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1.
Rev. SPAGESP ; 23(1): 44-58, jan.-jun. 2022.
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1356769

RESUMO

RESUMO Visando a investigar a experiência emocional de mães que tiveram uma criança "arco-íris" após terem experienciado uma perda gestacional/neonatal, foram entrevistadas quatro mães de crianças arco-íris de até três anos de idade. As entrevistas foram mediadas por uma narrativa interativa e, após cada encontro, uma narrativa transferencial foi redigida pela entrevistadora. O material foi analisado psicanaliticamente, segundo a Teoria dos Campos. Observou-se que as participantes, atravessadas por um enlutamento complexo, culpabilizaram-se pela perda e por terem seguido adiante no cuidado materno com os filhos arco-íris, oscilando entre a superproteção e o afastamento. Nota-se a importância de uma intervenção junto a esse coletivo, que geralmente só é foco de atenção (quando o é) durante a gestação/puerpério subsequente à perda gestacional/neonatal.


ABSTRACT Aiming to investigate the emotional experience of mothers who had a "rainbow" child after experiencing a gestational/neonatal loss, four mothers of rainbow children up to three years old were interviewed. The interviews were mediated by an interactive narrative. After each meeting, a transferential narrative was written by the interviewer. The material was analyzed psychoanalytically, according to the Theory of Fields. It was observed that the participants blamed themselves for the loss and for having carried on with the maternal care of the rainbow children, oscillating between overprotection and withdrawal. We have noticed the importance of intervention within this group, which is usually the focus of attention (when it is) only during the pregnancy/puerperium following the gestational/neonatal loss.


RESUMEN Con el objetivo de investigar la experiencia emocional de madres que tuvieron un hijo "arcoiris" después de experimentar la pérdida gestacional/neonatal, se entrevistó a cuatro madres de niños arcoiris de hasta tres años de edad. Las entrevistas fueron mediadas por una narrativa interactiva. Después de cada encuentro, la entrevistadora redactó una narrativa transferencial. El material fue analizado psicoanalíticamente, según la Teoría de Campos. Se observó que las participantes se culpaban por la pérdida y por haber seguido adelante con los niños arcoíris, oscilando entre la sobreprotección y el retraimiento. Se señala la importancia de una intervención junto a este colectivo, a la que normalmente se dirige (cuando se lo hace) sólo durante el embarazo/puerperio tras la pérdida gestacional/neonatal.


Assuntos
Humanos , Feminino , Criança , Adulto , Luto , Aborto Espontâneo , Poder Familiar , Período Pós-Parto , Relações Mãe-Filho
2.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48793

RESUMO

A Organização Mundial da Saúde (OMS) lança estudo sobre o impacto global do marketing digital na promoção e na venda de produtos que competem com o aleitamento materno, como fórmulas infantis e mamadeiras.


Assuntos
Aleitamento Materno , Fórmulas Infantis , Publicidade Direta ao Consumidor , Mamadeiras , Organização Mundial da Saúde , Internet , Período Pós-Parto , Publicidade de Alimentos
3.
PLoS One ; 17(5): e0265941, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35511885

RESUMO

The postpartum period is a challenging transition period with almost one in ten mothers experiencing depression after childbirth. Perceived social support is associated with mental health. Yet empirical evidence regarding the causal effects of social support on postpartum mental health remains scarce. In this paper, we used a nationally representative panel data of women to examine causality between perceived social support and postpartum mental health. We used fixed-effect method and included dependent variable lags to account for past mental health condition before birth (i.e., the pre-pregnancy and prenatal periods). The study also used an instrumental variable approach to address endogeneity. We find a declining trend in postpartum mental health between 2002 to 2018. Our study also showed that past mental health (i.e., before childbirth) is positively correlated with postpartum mental health. A universal routine mental health screening for expectant and new mothers should remain a key priority to ensure mental wellbeing for the mothers and their infants.


Assuntos
Depressão Pós-Parto , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Lactente , Saúde Mental , Mães/psicologia , Período Pós-Parto/psicologia , Gravidez , Apoio Social
4.
Obstet Gynecol ; 139(4): 571-578, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35594122

RESUMO

OBJECTIVE: To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies. METHODS: In this single-center randomized trial, we assigned individuals aged 13-50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3-5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated. RESULTS: From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome-available for more than 90% of participants-was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09-2.21; NNT nine, with 95% CI 5-42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03-1.32). CONCLUSION: Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04291040. FUNDING SOURCE: Funded in part by Investigator-Initiated studies of Organon.


