Subspecialty care for peripartum pelvic floor disorders.

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.

Ações do programa de puerpério na atenção primária: uma revisão integrativa / Postpartum program actions in primary health care: an integrative review

Resumo O puerpério trata-se de um período de significativa morbimortalidade para as mulheres, e a Atenção Primária à saúde (APS) é importante no desenvolvimento de ações para atender as necessidades de saúde das mulheres. Objetivou-se sistematizar o conhecimento produzido sobre as ações de programas de atenção pós-parto no âmbito da APS, tanto em nível nacional, como internacional. Utilizou-se revisão integrativa de literatura de artigos junto às bases Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), BDENF (Base de dados em Enfermagem), SciELO (Scientific Electronic Library Online) e PubMed (Biblioteca Nacional de Medicina dos Estados Unidos). A busca ocorreu de abril a maio de 2017. Atenderam aos critérios de seleção 43 artigos. Os resultados apontam que: a APS possui estrutura física para atenção à puérpera, porém com déficit em recursos humanos e materiais; há baixa cobertura de consulta pós-parto e visita domiciliar; boa avaliação do incentivo ao aleitamento materno, porém com foco na criança; rastreamento da Depressão Pós-Parto internacionalmente por meio da "Edimburgh Post-Natal Depression Scale", e déficit na atenção a esse agravo no Brasil. A atenção pós-parto ainda tem como foco o cuidado ao recém-nascido e são restritos, em sua maioria, ao puerpério imediato e tardio.

Abstract Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study aimed to systematize the knowledge produced on postpartum care programs actions within PHC at both national and international levels. This is an integrative review of the literature in databases LILACS (Latin American and Caribbean Health Sciences Literature), BDENF (Nursing Database), SciELO (Scientific Electronic Library Online) and PubMed (US National Library of Medicine). Search was performed in the period April-May 2017. Forty-three papers met the selection criteria. Results indicate that PHC has the physical structure to provide puerperae with care, but has a shortage of human and material resources; there is low postpartum consultation coverage and home visits; there is a good evaluation of the incentive for breastfeeding, but focused on the child; international screening of Postpartum Depression through the Edinburgh Postnatal Depression Scale and care shortage for this condition in Brazil. Postpartum care still focuses on care for the newborn and is mostly restricted to the immediate and late puerperium.

Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success.

Introduction: Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied. Materials and Methods: A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012-2015, were included. Mothers, 2-4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay. Results: Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97-1.32; aPR = 1.20, 95% CI: 1.07-1.36; and aPR = 1.25, 95% CI: 1.08-1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61-0.86; aPR = 0.57, 95% CI: 0.51-0.64; and aPR = 0.91, 95% CI: 0.80-1.03). Adjusted Cox models showed similar direction of associations. Conclusions: Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.

Brief Report: Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya.

BACKGROUND: Programmatic approaches for delivering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics. METHODS: Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya, to determine optimal clinic flow for PrEP integration into antenatal care (ANC) and postnatal care (PNC). A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys. RESULTS: Clinics developed 2 approaches for integrating PrEP delivery within ANC/PNC: (1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or (2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (interquartile range 15-26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (interquartile range 7-15) was spent on PrEP-related risk assessment and counseling. CONCLUSIONS: PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing.

Improving Human Papillomavirus (HPV) Vaccination in the Postpartum Setting.

Although the HPV vaccine has been shown to be highly effective in preventing cervical dysplasia, vaccination rates remain low. The objective of this study was to assess the effectiveness of an electronic medical record (EMR) prompt on HPV vaccination rates in the postpartum setting. We conducted a pre-post intervention study among postpartum women ages 18-26 seen at an outpatient clinic from 09/01/2012-08/31/2013 (pre-intervention) and from 10/01/2013-03/31/2014 (post-intervention). The intervention was a drop-down menu that was inserted into the EMR postpartum note template inquiring about the patient's HPV vaccination status and whether or not the vaccine was administered at that visit. HPV vaccination uptake was compared pre and post-intervention. Of the 278 postpartum visits during the study period, 241 were eligible for analysis. There was a significant increase of the HPV vaccine uptake, from 1.2 % (2/173) among pre-intervention visits to 26.5 % (18/68) among post-intervention visits (p < 0.001). After adjusting for age, ethnicity, insurance, and religion, HPV vaccination was significantly higher at postpartum visits during the intervention period, with an adjusted OR = 93.49 [95 % CI 15.29-571.52]. Among visits in which the vaccine was not given, HPV vaccination was not discussed in 46 % and patients refused the vaccine in 40 % of visits. An EMR prompt in the postpartum note could be an effective way to promote HPV vaccination in the postpartum setting. It will likely take a combination of strategies to optimize vaccination uptake.

Prevention and management of bronchopulmonary dysplasia: Lessons learned from the neonatal research network.

