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1.
Rev Gaucha Enferm ; 43: e20210127, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35920480

RESUMO

OBJECTIVE: To evaluate the clinical, obstetric, maternal and perinatal effects of the use of flower essences in labor, against factors that enhance it. METHOD: Clinical trial, randomized, controlled, in 164 parturients divided into two groups, flower essences and placebo, respectively, evaluated before and after the intervention. Carried out in a vaginal delivery center, in the city of São Paulo, from May to October 2018. Data were analyzed using descriptive statistics, Student's t test, bilateral hypothesis, negative and positive observed critical t, Pearson's chi-square, exact test. Fisher. RESULTS: It was observed in the Experimental Group, moderate increase in systolic blood pressure (p=0.046), frequency (p=0.055) and intensity of contractions (p=0.031), as well as a reduction in time to birth (194 minutes), higher number of vaginal deliveries (p=0.038) and better pattern of fetal vitality. CONCLUSION: There was evidence of a positive action of the Floral Essence on the potentiating factors of labor, being effective in maternal clinical and obstetrical repercussions, as well as perinatal ones.


Assuntos
Essências Florais , Trabalho de Parto , Brasil , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto/fisiologia , Parto , Gravidez
2.
PLoS One ; 17(8): e0272285, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913902

RESUMO

The 2011 Great East Japan Earthquake (within Fukushima, Iwate, and Miyagi prefectures) was a complex disaster; it caused a tsunami and the Fukushima Daiichi Nuclear Power Plant accident, resulting in radiation exposure. This study investigated the earthquake's effects on the migration patterns of pregnant women and their concerns regarding radiation exposure. We also considered the following large-scale earthquakes without radiation exposure: Great Hanshin-Awaji (Hyogo prefecture), Niigata-Chuetsu, and Kumamoto. Pregnant women were categorized as outflow and inflow pregnant women. Data on the annual number of births three years before and after the earthquake were used as a denominator to calculate the outflow and inflow rates per 100 births. The odds ratios of annual outflow and inflow rates after the earthquake, using three years before the earthquake as the baseline, were calculated. The odds-ratio for outflow significantly increased for Hyogo, Fukushima, Miyagi, and Kumamoto prefectures after the earthquake, particularly for Fukushima, showing a significant increase until three years post the Great East Japan Earthquake (disaster year: odds-ratio: 2.66 [95% confidence interval: 2.44-2.90], 1 year post: 1.37 [1.23-1.52], 2 years post: 1.13 [1.00-1.26], 3 years post: 1.18 [1.05-1.31]), while the remaining three prefectures reported limited increases post one year. The inflow decreased after the earthquake, particularly in Fukushima, showing a significant decrease until 2 years post the Great East Japan Earthquake (disaster year: 0.58 [0.53-0.63], 1 year post: 0.76 [0.71-0.82], 2 years post: 0.83 [0.77-0.89]). Thus, pregnant women's migration patterns changed after large-scale earthquakes, suggesting radiation exposure concerns possibly have a significant effects. These results suggested that plans for receiving assistance and support that considers the peculiarities of disaster related damage and pregnant women's migration patterns are needed in both the affected and non-affected areas.


Assuntos
Terremotos , Acidente Nuclear de Fukushima , Exposição à Radiação , Feminino , Humanos , Japão , Parto , Gravidez , Gestantes , Exposição à Radiação/efeitos adversos , Tsunamis
3.
PLoS One ; 17(8): e0271967, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913995