Assuntos
Contracepção Reversível de Longo Prazo , Anticoncepção/métodos , Anticoncepcionais , Feminino , Humanos , Recém-Nascido , Multimídia , Período Pós-Parto , Gravidez , Gravidez de Alto Risco
6.
Prim Care ; 49(2): 287-300, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35595483

RESUMO

The incidence of all diabetes types are increasing, including the rate of women with diabetes in pregnancy. Preconception counseling continues to be an important part of visits with women who have diabetes and those at risk for gestational diabetes. Intensive control of blood sugar reduces the risk of negative outcomes in mother and baby. Diet and insulin are the preferred treatments for diabetes in pregnancy. While metformin has shown benefits in pregnancy, its use is debated. Insulin dose adjustments are required to reach glycemic goals during pregnancy and tend to change throughout its course with higher doses needed with increasing insulin resistance in the second and third trimesters. Breastfeeding is encouraged for all women regardless of diabetes type. Insulin doses generally need adjustment after delivery due to placental delivery leading to decreased insulin and lactation increasing energy requirements.


Assuntos
Diabetes Gestacional , Hipoglicemiantes , Glicemia , Diabetes Gestacional/tratamento farmacológico , Feminino , Humanos , Insulina , Placenta , Período Pós-Parto , Gravidez
7.
Comput Math Methods Med ; 2022: 8002055, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35495879

RESUMO

In order to explore the application value of image enhancement algorithm in evaluating pelvic floor rehabilitation training in the prevention of postpartum female pelvic floor dysfunction (FPFD), 70 patients with FPFD were selected as the study subjects and randomly divided into two groups. One group received routine nursing (control group, n = 35), and the other group received pelvic floor rehabilitation training based on routine nursing (experimental group, n = 35). In ultrasound images based on an image enhancement algorithm, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Pelvic Floor Distress Inventory-20 (PFDI-20) were used to evaluate the efficacy. The results showed that after image enhancement algorithm processing, the image signal-to-noise ratio (SNR), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM) of ultrasound images of patients with FPFD were significantly improved (P < 0.05); the mean square error (MSE) was significantly decreased (P < 0.05); the diagnostic accuracy of FPFD in the original ultrasound images was 73.34%, and that after image enhancement algorithm processing was significantly improved to be 89.86% (P < 0.05). In addition, the overall clinical response rate of FPFD in the experimental group (82.86%) was obviously higher than that in the control group (51.43%) (P < 0.05). After rehabilitation training, the ICIQ-SF and PFDI-20 scores of patients with FPFD in the two groups suggested a significant decrease (P < 0.05). In summary, using an image enhancement algorithm has a good application prospect in evaluating pelvic floor rehabilitation training in preventing postpartum FPFD and is worthy of further promotion.


Assuntos
Distúrbios do Assoalho Pélvico , Incontinência Urinária , Algoritmos , Feminino , Humanos , Aumento da Imagem , Masculino , Diafragma da Pelve/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/prevenção & controle , Período Pós-Parto
8.
BMJ Open ; 12(5): e054787, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508349

RESUMO

OBJECTIVE: The ACROBAT pilot trial of early cryoprecipitate for severe postpartum haemorrhage used deferred consent procedures. Pretrial discussions with a patient and public involvement group found mixed views towards deferred consent. This study aimed to build an understanding of how the deferred consent procedures worked in practice, to inform plans for a full-scale trial. SETTING: Qualitative interview study within a cluster-randomised pilot trial, involving four London maternity services. PARTICIPANTS: Individual interviews were conducted postnatally with 10 women who had received blood transfusion for severe postpartum haemorrhage and had consented to the trial. We also interviewed four 'recruiters'-two research midwives and two clinical trials practitioners who conducted trial recruitment. RESULTS: Consent procedures in the ACROBAT pilot trial were generally acceptable and the intervention was viewed as low risk, but most women did not remember much about the consent conversation. As per trial protocol, recruiters sought to consent women before hospital discharge, but this time pressure had to be balanced against the need to ensure women were not approached when distressed or very unwell. Extra efforts had to be made to communicate trial information to women due to the exhaustion of their recovery and competing demands for their attention. Participant information was further complicated by explanations about the cluster design and change in transfusion process, even though the consent sought was for access to medical data. CONCLUSION: Our findings indicate that deferred consent procedures raise similar concerns as taking consent when emergency obstetric research is occurring-that is, the risk that participants may conflate research with clinical care, and that their ability to process trial information may be impacted by the stressful nature of recovery and newborn care. A future trial may support more meaningful informed consent by extending the window of consent discussion and ensuring trial information is minimal and easy to understand. TRIAL REGISTRATION NUMBER: ISRCTN12146519.


