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1.
BMC Pregnancy Childbirth ; 21(1): 667, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598709

RESUMO

BACKGROUND: Women across the world value choice and control throughout their maternity care experiences. In response to this health policy and frameworks are adapting and developing. The concepts of choice and control are extrinsically complex and open to interpretation by healthcare professionals and service users, with the two not necessarily aligning. Depending on a number of factors, women's experiences of choice and control within the same maternity care system may be very different. This study aimed to investigate the factors influencing women's perceptions of choice and control during pregnancy and birth in Ireland. METHODS: We conducted a cross-sectional study using an adapted version of the UK national maternity experience survey (National Perinatal Epidemiology Unit). During March - July 2017, a sample of 1277 women were recruited from the postnatal wards of three maternity units and a tertiary maternity hospital. Poisson regression was used to assess the association between twelve factors and a series of measures of the women's perception of choice and control. RESULTS: Most women reported not having choice in the model or location of their maternity care but most reported being involved enough in decision-making, especially during birth. Women who availed of private maternity care reported higher levels of choice and control than those who availed of public maternity care. This factor was the most influential factor on almost all choice and control measures. CONCLUSION: Most women experiencing maternity care in Ireland report not having choice in the model and location of care. These are core elements of the Irish maternity strategy and significant investment will be required if improved choice is to be provided. Availing of private maternity care has the strongest influence on a woman's perceived choice and control but many women cannot afford this type of care, nor may they want this model of care.


Assuntos
Tomada de Decisões , Maternidades , Serviços de Saúde Materna , Cuidado Pós-Natal/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Irlanda , Gravidez
2.
BMC Health Serv Res ; 21(1): 1077, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635125

RESUMO

BACKGROUND: Implementation science aims to embed evidence-based practice as 'usual care' using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). METHOD: Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. RESULTS: This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. CONCLUSION: This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.


Assuntos
Maternidades , Ciência da Implementação , Prática Clínica Baseada em Evidências , Feminino , Humanos , Gravidez , Pesquisadores
3.
Enferm. foco (Brasília) ; 12(2): 256-261, set. 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1291319

RESUMO

Objetivo: Analisar os acidentes de trabalho ocorridos em uma maternidade pública de referência para o nordeste brasileiro. Método: Estudo transversal realizado com dados de registros de 102 profissionais acidentados em uma maternidade pública de referência. Realizou-se análise estatística descritiva e aplicou-se o teste exato de Fisher. Resultados: O estudo apontou maior prevalência anual de acidentes de trabalho no ano de 2017 (2,44%), com predominância do sexo feminino (75,5%) e trabalhadores com 1 a 5 anos de tempo de serviço (32%). A categoria profissional mais acometida foi a de Técnico (a) de Enfermagem (38,6%); sendo mãos/dedos como as partes do corpo mais afetadas (53,6%) e os perfuro cortantes como os agentes causadores mais mencionados (48,5%). Conclusão: Evidenciou-se a necessidade de maior investimento nas ações de educação permanente em relação à notificação e às medidas preventivas com vistas à diminuição da ocorrência dos agravos relacionados ao trabalho. (AU)


Objective: Work accidents occurred in a public reference maternity hospital were analyzed. Methods: Cross-sectional study carried out with data from 102 injured professionals in a public reference maternity hospital. Descriptive statistical analysis and Fisher's exact test were performed. Results: The study pointed out the highest annual prevalence of occupational accidents in 2017 (2.44%), with a predominance of females (75.5%) and workers with 1 to 5 years of service (32%). The most affected professional was the Nursing Technician (38.6%); hands / fingers were found to be the most affected body parts (53.6%) and sharp perforations as the most commonly found causative agents (48.5%). Conclusion: There was a need for greater investment in continuing education actions in relation to notification and preventive measures with a view to reducing the occurrence of work-related injuries. (AU)


