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1.
PLoS One ; 18(2): e0280273, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36724156

RESUMEN

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women's perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the "welcomeness" of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.


Asunto(s)
Problemas Sociales , Humanos , Femenino , Embarazo , Investigación Cualitativa , Mujeres Embarazadas/psicología , Periodo Posparto
2.
BMC Pregnancy Childbirth ; 23(1): 83, 2023 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-36721113

RESUMEN

BACKGROUND: The COVID-19 pandemic and the resulting lockdowns triggered social discontent on an unprecedented scale. Descriptive phenomenological studies showed that pregnant women were under intense stress during the COVID-19 outbreak, even though they remained uninfected. The purpose of this study was to report on the experiences of pregnant women affected by mild COVID-19 during the first wave of the pandemic. METHODS: In this non- interventional qualitative study, we analyzed pregnant women's experiences using an interpretive phenomenological analysis approach. We conducted semi-structured interviews with women who had had a mild COVID-19 during their pregnancy, and gave birth or planned to give birth in the maternity units of Sorbonne University in Paris, France. RESULTS: Participants reported that at the time they had COVID-19, they were not afraid of being seriously ill, but of transmitting COVID-19 to their close relatives. Their main concern was being pregnant and becoming a parent in a world where the pandemic deeply altered social environment. This included uncertainty about the future and an acute feeling of isolation related to lockdown. The idea that their partner might not be allowed to attend childbirth was almost unanimously felt as intolerable. In contrast, women had positive feelings regarding the fact that lockdown resulted in a de facto paternity leave leading to a certain degree of equality in the couple regarding baby care and household chores. Unexpectedly, the pandemic social distancing measures helped participants escaping from behavioral constraints, including the unspoken rule that they should welcome greetings from friends and family, despite being exhausted by the recent birth. CONCLUSIONS: Our results suggest that avoiding separation from their partner is a key to benevolent medical care for pregnant women in times of health crises. The unexpected benefits women reported in a world of lockdown cast a new light on their expectation regarding parenthood today.


Asunto(s)
COVID-19 , SARS-CoV-2 , Embarazo , Lactante , Femenino , Humanos , Paris/epidemiología , Mujeres Embarazadas , Pandemias , Control de Enfermedades Transmisibles , Periodo Posparto
3.
PLoS One ; 18(1): e0278675, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36649247

RESUMEN

BACKGROUND: HIV may increase SARS-CoV-2 infection risk and COVID-19 severity generally, but data are limited about its impact on postpartum women and their infants. As such, we characterized SARS-CoV-2 infection among mother-infant pairs in Nairobi, Kenya. METHODS: We conducted a nested study of 62 HIV-uninfected and 64 healthy women living with HIV, as well as their HIV-exposed uninfected (N = 61) and HIV-unexposed (N = 64) infants, participating in a prospective cohort. SARS-CoV-2 serology was performed on plasma collected between May 1, 2020-February 1, 2022 to determine the incidence, risk factors, and symptoms of infection. SARS-CoV-2 RNA PCR and sequencing was also performed on available stool samples from seropositive participants. RESULTS: SARS-CoV-2 seropositivity was found in 66% of the 126 mothers and in 44% of the 125 infants. There was no significant association between SARS-CoV-2 infection and maternal HIV (Hazard Ratio [HR] = 0.810, 95% CI: 0.517-1.27) or infant HIV exposure (HR = 1.47, 95% CI: 0.859-2.53). Maternal SARS-CoV-2 was associated with a two-fold increased risk of infant infection (HR = 2.31, 95% CI: 1.08-4.94). Few participants (13% mothers, 33% infants) had symptoms; no participant experienced severe COVID-19 or death. Seroreversion occurred in about half of mothers and infants. SARS-CoV-2 sequences obtained from stool were related to contemporaneously circulating variants. CONCLUSIONS: These data indicate that postpartum Kenyan women and their infants were at high risk for SARS-CoV-2 infection and that antibody responses waned over an average of 8-10 months. However, most cases were asymptomatic and healthy women living with HIV did not have a substantially increased risk of infection or severe COVID-19.