Despite remarkable improvements in survival of extremely premature infants, the burden of BPD among survivors remains a frustrating problem for parents and caregivers. Advances, such as antenatal steroids and surfactant replacement, which have dramatically improved survival, have not reduced BPD among survivors. Other advances that have significantly improved the combined outcome of death or BPD, such as vitamin A and avoidance of mechanical ventilation, have had smaller magnitude effects on the outcome of BPD alone. Postnatal steroids have a clear beneficial effect on BPD, but the optimal preparation, dose, and timing for maximizing benefit and minimizing harm have yet to be determined. This persistent burden of BPD among the most immature survivors remains a challenge for the NRN and other researchers in neonatal medicine.

The Milky Way educational and support programme: Structure, content and strategies.

BACKGROUND: Health professionals have put much effort into supporting women to continue breastfeeding up to six months and beyond. The majority of those efforts have not been successful for primiparous women. Primiparous women who engaged in the Milky Way Programme had an improvement in breastfeeding rates of almost 50% at six months when compared to women in a control group. PURPOSE: To provide details of the Milky Way Programme including the educational structure, content and strategies as well as the process of postnatal telephone support. OVERVIEW: The details of the Milky Way Programme are presented including a summary of literature review that was used to design the programme. The structure and content of the programme is then presented. Finally, the strategies with some practical examples are outlined in more detail. CONCLUSION: The programme is evidence-based, theoretically informed and woman-centred. This paper provides the necessary information to health professionals who are trained to educate and support breastfeeding women to implement similar programmes in their workplaces.

[Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico]. / Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México.

OBJECTIVE: To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. MATERIALS AND METHODS: A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). RESULTS: The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). CONCLUSION: There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México / Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico

Objetivo. Explorar percepciones de proveedores de salud y beneficiarías del Programa Oportunidades sobre la práctica de actividad física durante el embarazo y posparto, e identificar características de la consejería sobre el tema en el primer nivel de atención en salud. Material y métodos. Estudio de métodos mixtos que forma parte de una intervención en nutrición del Programa Oportunidades. La información cualitativa se colectó por entrevista (50 mujeres; 34 proveedores de salud) y se obtuvo información cuantitativa a partir de un cuestionario (n=88 mujeres; n=64 proveedores; n=111 observaciones de consulta). Resultados. Se documentaron barreras a) individuales: falta de tiempo y de apoyo social; b) socioculturales: prejuicios de pares y familiares, y falta de instructores, y c) ambientales: falta de espacios físicos seguros y apropiados. 38% de las mujeres reporta haber recibido consejería sobre el tema versus 63.4% de proveedores que reportan haberla dado (p=0.002). Conclusiones. Urgen capacitación a proveedores y promoción de la actividad física que eliminen los prejuicios asociados al tema durante el embarazo y posparto.

Objective.To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. Materials and methods. A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). Results. The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). Conclusion. There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Who's responsible for the care of women during and after a pregnancy affected by gestational diabetes?

Despite its increasing incidence and high conferred risk to women and their children, gestational diabetes mellitus (GDM) is managed inconsistently during and after pregnancy due to an absence of a systemic approach to managing these women. New guidelines for GDM testing and diagnosis are based on stronger evidence, but raise concerns about increased workloads and confusion in a landscape of multiple, conflicting guidelines. Postnatal care and long-term preventive measures are particularly fragmented, with no professional group taking responsibility for this crucial role. Clearer guidelines and assistance from existing frameworks, such as the National Gestational Diabetes Register, could enable general practitioners to take ownership of the management of women at risk of type 2 diabetes following GDM, applying the principles of chronic disease management long term.

Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model.

A new model for the care of women in the postpartum focuses on the development of life skills that promote complete well-being. The year following childbirth is a time of significant transition for women. In addition to the physiologic changes associated with the postpartum period, a woman undergoes marked psychosocial changes as she transitions into a motherhood role, reestablishes relationships, and works to meet the physical and emotional needs of her infant and other family members. It is a time when women are vulnerable to health problems directly related to childbirth and to compromised self-care, which can manifest in the development or reestablishment of unhealthy behaviors such as smoking and a sedentary lifestyle. In addition to long-term implications for women, compromised maternal health in the postpartum period is associated with suboptimal health and developmental outcomes for infants. Maternal health experts have called for a change in how care is provided for women in the postpartum period. This article presents the rationale for a health promotion approach to meeting the needs of women in the postpartum period and introduces the Perinatal Maternal Health Promotion Model. This conceptual framework is built around a definition of maternal well-being that asserts that health goes beyond merely the absence of medical complications. In the model, the core elements of a healthy postpartum are identified and include not only physical recovery but also the ability to meet individual needs and successfully transition into motherhood. These goals can best be achieved by helping women develop or strengthen 4 key individual health-promoting skills: the ability to mobilize social support, self-efficacy, positive coping strategies, and realistic expectations. While the model focuses on the woman, the health promotion approach takes into account that maternal health in this critical period affects and is affected by her family, social network, and community. Clinical implications of the model are addressed, including specific health promotion strategies that clinicians can readily incorporate into antepartum and postpartum care.

