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1.
J Prev Med Public Health ; 54(1): 81-84, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33618503

RESUMO

The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.


Assuntos
Prática de Grupo/normas , Pobreza/classificação , Cuidado Pré-Natal/normas , Adulto , Feminino , Prática de Grupo/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos
3.
Am J Obstet Gynecol ; 224(4): 339-347, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33316276

RESUMO

The coronavirus disease 2019 pandemic led to some of the most drastic changes in clinical care delivery ever seen in the United States. Almost overnight, providers of prenatal care adopted virtual visits and reduced visit schedules. These changes stood in stark contrast to the 12 to 14 in-person prenatal visit schedule that had been previously recommended for almost a century. As maternity care providers consider what prenatal care delivery changes we should maintain following the acute pandemic, we may gain insight from understanding the evolution of prenatal care delivery guidelines. In this paper, we start by sketching out the relatively unstructured beginnings of prenatal care in the 19th century. Most medical care fell within the domain of laypeople, and childbirth was a central feature of female domestic culture. We explore how early discoveries about "toxemia" created the groundwork for future prenatal care interventions, including screening of urine and blood pressure-which in turn created a need for routine prenatal care visits. We then discuss the organization of the medical profession, including the field of obstetrics and gynecology. In the early 20th century, new data increasingly revealed high rates of both infant and maternal mortalities, leading to a greater emphasis on prenatal care. These discoveries culminated in the first codification of a prenatal visit schedule in 1930 by the Children's Bureau. Surprisingly, this schedule remained essentially unchanged for almost a century. Through the founding of the American College of Obstetricians and Gynecologists, significant technological advancements in laboratory testing and ultrasonography, and calls of the National Institutes of Health Task Force for changes in prenatal care delivery in 1989, prenatal care recommendations continued to be the same as they had been in 1930-monthly visits until 28 weeks' gestation, bimonthly visits until 36 weeks' gestation, and weekly visits until delivery. However, coronavirus disease 2019 forced us to change, to reconsider both the need for in-person visits and frequency of visits. Currently, as we transition from the acute pandemic, we should consider how to use what we have learned in this unprecedented time to shape future prenatal care. Lessons from a century of prenatal care provide valuable insights to inform the next generation of prenatal care delivery.


Assuntos
Assistência à Saúde/normas , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/normas , Assistência à Saúde/tendências , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/tendências , Estados Unidos
4.
Int J Gynaecol Obstet ; 153(1): 45-50, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33368273

RESUMO

OBJECTIVE: To assess the incidence and predictors of intimate partner violence (IPV) during pregnancy amidst the coronavirus disease 2019 pandemic. METHODS: This cross-sectional study was conducted at the prenatal care clinic of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, among pregnant women from 31 August to 2 November 2020. Participants were interviewed using Open Data Kit. Logistic regression was used to assess predictors. RESULTS: Among the 464 pregnant women, 33 (7.1%) reported IPV during pregnancy, and among these 24 (72.7%) reported emotional violence, 16 (48.5%) reported sexual violence, and 10 (30.3%) reported physical violence. Among the study participants, only 8 (1.7%) were screened for IPV. IPV was reported 3.27 times more often by women who reported that their partner chewed Khat compared with those women whose partner did not (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.45-7.38), and 1.52 times more often women who reported that their partner drank alcohol compared with those women whose partner did not (aOR 1.52; 95% CI 1.01-2.28). CONCLUSION: Very few women were screened for IPV. Partners drinking alcohol and chewing Khat are significantly positively associated with IPV during pregnancy. IPV screening should be included in the national management protocol of obstetric cases of Ethiopia.


Assuntos
Violência por Parceiro Íntimo , Cuidado Pré-Natal , Cônjuges , Transtornos Relacionados ao Uso de Substâncias , Adulto , /prevenção & controle , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Incidência , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Gestantes , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
5.
PLoS Med ; 17(10): e1003150, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027246

RESUMO

BACKGROUND: Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS: We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS: We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov under registration number NCT02626351.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cuidado Pré-Natal/normas , Carga Viral/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/diagnóstico , Humanos , Ciência da Implementação , Padrões de Prática em Enfermagem , Gravidez , Atenção Primária à Saúde , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , RNA Viral/sangue , População Rural , África do Sul , Gestão da Qualidade Total , Adulto Jovem
6.
Obstet Gynecol ; 136(5): 1001-1005, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030869

RESUMO

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.