Assuntos
Hemorragia Pós-Parto , Feminino , Humanos , Recém-Nascido , Consentimento Livre e Esclarecido , Masculino , Projetos Piloto , Hemorragia Pós-Parto/terapia , Período Pós-Parto , Gravidez , Pesquisa Qualitativa
9.
BMC Pregnancy Childbirth ; 22(1): 382, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501828

RESUMO

BACKGROUND: Women with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum. METHODS: A qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework. RESULTS: Analysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing. CONCLUSION: Acknowledging and understanding the breadth, complexity and depth of women's experiences is fundamental to improving outcomes. Our findings provide unique insights into women's experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.


Assuntos
Cardiopatias , Saúde Mental , Emoções , Feminino , Humanos , Período Pós-Parto/psicologia , Gravidez , Pesquisa Qualitativa
10.
Semin Vasc Surg ; 35(1): 60-68, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35501042

RESUMO

Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.


Assuntos
Aneurisma Dissecante , Período Pós-Parto , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Feminino , Humanos , Estudos Multicêntricos como Assunto , Período Pós-Parto/psicologia , Gravidez , Fatores de Risco
11.
J Hosp Med ; 17(2): 77-87, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35504571

RESUMO

BACKGROUND: Safety-net hospitals (SNHs) treat more maternal patients with risk factors for postpartum readmission. OBJECTIVE: To assess how patient, hospital, and community characteristics explain the SNH/non-SNH disparity in postpartum readmission rates. DESIGN: A linear probability model assessed covariates associated with postpartum readmissions. Oaxaca-Blinder decomposition estimates quantified the contribution of covariates to the SNH/non-SNH disparity in postpartum readmission rates. SETTING: Healthcare Cost and Utilization Project 2016-2018 State Inpatient Databases from 25 states. PARTICIPANTS: 3.5 million maternal delivery stays. MEASUREMENTS: The outcome was inpatient readmission within 42 days of delivery. SNHs had a share of Medicaid/uninsured stays in the top quartile. A range of patient, hospital, and community characteristics was considered as covariates. RESULTS: The unadjusted postpartum readmission rate was 4.2 per 1000 index deliveries higher at SNHs than at non-SNHs (19.1 vs. 14.9, p < .001). Adjustment reduced the risk difference to 0.65 per 1000 (95% confidence interval [CI]: -0.14, 1.44). Patient (66%), hospital (14%), and community (4%) characteristics explained 84% of the disparity. The single largest contributors to the disparity were race/ethnicity (20%), hypertension (12%), hospital preterm delivery rate (10%), and preterm delivery (7%). Collectively, patient comorbidities explained 31% of the disparity. CONCLUSION: Higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. Hospital initiatives are needed to reduce the risk of postpartum readmissions among SNH patients. Improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, requires enduring investments in public health.


