Assuntos
Assistência Perinatal , Humanos , Feminino , Gravidez , Características de Residência , Serviços de Saúde Mental , AdultoAssuntos
Ampicilina , Antibacterianos , Gentamicinas , Combinação Piperacilina e Tazobactam , Pontuação de Propensão , Humanos , Feminino , Gravidez , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Ampicilina/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico , Gentamicinas/uso terapêutico , Corioamnionite/tratamento farmacológico , Adulto , Estudos RetrospectivosRESUMO
BACKGROUND: Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30. METHODS: We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37-41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher's exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori. RESULTS: There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. CONCLUSION: Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.
Assuntos
Trabalho de Parto Induzido , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Índice de Massa Corporal , Estudos Transversais , Trabalho de Parto Induzido/efeitos adversos , CesáreaRESUMO
Background: Individuals with a body mass index (BMI) of ≥ 30 kg/m2 experience weight stigma when interacting with the healthcare system. There is limited data on how weight stigma impacts patient's experience of obstetric care. This study aims to assess perceived control over the birth process and compare patients with BMI ≥ 30 to those with BMI < 30. Methods: We performed a secondary analysis of a cross-sectional study of term patients. Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30. Results: There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. Conclusion: Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research is necessary into how weight stigma influences birthing people's experience.
Assuntos
Doenças Placentárias , Placenta , Feminino , Humanos , Pelve , Placenta/patologia , Doenças Placentárias/patologia , GravidezRESUMO
The second stage of labor is defined as the time from complete dilation of the cervix to delivery of the fetus. The objective of this seminar is to provide a contemporary, evidence-based approach to management of the second stage of labor. This seminar reviews background maternal and fetal characteristics that impact the duration of the second stage of labor, the recommended evidence-based management (e.g. immediate pushing, manual rotation, operative vaginal delivery), and the maternal/neonatal morbidity clinicians must consider when deciding between operative delivery and a prolonged second stage of labor.
Assuntos
Parto Obstétrico/métodos , Medicina Baseada em Evidências/métodos , Segunda Fase do Trabalho de Parto , Feminino , Peso Fetal , Humanos , Apresentação no Trabalho de Parto , Obesidade/complicações , Gravidez , Complicações na Gravidez/terapia , Fatores de TempoRESUMO
OBJECTIVE: To compare the independent risk of neonatal morbidity between the offspring of obese and nonobese women without hypertension or diabetes. METHODS: This is a secondary analysis of a prospective single-center cohort study of singleton deliveries at or beyond 37 weeks of gestation from 2010 to 2014. Women with diabetes (pregestational or gestational) and hypertensive disorders were excluded. The primary outcomes were 1) a composite neonatal morbidity including death, mechanical ventilation, respiratory distress, meconium aspiration, suspected sepsis, confirmed sepsis, hypoxic-ischemic encephalopathy, therapeutic hypothermia, or seizures; and 2) a composite of neonatal neurologic morbidity including hypoxic-ischemic encephalopathy, therapeutic hypothermia, or seizures. The primary outcomes were compared between the offspring of obese (body mass index 30 or greater) and nonobese women. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression. RESULTS: Of 6,458 women without diabetes or hypertensive disorders, 3,311 (51%) were obese. After adjusting for race, neonates of obese patients were at significantly increased risk for the composite neonatal morbidity (9.2% vs 7.2%, adjusted OR 1.39, 95% CI 1.15-1.67) and neurologic neonatal morbidity (0.7% vs 0.3%, adjusted OR 2.84, 95% CI 1.22-6.65). Specifically, neonates of obese patients were more likely to have hypoxic-ischemic encephalopathy (0.5% vs 0.2%, adjusted OR 2.80, 95% CI 1.02-7.68), hypothermia treatment (0.6% vs 0.2%, adjusted OR 2.92 95% CI 1.17-7.30), and suspected sepsis (7.6% vs 5.8%, adjusted OR 1.45, 95% CI 1.18-1.79). CONCLUSION: In patients who labor, maternal obesity is an independent risk factor for significant neonatal morbidity, even in the absence of hypertensive disorders or diabetes.
Assuntos
Doenças do Recém-Nascido/etiologia , Obesidade/complicações , Complicações na Gravidez , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto JovemRESUMO
OBJECTIVES: To examine how skilled nursing facility (SNF) nurses transition the care of individuals admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions. DESIGN: Qualitative study using grounded dimensional analysis, focus groups, and in-depth interviews. SETTING: Five Wisconsin SNFs. PARTICIPANTS: Twenty-seven registered nurses. MEASUREMENTS: Semistructured questions guided the focus group and individual interviews. RESULTS: SNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and components that they need to facilitate a safe, high-quality transition. CONCLUSION: Nurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions that support transitions of care, including the Interventions to Reduce Acute Care Transfers program.