Objetivo: Se analizaron los accidentes de trabajo ocurridos en una maternidad pública de referencia. Métodos: Estudio transversal realizado con datos de 102 profesionales lesionados en una maternidad pública de referencia. Se realizó un análisis estadístico descriptivo y la prueba exacta de Fisher. Resultados: El estudio señaló la mayor prevalencia anual de accidentes laborales en 2017 (2,44%), con predominio de mujeres (75,5%) y trabajadores con 1 a 5 años de servicio (32%). El profesional más afectado fue el Técnico de Enfermería (38,6%); Se encontró que las manos / dedos eran las partes del cuerpo más afectadas (53.6%) y las perforaciones agudas como los agentes causales más comúnmente encontrados (48.5%). Conclusión: Era necesaria una mayor inversión en acciones de educación continua en relación con la notificación y las medidas preventivas con el fin de reducir la aparición de lesiones relacionadas con el trabajo. (AU)


Assuntos
Acidentes de Trabalho , Saúde do Trabalhador , Serviços Básicos de Saúde , Maternidades
4.
Rev Bras Enferm ; 74(suppl 4): e20200689, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406273

RESUMO

OBJECTIVES: to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. METHODS: Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. RESULTS: the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. FINAL CONSIDERATIONS: obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.


Assuntos
Tocologia , Feminino , Teoria Fundamentada , Pessoal de Saúde , Maternidades , Humanos , Gravidez , Prevalência , Pesquisa Qualitativa
5.
Int Breastfeed J ; 16(1): 66, 2021 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454539

RESUMO

BACKGROUND: Although the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19. METHODS: Implementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed. RESULTS: Response rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p <  0.001), companion of choice during hospital stay (68% vs 90%; p = 0.006), and breastfeeding support (78% vs 94%; p = 0.02). Practices were significantly less prevalent in COVID-19 mothers compared to pre-pandemic situation. A lower accompaniment rate was observed in non-COVID-19 group during delivery (24% vs 47.9%; p <  0.01). Hospitals with higher commitment to BFHI practices reported higher rates of skin-to-skin contact (45.2% vs 10.5%; p = 0.01) and rooming-in (83.9% vs 57.9%; p <  0.05) in COVID mothers. Fewer restrictions were observed in hospitals located in the regions where the pandemic hit harder. In these regions there was a significantly higher level of BFHI commitment of the hospitals, but no significant differences were observed in the average size of the hospital. All the practices suffered even more restrictions during the first weeks of the pandemic. CONCLUSION: All mothers suffered restrictions in perinatal care during the COVID-19 pandemic. Women with COVID-19 infection suffered more restrictions in perinatal practices than women without infection. The degree of commitment to WHO-UNICEF perinatal quality standards, integrated into the BFHI, was associated with maintenance of good clinical practices.


Assuntos
Aleitamento Materno , Maternidades , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , SARS-CoV-2 , Espanha/epidemiologia
6.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34344752

RESUMO

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.


Assuntos
Trabalho de Parto , Serviços de Saúde Materna , Feminino , Maternidades , Humanos , Recém-Nascido , Gravidez , Melhoria de Qualidade , População Rural
7.
Artigo em Espanhol | PAHO-IRIS | ID: phr-54757

RESUMO

[RESUMEN]. Objetivo. Evaluar la cobertura y las desigualdades en las intervenciones de salud maternoinfantil entre haitia-nos, migrantes haitianos en la República Dominicana y dominicanos.Métodos. Estudio transversal con datos de encuestas representativas en el nivel nacional realizadas en Haití en el 2012 y en la República Dominicana en el 2014. Se compararon nueve indicadores: la demanda de pla-nificación familiar satisfecha con métodos modernos, la atención prenatal, la atención del parto (por personal de salud calificado), la vacunación infantil (con vacuna con la tuberculosis, el sarampión y tres dosis de la vacuna triple bacteriana), la gestión de casos de enfermedad en la infancia (administración de sales de rehi-dratación oral para la diarrea y búsqueda de atención sanitaria ante la sospecha de neumonía) e índice de cobertura compuesto. La riqueza se midió mediante un índice basado en los activos, dividido en terciles, y el lugar de residencia (urbano o rural) se determinó según la definición del país.Resultados. La población haitiana mostró la menor cobertura respecto de la demanda de planificación fami-liar satisfecha con métodos modernos (44,2%), atención prenatal (65,3%), asistencia calificada en el parto (39,5%) y búsqueda de atención sanitaria ante la sospecha de neumonía (37,9%), y la mayor cobertura respecto de la administración de sales de rehidratación oral para la diarrea (52,9%); los migrantes haitianos presentaron la menor cobertura en DPT3 (44,1%) y la administración de sales de rehidratación oral para la diarrea (38%) y la mayor cobertura en la búsqueda de atención sanitaria ante la sospecha de neumonía (80,7%). La población dominicana presentó la cobertura más alta en la mayoría de los indicadores, excepto en la administración de sales de rehidratación oral para la diarrea y en la búsqueda de atención sanitaria ante la sospecha de neumonía. El índice de cobertura compuesto fue de 79,2% para los dominicanos, 69,0% para los migrantes haitianos y 52,6% para los haitianos. Las desigualdades socioeconómicas tuvieron, en general, un patrón a favor de los ricos y de las zonas urbanas en todos los grupos analizados.Conclusión. Los migrantes haitianos en la República Dominicana presentaron una mayor cobertura que la población haitiana residente en Haití, pero menor que la población dominicana. Ambos países deberían planificar acciones y políticas para aumentar la cobertura y abordar las desigualdades existentes en las inter-venciones de salud materna.


