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1.
Sante Publique ; Vol. 31(5): 611-621, 2020 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33124787

RESUMO

OBJECTIVE: The objective of the article is to describe the follow-up of pregnancies at work and occupational exposure to potential risks for pregnancy. METHODS: A descriptive cross-sectional study was performed from April 1, 2017 to October 31, 2017 in the occupational health departments of French hospitals. After delivery and at the time of returning to work, 1,165 eligible workers were interviewed by occupational health physicians (OHPs). Socio-demographic information was self-reported. Occupational exposures were assessed by an OHP. Birth weight, gestational age, and sick leaves were also collected. RESULTS: Among recruited workers, 51.8% were exposed to more than 5 occupational hazards. Biological and physical hazards were the most common hazards at the workplace. Note that heavy lifting ≥ 15 kg concerned 9.5% of workers. Only 20.1% of workers had a specific "pregnancy at work" medical visit with OHP during pregnancy; 26.8% benefited from workstation adjustments. In contrast, the level of sick leaves was high (86.7%). CONCLUSIONS: Our data suggest that pregnant workers in hospitals must be strictly supervised.


Assuntos
Exposição Ocupacional/efeitos adversos , Complicações na Gravidez/prevenção & controle , Gestantes , Estresse Psicológico , Carga de Trabalho/psicologia , Local de Trabalho , Estudos Transversais , Feminino , França/epidemiologia , Hospitais , Humanos , Estresse Ocupacional , Gravidez , Estresse Psicológico/complicações , Mulheres Trabalhadoras , Trabalho/psicologia
2.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004643

RESUMO

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Assistência Perinatal/organização & administração , Fortalecimento Institucional , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Assistência Perinatal/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
3.
J Pregnancy ; 2020: 6153146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062334

RESUMO

Introduction: Obstetric danger signs are those signs that a pregnant woman will see or those symptoms that she will feel which indicate that something is going wrong with her or with the pregnancy. Evidence on the prevalence of obstetric danger signs and contributing factors were crucial in designing programs in the global target of reducing maternal morbidity and mortality. Objective: To assess the prevalence of obstetric danger signs during pregnancy and associated factors among mothers in a Shashemene rural district, South Ethiopia. Methods: A community-based cross-sectional study design was conducted among 395 randomly selected women who gave birth in the last six months. A pretested interviewer-administered questionnaire was utilized. Data were cleaned, coded, and entered into Epi data manager version 4.1 and then exported to SPSS version 20. Bivariable and multivariable logistic regression analyses were employed to assess the association between independent variables with the outcome variable. Statistical significance was declared at p < 0.05. Result: One hundred sixty-three (41.3%) of women had a history of obstetric danger signs during pregnancy. The most prevalent obstetric danger signs were vaginal bleeding (15.4%) followed by swelling of the body 12.7% and severe vomiting 5.3%. Women who have less than four times antenatal care visits were 6.7 times more likely to experience obstetric danger signs (AOR 6.7 (95% CI 3.05, 14.85)) compared to those who had antenatal care visit four times and above. Women who have inadequate knowledge of obstetric danger signs were 2.5 times more likely to experience obstetric danger signs during pregnancy (AOR 2.5 (95% CI 1.34, 4.71)), and primigravida women were 6.3 times more likely to have obstetric danger signs during pregnancy (AOR 6.3 (95% CI 2.61, 15.09)) compared to multiparous women. Conclusion: About half of the pregnant mothers have experienced at least one obstetric danger signs. Public health interventions on maternal health should give priority to the prevalent causes of obstetric danger signs, strengthening completion of four antenatal care visits and health education on obstetric danger signs for pregnant mothers at community level especially for primgravid women.