RESUMO

BACKGROUND: Short inter-pregnancy interval is a public health concern because it results in adverse perinatal outcomes such as postpartum hemorrhage, anemia, premature birth, low birth weight, and perinatal deaths. Although it is critical to understand the factors that contribute to short inter-pregnancy interval to reduce the risk of these negative outcomes, adequate evidence about the factors in the urban context is lacking. Therefore, we aimed to assess the duration of the inter-pregnancy interval and its predictors among pregnant women in urban South Ethiopia. METHODS: A community-based retrospective follow-up study was conducted among 2171 pregnant women in five geographically diverse urban settings in South Ethiopia. For the analysis, a Cox gamma shared frailty (random-effect) model was used. Adjusted hazard ratio (AHR) with a 95% CI was used to assess significant predictors. The median hazard ratio (MHR) used to report clustering effect. RESULTS: The median duration of the inter-pregnancy interval was 22 months, 95% CI (21, 23), with an inter-quartile range of 14 months. Maternal age ≥30 years [AHR = 0.75, 95% CI: 0.58, 0.97], having no formal education [AHR = 0.60, 95% CI: 0.46, 0.78], contraceptive non-use [AHR = 2.27, 95% CI: 1.94, 2.66], breastfeeding for <24 months [AHR = 4.92, 95% CI: 3.95, 6.12], death of recent child [AHR = 2.90, 95% CI: 1.41, 5.97], plan pregnancy within 24 months [AHR = 1.72, 95% CI: 1.26, 2.35], lack of discussion with husband [AHR = 1.33, 95% CI: 1.10, 1.60] and lack of husband encouragement about pregnancy spacing [AHR = 1.25, 95% CI: 1.05, 1.48] were predictors of short inter-pregnancy interval. Adjusting for predictors, the median increase in the hazard of short inter-pregnancy interval in a cluster with higher short inter-pregnancy interval is 30% [MHR = 1.30, 95% CI: 1.11, 1.43] than lower cluster. CONCLUSIONS: In the study settings, the duration of the inter-pregnancy interval was shorter than the World Health Organization recommendation. There is a need to improve contraceptive use and breastfeeding duration to maximize the inter-pregnancy interval. Men's involvement in reproductive health services and advocacy for women's reproductive decision-making autonomy are fundamental. The contextual disparities in the inter-pregnancy interval suggests further study and interventions.


Assuntos
Intervalo entre Nascimentos , Gestantes , Adulto , Anticoncepcionais , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Parto , Gravidez , Estudos Retrospectivos
4.
Womens Health (Lond) ; 18: 17455057221116505, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35916397

RESUMO

INTRODUCTION: Respectful maternity care is essential for improving maternal and neonatal health. Lack of respectful maternity care during childbirth services is one of the deterrents to women seeking facility-based deliveries. It is a health system failure and a violation of women's rights. There is limited data on respectful maternity care during childbirth and maternity care in Ethiopia, particularly at rural health facilities. But studies have shown that many women from rural areas were more likely to report disrespect and abuse than urban residents. OBJECTIVE: This study aims to assess respectful maternity care and associated factors among mothers who gave birth at health institutions in the South Gondar zone, northwest Ethiopia, 2021. METHODS: A multicenter institutional-based cross-sectional study design was conducted among mothers who gave birth at South Gondar Zone public health institutions, from 1 February to 30 March 2021. Six hundred twenty-two study participants were selected by using systematic random sampling. The data were collected through face-to-face interviews using a pretested and semi-structured questionnaire. Data were entered into Epi-Data version 4.6 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance. RESULT: A total of 611 participants were included in the study with the response rate of 98.2%. The study revealed that only 39.4%, of (95% confidence interval: 35.4-43.2) women received respectful maternity care. Completed secondary education (adjusted odds ratio: 2.47, 95% confidence interval: 1.35-4.50), having antenatal care follow-up (adjusted odds ratio: 0.098, 95% confidence interval: 0.03-0.34), planned pregnancy (adjusted odds ratio: 3.21, 95% confidence interval: 1.69-6.08), cesarean section delivery (adjusted odds ratio: 0.47, 95% confidence interval: 0.25-0.89), and daytime delivery (adjusted odds ratio: 1.9, 95% confidence interval: 1.33-2.72)) were significantly associated with respectful maternity care. CONCLUSION AND RECOMMENDATION: Only two out of five women received respectful maternity care during childbirth. Completed secondary education, having antenatal care follow-up, pregnancy intended/wanted, daytime delivery, and cesarean section delivery were identified factors. Therefore, giving emphasis to creating awareness of care providers on the standards and categories of respectful maternity care, improving care provider-client discussion, monitoring, and reinforcing accountability mechanisms for health workers to improve respectful maternity care during labor and childbirth were recommended.


Assuntos
Serviços de Saúde Materna , Mães , Cesárea , Estudos Transversais , Parto Obstétrico , Etiópia , Feminino , Humanos , Recém-Nascido , Parto , Gravidez , Saúde Pública
5.
Front Immunol ; 13: 893450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35911747

