" I carry their stories home ": experiences of nurses and midwives caring for perinatal adolescent mothers in primary health care settings in Rwanda.

INTRODUCTION: Adolescent mothers require trauma- and violence-informed care during the perinatal period due to trauma histories and ongoing violence as a result of pregnancy. Nurses and midwives play a critical role in caring for adolescent mothers in primary healthcare settings in Rwanda in the perinatal period. PURPOSE: To explore the experiences of nurses and midwives working with adolescent mothers in selected primary healthcare settings in Rwanda to inform the delivery of trauma- and violence- informed care. METHODS: This study utilized an interpretive description qualitative approach and was conducted in eight primary healthcare settings in Rwanda. Twelve nurses and midwives working in perinatal services and four heads of health centers participated in in-depth individual interviews. Data were analyzed thematically. RESULTS: The analysis revealed four main themes and 11 (sub-themes): (a) relational practice (being creative and flexible, "lending them our ears"); (b) individual challenges of providing care to adolescent mothers (lack of knowledge to provide care related to gender-based violence, and gendered experience); (c) factors contributing to workarounds (inflexible guidelines, lack of protocol and procedures, lack of nurses' and midwives' in service training, and the physical structure of the perinatal environment); and (d) vicarious trauma (living the feelings, "I carry their stories home," and hypervigilance in parenting). CONCLUSION: Nurses and midwives find caring for adolescent mothers challenging due to their unique needs. These needs require them to be creative, adaptable, and attentive listeners to better understand their challenges. These practitioners face difficulties such as insufficient specific knowledge related to, for example, gender-based violence, inflexible guidelines, and a lack of protocols and training. Additionally, in the perinatal environment attention to the needs of practitioners in those settings is often lacking, and many nurses and midwives report experiencing vicarious trauma. Consequently, there is a pressing need for guidelines and protocols specifically tailored for the care of adolescent mothers. Ongoing trauma- and violence- informed care training and professional education should be provided to enhance the ability of nurses and midwives to care for adolescent mothers and prevent re-traumatization and mitigate vicarious trauma effectively.

Exploring perinatal ketamine for postpartum depression following cesarean section: A systematic review.

The aim of this study was to explore the use of perinatal ketamine to see if it can be used for the reduction of postpartum depression (PPD) following cesarean section (C-section). PubMed, Cochrane, and Web of Science were the primary databases used for this review. Search terms used on January 5, 2024 incorporated "ketamine," "C-section," "postpartum depression," and related synonyms. The criteria for inclusion centered on studies published between January 1, 2008 and January 5, 2024. The final selection of articles was screened based on extraction criteria leaving eight randomized control trials in the final review. The selected data from the studies incorporated sample characteristics, study and population characteristics, and quantitative analyses covering Edinburgh Postpartum Depression Scale (EPDS) scores and depression rates. The Risk of Bias assessment was utilized to gain a deeper understanding of the quality of methodology used by the research studies. The review showed that ketamine can reduce the symptoms of PPD in mothers who have recently undergone C-sections. Some studies showed decreased EPDS scores following the administration of ketamine while two studies also reported no significant differences in PPD following ketamine administration in C-section patients. For example, Ma et al. found that the EPDS score at postpartum day 4 was significantly lower in the ketamine group compared with the control group (p = 0.007) while Yang et al. found that there were no significant differences between the ketamine and control group at 3 days postpartum (p = 0.553). The research from this review suggests that ketamine administration can prevent or decrease the symptoms of PPD, but more research is needed to establish the causal relationship between ketamine dosage and PPD in C-section patients.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions.  Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period. According to modified Coopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Genome sequences of 70 multidrug-resistant Gram-negative isolates in high-risk neonates in the Northeast of Mexico.

Infections by multidrug-resistant pathogens are steadily increasing worldwide. A considerable proportion of neonatal intensive care admissions have a bacterial infection with multidrug-resistant bacteria during their hospital stay. In this work, we report draft genome sequences of 70 selected isolates from high-risk neonates in the Northeast of Mexico.