Asunto(s)
COVID-19 , Infecciones por VIH , Femenino , Humanos , Lactante , COVID-19/epidemiología , COVID-19/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Kenia/epidemiología , Periodo Posparto , Estudios Prospectivos , ARN Viral/análisis , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Estudios de Casos y Controles , Heces/virología , Reacción en Cadena de la Polimerasa
4.
BMC Pregnancy Childbirth ; 23(1): 68, 2023 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-36703104

RESUMEN

BACKGROUND: Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one's breastfeeding self-efficacy have been shown to improve breastfeeding rates. METHODS: We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months. DISCUSSION: This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure - an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP. TRIAL REGISTRATION: ClinicalTrials.gov, # NCT04580927 , registered on Oct 9, 2020.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión Inducida en el Embarazo , Preeclampsia , Lactante , Embarazo , Femenino , Humanos , Lactancia Materna , Presión Sanguínea , Lactancia , Autoeficacia , Periodo Posparto , Ontario , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto
5.
Obstet Gynecol ; 141(2): 245-252, 2023 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-36603202

RESUMEN

OBJECTIVE: To assess whether immediate or delayed pushing in the second-stage results in higher risk of pelvic floor morbidity. METHODS: This study was a planned secondary aim of a multicenter randomized clinical trial that included nulliparous patients at 37 weeks of gestation or greater in labor with neuraxial analgesia. Participants were randomized in the second stage to initiate pushing immediately or wait 60 minutes before pushing. Participants had pelvic floor assessments at 1-5 days postpartum, 6 weeks postpartum, and 6 months postpartum. Rates of perineal lacerations, pelvic organ prolapse quantification (POP-Q) measures, and scores on validated symptom-specific distress and quality-of-life questionnaires (PFDI-20 [Pelvic Floor Distress Inventory], PFIQ [Pelvic Floor Impact Questionnaire], FISI [Fecal Incontinence Severity Index], and MMHQ [Modified Manchester Health Questionnaire]) were compared. It was estimated that 630 participants would provide more than 80% power to detect a 40% difference in second-degree or greater perineal lacerations and approximately 80% power to detect a 40% difference in stage 2 or greater pelvic organ prolapse (POP). RESULTS: Among 2,414 participants in the primary trial conducted between May 19, 2014, and December 16, 2017, 941 (39%) had pelvic floor assessments: 452 immediate pushing and 489 delayed pushing. The mean age was 24.8 years, and 93.4% had vaginal delivery. There were no significant differences in perineal lacerations at delivery and POP at 6 weeks and 6 months postpartum. Changes from baseline in total and subscale scores for the PFDI-20, the PFIQ, and the MMHQ were not significantly different at 6 weeks postpartum and 6 months postpartum. The change in FISI score was higher in the immediate pushing group at 6 months (2.9±5.7 vs 2.0±4.5, difference 0.9, P =.01), but less than the minimum important difference of 4. CONCLUSION: Among nulliparous patients in the second stage with neuraxial analgesia, immediate pushing, compared with delayed pushing, did not increase perineal lacerations, POP-Q measures, or patient-reported pelvic floor symptoms at 6 weeks and 6 months postpartum. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT02137200.


Asunto(s)
Laceraciones , Prolapso de Órgano Pélvico , Embarazo , Femenino , Humanos , Adulto Joven , Adulto , Diafragma Pélvico/lesiones , Laceraciones/epidemiología , Laceraciones/etiología , Periodo Posparto , Calidad de Vida , Morbilidad , Encuestas y Cuestionarios
6.
Reprod Health ; 20(1): 2, 2023 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-36593506

RESUMEN

BACKGROUND: The health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36-47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use. METHODS: Data from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis. RESULTS: In the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6-11 postpartum months, and further to 30% at months 12-17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12-17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months. CONCLUSIONS: These results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants.


We use information from mothers with a child under the age of 18 months, who were interviewed in a national survey conducted in 2018. We examine risk of an unintended pregnancy, using data on factors that protect against risk, namely delayed resumption of sex and menses, breastfeeding and contraceptive use. Among mothers with an infant aged less than 6 months, very few were at risk mainly because they had not resumed sex. Among those with an infant aged 6­11 months, 26% had still not resumed sex and an equal proportion was partially protected by delayed resumption of menses. Only 17% were protected by use of a modern contraceptive method, leaving 24% fully at risk. Among those with a child aged 12­18 months, 30% were fully at risk. As expected, well educated, urban women were more likely to use contraception than less privileged women but less likely to be protected by delayed resumption of sex and menses, with the consequence that pregnancy-risk was similar. Though three-quarters of mothers had taken their child for vaccination on three or more occasions, only one-third had discussed family planning with a health provider at a visit to a facility in the previous 12 months. The need for improved contraceptive services for mothers with young children is clear. Short intervals between births are common in Cameroon and these threaten the health of mothers and children. It is equally clear that closer integration of family planning into mainstream health services is needed.