RESUMO

The COVID-19 pandemic has occurred due to infection caused by the SARS-CoV-2 coronavirus, which impacts gestation and pregnancy. In SARS-CoV-2 infection, only very rare cases of vertical transmission have been reported, suggesting that fetal immune imprinting due to a maternal infection is probably a result of changes in maternal immunity. Natural killer (NK) cells are the leading maternal immune cells that act as a natural defense system to fight infections. They also play a pivotal role in the establishment and maintenance of pregnancy. While peripheral NK cells display specific features in patients infected with SARS-CoV-2 in the general population, information remains elusive in pregnant mothers and neonates. In the present study, we analyzed the characteristics of NK cells isolated from both neonatal umbilical cord blood and maternal peripheral blood close to the time of delivery. Phenotype and functions were compared in 18 healthy pregnant women and 34 COVID-19 patients during pregnancy within an ongoing infection (PCR+; N = 15) or after recovery (IgG+PCR-; N = 19). The frequency of NK cells from infected women and their neonates was correlated with the production of inflammatory cytokines in the serum. The expression of NKG2A and NKp30, as well as degranulation of NK cells in pregnant women with ongoing infection, were both negatively correlated to estradiol level. Furthermore, NK cells from the neonates born to infected women were significantly decreased and also correlated to estradiol level. This study highlights the relationship between NK cells, inflammation, and estradiol in patients with ongoing infection, providing new insights into the impact of maternal SARS-CoV-2 infection on the neonate.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Estradiol , Feminino , Humanos , Células Matadoras Naturais , Pandemias , Parto , Gravidez , SARS-CoV-2
6.
BMJ Open ; 12(8): e059115, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35926994

RESUMO

OBJECTIVE: When novel devices are used 'in human' for the first time, their optimal use is uncertain because clinicians only have experience from preclinical studies. This study aimed to investigate factors that might optimise use of the Odon Device for assisted vaginal birth. DESIGN: We undertook qualitative case studies within the ASSIST Study, a feasibility study of the Odon Device. Each 'case' was defined as one use of the device and included at least one of the following: observation of the attempted assisted birth, and an interview with the obstetrician, midwife or woman. Data collection and thematic analysis ran iteratively and in parallel. SETTING: Tertiary referral National Health Service maternity unit in the Southwest of England. PARTICIPANTS: Women requiring a clinically indicated assisted vaginal birth. INTERVENTION: The Odon Device, an innovative device for assisted vaginal birth. PRIMARY AND SECONDARY OUTCOME MEASURES: Determining the optimal device technique, device design and defining clinical parameters for use. RESULTS: Thirty-nine cases involving an attempted Odon-assisted birth were included in this study, of which 19 resulted in a successful birth with the device. Factors that improved use included optimisation of device technique, device design and clinical parameters for use. Technique adaptations included: applying the device during, rather than between, contractions; having a flexible approach to the application angle; and deflating the air cuff sooner than originally proposed. Three design modifications were proposed involving the deflation button and sleeve. Although use of the device was found to be appropriate in all fetal positions, it was considered contraindicated when the fetal station was at the ischial spines. CONCLUSIONS: Case study methodology facilitated the acquisition of rapid insights into device function in clinical practice, providing key insights regarding use, design and key clinical parameters for success. This methodology should be considered whenever innovative devices are introduced into clinical practice. TRIAL REGISTRATION NUMBER: ISRCTN10203171.


Assuntos
Extração Obstétrica , Tocologia , Estudos de Viabilidade , Feminino , Humanos , Parto , Gravidez , Medicina Estatal
7.
Sci Rep ; 12(1): 11289, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35789162

RESUMO

Lymphocyte populations, stimulated in vitro or in vivo, grow as cells divide. Stochastic models are appropriate because some cells undergo multiple rounds of division, some die, and others of the same type in the same conditions do not divide at all. If individual cells behave independently, then each cell can be imagined as sampling from a probability density of times to division and death. The exponential density is the most mathematically and computationally convenient choice. It has the advantage of satisfying the memoryless property, consistent with a Markov process, but it overestimates the probability of short division times. With the aim of preserving the advantages of a Markovian framework while improving the representation of experimentally-observed division times, we consider a multi-stage model of cellular division and death. We use Erlang-distributed (or, more generally, phase-type distributed) times to division, and exponentially distributed times to death. We classify cells into generations, using the rule that the daughters of cells in generation n are in generation [Formula: see text]. In some circumstances, our representation is equivalent to established models of lymphocyte dynamics. We find the growth rate of the cell population by calculating the proportions of cells by stage and generation. The exponent describing the late-time cell population growth, and the criterion for extinction of the population, differs from what would be expected if N steps with rate [Formula: see text] were equivalent to a single step of rate [Formula: see text]. We link with a published experimental dataset, where cell counts were reported after T cells were transferred to lymphopenic mice, using Approximate Bayesian Computation. In the comparison, the death rate is assumed to be proportional to the generation and the Erlang time to division for generation 0 is allowed to differ from that of subsequent generations. The multi-stage representation is preferred to a simple exponential in posterior distributions, and the mean time to first division is estimated to be longer than the mean time to subsequent divisions.