[ABSTRACT]. Objective. To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans.Methods. Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, meas-les and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition.Results. Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups.Conclusion. Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.


[RESUMO]. Objetivo. Avaliar cobertura e desigualdades nas intervenções em saúde materno-infantil entre os haitianos, migrantes haitianos na República Dominicana e dominicanos. Métodos. Estudo transversal utilizando dados de pesquisas representativas nacionalmente realizadas no Haiti em 2012, e na República Dominicana em 2014. Nove indicadores foram comparados: demanda por planejamento familiar atendida com métodos modernos, atendimento pré-natal, atendimento ao parto (pre-sença de profissional qualificado no parto), vacinação de crianças (BCG, sarampo e DPT3), atendimento de crianças (sais de reidratação oral para diarreia e demanda por assistência por suspeita de pneumonia) e índice composto de cobertura. A riqueza foi medida por meio de índice baseado em recursos, dividido em tercis, e o local de residência (urbano ou rural) foi estabelecido segundo a definição dos países. Resultados. Os haitianos apresentaram a menor cobertura de demanda por planejamento familiar atendida com métodos modernos (44,2%), atendimento pré-natal (65,3%), presença de profissional qualificado no parto (39,5%) e de atendimento por suspeita de pneumonia (37,9%), e a mais alta para sais de reidratação oral na diarreia (52,9%), enquanto os migrantes haitianos tiveram a menor cobertura de DPT3 (44,1%) e sais de reidratação oral para diarreia (38%), e a mais alta na assistência por suspeita de pneumonia (80,7%). Os dominicanos apresentaram a cobertura mais alta para a maioria dos indicadores, exceto para sais de reidratação oral para diarreia e demanda por assistência por suspeita de pneumonia. O índice composto de cobertura foi 79,2% para dominicanos, 69,0% para migrantes haitianos e 52,6% para os haitianos. De forma geral, as desigualdades socioeconômicas apresentaram padrão pró-riqueza e pró-urbano em todos os gru-pos analisados. Conclusões. Os migrantes haitianos apresentaram maior cobertura que os haitianos, mas coberturas inferio-res aos dominicanos. Ambos os países devem planejar ações e políticas para aumentar a cobertura e abordar as desigualdades nas intervenções em saúde materna.


Assuntos
Migração Humana , Saúde Materna , Saúde da Criança , Disparidades em Assistência à Saúde , Maternidades , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil , Haiti , República Dominicana , Migração Humana , Saúde Materna , Saúde da Criança , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil , Disparidades em Assistência à Saúde , Haiti , República Dominicana , Migração Humana , Saúde Materna , Saúde da Criança , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil , Disparidades em Assistência à Saúde
8.
Washington, D.C.; OPAS; 2021-08-11.
em Português | PAHO-IRIS | ID: phr-54638

RESUMO

Do ponto de vista fisiopatológico, a morte é o resultado final de um amplo espectro de complicações que provocam a disfunção de múltiplos órgãos. No entanto, há um grupo de mulheres que consegue sobreviver apesar de apresentar um quadro grave — um resultado que depende principalmente da qualidade dos serviços de saúde prestados por um país ou instituição. Dessa forma, esta publicação propõe um sistema de vigilância epidemiológica do indicador de morbidade materna extremamente grave (MMEG), que permite estimar a morbidade associada a doenças e complicações desenvolvidas durante a gravidez, parto ou puerpério, aprofundar a compreensão sobre mortes maternas evitáveis, incorporar aspectos de segurança do paciente e contribuir para detectar deficiências nos sistemas de saúde. Este trabalho é parte do objetivo mais amplo da Organização Pan-Americana da Saúde de reduzir a mortalidade materna e fortalecer a vigilância epidemiológica da saúde materna ao nível nacional. A ferramenta fornece às autoridades sanitárias dos países um sistema para identificar, coletar, processar e analisar ativamente as informações relacionadas à MMEG, podendo também ser útil para os prestadores e gestores de serviços de saúde locais e regionais.