Asunto(s)
Anticonceptivos , Servicios de Planificación Familiar , Niño , Femenino , Embarazo , Humanos , Lactante , Servicios de Planificación Familiar/métodos , Camerún/epidemiología , Periodo Posparto , Embarazo no Planeado , Anticoncepción/métodos
7.
PLoS One ; 18(1): e0265784, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36595538

RESUMEN

BACKGROUND: In Cambodia, the importance of valuing women's childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women's intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language into a target language. Yet, few earlier studies considered Cambodian cultural context. Thus, we developed the Cambodian version of the Person-Centered Maternity Care (PCMC) scale, by culturally adapting its original to Cambodian context for ensuring cultural equivalence and content validity. METHODS: Three rounds of cognitive interviewing with 20 early postpartum women were conducted at two governmental health facilities in Cambodia. Cognitive interviewing was composed of structured questionnaire pretesting and qualitative probing. The issues identified in the process of transcribing and translating audio-recorded cognitive interviews were iteratively discussed among study team members, and further analyzed. RESULTS: A total of 14 issues related to cultural adaptations were identified in the 31 translated questions for the Cambodian version of the PCMC scale. Our study identified three key findings: (i) discrepancies between the WHO recommendations on intrapartum care and Cambodian field realities; (ii) discrepancies in recognition on PCMC between national experts and local women; and (iii) challenges in correctly collecting and interpreting less-educated women's views on intrapartum care. CONCLUSION: Not only women's verbal data but also their non-verbal data and cultural contexts should be comprehensively counted, when reflecting Cambodian women's intrapartum practice realities in the translated version. This is the first study that attempted to develop the tool for measuring Cambodian women's experiences during childbirth, by addressing cross-cultural issues.


Asunto(s)
Servicios de Salud Materna , Humanos , Femenino , Embarazo , Cambodia , Periodo Posparto , Parto , Instituciones de Salud
8.
Reprod Health ; 20(1): 23, 2023 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-36707807

RESUMEN

BACKGROUND: Postpartum sterilization in Thailand has relatively few barriers compared to other countries. The procedure is covered by some healthcare plans, and paid out-of-pocket for others. We aim to determine if healthcare coverage and other socioeconomic factors affect the rate of postpartum sterilization in an urban, tertiary hospital. METHODS: We conducted a secondary analysis of data from a retrospective cohort of 4482 postpartum women who delivered at our hospital. Multivariable logistic regression was conducted to determine if sterilization reimbursement affects immediate postpartum sterilization rate. RESULTS: Overall immediate postpartum sterilization rate was 17.8%. Route of delivery and parity were similar in those who were reimbursed and those who were not. Women aged over 25 were more likely to have a healthcare plan that does not cover postpartum sterilization. Women whose healthcare plan reimbursed the procedure trended towards postpartum sterilization when compared to women who were not (aOR 1.05, 95% CI 0.86-1.28, p-value = 0.632). Women who delivered via cesarean section were more likely to undergo sterilization at the time of delivery (aOR = 5.87; 95% CI 4.77-7.24, p-value = < 0.001). Women aged 40-44 years were 2.70 times as likely to choose sterilization than those aged 20-24 years (aOR = 2.70; 95% CI 1.61-4.53, p-value < 0.001). CONCLUSIONS: Healthcare coverage of the procedure was not associated with increased postpartum sterilization in our setting.


Postpartum sterilization is an effective and popular method of contraception. In our hospital, postpartum sterilization is easily accessible compared to other countries where there are barriers such as mandatory waiting time, limited operating rooms and anesthesiologists. We examine factors that affect sterilization rates and found that older women and women with more children were more likely to choose postpartum sterilization. We also found that women who delivered by cesarean section were more likely to choose sterilization. Interestingly, whether the woman's healthcare plan covers postpartum sterilization does not affect the likelihood of sterilization.


