Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities.

BACKGROUND: Self-care behaviors during pregnancy significantly impacts mother and children's health. This study aimed to explore the self-care behaviors and the associations of these behaviors with the psychological well-being of women during pregnancy, as well as the mediating effects of different social support with these associations. METHODS: A cross-sectional data of 562 pregnant women at Hanoi Obstetrics & Gynecology Hospital and Ca Mau Obstetrics & Pediatrics in Vietnam were analyzed. Questions about self-care behaviors, pregnancy characteristics, social support, and psychological well-being were asked. Multivariate regression models were performed. Structural Equation Modeling (SEM) was employed to test the mediating effects of different social support with the association between self-care behaviors and psychological well-being. FINDINGS: Only 13% of pregnant women often or always did physical exercise at least three times a week, and 40% consumed enough fiber and five servings of vegetables a day. Only 78.7% always avoided alcohol drinking, and 53.9% of pregnant women avoided being exposed to second-hand smoking and 71,7% avoided using traditional medicine without physicians' prescriptions. Around 66% of pregnant women always or often had prenatal care checkups as scheduled. Information sources, social support and childbirth expectation were major drivers for self-care practices. SEM model showed that social support mediated the relationship between maternal health behaviors and mental well-being. CONCLUSION: This study highlighted the remarkable gaps in self-care practices among our pregnant women, which were significantly associated with their mental well-being. Social support-oriented consultancy and interventions should be warranted for improving behaviors and the mental well-being of pregnant women in Vietnam.

Improvement of symptoms after hysteroscopic isthmoplasty in women with abnormal uterine bleeding and expected pregnancy: A prospective study.

BACKGROUND: Cesarean scar myometrial defect as known as niche is associated with postmenstrual spotting, suprapubic pain and secondary infertility. Hysteroscopic isthmoplasty has been proposed in the treatment of niche. This study aims to determine the safety and effectiveness of hysteroscopic isthmoplasty in postmenstrual spotting treatment and improvement of spontaneous conceiving. MATERIALS AND METHOD: A prospective study was performed at Hanoi Obstetrics and Gynecology Hospital, Vietnam. We studied women who developed postmenstrual spotting related to niches and had desired to conceive for more than six months. Women with residual myometrium less than 2.5 mm were excluded. Twenty-three eligible women underwent hysteroscopic isthmoplasty with four main steps, including identification of relevant anatomy, resection of the cephalad edge of fibrosis, resection of the caudal edge of fibrosis, and ablation of the niche base. Participants were followed up at 1, 3, and 6 months postoperatively. RESULTS: The mean surgical duration was 17 min, and no complications took place. The number of women with improved postmenstrual spotting symptoms after 1, 3, and 6 months were 39.1% (9/23), 61.9% (13/21) and 68.8% (11/16), respectively. Suprapubic pain resolved in 94% (15/16) of the women in the first month. The rate of spontaneous pregnancies within 6 months of isthmoplasty was 30.4% (7/23). There were no differences in depth niche and residual myometrium thickness on ultrasound in the period before and after hysteroscopy. CONCLUSION: Our study supports that hysteroscopic isthmoplasty is a safe and effective procedure for women with a niche and postmenstrual spotting and wish to conceive.

Heavy uterine bleeding in adolescent caused by uterine vascular lesion: A case report.

OBJECTIVE: To analyze a case of heavy uterine bleeding in adolescence caused by an arteriovenous malformation (AVM) in Hanoi Obstetrics and Gynecology Hospital, Vietnam. METHODS: We observed a case of a 14-year-old girl, without vaginal sexual intercourse experience, having heavy uterine bleeding caused by AVM. She underwent a laparoscopic operation at the hospital for vascular lesions in the uterine anterior wall, which caused an internal hemorrhage of 1500 ml blood loss into the peritoneal cavity. Three years later, this patient was hospitalized twice for massive vaginal bleeding. RESULTS: Results of ultrasound and magnetic resonance imaging indicated a uterine intramural mass with enlarged vessels connecting to the endometrial cavity. A pelvic digital subtraction angiography was performed and showed profuse bleeding from a ruptured branch of the left uterine artery. This artery was embolized at Bach Mai hospital and the bleeding was stopped. The patient had stable health and normal menstrual periods after 4 months of follow up. CONCLUSION: Abnormal mass with dilated vessels in the myometrium in a patient experiencing heavy uterine bleeding is an exclusive sign of uterine vascular malformation and can be treated by angioembolization.