Assuntos
Modelos Biológicos , Listas de Espera , Animais , Teorema de Bayes , Feminino , Cadeias de Markov , Camundongos , Parto , Gravidez
8.
BMC Pregnancy Childbirth ; 22(1): 543, 2022 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-35790947

RESUMO

BACKGROUND: The cesarean delivery (CD) rate has been increasing globally. Trial of labor after cesarean delivery (TOLAC) has been used as a key method for the reduction of the CD rate. Little is known, however, about the association between the second-stage duration of TOLAC and adverse maternal and neonatal outcomes. This study evaluated the association between perinatal outcomes and the duration of second-stage labor in women undergoing TOLAC. METHODS: A 10-year retrospective cohort study was performed at the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2010 and January 2020. Women undergoing TOLAC who reached the second stage of labor were included in this study. Duration of the second stage of labor was examined as a categorical variable (group I: <0.5 h, group II: 0.5-2 h and group III: ≥2 h) and as a continuous variable to evaluate the association with adverse perinatal outcomes by using multivariable regression models and a Cox proportional hazards regression model adjusting for potential confounders. RESULTS: Of the 1,174 women who met the inclusion criteria, the median (interquartile range) length of the second stage was 0.5 h (0.3-0.9 h). Among them, 1,143 (97.4%) delivered vaginally and 31 underwent an unplanned CD. As the second-stage duration increased, operative vaginal delivery (OVD), CD, and postpartum hemorrhage (PPH) rates increased. Women in group III had higher risks of OVD (aOR = 11.34; 95% CI [5.06-25.41]), CD (aOR = 4.22; 95% CI [1.32-13.43]), and PPH (aOR = 2.43; 95% CI [1.31-4.50]) compared with group I. Correspondingly, blood loss and the oxytocin used to treat PPH increased significantly, while the postpartum hemoglobin reduced significantly in group III compared with group I. The incidence of uterine rupture, uterine atony, cervical laceration, red blood cell transfusion, and intensive care unit admission were similar in all three groups. Neonatal outcomes were not affected by the second-stage duration. CONCLUSIONS: Women undergoing TOLAC with second-stage duration of ≥2 h have higher odds of OVD, unplanned intrapartum CD, and PPH.


Assuntos
Hemorragia Pós-Parto , Prova de Trabalho de Parto , Cesárea , Feminino , Humanos , Recém-Nascido , Segunda Fase do Trabalho de Parto , Parto , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos
9.
BMC Pregnancy Childbirth ; 22(1): 547, 2022 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794544

RESUMO

BACKGROUND: Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran. METHODS: This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist. RESULTS: In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor). CONCLUSIONS: This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.


Assuntos
Cesárea , Dor do Parto , Cesárea/psicologia , Criança , Estudos Transversais , Medo/psicologia , Feminino , Humanos , Irã (Geográfico) , Parto/psicologia , Gravidez
10.
Int Breastfeed J ; 17(1): 49, 2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35799253

RESUMO

BACKGROUND: Skin-to-skin contact and breastfeeding initiation within the first hour after birth are key recommendations to promote breastfeeding. In Mexico, the National Survey of Demographic Dynamics 2018, known by its Spanish acronym ENADID, collected information about breastfeeding practices. The ENADID survey is probabilistic and allows results to be generalized to the entire population in Mexico. METHODS: Information from a public database featuring 26,587 mother-baby pairs was analyzed by proportions, means and associations, as well as machine learning methods, to conduct a comparison among the pairs according to immediate skin-to-skin contact after delivery status. RESULTS: Skin-to-skin contact was described by 78.7% of the mothers and was associated with receiving an explanation regarding how to give breastmilk or the breast to the baby immediately following birth [Odds ratio (OR) 6.46; 95% Confidence Interval (CI) 6.02, 6.97], initiating breastfeeding in the first hour of life (OR 2.01; 95% CI (1.84, 2.18) and a breastfeeding duration of ≥ 6 months (OR 1.16; 95% CI 1.08, 1.25). The breastfeeding duration, in days, was greater in the group with skin-to-skin contact than in the group without skin contact. CONCLUSIONS: In Mexico, immediate and uninterrupted skin-to-skin contact between newborns and their mothers should be facilitated. Support should be provided to mothers to favor skin-to-skin contact and breasting initiation during the first hour of life, ideally through an empathic explanation by trained health personnel. Future research should focus on the evaluation of strategies to modify maternity services to facilitate immediate skin-to-skin contact after delivery and develop training programs for health personnel to support the initiation of breastfeeding during the first hour of life.