Perinatal outcomes of antenatally diagnosed omphalocele and gastroschisis: a survey from a university hospital.

Objective: To evaluate the clinical features and perinatal outcomes of antenatally diagnosed fetuses with omphalocele and gastroschisis. Material and Methods: This was a retrospective, single-center, cohort study of prenatally diagnosed fetuses with omphalocele and gastroschisis followed-up and delivered at a university hospital. Demographic, pregnancy, birth and perinatal outcomes were compared between gastroschisis and omphalocele. Results: A total of 75 fetuses with omphalocele and 21 cases with gastroschisis were evaluated. The mean maternal age of women carrying a fetus with omphalocele was significantly higher than the women with gastroschisis (p=0.001). Associated structural anomalies were found in 53.3% and 4.7% of fetuses with omphalocele and gastroschisis, respectively (p<0.001). The rate of chromosomal anomaly was 8.3% in pregnancies with omphalocele. In liveborn pregnancies, the mean gestational age at delivery and birth weight did not differ between the study groups. Time to postoperative oral intake, duration of parenteral nutrition and length of hospital stay were significantly longer in babies with gastroschisis than omphalocele (p<0.01). Rates of termination, intrauterine, neonatal and infant death of fetuses with omphalocele were 25.3%, 6.7%, 10.7% and 2.7% respectively. Time to postoperative oral intake, duration of parenteral nutrition and duration of hospitalization were significantly longer in babies with complex compared to simple gastroschisis (p<0.01). Survival rates were 95.2%, 82.9% and 20% in fetuses with gastroschisis, isolated and non-isolated omphalocele, respectively. Conclusion: Associated structural and chromosomal anomalies were significantly more common in fetuses with omphalocele compared to those with gastroschisis. Prognosis of fetuses with omphalocele depended on the associated structural and chromosomal anomalies, whereas bowel compromise was the main determining factor in gastroschisis.

A systematic review of postpartum psychosis resulting in infanticide: missed opportunities in screening, diagnosis, and treatment.

PURPOSE: Impacting 1 in 1000 women, untreated postpartum psychosis is associated with a 4% infanticide rate. This systematic review aims to identify factors that are associated with infanticide resulting from psychosis in the puerperal period and pinpoint areas of missed opportunity for intervention. METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines to identify and synthesize cases of maternal infanticide among perinatal females with evidence of postpartum psychosis. Four independent reviewers screened 231 articles identified in searches of three databases (PsycInfo, PubMed, and Web of Science) for studies conducted from 2013 to 2023. RESULTS: Twelve studies were included in the final review. Findings indicate that those experiencing puerperal psychosis have increased incidence of infanticide suggesting missed opportunities for intervention and treatment. Common factors in mothers who committed infanticide as a result of delusions and/or hallucinations associated with PMADs were identified, including lack of standardized screening tools, preference for traditional and/or cultural healing practices, and access to care. CONCLUSION: The current body of evidence supports developing and evaluating clinical interventions aimed at improving maternal mental health outcomes and infant outcomes in perinatal women experiencing puerperal psychosis.

Pregnancy and offspring outcomes after pre-pregnancy bariatric surgery.

BACKGROUND: Bariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies. OBJECTIVE: This study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA). STUDY DESIGN: A statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery. RESULTS: Of the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). In the adjusted model, pre-pregnancy bariatric surgery was associated with a lower risk of LGA (OR 0.54, 95% CI 0.44-0.66) and higher risk of SGA (OR 1.78, 95% CI 1.46-2.17). CONCLUSIONS: These data suggest that pre-pregnancy bariatric surgery was associated with a reduction in several obesity related pregnancy complications at the expense of more pre-term births and SGA offspring.

Digital health in perinatal care: Exploring usage, attitudes, and needs among Swiss women in urban and rural settings.

