Insights Into the Employability of Midwifery Graduates. A Case Study of the International Hellenic University.

Background: This study examines the employability and career trajectories of International Hellenic University's (IHU) midwifery students who graduated between 2016 to 2021, with a focus on undergraduate curriculum changes. Objective: To comprehensively examine the post-graduation journey of recent IHU Midwifery graduates. This includes shedding light on their employment trajectories, satisfaction levels, and the practical application of academic knowledge. Through this exploration, the study seeks to inform educational strategies to ensure alignment with the evolving needs of midwifery professionals in Greece. Methods: Online questionnaires that explored post-graduation experiences, perspectives on the study program, and future plans. The questionnaires consisted of a mix of open and closed-ended questions and were completed by 273 recipients. The study was conducted from May to September 2023, with participant anonymity maintained. Statistical analysis was performed using SPSS. Results: This study revealed differences between graduates of the 'old' and 'new' midwifery undergraduate curriculum. There were notable variations in the perceived impact of the six-month internship on employment. The study also highlighted the impact of the COVID-19 pandemic on educational experiences, emphasizing the nuanced challenges faced during clinical practice, practical training, and simulation training. Finally, the self-employed professionals and those employed in the public sector expressed higher satisfaction with the alignment of their employment with their undergraduate studies, than their counterparts in the private sector (p=0.038). Conclusions: Our study offers valuable insights into job placement, knowledge sufficiency, and the impact of the pandemic on midwifery undergraduate education. These findings can guide tailored strategies for improved education and holistic professional development, ultimately enhancing maternal and neonatal care.

Cell­free fetal DNA at 11­13 weeks of gestation is not altered in complicated pregnancies.

Non-invasive maternal cell-free fetal DNA (cffDNA) is a promising biomarker for screening common genetic syndromes. Alterations in the expression levels of cffDNA in the maternal circulation have been demonstrated in abnormal pregnancies. However, the results are conflicting. The present study aimed to investigate whether cffDNA levels are associated with pregnancy complications. The study group comprised pregnant women who presented with pregnancy complications, such as preterm birth, gestational hypertension, intrauterine growth retardation, gestational diabetes, polyhydramnios, oligohydramnios, vaginal bleeding and placental abruption. The control group comprised women who had a normal pregnancy course. Blood samples were obtained from 500 pregnant women between 11-13 weeks of gestation. cffDNA was amplified, sequenced and analyzed using the next-generation aneuploidy test of a Panorama-Natera kit. Nuchal translucency (NT) thickness as well as pregnancy associated plasma protein-A (PAPP-A) and ß-human chorionic gonadotropin (ß-hCG) levels were also assessed. Statistical analysis was performed in 494 out of the 500 samples collected with SPSS v.26 using non-parametric methods. The parameters were normalized by the multiples of median (MoM) method. The expression levels of PAPP-A, ß-hCG, and the NT mean MoM values were significantly different between the study and control groups (P=0.005, P<0.001 and P=0.007, respectively). However, the expression levels of cffDNA and the mean MoM values were not significantly different between these two groups (P=0.687). The findings of the present study support the conclusion that cffDNA expression is not altered in a series of pregnancy complications. The prognostic value of cffDNA in predicting adverse pregnancy outcomes requires further investigation.

The Value of Non-invasive Electrocardiography in Assessing Fetal Status at Term Delivery.

Background: The electrocardiograph (ECG) is efficient method for the accurate assessment of fetal heart rate. The barriers for accurate assessment are maternal heart rate, uterine contractions and abdominal muscles. Although previous monitoring methods have struggled to overcome these barriers, recent advances have led to a greater degree of success for listening and recording pulse-by-pulse fetal heart rate. Objectives: A prospective cohort study evaluating the use, reliability and safety of non-invasive electrocardiography, in conjunction with Fetal Heart Rate parameters such as, Short Term Variability (STV) together with umbilical cord PH and Apgar score, during the active phase of childbirth. Methods: A total of 41 women with single, normal, full-term pregnancies had systematic obstetric monitoring with Monica AN24. 20 had only monitoring and 21 also had and arterial blood flow measurements. pH was measured and correlated with neonatal Apgar score at 1 and 5 min. The study also included a questionnaire about the safety and usability of obstetric monitoring. Statistical analysis was done using IBM SPSS v. 26.0. Results: Mean age was 28.8 years, (SD ± 6.153). Electrocardiogram recordings (ECG) were classified as normal (71%) and suspicious (29%). Baseline between ECGs was different (p = 0.025) similarly for Short term variability (STV) (p <0.0001). BMI did not differentiate SVT rates. Only high acceleration (p <0.029) and small slowdowns had a statistically significant difference between normal and suspected cardiographs (p <0.029). APGAR score did not differ, whereas the umbilical cord pH was different in normal ECGs compared to the suspect (p = 0.012) and STV was also differentiated. A usability and safety survey was conducted after recording with MONIKA AN24, and the response to whether they would accept recording with the device again, was positive for 96% of the 30 responders. Conclusion: The present study shows that the use of electrocardiography in obstetrics allows to draw conclusions about the fetal hematopoiesis and oxygenation status. This method could be clinically applied and be an important tool for further screening in embryos that may be hypoxic and to decide whether to continue with a vaginal or cesarean delivery, thereby achieving the goal of reducing perinatal morbidity and mortality.

The Effect of Breastfeeding on Food Allergies in Newborns and Infants.

Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow's milk formula during the first week of life should be avoided. Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. The prophylactic effects of breastfeeding have been the subject of many studies, some with weak evidence. In this narrative review, we aim to provide an up-to-date account of the effects of prophylactic breastfeeding on food allergy and other common allergies in infants and children up to 5 years of age. Colostrum in particular has been shown to be prophylactic against food allergy. The American Academy of Pediatrics cautions that the relationship between duration of breastfeeding and incidence of food allergy in early childhood is unclear. The protective role of breastfeeding has a positive effect on allergy prevention, which is opposed by the early introduction of solid foods, but larger studies are needed to confirm the evidence. There is evidence that breastfeeding is effective in providing partial protection to infants.

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants.

Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.