Assuntos
Aleitamento Materno , Mães , Demografia , Feminino , Humanos , Lactente , Recém-Nascido , México , Parto , Gravidez
11.
BMC Pregnancy Childbirth ; 22(1): 536, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35780118

RESUMO

BACKGROUND: Tailoring an intervention to the needs and wishes of pregnant women in vulnerable situations (e.g., socioeconomic disadvantages) can reduce the risk of adverse outcomes and empower these women. A relatively high percentage of pregnant women in the North of the Netherlands are considered vulnerable to adverse pregnancy outcomes because of their low socioeconomic status and the intergenerational transmission of poverty. In order to improve perinatal and maternal health, next to standard prenatal care, various interventions for pregnant women in vulnerable situations have been developed. We do not know to what extent these additional interventions suit the needs of (pregnant) women. Therefore, the aim of this study is to gain insight into the experiences and needs of women in vulnerable situations who receive additional maternity care interventions in the Northern Netherlands. METHODS: Qualitative research was performed. We used a phenomenological framework, which is geared towards understanding people's experiences in the context of their everyday lives. In-depth semi-structured interviews were conducted with 17 pregnant women in vulnerable situations living in the Northern Netherlands. A thematic analysis was carried out. RESULTS: We found three themes that reflect the experiences and needs of pregnant women in vulnerable situations in relation to the intervention they receive. These themes relate to the care provided by health professionals, to the impact of being offered an intervention, and to practical issues related to receiving an additional intervention. We found that the needs of pregnant women in vulnerable situations who received an additional maternity care intervention varied. This variation in needs was mainly related to practical issues. Women also expressed common needs, namely the desire to have control over their situation, the wish to receive tailor-made information about the intervention, and the wish for the intervention to be specifically tailored to their circumstances. CONCLUSIONS: Living in vulnerable situations and being offered additional care evoked diverse reactions and emotions from pregnant women. We recommend that health professionals ensure open and clear communication with women, that they ensure continuity of care and relationship-centered care, and that they become aware of the process of stigmatization of women in vulnerable situations.


Assuntos
Serviços de Saúde Materna , Obstetrícia , Feminino , Humanos , Parto/psicologia , Gravidez , Gestantes/psicologia , Pesquisa Qualitativa
12.
Biomed Res Int ; 2022: 1008538, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35782076

RESUMO

Objectives: We evaluated the effects of exposure to high concentrations of particulate matter (PM)10 on preterm birth (PTB) and identified a critical concentration of PM10 that could lead to PTB via a birth-based health information cohort study. Methods: We conducted a birth-based cohort study consisting of nonanomalous singleton births at 22-42 weeks. PTB was defined as babies born alive before 37 weeks of pregnancy. Pregnancy period exposure averages were estimated for PM10 based on the China National Environmental Monitoring Centre (CNEMC). Pregnant women who lived within 50 km of the monitor station were recruited into this study. Logistic regression analyses were performed to determine the association between PTB and exposure to PM10 at different pregnancy periods with adjustment for confounding factors. Results: The relative frequency of PTB was 8.7% in the study cohort of 5,291 singleton live births. A total of 1137 women had a high level of PM10 exposure (≥60 µg/m3) in the second trimester of pregnancy. The average concentrations of PM10 in the first, second, and third trimesters of pregnancy and throughout pregnancy were 53.8 µg/m3, 54.2 µg/m3, 55.6 µg/m3, and 54.3 µg/m3, respectively. The generalized additive model (GAM) analysis showed that there was a nonlinear correlation between PM10 and PTB in the second trimester of pregnancy (P < 0.001). The adjusted odds ratio between PTB and low concentration PM10 exposure (PM10 < 60 µg/m3) in the second trimester of pregnancy was 1.01 (95% CI 0.95-1.05). However, high PM10 exposure (PM10 ≥ 60 µg/m3) in the second trimester of pregnancy had an increased PTB risk even after adjustment for coexisting risk factors with an adjusted odds ratio of 1.78 (95% CI 1.69-1.87), and the incidence of PTB increased with an increase in PM10 exposure. Conclusions: Our research discovered that exposure to high levels of PM10 increases the risk of PTB and the second trimester is the most vulnerable gestational period to ambient air pollution exposure. PM10 concentrations more than 60 µg/m3 are detrimental to pregnant women in their second trimester. This study has implications for health informatics-oriented healthcare decision support systems.