Assuntos
Assistência Centrada no Paciente/normas , Gravidez Ectópica/diagnóstico , Gravidez não Desejada/psicologia , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde/normas , Algoritmos , Feminino , Humanos , Gravidez , Gravidez Ectópica/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia
9.
PLoS One ; 15(9): e0238844, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32913362

RESUMO

BACKGROUND: Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of risk of bias or evaluate the certainty of the evidence. Our objective was to perform an updated review, by including new trials, any comparative observational studies, and assessing the certainty of the evidence using the GRADE framework. METHODS: We searched MEDLINE, Embase and the Cochrane Library from 2000 to November 26, 2019. Relevant websites and bibliographies of systematic reviews and guidelines were searched for studies published before 2000. Outcomes of interest were sensitization and adverse events. Risk of bias was evaluated with the Cochrane tool and ROBINS-I. The certainty of the evidence was performed using the GRADE framework. RESULTS: Thirteen randomized trials and eight comparative cohort studies were identified, evaluating 12 comparisons. Although there is some evidence of beneficial treatment effects (e.g., at 6-months postpartum, fewer women who received RhIg at delivery compared to no RhIg became sensitized [70 fewer sensitized women per 1,000 (95%CI: 67 to 71 fewer); I2 = 73%]), due to very low certainty of the evidence, the magnitude of the treatment effect may be overestimated. The certainty of the evidence was very low for most outcomes often due to high risk of bias (e.g., randomization method, allocation concealment, selective reporting) and imprecision (i.e., few events and small sample sizes). There is limited evidence on prophylaxis for invasive fetal procedures (e.g. amniocentesis) in the comparative literature, and few studies reported adverse events. CONCLUSION: Serious risk of bias and low to very low certainty of the evidence is found in existing RCTs and comparative observational studies addressing optimal effectiveness of Rh immunoprophylaxis. Guideline development committees should exercise caution when assessing the strength of the recommendations that inform and influence clinical practice in this area.


Assuntos
Fatores Imunológicos/administração & dosagem , Cuidado Pós-Natal/normas , Cuidado Pré-Natal/normas , Isoimunização Rh/prevenção & controle , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Feminino , Abordagem GRADE , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Isoimunização Rh/imunologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-32748884

RESUMO

The satisfaction of women with the birth experience has implications for the health and wellness of the women themselves and also of their newborn baby. The objectives of this study were to determine the factor structure of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) questionnaire on satisfaction with the attention received during birth delivery in Spanish women and to compare the level of satisfaction of pregnant women during the birth process with that in other studies that validated this instrument. A cross-sectional study using a self-completed questionnaire of 385 Spanish-speaking puerperal women who gave birth in the Public University Hospitals of Granada (Spain) was conducted. An exploratory factor analysis of the WOMBLSQ4 questionnaire was performed to identify the best fit model. Those items that showed commonalities higher than 0.50 were kept in the questionnaire. Using the principal components method, nine factors with eigenvalues greater than one were extracted after merging pain-related factors into a single item. These factors explain 90% of the global variance, indicating the high internal consistency of the full scale. In the model resulting from the WOMBLSQ4 questionnaire, its nine dimensions measure the levels of satisfaction of puerperal women with childbirth care. Average scores somewhat higher than those of the original questionnaire and close to those achieved in the study carried out in Madrid (Spain) were obtained. In clinical practice, this scale may be relevant for measuring the levels of satisfaction during childbirth of Spanish-speaking women.