Background: Switzerland's healthcare system is known for its quality but faces challenges such as slow digitalization and fragmentation, especially in perinatal care. This study investigates Swiss women's use, needs, and attitudes in respect of digital health tools during pregnancy and postpartum, focusing on any differences between rural and urban populations. Methods: A web-based cross-sectional survey targeted pregnant women and those who had given birth in the last 12 months. Participants were recruited through social media, and the data were analyzed using principal component analysis and multivariable regressions to explore factors affecting the use of digital tools and attitudes toward eHealth. Results: A total of 1160 participants completed the survey. Healthcare professionals (92%) and private networks (77%) were the primary sources of information. Women expressed a strong preference for app features such as data access (73%), prescription management (73%), and scheduling appointments with healthcare professionals (71%). However, they also raised concerns about the impersonal nature of digital healthcare interactions (71%). Overall, rural women had more negative attitudes toward online health information seeking, which can be attributed to differences in education levels. Conclusion: The findings indicate that while Swiss women in the perinatal period do utilize digital tools, they focus more on nonmedical topics such as tracking physiological development. The study underscores the importance of adapting digital health solutions to the specific needs of women in the perinatal period. Emphasis should be placed on developing applications that are not only informative but also empower women on their healthcare journey while ensuring data privacy and supporting personal interactions with healthcare providers.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada.

BACKGROUND: Perinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents' lived experiences of social stressors and facilitators of perinatal psychological well-being. METHODS: Participants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed. RESULTS: Sixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care. CONCLUSIONS: Our results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country's social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

From intra- to extra-uterine: early phase design of a transfer to extra-uterine life support through medical simulation.

Introduction: Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure. Methods: Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians. Results & discussion: Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.

Low-income fathers are emotionally resilient: A qualitative exploration of paternal emotions across early parenting.

Emotions play an important role in fostering positive parenting and healthy child development. This qualitative study explored the affective experiences of racially diverse US fathers with low income across the prenatal, postnatal, and early childhood periods. Semi-structured interviews were conducted with 24 fathers. Interview questions asked about fathers' early parenting experiences that elicit parenting emotions of different valence. Results from thematic analysis demonstrated activation of multiple emotions depending on different proximal and distal experiences. Specific to proximal experiences, fathers reported feeling both excited and anxious about pregnancy and joyful and disappointed at childbirth. Related to distal experiences, fathers reported feeling encouraged by their social support networks that further aid their parenting, but feeling marginalized given systematic barriers (e.g., societal bias, high incarceration rates of Black fathers). Most importantly, fathers' parenting emotions, especially negative ones, led to them resolving to stay involved in their children's lives, gaining a sense of responsibility, and changing behaviors to do right by their children. Fathers resorted to various coping strategies to regulate their negative emotions. Overall, fathers with low income are emotionally resilient. Infant and early childhood health professionals should support fathers' mental health to promote father-child engagement and thus, ultimately, young children's mental health and wellbeing.

Las emociones juegan un papel importante en fomentar una crianza positiva y un saludable desarrollo del niño. Este estudio cualitativo exploró las experiencias afectivas de papás de Estados Unidos de bajos recursos económicos que son racialmente diversos a lo largo de los períodos prenatal, postnatal y la temprana niñez. Se llevaron a cabo entrevistas semiestructuradas con 24 papás. Las preguntas de la entrevista trataban acerca de las tempranas experiencias de crianza de los papás que provocaban emociones de crianza de valencia diferente. Los resultados de análisis temáticos demostraron la activación de múltiples emociones dependiendo de diferentes emociones proximales y distales. Específico a las experiencias proximales, los papás reportaron sentirse tanto emocionados como ansiosos acerca del embarazo y alegres y decepcionados al momento del nacimiento. Con relación a las experiencias distales, los papás reportaron sentirse animados por parte de sus redes de apoyo social que ayudaron en su acercamiento a la crianza y sentirse marginalizados dadas las barreras sistemáticas. De manera más importante, las emociones de crianza de los papás especialmente las negativas, les llevaron a decidir mantenerse involucrados en las vidas de sus niños, adquiriendo un sentido de responsabilidad y cambiando conductas para hacer lo correcto con sus niños. Los papás recurrieron a varias estrategias para regular sus emociones negativas. En general, los papás de bajas entradas económicas son emocionalmente fuertes. Los profesionales de la salud infantil y en la temprana niñez deben apoyar la salud mental de los papás para promover la compenetración papá­niño y a la larga, la salud mental y el bienestar de los niños pequeños.