Assuntos
Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Edema/epidemiologia , Edema/etiologia , Edema/prevenção & controle , Etiópia/epidemiologia , Feminino , Número de Gestações , Educação em Saúde , Humanos , Conhecimento , Mortalidade Materna , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Inquéritos e Questionários , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle , Vômito/epidemiologia , Vômito/etiologia , Vômito/prevenção & controle , Adulto Jovem
4.
BMC Psychol ; 8(1): 99, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962764

RESUMO

BACKGROUND: Pregnancy as a sensitive period of a woman's life can be affected by various psychological factors that can have adverse effects on the woman, her fetus and future baby. Since COVID-19 is a new phenomenon with limited information available, it may have adverse psychological effects on pregnant women. Therefore, this study was conducted to determine the status of depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19. METHODS: This descriptive-analytical cross-sectional study was performed on 205 pregnant women covered by Tabriz health centers in Iran. The sampling method used was cluster sampling. The data collection tool was the socio-demographic characteristics questionnaire and the DASS-21 (Depression, Anxiety and Stress Scale-21), which were completed online by pregnant women. The general linear model was used to determine the predictive factors of depression, anxiety and stress. RESULTS: The mean (SD) score of depression, stress, and anxiety were 3.91 (3.9), 6.22 (4.25), and 3.79 (3.39), respectively; the score range of 0 to 21. Depression, stress, and anxiety symptoms were observed in 32.7, 32.7, and 43.9% of the participants, respectively, with varying degrees from mild to very severe. Based on the adjusted general linear model, variables of education level, spouse's job and marital life satisfaction were the predictors of depressive symptoms. Variables of spouse's education level, spouse's support, marital life satisfaction and the number of pregnancies were the predictive factors of anxiety symptoms and the variables of spouse's education level, household income sufficiency, spouse's support and marital life satisfaction were predictors of stress symptoms. CONCLUSIONS: Considering the role of marital life satisfaction, high level of spouse's education and income in reducing symptoms of stress, anxiety, and depression in pregnant women in critical situations such as the prevalence of COVID-19, it seems that using strategies to promote marital life satisfaction and socio-economic status can play an effective role in controlling anxiety and reducing stress and depression in pregnant women.


Assuntos
Ansiedade , Infecções por Coronavirus , Depressão , Casamento , Pandemias , Pneumonia Viral , Complicações na Gravidez , Estresse Psicológico , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Socioeconômicos , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle
5.
Adv Exp Med Biol ; 1252: 101-105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816268

RESUMO

During pregnancy and lactation, breast vascularity increases and edema occurs in the breast . As a consequence, rate of complications of breast biopsy and surgery like bleeding, infection, delayed healing and wound dehiscence is expected to be higher. Milk fistula is a rare event that may complicate surgery or needle biopsy of the breast in a breastfeeding woman, or in late stages of pregnancy . Suppression of lactation has been proposed in the literature as both a preventive and a therapeutic step. However, the advantages of nursing for both mother and child are numerous, and the author do not propose it as a preventive measure nor as a must in treatment of milk fistula. Prevention and management of milk fistula are discussed in this chapter.


Assuntos
Mama/cirurgia , Lactação , Complicações na Gravidez , Biópsia por Agulha , Aleitamento Materno , Neoplasias da Mama/cirurgia , Feminino , Fístula/etiologia , Fístula/prevenção & controle , Fístula/terapia , Humanos , Lactente , Leite Humano , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
6.
Adv Exp Med Biol ; 1252: 107-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816269

RESUMO

Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.


Assuntos
Anestesia/efeitos adversos , Anestesia/métodos , Anestésicos , Mama/cirurgia , Complicações na Gravidez , Neoplasias da Mama/cirurgia , Feminino , Feto/efeitos dos fármacos , Humanos , Trabalho de Parto Prematuro/induzido quimicamente , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle
7.
J Pregnancy ; 2020: 7864816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802511

RESUMO

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.


Assuntos
Disparidades em Assistência à Saúde/tendências , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Fatores Etários , Grupos de Populações Continentais , Diabetes Gestacional , Escolaridade , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/etiologia , Gravidez , Complicações na Gravidez/etnologia , Complicações na Gravidez/etiologia , Prevalência , Risco , Estados Unidos/epidemiologia , Ganho de Peso
9.
Nutr Metab Cardiovasc Dis ; 30(9): 1520-1524, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32665208

RESUMO

BACKGROUND AND AIMS: Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS: We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS: The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.