Asunto(s)
Cesárea , Esterilización Tubaria , Embarazo , Femenino , Humanos , Estudios Retrospectivos , Centros de Atención Terciaria , Periodo Posparto , Atención a la Salud , Factores Socioeconómicos
9.
J Obstet Gynaecol ; 43(1): 2171280, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36708518

RESUMEN

This study explored the effect of individualised nutritional intervention on the postpartum nutritional status of patients with the growth and development of their offspring. This study included pregnant women with gestational diabetes mellitus (GDM) at Hangzhou Women's Hospital in 2019. At 42 days after childbirth, the HbA1c (95% CI: 0.44-0.56%, p < 0.001), the FPG (95% CI: 0.01-0.26 mmol/L, p < 0.05), 2HPG (95% CI: -0.01-0.73 mmol/L, p < 0.05) and TCH (95% CI: -0.34-0.00 mmol/L, p < 0.05) level of the control group were 0.14, 0.36, and 0.17 mmol/L higher than in the intervention group. There were no differences in TG and HGB between the two groups (all p > 0.05). There were significant differences in the number of macrosomia and neonatal weight between the two groups (both p < 0.05). Differences in WHZ after childbirth were not statistically significant between the two groups (all p > 0.05). Individualised nutritional intervention could improve blood glucose levels 42 days after childbirth and reduce macrosomia incidence in pregnant women with GDM.Impact statementWhat is already known on this subject? Individualised nutrition intervention can improve blood glucose status and complications during pregnancy, thus improving pregnancy outcomes.What the results of this study add? Individual nutrition intervention improved the blood glucose and nutritional status of patients at 42 days postpartum, but there was no difference in the growth and development indicators of their offspring at 0-24 months.What the implications are of these findings for clinical practice and/or further research? Improve nutritional intervention programs for gestational diabetes, improve blood glucose during pregnancy and postpartum, to improve pregnancy outcomes and reduce the occurrence of type 2 diabetes and other metabolic diseases; Extend the monitoring range of the growth and development of the offspring of gestational diabetes, find the problems and timely carry out the nutritional intervention, to improve the development of the offspring.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Recién Nacido , Humanos , Femenino , Embarazo , Macrosomía Fetal , Glucemia/metabolismo , Estado Nutricional , Aumento de Peso , Periodo Posparto
10.
Obstet Gynecol ; 141(2): 395-402, 2023 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-36657144

RESUMEN

OBJECTIVE: To evaluate whether there is an association between periviable delivery and new onset of or exacerbation of existing mental health disorders within 12 months postpartum. METHODS: We conducted a retrospective cohort study of individuals with liveborn singleton neonates delivered at 22 or more weeks of gestation from 2008 to 2017 in the MarketScan Commercial Research Database. The exposure was periviable delivery , defined as delivery from 22 0/7 through 25 6/7 weeks of gestation. The primary outcome was a mental health morbidity composite of one or more of the following: emergency department encounter associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide; new psychotropic medication prescription; new behavioral therapy visit; and inpatient psychiatry admission in the 12 months postdelivery. Secondary outcomes included components of the primary composite. Those with and without periviable delivery were compared using multivariable logistic regression adjusted for clinically relevant covariates, with results reported as adjusted incident rate ratios (aIRRs). Effect modification by history of mental health diagnoses was assessed. Incidence of the primary outcome by 90-day intervals postdelivery was assessed. RESULTS: Of 2,300,244 included deliveries, 16,275 (0.7%) were periviable. Individuals with periviable delivery were more likely to have a chronic health condition, to have undergone cesarean delivery, and to have experienced severe maternal morbidity. Periviable delivery was associated with a modestly increased risk of the primary composite outcome, occurring in 13.8% of individuals with periviable delivery and 11.0% of individuals without periviable delivery (aIRR 1.18, 95% CI 1.12-1.24). The highest-risk period for the composite primary outcome was the first 90 days in those with periviable delivery compared with those without periviable delivery (51.6% vs 42.4%; incident rate ratio 1.56, 95% CI 1.47-1.66). CONCLUSION: Periviable delivery was associated with a modestly increased risk of mental health morbidity in the 12 months postpartum.