Assuntos
Nascimento Prematuro , Provedores de Redes de Segurança , Feminino , Humanos , Recém-Nascido , Medicaid , Readmissão do Paciente , Período Pós-Parto , Gravidez , Estados Unidos
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(4): 469-478, 2022 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-35545342

RESUMO

OBJECTIVES: There is a high coagulation state in pregnant women, which is prone to coagulation and fibrinolysis system dysfunction. This study aims to explore the latest coagulation markers-thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor compound (tPAI-C) in different stages of pregnancy, establish reference intervals (RIs) for healthy pregnant women of Chinese population, and to provide an effective and reliable reference for clinicians. METHODS: A total of 492 healthy pregnant women, who underwent pregnancy examination and delivery in the Department of Obstetrics, Second Xiangya Hospital of Central South University from October 2019 to October 2020, were enrolled for this study. They were assigned into the first trimester group, the second trimester group, the third trimester group, and the puerperium group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. Plasma levels of TM, TAT, PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer. The RIs for TM, TAT, PIC, and tPAI-C were defined using non-parametric 95% intervals, determined following Clinical and Laboratory Standards Institute Document C28-A3c (CLSI C28-A3c), and Formulation of Reference Intervals for the Clinical Laboratory Test Items (WS/T402-2012). RESULTS: TM and TAT levels increased gradually in the first, second, and third trimester women and decreased in the puerperium women (P<0.05 or P<0.01). PIC level of healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), but PIC level of pregnant and puerperium women did not differ significantly (P>0.05). tPAI-C level in healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), and tPAI-C level was significantly decreases in the puerperium women (P<0.01). The RIs for TM were as follows: Healthy non-pregnant women at 3.20-4.60 TU/mL, the first and second trimester at 3.12-7.90 TU/mL, the third trimester at 3.42-8.29 TU/mL, puerperium at 2.70-6.40 TU/mL. The RIs for TAT were as follows: Healthy non-pregnant women at 0.50-1.64 ng/mL, the first and second trimester at 0.52-6.91 ng/mL, the third trimester at 0.96-12.92 ng/mL, puerperium at 0.82-3.75 ng/mL. The RIs for PIC were as follows: Healthy non-pregnant women at 0.160-0.519 ng/mL, pregnant women at 0.162-0.770 µg/mL. The RIs for tPAI-C were as follows: Healthy non-pregnant women at 1.90-4.80 ng/mL, the first and second trimester at 2.03-9.33 ng/mL, the third trimester at 2.80-14.20 ng/mL, puerperium at 1.10-8.40 ng/mL. CONCLUSIONS: The levels of 4 new coagulation markers TM, TAT, PIC, and tPAI-C in pregnant women are increased significantly during pregnancy and gradually return to normal after delivery. The RIs for TM, TAT, PIC, and tPAI-C in pregnant women by trimester are established according to CLSI C28-A3c, thus providing a clinical reference for clinician in judgement of thrombotic risk.


Assuntos
Gestantes , Ativador de Plasminogênio Tecidual , Biomarcadores , Coagulação Sanguínea , Feminino , Humanos , Período Pós-Parto , Gravidez , Valores de Referência
14.
Ir Med J ; 115(3): 566, 2022 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-35532911

RESUMO

Presentation We present a case of spontaneous coronary artery dissection (SCAD) in a 35-year-old lady who was 4 months post-partum. Despite a lack of typical risk factors, initial presentation and investigations were strongly suggestive of ACS. Diagnosis Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery with TIMI 0 flow. Angiographic appearances and intravascular ultrasound (IVUS) were consistent with SCAD. Treatment A single drug-eluting stent was deployed, successfully restoring good flow, without extending the dissection flap. Discussion SCAD should be considered as an important and underdiagnosed cause of ACS, predominantly in young women without other apparent risk factors.


Assuntos
Anomalias dos Vasos Coronários , Stents Farmacológicos , Adulto , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Período Pós-Parto , Doenças Vasculares/congênito
15.
Reprod Health ; 19(1): 112, 2022 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-35527298