Adequabilidade da assistência pré-natal em uma estratégia de saúde da família de Porto Alegre-RS / Adecuación de cuidado prenatal en una estrategia de salud familiar de Porto Alegre-RS / Adequacy of prenatal care in a family health strategy program from Porto Alegre-RS

O estudo objetivou avaliar a adequabilidade da assistência pré-natal de baixo risco, conforme a recomendação do Ministério da Saúde, quanto ao número mínimo de consultas, e verificar possíveis fatores associados. Avaliou-se a atenção pré-natal de uma coorte histórica de 95 gestantes. Mais de 50% das mulheres fizeram 6 ou mais consultas de pré-natal. O início do pré-natal ocorreu no primeiro trimestre de gestação para 52% das mulheres; 84,2% das mulheres realizaram todos os exames de pré-natal e apenas 16,8% realizaram consulta no puerpério. A assistência pré-natal foi considerada adequada para 2,1% da amostra. Maior número de consultas pré-natal foi observado entre as mulheres com companheiro e com maior número de filhos.Os registros demonstraram baixa adequação à totalidade dos critérios mínimos estabelecidos e poucos fatores parecem explicar esse cenário.

El objetivo del estudio fue evaluar la adecuación de la atención prenatal de bajo riesgo, según lo recomendado por el Ministerio de Salud, y el número mínimo de consultas, e identificar los posibles factores asociados. Se evaluó la atención de prenatal de una cohorte histórica de 95 embarazadas. Más del 50% de las mujeres hicieron 6 o más consultas de prenatal. El inicio del prenatal se realizó en el primer trimestre de gestación para el 52% de las mujeres; el 84,2% de las mujeres realizó todos los exámenes de prenatal y sólo el 16,8% realizó consulta en el puerperio. La asistencia prenatal fue considerada adecuada para el 2,1% de la muestra. Más números de consultas prenatales fueron observados entre las mujeres con compañero y con mayor número de hijos.Los registros demostraron baja adecuación a la totalidad de los criterios mínimos establecidos y pocos factores parecen explicar ese escenario.

The study aimed to evaluate the adequacy of low-risk prenatal care, as recommended by the Ministry of Health, concerning the minimum number of consultations, and identify possible associated factors. Prenatal care was evaluated in a historical cohort study of 95 pregnant women. Over 50% of the women underwent six or more prenatal consultations. The beginning of the prenatal care began in the first trimester of the gestation for 52% of the women, 84.2% of the women did all their prenatal medical tests, and only 16.8% had postpartum consultations. Prenatal assistance was considered adequate for 2.1% of the sample. A higher number of prenatal consultation was observed among women who had a partner and who had other children.The records reveal a low adequacy level with all minimum criteria established and few factors seem to explain this scenario.

Postpartum depression screening in yemeni and punjabi immigrant women.

This article describes strategies for using a postpartum depression screening tool with women from two immigrant minority populations (from Yemen and from the Punjab region of India). Techniques to maximize success while working with interpreters and with women's unique cultural considerations are presented. Two case studies provide examples of challenges presented and overcome by women from each of these populations.

Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers.

PURPOSE: To determine whether exclusively pumping mothers of preterm infants could achieve full milk production while using the Ameda Platinum breast pump the first 14 days postpartum. SUBJECTS: Twenty-six mothers who delivered infants between 26 and 32 weeks' gestation at 2 Intermountain Healthcare hospitals completed the study. Mothers could not take milk-enhancing or milk-reducing substances, feed directly at the breast, have had breast surgery, or use any other breast pump during the study. DESIGN: Nonexperimental, descriptive study. METHODS: Mothers were instructed to use the Ameda Platinum breast pump exclusively 8 times daily, for 14 days. They recorded milk volumes, suction pressures, cycle speeds, and time spent pumping. A "Performance Questionnaire" was completed at the end of the study with questions about the ease of use, preferred speed and suction settings, and overall performance of the pump. MAIN OUTCOME MEASURE: Full milk production was defined as 700 mL/d. Speed and suction settings, as well as average pumping session length, were analyzed in relation to categories of maximum milk volumes expressed. RESULTS: The average maximum daily milk volume for all mothers was 817 mL/d. Sixteen mothers produced milk volumes more than 700 mL/d and 9 of these mothers were able to express more than 1000 mL/d. Those with daily milk production more than 700 mL/d used lower suction pressure settings to stimulate the milk ejection reflex and to empty the breast. These higher-producing mothers also chose ending speeds of 50 to 60 cycles per minute, similar to the nutritive sucking pattern of a healthy newborn. Mothers producing less than 500 mL/d used higher suction pressures, faster ending cycle speeds, and longer pumping times. Suction pressures varied widely among all of the mothers and were influenced by the mothers' nipple or breast sensitivity, which varied from mother to mother and day to day. Mothers reported liking separate controls for speed and suction and used them to achieve maximum comfort and milk volume. CONCLUSIONS: The Ameda Platinum breast pump is an effective hospital-grade pump for exclusively pumping mothers to establish full milk production by 14 days postpartum. Separate control of speed and suction allows mothers a wide range of options to achieve greater comfort and multiple milk ejections, both of which contribute to optimal milk expression.