Asunto(s)
Trastornos Mentales , Salud Mental , Embarazo , Recién Nacido , Femenino , Humanos , Estudios Retrospectivos , Cesárea , Trastornos Mentales/epidemiología , Periodo Posparto
11.
BMC Pregnancy Childbirth ; 23(1): 9, 2023 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-36609241

RESUMEN

BACKGROUND: Postpartum hemorrhage (PPH) is the global leading cause of maternal mortality, affecting nearly 3 to 6 percent of all women giving birth in India. The World Health Organization (WHO) has updated its guidelines to recommend the early use of intravenous (IV) tranexamic acid (TXA) in addition to standard care for all diagnosed PPH cases. This study aimed to assess the cost-effectiveness of introducing TXA for PPH management in the Indian public health system. METHODS: A decision analytic model was built using a decision tree to determine the cost-effectiveness of administering IV TXA to women experiencing PPH within 3 h of birth to existing management with uterotonics and supportive care. Using a disaggregated societal perspective, the costs and consequences for a hypothetical cohort of women experiencing PPH in public health facilities was estimated. The model was populated using probabilities, clinical parameters, and utilities from published literature, while cost parameters were largely derived from a primary economic costing study. The primary outcome of interest was the incremental cost-utility ratio (ICUR). Associated clinical events and net benefits were estimated. One-way and probabilistic sensitivity analysis (PSA) was undertaken. The budget impact was estimated for a national-level introduction. RESULTS: For an estimated annual cohort of 510,915 PPH cases in India, the addition of IV TXA would result in a per-patient disaggregated societal cost of INR 6607 (USD 95.15) with a discounted gain of 20.25 QALYs, as compared to a cost of INR 6486 (USD 93.41) with a discounted gain of 20.17 QALYs with standard care PPH management. At an ICUR value of INR 1470 per QALY gained (USD 21), the addition of IV TXA is cost-effective in Indian public health settings. The intervention is likely to prevent 389 maternal deaths, 177 surgeries, and 128 ICU admissions per 100,000 PPH cases. The findings are robust under uncertainty, with 94.5% of PSA simulations remaining cost-effective. A cumulative increase of 2.3% financial allocation for PPH management over five years will be incurred for TXA introduction. CONCLUSIONS: Addition of tranexamic acid for primary PPH management, as recommended by WHO, is cost-effective in Indian public health settings. Policy guidelines, training manuals, and facility checklists should be updated to reflect this recommendation.


Asunto(s)
Antifibrinolíticos , Hemorragia Posparto , Ácido Tranexámico , Embarazo , Femenino , Humanos , Hemorragia Posparto/tratamiento farmacológico , Hemorragia Posparto/prevención & control , Ácido Tranexámico/uso terapéutico , Análisis Costo-Beneficio , Antifibrinolíticos/uso terapéutico , Salud Pública , Periodo Posparto
12.
J Matern Fetal Neonatal Med ; 36(1): 2170749, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36710393

RESUMEN

OBJECTIVE: To describe the prevalence and predictors of postpartum sleep disorders. DESIGN: A retrospective cohort study. SETTING: Postpartum. POPULATION: Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS: Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES: Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS: We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS: Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.


Asunto(s)
Depresión Posparto , Trastornos Puerperales , Trastornos del Inicio y del Mantenimiento del Sueño , Trastornos del Sueño-Vigilia , Trastornos Relacionados con Sustancias , Embarazo , Humanos , Femenino , Masculino , Prevalencia , Estudios Retrospectivos , Mortinato , Periodo Posparto , Trastornos del Sueño-Vigilia/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Sueño , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología
13.
In Vivo ; 37(1): 498-502, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36593053

RESUMEN

BACKGROUND/AIM: Acute pulmonary embolism during cesarean section is extremely rare and only a limited number of cases have been reported in literature. The aim of this study was to report a case of acute high risk pulmonary embolism during elective cesarean section treated with systemic thrombolysis and discuss the multidisciplinary management in both early recognition and prompt treatment. CASE REPORT: A 39-year-old, G5P2, ASA II parturient presented for repeat cesarean section under general anesthesia. A sudden drop in end-tidal CO2 after placenta delivery combined with significant hemodynamic instability after an uneventful intraoperative course was strongly indicative of pulmonary embolism. Urgent transthoracic ultrasound revealed a sizable thrombus in the inferior vena cava and the right atrium. Thrombolysis was carried out intraoperatively using recombinant tissue plasminogen activator, which was administered under continuous US monitoring until thrombus resolution. This resulted in significant bleeding that was treated in a stepwise manner beginning with implementation of massive transfusion protocol, Bakri balloon placement, and rescue hysterectomy several hours after the event. Follow-up was uneventful and she was discharged on the 12th postoperative day. CONCLUSION: Though pregnancy is one of the major risk factors of the development of venous thromboembolism, acute intraoperative pulmonary embolism is extremely rare. Specific guidelines for the management of such cases are difficult to issue due to the paucity of relevant data. Thus, an individualized approach by a multidisciplinary team for diagnosis and intervention is mandated.


