Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes.

BACKGROUND: Fetal macrosomia is associated with negative outcomes, although less is known about how severities of macrosomia influence these outcomes. Planned community births in the United States have higher rates of gestational age-adjusted macrosomia than planned hospital births, providing a novel population to examine macrosomia morbidity. METHODS: Maternal and neonatal outcomes associated with grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g) macrosomia were compared to normal birthweight newborns (2500-3999 g), using data from the MANA Statistics Project-a registry of planned community births, 2012-2018 (n = 68 966). Outcomes included perineal trauma, postpartum hemorrhage, cesarean birth, neonatal birth injury, shoulder dystocia, neonatal respiratory distress, neonatal intensive care unit (NICU) stay >24 hours, and perinatal death. Logistic regressions controlled for parity and mode of birth, obesity, gestational diabetes, and preeclampsia. RESULTS: Sixteen percent of the sample were grade 1 macrosomic, 3.3% were grade 2 macrosomic, and 0.4% were grade 3 macrosomic. Macrosomia grades 1-3 were associated in a dose-response fashion with higher odds of all outcomes, compared to non-macrosomia. The adjusted odds ratios and 95% confidence intervals for postpartum hemorrhage for grade 1, grade 2, and grade 3 macrosomia vs normal birthweight were 1.75 (1.56-1.96), 2.12 (1.70-2.63), and 5.18 (3.47-7.74), respectively. Other outcomes had similar patterns. DISCUSSION: The adjusted odds of negative outcomes increase as grade of macrosomia increases in planned community births; results are comparable with the published literature. Pre-birth fetal weight estimation is imprecise; prenatal supports and shared decision-making processes should reflect these complexities.

Current Resources for Evidence-Based Practice, March 2022.

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of systemic racism and its effect on maternal health in the United States and commentaries on reviews focused on barriers and facilitators to HPV vaccination and delayed cord clamping in preterm infants.

Current Resources for Evidence-Based Practice, May 2021.

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the prenatal prediction of fetal macrosomia and commentaries on reviews focused on the effects of date palm and dill seed on labor outcomes and the current research available on SARS-CoV-2 and pregnancy outcomes.

Current Resources for Evidence-Based Practice, January 2021.

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the WHO's new Labour Care Guide and commentaries on reviews focused on prevention of mastitis in women during the postpartum period and a comparison of outcomes for fresh versus frozen embryos for in vitro fertilization.

Dungeness crab fishermen perceptions of injury causation and factors in staying safe.

BACKGROUND: Commercial fishing is a hazardous occupation in the United States (US). Injury surveillance data relies heavily on US Coast Guard reports, which capture injuries severe enough to require reporting. The reports do not incorporate the fishermen's perspective on contributing factors to injuries and staying safe while fishing. MATERIALS AND METHODS: We conducted a pre-season survey of Dungeness crab fishermen during 2015 to 2016. Community researchers administered surveys to fishermen. Respondents reported their opinions about factors contributing to injuries and staying safe, which were grouped into similar themes by consen- sus. Descriptive statistics were calculated to explore the number of injuries, crew position, age, and years of experience. Chi-square tests compared perceptions of injury causation, staying safe, and other factors. RESULTS: Four hundred twenty-six surveys were completed. Injury causation perceptions were sorted into 17 categories, and staying safe perceptions were sorted into 13 categories. The most frequently cited causes of injury were heavy workload (86, 21.9%), poor mental focus (78, 19.9%), and inexperience (56, 14.3%). The most frequently cited factors in staying safe while fishing were awareness (142, 36.1%), good and well-maintained fishing gear/vessel (41, 10.4%), and best marine practices (39, 9.9%). Opinions were not significantly associated with experiencing an injury in the past while fishing, but some opinions were significantly associated with crew position, age, and years of experience. CONCLUSIONS: The perceptions of fishermen can be evaluated further and incorporated into training or intervention development. The fishermen-led approach of this project lends itself to developing injury pre- vention strategies that are effective, realistic and suitable. The resources available at FLIPPresources.org, such as informational sheets for new fishermen, sample crew agreements, and first aid kit resources, supply workers in this fishery with real solutions for issues they identified through their survey responses.

Non-Fatal Injuries and Injury Treatment in the West Coast Dungeness Crab Fishery.

Objectives: Non-fatal injuries in the high risk US Dungeness crab fishery have been under-documented, despite their potential for lost work time and income, long-term disability, and early unwanted retirement. The Fishermen Led Injury Prevention Program (FLIPP) characterized injuries in this fishery, in order to identify work hazards and inform injury control measures.Methods: The FLIPP injury survey was completed by 426 fishermen in 23 Washington, Oregon, and California fishing ports prior to the 2015-2016 Dungeness crab season; 413 (97%) provided injury information for this analysis. Participants indicated whether they had been injured in the previous 12 months, described the injury, any treatments received, and whether the injury limited their ability to work.Results: Participants were mostly male (98%), more than half (56.6%) worked as deckhands, and reported considerable fishing experience (median = 14 years, interquartile range 5-27). Eighty-nine fishermen (21.5%) reported an injury incident in the past year, of which 49 (55.1%) were limiting. The 89 incidents yielded 102 injuries, of which nearly two-thirds were sprains/strains (23, 22.5%), surface wounds/bruises (17, 15.0%), cuts (18, 17.6%), or punctures (11, 10.8%). More severe injuries, including eight fractures, were rare. The majority of injuries received either no treatment (27, 26.5%) or first aid (35, 34.3%); clinical care was less common (22, 21.6%), and emergency care rare (3, 2.9%).Conclusion: One in five Dungeness crab fishermen reported an injury incident in the previous year. Most injuries were not severe and did not result in clinical care, but approximately half were work-limiting. Control measures must account for the remote and resource-limited workplace in commercial fishing.