Assuntos
Endocrinologistas/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Medicina Interna , Complicações na Gravidez/prevenção & controle , Gravidez em Diabéticas/terapia , Adulto , Anticoncepção , Educação de Pós-Graduação em Medicina , Endocrinologistas/educação , Serviços de Planejamento Familiar , Bolsas de Estudo , Feminino , Humanos , Medicina Interna/educação , Internato e Residência , Masculino , Saúde Materna , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/fisiopatologia , Gravidez não Planejada , Medição de Risco , Fatores de Risco , Especialização , Inquéritos e Questionários
10.
PLoS One ; 15(7): e0236140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667936

RESUMO

BACKGROUND: Urinary Incontinence (UI) is when a person is unable to hold his/her urine effectively. This is a common problem which can develop and worsen during pregnancy. An effective way to manage UI is to educate patients on the Pelvic Floor Muscle Exercise (PFME) regularly. The present study aimed to ascertain the pregnant women's knowledge, attitudes, and practices (KAP) related to PFME. METHODS: This was a cross-sectional study done in a one primary care clinic located in a semi-urban area in Selangor, Malaysia. Simple random sampling was conducted among pregnant women aged 18 years old and above at any gestation. The validated study instruments used consisted of questions on socio-demography, KAP on UI, and also the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form to determine UI among the respondents. RESULTS: The response rate for this study was 72.1%, where 440 pregnant women consented to take part in the study. The median age of study respondents was 30 years old and majority of the study respondents was from the Malay ethnicity (80.9%). The prevalence of UI was 40.9%. The proportion of pregnant women with good knowledge, attitude and practice scores were 58.0%, 46.6% and 45.2% respectively. There was a significant association between UI and age (p = .03), body mass index (p = .03), ethnicity (p = .04), gravida. (p = .001), knowledge on PFME (p = .007) and attitude towards PFME (p = .006). CONCLUSIONS: Findings from this study fill a gap in the prevalence and KAP concerning PFME at the primary care level. The foundation areas for future education and health promotion on UI should address the importance of correct PFME. This education can be delivered through a pragmatic way to ensure its effectiveness and sustainability of the health promotion program.


Assuntos
Terapia por Exercício/métodos , Força Muscular , Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Complicações na Gravidez/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Incontinência Urinária/terapia , Adulto , Estudos Transversais , Feminino , Número de Gestações , Humanos , Malásia/epidemiologia , Gravidez
11.
J. obstet. gynaecol. Can ; 42(7): [ P906-917.E1], July 1, 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117182

RESUMO

To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality.


Assuntos
Humanos , Feminino , Gravidez , Placenta Prévia/diagnóstico , Placenta Prévia/mortalidade , Cuidado Pós-Natal/organização & administração , Complicações na Gravidez/prevenção & controle , Colo do Útero/anatomia & histologia , Cesárea/instrumentação , Nascimento Prematuro/mortalidade
12.
BMC Public Health ; 20(1): 1001, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32586374

RESUMO

BACKGROUND: This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. METHODS: Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. RESULTS: Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. CONCLUSIONS: Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.


Assuntos
Bem-Estar Materno/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Complicações na Gravidez/prevenção & controle , Adulto , Estudos Transversais , Violência Doméstica/prevenção & controle , Desenvolvimento Econômico , Feminino , Humanos , Bem-Estar Materno/psicologia , Pobreza/estatística & dados numéricos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Escalas de Graduação Psiquiátrica , População Rural/estatística & dados numéricos , Vietnã/epidemiologia
13.
Transl Res ; 225: 20-32, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32554071

RESUMO

Pregnancy associated venous thromboembolism (PA-VTE) is a leading cause of maternal morbidity and mortality worldwide. Despite the availability of international guidance on the prevention, diagnosis and treatment, practice differs between countries and clinical institutions. The evidence base in this area is limited due to the vulnerable population who are affected, with the majority of guidelines deriving their recommendations from experience in surgical and medical venous thromboembolic disease. This review includes best evidence in PA-VTE management, highlighting specific literature which supports current diagnosis, prevention, and treatment strategies. Additionally, we hope to demonstrate emerging trends in the field through discussion of ongoing trials designed to progress towards evidence-based practice in the context of PA-VTE.