RESUMO

BACKGROUND: Women's sexual health is generally defined and explored solely in relation to reproductive capacity, and often omits elements of sexual function and/or dysfunction. Concerted focus is given to women's health during pregnancy; however, women's sexual health is largely neglected after childbirth. This scoping review explored how the sexual health of postpartum women has been defined, measured, and researched in low- and middle-income countries (LMICs). METHODS: Articles eligible for review were those that investigated women's sexual health during the first 12 months postpartum and were conducted among women aged 15-49 in LMICs. Eligibility was further restricted to studies that were published within the last 20 years (2001-2021). The initial PubMed search identified 812 articles, but upon further eligibility review, 97 remained. At this time, the decision was made to focus this review only on articles addressing sexual function and/or dysfunction, which yielded 46 articles. Key article characteristics were described and analyzed by outcome. RESULTS: Of the final included articles, five studies focused on positive sexual health, 13 on negative sexual health, and the remaining 28 on both positive and negative sexual health or without specified directionality. The most common outcome examined was resumption of sex after childbirth. Most studies occurred within sub-Saharan Africa (n = 27), with geographic spread throughout the Middle East (n = 10), Asia (n = 5), North Africa (n = 3), and cross-geography (n = 1); notably, all five studies on positive sexual health were conducted in Iran. Negative sexual health outcomes included vaginismus, dyspareunia, episiotomy, perineal tears, prolapse, infection, obstetric fistula, female genital cutting, postnatal pain, uterine prolapse, coercion to resume sex, sexual violence, and loss of sexual desire/arousal. Most studies were quantitative, though eight qualitative studies elucidated the difficulties women endured in receiving information specific to sexual health and hesitance in seeking help for sexual morbidities in the postpartum period. CONCLUSIONS: Overall, the evidence base surrounding women's sexual health in the postpartum period within LMICs remains limited, with most studies focusing solely on the timing of resumption of sex. Integration of sexual health counseling into postnatal care and nonjudgmental service provision can help women navigate these bodily changes and ultimately improve their sexual health.


Assuntos
Saúde Sexual , Países em Desenvolvimento , Feminino , Humanos , Masculino , Parto , Período Pós-Parto , Gravidez , Saúde da Mulher
17.
BMJ Open ; 12(5): e060308, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35537784

RESUMO

OBJECTIVE: This study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning counselling either within the community setting by a field health worker or at a health facility by a healthcare attendant during the 12 months preceding the survey improves postpartum modern contraceptive uptake. DESIGN: We used a cross-sectional study of the Ethiopian Demographic and Health Survey conducted in 2016. SETTING: Ethiopia. PARTICIPANTS: A total of 1650 women who gave birth during the 12 months and had contact with service delivery points during the 12 months preceding the survey. PRIMARY OUTCOME: A weighted modified Poisson regression model was used to estimate an adjusted relative risk (RR) of postpartum modern contraceptives. RESULTS: Approximately half (48%) of the women have missed the opportunity to receive family planning counselling at the health service contact points during the 12 months preceding the survey. The postpartum modern contraceptive uptake was 27%. Two hundred forty-two (30%) and 204 (24%) of the counselled and not counselled women used postpartum modern contraceptive methods, respectively. Compared with women who did not receive counselling for family planning, women who received counselling had higher contraceptive uptake (RR 1.32, 95% CI 1.04 to 1.67). CONCLUSION: Significant numbers of women have missed the opportunity of receiving family planning counselling during contact with health service delivery points. Modern contraceptive uptake among postpartum women was low in Ethiopia. Despite this, our findings revealed that family planning counselling was associated with improved postpartum modern contraceptive uptake.


Assuntos
Anticoncepcionais , Serviços de Planejamento Familiar , Anticoncepção/métodos , Comportamento Contraceptivo , Aconselhamento , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Período Pós-Parto
18.
Trop Anim Health Prod ; 54(3): 180, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35522378

RESUMO

The purpose of this study was to evaluate the effect of retained placenta (RP) and clinical mastitis (CM) on the reproductive efficiency of crossbred dairy cows during the postpartum period and the effect in some innate immune system indicators. For this, two experiments were carried out. In the first, a total of 232 cows were evaluated and divided as: healthy control (n = 184), RP (n = 22), and CM (n = 26) groups. The RP and CM was evaluated until 30 days postpartum (DPP) and reproductive rates were measured. In experiment 2, cows were divided in control (n = 10), RP (n = 10), and CM (n = 30) groups. Between 40 and 50 DPP, clinical, gynecological examination and endometrial cytobrush were performed to evaluate subclinical endometritis (SE) and gene expression of interleukins 1ß (IL-1ß) and 6 (IL-6), chemokine ligand 5 (CCL5), estrogen α (ESR1), and progesterone (PGR) receptors by qRT-PCR analysis. In experiment 1, the conception rate at 1st artificial insemination (AI) was lower in RP and CM groups and pregnancy rate at 150 days decreased in CM group. Calving-to-1st AI interval and days open were shorter in healthy cows. In experiment 2, the occurrence of SE was 26.7% and higher in RP and CM groups. The expression of IL-1ß increased in RP and CM groups, while IL-6 was less expressed in RP group. The CCL5, ESR1, and PGR were similar between groups. In conclusion, cows with RP and CM had their reproductive efficiency negatively affected and had they initial pro-inflammatory response improved by the increase of IL-ß.