Assuntos
Pesquisas sobre Serviços de Saúde/normas , Satisfação do Paciente , Satisfação Pessoal , Cuidado Pré-Natal/normas , Inquéritos e Questionários/normas , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde/métodos , Humanos , Recém-Nascido , Trabalho de Parto , Parto , Gravidez , Reprodutibilidade dos Testes , Espanha
11.
Diabetes Res Clin Pract ; 166: 108290, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32615279

RESUMO

AIM: This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known about the GP perspective at initial diagnosis and management. GDM is increasingly managed in the secondary and tertiary sector, the confidence of GPs and their role in ongoing care has not been examined. Given GDM's poor follow up rates, all aspects of the patient journey warrant close examination. METHODS: Through purposive and snowball sampling, we conducted semi-structured interviews with GPs in Brisbane, Australia between April and October 2018. Data collection, until saturation, and analysis were concurrent, and the Leximancer analysis tool assisted with content analysis and suggestion of themes. RESULTS: Dominant themes include uncertainty/urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet patient needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is concern about the patient being 'taken away' by the hospital. Communication with the hospital is generally perceived as poor. CONCLUSIONS: The experience of GPs in the initial diagnosis and management of GDM may assist in improving GDM follow up.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Clínicos Gerais , Padrões de Prática Médica , Atenção Primária à Saúde , Adulto , Austrália/epidemiologia , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Seguimentos , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Parto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Encaminhamento e Consulta/estatística & dados numéricos
15.
BMC Health Serv Res ; 20(1): 485, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487097

RESUMO

BACKGROUND: According to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities. METHODS: Data were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker's training and availability of guidelines were assessed. Data were collected from October-December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05. RESULT: Among the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (ß = - 0.047, 95% CI: (- 0.1, - 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (ß = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015). CONCLUSION: This analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.


Assuntos
Instalações de Saúde/normas , Cuidado Pré-Natal/normas , Estudos Transversais , Etiópia , Feminino , Administração de Instituições de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários
16.
Enferm. clín. (Ed. impr.) ; 30(3): 168-175, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196682

RESUMO

OBJETIVO: Analizar la evolución de los cuidados para favorecer la lactancia materna (LM) y describir los resultados de la lactancia materna tras la implantación de la guía RNAO en diversos tipos de centros sanitarios nacionales. MÉTODO: Estudio descriptivo cuantitativo longitudinal de los resultados de la aplicación de las recomendaciones de la guía RNAO-LM en 9 centros sanitarios nacionales siguiendo la metodología del programa Best Practice Spotlight Organization®. Se recogen variables de proceso y resultado en el ámbito hospitalario y en atención primaria mediante el registro en la plataforma CAREVID. Los resultados globales se expresan como media ponderada de los centros participantes. RESULTADOS: La implantación de las recomendaciones de la guía de LM se asoció a un incremento relativo de: contacto piel con piel 57,7% (p < 0,000), LM exclusiva (LME) en la 1ª toma 47,8% (p < 0,000), LME al alta hospitalaria 18,4% (p < 0,000) y educación prenatal 63,95% (p < 0,00). CONCLUSIÓN: La implantación de la guía RNAO-LM en diversos centros en el ámbito nacional ha incrementado la aplicación de las recomendaciones, consiguiendo generalizar los cuidados adecuados en LM (como educación prenatal, aplicación del contacto piel con piel y LME en la primera toma), aproximándose significativamente a las recomendaciones internacionales sobre LM


OBJECTIVE: To analyse the progress of care in the promotion of breastfeeding and describe breastfeeding results following the implementation of the RNAO guideline in various types of national health centres. METHOD: Quantitative descriptive longitudinal study of the results of implementing the recommendations of the RNAO-Breastfeeding guideline in 9 national health centres following the implementation methodology of the programme of the Best Practice Spotlight Organization®. Process and result variables are collected at hospital level and in primary care by registering on the CAREVID platform. The weighted mean was calculated as a summary statistic. RESULTS: The implementation of the recommendations of the Breastfeeding guideline was associated with a relative increase in: skin-to-skin contact 57,7% (p < 0,000), exclusive breastfeeding in the 1st intake 47,8% (p < 0,000), exclusive breastfeeding on hospital discharge 18,4% (p < 0,000) and prenatal education 63,95% (p < 0,00). CONCLUSION: The implementation of the RNAO-Breastfeeding guideline in different national health centres has increased the application of the recommendations based on scientific evidence, generalising appropriate breastfeeding care (such as prenatal education, application of skin-to-skin contact and exclusive breastfeeding in the first intake) and is consequently significantly approaching the international recommendations on breastfeeding