Assuntos
Maternidades , Recém-Nascido , Serviços de Vigilância Epidemiológica , Morbidade , Mortalidade Materna , América Latina , Região do Caribe
9.
BMC Health Serv Res ; 21(1): 671, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238313

RESUMO

BACKGROUND: Health systems around the globe are struggling to recruit qualified health professionals. Work-related stress plays an important role in why health professionals leave their profession prematurely. However, little is known about midwives' working conditions and intentions to leave their profession, although this knowledge is key to work force retention. Therefore, we aimed to investigate work-related stress among midwives working in Swiss maternity hospitals, as well as differences between midwives and other health professionals and the stressors associated with midwives' intention to leave the profession. METHODS: We conducted a data analysis of two cross-sectional studies encompassing midwives working in labour, postpartum and/or gynaecology wards of 12 public Swiss maternity hospitals. Data was collected by self-report questionnaire assessing potential stressors and long-term consequences of stress at work. Data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression modelling. RESULTS: A total of 98 midwives took part in the study and one in three midwives reported doing overtime sometimes-always. Also, the score for work-private life conflicts was significantly higher among midwives than among other health professionals, with the exception of physicians (M = 37.0 versus 50.2, p < .001). Midwives' meaning of work score (M = 89.4) was significantly higher than that of other health professionals (e.g. nurses (M = 83.0, p < .001) or physicians (M = 82.5, p < .01)). Generation Y midwives showed a significantly higher intention to leave their organisation than did the baby boomers (Mean scores 29.3 versus 10.0, p < .01). Results of the regression model revealed that if midwives could compensate for their overtime in the same month, their intention to leave the profession was lower (OR = 0.23, p < .05). Additionally, the more midwives were affected by work-private life conflicts (OR = 3.01, p < .05) and thoughts about leaving their organisation (OR = 6.81, p < .05), the higher was their intention to leave their profession prematurely. CONCLUSIONS: The comparison with other health professions and the higher intention to leave the profession of younger midwife generations are important findings for heads of institutions as well as policy makers, and should stimulate them to develop strategies for keeping midwives on their staff. More extensive studies should implement and test interventions for reducing work-related stress and increasing the job and occupational satisfaction of midwives.


Assuntos
Tocologia , Estresse Ocupacional , Estudos Transversais , Feminino , Maternidades , Humanos , Intenção , Satisfação no Emprego , Estresse Ocupacional/epidemiologia , Gravidez , Inquéritos e Questionários , Suíça/epidemiologia
10.
Washington, D.C.; OPAS; 2021-07-23.
em Português | PAHO-IRIS | ID: phr-54545

RESUMO

A Organização Pan-Americana da Saúde, em reconhecimento ao papel fundamental dos profissionais de enfermagem e de obstetrícia nos sistemas de saúde, decidiu publicar esses relatos para tornar visíveis as iniciativas e contribuições desses profissionais com foco na saúde da mulher. Esta publicação contribui para destacar o importante trabalho que realizam, em diferentes níveis de atenção e ambientes profissionais, e destaca a realidade da saúde da mulher nos países da Região das Américas. As atividades, histórias e casos relacionados ilustram o papel dos profissionais de enfermagem e de obstetrícia na promoção do acesso universal à saúde e da cobertura universal de saúde, bem como sua importante contribuição para os sistemas de saúde, universidades e escolas nos países da Região.