Asunto(s)
Embolia Pulmonar , Trombosis , Embarazo , Humanos , Femenino , Adulto , Cesárea/efectos adversos , Activador de Tejido Plasminógeno , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Histerectomía/efectos adversos , Trombosis/cirugía , Terapia Trombolítica/efectos adversos , Periodo Posparto
14.
Prev Med ; 167: 107413, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36603606

RESUMEN

Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.


Asunto(s)
Calidad de Vida , Telemedicina , Humanos , Femenino , Ejercicio Físico , Periodo Posparto , Terapia por Ejercicio
15.
Rev. neurol. (Ed. impr.) ; 76(1): 21-30, Ene. 2023. tab
Artículo en Español | IBECS | ID: ibc-214338

RESUMEN

Introducción: La esclerosis múltiple afecta principalmente a mujeres en edad fértil, y el período de gestación y posparto es de especial interés por las peculiaridades que comporta en cuanto a evolución de la enfermedad y por las consecuencias terapéuticas que se derivan. En el período de lactancia materna (LM), la elección de la estrategia de tratamiento debe poner en una balanza, por un lado, los beneficios bien establecidos de la LM para el recién nacido y su madre y, por el otro, el perfil de seguridad y potenciales efectos adversos en el lactante derivados de la exposición a los fármacos modificadores de la enfermedad, por transferencia a través de leche materna. Desarrollo: Se realiza una revisión de la evidencia actual acerca de la seguridad de los fármacos modificadores de la enfermedad disponibles para el tratamiento de la esclerosis múltiple durante el período de LM, y se recogen datos de transferencia de los diferentes fármacos a la leche materna, así como los potenciales efectos adversos descritos en el lactante. Los fármacos considerados de primera elección durante este período son el interferón beta y el acetato de glatiramer. El resto de los fármacos modificadores de la enfermedad no están aceptados para su utilización en el período de LM por ficha técnica. Sin embargo, en los últimos años, se han publicado datos de estudios de práctica clínica y series de casos que indican que algunos de estos fármacos podrían utilizarse con seguridad durante este período. Conclusiones: Teniendo en cuenta los beneficios reconocidos de la LM para la salud tanto de la madre como del lactante, se debe recomendar la LM exclusiva a las pacientes con esclerosis múltiple siempre que sea posible. Es fundamental realizar una evaluación individualizada previa al embarazo y valorar las diferentes opciones de tratamiento en función de cada paciente.(AU)


Introduction: Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. Development: The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. Conclusions: Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Lactancia Materna , Esclerosis Múltiple , Periodo Posparto , Planificación Familiar , Antirreumáticos , Enfermedades Reumáticas
16.
Enferm. clín. (Ed. impr.) ; 33(1): 38-47, Ene-Feb. 2023. ilus, tab
Artículo en Español | IBECS | ID: ibc-214379

RESUMEN

Objetivo: Evaluar el efecto de la sutura continua de la herida perineal sobre la capacidad y la recuperación funcional de la mujer para realizar su autocuidado, el cuidado del recién nacido, lactancia materna y las actividades de la vida diaria: básicas e instrumentales, en el periodo posparto. Método: Ensayo clínico no aleatorizado con enmascaramiento de la asignación a los grupos de estudio, realizado en el Hospital Universitario Arnau de Vilanova de Lérida, hospital de tercer nivel. El grupo intervención recibió sutura continua para la reparación perineal y el grupo control sutura discontinua. La población de estudio fueron mujeres con parto eutócico y lesión perineal de segundo grado o episiotomía. Se realizaron 3 valoraciones posparto (48h, 7-10 días y al mes). Resultados: Ciento veintiséis mujeres con parto eutócico y lesión perineal de segundo grado o episiotomía participaron (n=126); 64 suturadas con técnica continua (grupo intervención) y 62 con técnica discontinua (grupo control). A las 48h posparto, el 85% de las mujeres con sutura continua fueron capaces de realizar su autocuidado y el 46,7% se recuperaron funcionalmente. A los 7-10 días, el 96,7% de las mujeres con sutura continua habían adquirido la capacidad para realizar las actividades instrumentales de la vida diaria, y el 60% se habían recuperado funcionalmente frente al 68,3% y 15%, respectivamente de las mujeres con sutura discontinua (p<0,001). A los 7-10 días, el 100% de las mujeres con sutura continua alcanzaron la recuperación funcional para el cuidado del recién nacido y el 80% para la lactancia materna, y en el grupo control el 81,7% y 30%, respectivamente (p<0,001 y p<0,001). Conclusión: Las mujeres con sutura continua restablecen su capacidad y la recuperación funcional para la realización de las AVD más precozmente y con menos dolor, que las mujeres con sutura discontinua, adaptándose más rápida y satisfactoriamente a la maternidad.(AU)