Assuntos
Humanos , Aleitamento Materno , Guias de Prática Clínica como Assunto/normas , Instalações de Saúde/normas , Atenção Primária à Saúde , Educação Pré-Natal/normas , Estudos Longitudinais , Cuidado Pré-Natal/normas , Cuidado Pós-Natal/normas
17.
J Perinat Med ; 48(5): 438-440, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32401226

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Terapias Fetais/métodos , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal/métodos , Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Infecções por Coronavirus/transmissão , Parto Obstétrico/métodos , Feminino , Terapias Fetais/normas , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Sulfato de Magnésio/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Pandemias , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Gravidez , Nascimento Prematuro/terapia , Nascimento Prematuro/virologia , Cuidado Pré-Natal/normas
18.
Eur J Endocrinol ; 183(2): G49-G56, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32454456

RESUMO

The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Women with gestational diabetes mellitus (GDM) are one of the largest high-risk groups accessing antenatal care. In reformulating the care offered to those with GDM, there is a need to balance the sometimes competing requirement of lowering the risk of direct viral transmission against the potential adverse impact of service changes. We suggest pragmatic options for screening of GDM in a pandemic setting based on blood tests, and risk calculators applied to underlying risk factors. Alternative models for antenatal care provision for women with GDM, including targeting high-risk groups, early lifestyle interventions and remote monitoring are provided. Testing options and their timing for postpartum screening in women who had GDM are also considered. Our suggestions are only applicable in a pandemic scenario, and usual guidelines and care pathways should be re-implemented as soon as possible and appropriate.


Assuntos
Diabetes Gestacional/diagnóstico , Endocrinologia/métodos , Obstetrícia/métodos , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/métodos , Adulto , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Endocrinologia/normas , Feminino , Humanos , Obstetrícia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/normas
19.
Rev Bras Enferm ; 73(3): e20180338, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32267410

RESUMO

OBJECTIVES: to understand breastfeeding meanings and practices produced by women attending prenatal care at a Basic Health Unit in the Brazilian Northeast. METHODS: a social research characterized as participant research. A Focal Group was conducted with nine pregnant women who had other children. For the analysis, Discursive Practices and Production of Meanings in Everyday Life perspectives were worked out. RESULTS: prenatal care, mother-baby relationship, family, and pain/suffering categories were produced. FINAL CONSIDERATIONS: breastfeeding benefits for the child, wife, family and society are numerous, but it is necessary for the woman to have access to a prenatal care and a qualified puerperium so that she feels supported by a perspective of comprehensive care.


Assuntos
Aleitamento Materno/psicologia , Educação de Pacientes como Assunto/normas , Cuidado Pré-Natal/normas , Adulto , Brasil , Aleitamento Materno/métodos , Aleitamento Materno/tendências , Feminino , Humanos , Relações Mãe-Filho , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/tendências , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa
20.
Obstet Gynecol ; 135(5): 1236-1238, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332408

RESUMO

Genital herpes simplex virus (HSV) infection during pregnancy poses a risk to the developing fetus and newborn. Genital herpes is common in the United States. Among 14- to 49-year-old females, the prevalence of HSV-2 infection is 15.9%. However, the prevalence of genital herpes infection is higher than that because genital herpes is also caused by HSV-1 (1). Because many women of childbearing age are infected or will be infected with HSV, the risk of maternal transmission of this virus to the fetus or newborn is a major health concern. This document has been revised to include that for women with a primary or nonprimary first-episode genital HSV infection during the third trimester of pregnancy, cesarean delivery may be offered due to the possibility of prolonged viral shedding.


Assuntos
Herpes Genital/terapia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/normas , Adolescente , Adulto , Antivirais/uso terapêutico , Cesárea/métodos , Feminino , Herpes Genital/epidemiologia , Herpes Genital/transmissão , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Prevalência , Simplexvirus , Estados Unidos/epidemiologia , Adulto Jovem
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