Assuntos
Obstetrícia , Ginecologia , Mulheres , Saúde da Mulher , Maternidades , Gravidez , Enfermagem Obstétrica , Enfermagem Materno-Infantil , Papel do Profissional de Enfermagem , Enfermagem
11.
Arch Gynecol Obstet ; 304(3): 679-686, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34059957

RESUMO

PURPOSE: COVID-19 has captured the world. We hypothesized that this pandemic reduced referral of other non-COVID-19 patients to the hospitals or clinics, including gynecological and perinatological referrals. Women can be at risk in limited use of health services. METHODS: In this retrospective study, referrals from gynecologic oncology, perinatology, and gynecology clinics in a large teaching hospital of Tehran University of Medical Sciences (TUMS) were compared from February 20 to May 20, 2020, with the same period in 2019. Finally, referral trends in 2020 were compared with the COVID-19 admission pattern. RESULTS: Total admissions to all three clinics declined 63% in 2020 compared to 2019. There was a significant relationship between the number of visits to three clinics during these2  years (p < 0.001). The reduction in referrals to the gynecology clinic was more than gynecologic oncology and perinatology. The COVID-19 referral pattern was conversely linked to gynecology-related admissions. CONCLUSION: As the pandemic situation makes patients hesitant to go to the hospitals or not, health policymakers should consider other non-COVID issues, including maternal and fetal concerns. Providing safe places for other patients to visit is a goal that can be achieved through developing guidelines for nosocomial hygiene and training informed healthcare staff. Moreover, non-urgent visits should be avoided or postponed. This issue calls for new strategies, including telemedicine in situations similar to the current pandemic to both identify and manage such conditions.


Assuntos
COVID-19/psicologia , Parto Obstétrico/estatística & dados numéricos , Neoplasias dos Genitais Femininos/epidemiologia , Ginecologia/estatística & dados numéricos , Perinatologia , Adulto , COVID-19/epidemiologia , Feminino , Maternidades/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , Obstetrícia/estatística & dados numéricos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
12.
Braz J Infect Dis ; 25(3): 101591, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133953

RESUMO

The outbreak of the new coronavirus (SARS-CoV-2) causing the coronavirus disease (COVID-19) has spread globally. As of June 18, 2020, a high maternal mortality rate due to SARS-CoV-2 infections was identified in Brazil, representing most of the world cases at that time. An observational, cross-sectional study was performed with pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24th up to July 17th of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Brasil/epidemiologia , Estudos Transversais , Feminino , Maternidades , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Gestantes , SARS-CoV-2
13.
Clin Biochem ; 95: 49-53, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34077758

RESUMO

BACKGROUND: The management of affected results in haemolysed samples (HS) is debated. In an infant-maternity setting, for reporting interfered test results, we provided the result itself, the degree of haemolysis (as free haemoglobin concentration), and a warning recommending sample recollection. We investigated the impact of this approach on sample quality and clinicians' decision-making. METHODS: Free haemoglobin was measured on Beckman Coulter AU680 as haemolytic index. We estimated the total HS number, the clinical wards more affected by HS, the most interfered analytes, and the retesting rate of interfered tests, by comparing data from Apr-Dec 2017, the period just after the introduction of the new policy, vs. Apr-Dec 2018. RESULTS: One year after the new report introduction, a significant HS decrease (5.8% vs. 7.8%, P < 0.001) was detected, together with a reduction of the frequency by which haemolysis affected results. The most affected wards, i.e., Paediatric and Neonatal Intensive Care Units, showed an improvement in sample quality (HS rate, 30.6% to 16.1%, P < 0.001, and 25.2% to 20.9%, P = 0.048, respectively). We noted a significant decrease in retesting after an alerted result for aspartate aminotransferase, magnesium, potassium, conjugated bilirubin, and lactate dehydrogenase. CONCLUSIONS: Our approach led to a HS decrease, suggesting that the provided report could be a driving force for improvement of phlebotomy quality, also helping clinicians in deciding if retesting is essential or not.