Men's Experiences With Perinatal Loss: An Integrative Review.

Introduction: Perinatal loss is a tremendous loss for many and can have consequences that affect physical and mental health. This topic has been substantially examined among women; however, men's experiences with perinatal loss have lacked attention. Many men report significant grief, self-blame, stigma, loss of self-identity, lack of recognition of their loss, marginalization, and gendered expectations that negate their grieving process. This places men at risk for complicated or disenfranchised grief. Most studies examining perinatal loss have been conducted in countries outside of the United States and outside of the discipline of nursing. As nurses are concerned about holistic care of men and women, the findings resulting from studies with women and other cultural perspectives may not be generalizable to men in the United States. Purpose: The purpose of this integrative review was to examine the current state of science regarding men's experiences with perinatal loss, what is known about this loss within the nursing discipline, to identify gaps in nursing knowledge, and to expose areas for further research. Method: Online databases including CINAHL, PubMed, and Scopus were used to perform the initial search. The search terms included "men," "perinatal loss," "miscarriage," "stillbirth," and "grief." Results: Themes were identified through a review of the literature that included that men experienced a loss of the role of fatherhood and identity. Additionally, men reported expectations about socially and gender-specific behavior that influenced their expressions of grief and their coping process. Finally, the lack of recognition of their loss as fathers in perinatal loss resulted in the marginalization and the use of avoidance and distraction to cope with the loss, as well as risks to the health of the partnered relationship.

Prevalence and risk factors of perinatal depression among mothers and fathers in Pakistan: a systematic review and meta-analysis.

Background: Perinatal mental health issues affect approximately 10% of women in high-income countries and 30% in low- or middle-income countries. This review aims to determine the prevalence of perinatal depression among mothers and fathers in Pakistan and identify associated risk factors. Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included quantitative studies on the prevalence or incidence of maternal and paternal perinatal depression, including antenatal or postnatal depression in Pakistan, with or without associated risk factors. We performed an electronic search, dual-title/abstract and full-text screening, and data extraction. Analysis was conducted on Revman and JBI SUMARI software. The quality of the included studies was assessed with the NHLBI tool. This review updated a previously published review that included 43 studies, with the last search date of 31st May 2019, now extended to literature published up to June 30, 2023. Results: Consistent with the previous review, our analysis of 61 studies indicated a pooled prevalence of 37% (95% confidence interval (CI): 30.6-43.6) for maternal antenatal depression. Postnatal depression at different time points, revealed rates of 34.2% (95% CI: 22.7-46.7), 40.9% (95% CI: 0-97.4), and 43.1% (95% CI: 24.4-62.9) at 3, 6 and 12 months, respectively. Paternal postnatal depression was observed at 40.5% (95% CI: 14.9-69) based on two studies. Risk factors for maternal perinatal depression include multiparity, contraceptive failure, inadequate antenatal care, pregnancy-induced hypertension, previous psychiatric illness, passive smoking, drug abuse, low socio-economic status, marital problems, family hardships, recent bereavement, housing difficulties, food insecurity, husband's illiteracy, his unemployment, and being blamed for child disability. Conclusion: The findings reveal a high prevalence of perinatal depression among mothers with very limited evidence of fathers residing in Pakistan, emphasising the need for prospective studies addressing mental health challenges. Registration: This review is registered on PROSPERO (CRD42023442581).

Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records.

INTRODUCTION: Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. METHODS: A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. RESULTS: The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. DISCUSSION AND CONCLUSIONS: Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

Rhekiss-The German Register for Child Wish and Pregnancies in Inflammatory Rheumatic Diseases.