Intrapartum management for prevention of mother-to-child transmission of HIV in resource-limited settings: a review of the literature.

Prevention of mother-to-child transmission (PMTCT) of HIV guidelines in resource-limited settings focus on antenatal and postnatal management. In this review of the literature, we present findings from select studies, highlight best practices, and present evidence-based guidelines for intrapartum PMTCT management that are applicable to resource-limited settings. We discuss the roles of intrapartum HIV testing, intrapartum antiretroviral medications, mode of delivery in settings with and without HIV RNA testing, other delivery practices, and infant care in the immediate postnatal period. With the advent of Option B+, which recommends all HIV-infected pregnant women commence lifelong combination antiretroviral therapy (ART), the potential impact for intrapartum interventions will be greatest for those women who recently have seroconverted and those with unknown HIV status. Research on intrapartum PMTCT interventions should focus on these populations.

The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial.

BACKGROUND: Suicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality. The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders, and includes a question on suicidal ideation (question 10). We aimed to investigate the prevalence, persistence and correlates of suicidal thoughts in postpartum women in the context of a randomised controlled trial of treatments for postnatal depression. METHODS: Women in primary care were sent postal questionnaires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression and in those with high levels of symptoms, a home visit with a standardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version (CIS-R). Other socio-demographic and clinical variables were measured, including functioning (SF12) and quality of the marital relationship (GRIMS). Women who entered the trial were followed up for 18 weeks. RESULTS: 9% of 4,150 women who completed the EPDS question relating to suicidal ideation reported some suicidal ideation (including hardly ever); 4% reported that the thought of harming themselves had occurred to them sometimes or quite often. In women who entered the randomised trial and completed the EPDS question relating to suicidal ideation (n = 253), suicidal ideation was associated with younger age, higher parity and higher levels of depressive symptoms in the multivariate analysis. Endorsement of 'yes, quite often' to question 10 on the EPDS was associated with affirming at least two CIS-R items on suicidality. We found no association between suicidal ideation and SF-12 physical or mental health or the EPDS total score at 18 weeks. CONCLUSIONS: Healthcare professionals using the EPDS should be aware of the significant suicidality that is likely to be present in women endorsing 'yes, quite often' to question 10 of the EPDS. However, suicidal ideation does not appear to predict poor outcomes in women being treated for postnatal depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN16479417.

A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial.

OBJECTIVE: to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. DESIGN: a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. SETTING: a 3900-bed medical centre in northern Taiwan with around 3000 births annually. PARTICIPANTS: a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. INTERVENTIONS: the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24-48 hours after birth to six months post partum. MEASUREMENTS: body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). FINDINGS: average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively. KEY CONCLUSIONS: a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. IMPLICATIONS FOR PRACTICE: the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle.

Maternal child home visiting program improves nursing practice for screening of woman abuse.

OBJECTIVE: This study investigated changes in public health nurse practices and the incidence of abuse inquiry and disclosure. DESIGN AND SAMPLE: A retrospective record review of cross-sectional data was collected before and after implementation of the Routine Universal Comprehensive Screening (RUCS) protocol within a maternal child home visiting program. Records of postpartum women receiving a universal home visit within 48 hr of discharge from the hospital were reviewed (pre-RUCS, n=459; post-RUCS, n=485). Also reviewed were the records of women receiving a family assessment for at risk home visiting (pre-RUCS, n=79; post-RUCS, n=66). MEASURES: The variables collected consisted of abuse inquiry, abuse disclosure, and the alone status. RESULTS: Documentation of women's alone status significantly improved for both types of home visits: the 48-hr home visits ( p<.001) and the at risk home visits ( p<.01). Disclosures of abuse significantly increased in both types of home visits ( p<.01). Ensuring privacy by not asking abuse questions if women were not alone during a visit significantly improved ( p<.001). CONCLUSIONS: Implementing a protocol to screen for woman abuse into an existing maternal child home visiting program demonstrated improved practices related to the safety and privacy of women, and an increase in abuse disclosures.