Assuntos
Análise Química do Sangue/normas , Coleta de Amostras Sanguíneas/normas , Química Clínica/métodos , Química Clínica/normas , Hemólise , Maternidades , Manejo de Espécimes/normas , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Hemoglobinas/análise , Humanos , Obstetrícia , Quartos de Pacientes , Manejo de Espécimes/estatística & dados numéricos
14.
Codas ; 33(6): e20200173, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34190811

RESUMO

PURPOSE: To verify the anatomophysiological, psychological, and sociocultural factors of the mother-newborn binomial, as well as their association with the initiation of breastfeeding. METHODS: Cross-sectional study conducted in a maternity hospital in Lima, Peru. The sample consisted of 304 healthy neonates and their mothers. Breastfeeding performance was estimated by clinical assessment using the Clinical Evaluation of Breastfeeding Efficacy scale and maternal self-perception by the Breastfeeding Self-Efficacy Scale. Multivariate Prevalence Ratios (PR) were estimated by Poisson Regression with Robust Variance and 95% confidence intervals (CI). RESULTS: The prevalence of clinical low breastfeeding performance was 27.6%. Primiparous women were associated with higher prevalence of low performance when they did not trust to succeed [PR:2.02(95%CI:1.18-3.44)] and lower prevalence in having a good latch [PR:0.52(95%CI:0.29-0.95)], as well as in coping successfully [PR:0.59(95%CI:0.37-0.91)]. Multiparous women showed higher prevalence when they were not confident in staying motivated [PR:3.47(95%CI:1.67-7.22)] and in calming the neonate [PR:4.07(95%CI:1.83-9.95)]. There was lower prevalence in keeping the neonate awake [PR:0.32(95%CI:0.14-0.75)] and when they did not feel confident in the presence of their family [PR:0.29(95%CI:0.13-0.64)]. CONCLUSION: It is important that health professionals be aware of emotional, social, and cultural issues to promote quality breastfeeding.


Assuntos
Aleitamento Materno , Maternidades , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Mães , Peru , Gravidez
15.
J Perinat Med ; 49(6): 686-690, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34187133

RESUMO

OBJECTIVES: The aim of our study is to present the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and evaluate its impact on maternal and neonatal outcomes. METHODS: We retrospectively reviewed the medical records of all COVID-19 positive pregnant women who were admitted to "Alexandra" maternity hospital from March to December 2020 (n=40). The infection status was determined via real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimen. We documented the demographic features, clinical status, pregnancy characteristics and maternal and fetal outcomes. RESULTS: Forty COVID-19 positive pregnant women were admitted to our clinic during the study period. Mean maternal age was 27.6 years. Gestational age (GA) ranged from 10-42 weeks of pregnancy with mean GA calculated at 38+3 weeks. Associated comorbidities included hypertension, hypothyroidism, epilepsy, hepatitis B and asthma. Thirty-five out of 40 women delivered within the study period. Cesarean section was performed in 57.1% of the cases. Most of the cases (87.5%) were asymptomatic while ventilation was required for only one patient. All neonates tested negative for SARS-CoV-2. Neither maternal nor neonatal deaths occurred. CONCLUSIONS: In alignment to other studies, our data show that the course of coronavirus disease 2019 (COVID-19) during pregnancy in the majority of cases is mild and neonatal outcomes also appear favorable.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Grécia/epidemiologia , Maternidades/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 21(1): 413, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078312

RESUMO

BACKGROUND: In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. METHODS: A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. RESULTS: We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25). CONCLUSION: Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.


Assuntos
Pré-Eclâmpsia/epidemiologia , Cuidado Pré-Natal , Encaminhamento e Consulta , Adulto , Estudos de Casos e Controles , Feminino , Maternidades , Humanos , Pré-Eclâmpsia/etiologia , Gravidez , Fatores de Risco , Serra Leoa/epidemiologia , Inquéritos e Questionários , Abastecimento de Água
17.
J Med Virol ; 93(9): 5505-5514, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33974301