Assuntos
Poluentes Atmosféricos , Nascimento Prematuro , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Exposição Materna/efeitos adversos , Material Particulado/efeitos adversos , Material Particulado/análise , Parto , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia
13.
Sci Rep ; 12(1): 11930, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35831421

RESUMO

A negative childbirth experience may have long term negative effects on maternal health. New international guidelines allow a slower progress of labor in the early active phase. However, a longer time in labor may influence the childbirth experience. In this population-based cohort study including 26,429 women, who gave birth from January 2016 to March 2020, the association between duration of different phases of active labor and childbirth experience was studied. The women assessed their childbirth experience by visual analogue scale (VAS) score. Data was obtained from electronic medical records. The prevalence of negative childbirth experience (VAS 1-3) was 4.9%. A significant association between longer duration of all labor phases and a negative childbirth experience was found for primi- and multipara. The adjusted odds ratio (aOR (95%CI)) of negative childbirth experience and longer time in active labor (above the 90th percentile) in primipara was 2.39 (1.98-2.90) and in multipara 2.23 (1.78-2.79). In primi-and multipara with duration of labor ≥ 12 h or ≥ 6 h the aOR (95%CI) of negative childbirth experience were 2.22 (1.91-2.58) and 1.91 (1.59-2.26) respectively. It is of great importance to identify and optimize the clinical care of women with longer time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.


Assuntos
Trabalho de Parto , Parto , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Razão de Chances , Gravidez
14.
BMC Pregnancy Childbirth ; 22(1): 553, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804305

RESUMO

BACKGROUND: Maternal and neonatal health significantly improves when birth is attended at health institutions where there are quality services and skilled attendants. In contrary, home birth results in high rates of maternal and neonatal mortality. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia based on the recent national survey. METHODS: Ethiopian mini-DHS-2019 data was used in this analysis. A weighted sample of 5423 mothers were included. While health facility was a reference, home and health post were used as comparison categories to identify determinants of place of birth in a survey multinomial logistic regression model. An adjusted relative risk ratio, marginal effect, and a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance. The Global Moran's I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The prevalence of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth. RESULT: Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 - 57.83). Whereas, only 2.99% (95% CI: 1.68 - 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low coverage of cluster level 4 + antenatal visits were predictors of home birth. Also, home birth was clustered across enumeration areas and it was over 40% in most parts of the country with > 75% in the Somali region. SaTScan analysis detected most likely primary clusters in the Somali region and secondary clusters in the rest five regions of the country. CONCLUSION: Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally, implementing the 2016 WHO's recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities by qualified providers and back-up systems in place could be supportive.


Assuntos
Parto , Cuidado Pré-Natal , Etiópia , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Prevalência , Análise Espacial
15.
BMC Pregnancy Childbirth ; 22(1): 551, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804308

RESUMO

BACKGROUND: Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman's birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population. METHODS: This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM-Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium). Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making. RESULTS: In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001). CONCLUSIONS: Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.


Assuntos
Tomada de Decisão Compartilhada , Tocologia , Bélgica , Estudos de Coortes , Estudos Transversais , Tomada de Decisões , Feminino , Humanos , Parto , Gravidez
16.
BMC Public Health ; 22(1): 1313, 2022 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-35804358

RESUMO

BACKGROUND: Food insecurity is a global health challenge exacerbated by COVID-19. In Liberia, two-thirds of pregnant women are anemic, one-third of children are stunted, and 70% of households experienced food insecurity due to COVID-19. Edible insects are a nutritious, environmentally responsible, and cost-effective dietary supplement used throughout sub-Saharan Africa. Rearing palm weevil insects at maternity waiting homes (MWHs)-residential dwellings near hospitals where pregnant women await childbirth and receive postpartum services-could serve as a nutritious supplement for expectant mothers in Liberia and provide an income generating activity for MWHs. METHODS: Following a one-day training, sixteen participants established palm weevil rearing sites at four MWHs in Liberia. Pre- and post-knowledge scores were assessed immediately prior to and following training. Pre-and post-knowledge scores were analyzed using paired t-test. Participants tracked two palm weevil rearing cycles (four months), using harvest amounts, turnover, barriers to implementation, and income generated as metrics. The number of women attending MWHs was recorded throughout the study period (July-December 2020). RESULTS: Sixteen participants from four MWHs completed the training and two rearing cycles (four months) successfully. All participants showed statistically significant increases in knowledge scores following the one-day workshop with a pre-test score of 2.31 and post-test score of 7.75 out of 10 (p < 0.001). Over the 6-month study, 217 women stayed in four MWHs. Larval production from the various rearing centers ranged from 120 to 721 larvae, with all four sites producing enough palm weevil to sustain MWH residents who desired to consume the insects. One site successfully commercialized its harvest to sell approximately 50% for a total of 2,000 LD (13 USD) in income. Three of the four sites continued edible insect production beyond the four-month study period. CONCLUSIONS: An edible insect project using palm weevil larva is one promising intervention as a nutrition supplement for expectant mothers at pre-established MWHs in rural Liberia. Edible insect rearing also has potential as an income generating activity for MWHs. Future studies should focus on addressing common barriers of remote implementation and metric tracking during the COVID-19 pandemic and reinforcing infrastructure to protect larvae rearing supplies.