Assuntos
Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Tromboembolia Venosa/complicações , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia
14.
J. negat. no posit. results ; 5(6): 597-602, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192323

RESUMO

Nos hallamos ante una situación epidemiológica causada por un coronavirus del cual todavía desconocemos muchos datos. Pese a esa carencia de información, los sistemas sanitarios están implantando protocolos para intentar proteger no sólo a los pacientes, si no a los sanitarios que en ellos trabajan. Además, tampoco sabemos demasiado del impacto del COVID-19 sobre poblaciones teóricamente más vulnerables, como las gestantes, en las cual se hace más necesario si cabe adoptar protocolos de actuación lo más basados en la evidencia posible para no caer en una deshumanización en su atención


We are facing a epidemiological situation caused by a coronavirus for which we still don't know much data. Despite this lack of information, health systems are implementing protocols to try to protect the patients, and also its health workers. Furthermore, we also don't know too much about the theoric impact of COVID-19 on vulnerable populations, such pregnant women, in which it becomes more necessary if it possible to adopt evidence-based protocols and not to fall into dehumanized treatment


Assuntos
Humanos , Feminino , Gravidez , Infecções por Coronavirus/epidemiologia , Parto Humanizado , Entorno do Parto/tendências , Complicações na Gravidez/prevenção & controle , Complicações do Trabalho de Parto/prevenção & controle , Capacidade de Resposta ante Emergências , Tratamento de Emergência/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Infecções por Coronavirus/complicações , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos
15.
J. obstet. gynaecol. Can ; 42(6): [806-812], June 01, 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117188

RESUMO

To assess the benefits and risks of progesterone therapy for women at increased risk of spontaneous preterm birth (SPB) and to make recommendations for the use of progesterone to reduce the risk of SPB and improve postnatal outcomes. To administer or withhold progesterone therapy for women deemed to be at high risk of SPB. Preterm birth, neonatal morbidity and mortality, and postnatal outcomes including neurodevelopmental outcomes. Intended Users Maternity care providers, including midwives, family physicians, and obstetricians.


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez/prevenção & controle , Administração Intravaginal , Nascimento Prematuro/prevenção & controle , Medida do Comprimento Cervical , Trabalho de Parto Prematuro/prevenção & controle , Progesterona/administração & dosagem
16.
PLoS One ; 15(5): e0232550, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433645

RESUMO

INTRODUCTION: The maternal mortality rate in Indonesia is still quite high. It requires good knowledge for early prevention. The study aimed to analyze the determinants of knowledge of the pregnancy danger signs in Indonesia. METHODS: The samples used were 85,832 women of childbearing age (15-49 years old). The variables included understanding of danger signs of pregnancy, types of residence, age, education, employment, marital status, wealth, parity, the autonomy of health, current pregnancy status, and media exposure. The determinant was pointed out by using binary logistic regression. RESULTS: Urban women were 1.124 times more likely to understand the pregnancy danger signs of than rural women. Older women could identify pregnancy danger signs better than those aged 15-19 years. The more educated a woman is, the higher knowledge of the pregnancy danger signs she has. Married women or those who live with their partner were at 1.914 times likely to identify the pregnancy danger signs than unmarried ones or those who have never been in a relationship. If the wealth status gets higher, knowledge of the pregnancy danger signs will be better too. Grande multiparous women were at 0.815 times more likely to understand the pregnancy danger signs than primiparous. Women with the autonomy of health had 1.053 times chances to identify the pregnancy danger signs than those without autonomy. Women who were currently pregnant had 1.229 times better understanding of the pregnancy danger signs than women who were not currently pregnant. Media exposure had a good effect on women's understanding of the pregnancy danger signs. CONCLUSION: All variables tested were the determinants of knowledge of the pregnancy danger signs in Indonesia. These include residence, age, education, employment, marital status, wealth, parity, the autonomy of health, current pregnancy status, and media exposure.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações na Gravidez/psicologia , Adolescente , Adulto , Fatores Etários , Escolaridade , Feminino , Humanos , Indonésia , Estado Civil , Pessoa de Meia-Idade , Paridade , Gravidez , Complicações na Gravidez/prevenção & controle , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
17.
PLoS One ; 15(5): e0232901, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396578