In pharmacoepidemiology, robust data are needed to judge the impact of drug treatment on pregnancy, pregnancy outcomes and breast-fed infants. As pregnant and breastfeeding women are usually excluded from randomised clinical trials, observational studies are required. One of those data sources are pregnancy registers specifically developed to focus on certain diseases or disease groups. The German Rhekiss register investigates pregnancies in women with chronic inflammatory rheumatic diseases (IRD). Rhekiss is a nationwide, multicentre, longitudinal study, in which women aged 18 years or older with an underlying IRD can be enrolled by a rheumatologist either when planning a pregnancy or in the first half of pregnancy. Data are collected prospectively at regular follow-up visits. Rheumatologists and patients provide information in a web-based system before conception (if enrolment was at the time of pregnancy planning), during and after pregnancy. A smartphone app is available for patients. Maternal and clinical information, general laboratory markers, treatment with antirheumatic and other drugs, adverse events, items related to course and outcome of pregnancy and the health of the child are uniformly assessed for all diseases. Individual information on the IRD includes classification criteria, diagnosis-specific laboratory parameters, clinical parameters and validated instruments to measure disease activity or damage. Furthermore, patient-reported outcome measures are captured. A total of 2013 individual patients have been enrolled in the register, and data on 1801 completed pregnancies are available. In summary, Rhekiss is a comprehensive and complex register that can answer various research questions about pregnancy in women with chronic IRDs.

Perinatal Airway Management Mandibular Anomalies: A National Inpatient Cohort Analysis.

OBJECTIVE: To characterize incidence of mandibular anomalies (MAs) and compare gestational age, airway interventions, and complications among individuals with MA phenotypes (isolated retrognathia, isolated micrognathia, syndromic micrognathia, micrognathia plus cleft palate/cleft lip and palate, agnathia/micrognathia plus cervical auricle/otocephaly, and agnathia/micrognathia plus microstomia) and unaffected individuals. METHODS: The Healthcare Cost and Utilization Project Kids' Inpatient Database was used to collect data over a 20-year period beginning in 2000. Interventions were classified as perinatal when performed on day of life (DOL) 0 or 1 and subsequent when performed during the birth hospitalization after DOL 1. Hypoxic complications included cardiac arrest, birth asphyxia, hypoxic-ischemic encephalopathy, anoxic brain damage, intraventricular hemorrhage or cerebral infarction. Descriptive statistics are reported, and the Rao-Scott chi-square test compared groups. RESULTS: MAs affected 119 per 100,000 birth visits. Preterm delivery was more frequent for all MA phenotypes. Individuals with MA phenotypes are more likely to require medical attention (airway intervention on DOL 0 or 1 OR no airway intervention received but patient sustained hypoxic complication/mortality): 16.2%-70.7% vs. 3.8%, p < 0.01. Despite receipt of airway interventions at a higher rate, collectively individuals with MAs who received an airway intervention on DOL 0 or 1 have a mildly elevated risk of hypoxic complication or mortality (32.4% vs. 26.4%, p < 0.01). CONCLUSIONS: Preterm birth is more common, however, does not account for the elevated rate of airway intervention. Individuals with MAs require higher rates of medical attention, and current airway management paradigms are insufficient to prevent complications and mortality. LEVEL OF EVIDENCE: III Laryngoscope, 2024.

Parental views on prospective consent: Experience from a pilot randomised trial recruiting extremely preterm infants during the perinatal period.