Assuntos
Doenças dos Bovinos , Endometrite , Mastite , Placenta Retida , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Endometrite/veterinária , Feminino , Expressão Gênica , Imunidade , Interleucina-6/farmacologia , Lactação , Mastite/veterinária , Placenta Retida/genética , Placenta Retida/veterinária , Período Pós-Parto , Gravidez , Reprodução
19.
BMC Pregnancy Childbirth ; 22(1): 397, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35538441

RESUMO

BACKGROUND: Placenta Accreta Spectrum is associated with significant clinical maternal morbidity and mortality, which has been extensively described in the literature. However, there is a dearth of research on the lived experiences of pregnant people and their support partners. The aim of this study is to describe living beyond a pregnancy and birth complicated by PAS for up to four years postpartum. Participants experiences inform the development of an integrated care pathway of family centered support interventions. METHODS: An Interpretative Phenomenological Analysis approach was applied to collect data through virtual interviews over a 3-month period from February to April 2021. Twenty-nine participants shared their stories; six people with a history of PAS and their support partners were interviewed together (n = 12 participants), six were interviewed separately (n = 12 participants), and five were interviewed without their partner. Pregnant people were eligible for inclusion if they had a diagnosis of PAS within the previous 5 years. This paper focuses on the postnatal period, with data from the antenatal and intrapartum periods described separately. RESULTS: One superordinate theme "Living beyond PAS" emerged from interviews, with 6 subordinate themes as follows; "Living with a different body", "The impact on relationships", "Coping strategies", "Post-traumatic growth", "Challenges with normal care" and recommendations for "What needs to change". These themes informed the development of an integrated care pathway for pregnant people and their support partners to support them from diagnosis up to one year following the birth. CONCLUSION: Parents described the challenges of the postnatal period in terms of the physical and emotional impact, and how some were able to make positive life changes in the aftermath of a traumatic event. An integrated care pathway of simple supportive interventions, based on participant recommendations, delivered as part of specialist multidisciplinary team care may assist pregnant people and their support partners in alleviating some of these challenges.


Assuntos
Prestação Integrada de Cuidados de Saúde , Placenta Acreta , Feminino , Humanos , Pais , Parto , Placenta Acreta/terapia , Período Pós-Parto , Gravidez
20.
Dev Psychobiol ; 64(5): e22280, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35603419

RESUMO

The perinatal period is characterized by distinct neurobiological and psychological changes initiated prenatally, which may both facilitate postpartum caregiving and increase vulnerability to stress. Parents need to adapt to the high demands of caregiving, which include responding to salient infant cues, such as infant cries. Therefore, assessing the impact of prenatal stress exposure on parents' neural processing of infant cries may elucidate mechanisms conferring early risk for detrimental perinatal outcomes. Using event-related potentials, we examined whether prenatal perceived stress affected neural markers of perceptual (N1, P2) and attentional (LPP) processes elicited by high- and low-distress infant cries in expectant mothers (n = 38) and fathers (n = 30). Results evidenced that prenatal perceived stress impacted parents' sustained attentional processing (LPP) of infant cries, but not early perceptual responses (N1, P2). Specifically, higher levels of prenatal perceived stress were associated with a greater LPP response to low-distress, but not high-distress, infant cries. There were no parental sex differences in prenatal perceived stress or neural responses to infant cries. Increased attentional processing of low-distress cries in highly stressed parents may reflect uncertainty regarding infant distress level, thereby requiring more attentional resources. Overall, our results suggest that prenatal stress impacts processing of infant cues, even before birth.


Assuntos
Choro , Mães , Potenciais Evocados , Pai/psicologia , Feminino , Humanos , Lactente , Masculino , Mães/psicologia , Período Pós-Parto , Gravidez , Estresse Psicológico/psicologia
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