Objective: To assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic (ABVD) and instrumental (IADL), during the postpartum period. Methods: Non-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48hours, 7-10 days and one month). Results: 126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n=126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48hours postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (P<.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (P<.001 and P<.001). Conclusions: Women who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.(AU)


Asunto(s)
Humanos , Femenino , Embarazo , Salas de Parto , Técnicas de Sutura , Periodo Posparto , Enfermería Maternoinfantil , Responsabilidad Parental , Dolor , Salud de la Mujer , Actividades Cotidianas , Enfermería , España
17.
Health Aff (Millwood) ; 42(1): 18-25, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36623214

RESUMEN

The Affordable Care Act (ACA) Medicaid expansions increased preconception and postpartum insurance coverage among low-income birthing people, leading to greater use of outpatient care. In this study we evaluated whether the expansions affected rates of postpartum hospitalization. Our analyses took advantage of underused longitudinal hospital data from the period 2010-17 to examine hospitalizations after childbirth. We compared changes in hospitalizations among birthing people with a Medicaid-financed delivery in states that did and did not expand Medicaid under the ACA. We found a 17 percent reduction in hospitalizations during the first sixty days postpartum associated with the Medicaid expansions and some evidence of a smaller decrease in hospitalizations between sixty-one days and six months postpartum. Our findings indicate that expanding Medicaid coverage led to improved postpartum health for low-income birthing people.


Asunto(s)
Medicaid , Patient Protection and Affordable Care Act , Femenino , Estados Unidos , Humanos , Hospitalización , Periodo Posparto , Pobreza , Cobertura del Seguro , Accesibilidad a los Servicios de Salud , Seguro de Salud
19.
Artículo en Inglés | MEDLINE | ID: mdl-36613202

RESUMEN

The literature has mainly focused on the impact of the negative aspects of the couple's relationship on the toddler's internalizing and externalizing problems. This study explored the impact of the positive and negative dimensions of the couple's relationship during the transition to parenthood on toddlers' psychological adjustment, considering the concurrent impact of the couple's relationship at 30 months postpartum. The sample comprised 115 mothers and fathers (N = 230) recruited during the 1st trimester of pregnancy. The mothers and fathers individually completed a measure of the couple's relationship (Relationship Questionnaire) during the first trimester of pregnancy, at 3 and 30 months postpartum, and the Child Behavior Checklist 1.5-5 at 30 months postpartum. Multiple linear regressions, cluster analyses, and univariate and multivariate analyses of variance were conducted. The positive dimension at the 1st trimester of pregnancy and the negative dimension of the couple's relationship at 3 months postpartum were the strongest predictors of the toddler's internalizing problems, while the negative dimension at 3 months postpartum and the positive dimension of the couple's relationship at 30 months postpartum were the strongest predictors of the toddler's externalizing problems. Two patterns of the couple's relationship (adjusted vs. non-adjusted) during the transition to parenthood were identified. Higher levels of internalizing and externalizing problems were found in toddlers from couples with a non-adjusted couple's relationship. Findings suggested the impact of both positive and negative dimensions of the couple's relationship during the transition to parenthood on the toddler's emotional and behavioral problems. Promoting the couple's relationship adjustment during the transition to parenthood can help to prevent toddlers' emotional and behavioral problems.


Asunto(s)
Problema de Conducta , Femenino , Embarazo , Humanos , Preescolar , Emociones , Madres/psicología , Periodo Posparto/psicología , Primer Trimestre del Embarazo
20.
J Obstet Gynaecol ; 43(1): 2158321, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36606701

RESUMEN

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning.IMPACT STATEMENTWhat is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning.What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning.What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement.


Asunto(s)
Servicios de Planificación Familiar , Hombres , Embarazo , Recién Nacido , Niño , Humanos , Masculino , Femenino , Uganda , Estudios Transversales , Periodo Posparto , Conocimientos, Actitudes y Práctica en Salud
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