Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study.

OBJECTIVE: To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth. DESIGN: A multicentre randomised controlled trial. SETTING: Three university hospitals in Copenhagen, Denmark. POPULATION: Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV. METHODS: We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat. MAIN OUTCOME MEASURE: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention. CONCLUSIONS: In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth. TWEETABLE ABSTRACT: Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.

The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants.

BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size. METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age. RESULTS: Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size. CONCLUSION: Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size. TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with trial registration number NCT01694108 .

"I would never be able to forgive myself if it ended up having consequences for the child": A qualitative study of perceptions of stress and worries among healthy first-time pregnant Danish women.

BACKGROUND: Becoming a mother is one of the most transitional experiences in life. It requires psychological, physical, and social adjustment and adaptation in various areas and can be conceived as both a stressful and joyful experience by many women. Especially, first-time pregnancies are recognised as a period of emotional sensitivity. Moreover, stress is a well-established risk factor for premature birth and low birth weight and might affect the health of the offspring. Thus, this study explores the perception of stress and worries in healthy Danish pregnant nulliparous women. METHODS: We used a qualitative, inductive, exploratory design. Three focus group interviews were conducted with 16 healthy pregnant nulliparous women. Data from the focus group interviews were analysed using content analysis according to Graneheim and Lundman. FINDINGS: Three main categories contributed to the core theme "Identity Limbo". The categories were: (1) The great responsibility, (2) Imagining picture-perfect, and (3) Two-in-one body. The participants expressed that holding on to their current identity was extremely important. They simultaneously tried to incorporate their new identity as mothers, which imposed sadness about saying goodbye to their old life, leaving them in an identity limbo. These women did not experience classic stressors such as bereavement, poverty, or trauma. Still, the great responsibility for the child's future, changes to their work and career, and saying goodbye to their pre-pregnancy identity were all essential contributors to feelings of stress in the women's current pregnancy and life. CONCLUSION: Our findings suggest that the identity limbo triggered by pregnancy can make the transition to motherhood stressful for some women. Therefore, with the potentially severe consequences of stress in mind, developing tools that can help women and midwives focus on the mental transition of pregnancy is needed.

Early Postpartum Stress, Anxiety, Depression, and Resilience Development among Danish First-Time Mothers before and during First-Wave COVID-19 Pandemic.

On 11 March 2020, a lockdown to limit the spread of COVID-19 was implemented in Denmark. The pandemic and the lockdown might have caused stress, depression, and anxiety in new mothers. Individuals with high resilience to stress may have been less affected. This study aimed to investigate if changes in perceived stress, anxiety, depression, and resilience from the second trimester until two months postpartum were different before and during the COVID-19 pandemic in Denmark in spring 2020. Pregnant women enrolled in an ongoing feasibility study completed an online questionnaire measuring perceived stress, depression, anxiety, and resilience in the second trimester and two months postpartum. Changes in scores between women completing the two-month postpartum questionnaire before (n = 26) or during (n = 47) the COVID-19 pandemic were calculated. No statistically significant differences in changes from baseline to follow-up between pre- and during-pandemic groups in Cohen's Perceived Stress Scale (PSS), the Depression, Anxiety, Stress Scale (DASS), or the Connor-Davidson Resilience Scale (CD-RISC) were found. Adjusted differences in group means were as follows: PSS: 0.70 (CI-2.45; 3.85); DASS Stress: 0.76 (CI-3.59; 2.08); DASS Anxiety: 0.47 (CI-0.84; 1.77); DASS Depression: 0.88 (CI-0.95; 2.71); and CD-RISC: 1.19 (CI-3.16; 5.54). In conclusion, we did not find significant differences in the development of stress, depression, anxiety, or resilience before or during the Danish COVID-19 pandemic in spring 2020.