Assuntos
COVID-19 , Serviços de Saúde Materna , Gorgulhos , Animais , Criança , Suplementos Nutricionais , Fazendas , Feminino , Acesso aos Serviços de Saúde , Humanos , Libéria , Pandemias , Parto , Gravidez , Cuidado Pré-Natal , População Rural
17.
Reprod Health ; 19(1): 160, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804419

RESUMO

BACKGROUND: Women experience disrespect and abuse during labour and birth all over the world. While the gravity of many forms of disrespect and abuse is evident, some of its more subtle forms may not always be experienced as upsetting by women. This study examines (1) how often women experience disrespect and abuse during labour and birth in the Netherlands and (2) how frequently they consider such experiences upsetting. We also examine (3) which respondent characteristics (age, ethnicity, educational level and parity) are associated with those experiences of disrespect and abuse that are upsetting, and (4) the associations between upsetting experiences of disrespect and abuse, and women's labour and birth experiences. METHODS: Women who gave birth up to five years ago were recruited through social media platforms to participate in an online survey. The survey consisted of 37 questions about experiences of disrespect and abuse divided into seven categories, dichotomised in (1) not experienced, or experienced but not considered upsetting (2) experienced and considered upsetting. A multivariable logistic regression analysis was performed to examine associated characteristics with upsetting experiences of disrespect and abuse. A Chi-square test was used to investigate the association between upsetting experiences of disrespect and abuse and overall birth experience. RESULTS: 13,359 respondents started the questionnaire, of whom 12,239 met the inclusion and exclusion criteria. Disrespect and abuse in terms of 'lack of choices' (39.8%) was reported most, followed by 'lack of communication' (29.9%), 'lack of support' (21.3%) and 'harsh or rough treatment/physical violence' (21.1%). Large variation was found in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. Primiparity and a migrant background were risk factors for experiencing upsetting disrespect and abuse in all categories. Experiencing more categories of upsetting disrespect and abuse was found to be associated with a more negative birth experience. CONCLUSIONS: Disrespectful and abusive experiences during labour and birth are reported regularly in the Netherlands, and are often (but not always) experienced as upsetting. This emphasizes an urgent need to implement respectful maternity care, even in high income countries.


Disrespect and abuse during labour and birth is a globally recognized phenomenon and has been linked to traumatic birth experiences and PTSD. In our study, we investigated how often women experience disrespect and abuse during labour and birth in the Netherlands and what proportion of these experiences was found to be upsetting. We also looked at risk factors for experiencing upsetting disrespect and abuse and to what extent upsetting disrespect and abuse influences the overall labour and birth experience.We conducted an online survey, with 12,239 respondents included in the analysis. We found a large variation in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. More subtle forms of disrespect and abuse, such as lack of choice, communication or support, were most prevalent and often considered upsetting. Giving birth for the first time and having a migrant background were risk factors for experiencing upsetting disrespect and abuse. Upsetting disrespect and abuse was found to have a strong impact on the overall labour and birth experience; with every additional experienced category of upsetting disrespect and abuse, the number of (very) positive labour and birth experiences decreases and the number of very negative ones increases.Although disrespect and abuse is a complex issue and its measurement subjective, this study shows that there is still a long way to go before achieving optimal respectful maternity care for all women, even in high income countries.


Assuntos
Trabalho de Parto , Serviços de Saúde Materna , Atitude do Pessoal de Saúde , Parto Obstétrico , Feminino , Humanos , Países Baixos , Parto , Gravidez , Relações Profissional-Paciente , Qualidade da Assistência à Saúde
18.
Artigo em Inglês | MEDLINE | ID: mdl-35805298