RESUMO

During pregnancy, an array of changes occurs in women body to enable the growth and development of the future baby and the consequent delivery. These changes are reflected in the range of motion of trunk, pelvis, lower limbs and other body segments, affect the locomotion and some of these changes may persist to the postpartum period. The aim of this study was to describe the changes affecting the gait during pregnancy and to determine the effect of tested footwear on kinematic gait characteristics during pregnancy as previous studies indicate that special orthopaedic insoles and footwear might be useful in prevention of the common musculoskeletal pain and discomfort related to pregnancy. Participants from the control group (n = 18), without any intervention, and the experimental group (n = 23), which was wearing the tested shoes, were measured at their 14, 28 and 37 gestational weeks and 28 weeks postpartum to capture the complete pregnancy-related changes in gait. The gait 3D kinematic data were obtained using Simi Motion System. The differences between the control and experimental group at the first data collection session in most of the analysed variables, as well as relatively high standard deviations of analysed variables indicate large individual differences in the gait pattern. The effect of tested footwear on kinematic gait pattern changes may be explained by its preventive effect against the foot arches falling. In the control group, changes associated previously with the foot arches falling and hindfoot hyperpronation were observed during advanced phases of pregnancy and postpartum, e.g. increase in knee flexion or increase in spinal curvature. For the comprehensive evaluation of the tested footwear on pregnancy gait pattern, future studies combining the kinematic and dynamic plantographic methods are needed.


Assuntos
Desenho de Equipamento/métodos , Marcha/fisiologia , Dor Musculoesquelética/prevenção & controle , Período Pós-Parto/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Órtoses do Pé , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle
18.
Cochrane Database Syst Rev ; 5: CD007471, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32378735

RESUMO

BACKGROUND: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. OBJECTIVES: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). DATA COLLECTION AND ANALYSIS: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. MAIN RESULTS: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. AUTHORS' CONCLUSIONS: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.


Assuntos
Terapia por Exercício/métodos , Incontinência Fecal/terapia , Diafragma da Pelve , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia , Incontinência Urinária/terapia , Incontinência Fecal/epidemiologia , Incontinência Fecal/prevenção & controle , Feminino , Humanos , Cuidado Pós-Natal , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária/epidemiologia , Incontinência Urinária/prevenção & controle
19.
Am J Public Health ; 110(7): 1031-1033, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437282

RESUMO

We evaluated the effectiveness of a community health worker-supported home visitor program on perinatal outcomes of 455 at-risk pregnant women with program data merged with electronic medical records from July 2015 through October 2017 in Rochester, New York. Program participants had fewer adverse outcomes than did nonparticipants, including lower rates of preterm birth (12% vs 20%; χ2, P = .05) and low birth weight (14% vs 22%; χ2, P = .05). This program was effective at achieving improved perinatal outcomes.


Assuntos
Agentes Comunitários de Saúde , Visita Domiciliar , Resultado da Gravidez , Cuidado Pré-Natal/organização & administração , Adulto , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , New York , Avaliação de Resultados em Cuidados de Saúde , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Complicações na Gravidez/prevenção & controle , Gravidez de Alto Risco , Nascimento Prematuro/prevenção & controle
20.
Am J Perinatol ; 37(8): 800-808, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32396948

RESUMO

As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. KEY POINTS: · Telehealth for prenatal care is feasible.. · Telehealth may reduce coronavirus exposure during prenatal care.. · Telehealth should be tailored for high risk prenatal patients..


Assuntos
Infecções por Coronavirus , Controle de Infecções/organização & administração , Pandemias , Pneumonia Viral , Complicações na Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal , Telemedicina , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Aconselhamento Genético/métodos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/tendências , Diagnóstico Pré-Natal/métodos , Consulta Remota/métodos , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/organização & administração
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