RESUMO

The impact of SARS-CoV-2 infection in pregnant women and their neonates is an area of research interest nowadays. To date, there is limited knowledge about SARS-CoV-2 prevalence, maternal and perinatal outcomes of pregnant women at term in middle- and low-income countries. In the present retro-prospective study, medical records of pregnant women admitted for delivery were reviewed from the largest Covid-19 dedicated Shri Maharaja Gulab Singh (SMGS) maternity hospital. The SARS-CoV-2 screening was carried out for all pregnant women admitted for delivery using RT-PCR. All neonates born from SARS-CoV-2-positive mothers were isolated and tested for SARS-CoV-2 infection. Most of the pregnant women (90.6%) were asymptomatic at the time of admission with a low prevalence (3.4%) of SARS-CoV-2. A higher rate of asymptomatic prevalence (86.1%) was found among SARS-CoV-2-positive pregnant women. On the basis of the RT-PCR result (negative vs. positive), statistically significant differences were found for maternal characteristics, such as mean gestational age (37.5 ± 2.2 vs. 36.6 ± 3.3), medical comorbidity (2.9% vs. 7.4%), and maternal outcomes like the C-section rate (29.8% vs. 58.3%), preterm delivery (14.6% vs. 28.3), and neonatal outcomes like mean birth weight (2840 ± 450 vs. 2600 ± 600), low Apgar score (2.7% vs. 6.48%), and fetal distress (10.9% vs. 22.2%) among SARS-CoV-2 negative and positive cases, respectively. No neonate from SARS-CoV-2-positive pregnant women was found to be positive for SARS-CoV-2 infection.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , COVID-19/prevenção & controle , Teste de Ácido Nucleico para COVID-19 , Cesárea/estatística & dados numéricos , Feminino , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/virologia , Idade Gestacional , Maternidades , Humanos , Índia/epidemiologia , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
18.
Best Pract Res Clin Obstet Gynaecol ; 73: 104-112, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33966980

RESUMO

The 2020 SARS-CoV-2 pandemic posed significant challenges to the health service. Many services cancelled all routine appointments and surgery, which allowed them to redirect care towards large numbers of infected patients requiring respiratory and other support. Maternity services are relatively unique in that most of the care is time sensitive and cannot be rescheduled. Assessment such as routine bloods need to be taken in early pregnancy, anatomic surveys are best conducted at 20-22 weeks' gestation, and births continue regardless of a pandemic. In this paper we describe how National Maternity Hospital Dublin, with an annual delivery rate of 8000 births, reorganised services to continue to care for our mothers and babies. This included the development of a 'hospital within a hospital' approach, and separate physical and care pathways for positive cases. The delivery of virtual outpatient appointments and a comprehensive online patient education portal have proved successful.


Assuntos
COVID-19 , Pandemias , Feminino , Maternidades , Humanos , Lactente , Irlanda/epidemiologia , Gravidez , SARS-CoV-2
19.
Artigo em Inglês | MEDLINE | ID: mdl-33946146

RESUMO

BACKGROUND: This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth. METHODS: A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016-2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge. RESULTS: Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding. CONCLUSIONS: It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.


Assuntos
Aleitamento Materno , Maternidades , Cesárea , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , Sicília
20.
J Infect ; 83(1): 37-45, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33862060

RESUMO

OBJECTIVES: The genomic epidemiology of group b streptococcal (GBS) isolates from the Rotunda maternity hospital, Dublin, 2008-2017, was investigated. METHODS: Whole genome sequences of isolates (invasive, n = 114; non-invasive, n = 76) from infants and women were analysed using the PubMLST database (https://pubmlst.org/sagalactiae/). RESULTS: Serotypes III (36%), Ia (18%), V (17%), II (11%) and Ib, (9%) and sequence types (ST) 17 (23%), ST-23 (14%), ST-1 (12%) and ST-19 (7%) were most common. Core genome MLST (cgMLST) differentiated isolates of the same ST, grouped STs into five lineages congruent with known clonal complexes and identified known mother-baby pairs and suspected linked infant cases. Clonal complex (CC) 17 accounted for 40% and 22% of infant and maternal invasive cases, respectively and 21% of non-invasive isolates. CC23 and CC19 were associated with maternal disease (30%) and carriage (24%), respectively. Erythromycin (26%) and clindamycin (18%) resistance increased over the study period and was associated with presence of the erm(B) gene (55%), CC1 (33%) and CC19 (24%). A multi-resistant integrative conjugative element incorporated in the PI-1 locus was detected in CC17, an ST-12 and ST-23 isolate confirming the global dissemination of this element. All isolates possessed one or more pilus islands. Genes encoding other potential protective proteins including Sip, C5a peptidase and Srr1 were present in 100%, 99.5% and 65.8% of isolates, respectively. The srr2 gene was unique to CC17. CONCLUSIONS: The PubMLST.org website provides a valuable framework for genomic GBS surveillance to inform on local and global GBS epidemiology, preventive and control measures.


Assuntos
Maternidades , Infecções Estreptocócicas , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Feminino , Genômica , Humanos , Lactente , Tipagem de Sequências Multilocus , Gravidez , Sorotipagem , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/genética
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