AIM: To explore parental perceptions of the consenting process and understanding of the study in a pilot randomised controlled trial wherein extremely premature infants (<29 weeks' gestation) were recruited either antenatally or by 4 h of life. METHODS: We prospectively surveyed parents who had consented, declined consent or were eligible infants in the Positioning Preterm Infants for Neuroprotection study, a low-risk intervention study in the first 72 h of life. Structured interview questions explored the process and acceptability of the consenting approach by the parents and their knowledge of the study. Additional comments made by the parents were transcribed verbatim. RESULTS: Sixty-two parents participated in the surveys; of those, 41 had provided their consent, 8 declined consent and 13 were parents of missed eligible infants. Overall, most parents reported they understood the study well before providing their consent and approaching them for consenting did not create a burden for them. A verbal explanation of the study by the study team, especially by the medical practitioners, was viewed as beneficial. Where consent was obtained in the birthing unit (imminent births and within 4 h of birthing), it was suggested that the 4-h period for obtaining post-natal consent may be too short. A deferred consent with a follow-up opportunity for obtaining informed consent could be a suitable alternative. CONCLUSION: Parents found the consenting process acceptable and indicated they had sufficient understanding of the study to provide an informed consent. Deferred consent should be explored for future, low-risk intervention studies as an alternative to prospective consent where extremely preterm infants need to be recruited in the immediate neonatal period.

Latina Mothers Recommendations on a Mindfulness-Based Cognitive Behavioral Therapy Group Intervention for Perinatal Depression.

Introduction: Perinatal depression affects 5-15% of childbearing women. However, literature suggests that Latina women are twice as likely to experience depression during pregnancy. Group telehealth-based interventions are a promising approach to increasing access and reducing barriers to mental health. However, little is known about the experience that Latinas have with navigating this approach. This paper aimed to explore Latina mothers' perspectives and recommendations in using telehealth to deliver a mindfulness-based cognitive behavioral therapy (MBCBT) group intervention. Methods: Fourteen pregnant or postpartum women participated in focus groups and individual interviews. Interview topics included perinatal depression, knowledge and content of interventions, and the feasibility and acceptability of the telehealth approach. Data were recorded, transcribed, and analyzed using a grounded theory approach. Results: Three broad themes emerged; (1) accessibility to telehealth, (2) relational connection through technology, and (3) technological issues affecting access (i.e., level of familiarity with portal, video quality, etc.). Enhancers promoting participation in the telehealth intervention included reduced scheduling concerns and no need for childcare. Barriers included mistrust of providers' engagement, concerns about privacy, and potential for lack of relational connection through technology. Conclusion: Specific recommendations were provided to increase participation and effectiveness of telehealth groups among Latinas.

Protocol for an intervention for new parents experiencing moderate psychosocial adversity: pilot feasibility randomised trial.

BACKGROUND: Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. METHOD: This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and 'virtual home visits' during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. CONCLUSION: To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.

Childhood Maltreatment and Perinatal Complications: A Scoping Review of Official Health Data.

Child maltreatment (CM) poses significant risks to victims, resulting in enduring physical, psychological, and developmental consequences. Adult survivors of CM seem especially vulnerable to perinatal complications. However, existing research on perinatal outcomes presents mixed results and relies heavily on self-reported data, which may not align with official medical data. Hence, a systematic review using official health data may provide clarity on this association; it may orient future research and the provision of perinatal services. This scoping review aimed to synthesize and evaluate the quality of the literature that utilizes official health data to explore associations between CM and perinatal complications. Following Arksey and O'Malley's model, searches across four databases (PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations/Thesis) produced 8,870 articles. After screening, 23 articles met the inclusion criteria (e.g., recorded perinatal complications using official health data, and peer-reviewed studies or dissertation). Evidence indicates CM survivors have less prenatal care visits, more fetal loss and preterm births, lower gestational age, and increases in emergency cesarean sections. Adults had more cervical insufficiency, lower episiotomies and sphincter ruptures, and overall pregnancy and postpartum complications while adolescents had lower Apgar scores. No associations were observed on other outcomes (e.g., vaginal bleeding, group B streptococcus, and fetal distress). Mixed findings emerged for other perinatal and maternal health concerns such as birth weight and blood pressure. CM survivors may face an increased risk of experiencing perinatal complications. Findings point to the relevance of leveraging health data for CM research and adopting trauma-informed practices in perinatal services.