance of local childbearing. We are making proposals to put the spotlight back on the newborn in order to promote a better quality of neonatal care.
Collapse
|