Case Report: Epidural Abscess Following Obstetric Epidural Anesthesia in Vietnam.

Epidural abscess after obstetric epidural anesthesia occurs infrequently and may result in severe morbidity. We report a clinical case of an epidural abscess in Vietnam. A 31-year-old woman who was in labor was admitted to our hospital and given epidural anesthesia indicated to relieve labor pain. After three hours of anesthesia, cesarean section was indicated for the patient due to signs of fetal failure, the epidural catheter was then used to relieve pain for the first 48 hours postoperatively. On post-partum day 5 she presented with high fever of 39-40°C, fatigue, stimulation, dyspnea, and lumbar pain. The patient then suffered from sepsis and lower limb paralysis. She was diagnosed with epidural abscess based on the MRI of the lumbar spine. The abscess was treated by surgery for draining and appropriate antibiotics with a satisfactory outcome as she completely recovered her motor function and stable health status.

Community-Based Screening for Cervical Cancer Using Visual Inspection With Acetic Acid: Results and Lessons Learned From a Pilot Study in Vietnam.

CONTEXT: Vietnam still applies the opportunistic cytology-based screening model, which failed to have an impact on the increasing burden of cervical cancer in Vietnam. OBJECTIVES: To pilot a community-based screening model for cervical cancer using visual inspection with acetic acid (VIA) in Vietnam by training midwife and assistant physician working at grassroots level of health care system. DESIGN: The study employed a pre-experimental design. SETTING: Cases from 2 provinces of Vietnam. PARTICIPANTS: The study trained 36 assistant physicians/midwives working at commune health centers to do VIA screening for cervical cancer and provided screening services for 1945 women 30 to 65 years of age. INTERVENTION: The pilot intervention had 2 aims: train health care workers to do VIA screening and assess the quality of screening services provided by the trained staffs by examining the diagnostics value of VIA. RESULTS: All selected health care workers were able to perform VIA screening method after training. Their VIA services had high diagnostic value: positive predicted value of 11.5% and negative predicted value of 99%; for the detection of cervical intraepithelial neoplasia (CIN) 2, the sensitivity of VIA is 100%, specificity of 67.0%, positive predicted value of 5.7%, and negative predicted value of 100%; for the detection of CIN 3, the sensitivity of VIA is 100%, specificity of 66.5%, positive predicted value of 3.8%, and negative predicted value of 100%. The diagnostic value of VIA is comparable with Papanicolaou test but requires far fewer resources and suitable with community-based setting. CONCLUSION: Local midwives and assistant physicians who currently work at commune health centers and district health centers can be trained to do VIA efficiently. Regarding to implications for policy and practice, VIA can offer significant advantages over Papanicolaou test in low-resource settings like Vietnam, particularly in terms of increased screening coverage, improved follow-up care, and overall program quality.

Medical costs for the treatment of cervical cancer at central hospitals in Vietnam.

Cervical cancer remains the second most common cancer amongst female aged 15 to 44 years old in Vietnam. We estimated medical costs for the treatment of cervical cancer patients. We employed the standard costing approach and health care provider perspective. We first computed the unit cost of 22 medical services related to cervical cancer treatments and then, based on standard cervical cancer treatment protocols, we estimated the cost of nine treatment scenarios for cervical cancer patients. We found that the medical costs for treatment of cervical cancers at central hospitals in Vietnam increased as the cancer progresses into later stages.