RESUMO

Negative childbirth experience may cause adverse psychological effects in postpartum mothers. The Childbirth Experience Questionnaire (CEQ) is a multidimensional tool designed to assess women's perceptions of labour and birth. We aim to validate the Malay version of the CEQ (CEQ-My) and evaluate its psychometric properties. The previously published Malay-translated CEQ was reviewed by a panel of experts and underwent minor changes. The original visual analogue scoring (VAS) was changed to a numerical scale. The reliability and construct validity of CEQ-My was assessed using Cronbach's alpha and exploratory analysis, respectively. Known-groups validation was conducted using the Mann-Whitney U test, whilst the inter-item correlations between CEQ-My and its subdomains were evaluated through Spearman's correlation. The final analysis involved 246 women. The questionnaire was easy to understand and all women preferred numeric scoring to the VAS. Based on the principal component factor analysis, we deleted one item and rearranged the domain for four items. The twenty-one items CEQ-My demonstrated good reliability with Cronbach's alpha of 0.77. Women who had spontaneous vaginal delivery demonstrated significantly greater CEQ-My scores than those who underwent operative delivery (p = 0.002). The domain of professional support was positively correlated to that of own capacity and participation (p-value of < 0.001 and 0.002, respectively). The CEQ-My is a valid and reliable instrument to assess Malaysian women's childbirth experiences. The easy-to-use electronic version of CEQ-My will improve future research and ease data collection.


Assuntos
Parto , Satisfação do Paciente , Feminino , Humanos , Malásia , Parto/psicologia , Gravidez , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
19.
Artigo em Inglês | MEDLINE | ID: mdl-35805312

RESUMO

Childbirth-related perineal trauma (CRPT) is defined as damage to the skin, muscles of the perineum, as well as to the anal sphincter complex and anal epithelium. The aim of the study was to analyze the risk factors for spontaneous injuries to the soft tissues of the birth canal during non-operative delivery. This was a single-center retrospective case-control study. The study included the analysis of two groups, the study group featured 7238 patients with spontaneous perineal laceration (any degree of perineal laceration) and the control group featured patients without perineal laceration with 7879 cases. The analysis of single-factor logistic regression showed that the factors related to perineal laceration during childbirth are the age of the patients giving birth (p = 0.000), the BMI before delivery (p = 0.000), the number of pregnancies (p = 0.000) and deliveries (p = 0.000), diagnosed gestational diabetes (p = 0.046), home birth (p = 0.000), vaginal birth after cesarean (VBAC) (p = 0.001), the use of oxytocin in the second stage of childbirth (p = 0.041), the duration of the second stage of childbirth (p = 0.000), body weight (p = 0.000), and the circumference of the newborn head (p = 0.000). Independent factors that increase the risk of perineal laceration during childbirth are an older age of the woman giving birth, a history of cesarean section, a higher birth weight of the newborn, and factors that reduce the risk of spontaneous perineal trauma are a higher number of deliveries and home birth.


Assuntos
Lacerações , Estudos de Casos e Controles , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Recém-Nascido , Lacerações/epidemiologia , Lacerações/etiologia , Parto , Gravidez , Estudos Retrospectivos , Fatores de Risco
20.
Artigo em Inglês | MEDLINE | ID: mdl-35805564

RESUMO

BACKGROUND: Previous studies have reported associations between high maternal anxiety, temporal perceptions during pregnancy, and a poor sense of self-efficacy. One type of anxiety expecting mothers experience is associated with childbirth, which previous studies have shown can be reduced by antenatal training. Recent contributions have pointed out that current prenatal courses, while providing important and useful knowledge, do not devote sufficient content to the mental health of the parturient and to the psychological issues that can arise before and after the birth. METHODS: In total, 80 pregnant women were provided with a special prepartum course in which ample space was devoted to topics such as maternal mental health, parenting skills and couple relationship, relaxation techniques, and assertiveness. Perception of threat, state anxiety, temporal focus, needs and expectations, and self-efficacy were assessed by comparing this psychoeducational intervention group with a traditional antenatal course group (n = 80), and a control group (n = 80). Two-way mixed ANOVAS (3 × 2) were performed for each dependent variable considered, including the time variable (pre-course-post-course) as a factor within the participants and the group variable as a factor between the subjects. RESULTS: The psychoeducational intervention actually induced significant and positive changes primarily on four dimensions: state anxiety, perceived self-efficacy, the need for information, and reassurance of the pregnant women who participated in this trial. CONCLUSIONS: The study suggests improving the quality of prenatal classes by paying particular attention to the content and communication used within the group, in order to gratify at the highest level, the need for information, reassurance, and sharing that characterize the parturient's request for support. The evidence collected recommends further replicating the intervention protocol described in order to improve the psychophysical well-being of women in a delicate moment such as pregnancy and preparation for childbirth, but especially in terms of the prevention and containment of the risks of psychological distress that currently affect a significant number of women after childbirth.


Assuntos
Parto , Autoeficácia , Ansiedade , Parto Obstétrico , Feminino , Humanos , Parto/psicologia , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/métodos
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