Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation.

INTRODUCTION: The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic. METHODS: This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used. RESULTS: When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033). CONCLUSIONS: Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.

Breathing Techniques During Labor: A Multinational Narrative Review of Efficacy.

We conducted a narrative review to assess the use and effectiveness of breathing techniques for pain control as the only non-pharmacological resource during labor and childbirth. A search was conducted using PubMed, PEDro, SciELO, and Scopus with publications between January 2005 and September 2021 in English, Portuguese, or Spanish. Seven publications were selected. Most of the articles reported on the use of slow and deep breathing during contractions in the first stage of labor and breathing associated with pushing-down efforts in the second stage. The information regarding the moment when guidance on the use of the techniques was provided varied across studies. According to the reviewed papers, breathing techniques offer benefits for women in labor without adverse effects on newborns.

Pregnant women's knowledge of non-pharmacological techniques for pain relief during childbirth.

INTRODUCTION: The objective of the study was to assess knowledge of pregnant women in the third trimester of pregnancy on non-pharmacological techniques for pain relief during labor and childbirth. METHODS: A cross-sectional study was conducted at a tertiary care facility of the University of Campinas, Brazil. The participants were 171 pregnant women, aged 18-35 years with 36 or more weeks of a singleton pregnancy. Participants responded to a questionnaire with data about sociodemographic and obstetric characteristics, knowledge on non-pharmacological techniques for pain relief during childbirth, the source of the information on these techniques, practice of physical activity and occurrence of pain during pregnancy. Parous women responded on the use of non-pharmacological techniques for pain relief during childbirth in previous deliveries. Multiple regression analysis with stepwise criteria of selection of variables was used to identify variables significantly associated with knowledge of non-pharmacological techniques for pain relief during childbirth. RESULTS: A total of 165 (96.5%) participants reported knowledge on at least one non-pharmacological technique; 87.1% on the use of a warm shower during labor for pain relief, 80.7% on the use of the birthing ball, and 74.8% on breathing techniques. There were no significant differences between nulliparous and parous women. The main source of information reported was the Internet. Multivariate analysis showed that pregnant women who had pain during pregnancy reported more knowledge on the use of warm showers during labor (OR=2.64; 95% CI: 1.03-6.73). CONCLUSIONS: Most women had knowledge of at least one non-pharmacological technique for pain relief during childbirth.

From hormone replacement therapy to regenerative scaffolds: A review of current and novel primary hypothyroidism therapeutics.

Primary hypothyroidism severely impacts the quality of life of patients through a decrease in the production of the thyroid hormones T3 and T4, leading to symptoms affecting cardiovascular, neurological, cognitive, and metabolic function. The incidence rate of primary hypothyroidism is expected to increase in the near future, partially due to increasing survival of patients that have undergone radiotherapy for head and neck cancer, which induces this disease in over half of those treated. The current standard of care encompasses thyroid hormone replacement therapy, traditionally in the form of synthetic T4. However, there is mounting evidence that this is unable to restore thyroid hormone signaling in all tissues due to often persistent symptoms. Additional complications are also present in the form of dosage difficulties, extensive drug interactions and poor patience compliance. The alternative therapeutic approach employed in the past is combination therapy, which consists of administration of both T3 and T4, either synthetic or in the form of desiccated thyroid extract. Here, issues are present regarding the lack of regulation concerning formulation and lack of data regarding safety and efficacy of these treatment methods. Tissue engineering and regenerative medicine have been applied in conjunction with each other to restore function of various tissues. Recently, these techniques have been adapted for thyroid tissue, primarily through the fabrication of regenerative scaffolds. Those currently under investigation are composed of either biopolymers or native decellularized extracellular matrix (dECM) in conjunction with either primary thyrocytes or stem cells which have undergone directed thyroid differentiation. Multiple of these scaffolds have successfully restored an athyroid phenotype in vivo. However, further work is needed until clinical translation can be achieved. This is proposed in the form of exploration and combination of materials used to fabricate these scaffolds, the addition of peptides which can aid restoration of tissue homeostasis and additional in vivo experimentation providing data on safety and efficacy of these implants.

Perspective of pregnant women regarding antenatal preparation: A qualitative study.

BACKGROUND: Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions. AIM: Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education. METHODS: A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling. FINDINGS: All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation. CONCLUSION: The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth.